Anterior cruciate ligament revision with Achilles tendon allograft in young athletes.

BACKGROUND: Return to sport after revision ACL reconstruction is a controversial topic, several studies reported the results of different techniques and graft in sportsman, presenting an incredibly wide range of return to the same pre-injury activity level, from 0% to 100%. The purpose of this study was to evaluate the clinical outcomes and return to sport rate in young athletes after non anatomic double-bundle revision ACL reconstruction with Achilles allograft. HYPOTHESIS: The present revision technique was effective in terms of stability, return to sport and functional outcomes. MATERIAL AND METHODS: All the athletes undergone Revision ACL reconstruction with non-irradiated Achilles tendon allograft with a non-anatomical double-bundle technique were included in the study. A split Achilles tendon allograft was used to reproduce the anteromedial (AM) bundle using the over-the-top position, while the posterolateral (PL) bundle was reconstructed through a femoral tunnel located in the anatomical PL footprint. Sport activity, knee function with Lysholm score, knee laxity and re-injury or re-operations were evaluated. RESULTS: Twenty-six athletes (23 males, three females) with a mean age of 23.4±3.6 years were evaluated at a mean follow-up of 6.0±1.6 years. Overall 69% of patients returned to sport both at elite (44%) or county level (56%) after a mean 6.7±1.5 (3-9 range) months. The mean Lysholm score showed a significant improvement from 64.4±8.1 at pre-operative status to 83.8±11.3 at final follow-up (P<.0001). Seven patients (30%) were rated as excellent, nine (39%) as good, five (22%) as fair and 2 (9%) as poor. Three patients (12%) experienced a further graft rupture after a mean 2.6 years, (3.5 months-48 months range) and two had >5mm side-to-side difference at KT-1000. Therefore, the overall survival rate at mean six years follow-up was 81%. CONCLUSION: The ACL revision with a double-bundle technique using Achilles tendon allograft was successful in 81% of athletes at six years mean follow-up. TYPE OF STUDY AND LEVEL OF EVIDENCE: Retrospective case series, level IV.

Total knee replacement: intraoperative and postoperative kinematic assessment.

BACKGROUND AND AIM: The main goals of the total knee arthroplasty (TKA) is to reduce the perceived pain and  restore knee mobility and function in case of osteoarthritic knees joints. Literature shows how the three major causes of TKA failures are related to wear, loosening and instability and this is due to a problem of imbalance and malalignment. Intraoperative and postoperative kinematics analysis could be of benefit for improving surgery outcome. The aim of the present paper is to give an overview of the two set-up with the highest accuracy for intraoperative and postoperative TKA kinematics evaluation, currently in use at Istituto Ortopedico Rizzoli. Introperative and Postoperative Evaluation: For intraoperative evaluation it has been presented a navigation system with a specifically developed software, while for the postoperative it has been presented the roentgen stereophotogrammetric analysis (RSA). The navigation system consists in a laptop connected with an optoelectronic localizer (Polaris, Northern Digital Inc, Canada).  Two reference arrays with passive optical markers and a marked probe are used to localize the knee joint in the 3D space and track the joint kinematics. The RSA is a radiographic technique used in orthopaedic field for measuring micromotion at bone/prosthesis interface or for joint kinematics evaluation. The RSA uses two X-ray sources synchronized with two digital flat-panels. CONCLUSIONS: The present paper shows that using the navigation system allows the surgeon to easily perform kinematic and alignment evaluation during TKA surgery while the RSA allows a quantitative evaluation of the joint kinematics during the recovery time.