Cruciate Ligament Reconstruction In Patients Research Articles

Early Functional Outcome After Anterior Cruciate Ligament Reconstruction in Patients Using Post-Operative Brace or No Brace: A Prospective Observational Case–Control Study

Early Functional Outcome After Anterior Cruciate Ligament Reconstruction in Patients Using Post-Operative Brace or No Brace: A Prospective Observational Case–Control Study

A modified anterior cruciate ligament reconstruction with BTB autograft

Background. Central third of the patellar tendon is a well know graft for anterior cruciate ligament (ACL) reconstruction. However, it’s usage can be difficult in case of long patella tendon, which causes graft length discrepancy. The aim of this article is to evaluate the results of arthroscopic anterior cruciate ligament reconstruction with a help of original method of bone patella tendon bone graft preparation. Methods. 26 males operated for ACL tear have been included in the study. On the preoperative MRI scans the approximate length of ACL, tibial tunnel, patella tendon length and tibial bone plug length have been measured. The technique of tibial bone plug cut was optimized based on preoperative MRI assessment. Results. In all cases, MRI-based assessments were consistent with intraoperative measurements, hence there was possible to avoid graft length discrepancy. In a period of 12 weeks the average score on the step-and-holds test was 23.8±1.1, the single-leg squat test was 6.7±0.9 and the Y-balance test was 83.2±1.4. The average IKDS score was 64.9±5.7. Conclusion. The proposed method is appropriate for anterior cruciate ligament reconstruction in patients with long patella tendon.

Both Hamstring and Quadriceps Tendon Autografts Offer Similar Functional Outcomes After Arthroscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 50 Years or Older

PurposeThe purpose of this study was to compare the outcomes of hamstring tendon (HT) and quadriceps tendon (QT) autografts for anterior cruciate ligament (ACL) reconstruction in patients older than 50 years in terms of patient-reported functional outcomes, graft failure rates, complications, return to sports activity and the preference for sports. MethodsBetween 2010 and 2022, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction using either HT or QT autograft and a minimum of 2 years of follow-up were included. Patients with concomitant meniscus, cartilage and MCL injury were also included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than HT or QT autograft, and patients with a contralateral knee injury or ipsilateral osteoarthritis (Ahlback stage 2 or higher) were excluded. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport. Mann-Whitney test was used for unpaired samples, whereas the Friedman test was used for analyzing variables over time. The chi-square statistic test was used to determine differences in categorical data between groups ResultsThe number of patients in the QT and HT groups was 85 and 143 respectively. The mean age was 54.4 [50-65] and 56.4 [50-65] for the QT and HT groups respectively, 49% and 51% were males in the QT and HT groups respectively. The two groups did not differ significantly in terms of age, gender, time from injury to surgery and concomitant injuries. No significant differences were found in the pre-injury patient-reported outcome scores (PROMs) as Lysholm, Tegner activity level and VAS for pain between the two groups (p>0.05). At the 2-year follow-up, Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores between the two groups (p>0.05).Furthermore, at the 2-year follow-up, Lysholm score, and VAS didn't show significant differences between QT and HT groups. (p=.390; p= .131). Similarly, no differences have been reported in Tegner activity level scores between HT and QT groups at 2 years of follow-up. No significant differences in terms of minimal clinically important difference (MCID) have been detected between the two groups for Lysholm and Tegner activity scores (p = 0.410 and p = 0.420 for Lysholm score and Tegner activity level score respectively).The two groups did not differ in terms of patient’s percentage of sports participation at baseline, and 2 years of follow-up (p>0.05). A significant decrease (p=0.01) in skiing/snowboarding was reported in the HT group at a 2-year follow-up compared to baseline [116 (81%) vs 98 (69%)]. No case of graft failures and quadriceps tendon rupture was reported in either of the groups. ConclusionArthroscopic ACL reconstruction by using HT or QT autograft in athletically active older than 50 years patients provide satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity.

Outcomes of Anterior Cruciate Ligament Reconstruction in Patients with Associated Anterolateral Ligament Injury.

