The concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction.

PURPOSE: To describe the concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction. METHODS: The PubMed/Medline database was searched using keywords pertaining to ACL reconstruction. Relevant articles were reviewed in order to summarize important concepts of individualized surgery in ACL reconstruction. Surgical experiences with case examples are also highlighted. RESULTS: Individualized ACL surgery allows for the customization of surgery to each individual patient. Accounting for graft selection and other characteristics such as anatomy, lifestyle and activity preferences may provide the patient with the best potential for a successful outcome. The surgeon should be comfortable with a variety of graft harvests and surgical techniques when practicing individualized surgery. CONCLUSION: Individualized anatomic ACL reconstruction is founded on the objective evaluation of functional anatomy and individual characteristics, thereby restoring the ACL as closely as possible to the native anatomy and function. The adoption and subsequent use of individualized surgery may facilitate improved clinical as well as objective outcomes, particularly in the long term. LEVEL OF EVIDENCE: V.

Comparison of preserved vascular allografts using glycerol and University of Wisconsin solution in a goat carotid artery transplantation model.

BACKGROUND: Prosthetic grafts have poor patency rates in peripheral arterial reconstructions. Glycerol (GL)-preserved grafts are an alternative. The aim of this study was to examine patency, graft morphology and function of GL-preserved allografts in a goat carotid artery animal model. METHODS: The first group (n = 7) underwent bilateral replacement of the carotid artery by a carotid allograft that was preserved in GL for 1 week. In the second group (n = 5), a carotid artery allograft that was preserved in University of Wisconsin solution (UW) for 48 h was used. In the third group (n = 5), the jugular vein (autologous vein, AU) was used. The follow-up was 3 months. RESULTS: One UW graft and 1 GL graft occluded in the first 24 h postoperatively. Three-month primary patency rates for GL, UW and AU grafts were 93, 100 and 80%, respectively (p = 0.39). Graft diameter was increased in UW allografts (p < 0.005), whereas GL allografts remained unchanged. After explantation, GL allografts demonstrated contraction and relaxation capacity and lower intimal thickness (p < 0.001). CONCLUSION: GL preservation has proven to be a feasible method for arterial allograft transplantation in a large animal model with decreased intimal hyperplasia and renewed functional capability.

The benefit of a human bone marrow stem cells concentrate in addition to an inorganic scaffold for bone regeneration: an in vitro study.

Background. This work compares the osteoblastic behaviour of a bone marrow (BM) aspirate and a prepared BM concentrate of nucleated cells associated with a glass reinforced hydroxyapatite composite (GRHC) in a microporous pellet formulation. Methods. BM aspirate (30 mL) was collected during 3 orthopedic surgical procedures, and a concentration system was used to achieve 3 rapid preparations of a concentrate of nucleated cells (3 mL) from the BM aspirates. The BM aspirates (53% cell viability; 2.7 × 10(6) nucleated cell/mL) and the BM concentrates (76% cell viability; 2 × 10(7) nucleated cell/mL) were cultured over glass reinforced hydroxyapatite pellets, at the same volume/mass ratio, for 30 days. Cultures performed in standard tissue culture plates were used as control. Results. The colonized BM concentrate/material constructs exhibited a representative osteoblastic proliferation/differentiation pathway, evidenced by a high alkaline phosphatase (ALP) activity, expression of collagen type 1, ALP, BMP-2, M-CSF, RANKL, and OPG, and formation of a calcium phosphate mineralized matrix. A clear improved behaviour was noticed compared to the BM aspirate/material constructs. Conclusions. The results suggest the benefit of using an autologous BM concentrate/material construct in the clinical setting, in bone regeneration applications.

Return of normal gait as an outcome measurement in acl reconstructed patients. A systematic review.

BACKGROUND: Current clinical outcome measurements may overestimate the long term success of anterior cruciate ligament reconstruction (ACLR). There is a need to understand biomechanics of the knee joint during daily activities. This systematic review provides a comprehensive overview of the literature related to gait in patients following ACLR. The purpose of this systematic review was to investigate the available literature and provide a comprehensive overview of kinematic and kinetic variables that present during gait in patients after ACLR. METHODS: A literature search was performed in AMED, CINAHL, EMBASE, Medline and Scopus between January 2000 and October 2012. Inclusion criteria included articles written in English, German or Dutch, and those reporting on gait analysis in patients after ACLR. Kinematic and/or kinetic data of the uninjured and ACLR knee and healthy controls (CTRL) were outcome measurements of interest. Each study's methodological quality was assessed using the Critical Appraisal Skills Programme critical appraisal tool. RESULTS: Twenty two studies fulfilled the inclusion criteria. A total of 479 patients with a mean age of 27.3 were examined. Time between the injury and surgery and ranged from 3 weeks to 5.7 years. Gait analysis was done at a mean of 29.3 months after surgery. Gait was found to be altered in the sagittal, frontal and transverse planes after ACLR and may take months or years to normalize, if normalization occurs at all. CONCLUSION: Patients after ACLR have altered gait patterns that can persist for up to five years after surgery. It is imperative that rehabilitation techniques are examined in order to minimize changes in knee biomechanics during gait, as they have the potential to impact on the development of osteoarthritis. LEVEL OF EVIDENCE: 3a.