Comparison of ACL and Anterolateral Ligament Reconstruction With Isolated ACL Reconstruction Using Hamstring Autograft: Outcomes in Young Female Patients With High-Grade Pivot Shift.

Background: Inferior return to sports (RTS) and functional outcomes have been reported in women after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis: The purpose was to evaluate the results of combined ACLR and anterolateral ligament reconstruction (ALLR) in young women with a high-grade pivot shift (grade ≥2). It was hypothesized that combined ACLR and ALLR would result in better RTS and rotational stability than isolated ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Two groups were retrospectively evaluated and compared. Group I (n = 39; mean age, 31.1 ± 5.7 years) underwent isolated ACLR using hamstring autografts; group C (n = 39; mean age, 30.4 ± 6.1 years) underwent combined ACLR and ALLR. Subjective outcome measures included the International Knee Documentation Committee subjective form, Lysholm, Tegner, and ACL-Return to Sport after Injury (ACL-RSI). Objective tests included a KT-2000 arthrometer stress test, a pivot-shift test, an isokinetic strength test, a Y-balance test, and a single-leg hop test. A postoperative questionnaire was administered to determine the rates and types of RTS, quality of sports performance, and reinjury and satisfaction rates. Subjective scores and clinical tests were performed at 2 years. Magnetic resonance imaging and second-look arthroscopy were conducted during the 1- and 2-year follow-ups, respectively. Results: The mean follow-up for groups I and C were 30.4 ± 3.9 and 29.3 ± 3.5 months, respectively (P = .194). Patients in group C had better anteroposterior (P = .001) and rotational (P = .005) stability and higher ACL-RSI scores (P = .025) than those in group I. Group C had higher composite and posteromedial reach scores on the Y-balance test than group I (P = .014 and P = .010, respectively). A total of 26 (66.7%) patients in group C and 17 (43.6%) in group I returned to their prior level of sports (P = .040). Rerupture of the ACL graft and contralateral ACL rupture occurred in 2 (5.1%) and 2 (5.1%) patients in group I, respectively, compared with no rerupture or contralateral ACL rupture in group C. Conclusion: Combined ACLR and ALLR in young women with a high-grade pivot shift was associated with better knee stability parameters, dynamic postural stability, and psychological readiness to RTS than isolated ACLR.

Additional Anterolateral Ligament Reconstruction Helps Patients Improve Dynamic Postural Stability in Revision Anterior Cruciate Ligament Reconstruction.

Background and Objectives: The goal in treating anterior cruciate ligament (ACL) injury especially in revision cases is return to sports activity by regaining dynamic postural stability. Among various methods to achieve this goal, additional anterolateral ligament reconstruction (ALLR) is gaining attention. The purpose of this study was to evaluate the effects of additional ALLR in revision ACL reconstruction (RACLR). Materials and Methods: Patients who underwent RACLR between July 2015 and June 2018 were enrolled. The exclusion criteria were less than 1-year follow-up, age older than 45 years, concomitant multiple ligament injuries, contralateral knee injury, subtotal or total meniscectomized state, and articular cartilage lesions worse than Outerbridge grade 3. Thirty-nine patients (20 patients; RACLR only (Group A), 19 patients; RACLR with additional ALLR (Group B)) were included. Clinical scores (Lysholm score, subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale), isokinetic strength test, single-leg-hop for distance test (SLHDT), Y-balance test (YBT) were checked preoperatively and 1-year postoperatively. Results: Limb symmetry index values in YBT showed significantly better result in Group B 1-year postoperatively (Group A: 97.2 ± 4.0, Group B: 100.3 ± 2.9, p = 0.010), although there were no differences preoperatively between groups (Group A: 90.4 ± 6.7, Group B: 89.3 ± 5.5, p = 0.594). Regarding clinical scores, isokinetic strength tests, and SLHDT, there were no differences between groups preoperatively nor 1-year postoperatively. Conclusions: Additional ALLR in RACLR helped patients gain better dynamic postural stability at 1-year postoperative follow-up.

Correlation of Y Balance with Clinical Scores and Functional Tests after Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients.

