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1.
Sung-Jae Kim Chong Hyuk Choi Sung-Hwan Kim Su-Keon Lee Wonyong Lee Taeyup Kim Min Jung 《Knee surgery, sports traumatology, arthroscopy》2018,26(9):2568-2579
Purpose
The present study aimed to compare 2- and 5-year outcomes of ACL reconstruction between patients with and without generalized joint laxity and to perform comparative evaluation between two types of grafts used for ACL reconstruction in patients with generalized joint laxity.Methods
Two hundred and thirty-seven patients who underwent ACL reconstruction from 2001 to 2008 were included. Patients were classified into two groups according to the presence or the absence of generalized joint laxity, and further subdivided into two subgroups based on the type of graft used: bone–patellar tendon–bone (BPTB) or hamstring. Generalized joint laxity was assessed with the Beighton and Horan criteria using a point scoring system. Stability reflected by the Lachman test, pivot-shift test, and anterior translation measured with KT-2000, and functional outcomes reflected by Lysholm knee score, and International Knee Documentation Committee (IKDC) subjective score were investigated. IKDC objective grade and radiographic grade were also assessed. Clinical assessments were conducted preoperatively and at 2 and 5 years after operation.Results
Two-year follow-up results showed that patients with generalized joint laxity receiving hamstring grafts had poorer outcomes than those without generalized joint laxity. Five-year follow-up results showed that patients with generalized joint laxity experienced poorer outcomes than patients without generalized joint laxity, irrespective of the type of graft. Comparison of grafts used showed that, in patients with generalized joint laxity, BPTB graft provided significantly better stability and functional outcomes than hamstring graft at both 2- and 5-year follow-ups. Comparisons between serial outcomes measured at 2 and 5 years demonstrated that stability and functional outcomes deteriorated over time in patients with generalized joint laxity.Conclusions
Less satisfactory stability and functional outcomes were noted in patients with generalized joint laxity, compared to patients without generalized joint laxity. Comparisons of stability and functional outcomes after ACL reconstruction in patients with generalized joint laxity between two different grafts demonstrated that BPTB graft achieves better results than hamstring graft.Level of evidence
III, a retrospective cohort study.2.
Emily Meike S. M. Howell M. L. Hull 《Knee surgery, sports traumatology, arthroscopy》2017,25(5):1500-1509
Purpose
After reconstructing a torn ACL with a soft tissue allograft, the long-term healing process of graft maturation following the short-term healing process of graft incorporation into the bone tunnels might lead to recurring instability and concomitant decreases in the activity level, function, and patient satisfaction. Relying on roentgen stereophotogrammetric analysis (RSA), the primary purpose was to determine whether anterior laxity increased and whether patient-reported outcomes declined between 1 and 7 years for a particular graft construct, surgical technique, and rehabilitation programme.Methods
Eighteen of 19 patients, who participated in an earlier RSA study which extended to 1 year after the surgical procedure, were contacted 7 years after the surgical procedure. An examiner, different from the treating surgeon, measured anterior laxity under 150 N of anterior force using RSA in 16 patients and obtained outcome scores in 17 patients. One patient moved abroad and could not be contacted. One patient reinjured his reconstructed ACL and was excluded.Results
The average increase in anterior laxity of 1.5 ± 2.1 mm between 1 and 7 years after surgery was not significant (p = 0.08), and the average increase in anterior laxity of 2.7 ± 2.3 mm between the day of surgery and 7 years was significant (p < 0.001). There were no significant declines in activity (median Tegner score, 6 at 1 year, 6 at 7 years), function (average Lysholm score, 94 at 1 year, 91 at 7 years), and subjective satisfaction (average International Knee Documentation Committee score, 90 at 1 year, 87 at 7 years) between 1 and 7 years after surgery.Conclusion
In demonstrating that the ACL graft construct remains functional in the long term, this study supports the use of a fresh-frozen tibialis allograft in patients with an average age of 37 years at the time of surgery when used in conjunction with a surgical technique which avoids roof and PCL impingement, uses slippage-resistant fixation devices, and allows brace-free, self-paced rehabilitation.Level of evidence
IV.3.
