Gracilis Autograft Research Articles

Functional outcome of arthroscopic posterior cruciate ligament reconstruction using quadrupled semitendinosus Gracilis graft: A prospective study

Background: Posterior cruciate ligament (PCL) is strongest of all ligaments around knee & its reconstruction remains a technically demanding surgery. Outcome of the surgery is multifactorial including graft material Selection, method of fixation etc. Our prospective study evaluates results of PCL reconstruction using quadripuled semitendinoses gracilis autograft, with 3 years follow up. Patients and Methods: 40 patients were included in the study which extended for 36 months. This was a prospective study and all cases which had PCL rupture during this period were considered for this study. Patients with isolated chronic PCL rupture as well as multi ligament injuries including PCL rupture were included in the study. Results: Physiotherapy was started on the second postoperative day and 40% had excellent outcome with Lysholm knee score whereas 60% had good outcome. Majority of the patients (95%)were men which implies that this kind of injuries common with RTA’s and worksite injuries. Conclusion: Reconstruction of PCL using quadripuled semitendinoses gracilis autograft improves the clinical outcome drastically.

Feasibility of lower trapezius and rhomboid minor transfer for irreparable subscapularis tears: an anatomic cadaveric study.

BackgroundPreviously reported outcomes after tendon transfers to reconstruct the subscapularis are unpredictable and often unsatisfactory, especially in the presence of anterior humeral head subluxation. We studied the anatomic feasibility of the lower trapezius and the rhomboid minor transfer to reconstruct irreparable tendon tears of the subscapularis. The aim of this study was to determine the feasibility of lower trapezius and rhomboid minor transfer to reconstruct irreparable subscapularis tendon tears.Materials and methodsWe measured the tendons dimensions, muscles excursions, distances to pedicles, and dissection needed to complete a successful lower trapezius and/or rhomboid minor transfer to the subscapularis footprint in 10 cadaveric shoulders. The transferred muscles were detached distally, augmented with a semitendinosus and gracilis autograft, and passed anteriorly between the scapula and the subscapularis remnant through a small serratus window to reach the lesser tuberosity. The risk of pedicle compression was subjectively assessed in all cases.ResultsThe trapezius and rhomboid tendons were asymmetric with an average length of 37.6 mm and 21.7 mm, an average width of 63 mm and 33.4 mm, respectively. The mean distances from each distal insertion to the lesser tuberosity were 109 mm for the trapezius and 144 mm for the rhomboid. Mean distances from tendon to pedicle were 57.9 mm and 33.1 mm, respectively. The mean size of the necessary serratus window was 49.4 mm, which was measured at maximal excursion achieved at maximal external rotation 90° representing two digitations. All of the tendon transfers were feasible, and the risk of pedicle compression was 20% for the trapezius and 10% for the rhomboid. Superior migration of the transfer was observed during passive external rotation if the insertion point was too high.ConclusionsTransfer of the lower trapezius and rhomboid minor to the lesser tuberosity to reconstruct an irreparable subscapularis tear is feasible without extensive dissection and with a low risk of nerve compression. We recommend not to transfer the rhomboid minor routinely, owing to the risk of tendon luxation after external rotation of the shoulder.

Evaluating the results of an all-inside arthroscopic posterior cruciate ligament reconstruction using hamstring tendon autograft

Abstract Introduction: The posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) are important to ensure the stability of the knee joint. Both PCL and ACL can be injured, but PCL injuries are much less common than ACL injuries. In order to summarize the experience and improve the quality of treatment, we conducted the research with the aim is to evaluate the results of arthroscopic all-inside posterior cruciate ligament reconstruction using hamstring tendon autograft. Materials and methods: From June 2018 to December 2019, all patients who had posterior cruciate ligament (PCL) rupture treated with all-inside arthroscopy PCL reconstructions using semitendinous and gracilis autograft at the Joint Surgery Department of 108 Military Central Hospital were enrolled. The results were evaluated according to the Lysholm - Gilquist and IKDC - 2000 score. Results: 28 patients were enrolled. The mean age was 34,1 years (range: 20 – 55 years old), the mean follow-up time was 15,8 months, good results accounted for 35,7%, fair: 57,1%, average: 7,2%. Conclusions: In patients with PCL rupture, who were treated with arthroscopy PCL reconstruction by all - inside technique, the results were good prospects. However, it needs to assess more patients and to follow-up for long term.

