International Knee Documentation Committee Activity Scores Research Articles

Clinical evaluations of anterior cruciate ligament reconstruction with platelet rich plasma

To investigate the clinical outcomes of autologous platelet rich plasma (PRP) for anterior cruciate ligament (ACL) reconstruction. Between August 2014 and August 2016, 42 patients with ACL ruptures who underwent arthroscopic ACL reconstruction were randomly divided into 2 groups: 21 patients received graft soaked with PRP (trial group) and 21 patients received routine graft in ACL reconstruction (control group). Because 6 patients failed to be followed up, 17 patients of trial group and 19 of control group were enrolled in the study. There was no significant difference in gender, age, body mass index, side, injury reason, disease duration, Kellgren-Lawrence grade, and preoperative visual analogue scale (VAS), Lysholm score, and International Knee Documentation Committee (IKDC) activity scores between 2 groups ( P>0.05). VAS score, Lysholm score, and IKDC activity scores were used to evaluate pain and function at 3 and 12 months postoperatively. Further, second arthroscopy and MRI examination were performed at 12 months postoperatively. The patients in both groups were followed up 3 to 12 months with an average of 9.83 months. The VAS score, Lysholm score, and IKDC activity scores were significantly improved at 3 and 12 months after operation in 2 groups ( P<0.05), and the scores of trial group were significantly better than those of control group at 3 months ( P<0.05), but no significant difference was found between 2 groups at 12 months ( P>0.05). No complications of effusion, infection, and allergy were observed in 2 groups during follow-up. MRI showed good position of ACL grafts and good signal quality of the graft in the majority of the cases. However, mixed hyperintense and presence of synovial fluid at the femoral bone-tendon graft interface were found in 3 patients of trial group and 4 patients of control group, indicating poor remodeling ligamentation. MRI score was 3.53±1.13 in trial group and was 3.21±0.92 in control group, showing no significant difference ( t=0.936, P=0.356). The second arthroscopy examination showed ligament remodeling score was higher in trial group than control group ( t=3.248, P=0.014), but no significant difference was found in synovial coverage score and the incidence of cartilage repair ( t=2.190, P=0.064; χ2=0.090, P=0.764). PRP application in allograft ACL reconstruction can improve knee function and relieve pain after operation, which may also accelerate graft remodeling.

Revision Rates After Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Allograft or Autograft in a Population 25 Years Old and Younger

To compare clinical outcomes and revision rates for anterior cruciate ligament (ACL) reconstructions using bone-patellar tendon-bone (BPTB) allografts versus BPTB autografts in a population of patients aged 25 years and younger. A consecutive series of patients 25 years or younger undergoing ACL reconstruction with either a patient-selected BPTB allograft or BPTB autograft fixed with biocomposite interference screws was retrospectively reviewed. Multiligamentous and posterior cruciate ligament tears were excluded. All allografts were from a single source and not chemically processed or irradiated. Two graft-specific rehabilitation programs were used. The primary outcome measure was graft failure. Failure was defined as a subsequent ACL revision surgery, 2+ Lachman test, positive pivot-shift, or side-to-side KT difference of greater than 5 mm. Secondary outcome measures included Cincinnati, Lysholm, and International Knee Documentation Committee (IKDC) activity scores. In 81 patients at least 24 months after surgery (28 allografts; 53 autografts), 7 failures were identified: 2 of 28 (7.1%) allografts and 5 of 53 (9.4%) autografts. Mean Cincinnati scores improved from 54.6 and 39.5 (allografts and autografts, respectively) to 86.2 and 85.1. Mean Lysholm scores improved from 60.3 and 44.8 (allografts and autografts, respectively) to 89.9 and 87.0. Average KT differences were 0.59 mm (allograft) and 0.34 mm (autograft group) (P= .58). IKDC activity scores were 2.9 (allografts) and 3.1 (autografts) postoperatively (P= .32). Using a patient-choice ACL graft selection program after appropriate counseling and using graft-specific rehabilitation programs, not chemically processed or irradiated BPTB allograft reconstructions have no greater failure rate than autografts in patients aged 25 years and younger at a minimum 2-year follow-up. No significant differences in Cincinnati, Lysholm, and IKDC activity scores were found between these 2 groups. Level III, retrospective comparative study.