4.
An Liu Miao Sun Chiyuan Ma Yunlin Chen Xinghe Xue Peng Guo Zhongli Shi Shigui Yan 《Knee surgery, sports traumatology, arthroscopy》2017,25(9):2751-2759
Purpose
The clinical outcomes of transtibial (TT) and anteromedial (AM) drilling techniques for anterior cruciate ligament reconstruction in preparing the femoral tunnel were directly compared by using a systematic literature review.Methods
PubMed, EMBASE, the Cochrane Library, and the ISI Web of Science were searched until 10 May 2014, using the following Boolean operators: transtibial AND (anteromedial OR transportal OR independent OR three portal OR accessory portal) AND anterior cruciate ligament. All prospective and retrospective controlled trials directly comparing physical examination and scoring system results between TT and AM techniques were retrieved. No language or publication year limitations were used in our analysis.Results
Of 504 studies retrieved, nine studies involving 769 patients were included. Results suggested that the AM was superior to the TT technique for preparing the femoral tunnel independent of the International Knee Documentation Committee (IKDC) Score (n.s.). A higher proportion of negative Lachman (p = 0.002) and pivot-shift test (p = 0.01) results, lower manual maximum displacement by KT-1000 (p = 0.004), higher Lysholm scores (p = 0.034), a higher incidence of IKDC grade A/B (p = 0.04), and higher visual analogue scale scores (p = 0.00) were observed with the AM compared with the TT technique.Conclusion
Although the increases in these scores were below the minimal clinically important difference, this systematic review indicated that the AM was superior to the TT drilling technique based on physical examination and scoring system results.Level of evidence
Therapeutic study (systematic review), Level III.5.
Nishith Shah Reetadyuti Mukhopadhyay Rohan Vakta Jaymin Bhatt 《Knee surgery, sports traumatology, arthroscopy》2016,24(3):768-772
Purpose
Posterior cruciate ligament (PCL) reconstruction is a challenge in the pre-pubescent and paediatric age group. It requires great skill in tunnel and graft placement and fixation through open physes. Another major concern is the source of graft, as the thickness of harvested hamstring graft is unpredictable in children and the bone patella tendon bone graft cannot be used due to un-ossified patella and tibial tuberosity. Quadriceps being an important agonist of PCL, we decided not to use it as a graft source.Methods
PCL reconstruction was done in three pre-pubescent children aged 3.5, 7 and 10 years using maternal allograft with follow-up of 7, 9 and 7 years (the 10-year-old boy was lost to follow-up after 2013), respectively.Results
All the patients showed excellent results with the median IKDC Pedi improving to 90 (85–92) at latest follow-up as against 29.9 (25–35) pre-operatively. The median Lysholm score improved from 45 (42–47) to 100 (95–100). The posterior drawer test showed no PCL laxity during the latest follow-up. The grafts were accepted well by all three with no evidence of graft rejection or tissue reaction.Conclusion
Living donor allografts may be a good option for paediatric ligament reconstruction. This, however, must be supported with more evidence from a larger study group and a longer follow-up until the closure of physes.Level of evidence
IV.6.
