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1.
Nikolaus A. Streich Sebastian Reichenbacher Alexander Barié Matthias Buchner Holger Schmitt 《International orthopaedics》2013,37(2):279-284
Purpose
Although the short- and mid-term outcomes of ACL reconstruction with a hamstring graft are promising, clinical investigations reporting the long-term results after ten years or longer are rare. Therefore we performed a retrospective single-blinded evaluation of ACL reconstruction using a four-stranded single-bundle reconstruction with a semitendinosus tendon graft with extracortical fixation.Methods/Results
At follow-up patients obtained at least the same level in the clinical outcome scores (Lysholm, IKDC, Tegner) compared to previous studies with a similar follow-up time using a STG graft. Furthermore there was no detectable difference in the incidence of osteoarthritis. Patients having a negative pivot shift test showed significantly fewer signs of radiographic osteoarthritis and better functional assessment scores.Conclusion
On the basis of our investigation, we conclude that the reconstruction of the ACL by a quadrupled semitendinosus tendon graft with extracortical anchorage can achieve excellent clinical and subjective results after a follow-up of ten years. 相似文献2.
M. Heitmann M. Gerau J. Hötzel A. Giannakos Prof. Dr. K.-H. Frosch A. Preiss 《Operative Orthopadie und Traumatologie》2014,26(1):19-29
Objective
Reconstruction of knee stability by primary ligament sutures and additional augmentation after knee dislocation.Indications
Acute knee dislocation Schenck type III and IV. Operative treatment should be performed within 7 days after injury.Contraindications
Chronic instability after knee dislocation, refixable bony avulsions, critical soft tissue, infection, lack of compliance.Surgical technique
Supine position with electric leg holder. Short arthroscopic assessment of concomitant injuries. Schenck type III medial injuries and Schenck IV injuries: anteromedial parapatellar arthrotomy. Injuries type Schenck III lateral: anteromedian arthrotomy. Armoring of ligament stumps for transosseus sutures. Placement of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) drill tunnels. Extracortical diversion of the suture armorings and insertion of augmentation systems. Fixation of the PCL augmentation in 70–90° flexion. Fixation of the ACL augmentation in 20–30° flexion. Knotting of the transosseus ligament sutures. If necessary (postero-)lateral and/or medial stabilization.Postoperative management
Limited weight bearing with 20 kg for 6 weeks. Stabilizing brace (e.g., Hypex-Lite®, Albrecht) generally for 12 weeks. Mobilization under tension of the quadriceps muscle for 6 weeks.Results
In total, 20 patients have been treated using the principle of “ligament bracing”. So far 8 patients (aged 18–60 years, median 33 years) have been assessed with a follow-up of 10–15 months (median 12 months) postoperatively. In all, 6 patients showed stable knees with good results. Recurrent instability of the ACL was observed in 2 patients; the collateral ligaments and PCL were stable. For the evaluation the following scores were used: IKDC score, Tegner score, and Lysholm score. To objectify the data, stress radiography and physical examination were performed. Using the operative technique mentioned above, no complications occurred. During follow-up 2 patients reported a deficiency of flexion. 相似文献3.
Xinxian Xu Tingting Huang Zhongtang Liu Hong Wen Luyou Ye Yuezheng Hu Huachen Yu Xiaoyun Pan 《Archives of orthopaedic and trauma surgery》2014,134(12):1753-1759
Introduction
Surgical reconstruction has been increasingly recommended for the surgical management of posterior cruciate ligament (PCL) ruptures. While the choice of tissue graft still remains controversial. Currently both hamstring tendon autograft (HTG) and ligament advanced reinforcement system (LARS) artificial ligament are widely used but there are seldom reports on the comparisons of their clinical results. Our study was aimed to assess the effectiveness of these two grafts.Materials and methods
Thirty-five patients with unilateral PCL rupture were enrolled in this retrospectively study. Sixteen of them received arthroscopically assisted PCL reconstruction using hamstring tendon autografts (HTG group) and nineteen using LARS ligaments (LARS group). All cases were followed up for 46–57 months with a mean of 51 months. Follow-up examinations included radiographic assessment, Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) rating scales and KT-1000 test.Results
All patients improved significantly at the final follow-up compared with the examinational results preoperatively and there were no significant differences between HTG group and LARS group with respect to the results of radiographic assessment, Lysholm score, Tegner score, IKDC rating scales and KT-1000 test.Conclusions
Similar good clinical results were obtained after PCL reconstruction using hamstring tendon autografts and LARS ligaments. Both LARS ligament and hamstring tendon autograft are ideal grafts for PCL reconstruction. 相似文献4.
