Anterior cruciate ligament reconstruction using patellar tendon allograft: an age-dependent outcome evaluation.

PURPOSE: To compare the outcomes of a consecutive series of nonrevision bone-patellar tendon-bone (BPTB) allograft anterior cruciate ligament (ACL) reconstructions in patients aged 40 years or older and patients aged younger than 40 years. METHODS: Prospectively collected data from consecutive BPTB allograft ACL reconstructions fixed with biodegradable interference screws and performed by a single surgeon were analyzed by use of established outcome measures. Preoperative and postoperative outcome assessments included Cincinnati, Lysholm, and Tegner scores and International Knee Documentation Committee (IKDC) activity scores. Lachman test, pivot-shift test, and KT arthrometer (MEDmetric, San Diego, CA) measurements were obtained at a minimum of 24 months after surgery. RESULTS: In total, 32 patients met the inclusion criteria (21 men and 11 women). The mean follow-up was 35 months (range, 24 to 58 months). Of the patients, 21 were aged younger than 40 years (66%) and 11 were aged 40 years or older (34%). The mean age was 35 years (range, 18 to 55 years). In patients aged younger than 40 years, the mean postoperative Cincinnati score was 82.4 (39.1 preoperatively); Tegner score, 6.2 (3.9 preoperatively); Lysholm score, 89.5 (46.8 preoperatively); and IKDC activity score, 2.7 out of 4 (1.7 preoperatively). Five patients had a positive postoperative Lachman test, but none had a positive pivot-shift test. KT examinations showed a manual maximum difference of less than 3 mm in all but 1 patient (mean, 0.7 mm). In patients aged 40 years or older, the mean postoperative Cincinnati score was 83.8 (44.4 preoperatively); Tegner score, 6.6 (3.9 preoperatively); Lysholm score, 88.8 (50.1 preoperatively); and IKDC activity score, 2.7 out of 4 (2.1 preoperatively). One patient had a positive postoperative Lachman test, but none had a positive pivot-shift test. KT examinations showed a manual maximum difference of less than 3 mm in all but 1 patient (mean, 1.3 mm). CONCLUSIONS: The outcomes of BPTB allograft ACL reconstructions were not different both subjectively and objectively for patients aged 40 years or older and patients aged younger than 40 years. BPTB allograft ACL reconstruction provides consistent results for patients of all age groups. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

FasT-Fix meniscal repair: mid-term results.

PURPOSE: The purpose of this study was to evaluate the clinical success of the FasT-Fix meniscal repair device (Smith & Nephew Endoscopy, Andover, MA) associated with an accelerated rehabilitation program. METHODS: A prospectively collected consecutive series of meniscal repairs performed with the FasT-Fix device was studied. The Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee activity scores, along with the clinical examination findings and adverse events, were recorded for all patients. Associated procedures were recorded. An accelerated postoperative rehabilitation program was followed, independent of concurrent anterior cruciate ligament surgery. RESULTS: Forty-one meniscal repairs were performed, with an average follow-up of 30.7 months (range, 12 to 58 months). Twenty-nine of 41 repairs were performed in conjunction with anterior cruciate ligment reconstruction. The other repairs were in stable knees. There were 26 medial and 15 lateral meniscus repairs. Both menisci were repaired in 5 knees. Repeat arthroscopies were performed for 12 repairs and 7 (17%) were found to have failed. The preoperative and postoperative Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee activity scores were 47.3 and 87.4, 3.4 and 7.2, 38.7 and 82.8, and 2.3 and 3.4, respectively. CONCLUSIONS: The FasT-Fix meniscal repair associated with an accelerated rehabilitation program resulted in clinically effective meniscal repair in 83% at the time of follow-up. Clinical outcome measures all improved. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study.

BACKGROUND: Further knee surgery after proximal tibial osteotomies has been reported to have a more difficult surgical exposure due to decreased patellar height after the osteotomy. Although a decrease in patellar height has been reported for closing-wedge proximal tibial osteotomies, it has not been widely verified among opening-wedge procedures. HYPOTHESIS: A significant decrease in patellar height would result after opening-wedge proximal tibial osteotomies and a postoperative change in tibial slope would also result, depending on the medial tibial plate position, which would affect patellar height. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients (n = 129) who underwent opening-wedge proximal tibial osteotomies (n = 130) were prospectively followed. Patellar height was calculated for preoperative lateral knee radiographs, and postoperatively at 2 weeks and 3 and 6 months. The Insall-Salvati, Blackburne-Peel, and Caton-Deschamps indices and a modified Miura and Kawamura index were used to calculate patellar height. Posterior tibial slope was also calculated for preoperative and 6-month postoperative knees. RESULTS: Coronal plane alignment changed significantly, from 24.6% to 55.2% of the tibial weightbearing axis. The overall decrease in patellar height for all patients was significant from preoperative assessment to the 2-week postoperative assessment and to both 3-month and 6-month follow-up with all 4 methods. The Insall-Salvati index decreased from 1.03 preoperatively to 0.99 at 2 weeks postoperatively, 0.97 at 3 months, and 0.95 at 6 months postoperatively. The Blackburne-Peel index decreased from 0.90 preoperatively to 0.75, 0.77, and 0.76, respectively, at each postoperative interval. The Caton-Deschamps index decreased from 0.98 preoperatively to 0.87, 0.86, and 0.84 at each postoperative measurement. The Miura-Kawamura index changed from 0.76 preoperatively to 0.61, 0.63, and 0.60 for each postoperative assessment. The average tibial slope significantly increased from 9.0 degrees to 11.9 degrees overall for all patients. In comparing the plate position, the tibial slope significantly increased from 8.8 degrees preoperatively to 13.1 degrees at 6 months postoperatively for anteromedially positioned plates and from 9.3 degrees to 10.3 degrees for posteromedially positioned plates. CONCLUSION: Opening-wedge proximal tibial osteotomies decrease patellar height within the first 3 postoperative months. Shortening of the patellar tendon may affect future surgeries and needs to be evaluated in preoperative assessment. Moreover, a significant increase in tibial slope occurred, which may affect patellar height and future ligament reconstructions.