Partial tears of anterior cruciate ligament: Results of single bundle augmentation

Background:

Partial tears of the anterior cruciate ligament (ACL) are common and usually present with symptomatic instability. The remnant fibers are usually removed and a traditional ACL reconstruction is done. But with increased understanding of ACL double bundle anatomy, the remnant tissue preservation along with a single bundle augmentation of the torn bundle is also suggested. The purpose of this study was to evaluate the results of selective anatomic augmentation of symptomatic partial ACL tears. Our hypothesis is that this selective augmentation of partial ACL tears could restore knee stability and function.

Materials and Methods:

Consecutive cases of 314 ACL reconstructions, 40 patients had intact ACL fibers in the location corresponding to the anteromedial (AM) or posterolateral (PL) bundle and were diagnosed as partial ACL tears perioperatively. All patients underwent selective augmentation of the torn bundle, while keeping the remaining fibers intact using autogenous hamstring graft. A total of 38 patients (28 males, 10 females) were available with a minimum of 3 years followup. 26 cases had AM bundle tears and 12 cases had PL bundle tears respectively. Patients were assessed with International Knee Documentation Committee (IKDC) 2000 Knee Evaluation Form, Lysholm score; instrumented knee testing was performed with the arthrometer (KT 2000). Statistical analysis was performed to compare the preoperative and postoperative objective evaluation.

Results:

At 3 years followup, 31.6% patients were graded A, 65.8% were graded B and 2.6% was graded C at IKDC objective evaluation. Manual laxity tests, Lysholm''s score, mean side to side instrumental laxity and Tegner activity score improved significantly. 76% patients returned to preinjury level of sports activity after augmentation.

Conclusion:

The results of anatomic single bundle augmentation in partial ACL tears are encouraging with excellent improvement in functional scores, side to side laxity and return to sports activity.     

Does Severity or Specific Joint Laxity Influence Clinical Outcomes of Anterior Cruciate Ligament Reconstruction?

It generally is believed generalized joint laxity is one of the risk factors for failure of anterior cruciate ligament (ACL) reconstruction. However, no consensus exists regarding whether adverse effects on ACL reconstruction are attributable to joint-specific laxity or are related to the severity of generalized joint laxity. We therefore asked whether knee stability and functional outcomes would be related to joint-specific laxity and would differ according to the severity of generalized joint laxity. The Beighton and Horan criteria were used to assess joint laxity in 272 subjects. All elements are added to give an overall joint laxity score ranging from 0 to 5. Knee translation did not increase in proportion to the severity of the generalized joint laxity. Patients with scores less than 4 showed similar knee stability. When all variables, including the severity of generalized joint laxity, were considered, only hyperextension of the knee independently predicted knee stability and function. In patients with knee hyperextension, a bone-patellar tendon-bone autograft provided superior stability and function compared with a hamstring tendon autograft. Our data suggest knee hyperextension predicts postoperative stability and function regardless whether patients have severe generalized joint laxity.     

Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: Results at 15 years follow-up

ABSTRACT: BACKGROUND: If anterior cruciate ligament (ACL) reconstruction is to be performed, decision regarding graft choice and its fixation remains one of the most controversial. Multiple techniques for ACL reconstruction are available. To avoid disadvantages related to fixation devices, a hardware-free, press-fit ACL reconstruction technique was developed.The aim of this study was to evaluate clinical outcome and osteoarthritis progression in long term after ACL reconstruction with central third patellar-tendon autograft fixed to femur by press-fit technique. METHODS: Fifty two patients met inclusion/excusion criteria for this study. The patients were assessed preoperatively and at 15 years after surgery with International Knee Documentation Committee Knee Ligament Evaluation Form, Lysholm knee score, Tegner activity scale and radiographs. RESULTS: Good overall clinical outcomes and self-reported assessments were documented, and remained good at 15 years. The mean Lysholm and Tegner scores improved from 59.7 +/- 18.5 and 4.2 +/- 1.0 preoperatively to 86.4 +/- 5.6 (p = 0.004) and 6.9 +/- 1.4 (p = 0.005) respectively at follow-up. The IKDC subjective score improved from 60.1 +/- 9.2 to 80.2 +/- 8.1 (p = 0.003). According to IKDC objective score, 75% of patients had normal or nearly normal knee joints at follow-up. Grade 0 or 1 results were seen in 85% of patients on laxity testing. Degenerative changes were found in 67% of patients. There was no correlation between arthritic changes and stability of knee and subjective evaluation (p > 0.05). CONCLUSIONS: ACL reconstruction with patellar tendon autograft fixed to femur with press-fit technique allows to achieve good self-reported assessments and clinical ligament evaluation up to 15 years. Advantages of the bone-patellar-tendon-bone (BPTB) press-fit fixation include unlimited bone-to-bone healing, cost effectiveness, avoidance of disadvantages associated with hardware, and ease for revision surgery. BPTB femoral press-fit fixation technique can be safely applied in clinical practice and enables patients to return to preinjury activities including high-risk sports.     