Poly L-Lactide Co-Glycolide/β-Tricalcium Phosphate Interference Screw Fixation for Bone-Patellar Tendon Bone Anterior Cruciate Ligament Reconstruction

The objective of this study was to prospectively evaluate the clinical effectiveness and radiographic response of a poly (l-lactide co-glycolide)/β-tricalcium phosphate (PlLA/PGA/β-TCP) interference screw used in bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. A prospective, consecutive series of 104 patellar tendon bone-tendon-bone ACL reconstructions fixed with PLLA/PGA/β-TCP biocomposite screws were studied. After receiving the approval from the Institutional Review Board, the following data were collected preoperatively from all patients: physical examination, Lysholm score, Cincinnati, and International Knee Documentation Committee (IKDC) activity scores, and standard knee radiographs. In addition to these, follow-up assessments included Lachman and pivot-shift tests, Tegner scores, and KT side-to-side differences. Surgical failure was defined by a 2+ Lachman test, positive pivot-shift test, side-to-side KT difference of greater than 5 mm or subsequent ACL revision surgery. Approximately 95% of patients (99 of 104) with an average follow-up of 36 months (range, 24 to 68) are reported. The average age was 30 years (range, 13 to 57 years). Postoperatively, four patients demonstrated +1 Lachman score and one patient demonstrated a +2 Lachman score. Postoperative pivot-shift tests were a trace positive in one patients and +1 in two patients. The average KT side-to-side difference was 0.65 mm. All, but five patients, demonstrated KT side-to-side measurements of 3 mm or less and those five demonstrated measurements of 5 mm or less. No revision reconstructions were performed. Significant improvements in Cincinnati score (41 to 85 postoperative) and Lysholm score (46 to 90) were observed. The average postoperative Tegner score was 7. IKDC activity score increased from 2.3 to 3.1. Approximately 4% of patients (4 of 99) met the criteria for failure. A PLLA/PGA/β-TCP biocomposite interference fixation screw provides good graft fixation, with good radiographic incorporation, without adverse events.The level of evidence of the study is IV.

A Comparison of Patellar Tendon Allograft to Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction in Athletes Under 25 Years of Age (SS-72)

Purpose: To compare the clinical outcomes of primary anterior cruciate ligament (ACL) reconstruction using either bone-patellar tendon-bone (BPTB) allograft or autograft performed in patients aged 25 years or younger. Methods: Prospectively collected data was reviewed retrospectively of a consecutive series of primary ACL reconstructions using BPTB allografts or autografts, fixed with bioabsorbable interference screws, and performed by a single surgeon using the same surgical technique. An inclusion criterion was patients no older than 25 years at the time of surgery. Graft choice was patient-selected. Patients were evaluated preoperatively and at a minimum of 24 months following their surgery using Cincinnati, Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores in addition to a physical examination which included range of motion, Lachman, and pivot-shift tests. Patients were also evaluated by KT arthrometer postoperatively and a side to side comparison was performed. Results: Two groups were identified. A total of 20 patients (12 males and 8 females) underwent allograft reconstruction (average follow-up 37 months). The mean postoperative scores were: Cincinnati 86 (60 preoperatively), Tegner 6.5, Lysholm 90 (67 preoperatively), and IKDC activity score was 3.1 out of 4 (2.0 preoperatively). A total of 26 patients (12 males and 14females) underwent autograft reconstruction (average follow-up 37 months). The mean postoperative scores were: Cincinnati 87 (40 preoperatively), Tegner 7, Lysholm 90 (46 preoperatively), and IKDC activity score was 3.0 (2.0 preoperatively). Only one allograft and two autograft patients had a positive Lachman test postoperatively. No patients had a positive postoperative pivot-shift test. One autograft patient had a KT side to side difference of 5 mm while all others had differences less than 3 mm. Mean KT difference for autografts was 1.0mm and 0.9 mm for allografts Both allograft and autograft ACL reconstructions provided excellent functional and clinical results in patients aged 25 years or younger less. No differences between these groups were identified.

Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Allograft: An Age-Dependent Outcome Evaluation

To compare the outcomes of a consecutive series of nonrevision bone-patellar tendon-bone (BPTB) allograft anterior cruciate ligament (ACL) reconstructions in patients aged 40 years or older and patients aged younger than 40 years. Prospectively collected data from consecutive BPTB allograft ACL reconstructions fixed with biodegradable interference screws and performed by a single surgeon were analyzed by use of established outcome measures. Preoperative and postoperative outcome assessments included Cincinnati, Lysholm, and Tegner scores and International Knee Documentation Committee (IKDC) activity scores. Lachman test, pivot-shift test, and KT arthrometer (MEDmetric, San Diego, CA) measurements were obtained at a minimum of 24 months after surgery. In total, 32 patients met the inclusion criteria (21 men and 11 women). The mean follow-up was 35 months (range, 24 to 58 months). Of the patients, 21 were aged younger than 40 years (66%) and 11 were aged 40 years or older (34%). The mean age was 35 years (range, 18 to 55 years). In patients aged younger than 40 years, the mean postoperative Cincinnati score was 82.4 (39.1 preoperatively); Tegner score, 6.2 (3.9 preoperatively); Lysholm score, 89.5 (46.8 preoperatively); and IKDC activity score, 2.7 out of 4 (1.7 preoperatively). Five patients had a positive postoperative Lachman test, but none had a positive pivot-shift test. KT examinations showed a manual maximum difference of less than 3 mm in all but 1 patient (mean, 0.7 mm). In patients aged 40 years or older, the mean postoperative Cincinnati score was 83.8 (44.4 preoperatively); Tegner score, 6.6 (3.9 preoperatively); Lysholm score, 88.8 (50.1 preoperatively); and IKDC activity score, 2.7 out of 4 (2.1 preoperatively). One patient had a positive postoperative Lachman test, but none had a positive pivot-shift test. KT examinations showed a manual maximum difference of less than 3 mm in all but 1 patient (mean, 1.3 mm). The outcomes of BPTB allograft ACL reconstructions were not different both subjectively and objectively for patients aged 40 years or older and patients aged younger than 40 years. BPTB allograft ACL reconstruction provides consistent results for patients of all age groups. Level III, retrospective comparative study.

