Quadriceps and hamstring tendon autografts in ACL reconstruction yield comparably good results in a prospective, randomized controlled trial.

INTRODUCTION: Comparable data of functional outcomes of anterior cruciate ligament reconstruction using either hamstring- or quadriceps tendon grafts is controversial. This prospective, randomized controlled trial aims to provide data comparing both grafts regarding the functional outcome. MATERIALS AND METHODS: A two centre trial involving symptomatic patients 18 years of age or older with an anterior cruciate ligament tear was conducted. We randomly assigned 27 patients to quadruple hamstring tendon reconstruction and 24 to quadriceps tendon reconstruction. The patients were evaluated preoperatively, at 3, 6, 12 and 24 months post-surgery. The primary outcome parameter was the side-to-side knee laxity measured with an arthrometer. Secondary outcomes included results in the International Knee Documentation Committee (IKDC) and Lysholm Scores and isokinetic testing of strength in knee extension and flexion. RESULTS: Forty-four patients (86%) completed the 2-year follow-up. There was significantly improved knee stability at all time intervals with no difference between the two study groups. The manual side-to-side displacement improved by 4.7 ± 3.0 mm in patients with hamstring tendon reconstruction and 5.5 ± 2.9 mm in patients with quadriceps tendon reconstruction. In addition, muscle strength and outcome scores (IKDC and Lysholm Score) did not show any differences between the hamstring tendon group and the quadriceps tendon group. Patients in the hamstring tendon group returned to their pre-injury activity level after 95.2 ± 45.5 days while patients in the quadriceps tendon group needed 82.1 ± 45.6 days. CONCLUSION: Quadriceps and hamstring tendon autografts yield comparably good results in primary anterior cruciate ligament reconstruction.

The evaluation of Rolimeter, KLT, KiRA and KT-1000 arthrometer in healthy individuals shows acceptable intra-rater but poor inter-rater reliability in the measurement of anterior tibial knee translation.

PURPOSE: To assess measurement equivalence, inter- and intra-rater reliability, standard error of measurements (SEM) and false positive measurements (FPM) of four different knee arthrometers (KLT,Karl Storz; KiRA, I + ; KT-1000 MEDmetric Corp; Rolimeter, Aircast) in healthy patients. METHODS: Four different investigators (two advanced (AR) and two beginners (BR)) examined 12 participants with healthy knees at two time points with regards to anterior tibial translation (ATT) and side-to-side difference (SSD). Test equivalence was assessed using the TOST (two-one-sided t test) procedure with ± 1 mm equivalence boundaries. Intraclass correlation coefficients (ICCs) were calculated using two-way mixed effects models. Furthermore, false positive-(SSD > 3 mm) and SEMs were assessed. RESULTS: A total of 2304 Lachman Tests were performed. Between-rater SSDs were equivalent between AR and BR raters for the Rolimeter only. Inter-rater ICC values (SSD, ATT) were graded as "poor" to "moderate" for all devices. Equivalent test-retest results were observed for all raters using the Rolimeter, KLT and KT-1000, whereas measurement consistency with KiRA was given in the advanced examiners group only. Intra-rater ICC values (Range: SSD, ATT) were graded as "poor" to "moderate" for SSD values and "moderate" to "good" for ATT. SEMs were lowest for the Rolimeter and highest for KiRA. FPM were never obtained with the Rolimeter (0%), twice (2.1%) with the KT-1000, three times (3.1%) with the KLT and 33 times (34.4%) using KiRA. CONCLUSION: There is acceptable intra-rater but poor inter-rater reliability with all tested arthrometers. Measures of knee laxity are comparable between Rolimeter, KLT and KT-1000 but higher for KiRA. Clinically, the present study shows that repeated arthrometry measurements should always be performed by the same investigators.

Comparison of volumetric bone mineral density in the operated and contralateral knee after anterior cruciate ligament and reconstruction: A 1-year follow-up study using peripheral quantitative computed tomography.

The purpose of this study was to quantify changes in volumetric bone mineral density (vBMD) in the tibial plateau of the operated and contralateral leg measured using peripheral quantitative computed tomography (pQCT) before and 3, 6, and 12 months after anterior cruciate ligament (ACL) reconstruction. The ACL was reconstructed with a hamstring tendon autograft using press-fit fixation. pQCT measurements of the proximal tibia were obtained in 61 patients after ACL reconstruction, and total, cortical, and trabecular vBMD were calculated. vBMD in the operated leg decreased from baseline to 3 months (-12% [total], -11% [cortical], and -12.6% [trabecular]; p<0.001) and remained below baseline for 12 months after surgery (6 months: -9.5%, -9.4%, and -9.6%, p<0.001; 12 months: -8%, -5%, and -11%, p<0.001). vBMD in the contralateral leg was slightly reduced only 6 months after surgery. Including age and sex as covariates into the analysis did not affect the results. ACL reconstruction contributed to loss in bone mineral density within the first year after surgery. The role of factors such as time of weight-bearing, joint mechanics, post-traumatic inflammatory reactions, or genetic predisposition in modulating the development of posttraumatic knee osteoarthritis after ACL injury should be further elucidated.

Traumatic and degenerative cartilage lesions: arthroscopic differentiation using near-infrared spectroscopy (NIRS).