Jae-Ang Sim Jong-Min Kim SahngHoon Lee Eun-Kyoo Song Jong-Keun Seon 《Knee surgery, sports traumatology, arthroscopy》2018,26(8):2338-2344
Purpose
The purpose of this study was to compare femoral tunnel geometry including tunnel position, length, and graft bending angle between trans-portal and outside-in techniques in anterior cruciate ligament (ACL) reconstruction and discover whether such differences in tunnel geometry could influence graft healing or clinical outcome.Methods
Sixty-four patients with anatomical single-bundle ACL reconstruction performed with either trans-portal technique (32 patients, one centre) or outside-in technique (32 patients, the other centre) were included in this retrospective study. Femoral tunnel location and length, and graft bending angle at the femoral tunnel were analysed on 3D CT knee model. The location and length of the femoral tunnel and graft bending angle were compared between the two techniques. All patients underwent MRI scans at around 1 year following ACL reconstruction. It was found that all patients had intact ACL graft on MRI images. On oblique axial image taken after ACL reconstruction to determine graft healing at femoral and tibial tunnels and the intra-articular portion, graft signal intensity ratio was calculated by dividing signal intensity (SI) of the reconstructed ACL by that of posterior cruciate ligament (PCL) in the region of interest selected with Marosis software. Clinical outcomes regarding Tegner activity scores, the International Knee Documentation Committee (IKDC) evaluation scores, Lachman test, and pivot shift test results were also compared between the two groups.Results
While the location of femoral tunnel was similar to each other in both groups, the femoral tunnel length was longer in the outside-in technique (37.0 vs. 32.4 mm, p = .02). Meanwhile, the outside-in technique showed significantly more acute graft tunnel angle than the trans-portal technique (106.7° vs. 113.8°, p = .01). However, signal intensity ratios of grafts (compared with SI of PCL) were similar in femoral and tibial tunnels and intra-articular portions. Moreover, there were no statistically significant differences in terms of IKDC scores (89.4 vs. 90.5, n.s.) or Tegner activity scores (6.2 vs. 6.4, n.s.) between the two groups. There was no significant difference in measurement of Lachman or Pivot shift test either between the two groups.Conclusion
Even though the outside-in technique in ACL reconstruction created a more acute femoral graft bending angle and a longer femoral tunnel length than the trans-portal technique, these had no negative effect on graft healing. In addition, trans-portal and outside-in techniques in ACL reconstruction showed similar femoral tunnel positions and clinical outcomes. Acceptable graft healing and clinical outcomes can be obtained for both trans-portal and outside-in techniques in ACL reconstruction.Level of evidence
III.7.
Barak Haviv Shlomo Bronak Yona Kosashvili Rafael Thein 《Knee surgery, sports traumatology, arthroscopy》2016,24(5):1427-1431
Purpose
To determine which specific factors influence the improvements in function and pain at the first year following arthroscopic partial meniscectomy.Methods
Between 2012 and 2013, patients who had arthroscopic partial meniscectomy were included (n = 201) and followed prospectively before surgery and at 12 months. Multivariable stepwise analysis included preoperative variables (age, gender, limb side, height, weight, body mass index, comorbidities, smoking, Tegner activity scale, Lysholm knee score, preceding injury and duration of preoperative symptoms) and arthroscopic findings (degree of cartilage lesions, medial or lateral meniscus involvement, type of meniscal tear and concomitant cruciate tear). The Lysholm clinical score at the last follow-up and the time interval for substantial pain relief was modelled as a function of the above predictor variables.Results
At the last follow-up, the mean Lysholm score improved by 14.6 points (95 % CI 10.4–18.8, P < 0.001), from 68.0 ± 16.1 to 82.6 ± 19.6 points and 153 (76 %) patients declared they were satisfied to have had the operation. The mean time interval for substantial pain relief was 3.5 ± 1.5 months. Females and patients with lower preoperative Lysholm score were correlated with lower post-operative Lysholm score, while females and patients with lateral meniscal tears (compared to medial meniscal tears) were correlated with longer recovery.Conclusions
Arthroscopic partial meniscectomy improved pain and function at the first year post-operatively. Female gender, lateral meniscal tear and less favourable preoperative function were relatively correlated to worse post-operative function and longer rehabilitation time.Level of evidence
IV.8.
Objectives
To describe the CT changes in patients with restrictive allograft syndrome (RAS) after lung transplantation, before and after clinical diagnosis.Methods
This retrospective study included 22 patients with clinical diagnosis of RAS. Diagnosis was based on a combination of forced expiratory volume (FEV1) decline (≥20 %) and total lung capacity (TLC) decline (≥10 %). All available CT scans after transplantation were analyzed for the appearance and evolution of lung abnormalities.Results
In 14 patients, non-regressing nodules and reticulations predominantly affecting the upper lobes developed an average of 13.9 months prior to the diagnosis of RAS. Median graft survival after onset of non-regressing abnormalities was 33.5 months, with most patients in follow-up (9/14). In eight patients, a sudden appearance of diffuse consolidations mainly affecting both upper and lower lobes was seen an average of 2.8 months prior to the diagnosis of RAS. Median graft survival was 6.4 months after first onset of non-regressing abnormalities, with graft loss in most patients (6/8).Conclusions
RAS has been previously described as a homogenous group. However, our study shows two different groups of RAS-patients: one with slow progression and one with fast progression. The two groups show different onset and progression patterns of CT abnormalities.Key points
? RAS is the newest discovered form of chronic lung allograft dysfunction (CLAD). ? RAS is not a homogenous group, as survival varies greatly between patients. ? In this study, we see two different CT onset and progression patterns. ? These two different CT patterns also correlate with a different survival rate.9.