Objective To evaluate if there is a significant difference in the outcomes of isolated anterior cruciate ligament (ACL) reconstruction in patients with or without associated anterolateral ligament (ALL) injury. Methods We conducted a retrospective cross-sectional study through the analysis of medical records and the application of the questionnaires of the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) Subjective Knee Form to patients undergoing isolated ACL reconstruction. Results The 52 participants included were divided into two groups: 19 with associated ALL injury and 33 with no associated ALL injury. None of the patients with associated ALL injury suffered an ACL rerupture, and 21.1% presented injuries to other knee structures after surgery. Among the patients with no associated injury, 6.1% suffered ACL rerupture, and 18.2% presented injuries to other structures after surgery ( p = 0.544). Return to activities at the same level as that of the preoperative period occurred in 60% of the patients with associated ALL injury and in 72% of those with no associated injury ( p = 0.309). The mean score on the Lysholm Knee Scoring Scale was of 81.6 points in patients with associated ALL injury, and of 90.1 in those with no associated injury ( p = 0.032). The mean score on the IKDC Subjective Knee Form was of 70.3 points in patients with associated ALL injury and of 76.7 in those with no associated injury ( p = 0.112). Conclusion There was no statistically significant difference regarding graft injuries or new injuries to other structures, satisfaction with the operated knee, or the score on the IKDC Subjective Knee Form. Return to activity was similar in the groups with and without associated ALL injuries. The scores on the Lysholm Knee Scoring Scale were better, with a statistically significant difference in the group with no associated ALL injuries.

Good clinical outcomes of anterior cruciate ligament reconstruction in patients over 60 years of age.

To evaluate the clinical outcomes following arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) in patients over 60 years and to investigate the potential impact of preoperative osteoarthritis (OA) on these outcomes. A retrospective study included ACL-injured patients over 60 years who underwent primary arthroscopic ACLR between 2010 and 2020. The Lysholm score and the International Knee Documentation Committee (IKDC) score were assessed preoperatively and at the final follow-up. The Tegner activity scale was performed to evaluate patients' activity levels. Data on return to sports, patient satisfaction, subsequent injuriesand complications were collected. Preoperative radiographs were used to grade OA according to the Kellgrene-Lawrenceclassification. Correlation analysis between OA and clinical outcomes was performed. The rates of achieving the minimal clinically significant differenceand patient-acceptable symptoms statewere documented. A total of 37 patients were included in this study. The mean age at surgery was 62.3 ± 2.3 years, with a mean follow-up of 6.3 ± 3.2 years (range: 2.1-12.4). Patients showed statistically significant (all p < 0.001) improvements in the mean IKDC (38.9 ± 9.4-66.8 ± 12.5), Lysholm (48.8 ± 15.4-83.0 ± 12.8)and Tegner (1-3) scores. Fourteen patients (37.8%) returned to sports. No correlation was observed between the degree of preoperative OA and clinical outcomes (n.s.). Patients over 60 years with symptomatic ACL-deficient knees could benefit from ACLR, even when mild to moderate OA is present preoperatively. Level IV.

Optimal Timing of Anterior Cruciate Ligament Reconstruction in Patients With Anterior Cruciate Ligament Tear

The timing of surgery has been regarded as a key factor in anterior cruciate ligament reconstruction (ACLR), and early vs delayed ACLR remains a controversial topic. To synthesize up-to-date published data from randomized clinical trials (RCTs) comparing early vs elective delayed ACLR for patients with ACL deficiency, in terms of clinical outcomes and complications. The PubMed, Cochrane Library, and Web of Science databases were systematically searched until September 9, 2022. All published RCTs comparing clinical and functional outcomes and complications associated with early ACLR vs elective delayed ACLR. Two reviewers independently extracted relevant data and assessed the methodological quality following the PRISMA guidelines. Due to the clinical heterogeneity, the random-effects model was preferred. The primary outcomes were functional outcomes and complications. The Mantel-Haenszel test was used to evaluate dichotomous variables and the inverse variance method was used to assess continuous variables. This meta-analysis included 972 participants in 11 RCTs stratified by follow-up duration. The following factors did not differ between early and delayed ACLR: operative time (mean difference, 4.97; 95% CI, -0.68 to 10.61; P = .08), retear (OR, 1.52; 95% CI, 0.52-4.43; P = .44), and infection (OR, 3.80; 95% CI, 0.77-18.79; P = .10). There were also no differences between groups in range of motion, knee laxity, International Knee Documentation Committee (IKDC rating scale), and Tegner score. IKDC score (mean difference, 2.77; 95% CI, 1.89-3.66; P < .001), and Lysholm score at 2-year follow-up (mean difference, 2.61; 95% CI, 0.74-4.48; P = .006) significantly differed between early and delayed ACLR. In addition, the timing of surgery was redefined in the included RCTs and subgroup analyses were performed, which validated the robustness of the principal results. This systematic review and meta-analysis found that early ACLR was not superior to delayed ACLR in terms of most factors analyzed, except for IKDC and Lysholm scores. This information should be available to patients with ACL deficiency and clinicians as part of the shared decision-making process of treatment selection.

