Small Size Autograft versus Large Size Allograft in Anterior Cruciate Ligament Reconstruction

BackgroundA small autograft diameter negatively affects functional outcomes, knee stability, and the risk of rerupture after anterior cruciate ligament (ACL) reconstruction, whereas the strength of allograft decreases over time. Therefore, it is not clear whether the use of smaller autografts or the use of larger allografts in ACL yields better results. The aim of this study was to compare the outcome of smaller autografts and larger allografts for ACL reconstruction.MethodsFifty-one patients who underwent ACL reconstruction with hamstring tendon autografts (size ≤ 8 mm) and 21 patients who underwent ACL reconstruction with allografts (size ≥ 10 mm) were included in our study. All patients underwent the same aggressive early postoperative rehabilitation program. There were no significant differences between the autograft and allograft groups regarding the preoperative patient age, sex, time from injury to surgery, and average follow-up time.ResultsThe mean diameter of the 4-stranded hamstring tendon grafts used as autografts was 7.48 ± 0.33 mm and the mean diameter of the allografts was 10.76 ± 0.67 mm. According to specific tests for the ACL (anterior drawer, Lachman, and pivot shift) and clinical evaluation tests (Lysholm knee scoring scale and International Knee Documentation Committee questionnaire), the final follow-up results were significantly better than the preoperative status in both autograft and allograft ACL reconstruction groups. Therefore, there were no significant differences between the autograft and allograft groups preoperatively and at the final follow-up.ConclusionsThe large size of the graft in ACL reconstruction has been reported to affect results positively. However, in our study, we could not find any significant differences between the smaller size autografts and larger size allografts in terms of inadequacy, rerupture, and final follow-up functional results. Although allografts were significantly larger than autografts, we did not have the positive effect of larger size grafts. Smaller size autografts were as effective as the larger size allografts.     

Allograft versus autograft for anterior cruciate ligament reconstruction: an up-to-date meta-analysis of prospective studies

Purpose

Although a large number of anterior cruciate ligament (ACL) reconstructions are performed annually, there remains a considerable amount of controversy over whether an autograft or an allograft should be used. The aim of this meta-analysis was to compare the clinical outcomes of allograft and autograft in primary ACL reconstruction.

Methods

The authors systematically searched electronic databases to identify prospective studies which compared allografts with autografts for primary ACL reconstruction. The results of the eligible studies were analysed in terms of instrumented laxity measurements, Lachman test, Pivot Shift test, objective International Knee Documentation Committee (IKDC) Scores, Lysholm Scores, Tegner Scores, and clinical failures. Study quality was assessed and relevant data were extracted independently by two reviewers. A random effect model was used to pool the data. Statistical heterogeneity between trials was evaluated by the chi-square and I-square tests.

Results

Nine studies, with 410 patients in the autograft and 408 patients in the allograft group, met the inclusion criteria. Five studies compared bone-patellar tendon-bone (BPTB) grafts, and four compared soft-tissue grafts. Four studies were randomized controlled trials, and five were prospective cohort studies. The results of the meta-analysis showed that there were no significant differences between allograft and autograft on all the outcomes in terms of instrumented laxity measurements (P = 0.59), Lachman test (P = 0.41), Pivot Shift test (P = 0.88), objective IKDC Scores (P = 0.87), Lysholm Scores (P = 0.79), Tegner Scores (P = 0.06), and clinical failures (P = 0.68). These findings were still robust during the sensitivity analysis. However, a subgroup analysis of Tegner scores by involving only BPTB grafts showed a statistical difference in favour of autografts (P = 0.005).

Conclusions

There was insufficient evidence to identify which of the two types of grafts was significantly better for ACL reconstruction, though the subgroup analysis indicated that reconstruction with BPTB autograft might allow patients to return to higher levels of activity in comparison with BPTB allograft. More high-quality randomized controlled trials with specified age and activity level are highly required before drawing a reliable conclusion.     

