Intra-arterial Ultra-low-Dose CT Angiography of Lower Extremity in Diabetic Patients

Purpose

To image lower extremity arteries by CT angiography using a very low-dose intra-arterial contrast medium in patients with high risk of developing contrast-induced nephropathy (CIN).

Materials and Methods

Three cases with long-standing diabetes mellitus and signs of lower extremity atherosclerotic disease were evaluated by CT angiography using 0.1 ml/kg of the body weight of contrast medium given via 10-cm-long 4F introducer by puncturing the CFA. Images were evaluated by an interventional radiologist and a cardiovascular surgeon. Density values of the lower extremity arteries were also calculated. Findings in two cases were compared with digital subtraction angiography images performed for percutaneous revascularization. Blood creatinine levels were followed for possible CIN.

Results

Intra-arterial CT angiography images were considered diagnostic in all patients and optimal in one patient. No patient developed CIN after intra-arterial CT angiography, while one patient developed CIN after percutaneous intervention.

Conclusion

Intra-arterial CT angiography of lower extremity might be performed in selected patients with high risk of developing CIN. Our limited experience suggests that as low as of 0.1 ml/kg of the body weight of contrast medium may result in adequate diagnostic imaging.

     

Safety of cerebral angiography and neuroendovascular therapy in patients with chronic kidney disease

Purpose

Contrast-induced nephropathy is a common clinical concern in patients undergoing neuroendovascular procedures, especially in those with pre-existent kidney disease. We aimed to define the incidence of contrast-induced nephropathy in these high-risk patients in our practice.

Methods

We analyzed data retrospectively from patients undergoing neuroendovascular procedures at two academic medical centers over a 4-year period. Contrast-induced nephropathy was determined by an absolute increase in serum creatinine of 0.5 mg/dL or a rise from its baseline value by ≥?25%, at 48–72 h after exposure to contrast agent after excluding other causes of renal impairment. High-risk patients were identified as those with pre-procedural estimated glomerular filtration rate <?60 mL/min irrespective of creatinine level, corresponding to stages 3–5 of chronic kidney disease.

Results

One hundred eighty-five high-risk patients undergoing conventional cerebral angiography and neuroendovascular interventions were identified. Only 1 out of 184 (0.54%) high-risk patients developed contrast-induced nephropathy. That one patient had stage 5 chronic kidney disease and multiple other risk factors.

Conclusion

We have observed a very low rate of renal injury in patients with chronic kidney disease, traditionally considered high risk for neuroendovascular procedures. Multiple factors may be responsible in the risk reduction of contrast-induced nephropathy in this patient population.

     

Contrast-induced nephropathy (CIN) of patients with renal dysfunction in CT examination

Purpose

To investigate the incidence and risk factors of contrast induced nephropathy (CIN) after contrast enhanced (CE) computed tomography (CT) in patients with renal dysfunction.

Materials and methods

Two hundred sixteen inpatients with estimated glomerular filtration rates (eGFR) <60 ml/min/1.73 m² underwent CE CT using iodine doses of 420 or 480 mg I/kg. Data of all enrolled patients was collected for baseline serum creatinine level (SCr), post-CE CT SCr within 3 days after CE CT, and conditions considered risk factors for CIN [renal dysfunction, contrast media dose, advanced age, diabetes mellitus, no intravenous hydration, cardiac dysfunction (left ventricular ejection fraction <60%) and intensive-care unit (ICU) admission]. CIN was defined as an increase in SCr level of more than 0.5 mg/dl or more than 25% from baseline within 3 days post-CE CT without any other identifiable cause of acute kidney injury.

Results

The incidence of CIN was 11/216 (5.1%) and was associated with cardiac dysfunction [odds ratio (OR) 6.540; 95% confidence interval (CI) 1.090–39.300; p = 0.040] and ICU admission (OR 11.500; 95% CI 2.050–64.100; p = 0.005).

Conclusion

Our results suggested that cardiac dysfunction and ICU admission may be risk factors for CIN in patients with preexisting renal dysfunction.

     

Low Contrast Dose Catheter-Directed CT Angiography (CCTA)

Purpose

Catheter-directed computed tomography angiography (CCTA) has been shown to reduce the contrast volumes required in conventional CTA, thus minimizing the risk of contrast-induced nephropathy (CIN).

Materials and Methods

A retrospective analysis was performed on cases where CCTA was used to assess access vessels prior to transfemoral aortic valve implantation (TAVI, n = 53), abdominal aortic aneurysm assessment for endovascular aneurysm repair (EVAR, n = 11), and peripheral vascular disease (PVD, n = 24).