Z-Plasty Lengthening for Iliotibial Band Friction Syndrome

Iliotibial band friction syndrome presents with lateral knee pain usually in runners. When conservative treatment fails, surgical lengthening, or Z-plasty, can provide symptomatic relief. This retrospective study evaluated the long-term results of iliotibial band Z-plasty for chronic iliotibial band friction syndrome in a consecutive series of patients. Inclusion criteria were failed nonoperative treatment for symptomatic iliotibial band friction syndrome for at least 3 months, minimum age of 17 years, and closed growth plates. Exclusion criteria were history of significant trauma, prior knee surgery, lateral compartment pathology, and anterior or posterior cruciate ligament instability. Postoperative evaluation included annual physical examination consisting of Tegner, Lysholm, Cincinnati, and International Knee Documentation Committee (IKDC) activity scores. Of an initial group of 11 patients, 8 were evaluated an average of 75.6 months postoperatively (range: 59-97 months). Average length of preoperative symptoms was 15.6 months (range: 3-36 months), and average length of nonoperative management was 6.9 months (range: 3-24 months). Postoperatively, mean Cincinnati score was 82.9 (range: 55-95), Tegner score was 4.4 (range: 2-7), Lysholm score was 88.6 (range: 57-100), and IKDC activity score was 2.6 (range: 1-4). No adverse events occurred during surgery. All patients reported complete resolution of lateral knee pain and a full return to preoperative activity levels. Iliotibial Z-plasty was successful for refractory iliotibial band friction syndrome. This improvement was maintained out to 8 years after surgery.

Clinical Results of the Accelerated Rehabilitation Program after Meniscal Repair using the RapidLoc Device

Purpose: The purpose of this study was to evaluate the clinical results of the accelerated rehabilitation program after performing meniscal repair using the RapidLoc device, and we wanted to investigate the incidence of complications related to using the RapidLoc device together with the accelerated rehabilitation program. Materials and Methods: We performed a retrospective review of a consecutive series of meniscal repairs that were done by single surgeon with using the RapidLoc meniscal repair device. An accelerated postoperative rehabilitation program followed, and this was independent of whether anterior cruciate ligament (ACL) surgery was also performed. The Lysholm and IKDC (International Knee Documentation Committee) activity scores, the clinical examination findings and the adverse events were recorded for all the patients. In addition, using Barrett's criteria, a repaired meniscus was considered healed if there was no joint line tenderness, effusion or a negative McMurray's test at the latest follow-up. Results: At follow-up, the mean IKDC activity score was 3.38 (1.75 preoperatively), the Lysholm score was 91.8 (48.7 preoperatively). Clinical success occurred for 30 repairs (93.7%) at the time of the last follow-up. Two patient had tenderness on joint line palpation and intermittent effusion, so theses repair were considered failure according to our criteria. There was no specific complication related to the RapidLoc device. Conclusion: Our results show that accelerated rehabilitation program after arthroscopic meniscal repair with using the RapidLoc device provided a high rate of clinical meniscus healing and this appeared to be safe and effective.

