Search

Background: Reports on greater posterior tibial slope (PTS) and its relationship to subsequent anterior cruciate ligament (ACL) injury show conflicting results; it has not been studied much in patients after ACL reconstruction with patellar tendon autograft (PTG). Hypothesis: Patients who suffered a subsequent ACL injury would have a larger PTS than patients who did not suffer a subsequent injury after primary or revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Patients received primary (n = 2439) or revision (n = 324) ACL reconstruction with PTG and were followed prospectively to determine the rate of graft tear and contralateral ACL tear. The PTS was measured preoperatively on digital lateral view radiographs. Intersecting lines were drawn along the medial tibial plateau and posterior tibia; the value of the acute angle at the lines' intersection was then subtracted from 90° to obtain the PTS. This procedure was completed by a clinical assistant with an intrarater reliability of 0.89. Chi-square analysis and t tests were used to determine the differences between rate of tears and measurements between groups. A threshold of PTS ≥10° was used for analysis. Results: The mean follow-up time was 11.6 ± 4.0 years. After primary surgery, the mean PTS in patients with graft tears was 5.4°± 3.1° versus 4.8°± 2.9° for patients without a tear (P =.041). The mean PTS was 4.9°± 3.4° for patients with contralateral tears (not statistically significantly different than the no-tear group; P =.80). Furthermore, patients with primary reconstruction with PTS ≥10° had a statistically significantly higher rate of graft tear (9.7%) than patients with PTS ≤9° (4.8%) (P =.003), but not a higher rate of contralateral tear. Among patients undergoing revision surgery, there were no statistically significant differences between the graft tear, contralateral tear, and no-tear groups with relation to PTS ≥10°. Conclusion: After primary ACL reconstruction, patients with PTS >10° had a higher rate of subsequent graft tear but not a higher rate of contralateral tear. With revision surgery, there was no significant association between PTS and the rate of subsequent tear. Therefore, caution should be exercised when considering more radical interventions, such as osteotomy, to prevent retear in patients with high PTS. [ABSTRACT FROM AUTHOR]

Purpose: This study presents a method to measure the size of quadriceps, patellar tendon and hamstring autografts using preoperative magnetic resonance imaging (MRI).Methods: Sixty-two subjects with a mean age of 25 ± 10 years who underwent ACL surgery between 2011 and 2014 were included. Patient anthropometric data were recorded for all subjects. During surgery, the respective autograft was harvested and measured using commercially available graft sizers. MRI measurements were performed by two raters, who were blinded to the intra-operative measurements.Results: The inter- and intra-rater reliability was ≥0.8 for all MRI measurements. The intra-class correlation coefficient between the MRI measurement of the graft and the actual size of the harvested graft was 0.639. There were significant correlations between quadriceps tendon thickness and height (r = 0.3, p < 0.03), weight (r = 0.3, p < 0.01), BMI (r = 0.3, p < 0.04) and gender (r = -0.4, p < 0.002) and patellar tendon thickness and height (r = 0.4, p < 0.01), weight (r = 0.3, p < 0.01) and gender (r = -0.4, p < 0.012).Conclusion: Preoperative MRI measurements of quadriceps, patellar tendon and hamstring graft size are highly reliable with moderate-to-good accuracy. Significant correlations between patient anthropometric data and the thicknesses of the quadriceps and patellar tendons were observed. Obtaining this information can be useful for preoperative planning and to help counsel patients on appropriate graft choices prior to surgery.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: Subsartorial saphenous nerve blockade (SSNB) is an effective analgesic alternative to femoral nerve blockade after anterior cruciate ligament (ACL) reconstruction with bone-tendon-bone (BTB) autograft. It was hypothesized that dexamethasone in a SSNB will prolong analgesia, improve pain and satisfaction, and reduce postoperative opioid requirements and side effects.Methods: One hundred ninety-five patients undergoing ACL reconstruction with BTB autograft (ages 16-65) were enrolled. Subjects received SSNB with 13 ml of 0.5 % bupivacaine (control group), 1 mg preservative-free dexamethasone +0.5 % bupivacaine (treatment group I), or 4 mg preservative-free dexamethasone +0.5 % bupivacaine (treatment group II). Subjects received identical perioperative management. On postoperative days 1 and 2, subjects reported perceived block duration, pain scores, satisfaction, opioid use, and side effects. Cox-proportional