Do outcomes of outpatient ACL reconstruction vary with graft type?

BACKGROUND: Studies establishing the feasibility of anterior cruciate ligament (ACL) reconstruction as an outpatient procedure in France were usually conducted with hamstring tendon grafts. The objective of this study was to evaluate the outcomes of outpatient ACL reconstruction according to whether the graft was harvested from the hamstring tendons or patellar tendon. HYPOTHESIS: Outpatient ACL reconstruction can be performed using any type of graft. METHODS: A single-centre retrospective study was conducted in consecutive patients older than 16 years who had primary ACL reconstruction using patellar tendon or hamstring tendons, with or without lateral tenodesis. Patients who underwent other procedures on bones or peripheral ligaments and those with a previous history of ACL reconstruction were excluded. The primary evaluation criterion was the occurrence of complications within 45 days after surgery. Secondary evaluation criteria were the visual analogue scale (VAS) for pain during the first 3 postoperative days, patient satisfaction on day 3, and the IKDC and Lysholm clinical scores on day 45. RESULTS: The analysis included 104 knees (one knee per patient). Hamstring tendons were used in 77 (74%) knees and patellar tendon in 27 (26%) knees. In the hamstring group, 2 (2.6%) patients spent the first postoperative night in the hospital and 2 others were re-admitted. No hospitalisations were recorded in the patellar-tendon group. None of the patients required revision surgery within 45 days of the reconstruction procedure. None of the postoperative criteria studied showed statistically significant differences between the two groups. DISCUSSION: ACL reconstruction can be performed on an outpatient basis using any type of graft. The main determinants of successful outpatient ACL reconstruction are a standardised clinical management strategy and an appropriate anaesthesia protocol. LEVEL OF EVIDENCE: Level IV, retrospective study.

Surgical management of combined anterior or posterior cruciate ligament and posterolateral corner tears: for what functional results?

INTRODUCTION: Management of combined anterior or posterior cruciate ligament and posterolateral corner tears is still poorly codified. The aim of this study was to evaluate functional outcome after complete surgical treatment. MATERIALS AND METHODS: This retrospective multicenter study included 53 patients. Mean age was 29.8 yrs. (15-49). The anterior and posterior cruciate ligaments were involved in respectively 48 and 5 cases. Mean time to surgery was 25.6 months (0-184), and in 10 cases less than 21 days. Nine patients were sedentary workers and 29 non-sedentary (13 laborers). All ligament injuries were treated surgically. Mean follow-up was 49 months (12-146). Last follow-up assessment used IKDC, Lysholm and KOOS scores. RESULTS: At last follow-up, IKDC score graded 14 patients A, 25 B, 8 C and 6 D, versus 0 A, 4 B, 25 C, 22 D and 2 ungraded preoperatively. Mean subjective IKDC and Lysholm scores were respectively 72.8 (11.5-100) and 77.5 (37-100). Mean KOOS scores (pain, symptoms, daily life, sports, quality of life) were respectively 78 (3-100), 70 (25-100), 88 (47-100), 53 (0-100) and 50 (0-100). Posterolateral laxity was corrected in all but two cases. All sedentary workers and 86.7% of non-sedentary workers could return to work. The job had to be changed in 10% of cases overall, but in 25% of cases for laborers. DISCUSSION: The present results are comparable with those of the literature. The strategy of combined surgical treatment showed functional efficacy, usually associated with return to work except for some laborers. There was a non-significant trend in favor of acute-phase ligament reconstruction. LEVEL OF EVIDENCE: IV (retrospective series).

Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review.

BACKGROUND: Combined injuries to the posterolateral corner and cruciate ligaments are uncommon. The heterogeneity of injury patterns in many studies complicates the assessment of outcomes. OBJECTIVE: To assess the prognosis and functional outcomes after surgery for combined injuries to the posterolateral corner and to the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL). MATERIAL AND METHODS: We systematically reviewed the literature for articles reporting outcomes 1 year or more after surgery for combined injuries to the posterolateral corner and ACL (n=4) or PCL (n=9). Patients with bicruciate injuries were not studied. RESULTS: Overall, 65% of patients were IKDC A or B after surgery. The mean Lysholm score improved from 67 to 90. Mean time to surgery was 4.43 months in the group with ACL tears and 18.4 months in the group with PCL tears, and mean follow-up was 34.4 and 40.7 months in these two groups, respectively. In the groups with ACL and PCL tears, the proportions of patients classified as IKDC A or B at last follow-up were 81.6% and 81.0%, respectively, whereas 88% and 99% of patients, respectively, were IKDC grade C or D before surgery. The mean Lysholm score improved from 77 to 92 in the group with ACL tears and from 65 to 89 in the group with PCL tears. Improvements in laxity ranged from 28% to 79% in the group with PCL tears. DISCUSSION: Most of the articles selected for our review provided level III or IV evidence. Functional outcomes were satisfactory but less good than those reported after surgical reconstruction of isolated cruciate ligament tears. Full reconstruction seems the best strategy in patients with combined ACL/posterolateral corner injuries. Outcomes were also good but more variable in the group with PCL/posterolateral corner injuries. The time to surgery, which reflected the time to diagnosis, was shorter in patients with ACL than with PCL tears in addition to the posterolateral corner injury. LEVEL OF EVIDENCE: Level III (systematic literature review).

The effect of gender on outcome of unicompartmental knee arthroplasty.

No report has specifically addressed the question of the influence of gender on outcome following unicompartmental knee arthroplasty (UKA). To clarify this issue, we studied two groups of 40 patients of each gender, matched by pre-operative clinical and radiological presentation, and with post-operative follow up of at least 2 years. The mean age at operation was 71 years and the mean follow-up was 5.9 years. In both groups, IKS score improved significantly, but without difference based on gender. No difference was found between groups in terms of range of motion, alignment, or radiologic progression of arthritis. These results suggest that when utilizing specific patient selection criteria, gender does not influence outcome following UKA.

Tibial component rotation assessment using CT scan in medial and lateral unicompartmental knee arthroplasty.

BACKGROUND: Rotation of tibial component has not been analysed in literature for unicompartmental knee arthroplasty. The purpose of the study was to determine and compare the rotation of medial and lateral unicompartmental knee arthroplasty (UKA) tibial components. We assumed both components (lateral and medial) were positioned with external rotation. PATIENTS AND METHODS: Eighteen lateral and 19 medial UKA patients were scanned postoperatively in neutral position with computed tomography enabling lower extremity three-dimensional image acquisition from the hip to the ankle. All the patients were operated by three different senior surgeons using the same surgical technique. From the reconstructions we measured the two-dimensional (2D) rotation of the tibial components. RESULTS: The rotation of the tibial component was external (mean 6.5°, SD 5.1°) for the medial UKA and external (mean 7.3°, SD 10.3°) as well for the lateral UKA. The difference was statistically insignificant (P=0.717). DISCUSSION: This study presents the first 2D in vivo analysis accurately determining and comparing medial and lateral UKA component rotation. Despite a wide range of value, we found both components were indeed externally rotated. The variability in implant positioning was observed despite the rigorous performance of an experienced surgeon using routine techniques in patients selected under routine criteria. Further analysis of these patients for satisfaction and implant survivorship in relation to implant rotation may give us an optimal range for the tibial component. If it is found that this ideal range cannot be consistently obtained with current surgical techniques then there may be a case for the use of a navigation system.