Average Lysholm Score Research Articles

POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH AUTOGRAFT OF THE DOUBLE SEMITENDINOSUS MUSCLES AND MIDDLE THIRD OF THE QUADRICEPS TENDON WITH DOUBLE FEMORAL AND SINGLE TIBIAL TUNNELS: CLINICAL RESULTS IN TWO YEARS FOLLOW UP

Objective: To evaluate the surgical aspects that may offer good anatomic and functional results in posterior cruciate ligament (PCL) reconstruction using an autologous graft of the quadriceps tendon and double semitendinosus through a double femoral tunnel. Methods: Fourteen patients with isolated PCL lesions, instability and pain were operated on by arthroscopy and evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scales. Posterior knee laxity was examined with a KT1000 arthrometer. Results: The mean postoperative posterior side-to-side difference was between 0-2 mm in 57.1% of patients and between 3 and 5 mm in 35.7% of cases. The average Lysholm score was 93 points in the final follow-up. In the IKDC evaluation, 3 patients were graded A, 10 were graded B, and 1 patient was graded C. Conclusions: Double bundle arthroscopic PCL reconstruction based on the anatomical positioning of the tunnels, with double semitendinosus tendon and single quadriceps, provides a clinically evident reduction in symptoms and restores satisfactory stability, although no statistically significant difference was found due to the small sample.

An Institution-Specific Analysis of ACL Reconstruction Failure

The purpose of this study was to determine the most common causes of failed anterior cruciate ligament reconstruction (ACLR) using modern reconstructive techniques at a single, high-volume institution. In addition, the clinical outcomes of patients undergoing revision ACLR will be reported. The surgical logs of four senior knee surgeons were retrospectively reviewed for all patients who had undergone ACLR between 2002 and 2009. Patients were excluded if they did not have both the primary and revision surgery on the same knee with the same surgeon. Out of 1944 ACL reconstructions, 28 patients (56 reconstructions) were included in the study. Radiographic studies, operative reports, KT-1000 scores, and chart notes were used to identify all potential factors that may have led to failure. All patients were invited to return for a follow-up examination and survey. Of the 28 patients, the mean age at the index and revision procedure was 22 +/- 11 (range, 12 to 50) and 24 +/- 11 (range, 14 to 57), respectively. In 20 cases, the cause of failure was determined to be acute trauma (sports, work, or accident); in 1 case, the cause was biologic failure; while in 7 cases, the cause was technical error. During the study period the surgeons performed a combined total of 1944 procedures, for an overall failure rate of 1.8%. Twenty patients (71%) were available for follow-up at a mean 30.2 +/- 17.7 months. The overall postrevision outcomes were good to excellent for a majority of patients, with an average Lysholm score of 84 +/- 15.5 and International Knee Documentation Committee score of 77.2 +/- 13.8. The pre- and postoperative KT-1000 scores were 12.1 +/- 2.8 and 6.7 +/- 2.8, respectively. The results from this study suggest that traumatic re-injury, and not surgical/surgeon error, is the most common cause of ACLR failure using anatomic reconstructive principles and strong fixation. In addition, good to excellent outcomes following revision ACLR can be expected in the majority of patients.

Suture anchor versus drilling suture for reconstruction of distal rupture of the quadriceps femoris

ObjectiveTo compare clinical outcomes of suture anchor and drilling suture for reconstruction of distal rupture of the quadriceps femoris.MethodsFrom January 2000 to October 2008,42 patients with distal rupture of the quadriceps femoris were treated with suture anchor or drilling suture at our department. In the drilling suture group, there were 18 men and 3 women, aged from 19 to 41 years (average,27.0 ±6. 2 years) . In the suture anchor group, there were 16 men and 5 women, aged from 16 to 37 years (average, 24. 0 ± 5.4 years). The 2 groups were compared in operation time, incision length, bleeding volume, and external fixation time, as well as Lysholm scores and American Knee Society Score(KSS) for functional recovery of the knee.ResultsAll the patients were followed up for 2 to 3 years(average, 2. 7 years). There were significant differences between the 2 groups in operation time, incision length, bleeding volume, external fixation time and patella position( P ＜ 0. 05) . All the patients obtained primary healing of wounds. Fourteen patients in the drilling suture group had their steel wire pulled out one year after surgery, but none in the suture anchor group needed a secondary operation. The average Lysholm score was 90. 0 ± 8.7 points for the drilling suture group, with no significant difference from that for the suture anchor groups (95.0 ±4. 5) ( t =- 1. 333, P =0. 190). By KSS system, there were 8 excellent, 8 good and 5 fair cases in the drilling suture group (with an excellent to good rate of 76. 2％ ); while there were 14 excellent, 5 good and 2 fair cases in the suture anchor group (with an excellent to good rate of 90. 5％ ).ConclusionAlthough both suture anchor and drilling suture can achieve satisfactory therapeutic effects in reconstruction of distal rupture of the quadriceps femoris, suture anchor method may be superior because of less invasion, more simplicity, better stability and earlier functional rehabilitation. Key words: Sutures; Bone nails; Wound and injuries; Quadriceps muscle; Patella