Background: Criteria for return to sports (RTS) following anterior cruciate ligament (ACL) reconstruction have been extensively studied. But there is no consensus among investigators regarding which factors are most important in determining a safe RTS. Methods: Sixty-one patients who underwent ACL reconstruction were included. Subjective knee scoring systems (International Knee Documentation Committee [IKDC] score and Lysholm score), functional performance tests (carioca test and single-leg hop for distance [SLHD] test), and isokinetic knee strength test were used for assessment and analyzed for association with the limb symmetry index (LSI) of the Y-balance test for lower quarter (YBT-LQ). Results: The LSI of the YBT-LQ was significantly correlated with Lysholm score, IKDC score, Carioca, LSI for the SLHD, and extensor strength deficit at 6 months after ACL reconstruction. At 12 months, Lysholm score, IKDC score, LSI for the SLHD, and extensor strength deficit were significantly correlated with the LSI of the YBT-LQ. Conclusions: The YBT-LQ test could be used conveniently as an additional tool to assess the patient's functional performance results after ACL reconstruction in outpatient clinics.

Patients with advanced lateral osteoarthritis can return to sports and work after distraction arthroplasty plus lateral meniscal allograft transplantation combined with cartilage repair.

PURPOSE: This study aimed to report return to sports (RTS) and return to work (RTW) outcomes after distraction arthroplasty (DA) plus lateral meniscal allograft transplantation (MAT) combined with cartilage repair in active patients with advanced osteoarthritis. It was hypothesised that DA combined with lateral MAT would improve clinical and radiological outcomes and enable RTS and RTW for most patients. METHODS: In total, 21 patients with advanced osteoarthritis (moderate to severe joint space narrowing at lateral edge on Rosenberg view and large cartilage defect of lateral femoral condyle) who underwent concomitant DA and MAT were retrospectively reviewed. Clinical outcomes were assessed using subjective knee scores [Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score, and Tegner activity scale (TAS)] and functional tests (isokinetic extensor muscle strength test, single-leg vertical jump test, and single-leg hop for distance test). The rates of RTS, RTW, and satisfaction were evaluated. Radiological outcomes were assessed using magnetic resonance imaging (MRI) and X-ray (Rosenberg view). RESULTS: The mean age at surgery and mean follow-up duration were 37.2 ± 5.9 years and 37.1 ± 5.4 months, respectively. All improvements in subjective scores were statistically significant (p < 0.001). The Lysholm score improved from 58.3 ± 8.1 to 84.3 ± 8.2, the IKDC subjective score from 53.9 ± 10.4 to 78.0 ± 7.7, and the TAS from 4.0 ± 0.5 to 5.1 ± 0.8. The limb symmetry index (LSI) (%) of the extensor peak torque at an angular velocity of 60°/s improved from 67.3 ± 19.2 to 88.4 ± 20.3% (p = 0.001). The LSI of the single-leg vertical jump test and single-leg hop for distance test improved from 62.8 ± 21.3 to 87.7 ± 19.5% and from 63.9 ± 20.8 to 85.5 ± 18.1%, respectively (all, p < 0.001). All patients were able to return to any sports activity and work. However, 67% and 90.5% returned to their defined or desired level of sports activity and occupation intensity, respectively. Further, 76.2% were very satisfied or somewhat satisfied with the outcome at the last follow-up. The JSW increased by 0.8 ± 0.4 to 2.3 ± 0.6 mm (p = 0.005). In more than 90% of patients, > 50% of cartilage lesion was covered. The mean graft extrusion was 2.6 ± 1.0 mm. CONCLUSION: All patients who underwent distraction arthroplasty plus lateral MAT combined with cartilage repair returned to any sports and work at the last follow-up. Significant improvements in clinical outcomes and the radiographic joint space width were observed. However, the activity ability was somewhat reduced compared with the best preoperative level. This one-stage joint salvage treatment is a promising option for young and active patients with advanced OA who wish to return to high levels of sports activity and occupation intensity (≥ Tegner activity scale 4). LEVEL OF EVIDENCE: III.

Internal Fixation of Lateral Trochlear Groove Osteochondritis Dissecans With Simultaneous Lateral Retinacular Lengthening in Adolescent Athletes.

