Autogenous Tendon Graft Research Articles

OUTCOME OF SIMULTANEOUS ARTHROSCOPIC ANTERIOR AND POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING AUTOGENOUS GRAFTS WITH ALL-INSIDE TECHNIQUE

Introduction: Bicruciate knee ligament injury is a lesion affecting both the posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL) simultaneously, which is one of the most severe knee joint injuries. Operative simultaneous reconstruction is the standard of treatment. Objectives: To evaluate clinical results of one-stage ACL and PCL reconstruction using autogenous tendon grafts with an all-inside technique. Material and methods: The medical records of patients operated on by a group of surgeons at the Orthopedic Center, Military Hospital 103 from March 2015 to March 2020 were retrospectively analyzed. Thirty-four patients (24 males, 10 females) with combined rupture of both ACL and PCL underwent one-stage ACL and PCL reconstruction using autogenous hamstring and peroneus longus tendon grafts with all-inside technique. Results: The mean time of follow-up was 32.09 ± 25.15 months (9 - 68 months). The mean age was 37.7 ± 9.0 years (range 23 - 56 years). At the final follow-ups, all patients were without limit extension, 5/34 patients (14.71%) with limit flexion. The Lachman test was negative in 32 patients (94.12%), the pivot shift testing in 32 patients (94.12%) was negative, 26 patients (76.47%) had a positive posterior drawer test. The Lysholm knee score preoperative and final follow-up were 46.76 ± 17.08 (range 12 - 82) and 89.29 ± 8.57 (range 50 - 99) (p < 0.01), respectively. Conclusion: This study demonstrates the effectiveness and safety of simultaneous arthroscopically assisted reconstruction of both ACL and PCL using autogenous hamstring and peroneus longus tendon for restoring knee stability with an all-inside technique.

The Potential of Using an Autogenous Tendon Graft by Injecting Bone Marrow Aspirate in a Rabbit Meniscectomy Model.

Bone marrow aspirate (BMA) is an excellent source of cells and growth factors and has been used successfully for bone, cartilage, and soft-tissue healing. This study aimed to investigate the histological and biomechanical properties of autogenous tendon graft by injecting BMA and its protective effect against degenerative changes in a rabbit model of meniscal defects. Adult white rabbits were divided into untreated, tendon, and tendon + BMA groups, and meniscal defects were created in the knees. The tendon graft and articular cartilage status were evaluated by macroscopic and histological analysis at 4, 12, and 24 weeks postoperatively among the three groups. The tendon graft in the tendon and tendon + BMA groups were used for biomechanical evaluation at 4, 12, and 24 weeks postoperatively. The meniscal covering ratio in the tendon + BMA group was better than that in the tendon and untreated groups at 12 and 24 weeks postoperatively. The matrix around the central portion of cells in the tendon + BMA group was positively stained by safranin O and toluidine blue staining with metachromasia at 24 weeks. The histological score of the tendon graft in the tendon + BMA group was significantly higher than that in the untreated and tendon groups at 12 and 24 weeks postoperatively. In the tendon + BMA group, cartilage erosion was not shown at 4 weeks, developed slowly, and was better preserved at 12 and 24 weeks compared to the untreated and tendon groups. Histological scores for the articular cartilage were significantly better in the tendon + BMA group at 24 weeks. The compressive stress on the tendon graft in the tendon + BMA group was significantly higher than that in the tendon group at 12 weeks postoperatively. Transplantation of autogenous tendon grafts by injecting BMA improved the histologic score of the regenerated meniscal tissue and was more effective than the tendon and untreated group for preventing cartilage degeneration in a rabbit model of massive meniscal defects.

Follow-up on a Biological Revision Technique for Large, Recurrent, Retracted, Rotator Cuff Tears.

