Lack of stability at more than 12 months of follow-up after anterior cruciate ligament reconstruction using all-inside quadruple-stranded semitendinosus graft with adjustable cortical button fixation in both femoral and tibial sides.

INTRODUCTION: The use of the semitendinosus tendon alone for anterior cruciate ligament reconstruction keeps the gracilis muscle intact and decreases anterior pain in comparison with the use of the patellar tendon. Recently, Lubowitz described a new all-inside technique with an ST4 tendon fixed with a cortical button in both femoral and tibial sides. We hypothesized that this type of graft with cortical button fixation provides well-controlled residual anterior tibial translation (<3mm). The aim of this study was to assess the results obtained with this technique in terms of laxity and IKDC score at more than 1 year of follow-up. MATERIAL AND METHODS: We performed a prospective single-center study to evaluate the results with this procedure with at least 1 year of follow-up. The primary endpoint was the objective IKDC score and side-to-side anterior tibial translation difference. The secondary endpoint was the subjective assessment using the subjective IKDC and Lysholm scores. Tunnel positioning was assessed using the Aglietti criteria. RESULTS: Thirty-five patients were included and reviewed with a mean follow-up of 19.7 months. Sixty-three percent of the patients were male and the mean age at the procedure was 28 years. The IKDC score was A or B in 43% of the patients and C or D in 57%; 54% of the patients had a residual side-to-side anterior tibial translation difference less than 3mm and 29% presented significant pivot shift (grade C or D). Five patients underwent revision surgery, including one for rupture of the ACL reconstruction. The meniscal status did not influence postoperative laxity and the IKDC grade. DISCUSSION: Our hypothesis was not verified and the postoperative stability of the knee was insufficient. Postoperative side-to-side anterior tibial translation difference remained greater than 3mm for 16 patients and the analysis seems to indicate that the distal cortical fixation of the graft with an adjusted loop is insufficient. LEVEL OF EVIDENCE: Prospective study - Level IV.

Post-traumatic lower cervical spine instability: arthrodesis clinical and radiological outcomes at 5 years.

BACKGROUND: Anterior cervical fusion is widely used to treat spinal injuries. Radiological evidence of disc abnormalities may develop on either side of the fused segment, raising concern about the potential for inducing adjacent-segment disease. Here, we report the long-term clinical, functional, and radiological outcomes after anterior cervical fusion. HYPOTHESIS: Anterior cervical fusion influences the development of adjacent-segment disease. MATERIALS AND METHODS: In a retrospective study, 15 patients aged 17 to 50 years were re-evaluated more than 5 years after anterior spinal fusion to treat post-traumatic cervical-spine instability. We used the Neck Disability Index (NDI) to assess function. Static and dynamic radiographs of the cervical spine were obtained. RESULTS: NDI values indicated good clinical and functional outcomes, and fusion was achieved consistently. Adjacent-segment disease was a consistent finding at last follow-up but induced no neurological manifestations. Complete fusion of a level adjacent to the treated level was noted in 2 patients. Revision surgery for adjacent-segment disease was not required in any patient. CONCLUSION: The causative factors of adjacent-segment disease are controversial. Disc degeneration is a normal manifestation of the ageing process. Nevertheless, disc disease is more prevalent at levels adjacent to interbody fusion than in the normal population, suggesting accelerated disc degeneration due to increased loading of the adjacent levels. Furthermore, lesions that are missed during the pre-operative work-up may play a role, as the available investigations do not always have high negative predictive values. LEVEL OF EVIDENCE: Level IV, retrospective study.