BACKGROUND: The goals of operative treatment for the adolescent athlete with unstable osteochondritis dissecans (OCD) lesion are rigid fixation and prevention of recurrence. PURPOSE: To evaluate clinical and radiological outcomes of internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Adolescent athletes who had undergone internal fixation and simultaneous lateral retinacular lengthening for an unstable OCD lesion of the lateral trochlear groove were retrospectively reviewed. Subjective assessments included the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Tegner activity scale, and an athletic questionnaire. Functional tests included isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance. Pre- and postoperative radiographs and magnetic resonance images were reviewed. RESULTS: The mean ± SD age of the 17 patients included in this study was 15.9 ± 0.9 years; last clinical follow-up duration was 37.7 ± 8.1 months. At the last follow-up, the Lysholm score improved from 68.7 ± 15.3 to 93.4 ± 12.4 and the IKDC subjective score from 60.2 ± 14.7 to 88.7 ± 12.7 (P < .001). The mean Tegner activity scale score was 9.4 ± 0.5 before injury and 8.9 ± 1.2 at the last follow-up (P = .059). The limb symmetry indices of isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance improved at the last follow-up; the mean limb symmetry index was ≥85% in each functional test. Regarding the athletic questionnaire, 16 (94.1%) patients were satisfied with the surgery. At the last follow-up, 2 patients had higher ability after returning to sports, 11 had the same ability, and 3 had lower ability than the preinjury level. Postoperative magnetic resonance imaging at 12-month follow-up showed that the OCD lesion appeared healed in 7 (41.2%) patients and partially healed in 9 (52.9%). CONCLUSION: Internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening in adolescent athletes achieved satisfactory clinical and radiological outcomes. Therefore, this combined surgical technique could be considered an effective treatment for lateral trochlear groove OCD, with a high rate of return to sport.

Adolescents show a lower healing rate of anterolateral ligament injury and a higher rotational laxity than adults after anterior cruciate ligament reconstruction.

BACKGROUND: This study aimed to compare anterolateral ligament (ALL) injuries in anterior cruciate ligament (ACL) ruptures, as well as ALL healing and clinical outcomes following ACL reconstruction between adolescents and adults. METHODS: This retrospective study involved 98 patients who underwent ACL reconstruction. They were divided into two groups according to age: group A (adolescents, 16-20 years of age; n = 49) and group B (adults, 21-45 years of age; n = 49). Subjective scores including ACL-Return to Sport after Injury (ACL-RSI) scale and objective tests were assessed. Follow up magnetic resonance imaging (MRI) and second-look arthroscopy was conducted at 1-year and 2-year follow up, respectively. RESULTS: Good healing rate of ALL was higher in adults than in adolescents (P = 0.048). Graft tension and synovial coverage showed no significant differences between two groups. Group A showed a higher rate of high-grade pivot shift and a lower ACL-RSI at last follow up than group B (P = 0.126 and P = 0.016). Poor healing of ALL was significantly associated with lower ACL-RSI and failure to return to sports (P < 0.001 and P = 0.001). Re-rupture of the ACL graft was found in four (8.2%) and one (2.0%) of group A and B, respectively. CONCLUSIONS: Adolescents showed a lower healing rate of ALL, a lower ACL-RSI, a higher rate of high-grade pivot shift than adults. Moreover, poor healing of ALL was significantly associated with a lower ACL-RSI and failure to return to sports. We suggest that adolescents need to pay more attention to the presence of ALL injury.

Evaluation of Anterolateral Ligament Healing After Anatomic Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Few studies have reported the healing process of anterolateral ligament (ALL) injuries. PURPOSE/HYPOTHESIS: This study investigated the healing status of ALL injuries after primary anterior cruciate ligament (ACL) reconstruction (ACLR). Additionally, we investigated the association between the healing status of ALL injuries and associated lesions such as osseous lesions and meniscal tears occurring at the time of an ACL rupture. We hypothesized that acute ALL injuries show a high rate (more than two-thirds) of healing at the 1-year follow-up after ACLR and that concomitant lesions observed at the time of an ACL rupture affect the healing status of the ALL. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We retrospectively investigated patients with ALL injuries who underwent primary ACLR between March 2015 and February 2017. Using magnetic resonance imaging (MRI), we evaluated the features of ALL injuries and concomitant lesions, and MRI was performed at the 1-year follow-up to assess the healing status of the ALL. We investigated the association between the healing status of the ALL and concomitant lesions observed at the time of an ACL rupture. A subjective assessment was performed using the Lysholm score, International Knee Documentation Committee subjective score, and Tegner activity scale. Objective tests included an isokinetic strength assessment and functional performance testing. RESULTS: With respect to the severity of ALL injuries, of 54 patients, a complete rupture occurred in 16 (29.6%) of the 54 patients and a partial rupture in 38 (70%). A significant association was observed between the severity of ALL injuries and bone contusions (lateral tibial plateau and medial tibial plateau [MTP]) and meniscus ramp lesions (Fisher exact test: P = .023, .012, and .023, respectively). Good and partial healing of the ALL occurred in 16 (29.6%) and 23 (42.6%) of 54 patients, respectively. Scar formation occurred in 12 (22.2%), and nonvisualization of the ALL was observed in 3 (5.6%) of 54 patients. Poor healing of the ALL was associated with preoperative MTP bone contusions and a high-grade pivot shift. Multivariate analysis showed that an MTP bone contusion was an independent risk factor associated with poor healing of the ALL. Among the functional tests performed, significant differences were observed between the good and poor healing groups with respect to the carioca test (P = .039). The good healing group (n = 16) showed a negative pivot shift at the last follow-up, whereas 5 (13.2%) of the patients from the poor healing group (n = 38) showed a positive pivot shift, including 2 (5.3%) with a high-grade pivot shift. CONCLUSION: Approximately 70% of acute ALL injuries showed poor healing at the 1-year follow-up. Poor healing of ALL injuries was significantly associated with preoperative MTP bone contusions and a high-grade pivot shift. Therefore, a careful assessment of posteromedial bone contusions at the time of an ACL rupture is warranted, particularly in patients with a high-grade pivot shift.

