Endoscopic Anterior Cruciate Ligament Reconstruction Research Articles

Long-term Outcome of Endoscopic Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft

Background Short-term results of anterior cruciate ligament reconstruction are well reported; however, there are no studies evaluating endoscopic reconstruction of the anterior cruciate ligament with a minimum 10-year follow-up. Hypothesis Anterior cruciate ligament reconstruction with patellar tendon graft affords good subjective results and clinical laxity assessments but may be associated with development of osteoarthritis over the long term. Study Design Case series; Level of evidence, 4. Methods Endoscopic anterior cruciate ligament reconstruction was performed in 67 consecutive patients without significant articular surface damage. Patients were assessed at 5, 7, and 13 years after surgery with the International Knee Documentation Committee Knee Ligament Evaluation Form, Lysholm knee score, hop tests, kneeling pain, and radiographs. Results At 13-year review, self-reported assessments remained excellent; 96% of patients reported normal or nearly normal knee function. Grade 0 or 1 results were seen in more than 92% of patients on laxity testing. Patients who had undergone meniscectomy at the time of reconstruction had increased laxity between 7 and 13 years on instrumented testing (P = .03) and 6 times greater odds of anterior cruciate ligament graft rupture than if they had not undergone meniscectomy (95% confidence interval, 1-37). Degenerative changes on radiographs were found in 79% of patients at 13 years and were associated with meniscectomy (P = .006), loss of extension (P = .05), and greater laxity on Lachman test (P = .04). Conclusions Endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft affords and maintains good self-reported assessments and clinical ligament evaluation up to 13 years. Radiographic degenerative changes were seen in three quarters of patients. Almost half developed loss of extension, suggesting onset of early osteoarthritis. Patients who had undergone meniscectomy at the time of reconstruction had increased clinical ligament laxity over time and greater odds of graft rupture, possibly reflecting the effect of prolonged increased strain on the graft. Continued follow-up is required to resolve concerns regarding integrity of the patellar tendon graft beyond 13 years, particularly in the absence of meniscal tissue.

Endoscopic anterior cruciate ligament reconstruction using a computer-assisted fluoroscopic navigation system

BackgroundDuring anterior cruciate ligament (ACL) reconstruction, placement of the reconstructed ligament affects the clinical results. To accomplish accurate and reproducible placement of the tibial bone tunnel, we employed a fluoroscopic navigation system for endoscopic ACL reconstruction. In this study, preciseness of the tibial tunnel placement was evaluated, and the advantages and disadvantages of this navigation system for endoscopic ACL reconstruction are discussed. MethodsAltogether, 16 knees of 16 patients who had undergone ACL reconstruction using this system (navi group) were evaluated regarding the positioning of the tibial tunnel against Blumensaat’s line using X-p and the route of the graft by magnetic resonance imaging (MRI). Another 16 knees of 16 patients who underwent endoscopic ACL reconstruction without the navigation system were the controls (control group). ResultsAt the 1-year follow-up, maximally extended lateral knee X-p revealed that the anterior edge of the tibial tunnel and Blumensaat’s line were almost aligned and that roof impingement was avoided; the T2-weighted MR images showed that the graft was placed close to and parallel to the intercondylar roof in all the knees of the navi group. The ratio of the distance between Blumensaat’s line and the anterior edge of the tibial tunnel at the level of the tibial plateau to the anteroposterior width in fully extended true lateral radiographs was 2.7% ±3.4% in the navi group and 8.4% ±7.4% in the control group. ConclusionsThe computer-assisted fluoroscopic navigation system improves accuracy and decreases dispersion of the tibial tunnel placement against Blumensaat’s line in singlebundle ACL reconstruction. This innovative device renders the reconstruction procedure more reliable, eliminating the problem of skeletal variation among patients. However, the function of this navigation system for femoral tunnel placement is insufficient at present. Further refinement of the system is necessary, and the method of application requires improvement.