Results

We show that CCTA can image vasculature with adequate diagnostic detail to allow assessment of lower extremity disease, anatomic suitability for EVAR, as well as potential contraindications to TAVI. Average contrast volumes for pre-TAVI, pre-EVAR, and PVD cases were 7, 11, and 28 mL, respectively.

Conclusion

This study validates the use of CCTA in obtaining diagnostic images of the abdominal and pelvic vessels and in imaging lower extremity vasculature.

     

Safe use of iodinated and gadolinium-based contrast media in current practice in Japan: a questionnaire survey

Purpose

To help establish consensus on the safe use of contrast media in Japan.

Materials and methods

Questionnaires were sent to accredited teaching hospitals with radiology residency programs.

Results

The reply rate was 45.4 % (329/724). For contrast-induced nephropathy (CIN), chronic and acute kidney diseases were considered a risk factor in 96.7 and 93.6 %, respectively, and dehydration in 73.9 %. As preventive actions, intravenous hydration (89.1 %) and reduction of iodinated contrast media dose (86.9 %) were commonly performed. For nephrogenic systemic fibrosis (NSF), chronic and acute kidney diseases were considered risk factors in 98.5 and 90.6 %, respectively, but use of unstable gadolinium-based contrast media was considered a risk factor in only 55.6 %. A renal function test was always (63.5 % in iodinated; 65.7 % in gadolinium) or almost always (23.1; 19.8 %) performed, and estimated glomerular filtration rate (eGFR) was the parameter most frequently used (80.8; 82.6 %). For the patients with risk factors for acute adverse reaction (AAR), steroid premedication or/and change of contrast medium were frequent preventive actions, but intravenous steroid administration immediately before contrast media use was still performed.

Conclusion

Our questionnaire survey revealed that preventive actions against CIN were properly performed based on patients? eGFR. Preventive actions against NSF and AAR still lacked consensus.

     

Using intravoxel incoherent motion MR imaging to study the renal pathophysiological process of contrast-induced acute kidney injury in rats: Comparison with conventional DWI and arterial spin labelling

Objectives

To investigate the potential of intravoxel incoherent motion (IVIM) to assess the renal pathophysiological process in contrast-induced acute kidney injury (CIAKI).

Methods

Twenty-seven rats were induced with CIAKI model, six rats were imaged longitudinally at 24 h prior to and 30 min, 12, 24, 48, 72 and 96 h after administration; three rats were randomly chosen from the rest for serum creatinine and histological studies. D, f, D* and ADC were calculated from IVIM, and renal blood flow (RBF) was obtained from arterial spin labelling (ASL).

Results

A progressive reduction in D and ADC was observed in cortex (CO) by 3.07 and 8.62 % at 30 min, and by 25.77 and 28.16 % at 48 h, respectively. A similar change in outer medulla (OM) and inner medulla (IM) was observed at a later time point (12–72 h). D values were strongly correlated with ADC (r?=?0.885). As perfusion measurement, a significant decrease was shown for f in 12–48 h and an increase in 72–96 h. A slightly different trend was found for D*, which was decreased by 26.02, 21.78 and 10.19 % in CO, OM and IM, respectively, at 30 min. f and D* were strongly correlated with RBF in the cortex (r?=?0.768, r?=?0.67), but not in the medulla.

Conclusions

IVIM is an effective imaging tool for monitoring progress in renal pathophysiology undergoing CIAKI.

Key Points

? IVIM analysis permits separate quantification of diffusion and perfusion. ? IVIM can provide useful biomarkers ifor changes in renal pathophysiology. ? IVIM can be useful for monitoring progress in renal pathophysiology undergoing CIAKI.

     

Low contrast media volume in pre-TAVI CT examinations

Purpose

To evaluate image quality using reduced contrast media (CM) volume in pre-TAVI assessment.

Methods

Forty-seven consecutive patients referred for pre-TAVI examination were evaluated. Patients were divided into two groups: group 1 BMI?<?28 kg/m² (n?=?29); and group 2 BMI?>?28 kg/m² (n?=?18). Patients received a combined scan protocol: retrospective ECG-gated helical CTA of the aortic root (80kVp) followed by a high-pitch spiral CTA (group 1: 70 kV; group 2: 80 kVp) from aortic arch to femoral arteries. All patients received one bolus of CM (300 mgI/ml): group 1: volume?=?40 ml; flow rate?=?3 ml/s, group 2: volume?=?53 ml; flow rate?=?4 ml/s. Attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the levels of the aortic root (helical) and peripheral arteries (high-pitch). Diagnostic image quality was considered sufficient at attenuation values > 250HU and CNR > 10.