Johannes Struewer Ewgeni Ziring Thomas M. Frangen Turgay Efe Steffen Meißner Benjamin Buecking Christopher Bliemel Bernd Ishaque 《International orthopaedics》2013,37(2):271-277
Purpose
The aim of this study was to evaluate patient-reported clinical outcome, instrumental stability and prevalence of radiological osteoarthritis (OA) based on a homogeneous patient sample after two years and on average ten years after isolated anterior cruciate ligament (ACL) reconstruction.Methods
Primarily we performed ACL reconstruction using a four-strand semitendinosus tendon (ST) autograft in 112 patients. Two years after reconstruction 98 patients could be re-evaluated. Long-term clinical and functional follow-up assessment was then performed on 52 patients on average 10.2 years after operative treatment. Inclusion criteria consisted of an isolated ACL rupture, reconstruction with ST graft and no associated cartilage alterations and meniscal lesions. Clinical and functional follow-up assessment included the International Knee Documentation Committee (IKDC) score and the scores of Tegner and Lysholm. Instrumental stability testing was carried out with the KT1000? arthrometer. The degree of degenerative changes and prevalence of OA was based on the Jäger-Wirth score.Results
The mean long-term follow-up was 10.2 years (eight–13 years), and the mean age was 40.4 years (24–62 years). About 72 % of patients were graded A or B according to the IKDC score. Activity levels according to the scores of Tegner and Lysholm were 4.8 and 88.2 on long-term follow-up. Radiological assessment revealed degenerative changes in the sense of a grade I OA in 21.2 % of patients. Prevalence of a grade II OA was found in 53.8 % of patients. A grade III OA and a grade IV OA were found in 19.2 and 5.7 %. Correlation analysis showed significant relationships between the long-term stability and prevalence of OA (p?<?0.05).Conclusions
Arthroscopic ACL reconstruction using four-strand ST autograft resulted in high patient satisfaction and good clinical results at two years and long-term follow-up. The prevalence of higher degree OA that developed in about 25 % of patients is significantly correlated with long-term knee joint stability. 相似文献5.
G. M. Salzmann B. Sah N. P. Südkamp P. Niemeyer 《Archives of orthopaedic and trauma surgery》2013,133(3):303-310
Study design
Case series: Level of evidence, 4.Background
Arthroscopic microfracture of chondral defects across the knee joint is a frequent treatment modality. There is only limited information on the clinical outcome in patients without previous surgery and single lesions.Purpose
Evaluation of clinical outcome following microfracture in patients without previous surgery and single lesions and identification of prognostic factors.Methods
Inclusion criteria were patients with single-lesion knee joint first-line microfracturing at minimum 2 years postoperatively. Charts were reviewed to identify patient and defect characteristics. Clinical outcome was evaluated by IKDC and Lysholm knee scores, Tegner activity scale and a numeric analogue scale (NAS) for function and pain (10 = highest possible function, no pain).Results
Totally, 145 patients (age at operation 47.92 ± 15.7) met inclusion criteria. Average defect size was 2.7 ± 1.9 cm2. Postoperatively, IKDC was 73.1 ± 18.5, Lysholm 77.6 ± 19.1, Tegner 4.5 ± 1.7, NAS pain 6.5 ± 2.6 and NAS function 6.4 ± 2.3. Significantly better clinical outcome was observed in male patients than in female patients. Regression analysis including all patient and defect characteristics highlighted that singly the parameter shorter symptom duration (P = 0.018) significantly predicted an improved postoperative clinical outcome.Conclusion
Microfracturing results in a satisfying clinical outcome, but no full recovery in patients without previous surgery and single lesions. Specific parameters facilitate outcome prognosis and therefore may aid in indicating surgery. 相似文献6.