371 Long term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: results at 13 years

371 Long term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: results at 13 years

Femoral attachment of the anterior cruciate ligament

Endoscopic anterior cruciate ligament (ACL) reconstruction is one of the most popular orthopaedic procedures. Correct tunnel positioning is a prerequisite to success. Current surgical techniques are unable to duplicate the complex anatomy and function of the native ACL. Surgery mainly aims at restoring anteroposterior laxity. The ACL is not isometric and only a few fibers are nearly isometric over the full range of motion. However, a nearly isometric behaviour of the ACL graft is desirable. Isometry is mainly influenced by femoral attachment; thus the femoral tunnel position has a greater effect than the tibial on graft length changes. The purpose of this article is to describe the anatomy of the femoral ACL insertion and to discuss the surgical techniques used to replicate it.

Changes in Cross-Sectional Area of Hamstring Anterior Cruciate Ligament Grafts as a Function of Time Following Transplantation

To measure the cross-sectional area (CSA) of hamstring anterior cruciate ligament (ACL) grafts in humans up to 2 years postoperatively and to estimate the appropriate graft-notch distance (the distance between ACL graft and roof or wall of the notch) at surgery. Case series. Fifty-nine patients, who had consented to have a magnetic resonance imaging (MRI) evaluation postoperatively, underwent endoscopic ACL reconstruction using 3- to 5-strand autogenous hamstring tendons. Intraoperatively, the CSA of the graft was measured using a custom-made area micrometer. Postoperatively, 115 axial MRIs of the grafts (48 at 3 months, 44 at 12 months, and 23 at 24 months) were obtained. They were transmitted to a personal computer and the CSAs of the grafts' midsubstance were calculated. To evaluate the accuracy of the MRI measurement, another 15 patients who consented to have MRI 2 days after surgery were selected and intraoperative graft CSA measurements and graft axial MRI were performed 2 days after surgery. The CSAs of the grafts measured by MRI 2 days after surgery were well correlated with those directly measured intraoperatively (gamma = 0.905). The CSA of the grafts measured intraoperatively was 43 +/- 5 mm2, and those estimated by MRI at 3, 12, and 24 months were 50 +/- 9 mm2, 54 +/- 9 mm2, and 48 +/- 12 mm2, respectively. The increase in graft diameter at 3, 12, and 24 months was 9% +/- 8%, 13% +/- 10%, and 7% +/- 12%, respectively. In humans, the increase in CSA of the ACL graft was smaller compared with previous animal studies. The graft CSA increased up to 29% (13% in diameter) 12 months after surgery. When a 95% confidence interval was used, the percent increase in diameter of the reconstructed graft was estimated to be less than 32% in 95% of the cases. When the graft diameter was 7, 8, or 9 mm, a 1.1-, 1.3-, or 1.4-mm graft-notch distance, respectively, was suitable for impingement-free graft during postoperative periods with 95% of probability. Level IIII.

Incidence and Risk Factors for Graft Rupture and Contralateral Rupture After Anterior Cruciate Ligament Reconstruction