Return to Sports and Clinical Outcomes After Arthroscopic Anatomic Posterior Cruciate Ligament Reconstruction With Remnant Preservation.

PURPOSE: To evaluate the clinical outcomes of transtibial posterior cruciate ligament reconstruction (PCLR) with remnant preservation in highly active patients and to investigate the rate of return to sports (RTS), quality of sports activities, and patient satisfaction. METHODS: Patients with a Tegner activity scale of >5 who underwent isolated PCLR from 2013 to 2016 with minimum 2-year follow-up were retrospectively reviewed. Single-bundle PCLR was performed using fresh frozen allograft irradiated with 50 kGy. Subjective assessments included the Lysholm score, subjective International Knee Documentation Committee score, and Tegner activity scale. A questionnaire elicited information associated with RTS and satisfaction. Functional tests included isokinetic muscle strength and single-leg hop tests. RESULTS: We evaluated 52 patients, with a mean (± standard deviation) follow-up duration of 29.5 ± 8.6 months. The subjective assessments and functional tests significantly improved postoperatively (all P < .001). Mean time to return to full sports activity was 9.7 ± 5.1 months. Thirty-eight (73.1%) and 45 (86.5%) patients could return to previous sports activities at 9 and 24 months, respectively. A sports-experience questionnaire indicated that 48% and 69.2% of the patients were participating with unlimited effort and performance, respectively, and no pain at 9 and 24 months. Multivariate analysis indicated that extensor deficit (odds ratio [OR] 4.2, 95% confidence interval [CI] 1.342 to 17.839), flexor deficit at 60°/s (OR 3.8, 95% CI 1.081 to 14.476), Limb Symmetry Index (%) for the single-leg vertical jump test (OR 2.2, 95% CI 1.212 to 9.227), and satisfaction (OR 2.8, 95% CI 1.186 to 10.281) were significantly associated with failure of not returning to preinjury sports activity levels at the 9-month follow-up. CONCLUSIONS: Arthroscopic anatomic PCLR with remnant preservation showed high rates of RTS and high patient satisfaction, as well as satisfactory clinical results in highly active patients. This surgical technique could be an effective treatment for grade III posterior cruciate ligament injury in highly active patients. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting.

BACKGROUND: This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting. METHODS: ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US). RESULTS: The S group showed significantly less deep flexor strength deficit than the D group (p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups (p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up. CONCLUSIONS: The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.

Clinical Outcomes of Isolated Revision Anterior Cruciate Ligament Reconstruction or in Combination With Anatomic Anterolateral Ligament Reconstruction.