Radek Hart Adel Safi Martin Komzák Pavel Jajtner Miloš Puskeiler Petra Hartová 《Archives of orthopaedic and trauma surgery》2013,133(9):1295-1301
Introduction
Recently an articular cartilage repair has been given much attention in the orthopaedic field. Cartilage regeneration capacity is very limited. Optimal approach seems to be a delivery of natural growth factors. Autologous platelet-rich plasma (PRP) contains proliferative and chemoattractant growth factors. The objective of the present study was to determine if PRP can increase tibiofemoral cartilage regeneration and improve knee function.Materials and methods
Fifty consecutive and strictly selected patients, affected by Grade II or III chondromalatia, underwent 1 year treatment (9 injections) with autologous PRP in a liquid form with 2.0 to 2.5-fold platelets concentration. Outcome measures included the Lysholm, Tegner, IKDC, and Cincinnati scores. Magnetic resonance imaging was used to evaluate cartilage thickness and degree of degeneration.Results
The study demonstrated significant improvement in Lysholm (p < 0.05), Tegner (p < 0.05), IKDC (p < 0.05), and Cincinnati (p < 0.05) scores. Results improved at 12-month follow-up. Cartilage assessment revealed no significant cartilage regeneration (p < 0.05). There were no adverse events reported.Conclusions
PRP significantly reduced pain and improved quality of live in patients with low degree of cartilage degeneration. Magnetic resonance imaging did not confirmed any significant cartilage condition improvement. 相似文献7.
Xiaosheng Li Tang Liu 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2013,23(6):691-697
Objectives
To summarize our experience and mid-term results of reconstruction with Iliotibial tract grafts for multiple ligament injuries.Methods
Between July 1997 and December 2003, multiple ligament injuries of 15 patients were reconstructed with Iliotibial tract grafts in arthroscopy. There were 5 women and 10 men. The mean age at the time of the surgery was 30.5 years (range 25–43 years). There were 7 cases who were injured with combined ACL rupture and the PCL, and 8 cases were with disruption of both the ACL and the PCL, combined with damage of the medial collateral ligament.Results
Fifteen patients were followed up for a mean of 7.5 years (range 6–12 years). The overall mean postoperative Lysholm score was 84.3 ± 5.7. At final IKDC qualification, 60.0 % of the knees were normal or nearly normal. The overall average Tegner activity score decreased significantly at the re-examination compared to the activity score before accident (3.6 ± 0.5 vs. 5.1 ± 0.6).Conclusions
Reconstruction with Iliotibial tract grafts in arthroscopy was a reliable treatment for multiple ligament injuries. 相似文献8.
Purpose
The purpose of this study was to prospectively evaluate outcomes of arthroscopic management of neglected ununited tibial eminence fractures in skeletally immature patients.Methods
The study was conducted and cases performed by two surgeons from two centres as a prospective case series of 13 patients with neglected ununited tibial eminence fractures: nine were girls and four were boys; ten were right knees and three were left. The average age at surgery was ten [standard deviation (SD) 2.6] years. Average follow-up was 10.8 (SD 6.8) months. Primary outcome measures used for evaluation were the Objective International Knee Documentation Committee Score (IKDC), subjective IKDC and modified Lysholm knee score. Secondary outcome measures were visual analogue scales (VAS) for pain and patient satisfaction.Results
Twelve patients had grade A objective IKDC score and one patient had grade B. Average subjective IKDC score was 80.5 (SD 16.7). Average modified Lysholm score was 91.2 (SD 8.9). Average VAS for operation satisfaction was 9.6 (SD 0.5) and for pain was 0.4 (SD 0.5). All patients showed radiological union and anatomical reduction at an average of 12.4 weeks postoperatively. At follow-up, all 13 patients showed complete range of motion (ROM). Eleven patients had negative Lachman, anterior drawer and pivot-shift tests, while two patients had grade 1 positive Lachman and negative anterior drawer and pivot-shift tests. No patient had complained of instability.Conclusion
Neglected ununited tibial eminence fractures in skeletally immature patients achieve good functional outcome results when treated with arthroscopic reduction and internal fixation using sutures. 相似文献9.