Meniscal Repair With the RapidLoc Meniscal Repair Device

The RapidLoc is an all-inside, self-adjusting, flexible meniscal repair device that combines a suture with an anchor component and, by using a reinforced sliding knot, allows for tightening to compress and hold the repaired meniscal segments. The purpose of this study was to evaluate the clinical success of the RapidLoc device. A prospective consecutive series of meniscal repairs performed with the RapidLoc device was studied. Lysholm, Tegner, Cincinnati, IKDC (International Knee Documentation Committee) activity scores, clinical examination findings, and adverse events were recorded on all patients. Associated procedures were recorded. An accelerated postoperative rehabilitation program was followed, independent of whether anterior cruciate ligament (ACL) surgery was also performed. A total of 32 patients underwent 32 meniscal repairs, with an average follow-up of 31 months (18 to 48 months). In all, 23 repairs were done in conjunction with ACL reconstruction, and 9 repairs were carried out in stable knees. Repairs were made to 25 medial menisci and 7 lateral menisci. Tears repaired consisted of peripheral longitudinal tears with an average length of 2 cm (range, 15 to 30 mm). Four failures (12.5%) were arthroscopically documented. Clinical success occurred in 87.5% at the time of last follow-up. At follow-up, mean Tegner score was 5.1 (2.8 preoperative), IKDC activity score was 3.1 (1.8 preoperative), Lysholm score was 93.6 (48.4 preoperative), and mean Cincinnati score was 88.1 (43.7 preoperative). The most common adverse event was cutting of the suture during RapidLoc insertion. One patient had excoriation and grooving of the medial femoral condyle associated with failed repair. Another patient developed a postoperative infection. The early clinical success rate was 87.5% with the RapidLoc device. Chondral grooving was observed in a single case. Level IV, therapeutic case series.

Midterm Results of Meniscal Repair Using the BioStinger Meniscal Repair Device

The purpose of this study was to evaluate the midterm healing rate and any adverse events from meniscus repair using the BioStinger meniscus repair device (Linvatec, Largo, FL). A retrospective review of a consecutive series of meniscal repairs performed by a single surgeon using the BioStinger was conducted. The BioStinger is cannulated, made of molded poly L-lactic acid, and inserted over a needle into the meniscus tissue. Clinical results and adverse events were noted, and Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee (IKDC) activity scores were obtained on all patients. Forty-one patients underwent 41 meniscal repairs with an average follow-up of 38.6 months (range, 24 to 69 months); 35 meniscus repairs were performed in conjunction with anterior cruciate ligament reconstruction and 6 in stable knees. Tears repaired were peripheral, posterior horn tears with an average length of 2 cm. Clinical evidence of meniscal healing was observed in 95% at the time of last follow-up. Six second-look arthroscopies were performed and 2 failures were found. All other patients were symptom free. At follow-up, the mean Tegner score was 6.1 (2.8 preoperative), IKDC activity score was 3.3 (2.1 preoperative), Lysholm score was 90.6 (48.7 preoperative), and the mean Cincinnati score was 86.7 (41.3 preoperative). Four patients had peripheral migration of the device without skin tenting or perforation; 3 underwent removal of the BioStinger from the soft tissues and the other resolved after 12 months. The midterm clinical success rate was 95% using the BioStinger device. Adverse events were observed in few cases. Level IV, cases series.

Poly-D,L-Lactide Interference Screws for Anterior Cruciate Ligament Reconstruction

Biodegradable interference fixation screws are widely used for anterior cruciate ligament surgery. This study evaluated 2 issues: the clinical effectiveness of a poly-D,L-lactide interference screw and the radiographic response. Prospective case series. A prospective series of anterior cruciate ligament reconstructions fixed with poly-D(2%),L(98%)-lactide screws were evaluated at annual intervals. Inclusion criteria were unilateral knee instability, positive Lachman and pivot-shift tests, minimum age of 16 years, and adequate bone density. Exclusionary criteria included posterior cruciate ligament tears and previous ligament surgery on the same knee. Tegner, Lysholm, International Knee Documentation Committee (IKDC) activity scores, Lachman and pivot-shift tests, and radiographs were obtained. Postoperative KT-2000 examinations were performed. Sixty-one patients with 63 knees met these criteria (39 male, 22 female), at an average follow-up of 24 months (range, 12 to 42 months). The average postoperative Cincinnati score was 86 (45 preoperative), median Tegner score was 6 (2 preoperative), average Lysholm score was 89 (53 preoperative), and average IKDC activity score was 3.3 out of 4 (1.5 preoperative). Two patients had positive postoperative Lachman tests (+1) with no positive pivot-shift tests. The average KT-2000 manual-maximum difference was 0.7 mm. Only 1 KT-2000 value was greater than 3 mm (4 mm). No adverse events were encountered during screw insertion and postoperative radiographs showed bone plug consolidation and tunnel obliteration with bone in-growth increasingly apparent at 2 and 3 years (significantly earlier than published reports using pure poly-L-lactide screws). This is the first clinical report of a poly-D(2%),L(98%)-lactide interference fixation screw. This copolymer is zinc catalyzed, instead of the conventional tin, making the polymer more hydrophilic. The "D" isomer speeds the degradation process. These screws worked well with no adverse events. Graft tunnel obliteration was observed at 2 and 3 years. Level 4, no or historical control.