hazards modelling was used to compare block duration, adjusting for body mass index, age, sex, tourniquet time, American Society of Anesthesiologists classification, and intravenous dexamethasone dose.Results: Patient-perceived block duration was significantly increased in treatment group I [hazard ratio (95 % confidence interval [CI]) 0.48 (0.31-0.75); P = 0.001] and treatment group II (hazard ratio (95 % CI): 0.52 (0.33-0.81); P = 0.004) compared to control. The block was extended from a median (95 % CI) of 33.1 (28.4-37.3) to 41.2 (32.4-50.9) and 46.5 (35.8-48.9) hours, respectively. Additionally, patients in treatment group II reported increased time that block provided pain relief, higher patient satisfaction, lower pain scores at rest, and decreased drowsiness and confusion.Conclusion: The addition of 1 and 4 mg of dexamethasone to the block injectate significantly increased SSNB duration by 8-13 h compared to control.Level Of Evidence: Therapeutic study, level 1. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Physical Medicine & Rehabilitation / Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi is the property of Turkish Society of Physical Medicine & Rehabilitation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The primary purpose of our study was to analyse the long-term outcome of patients treated for anterior cruciate ligament (ACL) tears by anatomical single-bundle ACL reconstruction with patellar tendon autograft. The secondary purpose was to identify predictive factors for good outcome and occurrence of osteoarthritis. Methods: Sixty-three patients ( m: f = 54:9; mean age at surgery, 27 ± 7 years) treated by ACL reconstruction were evaluated with a mean follow-up of 16 ± 1 years using IKDC2000, the SF36, Lysholm and Tegner score, Knee Society score, visual analogue scale for pain and satisfaction and KOOS. The femoral tunnel position was evaluated according to Sommer. It was also assessed in percentage of the Blumensaat line and the tibial tunnel position in percentage of the total anterior-posterior plateau length. The extent of osteoarthritis was graded according to the Kellgren-Lawrence score. Results: The total IKDC2000 was normal in 20 (32 %), nearly normal in 29 (46 %), abnormal in 12 (19 %) and severely abnormal in 3 (5 %) of patients. The mean total SF-36 was 89 ± 13, the Lysholm score 95 ± 12, the Knee Society score 191 ± 16 and the total KOOS 84 ± 19. The Tegner score decreased from pre-injury 7(4-10) to 6 (2-10) at follow-up. The Kellgren-Lawrence score was normal in 17 (27 %), suspected osteoarthritis in 25 (40 %), minimal osteoarthritis in 5 (8 %), moderate osteoarthritis in 9 (14 %) and severe osteoarthritis in 3 patients (5 %). The femoral tunnel was in zone A in 43 patients (68 %), in zone B in 16 (25 %) and in zone C in 4 patients (7 %). The femoral tunnel position in percentage of the Blumensaat line was 49 ± 3 (range, 44-57), and the tibial tunnel position in percentage of the total anterior-posterior plateau length was 32 ± 6 (range, 21-46). Patients with meniscal lesion at the time of ACL tear showed significantly less favourable outcomes than those without. Conclusions: Patients treated by the proposed ACL reconstruction technique showed on average good to excellent long-term results. A meniscal lesion at the time of ACL tear was highly predictive for less favourable outcome. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

The purpose of the present paper is to describe the isoanatomical, single bundle, bone-patellar tendon-bone A3B-ACL reconstruction technique (A3B = Anatomical Bruderholz, Burkart, Biedert) in detail. The technical key factors and the pitfalls are highlighted. In addition, the pros and cons of the technique are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To establish the influence of the type of surgical technique, competitive level, type of sport and the time before returning to competition on the reinjury rate after anterior cruciate ligament (ACL) surgery. Methods: The authors followed-up 540 competitive sportspeople who had undergone ACL surgery via patellar or hamstring tendon autograft (HTA) techniques in 2003 and 2004. The sportspeople (all of whom had competed at a regional or higher level) were asked to fill out a questionnaire during their fourth postoperative year. Results: The 298 respondees (reply rate: 55.1%) had the same characteristics as the initial (operated) population. The reinjury rates after HTA and patellar tendon autograft (PTA) were 12.7 and 6.1%, respectively. There was no statistically significant difference between these two values (P =0.14). Age and gender were not correlated with the frequency of reinjury. The reinjury rate rose slightly with increasing competitive level (regional level: 8.1%; national level: 10.4%; international level: 12.5%) but these