BACKGROUND: Although the cause of rotational instability after revision anterior cruciate ligament reconstruction (ACLR) is multifactorial, the rationale of adding an extra-articular procedure is based on its ability to restrict rotational instability. PURPOSE: To assess the effect of anterolateral ligament (ALL) reconstruction on revision ACLR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 87 patients who underwent revision ACLR between March 2011 and July 2014 with a follow-up of more than 3 years were included in this retrospective study. Patients were divided into the isolated revision ACLR group (group I, n = 45, from March 2011 to January 2013) or the revision ACLR in combination with ALL reconstruction group (group C, n = 42, from February 2013 to July 2014). Subjective knee assessments including the subjective International Knee Documentation Committee (IKDC) form, Lysholm score, Tegner activity scale, and Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale were used. Clinical and functional tests were performed before surgery and at ≥6 months after surgery. All tests were usually completed at 36 months of follow-up. RESULTS: The mean follow-up duration for groups I and C were 41.5 ± 8.2 and 38.2 ± 6.9 months, respectively ( P = .451). The subjective IKDC score, Tegner score, and ACL-RSI score were significantly better in group C compared with those in group I at the last follow-up (84.3 ± 18.5 vs 75.9 ± 19.2, 7.0 ± 0.8 vs 6.3 ± 0.7, and 69.5 ± 25.4 vs 51.9 ± 23.1, respectively), although they were not significantly different between the 2 groups at 12 months after surgery (79.2 ± 18.8 vs 76.7 ± 17.2, 6.7 ± 0.7 vs 6.5 ± 0.9, and 50.2 ± 24.6 vs 49.9 ± 25.1, respectively). There were no significant differences in KT-2000 arthrometer, isokinetic extensor strength, single-legged hop for distance, co-contraction test, or carioca test results between the 2 groups at the last follow-up ( P = .304, .068, .125, .056, and .066, respectively). Preoperatively, 43 (95.6%) patients in group I and 40 (95.2%) patients in group C had a grade 2 or 3 pivot shift ( P = .387). Postoperatively, 23 (53.5%) patients in group I and 38 (90.5%) patients in group C had a negative pivot shift ( P < .001). Group C showed a higher rate of return to the same level of sports activity than group I (57.1% vs 25.6%, respectively; P = .008), although there was no significant difference in the rate of return to any sports activity at the last follow-up (88.4% in group I vs 88.1% in group C; P = .713). CONCLUSION: Revision ACLR in combination with ALL reconstruction significantly reduced rotational laxity and showed a higher rate of return to the same level of sports activity than revision ACLR alone, although there were no significant differences in anterior laxity or functional test results between the 2 groups.

Single-leg vertical jump test as a functional test after anterior cruciate ligament reconstruction.

BACKGROUND: The aim of this study was to identify the correlations between the single-leg vertical jump (SLVJ) test and subjective and objective tests which were used widely for determining return-to-sports (RTS) after anterior cruciate ligament reconstruction (ACLR). METHODS: Seventy-five patients (29.5 ±â€¯9.2 years) who underwent ACLR between May 2012 and Jan 2014 were included. Subjective knee scoring systems including subjective International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale, and ACL-Return to Sports after Injury (ACL-RSI) scale were assessed. Objective tests were also performed. RESULTS: The limb symmetry index (LSI) for SLVJ test and single-leg hop for distance (SLHD) test was 89.4 ±â€¯14.9% and 90.7 ±â€¯11.7%. LSI for SLVJ test was correlated to subjective IKDC scores (r = 0.26, P = 0.024), Tegner activity scale (r = 0.64, P < 0.001), ACL-RSI scale (r = 0.61, P < 0.001), LSI for SLHD (r = 0.45, P < 0.001), Co-contraction (r = -0.57, P < 0.001), Shuttle run (r = -0.52, P < 0.001), and Carioca (r = -0.54, P < 0.001) tests. In isokinetic strength tests, extensor peak torque (r = 0.30, P = 0.009) and extensor strength deficit (r = -0.41, P < 0.001) were correlated with LSI for SLVJ test. CONCLUSION: There were considerable correlations between SLVJ test and subjective IKDC scores, Tegner activity scale, ACL-RSI scale, isokinetic extensor muscle strength, and all other functional tests. SLVJ test could be used conveniently to determine RTS after ACLR in outpatient clinics. LEVEL OF EVIDENCE: Level IV, case series.

Which Exercise Is Better for Increasing Serum Testosterone Levels in Patients with Erectile Dysfunction?

