Long-Term Outcomes of Primary Anterior Cruciate Ligament Reconstruction Using Achilles Tendon Allograft.

PURPOSE: This study sought to assess the long-term structural integrity of primary anterior cruciate ligament (ACL) reconstructions using Achilles tendon allografts by measuring the side-to-side difference in anterior-posterior tibial translation between the operative knee and the contralateral, asymptomatic knee. METHODS: This study was a retrospective case series consisting of patients who underwent primary ACL reconstruction with Achilles tendon allograft. Allografts were chemically processed using the AlloWash or AlloTrue methods and then received either gamma radiation or electron beam radiation (range: 0.95 to 1.4 Mrad dose). At the time of follow-up, anterior-posterior tibial translation of both the operative and contralateral knees was measured using the Lachmeter® device. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) questionnaire and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. RESULTS: The analysis included 20 patients (mean age: 41.38 ± 14.27 years) with a mean follow-up time of 7.01 ± 5.24 years. There were no graft failures requiring revision during the study period. The mean side-to-side difference in laxity between operative and contralateral knees was 1.10 ± 2.02 mm. Two patients (10%) met the criteria for complete ACL injury at the time of follow-up, while the remaining 18 patients (90%) met the criteria for no ACL injury. The mean IKDC score was 83.5 ± 13.8, and mean KOOS score was 88.4 ± 10.7. CONCLUSIONS: Primary ACL reconstruction using an Achilles tendon allograft in skeletally mature patients resulted in maintained knee stability and good functional outcomes over the long-term postoperative period.

Online Direct-to-Consumer Advertising of Stem Cell Therapy for Musculoskeletal Injury and Disease: Misinformation and Violation of Ethical and Legal Advertising Parameters.

BACKGROUND: There has been a recent surge in health-care providers offering stem cell therapy (SCT) to patients with musculoskeletal disease. The purpose of this study was to identify and quantify the misinformation present in online direct-to-consumer (DTC) advertising of SCT targeting patients with musculoskeletal disease in the U.S. It was hypothesized that DTC advertising of SCT contains substantial misinformation. METHODS: A list of keywords was used to identify web sites of practices advertising SCT directly to patients with musculoskeletal disease. Web sites were evaluated to determine the specialties of providers offering SCT, types of SCT being advertised, and misinformation presented. Categories of misinformation included false general claims, inaccurate statements regarding mechanism of action, unfounded results, and scare tactics. RESULTS: Of the 896 practice web sites included in the analysis, 95.9% contained at least 1 statement of misinformation, with a mean of 4.65 ± 3.66 statements of misinformation among the sites. Practices associated with an orthopaedic surgeon provided 22% fewer statements of misinformation than practices without an orthopaedic surgeon when we controlled for the effects of other specialties. Practices associated with a podiatrist also provided 22% fewer statements of misinformation. CONCLUSIONS: Nearly all practices failed to accurately represent the clinical efficacy of SCT in DTC advertising. While practices associated with an orthopaedic surgeon were less likely to provide misinformation, the majority of all web sites contained some type of misinformation, ranging from errors in the basic science of stem cells to outright false and misleading claims of their clinical effectiveness.