Arthroscopic single bundle reconstruction of the ruptured anteromedial bundle of anterior cruciate ligament

ObjectiveTo explore the surgical techniques and therapeutic effects of arthroscopic reconstruction of the ruptured anteromedial bundle of anterior cruciate ligament (ACL).MethodsFrom May 2004 to May 2010, 293 patients received arthroscopic ACL reconstruction at our department. Of them,40 cases (13.7％ ) were diagnosed as anteromedial bundle rupture of ACL during arthroscopic exploration.The ruptured anteromedial bundle was reconstructed using the autologous quadrupled hamstring graft while the posterolateral bundle was preserved during the procedure. Lysholm scoring and Lachman test were performed prior to and after the reconstruction to evaluate functional recovery of the knee. The proprioceptive function of the knee was evaluated by Threshold to Detection of Passive Motion (TDPM) system.ResultsAll the cases of ruptured anteromedial bundle were followed up for an average of 33 months (from 7 to 56 months).The average Lysholm score was 56.7 ± 8.6 before surgery and 92. 0 ± 5.0 at the last follow-up, with a significant difference ( t =27. 750, P =0. 000). By Lysholm scoring at the last follow-up, 19 patients were rated as excellent, 16 as good, 5 as fair and none as poor, with an excellent-to-good rate of 87. 5％. By the Lachman test, 34 patients were negative, 4 weakly positive and 2 positive. At the last follow-up, there was no significant difference between the average TDPM of the affected knees (2. 12° ±- 0. 15°) and that of the contralateral knees (2. 09° ±0. 16°) (t =0. 657, P =0. 515) . All the patients resumed normal activities after surgery with obviously improved stability of the knee.ConclusionArthroscopic reconstruction of the ruptured anteromedial bundle of ACL with preservation of the posterolateral bundle can help precise positioning of the bone tunnel, provide additional mechanical strength for graft fixation, and accelerate revascularization and sensory reinnervation of the reconstructed ACL. Key words: Anterior cruciate ligament; Arthroscopy; Anteromedial bundle

Gender-Based Differences in Outcome After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts

Background: Although previous studies suggested that female patients are predisposed to increase graft laxity compared with male patients after single-bundle anterior cruciate ligament reconstruction using autogenous hamstring tendons, there have been no studies specifically examining gender-based differences in outcome after anatomic double-bundle anterior cruciate ligament reconstruction with hamstring tendon autografts. Hypotheses: (1) Female patients have significantly smaller hamstring graft diameters than do men for anatomic double-bundle anterior cruciate ligament reconstruction surgery; (2) female patients will have increased graft laxity compared with male patients after anatomic double-bundle anterior cruciate ligament reconstruction using autogenous hamstring tendons. Study Design: Cohort study; Level of evidence, 2. Methods: The consecutive 174 patients who underwent anatomic double-bundle anterior cruciate ligament reconstruction using autogenous hamstring tendons were enrolled. Of these patients, 49 women and 73 men were prospectively evaluated 2 years after surgery. Results: The diameters for anteromedial and posterolateral grafts in the female group were significantly smaller than those in the male group. On Lachman testing, 98% of the female group and 97% of the male group were rated as negative. Regarding the pivot-shift test, 80% of the female group and 85% of the male group were rated as negative. No significant differences were found between the female and male groups in these tests. The average side-to-side differences in the KT-2000 knee ligament arthrometer values were 1.3 mm in the female group and 1.4 mm in the male group; this difference between females and males was not statistically significant. The average Lysholm scores were 96.7 points in the female group and 97.2 points in the male group. Thirty-five cases (73%) in the female group and 54 cases (74%) in the male group were graded as normal on the International Knee Documentation Committee (IKDC) evaluation. There were no significant differences in Lysholm score or IKDC evaluation between the female and male groups. Conclusion: The results of assessment for ligament laxity at the 2-year postoperative evaluation in the female group were approximately identical to those of the male group after anatomic double-bundle anterior cruciate ligament reconstruction using autogenous hamstring tendons. Therefore, the present study suggests that anatomic double-bundle anterior cruciate ligament reconstruction using autogenous hamstring tendons provides satisfactory knee stability to female patients as well as male patients.