PURPOSE: We investigated the correlations of serum total testosterone (TT) levels with body composition and physical fitness parameters in patients with erectile dysfunction (ED) to know the best exercise for testosterone deficiency. MATERIALS AND METHODS: Eighty-seven ED patients underwent serum TT assessment as well as body composition and basic exercise testing. The bioelectrical impedance analysis was used to assess body composition. Seven types of basic exercise tests were used to determine physical fitness. Correlations between serum TT levels and body composition/physical function parameters were evaluated using partial correlation analyses. A serum TT cut-off value was obtained for the parameters significantly correlated with serum TT levels. RESULTS: The subjects had a mean serum TT level of 342.1 ng/dL. Among the body composition parameters, body and abdominal fat percentages showed statistically significant negative correlations with serum TT levels. Among the basic exercise test parameters, only the cycle ergometer test for cardiorespiratory fitness showed a statistically significant positive correlation with serum TT levels. CONCLUSIONS: Serum TT levels in patients with ED, may be increased by reducing fat percentage and improving cardiorespiratory fitness via aerobic exercise.

Exercise improves the effects of testosterone replacement therapy and the durability of response after cessation of treatment: a pilot randomized controlled trial.

The effects of the combination of exercise and TRT on symptoms of late-onset hypogonadism (LOH) and the durability of response after cessation of TRT were investigated. A total of fifty patients with erectile dysfunction (ED) who had a sedentary lifestyle and low serum total testosterone (T) levels were enrolled and followed for 20 weeks. Patients were randomly divided into two groups; all of them received T gel for 12 weeks and it was discontinued for 8 weeks. Patients assigned to Group II were offered a supervised exercise program for 20 weeks. Measurement of serological testing was performed and self-assessment questionnaires and Global Assessment Question (GAQ) were asked. Baseline characteristics and the initial symptom scores showed no significant difference between the two groups. Serum total T levels and the symptom scores were increased at 12 weeks in both groups, and Group II showed better results with statistical significance. There was a decrease in T levels and worsening of symptom scores at week 20 compared to week 12 in both groups, and Group II showed better results with statistical significance. On the GAQ, Group II showed higher ratio of "yes" at week 12 and the same tendency was sustained at week 20 with significant difference between two groups. The combination of exercise and TRT showed significant improvements in serum T levels and LOH symptoms compared to TRT alone. In addition, these improvements were maintained in the combination group with continuous exercise, even after cessation of TRT.

Clinical and radiologic outcomes after meniscus allograft transplantation at 1-year and 4-year follow-up.

PURPOSE: To assess the clinical and radiologic outcomes of meniscus allograft transplantation (MAT) with serial evaluation at 1 year and at 4 years. METHODS: Among 151 patients who received MAT between March 2006 and June 2009, we prospectively recruited the patients who had undergone clinical and radiologic examinations at 1 year after the operation. The Lysholm score, International Knee Documentation Committee score, and Knee Society Score were determined. Plain radiography was used for evaluation of osteoarthritis, and magnetic resonance imaging (MRI) was used to assess the cartilage status and meniscal extrusion. RESULTS: Thirty-nine patients with a mean age of 40 ± 9 years were recruited. The first visit was conducted at a mean of 13.6 months (range, 11 to 17 months) postoperatively, and the last visit was conducted at a mean of 50.4 months (range, 48 to 72 months) postoperatively. Of the patients, 29 were men. The lateral side was involved in 27 patients. The Lysholm knee score increased to a median value of 89 (range, 75 to 100) at the first visit and 88 (range, 76 to 100) at the second visit from a preoperative median value of 79 (range, 37 to 99), which was statistically significant according to the Kruskal-Wallis test. According to the Kellgren-Lawrence grade based on anteroposterior radiographs, 21 patients (54%) showed no arthrosis progression and the overall status of arthrosis on anteroposterior radiographs was significantly changed (P < .001). On MRI, 25 patients (64%) showed no cartilage status change and the overall status was not changed significantly (P = .178). The meniscal extrusion extent was 4.2 ± 0.4 mm at the first visit and 4.2 ± 0.6 mm at the second visit (P = .678), and the relative percentage of extrusion was 0.44 ± 0.16 and 0.51 ± 0.21, respectively (P = .059). The subgroup in which arthrosis had progressed on MRI showed a larger amount of change in the relative percentage of extrusion (P = .023). No correlation was observed between meniscal extrusion and various outcomes. CONCLUSIONS: Repeat assessment at 4 years showed that MAT showed improvement in knee function, but it had decreased over time. Considerable meniscal extrusion was observed, but it did not increase during follow-up and did not show any correlation with other outcomes. Extrusion progression showed significant correlation with arthrosis progression. LEVEL OF EVIDENCE: Level IV, therapeutic case series.