Results

Diagnostic image quality for TAVI measurements was obtained in 46 patients. Mean attenuation values and CNR (HU?±?SD) at the aortic root (helical) were: group 1: 381?±?65HU and 13?±?8; group 2: 442?±?68HU and 10?±?5. At the peripheral arteries (high-pitch), mean values were: group 1: 430?±?117HU and 11?±?6; group 2: 389?±?102HU and 13?±?6.

Conclusion

CM volume can be substantially reduced using low kVp protocols, while maintaining sufficient image quality for the evaluation of aortic root and peripheral access sites.

Key points

? Image quality could be maintained using low kVp scan protocols. ? Low kVp protocols reduce contrast media volume by 34–67 %. ? Less contrast media volume lowers the risk of contrast-induced nephropathy.

     

Renal Angiomyolipoma: Mid- to Long-Term Results Following Embolization with Onyx

Purpose

Percutaneous transcatheter embolization is currently the preferred treatment for ruptured or enlarging renal angiomyolipoma (AML), although the optimum choice of embolic material has not yet been established. We present mid- to long-term outcomes following embolization of AMLs with Onyx.

Materials and Methods

Ten AMLs in seven patients (including two with tuberous sclerosis) were embolized with Onyx. Patients were followed-up clinically, with tumour size and renal function measured pre- and post-procedure.

Results

Mean pre-treatment AML size was 63.4 mm (range 42–100). Mean clinical follow-up was 431.4 days (range 153–986) and imaging follow-up 284.2 days (range 30–741). There was no haemorrhage from treated lesions within the follow-up period. Of patients who had cross-sectional imaging pre- and post-procedure, mean decrease in AML size of 22 mm was seen after Onyx embolization (p = 0.0058, 95 % CI 9.13–34.87). No significant difference between serum creatinine was seen pre- and post-procedure (p = 0.54, 95 % CI 8.63–4.85).

Conclusions

Onyx embolization of renal AMLs is effective in the medium to long term, with theoretical benefits in safety and durability of result.

     

Direct vasodilation by transdermal administration of nitroglycerin: preliminary,randomized, placebo-controlled trial of nitroglycerin skin spray for premedication before artery puncture

Purpose

Transdermal administration of nitroglycerin (NTG) before arterial puncture may improve puncture success. The objective of this study was to evaluate the vasodilation effect of NTG skin spray on brachial arteries.

Materials and methods

We recruited 10 healthy volunteers. On different days and in random order we sprayed their skin above the right or left brachial artery with a solution containing 0.3 mg NTG or above the right brachial artery with physiological saline. A radiologist ultrasonographically measured the cross-sectional area of right brachial artery before and at 5-min intervals for up to 25 min after spraying and calculated the rate of increase of the area.

Results

The average vasodilation rate after spraying with NTG above the right brachial arteries of 10 volunteers was 16.4% at 5 min, 23.6% at 10 min, 19.6% at 15 min, and 16.5% at 20 min; spraying with NTG above the left brachial artery or with physiological saline alone elicited few changes. The vasodilation rate 10 min after spraying with NTG above the right brachial artery was significantly higher than for control groups (P < 0.001).

Conclusions

Transdermal application of NTG spray dilated the targeted brachial artery. This technique may be a good premedication before artery puncture.

     

Indwelling Stent Embedded with Light-Emitting Diodes for Photodynamic Therapy of Malignant Biliary Obstruction

Purpose

We describe the design and preliminary characterization of a stent incorporating light-emitting diodes (LEDs) for photodynamic therapy (PDT) of malignant biliary obstruction.

Methods

A prototype was constructed with red (640 nm) LEDs embedded in a 14.5 French polyurethane tube. The device was evaluated for optical power and subjected to physical and electrical tests. PDT-induced reactive oxygen species were imaged in a gel phantom.

Results

The stent functioned at a 2.5-cm bend radius and illuminated for 6 months in saline. No stray currents were detected, and it was cool after 30 minutes of operation. Optical power of 5–15 mW is applicable to PDT. Imaging of a reactive oxygen indicator showed LED-stent activation of photosensitizer.

Conclusions

The results motivate biological testing and design optimization.