Diego Costa Astur Charles Marcon Cachoeira Tierri da Silva Vieira Pedro Debieux Camila Cohen Kaleka Moisés Cohen 《Knee surgery, sports traumatology, arthroscopy》2018,26(5):1362-1366
Purpose
To evaluate the anterior cruciate ligament graft failure rate in a population of 1376 patients submitted to single-bundle anterior cruciate ligament reconstruction procedure. It was hypothesized that the younger the patient, the greater the chance of a new anterior cruciate ligament graft ligament injury.Methods
A retrospective chart review was performed on patients who had SB anterior cruciate ligament reconstruction between the years, 2001 and 2016, with a minimum post-operative follow-up period of 6 months. The patient population was divided into three groups, according to age: group 1—under 16 years old; group 2—between 16 and 18 years old; and group 3—older than 18 years old. Data collected included sex, laterality and graft choice data.Results
In group 1 (under 16 years old), there were 61 primary ACL surgeries performed and 15 (24.6%) revision ACL surgeries. In group 2 (between 16 and 18 years old), there was 57 primary ACL procedures, of which 10 (17.5%) were revisions. In the group 3 (older than 18 years of age), 1258 surgeries were done with 116 (9.2%) revisions.Conclusion
The rate of ACL revision surgery in patients under 16 years of age was significantly higher than that found in patients older than 18 years old. When compared to the population between 16 and 18 years old, there were a higher number of failure cases, however, statistically non-significant.Level of evidence
IV.10.
Bo Hyun Kim Joong Il Kim Osung Lee Ki Woung Lee Myung Chul Lee Hyuk Soo Han 《Knee surgery, sports traumatology, arthroscopy》2018,26(8):2345-2352
Purpose
The purpose of the study was to evaluate the influence of synovial coverage of the remnant on clinical outcomes and graft healing in anterior cruciate ligament (ACL) reconstruction.Methods
Seventy-five patients who underwent second-look arthroscopy after a single-bundle ACL reconstruction using autologous quadriceps tendon graft were included. The patients were divided into two groups according to whether the remnant was preserved (group P, n = 42) or sacrificed (group S, n = 33). Group P was further classified according to the degree of synovial coverage of the remnant on initial arthroscopic findings: group A (remnant fully covered with synovium, n = 15), group B (synovial coverage >50%, n = 15), and group C (coverage <50%, n = 12). Clinical outcomes including manual laxity tests, KT-2000 side-to-side difference, modified Lysholm score, Tegner activity score, and International Knee Documentation Committee score were evaluated pre-operatively and prior to the second-look arthroscopy. Graft tension, degrees of synovialization, and gross integrity were evaluated on second-look arthroscopic examination.Results
There were no statistical differences in manual laxity tests, KT-2000 side-to-side difference, and clinical scores between groups P and S. In second-look arthroscopic examination, graft tension showed no difference between the two groups, but gross integrity and synovialization were significantly higher in group P (P = 0.032 and P = 0.008, respectively). In subgroup analysis, only group A showed higher grade regarding gross integrity and synovialization in comparison with group S (P = 0.007 and P < 0.001, respectively).Conclusions
Preservation of remnant in ACL reconstruction showed no superiority concerning knee stability and clinical outcomes over remnant sacrificing at post-operative 1-year second-look arthroscopy. Preservation of remnant with good synovial coverage had a positive effect on graft synovialization and maintenance of graft integrity, but this effect was not observed in cases of a remnant with poor synovial coverage. When deciding whether to preserve the remnant or not, the degree of synovial coverage should be considered.Level of evidence
III.11.