Revision of large recurrent rotator cuff tears by simple repair has a structural failure rate of 40% to 90%. The author presents a minimum 2-year follow-up study of revision rotator cuff reconstructions using a bridging patch graft composed of autogenous biceps tendon saturated with concentrated autologous iliac bone marrow, to determine how the technique compares to the reported outcome of simple repair as a treatment alternative. The principal entrance criterion was a symptomatic rotator cuff retear with retraction creating a 3- to 5-cm defect. Twenty-five consecutive patients (with an average age of 62 years) were enrolled. Twenty-two (88%) were available for follow-up at 24 to 120 months (mean 68 months) for interview and examination. Questionnaires using Constant, American Shoulder and Elbow Surgeons, and University of California at Los Angeles (UCLA) Shoulder scores were completed. In the terminal 15 patients, the presence of viable marrow mesenchymal cells fixed to the tendon graft at the time of implantation was determined by histological verification. Rotator cuff integrity was evaluated by ultrasonography examination. The Wilcoxon rank-sum test was used to compare nonparametric preoperative with postoperative questionnaire outcome scores. Twenty of 22 patients (91%) demonstrated an intact tendon construct. Two of 22 patients (9%) demonstrated structural failure. Viable mesenchymal cells were identified on all graft specimens in high concentration. All patients showed improved results: The mean Constant score increased from 13 to 76; American Shoulder and Elbow Surgeons from 17 to 81; UCLA from 6 to 29 (P < 0.001). The autogenous graft/marrow technique consistently and successfully reconstructed a large, recurrent rotator cuff tear in a clinical setting where the primary cuff repair had failed. The observation that an autogenous tendon graft saturated with concentrated marrow has the biological potential to reconstruct a difficult soft-tissue defect in the shoulder strongly implies its potential as a reconstructive tool for other soft-tissue defects.

Reconstruction of Chronic Injured Distal Tibiofibular Syndesmosis with Autogenous Tendon Graft: A Systematic Review.

Background Chronic injuries of the distal tibiofibular syndesmosis are common in patients who fail to receive adequate diagnosis and timely treatment. Reconstruction of the distal tibiofibular syndesmosis with an autogenous tendon graft in these patients is effective, although relatively rarely reported. Purpose To investigate clinical outcomes of syndesmosis reconstruction with an autogenous tendon graft for chronic injuries of the distal tibiofibular syndesmosis by reviewing the current literature. Methods An English literature search was conducted in the MEDLINE, CENTRAL, and Cochrane databases to identify published studies up to October 2017. Preset inclusion and exclusion criteria were applied to identify all eligible articles. Results Five studies (all with level IV evidence) that included a total of 51 patients who underwent reconstruction with an autogenous tendon graft were identified. It was reported that the symptoms were relieved postoperatively, including obviously improved functional outcomes and restoration of motions and exercise capacity. The mean American Orthopedic Foot and Ankle Society scale score of 16 patients was 53 preoperatively and 89 postoperatively. The visual analogue scale score of 14 patients decreased from 82.4 preoperatively to 12.6 postoperatively. A total of 5 (9.8%) complication cases were reported. Conclusion Reconstruction of the distal tibiofibular syndesmosis with an autogenous tendon for chronic syndesmosis injury showed a good therapeutic effect in terms of both subjective symptoms and objective evaluation scores. The interosseous ligament could be an appropriate reconstruction target in the treatment of chronic syndesmosis injury.

The gracilis tendon autograft is a safe choice for orthopedic reconstructive procedures: a consecutive case series studying the effects of tendon harvesting

BackgroundThe gracilis tendon is commonly used as an autograft to reconstruct torn tendons or ligaments in many parts of the body. Little is known about the subjective and functional outcome after gracilis tendon harvest. The aim of this study was to evaluate the outcome of the donor leg in patients undergoing such surgery.MethodsPatients with chronic acromioclavicular joint dislocations undergoing coracoclavicular ligament reconstructions using autogenous gracilis tendon grafts were eligible for this study. The graft harvesting procedure was carried out in a standard fashion using a tendon stripper. Knee injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and after 12 months. The first 5 patients were included retrospectively and lacked preoperative data, for these patients age- and gender matched normative KOOS scores were used as baseline values. Isometric knee flexor strength in 60° and 90° degrees of flexion was measured at final follow up at a median of 26 (14–56) months postoperatively with the non-operated leg used as reference.ResultsTwenty four patients were eligible for the study and 2 were excluded. The 22 patients available for analysis had a mean age of 44 (22–62) years at the time of surgery and 4 were women. There was no statistically significant change in KOOS 12 months postoperatively compared to baseline values but the patients were weaker in knee flexion in the operated leg compared to the non-operated one.ConclusionsGracilis tendon harvesting results in a weakness of knee flexion but does not impair subjective knee function and is a procedure that can be recommended when an autogenous tendon graft is needed.