Tarek Boutefnouchet Malek Bentayeb Qutub Qadri Salman Ali 《International orthopaedics》2013,37(2):337-343
Purpose
Posterior cruciate ligament (PCL) injury has a reported incidence of 3–20 %. PCL reconstruction is aimed at reducing onset of premature articular degeneration and improving function. Numerous operative techniques have been described with varying degrees of result consistency.Methods
We evaluated 15 patients treated for isolated primary posterior cruciate ligament injury with a mean follow-up of 4.1 years (range one to nine). Post-reconstruction clinical assessment included the Lysholm and Tegner knee scoring scale, international knee documentation committee (IKDC) ligament evaluation, and KT2000 arthrometer assessment.Results
On the Lysholm knee score 11 patients (73 %) had excellent results, three patients (20 %) had good results and one patient (7 %) had a poor result. On the Tegner activity score the majority of patients scored 7–8 with a return to high level sports. At the final follow-up, the post-reconstruction IKDC score was normal or nearly normal (A and B) in 14 (93 %) patients, and abnormal (C) in one (7 %) patient. According to KT-2000 arthrometer measurements at final follow-up review, 11 patients (73 %) were rated as normal (A, 0–2 mm), and four patients (27 %) as nearly normal (B, 3–5 mm). These results were independent of age, mechanism of injury, time elapsed to surgical reconstruction, and length of follow-up.Conclusions
Despite being a technically demanding procedure, the outcomes reported in this study show that single bundle transtibial arthroscopic PCL repair using four strands hamstring autograft provides satisfactory and consistent functional outcomes. 相似文献10.
Johannes Struewer Ewgeni Ziring Ludwig Oberkircher Karl F. Schüttler Turgay Efe 《International orthopaedics》2013,37(5):809-817
Purpose
Anterior cruciate ligament (ACL) deficiency contributes to symptomatic functional instability of the knee, regardless of age. We evaluated patient-reported clinical outcome, instrumental stability and prevalence of radiological osteoarthritis based on two homogenous patient samples aged 50 years, an average of three years after isolated ACL reconstruction.Methods
ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft was done in 19 patients and a four-stranded semitendinosus tendon (ST) autograft in 22 patients. Clinical and functional follow-up assessment was performed an average of 32 months after surgical treatment. Clinical and functional follow-up assessment included the International Knee Documentation Committee (IKDC) score, Tegner score and Lysholm score. Instrumental stability testing was carried out using the KT–1000? arthrometer. The degree of degenerative changes and prevalence of osteoarthritis was based on the Kellgren–Lawrence classification.Results
Mean follow-up was 32 months (range, 28–36). Mean age was 49.4 years in both groups. The median pre-injury Tegner score was 5.5 (range, 2–8) and the median preoperative Lysholm score was 35 (range, 15–69). At two years, all variables improved significantly for both groups compared to the preoperative values (P?<?0.05), with no significant intergroup differences. Approximately 76 % of patients were graded A or B according to the IKDC score in both groups. Activity level according to the scores of Tegner and Lysholm was 4.9/5.3 and 83.4/82.5 on two-year-follow up in both groups. Radiological assessment reported degenerative changes of grade I Osteoarthritis (OA) in 36 % of patients. Grade-II OA was found in 31 % of patients. Grade-III OA and grade-IV OA were found in about 24 % and 7 % of all patients, respectively. Correlation analyses showed significant relationships between conservation of knee-joint stability and clinical outcome according to the IKDC score, and activity level according to the Lysholm score (p?<?0.05).Conclusion
Arthroscopic ACL reconstruction using either BPTB graft or hamstring graft in appropriately selected middle-aged patients results in patient satisfaction and good clinical results, with return to a reasonable level of activity regardless of surgical method and graft choice. 相似文献11.
Philipp Niemeyer Gian Salzmann Matthias Feucht Jan Pestka Stella Porichis Peter Ogon Norbert Südkamp Hagen Schmal 《International orthopaedics》2014,38(10):2065-2070
Purpose
Since the introduction of autologous chondrocyte implantation (ACI) for the treatment of cartilage defects, the initial technique has undergone several modifications. Whereas an autologous periosteum flap was used for defect coverage in first generation ACI, a standardized collagen membrane was utilized in second generation ACI. To date, however, no study has proven the superiority of this modification in terms of long-term clinical outcome. The purpose of this matched-pair analysis was therefore to compare the clinical long-term outcome of first and second generation ACI with a minimum follow-up of ten years.Methods
A total of 23 patients treated with second generation ACI for isolated cartilage defects of the knee were evaluated after a minimum follow-up of ten years using Lysholm and IKDC scores. The results of these patients were compared to those of 23 matched patients treated with first generation ACI. Pair wise matching was performed by defect location, patient age, and defect size.Results
While all patient characteristics such as age (31.7 years SD 6.9 vs. 31.4 years SD 7.8), defect size (5.1 cm² SD 2.3 vs. 4.9 cm² SD 1.5), and follow-up time (10.7 months SD 1.0 vs. 10.5 months SD 0.6) were distributed homogenously in both treatment groups, significant better Lysholm (82.7 SD 9.9 versus 75.6 SD 11.8; p?=?0.031) and IKDC scores (76.4 SD 12.8 versus 68.0 SD 12.0, p?=?0.023) were found in the group of patients treated with second generation ACI compared to those treated with first generation ACI. In both groups, four patients (17.4 %) received surgical reintervention during follow-up.Conclusions
The use of a collagen membrane in combination with autologous chondrocytes (second generation ACI) leads to superior clinical long-term outcome compared to first generation ACI. Based on these results, second generation ACI should be preferred over first generation ACI. 相似文献12.