Purpose
To compare dynamic and static tibial translation, in patients with anterior cruciate ligament deficiency, at 2- to 5-year follow-up, with the tibial translation after 4 months of rehabilitation initiated early after the injury. Secondarily, to compare tibial translation in the injured knee and non-injured knee and explore correlations between dynamic and static tibial translation.Methods
Twelve patients with ACL rupture were assessed at 3–8 weeks after ACL injury, after 4 months of structured rehabilitation, and 2–5 years after ACL injury. Sagittal tibial translation was measured during the Lachman test (static translation) and during gait (dynamic translation) using a CA-4000 electrogoniometer.Results
Static tibial translation was increased bilateral 2–5 years after ACL injury, whereas the dynamic tibial translation was unchanged. Tibial translation was greater in the injured knee compared with the non-injured knee (Lachman test 134 N 9.1 ± 1.0 vs. 7.0 ± 1.7 mm, P = 0.001, gait 5.6 ± 2.1 vs. 4.7 ± 1.8 mm, P = 0.011). There were no correlations between dynamic and static tibial translation.Conclusion
Dynamic tibial translation was unchanged in spite of increased static tibial translation in the ACL-deficient knee at 2- to 5-year follow-up compared to directly after rehabilitation. Dynamic tibial translation did not correlate with the static tibial translation. A more normal gait kinematics may be maintained from completion of a rehabilitation programme to mid-term follow-up in patients with ACL deficiency treated with rehabilitation only.Level of evidence
IV.12.
Thomas R. Pfeiffer Ajay C. Kanakamedala Elmar Herbst Kanto Nagai Conor Murphy Jeremy M. Burnham Adam Popchak Richard E. Debski Volker Musahl 《Knee surgery, sports traumatology, arthroscopy》2018,26(5):1319-1325
Purpose/hypothesis
The purpose of this observational study was to determine which factors, including sex, are associated with increased rotatory knee laxity in collegiate athletes with no history of knee injuries. It was hypothesized that increased rotatory knee laxity, measured by a quantitative pivot shift test, would correlate with female sex, increased anterior translation during the Lachman test, generalized ligamentous laxity, and knee hyperextension.Methods
Ninety-eight collegiate athletes with a median age of 20 (range 18–25) years with no history of knee injuries were tested. IKDC and Marx activity scores were obtained and subjects underwent measurement of anterior translation during the Lachman test with a Rolimeter and measurement of knee hyperextension with a goniometer for both knees. A standardized pivot shift test was performed in both knees and quantified using image analysis technology. Generalized ligamentous laxity was assessed using the modified Beighton score.Results
The average anterior translation of the lateral compartment during the pivot shift test was 1.6 mm (range 0.1–7.1) with a mean side-to-side difference of 0.6 mm (range 0–2.7). The average anterior translation during the Lachman test was 9.0 (range 2–15). The anterior translation of the lateral compartment during the pivot shift test was significantly higher in females (median, 1.6; range 0.3–4.9) than in males (1.1, 0.1–7.1 mm) (p < 0.05). Anterior translation of the lateral compartment during the pivot shift test was significantly correlated with anterior translation during the Lachman test (r = 0.34; p < 0.05). There was no significant correlation between anterior translation of the lateral compartment during the pivot shift test and knee hyperextension or modified Beighton score (n.s).Conclusion
The data from this study show that female sex is associated with increased rotatory knee laxity measured during the pivot shift test and anterior translation during the Lachman test in collegiate athletes. In the future, these data may be helpful in diagnosing and managing ACL injuries in athletes and could be used in the clinic as a baseline by which to compare and identify patients who might exhibit increased rotatory laxity.Level of evidence
Diagnostic level II.13.