The aim of this study was to determine the rates of contralateral anterior cruciate ligament (ACL) rupture and of ACL graft rupture after ACL reconstruction using either patellar tendon or hamstring tendon autograft, and to identify any patient characteristics that may increase this risk. Case series. Over a 2-year period, 760 endoscopic ACL reconstructions were performed in 743 patients. Bone-patellar tendon-bone autograft was used in 316 patients and 4-strand hamstring tendon in 427 patients. Those patients with a previous contralateral ACL rupture or those who underwent a simultaneous bilateral ACL reconstruction were excluded, leaving 675 knees (675 patients) for review. Persons not involved in the index operation or the care of the patient conducted follow-up assessment by telephone interview conducted 5 years after surgery. Patients were questioned about the incidence of ACL graft rupture, contralateral ACL rupture, symptoms of instability or significant injury, family history of ACL injury, and activity level according to the International Knee Documentation Committee scale. From our prospective database we obtained further information on graft source, meniscal or articular surface injury, and gender. Binary logistic regression was used to measure the relative association between the measured variables and the risk of graft rupture and contralateral ACL rupture. Five years after primary ACL reconstruction, 612 of the 675 patients (90.7%) were assessed. ACL graft rupture occurred in 39 patients (6%) and contralateral ACL rupture occurred in 35 patients (6%). Three patients suffered both a graft rupture and a contralateral ACL injury. The odds of ACL graft rupture were increased 3-fold by a contact mechanism of initial injury. Return to level 1 or 2 sports increased the risk of contralateral ACL injury by a factor of 10. The risk of sustaining an ACL graft rupture was greatest in the first 12 months after reconstruction. No other studied variable increased the risk of repeat ACL injury. After reconstruction, repeat ACL injury occurred in 12% of patients over 5 years. Twelve months after reconstruction, the ACL graft is at no greater risk than the contralateral ACL, suggesting that adequate graft and muscular function for most activities is achieved by this time. Risk factors for repeat ACL injury identified included a return to competitive side-stepping, pivoting, or jumping sports, and the contact mechanism of the index injury. Female patients were at no greater risk of repeat ACL injury than male patients and graft choice did not affect the rate of repeat ACL injury. Level IV, case series.

Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks

Although it is still unclear what the ideal angle of the tibial tunnel in the coronal plane should be when performing anterior cruciate ligament (ACL) reconstruction using the endoscopic single-incision technique, researchers have recently shown that erroneous placement of the tibial tunnel in the coronal plane can lead to graft laxity and loss of extension. We have developed a simple, reproducible technique to provide an acceptable angle of the tibial tunnel in the coronal plane when using the endoscopic single-incision ACL reconstruction technique by using bony landmarks. With the ACL guide parallel to the femur, the external portion of the tibial tunnel guide is rotated so that the guidewire starting point is made at the bisection of a line between the tibial tubercle and the posteromedial border of the tibia. We have confirmed this technique in cadaver studies with angles of the tibial tunnel less than 75° in the coronal plane in all cases. In addition, we have used this technique with good clinical results in over 100 ACL reconstructions.

