In the last few years,much more information on the anterolateral complex of the knee has become available.It has now been demonstrated how it works in conjunction with the anterior cruciate ligament(ACL)controlling an...In the last few years,much more information on the anterolateral complex of the knee has become available.It has now been demonstrated how it works in conjunction with the anterior cruciate ligament(ACL)controlling anterolateral rotatory laxity.Biomechanical studies have shown that the anterolateral complex(ALC)has a role as a secondary stabilizer to the ACL in opposing anterior tibial translation and internal tibial rotation.It is of utmost importance that surgeons comprehend the intricate anatomy of the entire anterolateral aspect of the knee.Although most studies have only focused on the anterolateral ligament(ALL),the ALC of the knee consists of a functional unit formed by the layers of the iliotibial band combined with the anterolateral joint capsule.Considerable interest has also been given to imaging evaluation using magnetic resonance and several studies have targeted the evaluation of the ALC in the setting of ACL injury.Results are inconsistent with a lack of association between magnetic resonance imaging evidence of injury and clinical findings.Isolated ACL reconstruction may not always reestablish knee rotatory stability in patients with associated ALC injury.In such cases,additional procedures,such as anterolateral reconstruction or lateral tenodesis,may be indicated.There are several techniques available for ALL reconstruction.Graft options include the iliotibial band,gracilis or semitendinosus tendon autograft,or allograft.展开更多
BACKGROUND Partial tears of the anterior cruciate ligament(ACL)are frequent,and there is still considerable controversy surrounding their diagnosis,natural history and treatment.AIM To examine patient-reported outcome...BACKGROUND Partial tears of the anterior cruciate ligament(ACL)are frequent,and there is still considerable controversy surrounding their diagnosis,natural history and treatment.AIM To examine patient-reported outcomes,physical examination and magnetic resonance imaging(MRI)findings of partial ACL tears treated with an intraarticular injection of platelet-rich plasma(PRP)compared to a control group.METHODS From January 2015 to November 2017,consecutive patients from a single institution with partial ACL tears treated nonoperatively were prospectively evaluated.Partial tears were defined as a positive Lachman test with a clear endpoint,a negative pivot-shift and less than 3 mm of side-to-side difference using the KT1000 arthrometer.Patients in group 1 were treated with one intraarticular injection of PRP and specific physical therapy protocol.Control group consisted of patients treated only with physical therapy.Prospective analyzed data included physical examination,Tegner activity level and Lysholm and International Knee Documentation Committee scores.Baseline MRI findings and at 6 mo follow-up were reviewed.Failure was defined as those patients with clinical instability at follow-up that required a subsequent ACL reconstruction.RESULTS A total of 40 patients where included,21 treated with PRP injection with a mean follow-up of 25 mo[standard deviation(SD):3.6]and 19 in the control group with a mean follow-up of 25 mo(SD:5.68).Overall failure rate was 32.0%(n=13).No significant differences were observed between groups regarding subjective outcomes,return to sport and failure rate.MRI findings revealed an improvement in the ACL signal in half of the patients of both groups.However,we did not find a significant relationship between MRI findings and clinical outcomes.CONCLUSION Overall,95.0%of patients returned to sports at a mean follow-up of 25 mo.Mean time to return to sports was 4 mo.Out of these patients,almost 30.0%in each group had a new episode of instability and required surgery at a median time of 5 mo in group 1 and 8 mo in group 2.The addition of PRP alone was not sufficient to enhance any of the outcome measures evaluated,including MRI images,clinical evaluation and failure rate.展开更多