Sang Yub Lee Jaegu Yoon Young Seo Cho Rak Chae Son Sung Kwan Kim Sang Hyuk Ahn Hyeon-Kyeong Lee 《Knee surgery, sports traumatology, arthroscopy》2017,25(2):374-382
Purpose
Lateral meniscus allograft transplantation (LMAT) is a feasible surgical option for young meniscus-deficient patients. Although several studies have explored the factors that contribute to graft extrusion, they have not been fully elucidated. The aim of this study was to determine the various factors that contribute to graft extrusion.Methods
Patients with knees that had received LMAT using a keyhole technique (n = 87 knees in 82 patients) were reviewed. The median age of these patients was 22 years (range 19–54 years), and the median postprocedural follow-up interval was 5 days (range 1–136 days). Twelve magnetic resonance imaging (MRI) measurement parameters (axial and coronal location of the bone block) that could potentially influence graft extrusion were evaluated, along with absolute graft extrusion and relative percentage of extrusion (RPE).Results
A significant correlation was found between 8 of the 12 MRI measurement parameters and both the absolute extrusion and RPE (r = 0.241–0.438, p < 0.05). The absolute middle distance and depth of the bone block were independent predictors of the absolute extrusion (β = 0.30 and 0.15, respectively; p < 0.05), and the relative middle distance and relative bone-block elevation were found to be predictors of RPE (β = 2.29 and 1.44, respectively; p < 0.05).Conclusion
The rate of graft extrusions after LMAT was high in this study. Both the coronal and axial locations of the bone block were found to influence graft extrusion in LMAT. Therefore, correct positioning of the bone block, including in both the axial and coronal planes, is essential to minimize graft extrusion. Future studies need to investigate the long-term clinical outcome and longevity of extruded menisci after transplantation.Level of evidence
Therapeutic case series, Level IV.14.
Sang-Woo Jeon Min Jung Yong-Min Chun Su-Keon Lee Woo Seok Jung Chong Hyuk Choi Sung-Jae Kim Sung-Hwan Kim 《Knee surgery, sports traumatology, arthroscopy》2018,26(10):2912-2919
Purpose
To analyze the effect of percutaneous pie-crusting medial release on valgus laxity before and after surgery and on clinical outcomes.Methods
Eight-hundred fourteen consecutive patients who underwent an arthroscopic procedure for the medial compartment of the knee were evaluated retrospectively. Sex, age, type of operation (meniscectomy, meniscal repair, and posterior root repair), type of accompanying surgery (none, cartilage procedure, ligament procedure and osteotomy) were documented. Sixty-four patients who underwent percutaneous pie-crusting medial release (release group) and 64 who did not undergo medial release (non-release group) were matched using the propensity score method. Each patient was evaluated for the following variables: degree of valgus laxity on stress radiographs, Lysholm knee score, visual analog scale score, and International Knee Documentation Committee knee score and grade.Results
At the 24-month follow-up, no significant increase in side-to-side differences in the valgus gap was observed in comparison to the preoperative value in the release group [preoperative, ??0.1?±?1.3 mm; follow-up, ??0.1?±?1.4 mm; (n.s.)]. The follow-up Lysholm score, visual analog scale score and International Knee Documentation Committee knee score and grade were similar between the two groups.Conclusions
Percutaneous pie-crusting medial release is an additional procedure that can be performed during arthroscopic surgery for patients with a narrow medial joint space of the knee. Percutaneous pie-crusting medial release reduces iatrogenic injury to the cartilage and does not produce any residual valgus laxity of the knee.Level of evidence
IV.15.