Revision anterior cruciate ligament surgery

Anterior cruciate ligament (ACL) reconstruction surgery is one of the most frequently performed operative procedures in orthopaedic surgery. There are estimates that 100,000 new ACL injuries occur annually. Marked improvements have occurred in the last 15 years with regard to graft selection, tunnel placement, graft fixation, and rehabilitation that have resulted in predictable outcomes for ACL surgery using patellar tendon, hamstring, quadriceps tendon, autograft, and allograft tissues. Nevertheless, most studies report a clinical failure rate of between 10% and 15% at short- and intermediate-term follow-ups. 1 Bach Jr, B.R. Jones G.T. Sweet F.A. Hager C.A. Arthroscopy-assisted anterior cruciate ligament reconstruction using patellar tendon substitution. Two- to four-year follow-up results. Am J Sports Med. 1994; 22: 758-767 Crossref PubMed Scopus (176) Google Scholar , 2 Bach Jr, B.R. Levy M.E. Bojchuk J. Tradonsky S. Bush-Joseph C.A. Khan N.H. Single-incision endoscopic anterior cruciate ligament reconstruction using patellar tendon autograft. Minimum two-year follow-up evaluation. Am J Sports Med. 1998; 26: 30-40 PubMed Google Scholar , 3 Bach Jr, B.R. Tradonsky S. Bojchuk J. Levy M.E. Bush-Joseph C.A. Khan N.H. Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation. Am J Sports Med. 1998; 26: 20-29 PubMed Google Scholar Increasing numbers of ACL reconstruction failures are being seen. 4 Williams III, R.J. Warren R.F. Carson E.W. Wickiewicz T.L. Revision anterior cruciate ligament reconstruction The Hospital for Special Surgery experience. Tech Orthop. 1998; 13: 375-383 Crossref Scopus (7) Google Scholar , 5 Steadman J.R. Saterbak A.M. Revision anterior cruciate ligament reconstruction Techniques and tips—The Vail experience. Tech Orthop. 1998; 13: 384-390 Crossref Scopus (6) Google Scholar , 6 Clancy Jr, W.G. Pietropaoli M.P. Revision anterior cruciate ligament reconstruction using the “anatomic-endoscopic” method. Tech Orthop. 1998; 13: 391-410 Crossref Scopus (7) Google Scholar , 7 Bach Jr, B.R. Mazzocca A. Fox J.A. Revision anterior cruciate ligament surgery. in: Grana W.A. Orthopaedic knowledge online. American Academy of Orthopaedic Surgeons, Rosemont, IL2003 Google Scholar , 8 Brown Jr, C.H. Carson E.W. Revision anterior cruciate ligament surgery. Clin Sports Med. 1999; 18: 109-171 Abstract Full Text Full Text PDF PubMed Scopus (192) Google Scholar , 9 Barber F.A. McGuire D.A. Johnson D.H. Should allografts be used for routine anterior cruciate ligament reconstructions?. Arthroscopy. 2003; 19: 421-425 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar , 10 Noyes F.R. Barber-Westin S.D. Revision anterior cruciate ligament reconstruction Report of 11-year experience and results in 114 consecutive patients. Instr Course Lect. 2001; 50: 451-461 PubMed Google Scholar , 11 Uribe J.W. Hechtman K.S. Zvijac J.E. Tjin A.T.E.W. Revision anterior cruciate ligament surgery Experience from Miami. Clin Orthop. 1996; 325: 91-99 Crossref PubMed Scopus (134) Google Scholar The purpose of this article is to discuss the etiology of failure, approaches to the failed ACL patient, surgical technique issues, and results of revision ACL surgery. 7 Bach Jr, B.R. Mazzocca A. Fox J.A. Revision anterior cruciate ligament surgery. in: Grana W.A. Orthopaedic knowledge online. American Academy of Orthopaedic Surgeons, Rosemont, IL2003 Google Scholar

The use of intraoperative fluoroscopy to reduce femoral interference screw divergence during endoscopic anterior cruciate ligament reconstruction

Femoral interference screw divergence can potentially have detrimental consequences in the rehabilitation of anterior cruciate ligament (ACL) reconstruction. Several biomechanical studies suggest that divergence angles greater than 15° significantly decrease the pullout strength of the graft. Numerous techniques have been described in the literature that address this issue; however, the use of an image intensifier intraoperatively is not frequently discussed. We describe a technique in which fluoroscopy is used to confirm the proper position of the femoral interference screw at the time of the procedure, and therefore minimizes the incidence of significant screw divergence. Radiographic analysis of 62 patients who underwent endoscopic ACL reconstruction using bone–patellar tendon–bone autograft using this technique revealed significant divergence in only 3% of patients.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp 314–317

Femoral aimer deformation: Potential cause for altered femoral tunnel placement in anterior cruciate ligament surgery

In this case observational study, a standard commercially available femoral aimer used for endoscopic anterior cruciate ligament (ACL) reconstruction was found to have an abnormal bend in the offset tongue that is normally placed in the over-the-top position for ACL femoral aiming using an endoscopic technique. A standard 3/32-inch Steinmannn pin was placed through the aimer, and the offset distance measured 13 mm instead of the normal 7 mm. If this device had been used, significant error would have occurred, placing the anterior tunnel much more anterior than intended, thus potentially contributing to a surgical failure. The purpose of this case study is to alert physicians to check their femoral aimers to make certain that the offset tongue is parallel, thus assuring accurate placement of the provisional pin.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 2 (February), 2003: E7

Clinical Results of Endoscopic Anterior Cruciate Ligament Reconstruction with Multiplied Hamstring Tendon Autografts (Bi-socket technique)

Clinical Results of Endoscopic Anterior Cruciate Ligament Reconstruction with Multiplied Hamstring Tendon Autografts (Bi-socket technique)

Outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction

Purpose: To determine the healing rate of meniscal repair using the Meniscus Arrow (Bionx, Blue Bell, PA) in patients undergoing concurrent anterior cruciate ligament (ACL) reconstruction and to evaluate patient outcomes with the International Knee Documentation Committee (IKDC) form and a visual analog scale (VAS). Type of Study: Case series with outcomes analysis. Methods: We retrospectively analyzed 38 consecutive patients with 39 meniscal tears in knees undergoing concurrent endoscopic ACL reconstruction whose menisci were repaired with the Meniscus Arrow system. All meniscal tears were deemed amenable to repair according to length, stability, morphology, and zone of tear. There were 31 medial and 8 lateral meniscal tears, with an average tear length of 2.1 cm. An average of 2.5 arrows were used to repair each tear. All 39 tears were located in the posterior horn of the meniscus or extending into the body of the meniscus from the posterior horn. Follow-up was assessed by clinical examination, the knee disorders subjective history, VAS, and the IKDC evaluation form. Reconstructed ACL laxity was assessed by KT-2000 arthrometry and clinical evaluation. Results: At an average follow-up of 2.3 years (range, 18-39 months), 32 patients have been surveyed to date. The success rate was 90.6% (29 of 32 patients) with 3 patients going on to arthroscopic partial meniscectomy. KT-2000 arthrometry showed that sagittal knee laxity was less than 3 mm in all reconstructed knees. Clinical criteria for success in the rest of the repaired menisci included (1) the absence of locking, catching, or giving way; (2) no history of recurrent effusions; (3) no joint line tenderness; (4) a negative McMurray test; and (5) no subsequent surgical procedures on the repaired meniscus. Additionally, the VAS showed the ability of these patients to return to a high level of activity, including competitive sports, without symptoms suggestive of a meniscal tear. The IKDC showed normal or nearly normal function of all success knees. Conclusions: The study shows that a high rate of meniscus healing can be achieved by the all-inside, bioabsorbable Meniscus Arrow system in conjunction with ACL reconstruction. Also, patients have excellent function of their knee and are able to return to a high level of activity. Our healing rates are comparable to those previously reported with the inside-out suture techniques without the need for an additional posterior incision that would increase operative time and risk to neurovascular structures.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 6 (July-August), 2002: pp 569–577

Interference screw divergence in femoral tunnel fixation during endoscopic anterior cruciate ligament reconstruction using hamstring grafts

Purpose:To compare the divergence angles between bioabsorbable interference screws inserted into the femoral tunnel with the screwdriver placed through the anteromedial portal to those inserted with the screwdriver placed through the tibial tunnel and to examine the effect of the femoral tunnel interference screws’ divergence angles on fixation strength of hamstring grafts after anterior cruciate ligament (ACL) reconstruction using hamstring grafts. Type of Study:Cadaveric biomechanical pullout study. Methods:ACL reconstruction was performed in 8 pairs of fresh-frozen human cadaveric knees using hamstring grafts fixed within the femoral tunnels using bioabsorbable interference screws. Within matched pairs, 1 screw was placed into the femoral tunnel using a screwdriver placed through the tibial tunnel (group 1), and in the other knee it was placed into the femoral tunnel using a screwdriver placed through the anteromedial portal (group 2). Radiographs were taken to measure the degree of divergence between the interference screw and the femoral tunnel. After disarticulation, pullout strength was then measured using a cyclic-loading model. Results:In group 2, there was significantly more divergence between the screw and the femoral tunnel compared with group 1, particularly in the sagittal plane (average 14.4° compared with 3.4°, P =.00014). With the number of specimens available for comparison, no significant difference was detected between the 2 groups with regard to 3 mm and 5 mm of pullout when cyclically loaded (P =.77 and.74, respectively). Conclusions: The increased technical difficulty, combined with the potential risks of tibial tunnel widening and graft damage, with placement of the screwdriver through the tibial tunnel for the purpose of decreasing femoral interference screw divergence in ACL reconstruction using hamstring grafts may not be justified.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 5 (May-June), 2002: pp 510–514