BACKGROUND Between 43%and 75%of patients who undergo primary anterior cruciate ligament(ACL)surgery return to sport activity.However,after a revision ACL reconstruction(ACLR)the rate of return to sports is variable.A ...BACKGROUND Between 43%and 75%of patients who undergo primary anterior cruciate ligament(ACL)surgery return to sport activity.However,after a revision ACL reconstruction(ACLR)the rate of return to sports is variable.A few publications have reported returns to sports incidence between 56%to 100%after revision ACLR.AIM To determine return to sports and functional outcomes after a single-stage revision ACLR with a 5-year minimum follow-up at a single institution.METHODS All patients operated between 2010 and 2016 with a minimum 5 years of followup were included.Type of sport,intensity,frequency,expectation,time to return to sport and failure rate were recorded.Lysholm,Tegner and International Knee Documentation Committee forms were evaluated prior to the first ACLR surgery,at 6 mo after primary surgery and after revision ACLR at 5 years minimum of follow-up.Objective stability was tested with the knee arthrometer test(KT-1000 knee arthrometer,Medmetric Corp).RESULTS A total of 41 patients who underwent revision ACLR during that period of time were contacted and available for follow-up.Median patient age at time of revision was 29 years old[interquartile range(IQR):24.0-36.0],and 39(95.0%)were male.The median time from revision procedure to follow-up was 70 mo(IQR:58.0-81.0).Regarding return to sports,16(39.0%)were at the same level compared to preinjury period,and 25 patients(61.0%)returned at a lower level.Sixty-three percent categorized the sport as very important and 37.0%as important.One patient(2.4%)failed with a recurrent ACL torn.Mean preoperative Lysholm and(SD)16]and 50(SD 11),respectively.At follow-up,mean Lysholm and subjective International Knee Documentation Committee scores were 89(SD 8)and 82(SD 9)(P=0.0001).Mean Tegner score prior to primary ACLR was 6.7(SD 1.3),5.1(1.5 SD)prior to revision ACLR and 5.6(1.6 SD)at follow-up(P=0.0002).Overall,knee arthrometer test measurement showed an average of 6 mm(IQR:4.0-6.0)side-to-side difference of displacement prior to revision ACLR and 3mm(IQR:1.5-4.0)after revision.CONCLUSION Almost 40.0%of patients returned to preinjury sports level and 60.0%to a lower level.These may be useful when counseling a patient regarding sports expectations after a revision ACLR.展开更多
BACKGROUND One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature.AIM To evaluate failure rates,return to sports(RTS)rate,clinical out...BACKGROUND One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature.AIM To evaluate failure rates,return to sports(RTS)rate,clinical outcomes and magnetic resonance image(MRI)evaluation after meniscus suture repair for longitudinal tears at a minimum 2-year-follow-up.METHODS We conducted a retrospective review of meniscal repairs between January 2004 and December 2018.All patients treated for longitudinal tears associated or not with an anterior cruciate ligament reconstruction(ACL-R)were included.Meniscal ramp lesions,radial and root tears,associated with multiligament injuries,tibial fracture and meniscal allograft transplants were excluded.Surgical details and failure rate,defined as symptomatic patients who underwent a revision surgery,were analyzed.As isolated bucket handle tears(BHTs)were usually associated with higher failure rates,we compared BHTs and not BHTs associated or not with an ACL-R.Since 2014,the inside-out technique using cannulas and suture needles with 2-0 Tycron began to predominate.In addition,the number of stitches per repair was increased.In view of differences in surgical technique,we compared two different cohorts:before and after 2014.We recorded the RTS according to the level achieved and the time to RTS.Lysholm and IKDC scores were recorded.Patients were studied with x-rays and MRI as standard postoperative control.RESULTS One hundred and nineteen patients were included with a mean follow up of 7 years(SD:4.08).Overall failure rate was 20.3%at a mean 20.1 mo.No statistically significant differences were found when comparing failure for medial and lateral meniscal repair(22.7%and 15.3%,P=0.36),BHTs and not BHTs(26%and 17.6%,P=0.27),isolated or associated with an ACL-R(22.9%and 18%,P=0.47),or when comparing only BHTs associated with an ACL-R(23%and 27.7%,P=0.9)or not.When comparing cohorts before and after 2014,we found a significant decrease in the overall failure rate from 26%to 11%(P<0.03).Isolated lesions presented a decrease from 28%to 6.6%(P=0.02),BHTs from 34%to 8%(P=0.09)and those associated