differences were not statistically significant. Soccer had the highest reinjury rate (20.8%). Regardless of the surgical technique, sportspeople returning to competition within seven months of surgery had a greater risk of reinjury than those returning after this time point (15.3 versus 5.2%, P =0.014). The risk dropped from 13.9 to 2.6% (P =0.047) for PTA and from 16.6 to 7.6% (P =0.2) for HTA. Of the four reinjuries in sportspeople returning to competition with the first six months postoperative, three occurred within one month of resumption. Conclusion: Post-HTA reinjury rates are higher than post-PTA rates but the difference is not statistically significant. For sportspeople at a regional or higher level, the time interval before the return to competition has an influence on the risk of reinjury. [ABSTRACT FROM AUTHOR]

Background: Controversy remains over the most appropriate graft for anterior cruciate ligament reconstruction. Hypothesis: There is no significant difference in outcomes after 4-strand hamstring and patellar tendon autograft anterior cruciate ligament reconstructions using similar fixation techniques. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Between August 2000 and May 2003, 64 Keller Army Hospital patients with complete anterior cruciate ligament tears were randomized to hamstring (n = 32) or patellar tendon (n = 32) autograft anterior cruciate ligament reconstruction. Operative graft fixation and rehabilitative techniques were the same for both groups. Follow-up assessments included the Single Assessment Numeric Evaluation score, Lysholm score, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score. Postoperative radiographs were analyzed for tunnel location and orientation. Results: Eleven women and 53 men were randomized. Eighty-three percent of the patients (53 of 64) had follow-up of greater than 2 years, or to the point of graft rupture or removal (average follow-up, 36 months). Four hamstring grafts (12.5%) and three patellar tendon grafts (9.4%) (P = .71) ruptured. One deep infection in a hamstring graft patient necessitated graft removal. Forty-five of the 56 patients with intact grafts had greater than 2-year follow-up. Patients with patellar tendon grafts had greater Tegner activity scores (P = .04). Single Assessment Numeric Evaluation scores were 88.5 (95% confidence interval: 83.1, 93.8) and 90.1 (95% confidence interval: 85.2, 96.1) for the hamstring and patellar tendon groups, respectively (P = .53). Lysholm scores were 90.3 (95% confidence interval: 84.4, 96.1) and 90.4 (95% confidence interval: 84.5, 96.3) for the hamstring and patellar tendon groups, respectively (P = .97). There were no significant differences in knee laxity, kneeling pain, isokinetic peak torque, International Knee Documentation Committee score, or Knee Injury and Osteoarthritis Outcome Scores. Postoperative graft rupture correlated with more horizontal tibial tunnel orientation. Conclusion: Hamstring and patellar tendon autografts provide similar objective, subjective, and functional outcomes when assessed at least 2 years after anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the long-term in vivo degradation of biodegradable interference screws made of poly-L-lactic acid (PLLA) and β–tricalcium phosphate (β-TCP). Methods: Twenty patients undergoing patellar tendon autograft anterior cruciate ligament reconstruction fixed at both the femur and tibia with β-TCP–PLLA screws at least 44 months earlier were evaluated by physical, radiographic, and computed tomography (CT) evaluations. This study was approved by the institutional review board. Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee scores were also obtained. CT data were measured in Hounsfield units. Results: We evaluated 13 male and 7 female patients at a mean of 50 months after surgery (range, 44 to 56 months). CT scans and radiographs showed the bone plug fused to the tunnel wall with no β-TCP–PLLA screw remaining. The screws were replaced with clearly calcified non-trabecular material, denser than soft tissue. Osteoconductivity was present in 75% of the tunnels and complete in 10%. No positive pivot-shift tests were found. Lysholm, Tegner, and Cincinnati scores improved from 60.4, 3.7, and 53.3, respectively, preoperatively to 90.8, 5.8, and 86.4, respectively, at follow-up. The mean side-to-side difference determined by use of the KT arthrometer (MEDmetric, San Diego, CA) was 0.4 mm. Conclusions: The β-TCP–PLLA interference screw (Bilok; ArthroCare, Sunnyvale, CA) completely degraded, and no remnant was present 4 years after insertion. Osteoconductivity was confirmed by CT scans at 75% of the screw sites and completely filled the site in 10%. The addition of β-TCP to PLLA results in a biocomposite interference screw that is osteoconductive. Level of Evidence: Level IV, therapeutic case series. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to evaluate the clinical effectiveness and radiographic response of a poly-L-lactide (PLLA)/beta-tricalcium phosphate (TCP) interference screw for anterior cruciate ligament (ACL) reconstruction. Methods: In a consecutive series of patellar tendon autograft ACL reconstructions, all patients had both ends fixed with PLLA/beta-TCP screws. Inclusion criteria were positive Lachman and pivot-shift tests and closed or nearly closed growth plates. Exclusionary criteria were posterior cruciate ligament tears and bilateral ACL or multiple ligament injuries. Tegner, Lysholm, Cincinnati, and International Knee Documentation Committee activity scores; Lachman and pivot-shift data; radiographic examinations; and KT measurements (MEDmetric, San Diego, CA) were obtained. Results: In this study 41 patients met the criteria (31 male and 10 female patients), at a mean follow-up of 34 months (range, 24 to 44 months). Of these patients, 40 were available for follow-up (1 had died). Postoperatively, the mean Cincinnati score was 83 (64 preoperatively), the mean Tegner score was 5.5 (3.2 preoperatively), the mean Lysholm score was 88 (59 preoperatively), and the mean International Knee Documentation Committee activity score was 3.0 out of 4 (1.8 preoperatively). No patients had positive postoperative Lachman or pivot-shift tests. The maximum difference based on KT manual examinations 3 mm or less. Adverse events included screw breakage during insertion. Postoperative radiographs showed rapid bone plug incorporation. Radiographic tunnel obliteration with bony ingrowth was shown at 2 and 3 years' follow-up. Conclusions: The PLLA/beta-TCP interference screw performed well clinically based on both subjective and objective results. Radiographic screw incorporation into the adjacent bone was apparent at 3 years. Level Of Evidence: Level IV, therapeutic case series. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the long term in vivo degradation of poly-L-lactic acid (PLLA) interference screws with computed tomography (CT) and radiography as used in patellar tendon autograft anterior cruciate ligament (ACL) reconstruction.Methods: A total of 20 patients who had undergone patellar tendon autograft ACL reconstruction fixed with PLLA screws at least 7 years earlier were evaluated by physical examination, radiography, and CT to determine whether PLLA screw reabsorption and bone ingrowth had occurred. This study was granted Institutional Review Board approval. Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee (IKDC) scores were obtained. CT data were measured in Hounsfield units.Results: In all, 15 men and 5 women were evaluated 104 months after surgery (range, 89 to 124 months). CT and radiography demonstrated that the bone plug had fused to the tunnel wall, and that no intact interference screw was left. A parallel, threaded, and corticated screw tract was visible adjacent to the bone plug. No bone ingrowth had occurred at the screw site, although, occasionally, minimal calcification was seen. This was never as dense as cancellous bone, and no trabeculae were ever present. No positive pivot-shift test results were obtained. Lysholm, Tegner, and Cincinnati scores were 83, 5.6, and 75, respectively, at follow-up. Average KT difference was 0.7 mm.Discussion: PLLA interference screws completely degraded, and the resulting area demonstrated a low Hounsfield count, consistent with soft tissue 7 years after insertion. No significant bone ingrowth occurred at the screw site. Femoral and tibial ACL tunnels were absent of anything but fibrous tissue and usually had a sclerotic cortical lining.Conclusion: PLLA biodegradable ACL screws eventually disappear completely. PLLA material is not replaced by bone. ACL graft tunnels are filled with nonossified material. This study provides a baseline for comparison with other biodegradable interference screws that may encourage bone ingrowth as they degrade.Level Of Evidence: Level IV (no or historical control). [ABSTRACT FROM AUTHOR]

Objectives: To analyze ligamentous stability and isokinetic strength of knee extensor and flexor muscles after anterior cruciate ligament reconstruction using 2 different autografts with identical fixation. Design: This study implements a comparative case series design. Setting: Schulthess Clinic, Switzerland. Patients: A total of 153 consecutive patients (n = 87 bone-patellar tendon-bone [BPTB]/66 quadruple semitendinosus/gracilis tendons [QSGT] patients) who underwent BPTB and QSGT surgery were functionally assessed. Intervention: All patients were functionally assessed (knee extension/flexion isokinetic strength and knee joint laxity) at a mean follow-up time of 11 months. Main Outcome Measurements: Laxity was measured utilizing the Kneelax arthrometer, whereas