Revision Soft-Tissue Allograft Anterior Cruciate Ligament Reconstruction Is Associated With Lower Patient-Reported Outcomes Compared With Primary Anterior Cruciate Ligament Reconstruction in Patients Aged 40 and Older

To evaluate patient-reported outcomes (PROs) and graft failure rates in revision allograft anterior cruciate ligament reconstruction (ACLR) in patients aged 40 and older and compare them with primary ACLRs. Patients aged 40 and older who underwent arthroscopic soft-tissue allograft ACLR between 2005 and 2016 with a minimum 2-year follow-up were retrospectively reviewed. Patients were grouped based on revision versus primary ACLR. The rate of achieving an International Knee Documentation Committee (IKDC) patient acceptable symptom state (PASS) score was recorded. Patient satisfaction, PROs, and graft failure were compared between groups using the χ2 test, Fisher exact test, and Mann-Whitney U test. We identified 32 patients who underwent revision ACLR and 201 patientswho underwent primary ACLR aged 40 and older who met inclusion criteria with a mean follow-up of 6.2 and 6.9 years, respectively (P= .042). There was a lower rate of concomitant meniscal repair in the primary ACLR group (6%vs 21.9%, P= .007) There were no other differences in chondral injuries, mechanism of injury, or meniscal injuries between groups. The median IKDC score was greater in the primary ACLR group as compared with the revision ACLR group (83.9 vs 70.6, P < .001). Patients who underwent revision ACLR were less likely to achieve the IKDC PASS threshold (82.5% vs 56.3%, P= .001) and were less likely to report satisfaction as compared with patients who underwent primary ACLR (90.5% vs 78.1%, P=.038). No difference in graft failure rates was identified between groups (8% vs 15.6%, P= .180). Revision allograft ACLR in patients aged 40 and older was associated with lower PROs compared with primary ACLR. Patients who underwent revision ACLR failed to meet the IKDC PASS threshold more often and were dissatisfied with procedure results more than twice as often as patients that underwent primary ACLR. III, retrospective cohort study.

Hamstring tendon autografts and allografts show comparable clinical outcomes and knee stability after anterior cruciate ligament reconstruction in patients over fifty years old with no signs of osteoarthritis progression

PurposeThe aim of this study is to compare the functional outcomes and osteoarthritis (OA) progression after anterior cruciate ligament (ACL) reconstruction with either hamstring autografts or allografts in people over 50.MethodsThe clinical records of two consecutive cohorts of 61 cases in total over 50 years of age, undergoing ACL reconstruction, were included. The first cohort consisted of 29 allografts; the second cohort consisted of 32 autologous hamstring tendon grafts. The cases were evaluated pre- (T0) and post-operatively at six months (T1), 12 months (T2) and 24 months (T3). Clinical examination included the Lachman test, pivot shift test and objective (Objective IKDC [The International Knee Documentation Committee] score) and subjective clinical scores (Subjective IKDC score, Lysholm score and Tegner activity score). The degree of OA was evaluated using the Kellgren-Lawrence system at the time of the final follow-up, compared to the pre-operative condition.ResultsNo pre-operative difference was found between the two groups (p > 0.05). No statistical difference was noted between the two groups at each follow-up (p > 0.05). At the final follow-up, both the groups significantly improved statistically in all the clinical and functional scores (p < 0.05). In both groups, one graft re-rupture was noted. No progression of OA was noted in both groups at final follow-up (p > 0.05).ConclusionThe graft choice does not influence the outcomes two years after ACL reconstruction in people over 50; thus, both treatments help in regaining knee stability with no signs of OA progression.RegistrationResearchregistry7539–www.researchregistry.com.

Patient Reported Outcome Measures in Pediatric Anterior Cruciate Ligament Reconstruction: Does Promis Correlate with Pedi-Ikdc?