Influence of stability on range of motion after cruciate-retaining TKA

BACKGROUND: A loosely balanced total knee arthroplasty (TKA) is reported to produce a good postoperative range of motion (ROM), but too much laxity is thought to be the cause of persistent pain and worsened functionality. METHODS: The anteroposterior and mediolateral laxity values were measured to evaluate the influence of stability after cruciate-retaining (CR) TKA on ROM and the modified Knee Society score at 4-8 years after the operation. Twenty-one knees in 15 patients with an average age of 68 years who had undergone a CR TKA for osteoarthrosis were examined. The mean preoperative and postoperative ROM was 124 degrees and 112 degrees, respectively. The mean anteroposterior and mediolateral laxity values were 9.7 mm and 10.6 degrees, respectively. RESULTS: No correlation was found between the postoperative ROM and laxity or between the modified Knee Society score and laxity. A loosely balanced TKA did not produce a good postoperative ROM. No parameters suggested that lax knees showed a higher pain score and lower functional score than stable knees.     

Comparing 2-year outcomes of anterior cruciate ligament reconstruction using either patella-tendon or semitendinosus-tendon autografts: a non-randomised prospective study

PURPOSE: To compare the results of anterior cruciate ligament (ACL) reconstructions using either a patella-tendon autograft or a semitendinosus-tendon autograft. METHODS: Based on surgeon experience and preference, 68 patients underwent ACL reconstruction using either a quadruple-strand semitendinosus autograft (n = 34) or a central one-third bone-patella tendon-bone autograft (n = 34). Each patient was assessed preoperatively and postoperatively at 3, 6, and 24 months using the International Knee Documentation Committee (IKDC) knee score, Biodex muscle strength and endurance testing, and the KT1000 instrumented arthrometer test of knee laxity to anterior translation. All assessments at the 2-year follow-up were performed by the same physician and physiotherapist. RESULTS: While ACL reconstruction improved knee stability and IKDC knee scores significantly, there was no statistically significant difference between semitendinosus- and patella-tendon autograft reconstructions in terms of long-term knee score or laxity to anterior translation. Semitendinosus graft reconstruction was associated with less donor-site morbidity and hamstring weakness. Meniscectomy was associated with poorer long-term knee scores. CONCLUSION: ACL reconstruction is associated with a significantly better IKDC knee score and laxity measurement at 2-year follow-up. However, we were unable to demonstrate a significantly better long-term outcome in knee score or laxity to anterior translation with either a patella-tendon autograft or a semitendinosus-tendon autograft.     

Primary repair plus intra-articular iliotibial band augmentation in the treatment of an acute anterior cruciate ligament rupture