isokinetic strength of the knee extensor/flexor muscle groups was measured using the Biodex Multi Joint System 2 (180°/s and 300°/s). Results: The QSGT group had significantly greater knee joint laxity when compared with the BPTB group (P < 0.001). Furthermore, females in the QSGT group demonstrated the greatest knee joint laxity overall (P < 0.001). Additionally, a significant flexor torque deficiency was demonstrated in the QSGT group (P < 0.001); however, no differences in extensor torque were observed. Conclusions: The use of a BPTB autograft achieved better knee joint stability as well as greater knee flexor torque than the QSGT autograft. Both grafts exhibited a similar knee extensor torque deficit, indicating that only quadriceps strength is not graft-dependent. [ABSTRACT FROM AUTHOR]

Purpose: Biodegradable interference fixation screws are widely used for anterior cruciate ligament surgery. This study evaluated 2 issues: the clinical effectiveness of a poly-D,L-lactide interference screw and the radiographic response.Type Of Study: Prospective case series.Methods: A prospective series of anterior cruciate ligament reconstructions fixed with poly-D(2%),L(98%)-lactide screws were evaluated at annual intervals. Inclusion criteria were unilateral knee instability, positive Lachman and pivot-shift tests, minimum age of 16 years, and adequate bone density. Exclusionary criteria included posterior cruciate ligament tears and previous ligament surgery on the same knee. Tegner, Lysholm, International Knee Documentation Committee (IKDC) activity scores, Lachman and pivot-shift tests, and radiographs were obtained. Postoperative KT-2000 examinations were performed.Results: Sixty-one patients with 63 knees met these criteria (39 male, 22 female), at an average follow-up of 24 months (range, 12 to 42 months). The average postoperative Cincinnati score was 86 (45 preoperative), median Tegner score was 6 (2 preoperative), average Lysholm score was 89 (53 preoperative), and average IKDC activity score was 3.3 out of 4 (1.5 preoperative). Two patients had positive postoperative Lachman tests (+1) with no positive pivot-shift tests. The average KT-2000 manual-maximum difference was 0.7 mm. Only 1 KT-2000 value was greater than 3 mm (4 mm). No adverse events were encountered during screw insertion and postoperative radiographs showed bone plug consolidation and tunnel obliteration with bone in-growth increasingly apparent at 2 and 3 years (significantly earlier than published reports using pure poly-L-lactide screws).Conclusions: This is the first clinical report of a poly-D(2%),L(98%)-lactide interference fixation screw. This copolymer is zinc catalyzed, instead of the conventional tin, making the polymer more hydrophilic. The "D" isomer speeds the degradation process. These screws worked well with no adverse events. Graft tunnel obliteration was observed at 2 and 3 years.Level Of Evidence: Level 4, no or historical control. [ABSTRACT FROM AUTHOR]

Material and Method: Bioresorbable and biostable interference screws in operative reconstruction of anterior cruciate ligament (ACL) ruptures were compared concerning safety and efficacy. The randomized prospective clinical study consisted of 2 groups with 15 patients each, admitted at our center with acute (< 8 weeks) traumatic loss of ACL-stability. The ACL-reconstruction was performed in open technique using a bone-patellar tendon-bone autograft and fixation with bioresorbable (study group) or titanium (control group) interference screws. Results: Employing a special questionnaire patients' satisfaction was recorded. Functional results were scored using clinical examination and the Lachman test under sonographic control. Foreign-body reactions against the implants were assessed by clinical examinations and on radiographs. The follow-up of all patients was at least for 2 years. Ligament stability of the knee joint, operative and postoperative complication rate did not significantly differ between the two groups. 14 patients of the study group and 13 patients of the control group were completely satisfied. One patient of the study group was dissatisfied because of developing an infection. Conclusion: The results using bioresorbable interference screws in ACL-reconstruction are identic to those employing standard titanium implants. Differences in rates of operative and postoperative complications were not statistically significant. The advantages of the bioresorbable implants include the absence of urgent implant removal in case of secondary ACL-reconstruction procedures and undisturbed MRI and CT scans postoperatively. [ABSTRACT FROM AUTHOR]