Background:The Pedi-IKDC is a well-established patient reported outcome (PRO) measure used in knee and sports surgery. Recently, the computer adaptive PROMIS test has emerged as an alternative measure of patient function in this realm, but it is unclear if it captures information similar to the Pedi-IKDC and other PROs.Hypothesis/Purpose:The purpose of this study was to evaluate the strength of correlation between PROMIS and Pedi-IKDC scores for pediatric anterior cruciate ligament reconstruction (ACLR) patients during the postoperative period.Methods:Pediatric (<18yo) patients undergoing primary ACLR at a single urban tertiary care children’s hospital were identified. Patients completing both PROMIS and Pedi-IKDC within 2 weeks of each other were included. PROMIS domains including Physical Function, Anxiety, Depressive Symptoms, Fatigue, Peer Relationships, and Pain Interference were compared with the Pedi-IKDC using Pearson or Spearman correlations. Correlations were performed between Pedi-IKDC and PROMIS domains within subgroups based on timing of survey completion post-operatively (<6 weeks, 6-12 weeks, 3-6 months, 6-9 months, and >9 months). Multivariable robust regression modeling was performed to generate an equation of best fit to calculate a patient’s projected Pedi-IKDC result from PROMIS subdomains.Results:Study criteria were met by 150 patients. The cohort averaged 15.0 ± 2.2 years of age, was 50.7% male and underwent predominantly quadriceps (55.3%) or hamstring (36.7%) tendon ACLR. Score correlations appeared stronger with increased follow-up (Table 1.1). Both PROMIS Physical Function and Pain scores demonstrated moderate correlation to IKDC scores at 6-9 months (R=0.689, p<0.001; R=-0.556, p<0.001) and >9 month (R=0.487, p=0.001; R=-0.429, p=0.003) post-operatively. Across all timepoints, Pedi-IKDC and PROMIS Physical function demonstrated a strong correlation (R=0.844, p<0.001) while PROMIS Pain interference showed a moderate correlation (R=-0.541, p<0.001). A conversion equation for predicting Pedi-IKDC score was generated from PROMIS Physical Function and Pain Interference subdomains based on forward stepwise variable selection for robust regression model. This model demonstrates strong predictive ability for Pedi-IKDC (R⁁2=0.752, p<0.001) (Figure 1.2). Conclusion:The results from this study suggest that Pedi-IKDC demonstrates moderate to strong correlation with PROMIS physical function and pain interference domains following pediatric ACLR. Together, these two PROMIS domains also provide a reasonably strong prediction of a patient’s Pedi-IKDC score at a similar postoperative timepoint. These findings serve to facilitate cross-study outcome comparisons and can aid in the reduction of patient survey burden. Further work will be necessary to confirm these results across a broader patient cohort with longer periods of postoperative follow-up.Table 1.1.

Clinical and functional outcomes of isolated posterior cruciate ligament reconstruction in patients over the age of 40\xa0years

BackgroundTo assess clinical and functional outcomes of patients aged 40 years or older receiving PCL reconstruction surgery.MethodsAll patients older than 40 years with isolated PCL rupture who underwent PCL reconstruction surgery were enrolled into the retrospective study. Associated meniscal injuries, osteochondral lesions, postoperative complications, and the rate of return to the preinjury level of activity were extracted. Outcomes included International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity score. The minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were used to evaluate the clinically relevant value of PCL reconstruction in this population.ResultsIn total, 41 patients with a mean age of 51.7 years were included. The mean follow-up time was 32.8 months. Associated lesions included meniscal injuries (48.8%) and osteochondral lesions (97.6%). Improvement in the IKDC score (from 46.5 preoperatively to 79.0 postoperatively, p < 0.0001), Lysholm score (from 65.5 to 88.3, p < 0.0001), and Tegner activity score (from 2.3 to 4.0, p < 0.0001) was recorded. The clinically relevant value based on the MCID showed that 34 of 41 patients (82.9%) had a ΔIKDC score exceeding 16.8; all patients (100%) showed a ΔLysholm score exceeding 8.9; and 35 of 41 patients (85.4%) showed a ΔTegner activity score exceeding 0.5. Regarding the PASS, none of the patients had an IKDC score exceeding 75.9 preoperatively, whereas 27 of 41 patients (65.9%) had a score of more than 75.9 postoperatively. All patient had ≥ grade II knee instability preoperatively. Postoperatively, 36 patients (87.8%) had no significant joint translation, and 5 patients (12.2%) had grade I instability. Twenty-one patients (51.2%) returned to their preinjury level of activity. Five patients (12.2%) developed Ahlbäck grade I radiographic osteoarthritis. No rerupture or other major perioperative complications were reported.ConclusionsPCL reconstruction is a reliable surgery for middle-aged patients suffering from persistent instability even after failed conservative treatment, with significant improvement in patient-reported outcomes that exceeded MCID in the majority of patients, restoration of subjective instability, and approximately half of the patients returned to preinjury activity levels.Level of evidenceLevel IV, therapeutic case series.

Does anterolateral ligament internal bracing improve the outcomes of anterior cruciate ligament reconstruction in patients with generalized joint hypermobility?