INTRODUCTION: Cartilage lesions or defects are the most common finding during knee arthroscopy. During arthroscopy, it is often difficult to differentiate between degenerative and traumatic cartilage lesions. The study aimed to determine the impact of near-infrared spectroscopy (NIRS) on the distinction between traumatic and degenerative cartilage lesions in the medial femoral condyle (MFC). It was hypothesized that NIRS as able to distinguish between traumatic and degenerative cartilage lesions. MATERIALS AND METHODS: Arthroscopic evaluation was performed in six patients who had undergone anterior cruciate ligament (ACL) reconstruction and in six patients who had undergone high tibial osteotomy (HTO). In both groups, a grade III cartilage lesion was present within the MFC. NIRS evaluation was performed with a special probe (arthrospec-one, Arthrospec GmbH, Jena, Germany). NIRS measurements produced semi-quantitative values ranging from 0 (heavily degenerated cartilage) to 100 (completely intact cartilage). RESULTS: The mean near-infrared-light absorption within the traumatic lesions in the MFC of the ACL group was 71.5 (range 61-80). In the HTO patients, this value was significantly (p < 0.001) lower at 31.7 (range 31-33). The margin of the MFC outside the lesion in the ACL group had the same adsorption as the lesion (p = 0.549). CONCLUSION: After an injury, cartilage has a normal or nearly normal absorbance on near-infrared-light. Thus, it is possible to distinguish intraoperatively between traumatic and degenerative lesions. In addition, our results demonstrate that evaluating cartilage with NIRS is a dependable method for improving the diagnosis of significant chondral lesions.

Anatomic Double Bundle single tunnel Foreign Material Free ACL-Reconstruction - a technical note.

UNLABELLED: The anterior cruciate ligament (ACL) consists of two bundles, the anteromedial (AM) and posterolateral bundle (PM). Double bundle reconstructions appear to give better rotational stability. The usual technique is to make two tunnels in the femur and two in the tibia. This is difficult and in small knees may not even be possible. We have developed a foreign material free press fit fixation for double bundle ACL reconstruction using a single femoral tunnel ((R)). This is based on the ALL PRESS FIT ACL reconstruction. It is suitable for the most common medium and, otherwise difficult, small sizes of knees. METHOD: Using diamond edged wet grinding hollow reamers, bone cylinders in different diameters are harvested from the implantation tunnels of the tibia and femur and used for the press fit fixation. Using the press fit technique the graft is first fixed in tibia. It is then similarly fixed under tension in the femoral side with the knee in 120 degree flexion. This is called Bottom To Top Fixation (BTT). On extending the knee the graft tension is self adapting. Depending on the size of the individual knee, the diameter of the femoral bone plug is varied from 8 to 13 mm to achieve an anatomic spread with a double bundle-like insertion. The tibia tunnel can be applied with two 7 or 8 mm diameter tunnels overlapping to a semi oval tunnel between 10 to 13 mm. RESULTS: Since May 2003 we have carried out ACL-reconstructions with Hamstring grafts without foreign material using the ALL PRESS FIT technique. Initially, an 8 mm press fit fixation was used proximally with good results. Since April 2008, the range of diameters was increased up to 13 mm. The results of the Lachman tests have been good to excellent. Results of the Pivot shift test suggested more stability with femoral broader diameters of 9,5 to 13 mm. CONCLUSIONS: The foreign material free fixation of ham-string in the ALL PRESS FIT Bottom To Top Fixation is a successful method for ACL Reconstruction. The Diamond Instruments and tubed guiding devices are precise, reliable and easy to manage. On this basis a double bundle reconstruction is achieved using a single tunnel. A broad anatomic femoral insertion with autogenous bone plugs inserted near the cortex seems to improve rotational stability.

Implant-free press-fit fixation for bone-patellar tendon-bone ACL reconstruction: 10-year results.

OBJECTIVE: The aim of this study is to determine the outcome of anterior cruciate ligament (ACL) reconstruction without foreign material with patellar tendon bone graft in the fixation with bone dowels near the native insertion. MATERIALS AND METHODS: Between 1998 and 1999, 189 patients were operated with ACL reconstruction with BTB patellar tendon graft. In a prospective study, 148 (78%) (91M, 57F) patients could be seen for a mean follow-up of 10.3 years. All had foreign material-free press-fit and a bottom-to-top (BTT) fixation in 120 degrees knee flexion. All patients were evaluated with detailed history, clinical examinations, radiographic examination with weight bearing which could be compared to the time of surgery in 64 (43%) patients. Laxity testing was performed in Lachman position with the Rolimeter and pivot shift. All patients were graded according to the IKDC and Tegner activity score. RESULTS: 87% of the patients achieved an IKDC score of A/B. The subjective IKDC score was A/B in 94.6% of the subjects. The average side-to-side difference was 1.42 +/- 0.88 mm for the Lachman test, 97% of the patients were rated between 0 and 2 mm. The pivot-shift test was negative in 90% and was observed with a glide in 7% of the patients. Radiological joint space narrowing was found in the medial compartment in 8 (12.4%) cases, and laterally in 9 (14.1%) cases. All these patients had partial or total meniscus resections. The patello-femoral joint space was reduced in 21 (23%) cases. The Tegner activity score changed from 6.9 pre-injury to 5.0 at the 10-year follow-up. CONCLUSION: The implant-free fixation of the graft with bone dowels and BTT implantation has good and excellent results after 10 years in more than 80% of the patients. Loss of the meniscus is a main factor contributing to osteoarthritis. Advantages of patellar tendon bone press-fit fixation include anatomical positioning and fast bone-to-bone healing, ease for revision surgery and cost effectiveness.