This retrospective study reveals medium-term postoperative results in anterior cruciate ligament reconstruction with a bone-tendon-bone autograft of the middle third of the patellar ligament, 5 to 8 years after surgery. A total of 44 patients with a mean age of 34.7 years was followed up for an average of 72.5 months. Objective stability of the knee was evaluated by means of Lachman, pivot shift, anterior drawer and KT-1000 arthrometer measurements. 95.5% of the knees were stable, with a side-to-side difference < 3 mm. The evaluated knee score systems showed excellent results. Mean Lysholm score amounted to 95.5 points, and with the Tegner activity score, 81.8% of the patients regained their pre-injury activity level. Using IKDC grading, 88.6% of the knees were rated normal (A) or nearly normal (B), and asked for a personal assessment of their knee function, 93.2% of the patients rated it A or B, expressing a high grade of satisfaction with the result of surgery. The postoperative course of osteoarthritis showed a deterioration on the IKDC scale in 5 knees (11.4%), 2 with grade C signs of progressive osteoarthritis. A highly significant correlation (p < 0.01) was observed for progression of osteoarthritis and laxity of reconstruction >: 2 mm in the KT-1000 measurement. Reconstruction of the anterior cruciate ligament using a bone-tendon-bone autograft of the patellar ligament leads to good medium-term results with minimal progression of osteoarthritis. Restoration of ligamentous stability of the knee is important in preventing or retarding the progression of osteoarthritis following anterior cruciate ligament injury. [ABSTRACT FROM AUTHOR]

This retrospective study examined revision anterior cruciate ligament reconstruction using a bone-tendon-bone autograft of the patellar ligament. We followed up 44 patients (mean age 27.9 years) for an average of 41.2 months. Clinical examination with the Lachmann and pivot shift tests showed clearly improved stability; KT-1000 arthrometer measurements had a mean difference of 3.5 mm in side-to-side comparison. The evaluated knee scores were significantly improved (P<0.01); the median Lysholm score was 85 and the median Tegner activity score 5.0 at follow-up. In the IKDC ranking system 75.0% of knees were rated normal or nearly normal (grades A and B). According to a modified Fairbank scale, progression of radiographic signs of osteoarthritis was noted in 36.4%. There was a significant difference (P<0.05) in progression of radiographic signs of osteoarthritis between patients with major (grades III, IV) versus minor (grades I, II) lesions of the articular cartilage surface and between knees with versus without extensive synovitis due to previous synthetic graft reconstruction (P<0.05). Revision anterior cruciate ligament reconstruction using an autogenous patellar tendon graft shows good results with improved knee function compared to the prerevision status and is in line with various operative techniques described in the literature. Progression of osteoarthritis must be expected in patients with major lesions of the articular cartilage surface and knees with long-term extensive synovitis due to previous anterior cruciate ligament reconstruction using synthetic grafts. [ABSTRACT FROM AUTHOR]

Background: The two most common surgical treatment modalities for anterior cruciate ligament reconstruction (ACL), patellar tendon (PT) and hamstring tendon (HS) autografts, have been shown to have outcomes that are both similar and favorable; however, many of these are short or intermediate-term. The objective of this systematic review is to evaluate randomized controlled trials (RCTs) with a minimum 10-year follow-up data to compare the long-term outcomes of ACL reconstructions performed using PT and HS autografts., Methods: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A search of three databases (PubMed, Cochrane and EMBASE) was performed to identify RCTs with a minimum of 10-year follow-up that compared clinical and/or functional outcomes between PT and HS autografts., Results: Four RCTs with a total of 299 patients were included in the study. The mean follow-up ranged from 10.2 to 17 years (mean, 14.79 years). No significant differences in knee laxity or clinical outcome scores were demonstrated in any of the studies. One study found that PT autografts were significantly more likely to have osteoarthritis identified by radiographic findings. Two studies found that patients with PT autografts reported increase kneeling pain, while none of the four studies reported a difference in anterior knee pain. There were no significant differences in graft failure rates., Conclusion: This review demonstrates no long-term difference in clinical or functional outcomes between PT and HS autografts. However, radiographic and subjective outcomes indicate that patients with PT autografts may experience greater kneeling pain and osteoarthritis. Therefore, orthopaedic surgeons should consider patient-centric factors when discussing graft