Stability evaluation after isolated reconstruction of anteromedial or posterolateral bundle in symptomatic partial tears of anterior cruciate ligament.

OBJECTIVE: To evaluate the stability achieved in isolated reconstruction of each ACL bundles (minimum 2-year follow-up). STUDY GROUP: 39 consecutive patients (28.1 years of mean age) underwent anteromedial (AM) and posterolateral (PL) bundle reconstruction surgery (31.71 months of mean follow-up). CONTROL GROUP: 36 non-concurrent patients using single-bundle (SB) technique (more than 2-year follow-up). Evaluation based on IKDC scores, taking anterior-posterior translation and rotational stability as primary endpoints, and epidemiological data, ischaemia time, waiting time for surgery and complications as secondary endpoints. RESULTS: SB, AM and PL groups showed an anteroposterior translation (APT) at 2 years of 2.3, 1.8 and 1.8 mm, respectively, with an APT reduction of 5.4, 2.9 and 2.3 mm, respectively, but with no difference between both types of partial reconstruction (p = 0.552). IKDC scores in the AM group were as follows: preoperative (11 cases in group A, 12 B, 3 C), postoperative (24 A, 2 B); IKDC in the PL group: preoperative (7 B, 6 C), postoperative (10 A, 3 B). Mobility restored in all cases, while in group B, 2 AM patients and 3 PL had a slight Pivot Shift. There were no differences in complications as compared to conventional techniques. DISCUSSION: All techniques showed global significant enhancement in rotational stability (p < 0.0005). Improvement in anterior-posterior translation in AM group and in rotational stability in PL group was achieved; both showed no relevant statistical significance. Residual translation shows directly proportional relationship with preoperative status, surgical ischaemia time and patient weight. CONCLUSION: Reconstruction of one ACL bundle or the other can restore knee stability and function. Care should be taken to detect where the PL bundle reaches maximum tension and in improving patient preoperative status and ischaemia time.

Evaluation of autologous platelet concentrate for intertransverse lumbar fusion.

INTRODUCTION: The aim of the study was to analyze if the adding of autologous platelet concentrate (APC) to a mixture of local autograft plus tricalcium phosphate and hidroxiapatite (TCP/HA) would improve the fusion rate in posterolateral lumbar fusion. MATERIALS AND METHODS: A prospective, controlled, blinded, non-randomized clinical trial was carried out in 107 patients affected by degenerative lumbar pathology. The study group consisted of 67 patients, in which autologous platelet concentration was added to a mixture of autologous local bone graft and TCP/HA. A control group of 40 patients with same pathology and surgical technique but without APC addition was used to compare the fusion mass obtained. By means of plain X-rays, a blinded evaluation of the intertransverse fusion mass quality at twelve and twenty-four months was made according to type A (bilateral uniform mass), type B (unilateral uniform mass) and type C (irregular or lack bilateral mass). Patients with type C were regarded as pseudoarthrosis. RESULTS: In the study group 17 patients had lack or irregular fusion mass (25.4%) versus three patients in the control group (7.5%), which was statistically significant. CONCLUSIONS: This study shows that the adding of autologous platelet concentration to a mixture of autologous bone graft plus TCP/HA has decreased our rates of posterolateral lumbar fusion.