Modified Broström-Gould With Gracilis Autograft Augmentation Surgery and Accelerated Noncasted Rehabilitation in High Demand Patients With Lateral Ankle Instability

Lateral ankle instability that has failed conservative management can be physically debilitating. Good outcomes are obtained from Broström-Gould augmented repair techniques, however there are few studies evaluating the use of a gracilis autograft augmentation coupled with an accelerated rehabilitation program in high functional demand patients. We believe that the modified Broström-Gould technique utilizing a Gracilis autograft will provide significant improvements in stability while maintaining normal ankle biomechanics in young, high demand patients. The prospective cohort study involved 19 patients (20 ankles) who underwent surgery for chronic lateral ankle instability by a single surgeon, at a single institution between October 2014 and April 2016. Patients were followed for 33.8 ± 11.7 (range 12-48) months. Patients were assessed both pre- and postoperatively for talar tilt angle radiographically and with both American Orthopaedic Foot and Ankle Society Ankle and Hindfoot scores and Karlsson-Peterson scores. A Tegner activity score was taken at the last follow-up. The mean American Orthopaedic Foot and Ankle Society score increased from 68.85 ± 10.57 to 91.56 ± 5.31 points (p < .01) and mean Karlsson-Peterson score increased from 50.9 ± 15.53 to 88.11 ± 8.64 points (p value <.01) when compared preoperatively to mean postoperative follow-up of 33.8 months. Tegner activity score was 7.05 ± 0.89 at last follow-up. The technique was found to be effective in treating chronic lateral ankle instability and in combination with an accelerated rehabilitation protocol, patients returned to their premorbid level of activity with improved stability and no significant effect on donor graft site morbidity.

Evaluation of the results of arthroscopic anterior cruciate ligament reconstruction with quadruple strand hamstring autograft fixed by biodegradable screws

Introduction: Worldwide arthroscopic surgeons commonly used hamstring tendons as the favorable graft and biodegradable screws for fixation of the graft for Anterior Cruciate Ligament reconstruction (ACLR). The present research was undertaken to evaluate the results of arthroscopic ACL reconstruction with quadruple strand Semitendinosus and Gracilis (STG) autograft and fixed by biodegradable interference screws in both tibia and femur. Materials and Methods: This quasi-experimental research was included thirty (30) patients with ACL injuries and were treated in the form of arthroscopic reconstruction of ACL by quadruple strand hamstring autograft fixed by biodegradable screws in both tibia and femur. Preoperative and postoperative evaluations were performed according to the Lysholm Knee Scoring Scale and rehabilitation protocol was followed accordingly. Final outcome was evaluated at 24 weeks post-operatively. Results: In pre-operative evaluation, Lysholm Knee Score was poor in 93% cases and fair in 7% cases. Post operatively significant improvement was found. According to postoperative Lysholm knee score, an excellent result was obtained in 73% cases, good in 20% cases and fair in 7% cases which showed significant improvement. Conclusion: For arthroscopic ACL reconstruction, quadrupled hamstring autograft fixed with biodegradable screws in both tibia and femur brings an excellent and acceptable result.

Five-Strand Versus Four-Strand Hamstring Autografts in Anterior Cruciate Ligament Reconstruction—A Prospective Randomized Controlled Study

To compare the clinical outcomes of the routine use of 5-strand hamstring grafts (where possible) with those of 4-strand grafts in primary anterior cruciate ligament (ACL) reconstruction. A total of 64 patients were enrolled in a prospective randomized controlled study comparing the use of 5-strand and 4-strand semitendinosus-gracilis autografts in single bundle ACL reconstruction (n= 32 in each group). Four participants in each group were lost to follow-up and were excluded from the outcome analysis. The outcomes of 28 patients in the 5-strand group and 28 patients in the 4-strand group were analyzed. The diameters of all grafts were measured intraoperatively. Patients were assessed postoperatively at 2 years with objective assessments (anterior knee laxity using the KT-2000 arthrometer, Lachman test, pivot-shift test, hop test) and patient-reported outcome scores (Lysholm knee score, Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee subjective knee score, SF-36 physical and mental components, Tegner activity scale). Postoperative graft ruptures were also noted. There were improvements in all outcome measures postoperatively regardless of the number of graft strands. When we compared the study and control groups, there were no significant differences in all subjective and objective outcome measures except the Knee Injury and Osteoarthritis Outcome Score symptoms score (5-strand group 93.3 ± 9.2 vs 4-strand group 86.2 ± 14.7, P= .04). The KT-2000 side-to-side difference was 2.79 ± 2.11 mm in the 5-strand group and 2.54 ± 1.75 mm in the 4-strand group (P=.63). The 5-strand study group had 2 graft ruptures at 1 year, whereas the 4-strand control group had one partial graft rupture at 6 months. At 2-year follow-up, the routine use of the 5-strand hamstring tendon autograft was not superior to that of the quadrupled or 4-strand graft in primary ACL reconstruction. Level I, prospective randomized controlled trial.