Changes in patellar height after anatomical ACL reconstruction with BTB autograft with a focus on patellar tendon removal volume

BackgroundAlthough anatomical anterior cruciate ligament reconstruction (ACLR) can provide satisfactory outcomes, little is known about how this procedure impacts patellar height. Since harvesting bone-patellar tendon-bone (BTB) autografts is a potential risk factor for decreased patellar height, we examined changes in patellar height after anatomical ACLR with BTB autograft with a focus on the size of the harvested graft.MethodsSubjects were 84 patients (49 males, 35 females; mean age, 23 years) who underwent primary anatomical ACLR with central third BTB autograft. Preoperative to postoperative Caton-Deschamps index (CDI) ratio was calculated using lateral knee radiographs before and 6 months after surgery. The length and cross-sectional area (CSA) of the graft were measured intraoperatively, and the CSA of the contralateral patellar tendon was measured by ultrasound 6 months postoperatively. The difference in graft CSA relative to the contralateral tendon CSA, expressed as a percentage (gCSA:ctCSA percentage), was also calculated.ResultsPatellar height decreased slightly after surgery (preoperative CDI: 0.856 ± 0.113; postoperative CDI: 0.841 ± 0.113), with a mean difference between preoperative and postoperative CDIs of −0.015 (range: −0.293 to 0.101). Although the CDI of male subjects significantly decreased after surgery (preoperative: 0.852 ± 0.117; postoperative: 0.827 ± 0.115), no significant changes were noted in female subjects (preoperative: 0.862 ± 0.108; postoperative: 0.861 ± 0.108). Graft length and CSA did not significantly impact the CDI ratio (r = −0.138 and r = −0.038, respectively). Moreover, no significant relationship was observed between the gCSA:ctCSA percentage and CDI ratio (r = 0.118).ConclusionsAlthough patellar height slightly, but significantly, decreased at 6 months after anatomical ACLR with BTB autograft, it was not affected by the length and CSA of harvested grafts. The decrease in postoperative patellar height was observed only in male subjects, suggesting the potential importance of sex differences in soft tissue healing during the postoperative period.     

自体腘绳肌腱和同种异体半腱肌腱双束重建前十字韧带的比较研究

目的 对比自体腘绳肌腱和同种异体半腱肌腱双束重建前十字韧带的初期临床疗效.方法 2006年2月至8月,对单纯前十字韧带完全断裂患者分别采用自体腘绳肌腱(简称自体组,38例)和同种异体半腱肌腱(简称异体组,23例)行前十字韧带双束重建手术.客观指标包括:双侧膝关节前向松弛度差异、Lachman试验、轴移试验和双下肢周径差别;应用Tegner评分表、Lysholm评分表和IKDC评分表进行膝关节功能的主观评估.结果 自体组平均随访27个月,异体组平均随访26个月.末次随访时Lachman试验:自体组35例阴性,3例Ⅰ度阳性;异体组20例阴性,2例Ⅰ度阳性,1例Ⅲ度阳性.两组各有1例轴移试验阳性.双侧膝关节前向松弛度差异:自体组34例差异范围0～2 mm,4例3～5mm;异体组20例0～2mm,2例3～5 mm,1例>10 mm.双下肢周径差别:自体组(0.62±0.43)cm,异体组(0.57±0.42)cm.Tegner评分:自体组(6.21±0.84)分,异体组为(6.17±1.15)分.Lysholm评分:自体组(95.00±4.40)分.异体组(94.57±8.83)分.IKDC评分:自体组(90.26±2.92)分,异体组(89.48±7.27)分.结论 应用自体腘绳肌腱和同种异体半腱肌腱双束重建前十字韧带均能取得优良的初期临床结果.     