Radiological evaluation of cartilage after microfracture treatment: A long-term follow-up study

Recent literature revealed good short-term results after microfracturing (MFX) of isolated focal cartilage defects in the knee joint. Study purpose was a long-term evaluation of patients who received MFX through a multimodal approach, correlating clinical scores and morphological pre- and postoperative MRI-scans. Between 2000 and 2007 158 patients were treated with MFX for focal femoral or tibial defects at our department. Patients with instabilities, secondary surgical intervention, patellofemoral lesions, a plica mediopatellaris or more than one cartilage defect site and age >55 were excluded. 15 patients were included. Minimum postoperative follow-up (FU) was 18 months (18-78 m). Mean age at surgery was 45 years (27-54), mean FU-interval 48 months (18-78 m). Male to female ratio was 9:6. For clinical assessment the Knee Osteoarthritis Ou tcome Score (KOOS) and Lysholm Score were used, radiological evaluation was performed with radiographs and 3Tesla-MRI. Clinical knee function was rated good to excellent in 1 patient, fair in 2 and poor in 10 patients. 2/15 patients received full knee replacement due to insufficient cartilage repair through MFX during FU period. Evaluation of pre- and postoperative MRI showed good cartilage repair tissue in 1 (7.7%), moderate repair in 2 (15.4%) and poor fill in 10 patients (76.9%). In these 10 patients the defect size increased. Average defect size preoperatively was 187 mm(2) (range 12-800 mm(2)) and postoperatively 294 mm(2) (40-800 mm(2)). The KOOS-Pain averaged 60 (39-94), KOOS-Symptoms 60.6 (21-100), KOOS-ADL 69 (21-91), KOOS-Sports 35.7 (5-60) and KOOS-QUL 37.2 (6-81). The average Lysholm Score was 73.9 (58-94). 10 patients showed a varus leg axis deviation (Ø 5.9°), 3 had a neutral alignment. The alignment correlated positively with KOOS and especially with the Lysholm Score. Our study demonstrated that MFX as a treatment option for cartilage defect in the knee did not show the anticipated clinical and radiological long-term results. In 12 of 15 patients the cartilage defect size had increased after MFX, in 2 patients indicating full-knee replacement. Especially those with a leg malalignment >5° in varus were more prone to suffer from an increase in defect size. In our cohort the clinical scores correlated with the radiological findings.

Clinical valure of C-arm fluoroscopy in arthroscopic reconstruction of anterior cruciate ligament with LARS artificial ligament

Objective To discuss the operation skills and clinical effects of C-arm fluoroscopy in arthroscopic reconstruction of anterior cruciate ligament(ACL)with the Ligament Advancement Reinforcement System(LARS)artificial ligaments.Methods The study involved 36 patients with acute ACL rupture treated with the LARS artificial ligaments from June 2006.There were 25 males and 11 females,at age range of 22-51 years(average 28.3 years),involving 19 left knees and 17 right knees.The results of preoperative MRI of all patients suggested discontinuation of ACL,with average score of Lysholm on knee joint for 50.The operation was completed under arthroscope.While the locations of the femoral tunnel portal and the tibial tunnel exit were mainly determined by the C-arm fluoroscopy.The diameter of the LARS artificial ligament was 7.5 mm while that of the interference screw 8 mm.Results All 36 patients were followed up for a mean duration of 18 months(9-20 months).The average Lysholm Score was 52 preoperatively and 92 at the 12th week after operation.The clinical results were graded as excellent in 23 patients,good in nine and fair in four according to the Lysholm's classification,with excellence rate of 89%.Conclusions Arthroscopic reconstruction of anterior cruciate ligament with LARS artifical ligament under C-arm fluoroscopy takes advantages of convenient operation,accurate location and satisfactory clinical effect. Key words: Anterior cruciate ligament; Radiosurgery; LARS artifical ligament

Clinical Results of Technique for Double Bundle Anterior Cruciate Ligament Reconstruction Using Hybrid Femoral Fixation and Retroscrew

BackgroundAnatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome.MethodsGrafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. ResultsSignificant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 ± 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 ± 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up.ConclusionsOur new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes.