Peripherally Inserted Central Catheter-Related Infections in a Cohort of Hospitalized Adult Patients
Caroline Bouzad Sandrine Duron Aurore Bousquet François-Xavier Arnaud Laura Valbousquet Gabrielle Weber-Donat Christophe Teriitehau Jacques Baccialone Julien Potet 《Cardiovascular and interventional radiology》2016,39(3):385-393
Purpose
To determine the incidence and the risks factors of peripherally inserted central catheter (PICC)-related infectious complications.Materials and Methods
Medical charts of every in-patient that underwent a PICC insertion in our hospital between January 2010 and October 2013 were reviewed. All PICC-related infections were recorded and categorized as catheter-related bloodstream infections (CR-BSI), exit-site infections, and septic thrombophlebitis.Results
Nine hundred and twenty-three PICCs were placed in 644 unique patients, mostly male (68.3 %) with a median age of 58 years. 31 (3.4 %) PICC-related infections occurred during the study period corresponding to an infection rate of 1.64 per 1000 catheter-days. We observed 27 (87.1 %) CR-BSI, corresponding to a rate of 1.43 per 1000 catheter-days, 3 (9.7 %) septic thrombophlebitis, and 1 (3.2 %) exit-site infection. Multivariate logistic regression analysis showed a higher PICC-related infection rate with chemotherapy (odds ratio (OR) 7.2–confidence interval (CI) 95 % [1.77–29.5]), auto/allograft (OR 5.9–CI 95 % [1.2–29.2]), and anti-coagulant therapy (OR 2.2–95 % [1.4–12]).Conclusion
Chemotherapy, auto/allograft, and anti-coagulant therapy are associated with an increased risk of developing PICC-related infections.Clinical Advance
Chemotherapy, auto/allograft, and anti-coagulant therapy are important predictors of PICC-associated infections. A careful assessment of these risk factors may be important for future success in preventing PICC-related infections.16.
Peter P. Koch Sandro F. Fucentese Samuel C. Blatter 《Knee surgery, sports traumatology, arthroscopy》2016,24(9):2736-2740
Purpose
Reconstruction of the anterior cruciate ligament (ACL) remains a major concern in the prepubescent, skeletally immature patient with wide open growth plates. Different surgical techniques have been proposed. This study reports the results and complications of ACL reconstruction in young children using an all epiphyseal technique.Methods
Between 2006 and 2010, 12 patients (10–13 years, median 12.1 years) underwent epiphyseal primary ACL reconstruction, with a total of 13 knee procedures. Patients were assessed retrospectively with a median follow-up of 54 months (range 39–80 months) consisting of a clinical examination, instrumented arthrometer testing and radiological analysis. Functional status was assessed using the Lysholm knee score, Tegner activity scale and IKDC-2000 form.Results
According to the IKDC examination form, five knees were rated as normal, six near normal and two abnormal. The median IKDC score at follow-up was 88.5 points (range 75–99 points). The mean side–to-side difference in KT-1000 ligament laxity testing was 1.5 mm (±2.5 mm). In two patients, reoperation was necessary due to graft failure. Two patients developed significant leg length inequality; one with 20 mm overgrowth and varus malalignment after re-reconstruction and the second developed arthrofibrosis and overgrowth of 16 mm. Four patients had minor limb length discrepancy ranging between +5 and +10 mm; no growth arrest was noted. One patient with an intact but slightly elongated graft required a meniscal suture 34 months after ACL reconstruction following a traumatic medial meniscal lesion.Conclusion
Despite using the epiphyseal technique in ACL reconstruction, relevant growth discrepancy can occur. Thereby, overgrowth rates appear to potentially pose a major clinical problem, which has remained unreported so far. Overall, there is a considerable high risk of complications in this patient group.Level of evidence
IV.17.
Benedikt Schliemann Johannes Glasbrenner Dieter Rosenbaum Katharina Lammers Mirco Herbort Christoph Domnick Michael J. Raschke Clemens Kösters 《Knee surgery, sports traumatology, arthroscopy》2018,26(2):374-380
Purpose
Dynamic intraligamentary stabilization (DIS) has been introduced as a new technique to repair the torn anterior cruciate ligament (ACL) and to restore knee joint kinematics after an acute ACL tear. Aim of the present study was to compare the early post-operative activity, restoration of gait pattern and functional results after DIS in comparison with primary ACL reconstruction (ACLR) for acute ACL tears. It was hypothesized that functional results, post-operative activity and changes in gait pattern after DIS are comparable to those after ACLR.Methods
Sixty patients with acute ACL tears were included in this study and underwent either DIS or ACLR with an anatomic semitendinosus autograft in a randomized manner. Patients were equipped with an accelerometric step counter for the first 6 weeks after surgery in order to monitor their early post-operative activity. 3D gait analysis was performed at 6 weeks and 6 months after surgery. Temporal-spatial, kinematic and kinetic parameters were extracted and averaged for each subject. Functional results were recorded at 6 weeks, 6 months and 12 months after surgery using the Tegner activity scale, International Knee Documentation Committee score and Lysholm score.Results
Patients who underwent DIS showed an increased early post-operative activity with significant differences at week 2 and 3 (p = 0.0241 and 0.0220). No significant differences between groups were found for knee kinematic and kinetic parameters or the functional scores at any time of the follow-up. Furthermore, the difference in anterior tibial translation was not significantly different between the two groups (n.s.).Conclusion
Early functional results and changes in gait pattern after DIS are comparable to those of primary ACLR. Therefore, ACL repair may be an alternative to ACLR in this cohort of patients.Level of evidence
I.18.