Ankle Arthrodesis Fusion Rates for Mesenchymal Stem Cell Bone Allograft Versus Proximal Tibia Autograft

Ankle arthrodesis is commonly used in the treatment of ankle arthritis. The present study compared mesenchymal stem cell (MSC) bone allografts and proximal tibia autografts as adjuncts in performing ankle arthrodesis. A total of 109 consecutive ankle fusions performed from 2002 to 2008 were evaluated retrospectively. Of the 109 fusions, 24 were excluded from the present study, leaving 85 patients who had undergone ankle arthrodesis. Of the 85 patients, 41 had received a proximal tibia autograft and 44, an MSC bone allograft. These 2 groups were reviewed and compared retrospectively at least 2 years postoperatively for the overall fusion rate, interval to radiographic fusion, and interval to clinical fusion. A modified and adjusted American College of Foot and Ankle Surgeons ankle scale was used to measure patient satisfaction. The overall fusion rate was 84.1% in the MSC bone allograft group and 95.1% in the proximal tibia autograft group (p = .158). The corresponding mean intervals to radiographic fusion were 13.0 ± 2.5 weeks and 11.3 ± 2.8 weeks (p ≤ .001). The interval to clinical fusion was 13.1 ± 2.1 weeks and 11.0 ± 1.5 weeks (p ≤ .001) in the MSC bone allograft and proximal tibia autograft group, respectively. No statistically significant difference was found in the fusion rates between the MSC bone allograft and proximal tibia autograft groups. Also, no statistically significant difference was found between the preoperative and postoperative scores using a modified and adjusted American College of Foot and Ankle Surgeons ankle scale between the 2 groups (p = .41 and p = .44, respectively). A statistically significant delay to radiographic and clinical fusion was present in the MSC bone allograft group compared with the proximal tibia autograft group; however, no difference was found in patient satisfaction.     

Anterior cruciate ligament reconstruction: Allograft versus autograft

Purpose: This study was performed to compare the minimal 2-year outcome of anterior cruciate ligament (ACL) reconstruction using bone–patellar tendon–bone (BPTB) allografts versus autografts, both augmented with an iliotibial band tenodesis. Type of Study: Retrospective review. Methods: Forty-six of 52 BPTB ACL reconstructions using allografts and 33 of 37 BPTB ACL reconstructions using autografts were followed up at a mean of 2.75 and 3.36 years, respectively. All patients had an iliotibial band tenodesis. Evaluations included the Lysholm II scale, a questionnaire, physical examination findings, and KT-1000 arthrometry. Results: No statistically significant differences were seen between groups in Lysholm II scores or in any subjective category. Most patients (91% allograft; 97% autograft) had good to excellent Lysholm II scores. Sixty-five percent of allograft patients and 73% of autograft patients returned to their preinjury activity level. More allograft patients complained of retropatellar pain (16% v 9% for autograft patients). Fifty-three percent of allograft patients versus 23% of autograft patients had a flexion deficit of 5° or more when compared with the normal contralateral side. When comparing KT-1000 side-to-side differences, we found no significant differences between groups. Ninety-one percent of both groups had maximum side-to-side differences less than 5 mm. Three allograft patients (6.5%) had traumatic ruptures at 12, 19, and 43 months postoperatively versus none in the autograft group. All three allograft patients who sustained postoperative traumatic ruptures had received fresh frozen, nonirradiated allografts. Conclusions: Results of ACL reconstruction using allografts or autografts augmented with an iliotibial band tenodesis were comparable. The BPTB autograft should remain the gold standard, although the BPTB allograft in ACL reconstruction is a reasonable alternative.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 5 (May-June), 2003: pp 453–462     

Accelerated Versus Non-accelerated Rehabilitation After Primary Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts: A Systematic Review and Meta-analysis of Comparative Studies

