Pre-injury Sports Activity Level Research Articles

Can meniscal suture repair in athletes prevent early development of osteoarthritis without compromising the preinjury sports activity level

In a retrospective study we evaluated the outcome of arthroscopic assisted meniscal repair in athletes on different competitive sports levels. Examination included early osteoarthritic changes and full recovery in sports activities. Fifty athletes were followed up with an average of 6,5 years after meniscal refixation from 1984 through 1998. Twenty-three patients had isolated full-thickness meniscal tears, twenty-seven an associated rupture of the anterior cruciate ligament. Preoperative sports levels were evaluated with Tegners score. Reexamination included Lysholm score, IKDC score and Fairbanks score. With no persisting anterior knee instability 86 % of the professional athletes returned to former full sports activities on competitive levels. Noncompetitive athletes returned in all cases (100 %) to their former level. Fairbanks score increased by 0,1 observing minimal osteoarthitic signs. However, persisting anterior knee instability showed on reexamination poor results. Only one third of all athletes were able to return to former activity levels. Osteoarthritic changes were observed in all patients. Professional athletes had the most severe osteoarthritic changes with an increase of 0,8 in the Fairbanks score. The results demonstrate that complete recovery on sports activities is not possible without reconstruction of the anterior cruciate ligament. Isolated meniscal repair shows poor results in persisting anterior knee instability and does not prevent increasing osteoarthritic changes in athletes.

Anterior cruciate ligament reconstruction using four-strand semitendinosus and gracilis tendon grafts and metal interference screw fixation

Purpose: The purpose of this study was to determine the outcome of 200 anterior cruciate ligament (ACL) reconstructions using hamstring tendons. Type of Study: This is a case series reporting on 200 endoscopic procedures for reconstruction of the ACL. Methods: This study included patients over 18 years old with a healthy controlateral knee, intact posterior cruciate ligament, and without any peripheral surgical procedure or cartilage injury. Patients having undergone prior ligament reconstruction were excluded from the study. The minimum follow-up was 1 year. Clinical review allowed for documentation of International Knee Documentation Committee (IKDC), KT-1000 arthrometer laxity measurement, and isokinetic dynamometric analysis. Results: Quadriceps and hamstring muscle strength loss was less than 17%. At review, overall IKDC evaluation found that 50% of patients graded A, 44% graded B, and 6% were C or D. The differential anterior laxity was graded A for 157 patients with a median of 1 mm. Of the 113 high-performance athletes, 98 (86%) had resumed a preinjury level of sporting activity. Conclusions: Endoscopic reconstruction using 4-strand hamstring autograft may be considered safe, reliable, and reproducible. Preliminary outcome is fulfilling and this technique corresponds completely to therapeutic fields regarding ACL reconstructions.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 3 (March), 2002: pp 232–237

Arthroscopic Treatment on the Osteochondritis Dissecans of the Adolescent Elbow

Purpose : The purpose of this study was to evaluate the effect of arthroscopic management of osteochondritis dissecans(OD) of the elbow. Materials and Methods : Seven patients rangeing from 13 to 20 years of age, and average age 15.7 years were evaluated in this study. All patients underwent arthroscopic removal of loose bodies followed by multiple drilling into the defect of the capitellum. The average follow-up period was 19.7 months (range, 16 to 28 months). Results were analyzed clinically using the elbow scoring system of Broberg and Morrey. Results : There were five good and two excellent results. Three cases, however, showed slight medial instability while performing the valgus stress test. All patients had no or slight pain, and regained a full range of motion. Although four amateur athletes showed good results, they were unable to recover their pre-injury sports activity level . Conclusion : Arthroscopic removal of loose fragments for late stage OD enabled the evaluation of lesions of the anterior and posterior aspects of the joints, and minimized morbidity.

Bone-patellar tendon-bone reconstruction of the anterior cruciate ligament

Ninety-one patients were assessed 5-9 years after an anterior cruciate ligament reconstruction (bone patella-tendon bone autograft). Forty-eight patients had been treated within 6 weeks of the injury (Group I) and 43 patients more than 3 months after the injury (Group II). 73 patients had either a normal or nearly normal final outcome. The mean Lysholm score was 82 and the mean Marshall score was 42. Eighty nine patients had normal or nearly normal stability in the operated knee when compared to the contralateral joint. In none of these results was there any significant difference between the groups. Results of functional and of isokinetic strength tests, as well as the presence of anterior knee pain, were also similar in both groups. However, patients with early reconstruction had fewer degenerative changes in the tibio-femoral joint and were more satisfied with the result. They also returned to their pre-injury level of sports activity more often than those patients in the late reconstruction group.

The natural history of anterior cruciate ligament reconstruction using patellar tendon autograft

The purpose of this study was to review the results of ACL reconstruction using a patellar tendon graft placed ‘over the top’ plus a Macintosh lateral tenodesis, examining changes in knee laxity and functional status with increasing time. There were 74 patients operated on over an 11 year period, and divided into four groups for analysis according to postoperative time. There was a significant and progressive increase in side-to-side laxity difference with time, although functional status did not change significantly, indicating a lack of correlation between objective clinical tests and subjective findings. The highest Lysholm, Tegner and IKDC scores were at 4–5 years after operation, when 60% of patients were at their pre-injury level of sports activity. However, there was always a very significant difference between actual and desired Tegner activity levels for the group as a whole. While there was a significant correlation between degenerative changes and the time between injury and reconstruction, there was no correlation with postoperative time: this provides evidence that ACL reconstruction can protect the knee from later degeneration.

Reconstruction of mid-substance anterior cruciate rupture in adolescents with open physes.

Five cases of anterior cruciate ligament reconstruction, performed for symptomatic episodes of giving way or during surgery for associated injury, were carried out in preepiphyseal closure adolescents (ages 12-15 years), utilising a strip of iliotibial band placed over the top of the lateral femoral condyle in a MacIntosh type repair, and avoiding drilling through epiphyseal plates. At a mean follow-up of 4.4 years, all five were symptomatically satisfactory and all five patients had returned to their preinjury level of sports activity. Although objective assessment revealed that increased laxity, when compared to the normal leg anterior laxity measured by the KT-1000, was within normal limits in four of five patients. Only one patient, who had had a fracture of the contralateral femur, had any leg length discrepancy.

Synthetic Augmented Repair of Proximal Ruptures of the Anterior Cruciate Ligament

The long-term results (five-to eight-year follow-up evaluation) of 66 patients with high proximal ruptures of the anterior cruciate ligament (ACL) who were treated operatively are presented in a retrospective and uncontrolled study. Technique of surgery was the reinsertion of the ACL in a multiple suture loop technique, augmented with Kennedy-LAD (ligament augmentation device) on over the top route in temporary double-end fixation. This technique was used in patients with proximal rupture of the anterior cruciate ligament found at arthroscopy. In the follow-up as well as in instrumented measurement, 97% of the knee joints have normal joint laxity. According to the evaluation sheet designed by the Orthopädische Arbeitsgemeinschaft Knie (OAK), excellent or good results were found in 86% of the patients. Nine percent had limited range of motion. The ACL reconstruction technique allowed 75% of the patients to regain their preinjury sports activity level. The potential advantages of synthetic augmented reinsertion of the ACL are anatomic reconstruction without destruction of other anatomic structures as grafts; securing early rehabilitation with weight bearing of the operated limb depending on individual pain tolerance; and presenting excellent long-term results of normal joint laxity.