6-year follow-up of 84 patients with cartilage defects in the knee

Background and purpose The natural history of focal cartilage injury is largely unknown. In this study we investigated 6-year outcomes in patients with arthroscopically verified, focal, full-thickness cartilage injuries of the knee.Methods In a previous report (baseline study) of 993 knee arthroscopies, 98 patients were less than 50 years old at baseline and showed grade 3–4 focal cartilage injury, as assessed with the International Cartilage Repair Society (ICRS) scale. In the present study, 84 of the 98 patients completed follow-ups at median 6.1 (5.3–7.8) years after baseline assessments. At baseline, the patients had undergone different types of cartilage repair (n = 34) or had no treatment or only debridement (n = 64) for their cartilage injury. The follow-up included evaluations with the ICRS knee evaluation form, the Lysholm score, and other knee evaluation tests. 68 patients underwent radiographic assessments with weight bearing.Results Improvements compared to baseline were noted in the average ICRS functional score, visual analog scale (VAS) pain score, and the patients' rating of the function in the affected knee compared to the contra-lateral knee. However, the average ICRS activity level had decreased from baseline. The average Lysholm score was 76 (SD 21). 19 patients had Kellgren-Lawrence grades 2–3 in the affected knee and 6 patients had grades 2–3 in the contralateral knee. There was a statistically significant difference between affected and contralateral knees.Interpretation Patients with arthroscopically diagnosed ICRS grade 3–4 cartilage injuries in the knee may show improvement in knee function over the following 5–8 years, with or without cartilage repair. However, knee function remains substantially affected. Further studies are needed to determine whether cartilage surgery can yield better functional outcomes than non-surgical or less invasive surgical treatments.

Osteochondral autografts in full thickness patella cartilage lesions

The purpose of this study was to evaluate clinical, functional and imaging results of full thickness patella cartilage lesions treated with osteochondral autografts (OCA). We studied a consecutive case series of 10 patients. At follow-up, Lysholm and International Knee Documentation Committee (IKDC) scores were obtained. Magnetic resonance imaging (MRI) evaluation was performed at an average of 8 months post-op. The average cartilage lesion area was 1.2 cm 2. An average of 1.9 grafts was used per patient. The average Lysholm scores were: pre-op 73.8 ± 8.36; post-op 95 ± 4.47 points ( p < 0.05). The average IKDC post-op score was 95 ± 1.74 points. No postoperative complications were registered. In the MRI analysis we found that in all cases, OCA presented flush characteristics when compared with adjacent cartilage. The majority of cases presented no fissures in the graft–receptor interface (60%). In 80% we observed mild bone marrow edema around the graft. According to the International Cartilage Research Society (ICRS) cartilage lesions classification, all grafts were considered 1A; in the periphery cartilage was classified as 1A in 60%. We conclude that patellar OCA is a good alternative for the treatment of full thickness patellar cartilage lesions, offering good clinical, functional and imaging results at midterm follow-up.

Arthroscopic all-inside meniscal repair—Does the meniscus heal?