PurposeThis study aimed to compare the clinical outcomes between accelerated rehabilitation (AR) and non-accelerated rehabilitation (NR) after anterior cruciate ligament reconstruction (ACLR) using hamstring autografts through a systematic review and meta-analysis.MethodsTo compare the outcomes between AR and NR, we searched Medline, Embase, and the Cochrane Library. Studies comparing their clinical outcomes after ACLR using hamstring autografts were included. AR was characterized by the starting range of motion and weight-bearing within 3 days and return to sports within 6–9 months. A meta-analysis of clinical outcome parameters used in ≥ 3 studies was conducted.ResultsSeven studies were included. The International Knee Documentation Committee subjective score was significantly higher in AR than in NR at the 3- (mean difference [MD], 7.30; 95% confidence interval [CI] 1.55–13.05; P = 0.013) and 6-month follow-ups (MD, 5.64; 95% CI 0.11–11.17; P = 0.046). The side-to-side difference in anterior tibial translation at the final follow-up assessed in four studies was significantly lower in NR than in AR (MD, 0.59; 95% CI 0.12–1.07; P = 0.015). Overall Tunnel widening at the final follow-up assessed in four studies was also smaller in NR than in AR (MD, 0.48; 95% CI 0.00–0.96; P = 0.0479). However, the mean side-to-side difference and overall tunnel widening between them was < 1 mm.ConclusionThe early subjective clinical outcomes of AR after ACLR using hamstring autografts were superior to those of NR. Although tunnel widening and anterior instability were also significantly larger in AR than in NR, the difference was not clinically relevant.     

Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: A 5-year follow-up

Purpose: To compare the long-term results of allograft versus autograft central one-third bone–patellar tendon–bone reconstruction of the anterior cruciate ligament (ACL), 2 groups of 30 patients were evaluated subjectively and objectively at an average follow-up of 63 months (range, 55 to 78 months). Type of Study: A prospective nonrandomized study. Methods: All surgeries were performed endoscopically by a single surgeon using metal interference screw fixation between May 1991 and November 1992. Early aggressive rehabilitation was employed and follow-up visits at 3, 6, 12, 24, and 60 months noted swelling, pain, range of motion, and patellofemoral crepitus, and Lachman test, pivot shift test, and side-to-side arthrometer differences. Results: Results were analyzed using 2-sample t test and χ-square analysis. Average age at surgery for autografts was 25 years (range, 14 to 49) and for allografts was 28 years (range, 14 to 53). The presence of meniscal tears were similar (allografts, 23 tears; autografts, 19 tears). At follow-up, no statistically significant difference was found for the presence of pain, giving way, effusion, Lachman and pivot shift results, or arthrometer measurements. Two patients, 1 allograft and 1 autograft had complete rupture of their grafts. There was no late stretching out of either graft and patients stable at 2 years were stable at 5 years, with the exception of the 1 ruptured graft in each group. Conclusions: A trend toward a greater incidence of glide on pivot testing was seen in the allografts (4 allografts v 2 autografts) but was present at 2 years and did not change at 5 years. A trend toward greater loss of extension in autografts (2.47°) than allografts (1.07°) was seen at 5-year follow-up, not seen at 2 years.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 9–13     

The lateral meniscal extrusion after repair with concomitant anterior cruciate ligament reconstruction at a mean follow-up of 3.5 years