Patellar Tendon Versus 4-Strand Semitendinosus and Gracilis Autografts for Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Randomized Controlled Trials With Mid- to Long-Term Follow-Up

To compare patellar tendon (PT) autografts with 4-strand semitendinosus and gracilis (STG) autografts concerning knee stability, functional outcomes, as well as complications after anterior cruciate ligament (ACL) reconstruction at minimal follow-up of 5 years. A systematic search of the literature was performed in PubMed, Embase, and the Cochrane Library to identify published prospective randomized controlled trials on clinical studies comparing PT autograft and 4-strand STG autografts for ACL reconstruction. The results of the eligible studies were analyzed in terms of knee stability (laxity measurements, Lachman test, and pivot-shift test), functional outcomes (Lysholm score, International Knee Documentation Committee score, Cincinnati score, Tegner score, single-legged hop test, and return to preinjury activity level), and complications (loss of range of motion [ROM], pain, graft re-rupture, revision, and osteoarthritis [OA]). Nine clinical studies with 630 patients (313 PT and 317 STG autografts) met the inclusion criteria. No statistically significant differences were found between the PT and STG group in Lachman test, pivot-shift test, International Knee Documentation Committee score, Cincinnati score, loss of ROM, kneeling pain, graft re-rupture rate, revision rate, and OA rate. The STG group was found with less anterior knee pain (P= .003). There were no clinically significant differences for the outcomes of SSD, Lysholm score, and Tegner score. Except for significantly greater risk of anterior knee pain, PT autograft had comparable results with 4-strand STG autograft in terms of knee stability and functional outcomes after ACL reconstruction with mid- to long-term follow-up. Besides, we found no statistically significant difference in loss of ROM, kneeling pain, graft re-rupture rate, revision rate, and OA change, but these results were underpowered. Level I, meta-analysis of Level I studies.

Computed tomography (CT), X-ray, and MRI evaluation of two anterolateral knee reconstruction techniques: lateral extra-articular tenodesis (LET) and the anterolateral ligament (ALL) reconstruction.

The anterolateral ligament (ALL) and capsule of the knee are anatomical structures involved in rotational stability and pivot-shift control. As such, it has been demonstrated that the extra-articular anterolateral procedures improve clinical outcome when performed as an augmentation of the anterior cruciate ligament (ACL) reconstruction in specific groups of patients. This review describes the postoperative imaging findings of two techniques used to perform these procedures, using magnetic resonance imaging (MRI), computed tomography (CT), and radiography. The first technique described is the lateral extra-articular tenodesis (LET), which uses a strip of the iliotibial band that is harvested, passed underneath the lateral collateral ligament (LCL) and fixed posterior, and proximal to the lateral femoral epicondyle (LFE), preserving ITB insertion on Gerdy's tubercle. The second technique described is the ALL reconstruction, a procedure that attempts to recreate the anatomy of the ALL, using most often a gracilis autograft. In this procedure, femoral fixation is performed proximal and posterior to the LFE, and tibial fixation is slightly distal to the joint line, halfway from Gerdy's tubercle to the fibular head. The main objective of this review is to provide an overview of the postoperative imaging aspects of these two procedures with MRI, CT, and radiography and to describe possible complications. As they become more common, it is important for the radiologist and the orthopedic surgeon to understand their particularities in combination with the already well-known ACL reconstruction.

Does graft choice influence the outcome of MPFL reconstruction in patients with patellofemoral instability and increased TT-TG distance?