The purpose of this study was to correlate clinical and radiological results using a 3-T MRI to verify meniscal healing after arthroscopic all-inside meniscus repair. We selected 27 patients (14 men and 13 women) with an average age of 31 ± 9 years and retrospective clinical examinations and radiological assessments using a 3-T MRI after all-inside arthroscopic meniscal repair were conducted. Repair of the medial meniscus was performed in 19 patients and of the lateral meniscus in eight. In 17 patients (63%), we performed concomitant anterior cruciate ligament reconstruction. The mean follow-up period was 4.5 ± 1.7 years. The Lysholm score and Tegner activity index were used for clinical evaluation. Four grades were used to classify the radiological signal alterations within the meniscus: central globular (grade 1); linear horizontal or band-like (grade 2); intrameniscal alterations and linear signal alterations communicating with the articular surface (grade 3); and complex tears (grade 4). At follow-up, the average Lysholm score was 76 ± 15 points, with ten of the patients placed in group 6 based on the Tegner activity index. MRI examinations revealed no signal alteration in three patients, grade 1 in 0, grade 2 in five, grade 3 in 13, and grade 4 in six. The MRI findings correlated positively with the clinical scores in 21 patients (78%). Correlation of clinical and radiological examination was performed using 3-T MRI. In spite of satisfactory clinical outcomes at follow-up, a radiological signal alteration may still be visible on MRI, which was believed to be scar tissue, but could not be proven definitively. Imaging with a 3-Tesla MRI after meniscal suture surgery provides good but no definitive reliability on meniscus healing and therefore gives no advantage compared to 1.5-T MRI, with good clinical outcome using an all-inside arthroscopic meniscal repair. 3T-MRI can not substitute diagnostic arthroscopy in patients with persistent complaints after arthroscopic all-inside meniscal repair.

Arthroscopic anterior cruciate ligament reconstruction with remnant preservation

Objective To evaluate the clinical value of arthroscopic anterior cruciate ligament(ACL)reconstruction with remnant preservation in enhancing the revascularization of the graft and preserving proprioceptive function.Methods From January 2007 to January 2009,82 cases of ACL rupture were treated with single-bundle ACL reconstruction in which the ligament remnants were preserved.The tibial remnant and the synovial shell were preserved as much as possible.Grafts were pulled intra-articularly through the tibial remnant under arthroscopic visualization.The ACL tibial remnant was compacted by the tendon passage.All patients were followed up for more than one year as scheduled.Rolimeter measurement,Lysholm,Tegner and International Knee Documentation Committee(IKDC)rating scale were used to evaluate the curative effects at the last follow-up.Results At the last follow-up,79 patients(96.3%)had negative Lachman results,and only 3 patients had positive Lachman results.Rolimeter examination showed that the average difference of anterior laxity was(7.3± 2.6)mm before operation and(2.3 ± 1.5)mm at the final follow-up(t = 1.981,P =0.023).All patients showed a negative pivot shift test and a normal range of motion.The average Lysholm score was 61.2 ±7.6 before operation and 91.5±4.5 at the last follow-up(t =2.915,P = 0.002).The average Tegner score was 3.7 ± 1.4 before operation and 6.5 ± 1.2 at the last follow-up(t = 2.189,P = 0.012).The average IKDC score was 65.1 ± 7.9 before operation and 93.4 ± 5.7at the last follow-up(t = 3.286,P = 0.001).Conclusion Preserving the remnant tissue of the ACL for ACL reconstruction is beneficial for the graft revascularization and rehabilitation of proprioceptive function. Key words: Arthroscopy; Knee joint; Anterior cruciate ligament

Arthroscopic reconstruction of anterior cruciate ligament with V-shaped plasty graft fixed by Endo-buttorn

Objective To introduce the arthroscopie reconstruction of anterior cruciate ligament(ACL)with a Ⅴ-shaped plasty graft fixed by Endo-buttorn in femur.Methods From March 2008 to January 2009,12 patients with ACL rupture were treated in our department.They were 8 males and 4 females,with an average age of 25.2 years(range,17 to 36 years).The injury involved 9 left and 3 right knees,and was caused by sports in 11 cases and a traffic accident in one.One rupture was acute and 11obsolete.The autoallergic and allogeneic tendons were woven into a Ⅴ-shaped plasty graft of six-bundles,before implantation.The ACL was re-established via twin tunnels in tibia and a single tunnel in femur by using Endo-butteru in femur.The postoperative curative effects were observed.The knee-joint functions were compared between pre-and pest-operation in Lysholm,Larson and International Knee Documentation Committee(IKDC)scores.The bone tunnels were observed by Ⅹ-ray examinations.Results All the patients were followed up for an average of 15 months(12 to 18 months).All knee joints recovered a normal range of motion.The average Lysholm scores increased from the preoperative(61.25 ± 3.77)to the postoperative(91.50 ± 2.78),with a significant difference(t = 22.376,P =0.000).The average Larson scores improved significantly from(58.08 ±2.58)preoperatively to(90.08±2.68)postoperatively(t =29.837,P=0.000).The average IKDC scores increased from(63.33 ± 2.84)to(91.75 ± 2.38),with a significant difference(t = 26.576,P =0.000).Ⅹ-rays revealed no narrowness in joint space in all the eases.Conclusion ACL Reconstruction with a Ⅴ-shaped plasty graft fixed by Endo-buttprn in the femur can restore a good joint stability,showing an excellent short-term therapeutic effect,but its long-term therapeutic effect is to be observed. Key words: Knee joint; Anterior crnciate ligament; Arthroscopy

