A simple arthroscopic technique for treatment of displaced "hinged" type of posterior cruciate ligament avulsion fractures.

BACKGROUND: The surgical technique for treatment of tibial avulsion fractures of the posterior cruciate ligament (PCL) remains challenging due to the deep-located lesion and the complexity of the anatomy. The purpose of this study was to report preliminary results of an arthroscopic technique in patients with the "hinged" type PCL tibial avulsion fractures. METHODS: Twenty-eight patients with the displaced "hinged" fractures with elevation of the posterior aspect of the bony fragment were arthroscopically treated. The bony fragment was reducted and fixed with the sutures passing through only one single tibial tunnel. The clinical outcomes were assessed by Lysholm score, Tegner activity score, and the side-to-side differences of KT-1000 measurement. The reduction and union of the fracture were assessed by radiography of the knee. RESULTS: Patients were followed up for a mean of 19 (12 to 24) months. There were no surgery-related complications, and all patients regained normal range of motion of the knees at the last follow-up. The Lysholm score significantly increased from preoperative 14.78 ± 8.23 to postoperative 96.96 ± 3.62 (P = 0.000). The Tegner score was 6.78 ± 1.35 pre-injury and 6.48 ± 1.20 at the last follow-up with no statistical difference (P = 0.688). The KT-1000 side-to-side differences significantly decreased from 8.26(SD 1.86; 6 to 12) pre-operatively to 0.91 (SD 0.85; 0 to 3) (P = 0.000). X-rays showed that satisfactory reduction and solid union was achieved in all patients. CONCLUSION: The arthroscopic suture fixation through single-tibial tunnel technique yielded good clinical and radiographic outcome for treatment of displaced "hinged" type of PCL avulsion fractures.

Surgical medial patellofemoral ligament reconstruction versus non-surgical treatment of acute primary patellar dislocation: a prospective controlled trial.

PURPOSE: The acute primary (first-time) lateral patellar dislocation is associated with a high rate of functional disability. There is no consensus as to the choice of surgical or non-surgical treatment for these patients. The aim of this study is to compare the clinical results between the surgical (reconstruction of the medial patellofemoral ligament [MPFL]) and non-surgical treatments for acute primary patellar dislocations. METHODS: Sixty-nine skeletally mature patients (69 knees) were included in this prospective non-randomized controlled trial. At least one predisposing factor for patellar dislocation (including patella alta, high lateral patellar tilt, trochlear dysplasia, and increased TT-TG distance) was identified in the included patients. Thirty patients were treated surgically with MPFL reconstruction, and the other 39 patients were treated non-surgically. The main outcome variable was patellar redislocation within a two year follow-up period. The Kujala questionnaire was applied for analyzing the pain and the quality of life. The additional surgeries due to patellofemoral problems were also recorded. RESULTS: Patellar redislocation occurred in eight patients in the non-surgical group, while no redislocation occurred in the surgical group (P < 0.05). Four patients in non-surgical group underwent further surgery due to patellar redislocation and poor function during the follow-up period. The Kujala score and the percentage of "good/excellent" results on the Kujala score of the surgical group were significantly better than that of the non-surgical group (P < 0.05). CONCLUSIONS: The surgical MPFL reconstruction achieved better clinical outcomes compared with non-surgical treatment for the acute primary patellar dislocation in the skeletally mature patients with the presence of abnormal patellofemoral anatomy. Surgery should be considered as the better choice for these specific patients.

Clinical outcomes and second-look arthroscopic findings of anterior cruciate ligament reconstruction with autograft, hybrid graft, and allograft.

BACKGROUND: There is no consensus as to the choice of grafts for primary anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the clinical and second-look arthroscopic outcomes after ACL reconstruction by use of autograft, hybrid graft, and γ-irradiated allograft. METHODS: Ninety-seven patients who underwent second-look arthroscopy after ACL reconstruction with autografts (28 patients, hamstring autograft), hybrid grafts (32 patients, hamstring autograft augmented with γ-irradiated tibialis anterior tendon allograft), or γ-irradiated allografts (37 patients, tibialis anterior tendons) were included in this study. The clinical outcomes were compared by using Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity score, and the side-to-side differences of KT-1000 measurement. Second-look arthroscopic findings were compared in terms of synovial coverage and graft tension. RESULTS: There were no statistical significances among the three groups in Lysholm score, IKDC score, or Tegner activity score (P > 0.05). The KT-1000 examination showed more anterior laxity in the γ-irradiated allograft group than in the autograft or hybrid graft groups (P = 0.006, and P = 0.013, respectively). Two patients in the autograft group, 2 patients in the hybrid graft group and 4 patients in the allograft group were evaluated as graft failure on second-look arthroscopy. The synovial coverage was superior in the autograft group than that in the hybrid graft group or the allograft group (P = 0.013 and P = 0.010, respectively), and was comparable between the hybrid graft group and allograft group (P = 0.876). With regard to graft tension, the autograft group and hybrid group were comparable (P = 0.883) but showed better results than the allograft group (P = 0.011 and P = 0.007, respectively). CONCLUSION: The hamstring autografts and hybrid grafts used for ACL reconstruction produced equal efficacy but provided better knee stability than allografts. In addition, the hamstring autografts showed better synovial coverage than the other two graft types.

Effects of graft preconditioning on γ-irradiated deep frozen tendon allografts used in anterior cruciate ligament reconstruction.

Preconditioning of the grafts prior to implantation into the knee is considered to reduce the loss of tension caused by graft viscoelasticity after anterior cruciate ligament reconstruction. The present study analyzed the impacts of different preconditioning forces on the biomechanical properties of the γ-irradiated deep frozen tendon allografts. A total of 36 tendon grafts were randomly divided into three groups and were preconditioned at 80 N (group 1), 160 N (group 2) and 320 N (group 3) for 10 min. Subsequently, the grafts were gradually completely relaxed for 1 min and subsequently received 25 cyclic loads of 0-80 N. Afterwards, the grafts were loaded to 80 N, which was maintained for 30 min. Finally, load was gradually increased until ultimate failure at maximum load (UFML) was obtained. There were significant differences in the stiffness and UFML values between the 3 groups (all P<0.05). The graft stiffness in group 3 significantly increased compared with the other 2 groups, and the stiffness of group 2 grafts increased compared with group 1. The UFML in group 3 was significantly lower compared with groups 1 and 2, while there was no significant difference between groups 1 and 2. In the present study, the results suggested that increasing the initial tension could effectively reduce the loss of stiffness due to viscoelasticity for the γ-irradiated deep frozen allogeneic tendon grafts. However, overloaded initial tension decreased the tensile strength.