with an ACL-R from 25%to 10%(P=0.09).Mean RTS time was 6.5 mo in isolated lesions and 8.64 mo when associated with an ACL-R.Overall,56%of patients returned to the same sport activity level.Mean pre and postoperative Lysholm scores were 64 and 85(P=0.02),and IKDC 58 and 70(P=0.03).Out of 84 asymptomatic patients evaluated with MRI,39%were classified as“not healed”and 61%as“healed”.CONCLUSION Even though the overall failure rate of our series was 20.3%,we found a statistically significant decrease from 26%to 11%,not only for isolated lesions,but also for BHT’s and those associated with an ACL-R when comparing our series in two different cohorts,most probably due to improvements in surgical technique.展开更多
文摘In the last few years,much more information on the anterolateral complex of the knee has become available.It has now been demonstrated how it works in conjunction with the anterior cruciate ligament(ACL)controlling anterolateral rotatory laxity.Biomechanical studies have shown that the anterolateral complex(ALC)has a role as a secondary stabilizer to the ACL in opposing anterior tibial translation and internal tibial rotation.It is of utmost importance that surgeons comprehend the intricate anatomy of the entire anterolateral aspect of the knee.Although most studies have only focused on the anterolateral ligament(ALL),the ALC of the knee consists of a functional unit formed by the layers of the iliotibial band combined with the anterolateral joint capsule.Considerable interest has also been given to imaging evaluation using magnetic resonance and several studies have targeted the evaluation of the ALC in the setting of ACL injury.Results are inconsistent with a lack of association between magnetic resonance imaging evidence of injury and clinical findings.Isolated ACL reconstruction may not always reestablish knee rotatory stability in patients with associated ALC injury.In such cases,additional procedures,such as anterolateral reconstruction or lateral tenodesis,may be indicated.There are several techniques available for ALL reconstruction.Graft options include the iliotibial band,gracilis or semitendinosus tendon autograft,or allograft.
文摘BACKGROUND Partial tears of the anterior cruciate ligament(ACL)are frequent,and there is still considerable controversy surrounding their diagnosis,natural history and treatment.AIM To examine patient-reported outcomes,physical examination and magnetic resonance imaging(MRI)findings of partial ACL tears treated with an intraarticular injection of platelet-rich plasma(PRP)compared to a control group.METHODS From January 2015 to November 2017,consecutive patients from a single institution with partial ACL tears treated nonoperatively were prospectively evaluated.Partial tears were defined as a positive Lachman test with a clear endpoint,a negative pivot-shift and less than 3 mm of side-to-side difference using the KT1000 arthrometer.Patients in group 1 were treated with one intraarticular injection of PRP and specific physical therapy protocol.Control group consisted of patients treated only with physical therapy.Prospective analyzed data included physical examination,Tegner activity level and Lysholm and International Knee Documentation Committee scores.Baseline MRI findings and at 6 mo follow-up were reviewed.Failure was defined as those patients with clinical instability at follow-up that required a subsequent ACL reconstruction.RESULTS A total of 40 patients where included,21 treated with PRP injection with a mean follow-up of 25 mo[standard deviation(SD):3.6]and 19 in the control group with a mean follow-up of 25 mo(SD:5.68).Overall failure rate was 32.0%(n=13).No significant differences were observed between groups regarding subjective outcomes,return to sport and failure rate.MRI findings revealed an improvement in the ACL signal in half of the patients of both groups.However,we did not find a significant relationship between MRI findings and clinical outcomes.CONCLUSION Overall,95.0%of patients returned to sports at a mean follow-up of 25 mo.Mean time to return to sports was 4 mo.Out of these patients,almost 30.0%in each group had a new episode of instability and required surgery at a median time of 5 mo in group 1 and 8 mo in group 2.The addition of PRP alone was not sufficient to enhance any of the outcome measures evaluated,including MRI images,clinical evaluation and failure rate.