A systematic review of the literature was conducted to determine the effect of graft choice on patient outcomes in patients undergoing a medial patellofemoral ligament (MPFL) reconstruction with concomitant tibial tubercle transfer (TTT). Utilizing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and QUORUM (Quality of Reporting of Meta-Analyses) protocol, a systematic search identified and analyzed the published literature pertaining to MPFL reconstruction with TTT. The literature search yielded eight eligible studies with a total of 183 knees treated with a MPFL reconstruction with TTT procedure involving either a gracilis autograft, a semitendinosus autograft, or a medial retinaculum autograft. The eight studies varied on the outcome measures reported, but the outcome measures most consistently used and assessed in this systematic review included the complication rate, postoperative instability rate, Kujala score, Lysholm score, International Knee Documentation Committee functional evaluation form, and the Tegner activity scale. Our study found that patients undergoing MPFL reconstruction with TTT resulted in good overall patient outcomes. No statistical difference was found between the graft choices on any of the outcome measures. While MPFL reconstruction with TTT resulted in low to moderate complication rates and low postoperative patellofemoral instability rates, one potential explanation for the postoperative instability and knee stiffness observed may derive from graft choice. Future research may consider addressing the effect of graft choice on improperly tensioned grafts and overmedialized TTTs.

Clinical and radiological results after one hundred fifteen MPFL reconstructions with or without tibial tubercle transfer in patients with recurrent patellar dislocation—a mean follow-up of 5.4 years

Medial patellofemoral ligament reconstruction (MPFLR) shows low recurrent rates and high satisfaction. Reports on outcome at mid-term follow-up in a large cohort with or without tibial tubercle transfer (TTT) are scarce. One hundred six patients (115 knees; 24.3 ± 8.7years) with recurrent patellar dislocation underwent MPFLR with ipsilateral gracilis autograft and were included in this retrospective follow-up study. In 43 knees, simultaneous TTT was performed for patellar maltracking due to patella alta or increased tibial tubercle trochlear groove distance (TT-TG). Kujala and subjective knee scores were recorded pre- and post-operatively. Eighty-seven percent of the patients were satisfied at a mean follow-up of 5.4 ± 3.1years. The Kujala score increased in 81.7% of all knees from 50.9 to 76.2 points (p < 0.01). Patients with a decreased Kujala score were not different in terms of follow-up time, age, trochlear dysplasia, or post-operative patellar height. The decline was related to an increase in pain, whereas functional scores remained identical. There were six patients with persisting instability, three with patellar re-dislocation. Re-operation was necessary in 24 patients (21.2%), mainly for implant removal after TTT and loss of flexion. Performing TTT had no significant influence on the subjective outcome. Patients with more than eightyears of follow-up (n = 27) did not show any difference in the subjective outcome parameters, or in osteoarthritis progression. MPFLR with and without TTT is a reliable treatment option for recurrent patellar dislocation without deterioration at mid-term follow-up. Persisting pain is a major post-operative issue that seems to be unrelated to patellofemoral anatomy.

Graft and Button Modification of Technique of Coracoclavicular Joint Reconstruction in Treatment of Chronic Type V Acromioclavicular Joint Dislocation: A Case Report

Treatment of chronic Rockwood’s type V Acromioclavicular (AC) joint dislocation remains controversial. We describe a surgical technique to reduce and maintain AC joint using a combination of gracilis autograft with GraftMax™ button (Conmed Inc, Utica, NY). Graft was prepared using running whip stitch technique with No. 5 Hi-Fi high strength suture (ConMed Linvatec, Largo, FL). Our technique reduces intraoperative clavicular and coracoid tunnel fracture and restores anatomical coracoclavicular ligament. At sixth week and third month postoperatively, the patient demonstrated good clinical and radiographic outcome.

Allograft Augmentation of Hamstring Anterior Cruciate Ligament Autografts Is Associated With Increased Graft Failure in Children and Adolescents