The Clinical Use of Human Culture–Expanded Autologous Bone Marrow Mesenchymal Stem Cells Transplanted on Platelet-Rich Fibrin Glue in the Treatment of Articular Cartilage Defects

Objective:To test the hypothesis that platelet-rich fibrin glue (PR-FG) can be used clinically as a scaffold to deliver autologous culture-expanded bone marrow mesenchymal stem cells (BM-MSCs) for cartilage repair and to report clinical results 1 y after implantation of MSCs PR-FG.Patients and Methods:Autologous BM-MSCs were culture expanded, placed on PR-FG intraoperatively, and then transplanted into 5 full-thickness cartilage defects of femoral condyles of 5 patients and covered with an autologous periosteal flap. Patients were evaluated clinically at 6 and 12 mo by the Lysholm and Revised Hospital for Special Surgery Knee (RHSSK) scores and radiographically by x-rays and magnetic resonance imaging (MRI) at the same time points. Repair tissue in 2 patients was rated arthroscopically after 12 mo using the International Cartilage Repair Society (ICRS) Arthroscopic Score.Study Design:Case series; level of evidence 4.Results:All patients’ symptoms improved over the follow-up period of 12 mo. Average Lysholm and RHSSK scores for all patients showed statistically significant improvement at 6 and 12 mo postoperatively (P < 0.05). There was no statistically significant difference between the 6 and 12 mo postoperative clinical scores (P = 0.18). ICRS arthroscopic scores were 8/12 and 11/12 (nearly normal) for the 2 patients who consented to arthroscopy. MRI of 3 patients at 12 mo postoperatively revealed complete defect fill and complete surface congruity with native cartilage, whereas that of 2 patients showed incomplete congruity.Conclusion:Autologous BM-MSC transplantation on PR-FG as a cell scaffold may be an effective approach to promote the repair of articular cartilage defects of the knee in human patients.

Results of isolated posterolateral corner reconstruction

BackgroundIsolated posterolateral corner (PLC) tears are relatively rare events. Various surgical techniques to treat posterolateral knee instability have been described; because surgical results are linked to cruciate reconstructions it has been difficult to date to define whether one surgical procedure has better prognosis than another. The goal of this study is to determine the clinical outcome of PLC reconstruction following fibular-based technique.Materials and methodsWe retrospectively evaluated a case series of patients who received isolated PLC reconstruction between March 2005 and January 2007. Ten patients were surgically treated for isolated injuries and were available for follow-up; average patient age was 27.4 years (range 16–47 years). All patients were treated following the fibular-based technique: double femoral tunnel was performed in six patients, while in the remaining four patients, the reconstruction of the PLC was performed with a single femoral tunnel. Six patients had semitendinosus allograft and four had semitendinosus autograft. All patients had the same evaluation and the same rehabilitation protocol.ResultsMean follow-up was 27.5 months (range 18–40 months). Mean range of motion (ROM) was 143.5° for flexion (range 135–150°) and 0.5° for extension (range 0–3°). Three patients showed 1+ on varus stress test, while on Dial test another three patients showed 10° reduction of external rotation compared with contralateral knee. The average Lysholm score was 94 points (range 83–100), and the mean International Knee Documentation Committee (IKDC) subjective result was 88.48 (range 74–96.5). Based on Lysholm score, the results were excellent in eight knees and good in two knees. On IKDC evaluation, two patients were grade A and eight were grade B. No significant difference in clinical results was observed between single and double femoral tunnel.ConclusionFibular-based technique showed good results in terms of clinical outcome, restoring varus and rotation stability of knees in treatment of chronic isolated PLC injury.