Synovial response to intra-articular metal debris

Purpose: Intra-articular metal debris is occasionally seen after completion of an endoscopic anterior cruciate ligament reconstruction. The purpose of this study was to examine the tissue response to intra-articular stainless steel metal debris in order to better understand its role in the inflammatory process. Type of Study: Animal case control study. Methods: Metal filings created from a Beath pin were injected into 10 rabbit knees. The opposite knee of each rabbit was used as a control. The animals were killed at 4 weeks. The knee joints were fixed, sectioned, stained, and examined under light microscopy. Results: Mild to moderate levels of synovial proliferation were observed in all knees injected with metal particles. There was no evidence of phagocytosis of the metal particles, nor was there any evidence of an inflammatory response. No articular cartilage damage was observed as a result of the metal debris. Conclusions: We believe that the few particles of stainless steel that may be produced during the reaming process in anterior cruciate ligament reconstruction do not pose a significant risk of inciting an inflammatory reaction or cause articular cartilage damage within the knee joint.

The effect on leg strength of tourniquet use during anterior cruciate ligament reconstruction: A prospective randomized study

Purpose: The purpose of this study was to prospectively evaluate the effect of tourniquet use during endoscopic anterior cruciate ligament (ACL) reconstruction surgery on dorsiflexion strength, plantarflexion strength, quadriceps strength, and calf and thigh girth. Type of Study: The study was a prospective, double-blind, randomized clinical trial. Methods: Forty-eight patients were prospectively randomized into 2 groups: (1) tourniquet use during surgery (T) and, (2) no tourniquet use during surgery (NT). Within 1 week before ACL reconstruction, all patients were evaluated for isometric plantarflexion and dorsiflexion strength, thigh strength, and thigh and calf girth. These same measurements were repeated 3 weeks postoperatively. At 6 months, isokinetic quadriceps strength was evaluated at 60° per second. All patients underwent ACL reconstruction using a patella-tendon autograft and a tourniquet was placed on the affected extremity. In all 25 T patients, the tourniquet was inflated to 300 mm Hg. The average tourniquet time was 85 ± 7 minutes (range, 51 to 114 minutes). Results: ACL reconstruction resulted in a significant decrease in thigh girth (P <.01), calf girth (P <.01), dorsiflexion strength (P <.01), and plantarflexion strength (P <.05) at 3 weeks postoperatively in both groups. The T group had a greater decrease in thigh girth than the NT group (P <.05). Tourniquet use did not have an effect on calf girth (P =.53), dorsiflexion strength (P =.17), or plantarflexion strength (P =.32) at 3 weeks postoperatively. Tourniquet use also had no effect on quadriceps strength at 6 months postoperatively (P =.78). Conclusions: Tourniquet use of less than 114 minutes during ACL reconstruction had no effect on the strength of the lower extremity after surgery.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 603–607

Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft

Purpose: The purpose of this study was to prospectively evaluate changes in the tibial bone tunnel following endoscopic anterior cruciate ligament (ACL) reconstruction with patellar tendon autograft. We used computed tomography (CT) sequentially to monitor the time course of these changes over a 2-year period and correlated the results to clinical outcome and instrumented laxity measurements. Type of Study: Case series. Methods: Thirty-four patients (11 women, 23 men; mean age, 26.4 ± 4.5 years) who underwent endoscopic patellar tendon ACL reconstruction, were evaluated clinically according to IKDC, Lysholm, and Tegner scores as well as with respect to changes in tibial tunnel morphology over a 2-year period. Subsequent CT scans were performed at 1 and 6 weeks and at 3, 6, 12, and 24 months postoperatively. The tibial bone tunnel was measured in the sagittal and coronal planes at 5 different levels (L1 to L5). Results: The diameters of the tibial tunnel increased an average overall by 30.6% in the sagittal plane and 16.4% in the coronal plane within 2 years. The enlargement was significantly higher (P <.05) in the mid portion of the tunnel (L 2/3: 44.0% and 47.9% in the sagittal and 29.8% and 29.9% in the coronal plane, respectively), which resulted in a uniform cavity-type appearance. The percentage of change in tunnel size was significantly higher (P <.05) within the first 6 weeks following surgery compared with all other time intervals. No correlation between the amount of tunnel enlargement and the clinical results or between tunnel enlargement and KT-1000 measurements could be detected. Conclusions: Endoscopic ACL reconstruction is associated with tibial tunnel enlargement, which is already present within weeks following surgery. However, no negative effects on the clinical results were found over a 24-month period in our study population.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 2 (February), 2001: pp 138–143