Between September 1987 and November 1989, we treated 90 consecutive patients with an acute anterior cruciate ligament (ACL) rupture with the multiple suture technique and iliotibial band augmentation. Seventy of these patients were re-examined 2 to 5 years after the operation (mean 3.5 years), the examination consisting of a questionnaire, clinical examination, laxity tests with the KSS machine (Acufex), radiological examination and isokinetic muscle strength testing (Cybex 6000). There were 32 men and 38 women (mean age 34 years). The injury was sustained in sports in 44 (63%) cases, and the sports most frequently involved were downhill skiing (18 cases), soccer (9 cases) and volleyball (5 cases). Of the injuries, 38 were isolated ACL ruptures and 31, ACL ruptures combined with a medial CL rupture. In 9 cases, an additional meniscus injury and in one case an additional posterior CL - lateral CL rupture was found. At the follow-up, 55 patients (79%) were satisfied with the end result, and according to our objective functional criteria 55 (79%) had an excellent or good outcome. According to the Lysholm score, 53 (76%) patients were excellent or good ( 82 points). In the Lachman test, 29 knees (41%) were completely stable. The Lachman test was mildy positive in 40 knees (57%) (36 had 1+ laxity and 4, 2+ laxity), and one patient had 3+ laxity with a hard end-point. Similarly, the anterior drawer test was negative in 53 knees (76%); and the other 17 (24%) had mild laxity (16 had 1+ laxity and 1, 2+ laxity). The total anterior-posterior laxity measured with the KSS averaged 9.7 ± 3.5 mm in the injured knee and 7.3 + 3.0 mm in the uninjured knee (the laxity measured at a knee angle of 20° of flexion). Corresponding values at a knee angle of 90° of flexion were 6.1 ± 2.4 mm and 4.7 ± 1.9 mm, respectively. The pivot shift test was negative in 62 patients (89%) and l+ positive in the remaining 8 patients (11%). Fifty-eight patients (83%) had full knee extension and 40 patients (57%), full knee flexion. Compared with the uninjured knee, the operated knees showed an average 14% strength deficit in isokinetic knee extension and 6% deficit in flexion at the speed of 60°/s. At the speed of 180°/s, the corresponding deficits were 8% and 4%, respectively. Of the 44 patients who were active in sport before the injury, 40 (91%) were able to return to sports. A flexion deficit of 5° or more was associated with thigh muscle atrophy (P < 0.05) and quadriceps weakness, both at the slow speed (P < 0.05) and high speed (P < 0.001) of the isokinetic movement. In conclusion, in an acute rupture of the ACL, primary repair of the ligament with intraarticular iliotibial band augmentation seems to be a good method to restore the functional capacity of the injured knee.     

Considerations for the indications for anterior cruciate ligament reconstruction. Results of conservative versus operative treatment

Summary Medium-term results with a follow-up of at least 3 years were done in 160 patients (average follow up 51 months) after ACL reconstruction using IKDC evaluation form and Noyes score and in 110 patients (average follow Up 53 months) after non-operative management. Unlike objective good parameters the subjective assessment of knee function according to the Noyes score reveals significantly worse results in cases with ACL reconstruction compared to the knees without surgery. The best functional results we found in professional athletes after ACL reconstruction. Comparable positive results of knee function is only achieved in approx. 15 % of the patients from the natural history group, who can maintain high risk pivoting activity level feeling no giving way. In our opinion compensatory proprioceptive mechanism account for the surpassing results in these two groups of patients. It will be postulated that it is not the absolute power of the hamstring but the latency period of recruition that influences the compensation of anterior knee instability. We have modified our rehabilitation methods in order to improve proprioception and dynamic stability of the ACL-deficient knee. Based on our results we primarily limitate the ACL reconstruction on a group of patients practicing high-risk-pivoting sports. Only when menisceal lesions appear or patients suffer from giving way episodes we support secondary surgery. The pivot shift sign is reflecting the dynamic aspect of knee instability. In our opinion it is the decisive parameter to assess knee instability unless there are useful technical procederes.      

The clinical relevance of instrumented testing for ACL insufficiency. Experience with the UCLA clinical knee testing apparatus

An instrumented clinical testing device developed at UCLA records a continuous anteroposterior force versus displacement curve of the tibia with respect to the femur at 20 degrees of flexion. Laxity and stiffness are calculated from the response curve. With this device, 95% of normal knees have an anterior laxity less than 7.5 mm and a side-to-side difference less than 2 mm. In contrast, an anterior cruciate ligament (ACL) absent knee has a mean anterior laxity of 10 mm and a mean side-to-side difference of 5 mm. In a small group of patients with an intraarticular ACL substitution using the medial or lateral one-third of the patellar tendon, laxity and stiffness of the injured knees were returned to within the normal range and remained constant three years after surgery. In a group of 76 patients treated with ACL substitution using the torn meniscus, 51% of the patients still had an anterior laxity outside the normal range 3.5 years after surgery. In a preliminary study of 19 patients receiving a Gore-Tex synthetic ACL substitution, 55% of the patients still had a side-to-side difference greater than 2 mm two years after the procedure. These studies illustrate the advantages of impartial, objective measurements of knee stability. Laxity and stiffness values can supplement, but never replace, a thorough patient examination and patient history. As sports medicine matures as a scientific discipline, improved instrumented test devices may ultimately provide a standardized means for reporting knee stability parameters.     