Bridging Repair of Large Rotator Cuff Tears Using a Multilayer Decellularized Tendon Slices Graft in a Rabbit Model

The purpose of this study was to evaluate the efficacy of an extracellular matrix scaffold with multilayer decellularized tendon slices (MDTSs) for reconstructing large rotator cuff tears in a rabbit model. Large defects in the infraspinatus tendons were created bilaterally in 36 rabbits. The graft group underwent bridging repair of the defects with the MDTSs grafts from Achilles tendons of adult beagle dogs, and the control group underwent repair with the autologous excised tendon. Specimens underwent histologic observation, biomechanical testing, and microcomputed tomography analysis at 2, 4, and 8weeks after surgery. Histologic analysis confirmed that the MDTSs graft promoted cell ingrowth and tissue integration, and fibrocartilage and Sharpey fibers formed at the enthesis at 8weeks. Accordingly, the MDTSs graft generated a histologic appearance similar to that of the autogenous tendon graft. Mechanical testing revealed a significant increase of the regenerated tendons in ultimate load and stiffness from 4 to 8weeks postoperatively, which was similar to autologous tendon repair. Microcomputed tomography analysis demonstrated that the MDTSs graft promoted bone formation at the tendon-bone insertion, thus improving the mechanical properties of the repair tendon. The MDTSs graft used to bridge large rotator cuff defects in a rabbit model promoted host cell ingrowth, enhanced the remodeling of regenerated tendon, and promoted fibrocartilage formation, thus improving the biomechanical properties of the repaired tendon. This study thereby provides fundamental information for rotator cuff regeneration with the MDTSs graft. Rotator cuff regeneration using MDTSs grafts is a promising procedure for large rotator cuff tears.

Acromio-Clavicular Joint Dislocation Types IV to VI: Does the Outcome with the modified Weaver-Dunn Procedure Justify the Treatment?

Introduction: The optimal surgical treatment for acromioclavicular joint (ACJ) injuries remains controversial. The modified Weaver-Dunn (WD) procedure is one of the frequently used techniques. Recently when it was compared with anatomical autogenous tendon graft reconstruction procedures, the results were inferior. However, these anatomical procedures are technically more demanding with small margin of error and they have tendency for postoperative pain because of extra donor site incision.Materials and Methods: Forty patients with type IV to VI ACJ dislocations were treated by modified WD procedure using non-absorbable synthetic suture passed through the base of coracoid process for augmentation of transferred coraco-acromial (CA) ligament. Functional outcome was assessed using the Oxford Shoulder Score, Nottingham Clavicular Score and Visual Analog Score (VAS) at the final follow-up after surgery.Results: The mean pre-operative Oxford Shoulder Score improved from 25.22±2.64 (range 20 to 30) to 44.75±1.99 (range 40 to 48) and mean pre-operative Nottingham Shoulder Score improved from 49.25±4.91 (range 39 to 58) to 87.27±4.39 (range 79 to 96) at last follow-up after surgery with p-value <0.001. Thirty-five (87.5%) patients had excellent outcomes, four (10%) patients had good outcomes and one (2.5%) patient had fair outcome. Thirty-eight (95%) patients had no pain while two (5%) had moderate pain based on VAS score.Conclusion: Modified Weaver-Dunn is a simple well established technique for grade IV to VI ACJ dislocation. We cannot consider this procedure as old and outdated on the argument that the long term functional outcomes are not suboptimal.