Generalized joint hypermobility (GJH) is a risk factor for anterior cruciate ligament (ACL) injury and ACL graft failure and is considered an indication for anterolateral ligament (ALL) reconstruction. The aim of this retrospective study was to compare functional outcomes, rupture rates, and residual instability in patients with GJH undergoing isolated ACL reconstruction or combined ACL reconstruction and ALL augmentation with internal bracing (ALL-IB). Sixty-eight patients with GJH and unilateral ACL injury were randomly assigned to undergo either isolated ACL reconstruction (Group 1) or combined ACL reconstruction and ALL-IB (Group 2). The patients were evaluated pre- and postoperatively; their medical histories; physical examination results; anterior knee translation, as measured using the KT-1000 arthrometer; and scores of validated knee assessments were recorded. Groups 1 and 2 consisted of 37 and 31 patients, respectively. The mean follow-up was 30.1±4.1 and 28.1±2.9 months, respectively. In the final evaluation, the patients in Group 2 showed better rotational stability, as evaluated by the pivot-shift test (p=0.013); better anteroposterior stability, as evaluated by KT-1000 arthrometry (p=0.001); similar function (p=0.14 for the Lysholm, p=0.11 for the Cincinnati, and p=0.19 for the International Knee Documentation Committee subjective score); and failure rate (p=0.41). The functional outcomes were similar between the groups. The stability outcomes after combined ACL and ALL-IB were better than those after isolated ACL reconstruction in patients with GJH. However, the technique and its results need to be validated in larger patient series and prospective randomized controlled trials.

Isokinetic exercises in quadriceps strength and endurance recovery after anterior cruciate ligament reconstruction

Background/Aim: Muscle strength and endurance recovery of the quadriceps after anterior cruciate ligament reconstruction is necessary for normal knee function. In addition to the use of the isokinetic dynamometer for diagnostic purposes, its possible therapeutic effect is also important, ie targeted correction of the measured muscle deficit. This work was aimed to examine the level of quadriceps strength and endurance recovery 6 months after the anterior cruciate ligament reconstruction in patients who performed isokinetic training and to determine whether it is a superior therapeutic intervention compared to isodynamic training. Methods: A total of 70 patients of both sexes were monitored in a prospective clinical study. Three months postoperatively, all patients had quadriceps torque measured to body weight on an isokinetic dynamometer at angular speeds of 60 and 180 °/s. Patients were divided into two groups according to the type of applied rehabilitation protocol. Group A patients (n = 35) underwent a rehabilitation program 5 times a week using an individual kinesitherapy program (isometric and isotonic exercises for quadriceps and hamstrings) and neuromuscular electrostimulation of the quadriceps. In addition patients from group B (n = 35) were included in targeted isokinetic exercises for the quadriceps. Control isokinetic testing was performed 6 months after surgery. The comparison of the effect of the applied therapeutic procedures in groups A and B was performed with the Student t-test (p &lt; 0.05). Results: An average age of patients was 27.29 ± 5.94 years. In patients in group B, statistically significantly higher values of the peak torque to body weight were measured at angular velocities of 60 and 180 °/s for the quadriceps of the operated knee 6 months after reconstruction of the anterior cruciate ligament with hamstring tendons (p &lt; 0.05). Conclusion: Isokinetic training achieved significantly better quadriceps strength and endurance in patients 6 months after anterior cruciate ligament reconstruction with hamstring tendons compared to dynamic exercises.

Kết quả phẫu thuật nội soi tái tạo dây chằng chéo trước khớp gối ở người bệnh trên 50 tuổi tại Bệnh viện Hữu nghị Việt Đức

Abstract Introduction: A few years ago, arthroscopic became one of the most common treatments for anterior cruciate ligament (ACL) injury. Patients who are older than 50 years of age have problems of degenerative knee, ACL reconstruction indication in this group has many different perspectives. Materials and Methods: Retrospective and prospective descriptive study was conduted in the patients group over 50 years of age having ACL reconstruction in Viet Duc University Hospital from April 2017 to November 2018. Follow-up examination was in one, three and six months. Results: After 1 month, 96,2% of the patients had movement amplitude over 90 degrees, there were no cases of swelling knee, knee joint effusion or infection of the incision. After 3 months of surgery, all patients could flex their knee joints over 120 degrees, 93,2% of patients had negative the Lachmann sign, 91% of them had negative anterior draw test and negative Pivot shift sign ratio was 97,7%. Re-examination after 6 months of surgery showed that 83,9% patients had good or very good the Lysholm score, amplitude of joint movement means was 147 ± 11,8 degree. Conclusion: Our results suggest that individuals 50 years and older who have symptomatic instability from an absent or insufficient ACL can have good outcomes with surgical reconstruction if there are no contraindications. Key word: Laparoscopy surgery, anterior cruciate, over 50 years old. Tóm tắt Đặt vấn đề: Trong những năm gần đây, phẫu thuật nội soi đã trở thành phương pháp thường quy để điều trị đứt dây chằng chéo trước (DCCT) khớp gối cho người bệnh dưới 50 tuổi, có nhu cầu hoạt động thể lực. Tuy nhiên tổn thương dây chằng chéo trước (DCCT) ở lứa tuổi trên 50 thường kèm theo bệnh lý thoái hóa khớp gối, vì vậy chỉ định phẫu thuật nội soi tái tạo DCCT ở lứa tuổi này còn nhiều quan điểm khác nhau. Phương pháp nghiên cứu: Nghiên cứu mô tả hồi cứu kết hợp tiến cứu được tiến hành trên 56 người bệnh trên 50 tuổi, được phẫu thuật nội soi tái tạo DCCT tại Bệnh viện Hữu nghị Việt Đức từ tháng 4/2017 đến tháng 11/2018. 100% người bệnh được tái khám, đánh giá kết quả sau phẫu thuật 1, 3, 6 tháng. Kết quả: Sau 1 tháng phẫu thuật, 96,2% người bệnh có biên độ vận động &gt; 900, không có trường hợp nào nhiễm trùng vết mổ. Sau phẫu thuật 3 tháng, tất cả người bệnh có biên độ gấp gối đạt trên 1200, duỗi hết gối, 93,2% người bệnh có dấu hiệu Lachmann âm tính, 91% có dấu hiệu rút ngăn kéo trước âm tính, tỷ lệ âm tính với dấu hiệu Pivot shift là 97,7%. Đánh giá lại sau 6 tháng điều trị có 83,9% người bệnh có điểm Lysholm ở mức tốt hoặc rất tốt, biên độ vận động khớp gối trung bình là 147 ± 11,8 độ. Kết luận: Kết quả của chúng tôi cho thấy rằng những người bệnh từ 50 tuổi trở lên có triệu chứng lâm sàng do tổn thương ACL có thể cho kết quả tốt với phẫu thuật nội soi tái tạo nếu không có chông chỉ định. Từ khóa: Phẫu thuật nội soi, dây chằng chéo trước, trên 50 tuổi.