文摘BACKGROUND Between 43%and 75%of patients who undergo primary anterior cruciate ligament(ACL)surgery return to sport activity.However,after a revision ACL reconstruction(ACLR)the rate of return to sports is variable.A few publications have reported returns to sports incidence between 56%to 100%after revision ACLR.AIM To determine return to sports and functional outcomes after a single-stage revision ACLR with a 5-year minimum follow-up at a single institution.METHODS All patients operated between 2010 and 2016 with a minimum 5 years of followup were included.Type of sport,intensity,frequency,expectation,time to return to sport and failure rate were recorded.Lysholm,Tegner and International Knee Documentation Committee forms were evaluated prior to the first ACLR surgery,at 6 mo after primary surgery and after revision ACLR at 5 years minimum of follow-up.Objective stability was tested with the knee arthrometer test(KT-1000 knee arthrometer,Medmetric Corp).RESULTS A total of 41 patients who underwent revision ACLR during that period of time were contacted and available for follow-up.Median patient age at time of revision was 29 years old[interquartile range(IQR):24.0-36.0],and 39(95.0%)were male.The median time from revision procedure to follow-up was 70 mo(IQR:58.0-81.0).Regarding return to sports,16(39.0%)were at the same level compared to preinjury period,and 25 patients(61.0%)returned at a lower level.Sixty-three percent categorized the sport as very important and 37.0%as important.One patient(2.4%)failed with a recurrent ACL torn.Mean preoperative Lysholm and(SD)16]and 50(SD 11),respectively.At follow-up,mean Lysholm and subjective International Knee Documentation Committee scores were 89(SD 8)and 82(SD 9)(P=0.0001).Mean Tegner score prior to primary ACLR was 6.7(SD 1.3),5.1(1.5 SD)prior to revision ACLR and 5.6(1.6 SD)at follow-up(P=0.0002).Overall,knee arthrometer test measurement showed an average of 6 mm(IQR:4.0-6.0)side-to-side difference of displacement prior to revision ACLR and 3mm(IQR:1.5-4.0)after revision.CONCLUSION Almost 40.0%of patients returned to preinjury sports level and 60.0%to a lower level.These may be useful when counseling a patient regarding sports expectations after a revision ACLR.
文摘BACKGROUND One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature.AIM To evaluate failure rates,return to sports(RTS)rate,clinical outcomes and magnetic resonance image(MRI)evaluation after meniscus suture repair for longitudinal tears at a minimum 2-year-follow-up.METHODS We conducted a retrospective review of meniscal repairs between January 2004 and December 2018.All patients treated for longitudinal tears associated or not with an anterior cruciate ligament reconstruction(ACL-R)were included.Meniscal ramp lesions,radial and root tears,associated with multiligament injuries,tibial fracture and meniscal allograft transplants were excluded.Surgical details and failure rate,defined as symptomatic patients who underwent a revision surgery,were analyzed.As isolated bucket handle tears(BHTs)were usually associated with higher failure rates,we compared BHTs and not BHTs associated or not with an ACL-R.Since 2014,the inside-out technique using cannulas and suture needles with 2-0 Tycron began to predominate.In addition,the number of stitches per repair was increased.In view of differences in surgical technique,we compared two different cohorts:before and after 2014.We recorded the RTS according to the level achieved and the time to RTS.Lysholm and IKDC scores were recorded.Patients were studied with x-rays and MRI as standard postoperative control.RESULTS One hundred and nineteen patients were included with a mean follow up of 7 years(SD:4.08).Overall failure rate was 20.3%at a mean 20.1 mo.No statistically significant differences were found when comparing failure for medial and lateral meniscal repair(22.7%and 15.3%,P=0.36),BHTs and not BHTs(26%and 17.6%,P=0.27),isolated or associated with an ACL-R(22.9%and 18%,P=0.47),or when comparing only BHTs associated with an ACL-R(23%and 27.7%,P=0.9)or not.When comparing cohorts before and after 2014,we found a significant decrease in the overall failure rate from 26%to 11%(P<0.03).Isolated lesions presented a decrease from 28%to 6.6%(P=0.02),BHTs from 34%to 8%(P=0.09)and those associated with an ACL-R from 25%to 10%(P=0.09).Mean RTS time was 6.5 mo in isolated lesions and 8.64 mo when associated with an ACL-R.Overall,56%of patients returned to the same sport activity level.Mean pre and postoperative Lysholm scores were 64 and 85(P=0.02),and IKDC 58 and 70(P=0.03).Out of 84 asymptomatic patients evaluated with MRI,39%were classified as“not healed”and 61%as“healed”.CONCLUSION Even though the overall failure rate of our series was 20.3%,we found a statistically significant decrease from 26%to 11%,not only for isolated lesions,but also for BHT’s and those associated with an ACL-R when comparing our series in two different cohorts,most probably due to improvements in surgical technique.