Background and aim
There is still no gold standard technique for graft fixation during anterior cruciate ligament reconstruction. We compared the functional outcomes of patients receiving either ToggleLoc with ZipLoop technology or Translig transverse crosspin device for femoral graft fixation.Materials and methods
A total of 118 patients were randomly allocated into two groups to receive either Translig® transverse crosspin (Translig group 1: n = 51, mean age 28.34 ± 7.83 years, age 18–40 years) or ToggleLoc with ZipLoop technology (ToggleLoc group: n = 67, mean age 26.85 ± 8.76, age 16-41 years) for femoral graft fixation. Early and 1-year assessment was made with Lysholm knee scale, International Knee Documentation Committee Scoring, Tegner Activity Level Scale, KT-1000 arthrometer and pivot shift test.Results
Preoperative vs. postoperative functional parameters showed significant improvement in both groups. Two groups were similar in terms of Lysholm knee scale, IKDC and Tegner activity scores (p > 0.05). The KT-1000 arthrometer revealed slightly less anterior sliding in Translig group than that in ToggleLoc group (p > 0.05). ToggleLoc technique allowed a radiographically more horizontal placement of the graft than Translig technique.Conclusion
Two distinct techniques used in this study are likely to be suitable for femoral graft fixation during anterior cruciate ligament reconstruction with the femoral tunnel being created via anteromedial approach. 相似文献13.
Background
The best treatment of a combined rupture of the anterior and posterior cruciate ligaments is still unclear.Methods
Nine patients with unilateral traumatic ruptures of both the anterior and posterior cruciate ligaments were treated by arthroscopically-assisted simultaneous reconstruction. The operation was done using hamstring tendon and patellar tendon autografts, an average of 235 days (range 52–567) after the initial trauma. Patients were followed up for an average of 37 months (range 24–58) after surgery. For this retrospective cohort study, we used the Lysholm knee score, the Tegner activity score, and the SF-36 questionnaire as a means of assessment.Results
The evaluation at follow-up showed an average score of 74 points on the Lysholm scale. Using the IKDC evaluation, four patients could be placed in group B and five patients in group C. A significant increase, from 1.9 points before trauma to 5.0 points at follow-up, was observed on the Tegner activity score. Comparing the operated with the healthy knees, with respect to stability and isokinetic muscle strength, we noted significantly better scores in the healthy knees. Using the SF-36 questionnaire, patients showed a reduced level of physical well-being.Conclusion
The treated patients were able to carry out their activities of everyday life. However, none of them returned to their preinjury activity level. 相似文献14.
Arthur Grzesiak Kamiar Aminian Estelle Lécureux Florence Jobin Brigitte M. Jolles 《International orthopaedics》2014,38(4):717-724
Purpose
The aim of this study was to determine outcomes of total hip replacement (THR) with the Lemania cemented femoral stem.Methods
A total of 78 THR patients were followed and compared to 17 “fit”, healthy, elderly and 72 “frail” elderly subjects without THR, using clinical outcome measures and a portable, in-field gait analysis device at five and ten years follow-up.Results
Forty-one patients (53 %), mean age 83.4 years, available at ten years follow-up, reported very good to excellent satisfaction. Mean Harris Hip and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were 81.2 and 10.5 points, respectively, with excellent radiological preservation of proximal femur bone stock. Spatial and temporal gait parameters were close to the fit group and better than the frail group.Conclusions
Lemania THR demonstrated very good, stable clinical and radiological results at ten years in an older patient group, comparable to other cemented systems for primary THR. Gait analysis confirmed good walking performance in a real-life environment. 相似文献15.