Nonunited avulsion fractures of the intercondylar eminence of the tibia

Summary: We report 3 cases of nonunited avulsion fracture of the intercondylar eminence of the tibia. Characteristics of the clinical symptoms were limitation of knee extension, pain at knee extension, and a small amount of anterior instability. For the patient with a normal anterior cruciate ligament (ACL), the fragment was fixed by sutures with a button after curettage of the fibrous tissue. Two patients underwent endoscopic ACL reconstruction using quadrupled semitendinosus tendon because their ACLs had degenerated. Since the technique of ACL reconstruction under arthroscopic control has been well refined, endoscopic ACL reconstruction is considered to be 1 of the surgical options for nonunited avulsion fracture with symptomatic anterior instability if the ACL is degenerated.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 7 (October), 2000: pp 757–762

Bioabsorbable polyglyconate interference screw fixation in anterior cruciate ligament reconstruction: A prospective computed tomography–controlled study

Purpose: It was the purpose of the study to evaluate a new polyglyconate bioabsorbable interference screw for graft fixation in anterior cruciate ligament (ACL) reconstruction. Type of Study: Prospective randomized. Materials and Methods: Forty patients who underwent endoscopic ACL reconstruction were included in the study and randomized intraoperatively. Group A consisted of 20 patients (6 women, 14 men; mean age, 29.6 years) who had femoral bone block fixation with a bioabsorbable interference screw and tibial fixation with a titanium interference screw. Group B included 20 patients (5 women, 15 men; mean age 29.6 years) who had fixation of both femoral and tibial bone blocks with titanium interference screws. There was no significant difference between the groups with regard to age, gender, height, weight, time from injury to surgery, activity level, and concomitant injuries. Results: Clinical results (using IKDC, Lysholm, Tegner scores) of the 2 groups as well as instrumented laxity measurements (KT-1000) did not show significant (P >.05) differences at any stage of follow-up. No complications with respect to graft fixation could be found. Computed tomography scans, performed within the first postoperative week, at 6 weeks, and at 3, 6, 12, and 24 months postoperatively revealed a uniform picture for all patients within the groups, showing completed screw degradation at 12 months in group A. Conclusion: Polyglyconate interference screw fixation for patellar tendon grafts has not been found to be associated with increased clinical complications or significant osteolysis. It provided equivalent fixation and clinical results compared with titanium screws. However, replacement of the screw with bone did not take place for up to 3 years postoperatively.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 16, No 5 (July), 2000: pp 491–498

骨付き膝蓋けんを用いた鏡視下前十字靭帯再建術時の工夫

Patellar tendon is a very useful autogenous material for anterior cruciate ligament reconstruction, but this surgery is not easy. Double-skin incision and a bone plug cutter are used to examine the problems in the use of the patellar tendon for endoscopic anterior cruciate ligament reconstruction.The double-skin incision presented little saphenous nerve injury in front of the knee and satisfied the patients in cosmetic appearance. The use of the bone plug cutter facilitated achievement of the bone-tendon-bone from the patellar tendon and made it easy to insent the bone-tendonbone into the drilled holes of the femur and tibia for the endoscopic anterior cruciate ligament reconstruction.

Complications and Prognostic Factors of Endoscopic Anterior Cruciate Ligament Reconstruction Using Autogenous Patellar Tendon

Complications and Prognostic Factors of Endoscopic Anterior Cruciate Ligament Reconstruction Using Autogenous Patellar Tendon