No difference at two years between all inside transtibial technique and traditional transtibial technique in anterior cruciate ligament reconstruction.

BACKGROUND: one of the most recent technique is the "all inside" anterior cruciate ligament (ACL) reconstruction. One of the main characteristic of this procedure is the sparing of the tibial cortex. Furthermore, the all-inside technique requires only one tendon harvested. PURPOSE: the present study describes two year clinical outcomes of the all-inside method for ACL reconstruction, and compares them with clinical results of a group of patients treated with the traditional transtibial single-bundle ACL reconstruction technique using the semitendinosus and gracilis tendons (ST-G). STUDY DESIGN: pilot study, using historical controls. METHODS: ACL reconstruction was performed on two groups of 20 patients each. The patients in one group underwent the all-inside transtibial technique with ST tendon alone. The second group underwent ACL reconstruction with the traditional transtibial single-bundle procedure using quadrupled ST-G tendons. Follow up at 24 months was undertaken using the IKDC, VAS pain score, Lysholm and Tegner scales. RESULTS: the VAS pain score for the traditional ACL group was 84.6 ± 12.6; whereas the score for the all-inside group was 81.6 ± 13.1, with no statistically significant differences between the two groups. In the traditional ACL reconstruction group the Lysholm scale gave a "good results" for 7 patient (35%) and "excellent results" for 13 patients (65%) and the all-inside group gave "sufficient results" for 4 patients (20%), "good results" for 7 patients (35%) and "excellent results" for 9 patients (45%) (n.s.). The median of Tegner score was 6.5 (2-10) for the standard method group and 6 (1-9) for the all-inside group (n.s). The IKDC evaluated 50% of patients from the standard technique group as class A, and 45% as class B and 5% as class C. As regards patients of the all inside technique 55% were class A, 40% class B and, here too, just 5% scored as class C. No patients were classed as group D in each group. CONCLUSIONS: this study suggests that, in respect to return to sports and adequate articular function, there are no differences between the all-inside transtibial ACL reconstruction technique and the traditional transtibial ACL reconstruction using ST-G. The role of all-inside transtibial ACL reconstruction remains dubious. LEVEL OF EVIDENCE: III or Level C according with Oxford Center of EBM.

Treatment of chondral defects of the knee with one step matrix-assisted technique enhanced by autologous concentrated bone marrow: in vitro characterisation of mesenchymal stem cells from iliac crest and subchondral bone.

Cartilage repair is still an unsolved problem. In the last years many cell-based treatments have been proposed, in order to obtain good regeneration of cartilage defects. The Autologous Matrix-Induced Chondrogenesis technique (AMIC(®)) combines the micro-fracture procedure with the use of a specific biological membrane. The phenotypic feature of bone marrow cell population, harvested from iliac crest and knee subchondral bone of patients treated with the AMIC(®) technique, enhanced by autologous concentrated bone marrow, was analysed to evaluate potential variations of the cell population. Samples of eleven patients, with isolated chondral lesions grade III or IV were treated with the AMIC(®) technique, enhanced by the use of autologous concentrated bone marrow. A small fraction of bone marrow samples, both from iliac crest and from the created micro-fractures, was analysed by FACS analysis and then cultured to verify their proliferative and differentiation potential. An average of 0.04% of concentrated bone marrow cells harvested from the iliac crest, presented mesenchymal stem cell phenotype (CD34(-)/CD45(low)/CD271(high)), whereas just 0.02% of these cells were identified from the samples harvested during the creation of micro-fractures at the knee. After two passages in culture, cells expressed a peculiar profile for MSC. Only MSC from bone marrow could be long-term propagated and were able to efficiently differentiate in the cultures. Although the AMIC(®) approach has many advantages, the surgical technique in the application of the microfracture technique remains essential and affects the final result.

ACL reconstruction in sports active people: transtibial DB technique with ST/G vs. transtibial SB technique with BPTB: preliminary results.

The single-bundle ACL reconstruction ensures good outcomes and it is a well-established and widespread technique. Nevertheless, some patients still present residual pain and instability. Recent studies have showed that the double-bundle technique restores better natural ACL-fitting kinematics. Long-term clinical studies comparing the two surgical techniques are not frequent and there is no instrument to evaluate function and kinematics during the knee rotation in vivo. In this randomised prospective study performed on sportive people, we compare the BPTB single-bundle ACL reconstruction technique, which is the most common surgical technique performed on these patients' category, with the ACL double-bundle reconstruction technique (DB), in order to evaluate possible differences between the groups. Comparing the two groups, no statistically significant difference regarding the post-operative Lysholm score (p=0.368) the Tegner activity scale (p=0.519) and the arthrometric evaluation with KT-1000 (p=0.74) have been observed. On the contrary, the IKDC evaluation showed a statistically significant difference (p=0.004) better results of the DB group. Moreover, as assessed by the Tegner activity scale, only patients of the DB group were able to return to sports at a pre-injury level. Our data suggest that the double bundle ST/G ACL reconstruction technique results into slightly better outcome than the traditional technique of single-bundle BPTB. The verification and quantification of the advantages of this technique is anticipated with future studies focusing to the accurate measurement of knee rotation during different activities.