The value of conservative treatment in ruptures of the anterior cruciate ligament (ACL)

BACKGROUND: Thirty-eight of the 73 consecutive acute ruptures of the anterior cruciate ligament (ACL) proven by a magnetic resonance imaging scan (MRI) in skeletally mature patients (16-55 years old) were classified as suitable for primarily conservative treatment. Patient selection was performed using a preoperative screening protocol based on the structural damage, clinical symptoms, compliance, sportive activity, and the consent of a well-informed patient. METHODS: In 12 of the 38 treated patients, the conservative protocol showed a good to very good outcome, 2 patients had persistent giving-way and were considering ACL reconstruction, 14 patients had a secondary ACL reconstruction in our clinic (average 5.3 months after injury), 9 patients were operated on in other hospitals (average 13.3 months after injury), and 1 patient was lost to follow-up. RESULTS: All patients with successful conservative treatment were able to perform low-risk pivoting sports and two patients are practicing high-risk pivoting sports. The average International Knee Documentation Committee (IKDC) score was 92.5 (82.8-98.9); the subjective overall knee function was 93% (60% to 100%). Of the 12 patients with good and very good results, 6 continued playing the same sports at an unreduced intensity, 4 patients reduced their activities slightly, and 1 patient played more sports than before. CONCLUSIONS: Although the authors performed a preoperative screening to select patients suitable for conservative treatment, almost two-thirds of the primarily conservatively treated ACL ruptures needed an operative reconstruction in the long term. In one-third of the patients, conservative treatment led to a good or very good result. At the endpoint of the study only 12 (16%) of a total of 73 patients with acute injuries of the ACL had successful conservative treatment. Therefore, patients must be comprehensively instructed about the treatment program and the chances of success of conservative ACL treatment.     

Arthroscopic anterior cruciate ligament reconstruction using a hamstring graft with interference screw fixation.

BACKGROUND AND AIMS: This study assessed the clinical and radiographic results 3 to 8 years after an arthroscopic ACL reconstruction using a hamstring graft with interference screw fixation on femoral and tibial sites. MATERIAL AND METHODS: Seventy-six of 100 patients, who underwent an arthroscopic ACL reconstruction, could be re-examined with a mean follow-up of 5 years. RESULTS: The mean Tegner activity score was 4 (scale: 0 to 10) before surgery, and 5 at the follow-up. Fifty-four patients (78%) achieved a satisfactory result in the IKDC rating. The mean Lysholm score was 85 (scale: 0 to 100), the score being better in patients without meniscal resection than those with (P = 0.04). The mean side-to-side difference in anterior-posterior knee laxity was 1.8 mm, and 62 patients (90%) had good stability. Sixty-four patients (93%) had normal range of motion of the knee. Twelve patients (46%) with meniscal resection had osteoarthritic changes, compared with only 8 of those (20%) without meniscal resection (P = 0.03). CONCLUSIONS: This medium-term follow-up study showed that good stability and function and normal range of motion of the knee can be achieved in majority of the patients who have undergone an ACL reconstruction with a hamstring graft and interference screw fixation.     

Objective anterior cruciate ligament testing

We examined subjects with the Stryker knee laxity tester as part of the clinical examination to determine its usefulness in evaluating the anterior cruciate ligament. We measured 123 athletes with no history of knee injury, as well as 30 patients with ACL injury proven by arthroscopy, and 11 injured patients with intact ACL at arthroscopy. We recorded anterior and posterior tibial displacement at 20 degrees of knee flexion and 20 lbs force in each direction. Anterior laxity and side to side difference correlated with ACL injury; posterior and total AP laxity did not. In normal subjects, mean anterior laxity was 2.5 mm. Only 8% of normal knees had anterior laxity of 5 mm or more. Ten percent of normal subjects had a side to side difference of 2 mm or more. In ACL tears, mean laxity was 8.1 mm, with 94% measuring 5 mm or more. Of the subjects, 89% with unilateral ACL injury had an increase of 2 mm or more on the injured side. Ten of ten acute ACL tears were detected by these criteria, with no false positives. In injured knees with intact ACL, measurements did not differ significantly from normal. We found the objective knee laxity measurement to be a useful complement to clinical knee examination.     

Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5-9 years after surgery

BACKGROUND: Rupture of the anterior cruciate ligament (ACL) may cause osteoarthrosis (OA) and functional impairment. We wanted to find out whether the degree of knee stability obtained after ACL reconstruction correlates with radiographic and clinical outcome. PATIENTS AND METHODS: We examined 63 patients 2 and 5-9 years after anterior cruciate ligament (ACL) reconstruction. Knee stability was assessed 2 years after surgery by recording AP laxity using radiostereometric technique (RSA) and by performing the pivot shift test. Degeneration of the knee joint was evaluated with bone scintigraphy, and radiographically. Functional outcome was assessed with Lysholm score, Tegner activity scale and with the one-leg hop test. RESULTS: Radiographic signs of osteoarthrosis at the most recent follow-up (5-9 years) did not correlate with knee stability. Patients with positive pivot shift test 2 years after surgery showed increased scintigraphic activity of the subchondral bone at the most recent follow-up, and inferior subjective functional outcome 2 years after surgery. Knees having had meniscus resections had more often OA. Radiographical signs of OA were associated with higher scintigraphic uptake in the operated knee relative to the contralateral knee. INTERPRETATION: The ability to obliterate the pivoting by ACL reconstruction appears to be more important than normalizing the AP laxity in order to prevent later OA.     

Positive pivot shift after ACL reconstruction predicts later osteoarthrosis63 patients followed 5–9 years after surgery

Background?Rupture of the anterior cruciate ligament (ACL) may cause osteoarthrosis (OA) and functional impairment. We wanted to find out whether the degree of knee stability obtained after ACL reconstruction correlates with radiographic and clinical outcome.Patients and methods?We examined 63 patients 2 and 5–9 years after anterior cruciate ligament (ACL) reconstruction. Knee stability was assessed 2 years after surgery by recording AP laxity using radiostereometric technique (RSA) and by performing the pivot shift test. Degeneration of the knee joint was evaluated with bone scintigraphy, and radiographically. Functional outcome was assessed with Lysholm score, Tegner activity scale and with the one-leg hop test.Results?Radiographic signs of osteoarthrosis at the most recent follow-up (5–9 years) did not correlate with knee stability. Patients with positive pivot shift test 2 years after surgery showed increased scintigraphic activity of the subchondral bone at the most recent follow-up, and inferior subjective functional outcome 2 years after surgery. Knees having had meniscus resections had more often OA. Radiographical signs of OA were associated with higher scintigraphic uptake in the operated knee relative to the contralateral knee.Interpretation?The ability to obliterate the pivoting by ACL reconstruction appears to be more important than normalizing the AP laxity in order to prevent later OA.     

Early arthroscopic evaluation of acute repair of the anterior cruciate ligament

Follow-up arthroscopy was performed in 71 patients who had undergone primary repair of an acute rupture of the anterior cruciate ligament (ACL) after 6-19 months. An augmented repair was done on 61 patients and 10 patients had a nonaugmented repair. Based on the arthroscopic findings, the ACL repair was classified into three categories. Four years after the injury a clinical reexamination, including a laxity test using instrumentation and a standard knee-function test, was done on 66 patients. Arthroscopy revealed that 64 of the 71 patients (90%) had a defined ACL repair, although the repair was elongated in 37 patients. Seven patients with a nonfunctioning ACL repair had inferior knee function after 4 years. Arthroscopy also showed superficial cartilage lesions in 24 patients and meniscal pathology in 6 patients. Two patients with more advanced chondral lesions had inferior knee function. Treatment of meniscal injuries did not affect the long-term results.     