BackgroundA meniscal repair is often performed on radial/flap or longitudinal tears of the lateral meniscus (LM) combined with anterior cruciate ligament reconstruction (ACLR). However, it is unknown if meniscal extrusion changes over time after repair. This study evaluated whether meniscal extrusion of the LM is maintained after repair or progresses with time using magnetic resonance imaging (MRI).MethodsAmong 574 patients who underwent primary anatomic ACLR, 123 patients followed up for more than 2 years were retrospectively analyzed. Forty patients with concomitant radial/flap tears of the LM (group R), 43 with longitudinal LM tears (group L), and 40 with intact LM (group C, matched-control group) were included. Clinical findings (pain, range of motion, swelling, and anterior laxity), lateral joint space on radiograph, and meniscal extrusion on MRI were assessed. Lateral/posterior meniscal extrusions were examined preoperatively, within 3 weeks after surgery, and at the final follow-up, and the absolute values and relative values (the preoperative values as baseline) were assessed respectively.ResultsThere were no significant differences in the clinical and roentgenographic findings among the groups. No difference was observed in the relative values within 3 weeks after surgery among three groups, although the absolute values were larger in the repaired groups than in group C. At the final follow-up, however, the lateral extrusion in group L had progressed significantly, compared with that in group C (P = 0.033), while no significant difference was detected in the lateral extrusion between groups R and C (P = 0.177). The posterior extrusion in groups R and L had progressed significantly compared with that in group C (P < 0.001).ConclusionsLM extrusion could not be improved even immediately after meniscal repair, and it progressed laterally and posteriorly for more than 2 years after surgery.     

Revision of anterior cruciate ligament reconstruction with patellar tendon allograft and autograft: 2- and 5-year results

Introduction

The most common failure reasons of an anterior cruciate ligament (ACL) graft are incorrect positioning of the drill channels and insufficient fixation. In many cases, one-stage revision with patellar tendon graft and the appropriate corrections are possible. For previous use of the ipsilateral patellar tendon third, an allograft seems favorable for reconstruction. So far, no study compared the results of revision surgery of autologous versus allogenous patellar tendon grafts for revision surgery of the ACL in a 5-year follow-up.

Materials and methods

A retrospective study was conducted to analyze the clinical outcome and stability results 2?years (19.2?±?5.8?months) and 5?years (68.8?±?6.8?months) after revision of ACL reconstruction using middle-third patellar tendon allografts and autografts. The allografts were cleansed by mechanical means only. There were 15 patients in the allograft group and 14 in the autograft group. Patients with isolated re-rupture of the ACL graft were included in the study. Clinical results were evaluated by International Knee Documentation Committee 2000 forms (IKDC), Lysholm score, Tegner activity score, and visual analog scale. Stability was evaluated by means of KT-1000 arthrometer, Lachman test, and pivot-shift test. Location of drill holes was evaluated radiologically. Gonarthritis was graded according to Kellgren and Lawrence on the basis of radiographs.

Results

There were no significant differences between the two groups in anterior translation, manual examination for stability, IKDC 2000 findings, Tegner activity score, or Lysholm score. Extension deficits were more frequent in the autograft group at the first follow-up (P?=?0.010). Lateral gonarthritis and femoral tunnel widening were more common in the allograft group at the second follow-up (P?=?0.049 and P?=?0.023, respectively). Pain on walking downhill was significantly more frequent in the allograft group at the second follow-up (P?=?0.027).

Conclusions

The functional results with allografts that had not undergone irradiation or chemical sterilization were comparable to those with autografts in ACL revision surgery. Allografts represent a good alternative to autogenous patellar tendons in revision surgery.     

Effects of a New Allograft Processing Procedure on Graft Healing in a Canine Model: A Preliminary Study

Graft healing in vivo can be affected by allograft processing. We asked whether a new processing technique influenced graft-host healing compared with autograft and a standard processing technique in a canine ulna model. We used bilateral intercalary allografts or autografts in the ulna of 13 skeletally mature male coonhounds. Each animal received two allografts, either one autograft and one allograft, or two autografts. At term (90 days), the graft sites were harvested. We assessed union with high-resolution xray imaging. Each specimen was processed for nondecalcified histologic analysis to assess the graft-host interface. Quantitative histomorphometric analysis was performed to determine spatial location and area of bone. Radiographic analysis, histologic analysis, and histomorphometric measures revealed no differences in union, mean total bone area, or total endosteal/intramedullary bone for the new process, standard process, and autografts. Our preliminary data suggest the new processing techniques may increase the safety of allograft transplantation without adversely affecting union when compared with standard processing techniques and autograft in a canine model.     