The outcome of anterior cruciate ligament reconstruction in skeletally immature patients with transphyseal tunnels

Objective To evaluate the clinical outcomes after transphyseal anterior cruciate ligament (ACL) reconstruction with hamstring autograft in skeletally immature patients. Methods Ten skeletally immature pubescent patients (10 knees) with a mean age of 13.4 years underwent transphyseal ACL reconstruction with hamstring autograft between May 2004 and March 2012. There were 5 males and 5 females. The average duration from injury to surgery was 5.3 months (range 1-12 months). Arthroscopy confirmed ACL rupture in ten knees. Concurrent meniscal surgery was performed in 5 knees. The surgery was conducted via arthroscopically assisted transphyseal reconstruction of the ACL with use of an autogenous quadrupled hamstring tendon graft and fixation devices that do not cross the physes. A protective knee brace was used for 3 months postoperatively with motion limits for the first 2 weeks. The follow-up duration was 6.7 years (range 3-12 years), with evaluation for the following outcomes: physical examination, namely KT-2000 measurements and functional outcome instruments (the International Knee Documentation Committee subjective knee form, the Lysholm scoring, and the Tegner knee activity scale). Radiographs were performed for asymmetrical physeal closure, growth arrest lines and leg-length measurements. Results At the latest follow-up, the mean 2000 IKDC score improved from preoperative 75.1±5.1 to 93.3±3.0, the mean Lysholm score from preoperative 66.1±8.2 to 94.8±3.6 and the mean Tegner score from 4.4±0.8 to 8.5±0.7. All these outcomes had statistically significant difference. Lachman and pivot-shift testing were weekly positive in 3 knees and negative in 7 knees. The mean range of motion of the knee was 140°. Compared with the contralateral knee, no restriction in knee range of motion of 5° or greater was observed in any patient. All patients had normal range of motion. The mean KT-2000 manual maximum side-to-side difference was 1.5±0.7 mm, while that in 3 patients was greater than 2 mm but smaller than 3 mm. No angular deformities were reported. All leg-length measurements were symmetric bilaterally on clinical examination. The mean lateral distal femoral angle was 87.4°±0.6°, and the mean medial proximal tibial angle was 88.3°±0.7°. No patients reported traumatic graft disruption or underwent revision ACL reconstruction, whereas meniscus injury occurred in 3 patients. Conclusion Transphyseal ACL reconstruction with autogenous quadrupled hamstring graft in treating skeletally immature pubescent patients yields satisfied functional outcomes without growth disturbance at a mean follow-up of 6.7 years. Key words: Anterior cruciate ligament; Wounds and injuries; Anterior cruciate ligament reconstruction; Adolescent; Growth plate

Tension Regulation at the Suture Lines for Repair of Neglected Achilles Tendon Laceration.

Operative intervention is the preferred option for management of the neglected laceration of the Achilles tendon. However, the commonly used techniques rarely follow the principles of the regenerative medicine for the restoration of the lost tissue. This study postulated that incorporation of the autogenous tendon graft would properly progress when the interplay between mechanical loading and healing phases was correctly applied. A prospective study included 15 patients who were treated for neglected Achilles tendon laceration using the technique of lengthening of the proximal tendon stump. An absorbable reinforcement suture was used for control of the mechanical environment at the suture lines. By an average 5 years of the prospective follow-up, all the repaired tendons had restored continuity and length. The calf circumference equalized to the uninjured side in 12 patients. However, 3 patients had calf atrophy but they improved compared to the preoperative measurements. Sonogram confirmed the restoration of the normal thickness and the gliding characteristics of the repaired tendon. The technique restored continuity and tension of the repaired tendon, preserved the calf circumference, and prevented peritendinous adhesions. The absorbable reinforcement suture spontaneously allowed for the mechanical loading of the grafted tendon. Level IV, case series.

Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations

This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications. There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P < .001), and 10.6 ± 3.3 mm (24% ± 39%) at the final assessment (P < .001), showing an increase of the CC distance during the follow-up. Loss of reduction (defined as >25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P < .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P < .001]). In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes.