A prospective study to assess the outcomes of revision anterior cruciate ligament reconstruction

Purpose

Continuously increasing numbers of primary anterior cruciate ligament (ACL) reconstructions invites a parallel increase in graft failures and need for revision ACL reconstruction surgery. High failure rates has previously stigmatised the revision surgery. We performed this study using multiple outcome measures together with clinical examination to offer a full assessment of the outcomes of this procedure.

Methods

Twenty patients, with mean age of 29.4 years (17–50 years), were included in this study prior to their revision ACL reconstruction surgery. All patients were followed prospectively collecting the Knee injury and Osteoarthritis Outcome (KOOS), International Knee Documentation Committee (IKDC) and Tegner-Lysholm scores pre- and post-operatively together with clinical assessment of the antero-posterior knee laxity.

Results

After a mean follow up interval of 30 months (16–60 months) significant post-operative improvement of IKDC, Tegner-Lysholm scores and knee antero-posterior laxity together with the Symptoms, Activities of Daily Living (ADL) and Quality of Life (QOL) components of the KOOS score was noticed (P < 0.05). However, there was no similar improvement in pain and sports components of the KOOS score (P > 0.05). There was no difference in the outcomes of different graft types.

Conclusion

Good outcomes of revision ACL reconstruction surgery are achievable. The use of different graft types did not affect the outcome of the procedure. Most of the patients opted to less aggressive sports participation after the revision procedure.     

Treatment of the anterior cruciate ligament-absent knee with associated meniscal tears. Instrumented testing and clinical evaluation of two patient groups

The UCLA instrumented clinical testing apparatus was used to measure postoperative stiffness and laxity for two groups of patients with documented chronic absence of the anterior cruciate ligament (ACL) and associated meniscal tears. Group 1 consisted of 76 patients (average age, 25 years) who had undergone anterior cruciate substitution using the torn meniscus, and a second group of 34 patients (average age, 31 years) who had partial meniscectomy alone without ACL substitution. Subjective and objective evaluations were significantly higher and symptoms of pain and buckling significantly lower in the substitution group. In addition, 29% of Group 1 and only 7% of Group 2 patients were able to return to their preinjury sports without limitations, while 5% of the former and 12% of the latter could not return to any sport. At 90 degrees of flexion, there were no significant differences in stiffness or laxity between the patient groups. At 20 degrees of flexion and neutral foot rotation, the meniscal substitution group had an average of 1.4 mm less side-to-side laxity difference than the partial meniscectomy patients; 51% of the substituted patients still had an injured knee laxity that was at least 2 mm greater than the uninjured knee, as contrasted to 67% of the partial meniscectomy patients who exceeded this upper limit of the normal range. At 20 degrees, anterior stiffness of the injured knees of the substitution patients was 28% greater than the injured knees of the partial meniscectomy group; 42% of the substituted patients had an injured knee stiffness within the normal range, while only 18% of the partial meniscectomy patients fell within normal limits. There were no statistical correlations of stiffness or laxity values with clinical scores or patient symptomatology in either group.     

The effect of injury chronicity and progressive rehabilitation on single-incision arthroscopic anterior cruciate ligament reconstruction

We conducted a prospective study on 50 consecutive patients who received a single-incision arthroscopic patellar tendon autograft reconstruction for anterior cruciate ligament (ACL) rupture. The purposes were to determine if differences existed in results between patients with acute and chronic ACL ruptures, and if a progressive rehabilitation program could safely return patients to sports activities early without compromising knee stability. Forty-two patients (84%) returned for follow-up a mean of 31 months postoperatively. Twenty-one patients had acute ruptures, and 21, chronic ruptures. A progressive rehabilitation program was used by 28 patients (67%) who met strict criteria, which allowed early return to running and sports activities. The results were rated with the Cincinnati Knee Rating System. We found no effect of either injury chronicity or time to return to activity for 21 factors, including anterior-posterior displacement, patellofemoral crepitus, range of knee motion, quadriceps muscle strength, symptoms, functional limitations, or the patient rating of outcome. Using arthrometer and pivot-shift test data, 30 knees (71%) had a functional reconstruction; 8 knees (19%) had partial function; and 4 knees (10%) failed. Patients expressed satisfaction with the operation as follows: 23 (55%) rated their overall knee condition as normal; 16 (38%), very good; and 3 (7%), good. No patients rated their knee condition as fair or poor.Arthroscopy 1998 Jan-Feb;14(1):15-22     