股四头肌与骨-髌腱-骨自体移植对前交叉韧带重建的Meta分析

目的:通过Meta分析比较股四头肌与骨-髌腱-骨自体移植对前交叉韧带重建手术疗效的影响。方法:计算机检索建库至2019年5月PubMed、EMbase、Cochrane图书馆、万方数据库和中国知网发表的比较股四头肌、骨-髌腱-骨自体移植物的病例对照研究文献,根据纳入与排除标准进行文献筛选、质量评价及数据提取,采用Review Manager 5.3统计学软件对患膝与健膝前向移位差值、Lachman试验、轴移试验、Lysholm评分、IKDC (International Knee Documentation Committee)客观等级、膝前疼痛和移植失败率进行Meta分析。结果:共纳入6篇文献,915例患者,其中股四头肌自体移植495例,骨-髌腱-骨自体移植420例。Meta分析结果显示:股四头肌自体移植与骨-髌腱-骨自体移植在胫骨向前移位差值>3 mm[OR=1.53,95%CI(0.68,3.44),P=0.31],3～5 mm[OR=0.64,95%CI(0.31,1.35),P=0.24],>5 mm[OR=1.18,95%CI(0.33,4.22),P=0.80...     

Complications of Superior Capsule Reconstruction for the Treatment of Functionally Irreparable Rotator Cuff Tears: A Systematic Review

PurposeThe purpose of this systematic review is to characterize the complications associated with superior capsule reconstruction (SCR) for the treatment of functionally irreparable rotator cuff tears (FIRCTs).MethodsThis systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two independent reviewers completed a search of PubMed, Embase, and Medline databases. Studies were deemed eligible for inclusion if they reported postoperative outcomes of arthroscopic SCR for FIRCTs and considered at least 1 postoperative complication. Statistical heterogeneity was quantified via the I² statistic. Due to marked heterogeneity, pooled proportions were not reported. All complications and patient-reported outcomes were described qualitatively.ResultsFourteen studies met the inclusion/exclusion criteria. The overall complication rate post-SCR ranged from 5.0% to 70.0% (I² = 84.9%). Image-verified graft retear ranged from 8% to 70%, I² = 79.4%), with higher rates reported when SCR was performed using allograft (19%-70%, I² 76.6%) compared to autograft (8%-29%, I² = 66.1%). Reoperation (0%-36%, I² = 73.4%), revision surgeries (0%-21%, I² = 81.2%), medical complications (0%-5%, I² = 0.0%), and infections (0%-5%, I² = 0.0%) were also calculated.ConclusionsSCR carries a distinct complication profile when used for the treatment of FIRCTs. The overall rate of complications ranged from 5.0% to 70.0%. The most common complication is graft retear with higher ranges in allografts (19%-70%) compared to autografts (8%-29%). The majority of studies reported at least 1 reoperation (range, 0%-36%), most commonly for revision to reverse shoulder arthroplasty.Level of EvidenceLevel IV, systematic review of Level IV or better investigations.     

Replacement of the anterior cruciate ligament. A comparison of autografts and allografts in dogs

To compare the efficacy of allograft versus autograft replacement of the anterior cruciate ligament, 15 dogs had the ligament cut and replaced 1 month later: 11 dogs received a frozen bone-ligament-bone allograft cruciate ligament, while 4 dogs received a standard autogenous replacement with iliotibial band. Three of 11 allograft dogs developed postoperative infections and were removed from the study; and two of the remaining eight allograft ligaments were absent at autopsy. All the autograft ligaments were present. From serial clinical and radiographic examinations, there were no differences observed in the two groups. Autopsy studies at 4 months, however, showed an increased inflammatory, pannus-like reaction about the origins and insertions of the six allograft ligaments as compared with the four autografts. The ligament hydroxyproline uptake was lower in the allograft group, averaging 60 percent of the contralateral unoperated on control versus equal to the control in the autograft group. The tensile strength of the allografts reached only 17 percent of the control value versus 41 percent for the autografts. Lymphocytotoxicity testing at 1 month revealed a donor-specific antibody response in 4 of 8 allograft dogs; however, no histologic evidence of immune response was observed in the ligaments. The synovial fluid leukocyte count was elevated in the allograft group at 4 months. The increased synovial leukocyte counts and joint cartilage erosion, the decreased strength and metabolic activity of the grafts, and the evidence of an immune response in the allograft dogs do not support implantation of cadaver cruciate ligaments clinically at this time.     