Background: Anterior cruciate ligament (ACL) reconstruction in adolescents is commonly performed with hamstring tendon autografts. Small graft diameter is one risk factor for graft failure and options to upsize the autologous hamstring graft include allograft augmentation and tripling one or both of the hamstring tendons. Purpose: To evaluate the association of upsized hamstring graft constructs and graft rupture after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed of patients 19 years of age and younger who underwent hamstring autograft ACL reconstruction with or without soft tissue allograft augmentation from 2012 to 2016. All patients were skeletally mature or had less than 2 years of growth remaining. Graft constructs included 4-strand doubled semitendinosus and gracilis autograft (4-STG), 5-strand tripled semitendinosus and doubled gracilis autograft (5-STG), and 6-strand doubled gracilis and semitendinosus autograft augmented with a soft tissue allograft (6-STGAllo). The primary outcome measure was graft rupture. Results: A total of 354 patients with a mean age of 15.3 years (range, 10-19 years) were included. Graft constructs included 4-STG (198 knees), 5-STG (91 knees), and 6-STGAllo (65 knees). The average diameter of the graft constructs was 8.3 mm for 4-STG, 8.9 mm for 5-STG, and 9.2 mm for 6-STGAllo (P < .001). The mean follow-up was 26 months (range, 6-56 months). There were 50 (14%) graft ruptures and 24 (7%) contralateral ACL tears. The graft failure rates were 14% for 4-STG, 12% for 5-STG, and 20% for 6-STGAllo (P = .51). The average time to graft failure was 16 months (range, 2-40 months). After adjusting for age and graft size, patients who had allograft-augmented grafts (6-STGAllo) had 2.6 (95% CI, 1.02, 6.50) times the odds of graft rupture compared with 4-STG. There was no significant difference in failure rate between patients who had 5-STG grafts compared with 4-STG (OR, 1.2; 95% CI, 0.5, 2.7). Conclusion: ACL reconstruction with hamstring tendon autografts augmented with allografts has a significantly increased risk of graft rupture compared with comparably sized hamstring tendon autografts. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend obtaining a larger graft diameter by tripling the semitendinosus rather than augmenting with an allograft.

Superficial and Deep Medial Collateral Ligament Reconstruction for Chronic Medial Instability of the Knee

There are several surgical techniques for medial collateral ligament reconstruction, including anatomic or nonanatomic medial knee reconstruction. Although the medial collateral ligament consists of the superficial medial collateral ligament (sMCL) and deep medial collateral ligament (dMCL), surgical procedures have only been described for reconstruction of the sMCL alone or reconstruction of the sMCL and posterior oblique ligament. The dMCL assists the knee in rotational stability, primarily in extension, moving into early flexion. We describe sMCL and dMCL reconstruction with semitendinosus and gracilis autografts using adjustable-length loop suspensory fixation devices for tibial fixation. By use of our technique, it is possible to provide good stability and satisfactory results for medial instability of the knee.

A Clinical and Magnetic Resonance Imaging Assessment of Anterior Cruciate Ligament Reconstruction with Different Fixation Techniques Using Gracilis and Semitendinosus Autograft

Background:Hamstring tendons are widely used in anterior cruciate ligament reconstruction. Improvements in fixation materials have increased the success of the reconstruction procedures using this type of graft. The main advantage of the hamstring tendon autograft is the lower donor site morbidity associated with its harvesting. On the other hand, tunnel widening is reported more frequently with the use of hamstring tendon autograft compared to patellar or quadriceps tendons. The objective of the present study was to evaluate three different fixation techniques at a minimum of 2 years after Anterior Cruciate Ligament (ACL) reconstruction using gracilis and semitendinosus autograft.Methods:Between February 2012 and March 2016, 112 ACL reconstructions using double looped semitendinosus and gracilis graft were performed. Patients were divided into 3 groups in a randomized fashion. 98 patients were followed up for 2 years. In the first group (43 patients), suspensory fixation using Retrobutton (Arthrex, Inc, Naples, Florida) was used. In the second group (30 patients), transcondylar graft fixation Bio-Transfix (Arthrex, Naples, Florida) was performed, and in the third group (25 patients), aperture fixation using AperFix (Cayenne Medical, Scottdale, Arizona, Biomet) was performed. Clinical evaluation was performed using the International Knee Documentation Committee (IKDC) form, Lysholm knee and Tegner activity level scores, as well as arthometer measurements. Tunnel enlargement and graft integrity were evaluated using Magnetic Resonance Imaging (MRI) at 6, 12 and 24 months.Results:Ten patients were completely lost to follow up, and four had undergone a revision ACL reconstruction before the two-year follow up period, leaving 98 patients for analysis. No statistically significant differences between the three groups were noted other than that the first group tended to have more tunnel enlargement than the other two groups, especially at the femoral tunnel (p=.026), but not at the tibial tunnel (p&gt;0.408). Our results showed that almost 90% of the patients in the three groups had functionally normal or near normal IKDC, Lysholm and Tegner scores.Conclusion:The three different techniques yielded equal results as regards improved patient performance. The functional results as well as knee stability tests were not related with tunnel enlargement, at least in the short term.

Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers

Background: Professional baseball pitchers are at high risk for tears of the ulnar collateral ligament (UCL) of the elbow, often requiring surgical reconstruction. Despite acceptable published return-to-play outcomes, multiple techniques and graft types have been described. Purpose: This study compares UCL reconstruction (UCLR) outcomes based on tunnel configuration and graft type. Study Design: Cohort study; Level of evidence, 3. Methods: After approval from our institutional review board and Major League Baseball (MLB), 566 professional baseball pitchers who underwent UCLR between 2010 and 2014 were identified and included. The following patient characteristics were analyzed: age, pitching role (starter vs reliever), level of play (MLB vs Minor League Baseball [MiLB]), and throwing side dominance. Surgical factors analyzed included reconstruction technique, graft type, and concomitant procedures. Primary outcome measures consisted of the ability to return to play at any level (RTP), ability to return to the same level of play (RSL), time to return, subsequent elbow injuries, and need for subsequent or revision elbow surgery. The effects of patient and surgical factors on outcomes were analyzed using multivariate linear and logistic regression modeling. Results: The RTP rate was 79.9%, and the RSL rate was 71.2%. Grafts used to reconstruct the UCL included the palmaris longus autograft (n = 361, 63.7%), the gracilis autograft (n = 135, 23.8%), and other grafts (n = 70, 12.5%). Surgical techniques utilized were the docking technique (n = 171, 30.2%), the modified Jobe technique (n = 290, 51.2%), and other techniques (n = 105, 18.6%). There were no significant differences in the time to RTP or RSL based on reconstruction technique or graft type. RTP rates were similar for the docking versus modified Jobe technique (80.1% vs 82.4%, respectively; P = .537) and for the 2 primary graft types (83.1% for palmaris longus vs 80.7% for gracilis; P = .596). The rate of subsequent elbow surgery was 10.5% for the docking technique versus 14.8% for the modified Jobe technique (P = .203), and the rate of revision UCLR was 2.9% versus 6.2% for the docking versus modified Jobe technique, respectively (P = .128). Significant trends toward an increasing use of the palmaris longus autograft (P = .023) and the docking technique (P = .006) were observed. MLB pitchers were more likely than MiLB pitchers to RTP (P < .001) and RSL (P < .001), but they required a longer time to return (mean difference, 35 days; P = .039) and had a higher likelihood of subsequent elbow (odds ratio [OR], 3.58 [95% CI, 2.06-6.23]; P < .001) and forearm injuries (OR, 5.70 [95% CI, 1.99-16.30]; P = .004) but not subsequent elbow surgery. No specific variables correlated with the rates of subsequent elbow surgery or revision UCLR in the multivariate analysis. The use of concomitant ulnar nerve transposition did not affect outcomes. Conclusion: Surgical outcomes in professional baseball players are not significantly influenced by UCLR technique or graft type. There was a high rate (46.3%) of subsequent throwing elbow injuries. MLB pitchers were more likely to RTP and RSL, but they had a higher frequency of subsequent elbow and forearm injuries than MiLB pitchers. Both the docking technique and the palmaris longus autograft are increasing in popularity among surgeons treating professional baseball players.

Anatomic Reinforced Medial Meniscal Root Reconstruction With Gracilis Autograft

Meniscal root tears, left untreated, result in accelerated progression of arthritis. Numerous techniques to repair medial meniscus posterior root tears have been presented in the literature. Direct repair of the meniscus to bone without reconstructive tissue may result in a nonanatomic and biologically weak construct with a significant number of structural repair failures. Re-creation of the ligament-like structures that fix the meniscal root to bone is critical to restoring normal knee biomechanics. We present an arthroscopic reconstructive technique using gracilis autograft with suture reinforcement for medial meniscus posterior root tears.

Peak torque angle of anterior cruciate ligament-reconstructed knee flexor muscles in patients with semitendinosus and gracilis autograft is shifted towards extension regardless of the postoperative duration of supervised physiotherapy.