The clinical outcome of minimally invasive popliteal tendon recess procedure is comparable to arthroscopic popliteal tendon reconstruction in patients with type A posterolateral rotational instability.

To compare the objective and subjective clinical outcome of minimally invasive popliteal tendon (PT) recess procedure versus arthroscopic PT reconstruction, combined with posterior cruciate ligament reconstruction in patients with Type A posterolateral rotational instability (PLRI). The hypothesis was that the two techniques had comparable clinical outcomes. Between 2012 and 2017, patients who were eligible for inclusion in this study if they (1) had Type A PLRI according to Fanelli's classification with posterior tibial translation > 12mm on stress radiography and side-to-side difference of dial test external rotation > 10°, (2) PT peel-off lesion or laxity with structural integrity (3) were followed for a minimum of 2years with examination under anesthesia (EUA) and stress radiograph results. Evaluation included subjective scoring, knee stability examinations and second-look arthroscopic lateral gutter drive-through (LGDT) test. Patients who underwent PT recess procedure were designated as Group A, while patients who underwent arthroscopic PT reconstruction were labelled as Group B. The differences between the two groups were analyzed. A total of 61 eligible patients with a minimum follow-up time of 2years were evaluated in the present study. At the final follow-up, there were no significant inter-group differences in Lysholm scores (Group A: 69.0 ± 16.5, Group B: 75.8 ± 14.6, ns), Tegner scores [Group A: 2 (1-4), Group B: 3 (1-5), ns], or IKDC subjective scores (Group A: 70.5 ± 13.5, Group B: 71.1 ± 9.1, ns). No significant difference in side-to-side difference on posterior stress radiography (Group A: 4.3 ± 3.8mm, Group B: 4.7 ± 4.6mm, P = 0.701), dial test result (Group A: 0.9 ± 4.4°, Group B: 1.6 ± 4.9°, ns) or LGDT test positive rate (Group A: 2/34, 5.9%, Group B: 2/27, 7.7%, ns) was observed. Both minimally invasive PT recess procedure and arthroscopic PT reconstruction significantly improved the knee stability and subjective outcome comparing with preoperative value. In a comparison with arthroscopic PT reconstruction, the recess procedure demonstrated comparable subjective and objective clinical outcome. When both PT reconstruction and PT recess procedure are indicated, the minimally invasive and graft-free recess procedure can be a viable option. III.

Female gender and medial meniscal lesions are associated with increased pain and symptoms following anterior cruciate ligament reconstruction in patients aged over 50years.