B. Geiges C. von Falck K. Knobloch C. Haasper R. Meller C. Krettek S. Hankemeier J. Brand M. Jagodzinski 《Der Unfallchirurg》2013,116(2):109-117
Background
Press-fit fixation of a tendon graft has been advocated in order to achieve tendon to bone healing.Hypothesis
Fixation of a tendon graft with a porous bone scaffold limits bone tunnel enlargement compared with a biodegradable interference screw fixation.Methods
Between 2005 and 2006, 20 patients (17 men, 3 women) were enrolled in this study for primary reconstruction of the ACL. Patients were randomized to either obtain graft fixation in the tibial tunnel by means of an interference screw (I) or a press-fit fixation with a porous bone cylinder (P). Three months after surgery, a CT scan of the knee was performed and tunnel enlargement was analysed in the coronal and sagittal planes for the proximal, middle and distal thirds of the tunnel. After 6 months, 1 and 2 years, International Knee Documentation Committee (IKDC), Tegner and Lysholm scores of both groups were compared.Results
The bone tunnel enlargement was 106.9±10.9% for group P and 121.9±9.0% for group I (P<0.02) in the AP plane and 102.8±15.2% vs 121.5±10.1% in the coronal plane (P<0.01). IKDC, Tegner, and Lysholm scores improved in both groups from pre- to postoperative assessment without significant differences between the two groups. There was a trend to higher knee stability in group P after 3 months (0.6±1.4 mm vs 1.81±.5 mm, P=0.08).Conclusions
Both interference screw and a press-fit fixation lead to a high number of good or very good outcomes after ACL reconstruction. Tibial press-fit fixation decreases the amount of proximal bone tunnel enlargement. Press-fit fixation decreases the amount of proximal bone tunnel enlargement and improves bone to tendon contact. 相似文献16.
In-Jung Chae Ji-Hoon Bae Joon-Ho Wang Jinho Jeon Jong-Hoon Park 《Archives of orthopaedic and trauma surgery》2013,133(6):819-825
Purpose
We describe a surgical technique of double-bundle ACL reconstruction with a single tibia tunnel and report the clinical outcome.Methods
The Achilles tendon portion was split longitudinally into two separate bundles, namely, an anteromedial (AM) bundle with 7–8 mm diameter and a posterolateral (PL) bundle with 4–6 mm diameter. The central portion of the calcaneal bone plug was prepared with a diameter of 10 mm and a length of 30 mm. For the femoral tunnel preparation, we preferred inside out target through an accessory anteromedial portal for an approach to native ACL footprint and outside in reaming through separate incision on the lateral aspect of distal thigh to prevent cartilage injury of medial femoral condyle. 10 mm diameter of single tibia tunnel was prepared at the central portion of ACL tibial footprint. After graft passage from tibia to femoral side, fixation of calcaneal bone plug within the tibia tunnel was performed using two bioabsorbable cross pins. Then, AM bundle was first fixed at 45° of flexion while the PL bundle was fixed at 10° of flexion using bioabsorbable interference screws and augmented staples. Clinical results of 22 patients (18 males and 4 females, average age 30.7 years) who underwent double-bundle anterior cruciate ligament (ACL) reconstruction with this technique were evaluated.Results
At an average follow-up of 30 months, there was significant improvement of the Lysholm knee score, the 2,000 IKDC subjective knee score, the median Tegner activity score and the side-to-side difference. According to the 2,000 IKDC knee examination form, the grade rated as normal in seven patients, nearly normal in 14 patients and abnormal in one patient at the latest follow-up. There were no postoperative complications and revisional surgeries.Conclusions
Split Achilles allograft and single tibia tunnel technique for double-bundle ACL reconstruction can be an alternative option for patients with small tibial insertion sites.Level of evidence
Level IV, therapeutic study. 相似文献17.