     

Long-Term Results from the MAJESTIC Trial of the Eluvia Paclitaxel-Eluting Stent for Femoropopliteal Treatment: 3-Year Follow-up

Purpose

To report the 3-year results of the MAJESTIC first-in-human study of the Eluvia Drug-Eluting Vascular Stent System for treating femoropopliteal artery lesions.

Methods

The prospective, single-arm, multicenter clinical trial enrolled 57 patients with symptomatic lower limb ischemia (Rutherford category 2, 3, or 4) and lesions in the superficial femoral artery or proximal popliteal artery. Mean lesion length was 70.8 ± 28.1 mm, and 46% of lesions were occluded. Efficacy measures at 2 years included primary patency, defined as duplex ultrasound peak systolic velocity ratio of ≤2.5 and the absence of target lesion revascularization (TLR) or bypass. Safety monitoring through 3 years included adverse events and TLR.

Results

Primary patency was estimated as 83.5% (Kaplan–Meier analysis) at 24 months, and 90.6% (48/53) of patients maintained an improvement in Rutherford class. At 36 months, the Kaplan–Meier estimate of freedom from TLR was 85.3%. No stent fractures were identified, and no major target limb amputations occurred.

Conclusion

MAJESTIC results demonstrated long-term treatment durability among patients whose femoropopliteal arteries were treated with the paclitaxel-eluting Eluvia stent.

Level of Evidence

Level 2b, cohort study

     

The effect of four-phasic versus three-phasic contrast media injection protocols on extravasation rate in coronary CT angiography: a randomized controlled trial

Objectives

Contrast media (CM) extravasation is a well-known complication of CT angiography (CTA). Our prospective randomized control study aimed to assess whether a four-phasic CM administration protocol reduces the risk of extravasation compared to the routinely used three-phasic protocol in coronary CTA.

Methods

Patients referred to coronary CTA due to suspected coronary artery disease were included in the study. All patients received 400 mg/ml iomeprol CM injected with dual-syringe automated injector. Patients were randomized into a three-phasic injection-protocol group, with a CM bolus of 85 ml followed by 40 ml of 75%:25% saline/CM mixture and 30 ml saline chaser bolus; and a four-phasic injection-protocol group, with a saline pacer bolus of 10 ml injected at a lower flow rate before the three-phasic protocol.

Results

2,445 consecutive patients were enrolled (mean age 60.6?±?12.1 years; females 43.6%). Overall rate of extravasation was 0.9% (23/2,445): 1.4% (17/1,229) in the three-phasic group and 0.5% (6/1,216) in the four-phasic group (p?=?0.034).

Conclusions

Four-phasic CM administration protocol is easy to implement in the clinical routine at no extra cost. The extravasation rate is reduced by 65% with the application of the four-phasic protocol compared to the three-phasic protocol in coronary CTA.

Key Points

? Four-phasic CM injection-protocol reduces extravasation rate by 65% compared to three-phasic. ? The saline pacer bolus substantially reduces the risk of CM extravasation. ? The implementation of four-phasic injection-protocol is at no cost.

     

Length of stay and its impact upon functional outcomes following lower limb arthroplasty

Purpose

The aim was to investigate the interplay between patient characteristics and (1) length of hospital stay and (2) one-year patient-reported outcome following total knee and hip arthroplasty.

Methods

Event (survival) analysis and structural equation modelling were performed for 1001 patients undergoing knee (n = 566) and hip (n = 435) arthroplasty in a single institution.

Results

Age, body mass index and co-morbidities were independent predictors of length of stay in both event analysis and structural equation modelling. These patient characteristics and type of arthroplasty had both small direct and indirect effects on patient-reported outcome measures at one year. Length of stay had a small effect (<2 %) in SF-36 scores at one year.

Conclusion

Predictors that influence length of stay also impact on one-year post-operative outcome and therefore should be taken into account during patient selection and discharge planning.

Level of evidence

Retrospective cohort study, Level III.

     

Motor learning strategies in basketball players and its implications for ACL injury prevention: a randomized controlled trial

Purpose

Adding external focus of attention (EF, focus on the movement effect) may optimize current anterior cruciate ligament (ACL) injury prevention programmes. The purpose of the current study was to investigate the effects of an EF, by a visual stimulus and an internal focus, by a verbal stimulus during unexpected sidestep cutting in female and male athletes and how these effects remained over time.

Methods

Ninety experienced basketball athletes performed sidestep cutting manoeuvres in three sessions (S1, S2 and S3). In this randomized controlled trial, athletes were allocated to three groups: visual (VIS), verbal (VER) and control (CTRL). Kinematics and kinetics were collected at the time of peak knee frontal plane moment.