options with patients., Competing Interests: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Background: The aim of this study is to evaluate a possible correlation between specific anthropometric parameters and sizes of knee tendons commonly used for ACL reconstruction. We hypothesized that specific clinical and radiological knee measurements could be better tendon sizes predictors than age, gender, height and weight., Materials and Methods: 100 consecutive patients were enrolled and 77 patients met the inclusion criteria of the study. All patients underwent a MRI of the knee with a 1.5 T super conducting MR System. For each patient, anthropometric data such as gender, height, weight, body mass index (BMI) and knee circumference were recorded. Specific MRI knee measurements were performed on each study: patellar tendon (PT) thickness and length, quadriceps tendon (QT) thickness, semitendinosus tendon (ST) diameter, gracilis tendon (GR) diameter, the largest patella and intercondylar width., Results: The mean ST diameter, QT thickness and PT thickness were higher in males than in females. No significant differences were noted between males and females concerning GT diameter and the knee circumference. In addition, male knees had greater patellar and intercondylar width than female knees. Significant, but only weak correlations were found between patient anthropometric data and hamstrings diameter, PT length, and QT and PT thickness. Intercondylar and patellar width present a moderate correlation between PT thickness, PT length and ST diameter., Conclusion: The intercondylar and patellar width presented a moderate correlation with PT thickness, PT length and ST diameter. Further, weak correlations were found between patient anthropometric data (gender, weight, height, BMI) and GR and ST diameter, PT length, and QT and PT thickness. This results may help surgeons during preoperative planning, specifically regarding graft choice and size., Level of Evidence: III.

Background: Using intra-operative findings and clinical results, including return to play (RTP) at the pre-injury level, this study investigated the causes of primary graft failure after revision anterior cruciate ligament (ACL) reconstruction with bone-patellar-tendon-bone (BPTB) autografts., Methods: A total of 54 patients were followed for a mean of 38.2 ± 10.2 months post-surgery. Subjective and objective results were evaluated using single assessment numeric evaluation (SANE) scores, Lachman tests, KT-2000 arthrometer results, and pivot-shift tests. The change in each patient's Tegner activity scale and RTP at the pre-injury level were also evaluated., Results: Inappropriate positioning of the tunnels was the most important reason (54%) for primary graft failure. After revision surgery, anterior knee stability was significantly improved (1.2 (mean) ± 1.2 (SD)mm vs 4.5(mean) ± 1.9 (SD)mm; P < 0.01). Two (4%) patients sustained revision graft ruptures while two (4%) sustained contralateral knee ACL tears. The rate of RTP at the pre-injury level was 67% (36 patients), and mean SANE scores at the time of RTP were higher than before surgery (74.8 ± 13.8 points vs 24.1 ± 16.4; P<0.001). The average time from primary graft failure to revision surgery was shorter (12.2 (mean) ± 4.0 (SD) vs 37.6 (mean) ± 8.8 (SD)months; P < 0.01) and the ratio of major cartilage injury was lower (39% vs 83%; P < 0.05) in the RTP group than that in the non-RTP group., Conclusions: The time from primary graft failure to revision surgery and the extent of the cartilage injury are major factors in RTP after revision ACL reconstructions., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Abstract: In a previous study bioabsorbable screws composed of poly-L-lactic acid were used for graft fixation and examined prospectively with serial magnetic resonance imaging (MRI) scans 8, 16, and 24 months after anterior cruciate ligament reconstruction. Autogenous patellar tendon graft was used in all 10 patients. Although the manufacturer’s estimated time to absorption was 2 years, only 1 of 20 screws had been absorbed at 24 months’ follow-up. After 10 years, 6 patients were available for follow-up. None of the patients had instability, persistent effusions, or clinically detectable adverse reactions to the screws. MRI showed that all of the screws had been absorbed. However, all of the patients who underwent MRI had evidence of intraosseous fluid collections at the tibial BioScrew site (Linvatec, Largo, FL), and 4 of 6 had fluid collections at the femoral screw site. The persistence of intraosseous fluid collections 10 years after implantation underscores the importance of long-term follow-up of bioabsorbable implants, particularly given the rapid evolution of bioabsorbable materials used for interference screws. [Copyright &y& Elsevier]