Several studies report satisfactory clinical outcomes following ACLR in older patients, but none evaluated the effects of meniscal and cartilage lesions. The aim was to evaluate the influence of meniscal and cartilage lesions on outcomes of ACLR in patients aged over 50years. The authors prospectively collected records of 228 patients that underwent primary ACLR, including demographics, time from injury to surgery, whether injuries were work related, and sports level (competitive, recreational, or none). At a minimum follow-up of 6months, knee injury and osteoarthritis outcome scores (KOOS), International Knee Documentation Committee (IKDC) score and Tegner activity level were recorded, and differential laxity was measured as the side-to-side difference in anterior tibial translation (ATT) using instrumented laximetry devices. Regression analyses were performed to determine associations between outcomes and meniscal and cartilage lesions as well as nine independent variables. A total of 228 patients aged 54.8 ± 4.3years at index ACLR were assessed at a follow-up of 14.3 ± 3.8months. KOOS subcomponents were 85 ± 13 for symptoms, 91 ± 10 for pain, 75 ± 18 for daily activities, 76 ± 18 for sport, and 88 ± 12 for quality of life (QoL). The IKDC score was A for 84 (37%) knees, B for 96 (42%) knees, C for 29 (13%) knees, and D for 8 (4%) knees. Tegner scores showed a decrease (median 0, range -4 to 4) and differential laxity also decreased (median - 4, range - 23.5 to 6.0). KOOS symptoms worsened with higher BMI (p = 0.038), for women (p = 0.007) and for knees that had medial meniscectomy (p = 0.029). KOOS pain worsened with higher BMI (p ≤ 0.001), for women (p = 0.002) and for knees with untreated (p = 0.047) or sutured (p = 0.041) medial meniscal lesions. Differential laxity increased with follow-up (p = 0.024) and in knees with lateral cartilage lesions (p = 0.031). In primary ACLR for patients aged over 50years, female gender and medial meniscal lesions significantly compromised KOOS symptoms and pain, while lateral cartilage lesions significantly increased differential laxity. Compared to knees with an intact medial meniscus, those with sutured or untreated medial meniscal lesions had worse pain, while those in which the medial meniscus was resected had worse symptoms. These findings are clinically relevant as they could help surgeons with patient selection and adjusting expectations according to their functional demands. III.

Surgical Wound Complications after Knee Cruciate Ligament Reconstruction in Patients with Atopic Dermatitis.

Atopic dermatitis (AD), sometimes referred to as eczema, is a common skin disease, and skin barrier dysfunction and immunological disorders are well recognized. However, surgical wound complications after orthopaedic surgery in patients with AD have not been described. This study aimed to report four patients with AD who developed foreign body reactions to FiberWire sutures with or without surgical wound infection (SSI) after knee cruciate ligament reconstruction (CLR). The mean age was 19.8 (range, 16-25) years, and patients 1 and 3 underwent reconstructions of the posterior and anterior cruciate ligament, respectively. At a mean of 7.5 (range, 4-10) weeks postoperatively, discharge from the surgical wound at the tibial side of the fixed graft was identified. All patients were treated with continuous saline lavage and antibiotics; however, their wounds did not heal. Second-look arthroscopy and hardware removal were performed at a mean 12.2 (range, 9-15) months postoperatively. Proliferated granulation tissue surrounding the FiberWire was identified. Intraoperative wound cultures were negative in three of the four patients. Histological examination of the tissues adjacent to the FiberWire revealed a foreign body reaction. All wounds healed immediately after the second surgery. In addition to SSI, foreign body reactions are more likely to occur in patients with AD than in those without AD. Preoperative management of AD by dermatologists and consideration of appropriate suture materials are mandatory to reduce surgical wound complications after knee CLR in patients with AD.

Over the top anterior cruciate ligament reconstruction in patients with open physes: a long-term follow-up study

Anterior cruciate ligament (ACL) rupture in skeletally immature athletes is becoming an injury with increasing incidence. Choices of treatment are still debated, including conservative management vs. various surgical techniques. The lack of long-term reports has been highlighted in the literature. To evaluate long-term results of ACL reconstructions performed in skeletally immature patients using the Over the Top technique with lateral extra-articular tenodesis. Retrospective study. All surgeries performed by same surgeon. A total of 42 patients included. All patients had pre-operative radiological studies. 30 males and 12 females. Average age: 12.5years (range 11-14years). Average follow-up: 96.1months. Clinical evaluation: Pedi-IKDC, Tegner-Lysholm, KT-1000 and plain radiographs. Standardized rehabilitation protocol. No instability or leg length discrepancy was recorded. Average pre-operative Tegner-Lysholm and Pedi-IKDC scores were 55 and 40, respectively, with a score of 94.8 (p < 0.05) and 94.78, respectively, at final follow-up (p < 0.05). Average post-operative (1month) Tegner-Lysholm score: 75 (range: 62-79). Median post-operative Tegner activity: 8. Mean side-to-side (KT-1000): 1.2mm. A total of 22 patients could go back to pre-injury sport activity, with an average rehabilitation of 7.3months. A significant number of cases were included in our structured standardized study and follow-up. Functional scores were excellent overall. Excellent results are testified by a final achievement of 22 patients going back to pre-injury sport activity, which is in keeping with the literature. Our experience exhibited a low complication rate and no metalwork failure. We correlate our results to the use of the Over the Top technique with lateral extra-articular tenodesis. The studied procedure seems to be an excellent option and an effective, feasible and safe technique when treating ruptured ACLs in skeletally immature patients.