Patellofemoral Instability in Athletes

Background Surgical treatment of patellofemoral instability can successfully diminish episodes of subluxation and dislocation, as well as symptoms of pain and instability. Hypothesis Surgical treatment of lateral patellar instability in a strictly athletic population will facilitate return to sports. Study Design Case series; Level of evidence, 4. Methods From 1999 to 2004, 41 Fulkerson osteotomies combined with an arthroscopic lateral release were performed in 34 athletes for patellofemoral instability. Three patients were lost to follow-up. All patients participated in sports at least 3 times per week in at least one sport for 4 months of the year. There were 4 male and 30 female patients; 7 patients underwent bilateral, staged procedures. There were 14 high school, 12 collegiate, and 8 recreational athletes. Results were obtained by an independent examiner. Results The mean age was 20.05 years (range, 14-54 years) with a mean follow-up of 46 months (range, 22-71 months). Patients averaged 1.3 dislocations before reconstruction (range, 0-6). The average Lysholm score was 91.8 (range, 67-100) at follow-up. The International Knee Documentation Committee (IKDC) scores were A (normal) in 27 knees, B (near normal) in 12, and C (abnormal) in 2. Seventeen patients had symptomatic hardware removed at an average of 8 months. There were 2 complications: one saphenous neuroma that resolved, and one recurrent dislocation in a patient later diagnosed with Ehlers-Danlos syndrome. Conclusion This series is the largest to date documenting the successful treatment of patellofemoral instability in athletes with concomitant Fulkerson osteotomy and arthroscopic lateral release. Forty-nine percent of patients in our series required removal of screws from the osteotomy site.

Autologous Chondrocyte Implantation

Background: The medium-term results of autologous chondrocyte implantation (ACI) have shown good to excellent outcomes for the majority of patients. However, no long-term results 10 to 20 years after the surgery have been reported. Hypothesis: Autologous chondrocyte implantation provides a durable solution to the treatment of full-thickness cartilage lesions of the knee, maintaining good clinical results even 10 to 20 years after implantation. Study Design: Case series; Level of evidence, 4. Methods: In this uncontrolled study, questionnaires with the Lysholm, Tegner-Wallgren, Brittberg-Peterson, modified Cincinnati (Noyes), and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were sent to 341 patients. Preoperative Lysholm, Tegner-Wallgren, and Brittberg-Peterson scores were also retrieved when possible from patients’ files. The patients were asked to grade their status during the past 10 years as better, worse, or unchanged. Finally, they were asked if they would do the operation again. Results: There were 224 of 341 patients who replied to our posted questionnaires and were assessed. The mean cartilage lesion size was 5.3 cm2. Ten to 20 years after the implantation (mean, 12.8 years), 74% of the patients reported their status as better or the same as the previous years. There were 92% who were satisfied and would have the ACI again. The Lysholm, Tegner-Wallgren, and Brittberg-Peterson scores were improved compared with the preoperative values. The average Lysholm score improved from 60.3 preoperatively to 69.5 postoperatively, the Tegner from 7.2 to 8.2, and the Brittberg-Peterson from 59.4 to 40.9. At the final measurement, the KOOS score was on average 74.8 for pain, 63 for symptoms, 81 for activities of daily living (ADL), 41.5 for sports, and 49.3 for quality of life (QOL). The average Noyes score was 5.4. Patients with bipolar lesions had a worse final outcome than patients with multiple unipolar lesions. The presence of meniscal injuries before ACI or history of bone marrow procedures before the implantation did not appear to affect the final outcomes. The age at the time of the operation or the size of lesion did not seem to correlate with the final outcome. Conclusion: Autologous chondrocyte implantation has emerged as an effective and durable solution for the treatment of large full-thickness cartilage and osteochondral lesions of the knee joint. Our study suggests that the clinical and functional outcomes remain high even 10 to 20 years after the implantation.