İbrahim Azboy Abdullah Demirtaş Mehmet Gem Seymuz Kıran Celil Alemdar Mehmet Bulut 《Archives of orthopaedic and trauma surgery》2014,134(7):963-969
Introduction
The purpose of this study was to compare clinical and radiological outcomes of patients who underwent single-bundle anterior cruciate ligament (ACL) reconstruction with anteromedial portal (AMP) and transtibial (TT) techniques.Materials and methods
Arthroscopic single-bundle ACL reconstruction was performed using AMP technique in 34 patients and TT technique in 30 patients. The patients were evaluated retrospectively. Aperture fixation was used for femoral fixation, and absorbable screws and U staples were used for tibial fixation of the graft. Pivot shift test, Lachman test, Lysholm, Tegner, and International Knee Documentation Committee (IKDC-2000) scoring systems were used in the clinical and functional evaluation of patients before and after the surgery. Time to return sports and activity level were assessed. In the radiological evaluation of non-anatomic bone tunnel placement, the criteria developed by lllingworth et al. were used. The mean duration of follow-up was 20.4 and 24.6 months in the AMP and TT groups, respectively.Results
There was a significant difference between the AMP group (86.7 %) and the TT (14.7 %) group in terms of anatomical placement of the femoral tunnels and grafts (p < 0.001). No significant difference was observed between the two groups in terms of the Pivot shift test, Lachman test, Lysholm, Tegner, and IKDC scores, and activity level (p > 0.05). The patients in the AMP group returned to sports 1.5 months earlier on average (p < 0.001).Conclusions
It was shown that AMP technique was superior to the TT technique in providing anatomical placement of the graft and in recovery time to return sports; however, there was no difference between groups in early periods in terms of the clinical and functional outcomes. 相似文献18.
Jae-Hwa Kim Jung Ryul Kim Dong Hoon Lee Jin-Young Bang In-Tae Hong 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2013,23(6):679-683
Purpose
Patellofemoral arthritis comes frequently with medial compartmental osteoarthritis. The combination of closed wedge high tibial osteotomy with tibial tuberosity anteriorization osteotomy has been introduced in several reports, but this technique is a technically demanding procedure and the outcomes of this technique show variable results. This article describes a novel osteotomy technique that combines medial open-wedge high tibial osteotomy (HTO) and tibial tuberosity anteriorization osteotomy (TTAO) for medial compartmental osteoarthritis and patellofemoral arthritis of the knee.Methods
Twelve knees in 10 patients who were diagnosed with combined medial compartmental osteoarthritis with patellofemoral compartmental arthritis were treated with the combination of medial open-wedge HTO and TTAO and were followed up for more than 1 year. We evaluated the patients with the Lysholm functional questionnaires, the hospital for special surgery score (HSS), and the international knee documentation committee (IKDC) criteria (mean follow-up, 14.8 months).Results
Union was achieved in all cases within 12 weeks. The mean Lysholm score increased from 42 preoperatively to 82.5 postoperatively (p < 0.001), the HSS increased from 57.5 preoperatively to 83 postoperatively (p < 0.001), and the IKDC score increased from 51 preoperatively to 82 postoperatively (p < 0.001). There were no other complications, such as iatrogenic fractures, nonunion, wound problem, collapse or loss of correction, and so on.Conclusions
The combination of medial open-wedge HTO and modified Maquet procedure (TTAO) is considered to be an effective treatment modality for medial and patellofemoral compartmental osteoarthritis. This technique could, therefore, constantly provide a minimally invasive, precise correction of the deformity and a firm fixation that is enough to allow early rehabilitation. 相似文献19.
Sandor Roth Tomislav Madarevic Lucian Vukelic Aron Roth Davorka Gudac Madarevic Tedi Cicvaric 《Archives of orthopaedic and trauma surgery》2013,133(10):1441-1445
Introduction
The aim of this study is to prove the influence of the arthroscopic lateral release on functional recovery in adolescents with recurrent lateral dislocation of patella.Materials and methods
From 2006 to 2009, arthroscopic release of the lateral retinaculum was done on 27 adolescent patients (24 women, 3 men) and 33 knees (in 6 patients on both knees). All of them were active in different sports. The severity of patellar subluxation and dislocation was analysed on X-ray; the Q angle, congruence angle, sulcus angle, patellofemoral angle and height ratio were measured. Functional scores (Lysholm, Kujala, Tegner) were measured preoperatively and postoperatively. The average duration of clinical and X-ray follow-up was 4.5 years (range 3–6 years).Results
The mean age of the patients was 14.56 years (range 11–18 years). There was an average of 4.16 dislocations (range 2–28 dislocations) before surgery. The mean Lysholm score improved from 64 to 95 (p = 0.0002), and the mean Kujala score improved from 66 to 94 (p < 0.0001). Congruence angle and lateral patellofemoral angle improved but without any significant differences.Conclusion
Arthroscopic lateral release successfully treats recurrent patellar dislocations in adolescents, influences functional recovery and improves knee function. 相似文献20.
Seyed Taghi Norbakhsh Zohreh Zafarani Arvin Najafi Hamidreza Aslani 《Archives of orthopaedic and trauma surgery》2014,134(12):1723-1730