Replacement of the anterior cruciate ligament with a bone-ligament-bone anterior cruciate ligament allograft in dogs

Acute replacement of the canine anterior cruciate ligament (ACL) with a frozen, bone-ligament-bone anterior cruciate ligament preparation was studied using biochemical, immunologic, and biomechanical testing methods. Nine dogs were used for the study, six dogs received allografts and three received autografts. No tissue antigen matching was performed. All nine dogs were killed nine months after surgery. Necropsy examination revealed that the ACL was not present in three joints (one autograft, two allografts). The two autograft and four allograft ligaments available for mechanical testing sustained mean maximum loads that were 10% and 14%, respectively, of the mean maximum loads sustained by the contralateral ACL. Autoradiography indicated that cellular activity was more pronounced in the autograft specimens. Hydroxyproline uptake was 200% and 45% of normal in the autograft and allograft ligaments, respectively. Both autograft and allograft specimens were producing Type I collagen at the time of killing. Antidonor dog leukocyte antigen (DLA) antibody was detected in the synovial fluid taken at the time of killing from six of six dogs that received allografts and in zero of three dogs that received autografts.     

A Prophylactic Tibial Stem Reduces Rates of Early Aseptic Loosening in Patients with Severe Preoperative Varus Deformity in Primary Total Knee Arthroplasty

BackgroundPatients with a preoperative varus deformity >8 degrees are at increased risk of aseptic loosening after total knee arthroplasty. This study analyzes the effect of a tibial stem on the rate of aseptic loosening in patients with a severe preoperative varus deformity.MethodsPatients with a preoperative varus deformity of >8 degrees and 2-year minimum follow-up with a stemmed tibial component (n = 67) were matched 1:2 to patients with a similar preoperative varus deformity with a standard tibial component (n = 134). Radiolucent lines were measured on the tibia at 6 weeks, 1 year, and 2 years postoperatively using the Knee Society Radiographic Evaluation System. Failure was defined as revision due to aseptic loosening of the tibial component. Outcomes were evaluated using Student’s t-tests and log-rank tests.ResultsPatients with tibial stems had greater preoperative deformity (12.9 vs 11.3 degrees, P = .004). There was no difference in postoperative alignment (1.7 vs 2.1 degrees varus, P = .25) or tibial component angle (1.8 vs 2.1 degrees varus, P = .33). Patients with stems were more likely to have more constraint (44.8% vs 1.5%, P < .001). Progression of radiolucent lines >2 mm was observed in 17.6% (23/134) vs 5.97% (4/67) of patients in the stem group (P = .03). Rates of aseptic loosening were lower in the stem group (0% vs 5.15%, P = .05).ConclusionDespite worse preoperative deformity and higher utilization of constraint, tibial stem use in patients with severe preoperative varus deformity resulted in lower rates of aseptic loosening. Prophylactic use of stems in these patients may help increase implant survival.     

关节镜下同种异体胫前肌腱与自体腘绳肌腱重建前交叉韧带远期效果的比较

目的:对比同种异体胫前肌腱(tibialis anterior allograft,TAA)与自体腘绳肌腱(hamstring tendon autograft,HTA)重建前交叉韧带(anterior cruciate ligament,ACL)的10年随访临床疗效.方法:回顾分析2007年3月至2010年3月单束重...