Results

Males in the VIS group showed a larger vertical ground reaction force (S1: 25.4 ± 3.1 N/kg, S2: 25.8 ± 2.9 N/kg, S3: 25.2 ± 3.2 N/kg) and knee flexion moments (S1: ?3.8 ± 0.9 Nm/kg, S2: ?4.0 ± 1.2 Nm/kg, S3: ?3.9 ± 1.3 Nm/kg) compared to the males in the VER and CTRL groups and to the females in the VIS group (p < 0.05). Additionally, the males in the VIS group reduced knee valgus moment and the females in the VER group reduced knee varus moment over time (n.s.).

Conclusion

Male subjects clearly benefit from visual feedback. Females may need different feedback modes to learn a correct movement pattern. Sex-specific learning preferences may have to be acknowledged in day by day practice. Adding video instruction or feedback to regular training regimens when teaching athletes safe movement patterns and providing individual feedback might target suboptimal long-term results and optimize ACL injury prevention programmes.

Level of evidence

I.

     

Assessing coronal laxity in extension and flexion at a minimum of 10 years after primary total knee arthroplasty

Purpose

Favourable long-term results after total knee arthroplasty (TKA) require appropriate soft tissue balance. However, the relationships between long-term results after TKA surgery and mediolateral laxities at extension and at 90° flexion remain unknown. This study therefore quantitatively assessed ligament balance at extension and at 90° knee flexion at least 10 years after primary TKA, as well as clarifying the relationships between long-term outcomes and mediolateral laxities.

Methods

This study included 49 knees (19 CR type and 30 PS type) of 33 patients followed up for at least 10 years after TKA at our hospital. Plain radiographs were obtained with about 150 N of varus or valgus stress using a Telos arthrometer at extension. At 90° flexion, epicondylar views were obtained under a 1.5-kg load and with about 10 kg of varus or valgus stress.

Results

Lateral laxity of about 5° was observed in both extension and flexion, with total laxities of varus and valgus stress each less than 10°. Postoperative clinical outcomes were good, with significant improvements in extension angle, femorotibial angle, and KSS, and no loosening in any knee.

Conclusions

Good long-term results of TKA can be obtained with a lateral laxity of about 5°, equivalent to that of healthy knees.

Level of evidence

III.

     

The prevalence and significance of renal perfusion defects in early kidney transplants quantified using 3D contrast enhanced ultrasound (CEUS)

Objectives

Vascular complications are one of the most common causes of early kidney transplant dysfunction. Contrast enhanced ultrasound increases sensitivity to vascular changes. The aim of this study was to assess the prevalence and size of vascular abnormalities in early renal transplants using 3D CEUS and the significance of perfusion defects on renal function.

Methods

Ninety-nine renal transplant patients underwent 3D CEUS after surgery to quantify perfusion defects as percentage total renal volume (TRV). Serum creatinine and estimated glomerular filtration rate (eGFR) were recorded up to 3 months post-surgery.

Results

Twenty participants had focal perfusion defects (0.2–43%TRV). There was a meaningful difference in patients with perfusion defects in eGFR at 1 month (90% CI 2.7–19.2 mL/min/1.73 m²) and 3 months (90% CI 1.9-19.6 mL/min/1.73 m²) and creatinine at 3 months (90% CI -56 – -8 μmol/L) using a predetermined clinical threshold. Perfusion defect size correlated well with both serum creatinine and eGFR at 3 months (R?=?0.80, p?≤?0.000 and 0.58, p?=?0.038). No correlation was seen prior to 3 months.

Conclusions

Perfusion defects in kidney transplants were more common than expected and were highly likely to reduce renal function at 1-3 months, and the size of the defect affected the degree of functional change at 3 months.

Key Points

? Perfusion defects were more common than previously thought. ? Perfusion defects could be quantified using 3D CEUS. ? The presence of even small perfusion defects may affect kidney function. ? Size of perfusion defects correlated with subsequent kidney function at 3 months. ? Potentially useful in informing clinician expectations of kidney function post-surgery.

     

Femoral rotation in total knee arthroplasty: a comparison of patient individualized jigs with gap balancing in relation to anatomic landmarks

Purpose

The purpose of our study was to compare the accuracy of the rotational position of the femoral component in total knee arthroplasty aligned with patient individualized jigs (PSJ) to a gap balancing technique (GBT).