Split-tendon Flexor Pulley Reconstruction with Application of Tendon Rod

Purpose: Flexor pulley reconstruction is a challenging surgery. Regardless of the reconstructive technique used, the surgeon should make every effort to imitate the length, tension and glide of the normal pulley. We describe in the present study a new method for pulley reconstruction in using a split tendon graft. Patients and methods: Twelve adult patients had A2 and/or A4 pulley reconstruction using split-tendon during application of tendon rod as a first stage tendon reconstruction. This was followed by application of an autogenous tendon graft in a second stage 12 weeks from the first stage. Patients were followed for 6 months after the second stage. Results: All patients recovered a satisfactory range of motion with an average finger to palm distance of 16 mm. Conclusion: The described technique is versatile and provides an autogenous thin graft that is free of donor site morbidity with excellent tendon gliding.

Modified Weaver-Dunn Procedure Versus The Use of Semitendinosus Autogenous Tendon Graft for Acromioclavicular Joint Reconstruction.

Background:The optimal operative method for acromioclavicular joint reconstruction remains controversial. The modified Weaver-Dunn method is one of the most popular methods. Anatomic reconstruction of coracoclavicular ligaments with autogenous tendon grafts, widely used in treating chronic acromioclavicular joint instability, reportedly diminishes pain, eliminates sequelae, and improves function as well as strength. Objective:To compare clinical and radiologic outcomes between a modified Weaver-Dunn procedure and an anatomic coracoclavicular ligaments reconstruction technique using autogenous semitendinosus tendon graft.Methods:Twenty patients (mean age, 39 years) with painful, chronic Rockwood type III acromioclavicular joint dislocations were subjected to surgical reconstruction. In ten patients, a modified Weaver-Dunn procedure was performed, in the other ten patients; autogenous semitendinosus tendon graft was used. The mean time between injury and the index procedure was 18 month (range from 9 – 28). Clinical evaluation was performed using the Oxford Shoulder Score and Nottingham Clavicle Score after a mean follow-up time of 27.8 months. Preoperative and postoperative radiographs were compared.Results:In the Weaver-Dunn group the Oxford Shoulder Score improved from 25±4 to 40±2 points. While the Nottingham Clavicle Score increased from 48±7 to 84±11. In semitendinosus tendon graft group, the Oxford Shoulder Score improved from 25±3 points to 50±2 points and the Nottingham Clavicle Score from 48±8 points to 95±8, respectively.Conclusion:Acromioclavicular joint reconstruction using the semitendinosus tendon graft achieved better Oxford Shoulder Score and Nottingham Clavicle Score compared to the modified Weaver-Dunn procedure.

Surgical treatment of chronic acromioclavicular joint dislocation with autogenous tendon grafts.

BackgroundConservative treatment of acromioclavicular (AC) joint dislocation is not always successful. A consequence of persistent AC joint dislocation may be chronic pain and discomfort in the shoulder region as well a sensation of constant AC joint instability and impaired shoulder function. Stabilization of the AC joint may reduce these sequels.Materials and methodsDue to chronic AC joint dislocation, 39 patients in our hospital underwent coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus and gracilis tendons between May 2005 and April 2011. We examined 25 patients after a mean of 4.2 years. The outcomes were Constant shoulder Score (CS), Disabilities of the Arm, Shoulder and Hand (DASH), pain (Visual Analog Scale, VAS), cross-arm test, stability of the AC joint, and complications. The follow-up visits included anteroposterior and axillary radiographs.ResultsMean CS was 83 in the injured shoulder and 91 in the uninjured shoulder (p = 0.002). Mean DASH was 14. In 14 patients, the AC joint was clinically stable; pain was minor. In radiographs, osteolysis of the lateral clavicle and tunnel widening were markedly common. Fracture of the coracoid process occurred in 5 patients, and 3 suffered a fracture of the clavicle; 2 had a postoperative infection.ConclusionsAnatomic reconstruction of CC ligaments showed a moderate subjective outcome at the 4-year follow-up. After surgery, almost half the AC joints failed to stabilize. Lateral clavicle osteolysis and tunnel widening were notably common complications.

Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow

BackgroundThe disruption or insufficiency of lateral ligament complex including lateral ulnar collateral ligament (LUCL) leads to posterolateral rotatory instability (PLRI). An accurate clinical staging is quite useful in predicting the prognosis. The purpose of our study is to review our experience with surgical reconstruction for PLRI of the elbow and to investigate the relationship between the clinical stage of elbow instability and the functional outcomes of PLRI. Materials and methodsPatients with PLRI of the elbow determined by fluoroscopic stress view under anaesthesia underwent surgical reconstruction of the LUCL with autogenous tendon graft. ResultsThirteen of the fourteen patients (93%) were subjectively satisfied with the outcome of the surgery. The mean follow-up was 49 months (range: 24–72). The results were better in patients with stage 1 or 2 instability (group I) compared to those with stage 3 instability (group II). ConclusionsReconstruction of the LUCL using an autogenous tendon graft is an effective method for patients with PLRI of elbow. Since better results were obtained in patients with stage 1 or 2 instability rather than stage 3, accurate clinical staging determined by fluoroscopic stress view under anaesthesia is important before surgery for appropriate treatment and prediction of functional outcomes.

Surgical options for reconstruction of the extensor mechanism of the knee after limb-sparing sarcoma surgery: an evidence-based review

Limb-salvage surgery remains current best practice for management of soft tissue and bony sarcomas about the knee, with the range of reconstructive options all providing reassuring levels of long-term survival and function. There is no current consensus as to the best method of reconstruction of the extensor mechanism of the knee (quadriceps-patellar complex), with a wide variety of options proposed. The techniques described in the literature include prosthetic reconstruction, soft tissue reconstruction (comprising reconstruction with pedicled muscle flaps or autogenous tendon grafts), and bony reconstructions (including vascularised fibula flaps). An evidence-based literature review assessing the available reconstructive options has not been undertaken. A thorough literature review was undertaken, evaluating the current evidence regarding the use of surgical techniques for reconstruction of the extensor mechanism of the knee following oncologic resection. The literature identified was critically evaluated based on the current Oxford Centre for Evidence-Based Medicine definitions. There are no randomised trials in the literature in this setting, and thus no level 1 or level 2A studies to support any given technique. As such, there are many favourable techniques for reconstruction that have been well described and have some evidence base to support their use. Overall, there is a trend towards improved outcomes with biological reconstructive options, with lower reported levels of failure, infection and amputation. Despite this, no single technique has adequately proven to be superior. Given the proposed difficulties in randomising patients, good evidence for the optimal reconstructive choices may be hard to establish.

Limb salvage operation using intraoperative extracorporeal autogenous irradiated bone and tendon graft for myxoid liposarcoma on dorsum of foot

Foot and ankle sarcomas are conventionally treated with amputation. In this article, we report a case of myxoid liposarcoma on the dorsum of the foot treated by limb salvage operation with intraoperative extracorporeal autogenous irradiated bone and tendon grafts. The patient was a 76-year-old woman with a soft tissue tumor beneath the extensor tendons with attachment to the tarsal and metatarsal bones. The histological diagnosis was myxoid liposarcoma. Wide margin was achieved by splitting the tarsal and metatarsal bones into dorsal and plantar parts. The dorsal part of the bones and tendons was isolated from the resected material, irradiated ex-vivo and re-implanted into the host's bones and tendons. No local recurrence was detected around the irradiated bones and tendons during the follow-up at 36 months. The functional rating was 74% according to the ISOLS rating system. This method may be a better procedure for limb salvage operation of sarcomas on the dorsum of the foot.