Good results five years after surgical management of anterior cruciate ligament tears, and meniscal and cartilage injuries

In athletes with anterior cruciate ligament (ACL) tears combined with meniscal and cartilage injuries, the goals are to restore knee laxity and relieve symptoms, while long-term goals are the return to pre-injury sport activity and to prevent onset of degenerative changes. We compared the post-operative (minimum 5years) clinical and radiological outcomes of 50 patients, similar for ACL rupture and meniscal tears, but different for the grade of cartilage lesion. The patient population was divided into two groups similar for ACL reconstruction and surgical meniscal management. Group 1 included 25 patients undergoing microfracture management of grade III-IV cartilage lesions, while Group 2 included 25 patients with grade I-II cartilage lesions, managed by radiofrequency. Comparing pre- and post-operative status, Lachman test, pivot shift values and KT 1000 side to side difference measurements improved significantly (<.001) in both groups, with NS difference between the two groups (>0.05) at the intermediate and latest assessments. At both post-operative appointments, in both groups, the average Lysholm score and IKDC ranking rates improved significantly (<0.001) compared to pre-operative values, but slight worsening was observed in Group 1 patients at the latest review. At the latest assessment, 10 knees (40%) in Group 1 and 3 knees (15%) in Group 2 demonstrated degenerative changes according to Fairbank grading. Concerning the WOMAC index score and sport activity level rating, Group 1 patients had significantly lower scores than Group 2 patients (P<0.05). In patients with symptomatic ACL instability combined to grade III-IV cartilage lesions, microfractures give excellent short-term clinical and functional improvement but do not prevent the evolution of degenerative changes.

Clinical and Radiologic Results of Transtibial Single Bundle Reconstruction and Double Bundle Reconstruction of the Posterior Cruciate Ligament Using the Allo-achilles Tendon

Purpose: We performed transtibial single and double bundle reconstruction of the posterior cruciate ligament using the allo-achilles tendon and compared the results of single bundle reconstruction and double bundle reconstruction both clinically and radiologically. Materials and Methods: This study included 41 cases of posterior cruciate ligament reconstruction between February 2000 and June 2007 that had data available for at least 2 years of follow-up. Twenty-two cases (53.7%) underwent single bundle reconstruction and 19 cases (46.3%) underwent double bundle reconstruction. Clinical results were analyzed by Lysholm score and IKDC standards scale, and the radiologic results were analyzed by the Telos posterior translation test. Results: The average Lysholm score at last follow-up was in the single bundle group and in the double bundle group. IKDC scores were grade A in 4 (18.2%), grade B in 14 (63.6%) and grade C in 4 (18.2%) in the single bundle group; they were 1 (15.3%), 15 (78.9%) and 3 (15.8%) in the double bundle group. Telos posterior translation test scores were 5.06 mm (3.04-7.43 mm) in the single bundle group, and 4.04 mm (2.18-7.20 mm) in the double bundle group. There was significant improvement in clinical and radiological scores in both groups (p0.05). Conclusion: Further study with longer term follow-up is needed.

Septic arthritis of the knee following anterior cruciate ligament reconstruction

Septic arthritis of the knee is a rare complication after arthroscopic anterior cruciate ligament reconstruction, and the most appropriate treatment is unclear. All case series reported so far have been retrospective, and case numbers of septic arthritis have ranged from 4 to 11. From a consecutive case series of 1,283 patients who underwent arthroscopic anterior cruciate ligament reconstruction between January 1997 and May 2008, we report on 3 patients (0.23%) with post-operative septic arthritis. All patients had acute infection (“ 2 weeks), bacterial cultures showed Staphylococcus species in 2 patients, while the bacterial culture was negative in the third. All of them underwent immediate arthroscopic debridement and lavage with continuous irrigation, as well as antibiotic treatment. The results were evaluated with physical and radiographic examination, functional testing, KT-2000, Lysholm and Tegner scales. The infection was successfully eradicated without further surgical treatment and the ligament graft was retained in all patients. Follow-up, at an average of 33 months, revealed that the patients had full symmetric knee range of motion and no effusion. The average Lysholm score was 91 points. In the patient with a lower subjective score, radiographs demonstrated patellofemoral joint-space narrowing, which is most probably in correlation with his anterior knee pain problems and lower activity level. The 134 N KT-2000 arthrometer side-to-side differences averaged 13 mm. Their performance in the single-legged hop test gave excellent results. The goals of treatment for septic arthritis after anterior cruciate ligament reconstruction are, primarily, to protect the articular cartilage and, secondly, to protect the graft. Through early diagnosis and prompt treatment, the infection can be successfully eradicated, with stability of the knee and full range of motion achieved.