Methods

A consecutive series of 21 osteoarthritic patients were treated with 22 cruciate-retaining total knee prostheses. During surgery, the rotation of the femoral component pinholes was recorded for all knees using PSJ and GBT and transferred to computer tomograms (CT). The rotational differences between PSJ and GBT relative to the transepicondylar axis were analysed.

Results

The medium rotation of the femoral component pinholes was 1.3° ± 5.1° (min = ?6.3°; max = 14.4°) for PSJ and 0.1 ± 1.4° (min = ?1.6°; max = 3.4°) for GBT. Outliers of more than 3° were found more frequently with PSJ in 12 cases but only in one for GBT.

Conclusion

Based on our study, we would not recommend relying intra-operatively solely on the CT-based PSJ without the option to adjust or control femoral rotation.

Level of evidence

II.

     

Clinical outcome of exercise therapy and early post-operative rehabilitation for treatment of neglected Achilles tendon rupture: a randomized study

Purpose

Treatment of neglected Achilles tendon rupture is very challenging. This randomized study aimed to compare the clinical outcome of early post-operative rehabilitation (EPR) with post-operative cast immobilization (PCI).

Methods

Fifty-seven patients with neglected Achilles tendon rupture were randomized to receive EPR (n = 26) or PCI (n = 31) management following surgery. Clinical outcome was monitored by follow-up at weeks 8, 12, 18 and 26 and year 2. The significance of intergroup differences from the Leppilahti scoring system (LSS), ultrasonography, multislice spiral computerized tomography (MSCT) and electromyography was assessed.

Results

Ultrasonography and MSCT revealed no occurrence of tendon elongation or adhesion. Four patients could perform sustained single-leg heel-raise exercise for 60 s at post-operative day 40. The PCI group also showed increased post-operative LSS score, but recovery was slower. Post-operative complications, such as ankle joint ankylosis and osteoporosis, only occurred in the PCI group.

Conclusions

Compared with cast immobilization, early post-operative rehabilitation results in better clinical outcome and faster overall tendon regeneration of neglected Achilles tendon rupture.

Level of evidence

II.

     

Metabolism of the new synthetic cannabinoid EG-018 in human hepatocytes by high-resolution mass spectrometry

Purpose

The present study aims to recommend appropriate urinary marker metabolites for documenting EG-018 consumption by investigating its metabolism in human hepatocytes.

Methods

For metabolite profiling, 10 µM EG-018 was incubated in human hepatocytes for 3 h. Metabolite identification in hepatocyte samples was accomplished with high-resolution mass spectrometry via information-dependent data acquisition.

Results

EG-018 was highly metabolized in human hepatocytes. A total of eight metabolites were characterized, mainly generated from hydroxylation and carbonylation on the pentyl chain. Dihydrodiol formation, N-dealkylation, and glucuronidation of hydroxylated metabolites were the other major pathways.

Conclusions

The primary metabolites of EG-018 in human hepatocyte incubation were pentyl hydroxylated EG-018 (M6) and pentyl carbonylated EG-018 (M8). These two metabolites are proposed as the best urinary markers for confirming EG-018 intake.

     

Better 4-year outcomes for anterior cruciate ligament reconstruction with double-layer versus single-layer bone-patellar tendon-bone allografts

Purpose

To evaluate the results of anterior cruciate ligament reconstruction using a double-layer bone-patellar tendon-bone (DBPTB) graft.

Methods

Between 2010 and 2011, 98 patients underwent anterior cruciate ligament reconstruction with an allograft. Forty-seven of these patients received a DBPTB allograft and 51 received a traditional monolayer BPTB graft. Outcomes were evaluated at the end of a minimum 4-year follow-up in both groups using KT 1000 arthrometer measurements, Lachman and pivot-shift tests, the International Knee Documentation Committee form, and Lysholm scores.

Results

One patient (1/47, 2 %) in the DBPTB allograft group and six patients (6/51, 12 %) in the traditional monolayer BPTB graft were lost during follow-up because of graft rupture (n.s.). The mean side-to-side differences in the DBPTB and monolayer BPTB graft groups 4 years post-operatively were significantly different at 1.4 ± 1.3 and 1.7 ± 1.6 mm, respectively (p < 0.05). The DBPTB group performed significantly better than the BPTB group on the Lachman test, International Knee Documentation Committee knee score, and Lysholm scores (p < 0.05).

Conclusions

The DBPTB allograft group achieved better outcomes than the traditional BPTB allograft group regarding success rate, anterior stability, and knee function.

Level of evidence

Level II.