Michael Phegan Jane E. Grayson Christopher J. Vertullo 《Knee surgery, sports traumatology, arthroscopy》2016,24(9):2729-2735
Purpose
To investigate the pre-soaking of hamstring grafts in topical vancomycin, in addition to IV prophylaxis, during anterior cruciate ligament (ACL) reconstruction to reduce the incidence of post-operative infection, and to describe an evidence-based diagnostic and treatment algorithm to facilitate early diagnosis and appropriate management of possible knee sepsis post-operatively after ACL reconstruction.Methods
This study is a controlled observational series comprising of 1585 individuals who underwent ACL reconstruction over a 13-year period. All surgeries were performed by a single surgeon at the same hospital. Group 1 consisted of 285 patients who received pre-operative IV antibiotics without topical graft pre-soaking. Group 2 consisted of 1300 individuals who received IV antibiotics and graft pre-soaking in a vancomycin solution of 5 mg/mL.Results
In group 1, a total of four patients suffered a post-operative joint infection (1.4 %). Three out of the four were culture positive for Staphylococcus species. The fourth was culture negative but was managed as an acute infection. Group 2 suffered no post-operative infections (0 %). Statistical analysis of the vancomycin pre-soak with IV antibiotics group, compared with IV antibiotics-alone group, revealed a significantly reduced post-operative infection rate using a Fisher’s exact test (P = 0.0011) and Chi-square test with Yates’ correction (P = 0.0003).Conclusions
Pre-soaking of hamstrings grafts with topical vancomycin reduced the rate of post-operative infection when compared to IV antibiotics alone. This technique should be utilised by surgeons to reduce the overall incidence of knee sepsis post-ACL reconstruction.Level of evidence
III.19.
Antonio Altenor Bessa de Queiroz Pedro Debieux Joicemar Amaro Mario Ferretti Moises Cohen 《Knee surgery, sports traumatology, arthroscopy》2018,26(10):2934-2941
Purpose
The treatment approach for a patient with knee joint focal cartilage lesion is a difficult decision. To date, there has been no randomized clinical trial involving Hydrogel (Cartiva?). This study evaluated and compared the results of a hydrogel implant (Cartiva?) with autologous osteochondral transplantation (AOT) for treating knee joint focal cartilage lesions.Methods
Thirty-eight symptomatic patients, with a focal cartilage lesion of Outerbridge grades III or IV, were randomized into one of two groups according to the inclusion and exclusion criteria. Group I underwent AOT, and Group II was treated with a Hydrogel implant. Patients were evaluated preoperatively and again postoperatively at 6, 12, and 24 months using the subjective International Knee Documentation Committee (IKDC) scores, Visual Analog Scale for Pain (VAS Pain), Activities of Daily Living Scale (ADLS) and Lysholm score.Results
Both groups showed significant improvements from baseline (pre-surgery) to post-surgery (6, 12, and 24 months; p?<?0.05), but there was no difference between the groups. Regarding complications, prolonged pain was observed in four patients (10.5%), two from each group, with a regression of symptoms within 1 year.Conclusion
The Hydrogel implant showed similar efficiency as the autologous osteochondral graft for treating knee joint focal cartilage lesions. Both techniques showed satisfactory results compared to preoperative status. The Hydrogel implant was safe and effective, and it provided good stability and joint function at 2-year follow-up.Level of evidence
I.20.