前交叉韧带重建术后膝关节功能及三维运动步态分析

目的 探讨前交叉韧带(ACL)重建术后膝关节稳定性、功能及三维步态运动学情况.方法 回顾性分析2015年7月到2017年7月在佛山市中医院运动学科采用自体腘绳肌腱行ACL重建并进行了二次关节镜探查的270例病例,其中男164例,女106例.采用Lysholm评分、国际膝关节评分委员会(IKDC)评分、Tenger评分、...     

Endoscopic single-bundle posterior cruciate ligament reconstruction: results at minimum 2-year follow-up

Purpose:The goal of this study was to evaluate the clinical outcome of single-bundle posterior cruciate ligament (PCL) reconstruction with retention of the PCL remnant and hamstring tendon autograft with interference screw fixation in patients with isolated PCL laxity.Type of Study:Prospective case series with minimum 2-year follow-up evaluation.Methods:Thirty-one patients for whom conservative management had failed underwent surgery using a 4-strand hamstring tendon autograft with interference screw fixation. The median time from injury to reconstructive surgery was 9 months (range, 4 to 120 months). At a minimum of 2 years after surgery, patients were assessed with the International Knee Documentation Committee (IKDC) Knee Ligament evaluation, Lysholm knee score, and KT-1000 instrumented testing.Results:Before surgery, the median Lysholm knee score was 64 (95% confidence interval, 51 to 67). No patient rated knee function as normal, and all patients showed at least grade 2 posterior drawer laxity. At review, the median Lysholm knee score was 94 (95% confidence interval, 83 to 94), 56% rated the knee as normal and only one patient was found to exhibit grade 2 laxity on posterior drawer testing. Before injury, 94% of patients participated in moderate or strenuous activity. This figure fell to 26% after injury and had increased to 63% at review.Conclusions:Endoscopic reconstruction of PCL laxity using single-bundle 4-strand hamstring tendon autograft, without removal of the PCL stump, provides a significant reduction in knee symptoms and allows 63% of patients to return to moderate or strenuous activity. This is an effective procedure for symptomatic patients who have isolated PCL laxity and for whom conservative management has failed.     

Multiple arthroscopic debridement and graft retention in septic knee arthritis after ACL reconstruction: a prospective case–control study

Purpose

This study was undertaken to prospectively analyse, at a mean five-year follow-up, the clinical, functional, and radiographic outcomes in patients who developed postoperative acute septic knee arthritis following anterior cruciate ligament (ACL) reconstruction using hamstring autograft. We also assessed the effect of multiple arthroscopic debridement and graft retention on the functional outcomes in comparison with the matched control group.

Methods

From a consecutive case series of 2,560 ACL-injured patients who were treated with arthroscopic ACL reconstruction, we report on 24 cases with postoperative septic knee arthritis. These patients were individually matched for age, sex, comorbidity, body mass index (BMI) and preinjury Tegner activity scale in a ratio of 1/1. Clinical, laboratory, synovial fluid analysis and culture were performed. Arthroscopic debridement and graft retention was done for all cases, in addition to antibiotic therapy IV. A detailed physical examination, KT1000 laxity testing, Lysholm knee score, Tegner activity level scale, International Knee Documentation Committee (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were completed.

Results

In all cases, treatment of infection was successful after a median of three (range one to six) repeated arthroscopic graft debridement and retention, in addition to antibiotic therapy IV. At an average of five years follow-up, two patients had over five millimetres manual maximum side-to-side difference in laxity. There were no significant differences between groups regarding Lysholm score, IKDC and KOOS. Median final Tegner activity score was 5.5 versus 7 in the control group (p = 0.004). Complications included graft rupture in three patients, loss of range of motion in five, Sudeck’s atrophy in one and moderate joint narrowing in two. There were no recurrences of septic arthritis or bone infection.

Conclusion

Graft retention seems not only possible but appropriate in view of the experience presented in this article for postoperative septic knee arthritis using hamstring autograft. A potential residual complication is arthrofibrosis, which deserves maximum attention.