Radiographic Landmarks for Femoral Tunnel Positioning in Lateral Extra-articular Tenodesis Procedures

Background: Lateral extra-articular tenodesis (LET) is being increasingly performed as an additional procedure in both primary and revision anterior cruciate ligament reconstruction in patients with excessive anterolateral rotatory instability. Consistent guidelines for femoral tunnel placement would aid in intraoperative reproducible graft placement and postoperative evaluation of LET procedures. Purpose: To determine radiographic landmarks of a recently described isometric femoral attachment area in LET procedures with reference to consistent radiographic reference lines. Study Design: Descriptive laboratory study. Methods: Ten fresh-frozen cadaveric knees were dissected. The footprints of the lateral femoral epicondyle (LFE) apex and the deep aspects of the iliotibial tract, with its Kaplan fiber attachments (KFAs) on the distal femur, were marked with a 2.5-mm steel ball. True lateral radiographic images were taken. Mean absolute LFE and KFA distances were measured from the posterior cortex line (anterior-posterior direction) and from the perpendicular line intersecting the contact of the posterior femoral condyle (proximal-distal direction), respectively. Furthermore, positions were measured relative to the femur width. Finally, radiographic descriptions of an isometric femoral attachment area were developed. Results: The mean LFE and KFA positions were found to be 4 ± 4 mm posterior and 4 ± 3 mm anterior to the posterior cortex line, and 6 ± 4 mm distal and 20 ± 5 mm proximal to the perpendicular line intersecting the posterior femoral condyle, respectively. The mean LFE and KFA locations, relative to the femur width, were found at –12% and 11% (anterior-posterior) and –17% and 59% (proximal-distal), respectively. Femoral tunnel placement on or posterior to the femoral cortex line and proximal to the posterior femoral condyle within a 10-mm distance ensures that the tunnel remains safely located in the isometric zone. Conclusion: Radiographic landmarks for an isometric femoral tunnel placement in LET procedures were described. Clinical Relevance: These findings may help to intraoperatively guide surgeons for an accurate, reproducible femoral tunnel placement and to reduce the potential risk of tunnel misplacement, as well as to aid in the postoperative evaluation of LET procedures in patients with residual complaints.

The Clinical Outcome of Arthroscopic Versus Open Popliteal Tendon Reconstruction Combined With Posterior Cruciate Ligament Reconstruction in Patients With Type A Posterolateral Rotational Instability

To compare the objective and subjective clinical outcomes of arthroscopic versus open popliteal tendon (PT) reconstruction combined with posterior cruciate ligament reconstruction in patients with type A posterolateral corner injury. From January 2012 to March 2016, patients were eligible for inclusion in this study if they (1) had type A posterolateral rotational instability according to Fanelli's classification, (2) underwent arthroscopic (group A) or open PT (group B) reconstruction, and (3) were followed for a minimum of 2years with second-look arthroscopic findings. For evaluation, this study used subjective scoring systems (Lysholm, Tegner, and International Knee Documentation Committee subjective scores), knee stability examinations (side-to-side differences of tibial external rotation angle by dial test and posterior and varus stress radiographs), and second-look arthroscopic lateral gutter drive-through tests during hardware removal operations. A total of 38 patients were included in the study. The mean follow-up period was 31.0 ± 5.8months in group A (n= 21) and 34.8 ± 12.7months in group B (n= 17). At the final follow-up, all subjective and objective evaluation results were significantly improved compared with the preoperative condition. There were no significant intergroup differences in Lysholm score (group A, 72.7 ± 17.2; group B, 67.2 ± 14.2; P= .818), Tegner score (group A, 2; group B, 2; P= .710), or International Knee Documentation Committee subjective score (group A, 73.0 ± 13.8; group B, 69.7 ± 20.7; P= .561) at the final follow-up. In terms of objective evaluations, there was no difference in side-to-side difference of posterior stress radiography (group A, 4.0 ± 3.2mm; group B, 5.0 ± 2.9mm; P= .336) or lateral gutter drive-through test positive rate (group A, 1/21, 4.8%; group B, 2/17, 11.8%; P= .426). Both arthroscopic and open PT reconstruction significantly improved the knee stability and subjective outcome of patients with type A posterolateral rotational instability. In comparison with the open procedure, the arthroscopic PT reconstruction showed similar subjective and objective clinical outcomes. Level III, retrospective cohort study.

The Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction in Patients Using Different Graft Tension During Tibial Fixation

The Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction in Patients Using Different Graft Tension During Tibial Fixation