Role of gracilis harvesting in four-strand hamstring tendon anterior cruciate ligament reconstruction: a double-blinded prospective randomized clinical trial.

PURPOSE: Weakness in knee flexion following anterior cruciate ligament (ACL) reconstruction is one of the key issues in the treatment of an ACL tear. The purpose of this study was to examine and compare clinical outcome measures of ACL reconstruction using semitendinosus autograft (ST) versus semitendinosus + gracilis (ST/G) reconstructive techniques. METHODS: In a double-blind randomized clinical study, 19 patients with an ACL tear underwent either ST (59) or ST/G (61) and observed for 1 year. Both patients and the final examiner were unaware as to the type of graft received. Patients were evaluated according to subjective criteria, functional assessment tests, knee isometric torques, knee laxity using KT-2000 and knee range of motion. RESULTS: The study included 21 (17.6 %) female and 99 (82.4 %) male patients with a mean age of 29.9 ± 7.8 in the ST group and 32.4 ± 6.3 in the ST/G group. There were no significant differences found in surgical complications; IKD; Knee injury and Osteoarthritis Outcome Score; Lysholm; strength of the knee isometric flexors; and flexion and extension loss between the two groups. At the final visit, 86.9 % of ST group and 89.6 % of ST/G group had side-to-side difference of laxity <3 mm (n.s.). CONCLUSIONS: Since anterior cruciate ligament reconstruction using quadrupled ST is more technically demanding than doubled STG and with there being no difference in outcomes and complications, no compulsory advice should be made on the former technique. However, gracilis harvesting may not be necessary based on the function and strength of the knee. LEVEL OF EVIDENCE: Randomized controlled trial, Level I.

Incidence and risk factors of transplant renal artery stenosis in living unrelated donor renal transplantation.

BACKGROUND: This study was designed to evaluate the incidence and risk factors of transplant renal artery stenosis (TRAS) among living donor unrelated kidney recipients. PATIENTS AND METHODS: Three hundred and sixty kidney consecutive transplant recipients were included in this retrospective cohort study. Informed written consent was obtained, only TRAS occurring three months after transplantation were considered. After five-year follow up, TRAS was established in 6.6% (24 patients) of patients. RESULTS: Mean +/- SD age of recipients was 39.8 +/- 14.9 years old (range 16-77). Upon multivariate analysis recipient age >50 (RR = 2.9, CI 95%: 1.33-2.93, p = 0.008), recipient BMI >30 (kg/m(2)) (RR: 7.97, CI 95%: 3.44-18.46, p < 0.001), retransplantation (RR = 4.88, CI 95%: 2.21-10.77, p < 0.001), cytomegalovirus (CMV) infection and delayed graft function (DGF) (RR: 4.29, CI 95%: 3.12-13.79, p = 0.01) appeared to be independently associated with TRAS. Positive CMV-antibody was more frequent in recipients with TRAS (95.83% vs. 70.8%, p = 0.04) but all of them were HCV-antibody negative. Other variables as discussed were similar between two groups. CONCLUSION: High recipient age, BMI > 30, hyper trigelyceridaemia, previous transplantation, CMV infection and DGF are shown to be risk factors for TRAS.

Impact of obesity on urologic complications among unrelated living donor kidney transplants.

PURPOSE: Although obesity has been associated with improved survival on dialysis, its effects on renal transplantation outcomes remain unclear. Herein we aimed to evaluate the effect of obesity on posttransplantation complications. PATIENTS AND METHODS: A retrospective analysis of consecutive renal transplant recpients from un related living donors was undertaken from 2006 to 2008. RESULTS: We included 180 patients, 34 (18%) were obese (body mass index >30 kg/m(2)) and 146 were lean. Obese patients were more likely to develope renal artery stenosis (17.6% vs 2.8%, p < 0.001), hematoma (47.9% vs 17.6, p = 0.009), wound complications (64.7% vs 9.6%, P < 0.001) and renal vein thrombosis(2% vs 0%, p < 0.001). Urologic complications consisting ureteral, ureteropelvic and ureterovesicular junction stenosis, wound bleeding, urinary leakage and renal artery thrombosis and also hospitalization time were found similar between the two groups. 2 year patiets and graft survival were not statististically different. CONCLUSIONS: Renal transplantation could be performed with reasonable urologic complications in obese patients.