RESUMEN
The purpose of this study was to evaluate the histologic and biomechanical changes that occur between 12 and 52 weeks in an intraarticular, semitendinosus autograft placed through tibial and femoral drill holes in a rabbit model. The results of this study show that, in this rabbit model, the soft tissue graft maintained its biologic fixation in the osseous tunnel when stressed to failure at 1 year. The bony fixation occurred by the formation of an indirect tendon insertion, and this formation was complete by 26 weeks. At 52 weeks, large differences persisted in the strength and stiffness of the graft compared with the normal semitendinosus tendon and anterior cruciate ligament. Based on the results of this study, we support a cautious approach in returning patients to early full activity, including sports, after anterior cruciate ligament reconstruction with a semitendinosus autograft.
Asunto(s)
Ligamento Cruzado Anterior/cirugía , Tendones/trasplante , Actividades Cotidianas , Animales , Ligamento Cruzado Anterior/patología , Ligamento Cruzado Anterior/fisiopatología , Fenómenos Biomecánicos , Colágeno , Tejido Conectivo/patología , Modelos Animales de Enfermedad , Elasticidad , Estudios de Evaluación como Asunto , Fémur/patología , Fémur/cirugía , Estudios de Seguimiento , Miembro Posterior/cirugía , Humanos , Conejos , Rotura , Deportes , Estrés Mecánico , Tendones/patología , Tendones/fisiopatología , Tibia/patología , Tibia/cirugía , Trasplante Autólogo , Cicatrización de HeridasRESUMEN
Although intramedullary fixation has standardized the management of femoral shaft fractures, compression plating may offer a viable alternative. A retrospective review of acute femoral shaft fractures managed by open reduction and compression plating between 1980 and 1987 revealed 71 fractures in 69 patients. There were 58 closed fractures, and six grade I and seven grade II open fractures. All patients received prophylactic antibiotics. Sixty-nine percent of patients were bone grafted. Sixty-six of 71 fractures (93%) healed uneventfully. The average time until union was 16 weeks (range: 23 to 72). Complications included two nonunions, two refractures, and one broken implant (7%). Careful adherence to the principles of prophylactic antibiotics, medial cancellous bone grafting, and meticulous soft tissue technique can significantly reduce the complication rate of compression plating.