Surgical Repair of Acute and Chronic Tibialis Anterior Tendon Ruptures

Rupture of the tibialis anterior tendon is an uncommon disorder that can cause a substantial functional deficit as a result of loss of ankle dorsiflexion strength. We are not aware of any reports on a large clinical series of patients undergoing surgical repair of this injury. Nineteen tibialis anterior tendon ruptures were surgically repaired in eighteen patients ranging in age from twenty-one to seventy-eight years. Early repair was performed for one traumatic and seven atraumatic ruptures three days to six weeks after the injury. Delayed reconstruction was performed for two traumatic and nine atraumatic ruptures that had been present for seven weeks to five years. Direct tendon repair was possible for four of the early repairs and three of the delayed reconstructions. An interpositional autogenous tendon graft was used for four early repairs and eight delayed reconstructions. Patients were reassessed clinically and with the American Orthopaedic Foot and Ankle Society hindfoot score at an average of 53.3 months after surgery. The average hindfoot score improved significantly from 55.5 points preoperatively to 93.6 points postoperatively. The surgical results did not appear to vary according to patient age, sex, or medical comorbidity. Complications requiring a second surgical procedure occurred in three patients. Recovery of functional dorsiflexion and improvement in gait was noted in eighteen of the nineteen cases. Ankle dorsiflexion strength was graded clinically as 5/5 in fifteen of the nineteen cases. Three patients regained 4/5 ankle dorsiflexion strength, and one patient had 3/5 strength with a poor clinical result. Surgical restoration of the function of the tibialis anterior muscle can be beneficial regardless of age, sex, medical comorbidity, or delay in diagnosis. Early surgical treatment may be less complicated than delayed treatment, and an intercalated free tendon graft and/or gastrocnemius recession may be necessary to achieve an appropriately tensioned and balanced repair.

Acromioclavicular reconstructions with hamstring tendon grafts: A comparative biomechanical study

The surgical treatment of chronic acromioclavicular injuries remains controversial. There is increasing use of autogenous tendon grafts to perform these reconstructions. This study examined the mechanical properties of differing configurations of these grafts. Mechanical testing of acromioclavicular joint reconstructions was performed with a screw and soft tissue washer for tendon fixation, a simple loop of tendon tied to itself, and a bio-interference screw for tendon fixation, with and without a loop of nonabsorbable suture for reinforcement. The bio-interference screw fixation, with reinforcement by a loop of nonabsorbable suture, gave the highest load to failure among the group (502N +/- 177), which was not significantly different from the intact ligaments (705 N +/- 132), although it was significantly less stiff than the intact group (57.2 N/mm +/- 12.6 and 109.7 N/mm +/- 32.6, respectively). All other reconstructions had an ultimate load and stiffness which were significantly less than that of the intact specimens.

Simultaneous anterior and posterior cruciate ligament reconstruction in chronic knee instabilities: surgical concepts and clinical outcome

The purpose of this study was to evaluate the clinical results of simultaneous arthroscopically assisted reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) using autogenous tendon grafts in chronic knee injuries. Nineteen patients (17 men and 2 women) with chronic multi-ligamentous injuries underwent one-stage ACL and PCL reconstruction. ACL, PCL and medial collateral ligament were reconstructed in seven knees, and ACL, PCL and posterolateral structure were reconstructed in two knees. Function of the operated knee was evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scale. Anterior and posterior knee laxity was examined with a KT-2000 arthrometer. Eighteen of 19 patients were able to return for follow-up and were evaluated objectively and subjectively. The average patient age at surgery was 30.5 years, and the average postoperative follow-up was 3.5 years. No patients showed loss of knee extension more than 5 degrees , while three patients revealed loss of knee flexion more than 16 degrees . The mean postoperative total anterior-posterior side-to-side difference was 1.9 +/- 1.5 mm at 20 degrees and 2.1 +/- 1.9 mm at 70 degrees . The average of the Lysholm score was 95.1 points at the final follow-up. At the IKDC evaluation, three patients were grade A, 11 were grade B, 3 were grade C, and 1 patient was grade D. The results showed the effectiveness and safety of one-stage reconstruction of combined ligamentous injuries of the knee that can adequately restore satisfactory stability.

A Modified Press-fit Fixation for Reconstruction of Anterior Cruciate Ligament

Abstract Anterior cruciate ligament (ACL) ruptures can lead to recurrent knee instability, meniscal tears, and articular cartilage degeneration. To restore the stability of the knee, the procedure of ACL reconstruction is always needed. Most surgeons prefer an autogenous graft for ACL reconstruction. However, the advantages of different grafts are still under debate. We performed ACL reconstruction with modified press-fit fixation on 101 patients and selected autogenous tendon grafts based on the patients' specific condition. Ninety-eight patients were followed up for a mean of 3.5 years, and the knee functions were significantly improved in 85.7% of the patients according to the knee functional scale.