BackgroundThe observational cohort study investigated whether the flexor muscles peak torque (PT) angle shifting towards extension observed in the involved knee in patients after anterior cruciate ligament reconstruction (ACLR) using semitendinosus and gracilis tendon (STGR) autograft is associated with the postoperative physiotherapy supervision duration.MethodsFrom 230 ACL-reconstructed males, we identified patients after ACLR utilizing STGR autograft and divided them into those who completed supervised physiotherapy <6 months (Group I; n = 77) and those who completed supervised physiotherapy ≥6 months (Group II; n = 66). The mean follow-up time was 6.84 ± 1.47 months. The ACL-reconstructed patients were compared to 98 controls (Group III). Bilateral knee flexor muscle PT measurements were performed. The relative PT at 180°/s (RPT), PT angle at 180°/s, and range of motion at 180°/s were analysed. The RPT limb symmetry index (LSI) was calculated. Tests for dependent samples, one-way analysis of variance, post hoc test, and linear Pearson’s correlation coefficient (r) calculations were performed.ResultsThe shift towards extension was noted when comparing the ACL-reconstructed limb to the uninvolved limb (Group I, p ≤ 0.001; Group II, p ≤ 0.001) and to Group III (p ≤ 0.001), but it was not correlated with physiotherapy supervision duration (r = -0.037, p = 0.662). In ACL-reconstructed patients, there was a moderate association of supervision duration and knee flexor LSI (r = 0.587, p < 0.001).ConclusionsThe ACL-reconstructed knee flexors PT angle shift towards extension was observed regardless of the duration of postoperative physiotherapy supervision. However, the analysis revealed that the duration of supervised physiotherapy positively influenced the RPT and LSI in patients after the ACLR.

Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Reconstruction

There has been a renewed interest in anterior cruciate ligament (ACL) repairs over the last decade with some early promising results in the right patient population. Additionally, the anterolateral ligament has been extensively studied and has recently been shown to have a protective effect on standard ACL reconstructions in a clinical trial. Given its protective effect on ACL reconstructions, we believe this phenomenon is also relevant to ACL repairs and can decrease rerupture rates. In this publication, we demonstrate a surgical technique for ACL repair using an internal brace combined with an anterolateral ligament reconstruction using a gracilis autograft.

Concomitant Reconstruction of Anterior Cruciate Ligament and Medial Collateral Ligament Surgical procedure and clinical outcomes

The purpose of this paper was to evaluate the postoperative clinical outcomes of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) reconstruction and to briefly describe the surgical procedure. The current study is a retrospective observational analysis, which included 12 patients with acute ACL and grade III MCL injuries. Combined ACL-MCL reconstruction was performed using bone-tendon-bone patellar autograft and semitendinosus and gracilis autograft, respectively. Preoperative and postoperative assessments were performed for each patient using the same protocol. Combined ACL-MCL reconstruction is associated with improved postoperative results. No recurrent knee instability was reported at the end of follow-up period. In conclusion, acute ACL and grade III MCL injuries can be successfully treated by combined ACL-MCL reconstruction, which is an effective option for the treatment of these patients, associated with good clinical results.

Revision Anterior Cruciate Ligament Reconstruction With Hamstrings and Extra-articular Tenodesis: A Mid- to Long-Term Clinical and Radiological Study

To present the mid- to long-term clinical and radiographic outcomes of a series of patients who underwent revision anterior cruciate ligament (ACL) reconstruction with doubled gracilis and semitendinosus (DGST) autograft and a lateral extra-articular tenodesis (LET). Patients who underwent revision ACL reconstruction with DGST and LET by a single surgeon between January 1997 and December 2013 were included. Revision was indicated by ACL failure noted on magnetic resonance imaging, persistent clinical instability, or laxity on clinical exam. Patients were evaluated preoperatively and at latest follow-up by an independent board-certified orthopaedic surgeon. Outcomes included Lachman and pivot shift tests, validated clinical and patient reported outcomes scores, and radiographic analysis. The presence of previous meniscectomy or chondral injury was recorded intraoperatively. A total of 118/132 potential patients (89.4%) was available for follow-up at a mean 10.6years (3-19years) postoperatively. Lachman and pivot shift examinations as well as the side-to-side difference on an KT-1000 arthrometer demonstrated significant improvement at latest follow-up (P < .05) versus preoperative evaluation. Severe degenerative disease was present in 25% of patients on radiograph and correlated with worsened clinical outcomes. Previous meniscectomy was the only risk factor analyzed that correlated with worsened radiographic grade. No patients had a graft tear based on clinical and/or magnetic resonance imaging evaluation, but 9 (7.6%) failed based on a side-to-side difference of >5mm on the KT-1000, a grade ≥2+ on pivot shift, or report of continued instability. Revision ACL reconstruction with DGST and LET at mid- to long-term follow-up provides continued improvement in clinical and radiological outcomes from preoperative assessment. Meniscectomy was the only factor related to worsened radiological grades and clinical outcomes. Level IV, case series.