Remodeling of patellar tendon grafts augmented with woven polyester after anterior cruciate ligament reconstruction in humans

[Artificial ligaments applied in anterior cruciate ligament repair and reconstruction: Current products and experience]

The application of artificial ligament products in anterior cruciate ligament (ACL) surgeries has gone through a long twisty way. In the 1970s, early artificial ligament products were initially used for ACL surgeries, which showed poor clinical efficacy and eventually ended up in failure. Over the last 20 years, there has been a growing number of ACL reconstruction with new artificial ligament products, including the Leeds-Keio TM, the LARS TM (Ligament Advanced Reinfocement System), and the Trevira Hochfest TM. Among these new products, the LARS TM has been more commonly applied for ACL surgeries. Although these new artificial ligament products have good mechanical properties and show significant improvement of cumulative failure and complication rate, they still have limitations.

Chronic acromioclavicular separation: the medium term results of coracoclavicular ligament reconstruction using braided polyester prosthetic ligament

In this series, we treated chronic acromioclavicular disruption with an artificial coraco-clavicular ligament made from braided polyester (The Nottingham Surgilig). The ligament has a loop at each end and is passed around the coracoid process, threaded through itself, then passed around the posterior aspect of the clavicle and finally anchored to it with a bone screw. Eleven men with an average age of 39 underwent this procedure. Three patients had previously been operated on using the Weaver-Dunn procedure which had failed. All eleven patients have been reassessed clinically and radiographically at an average of 55 months. Using the Imatani evaluation score, 10 patients achieved a good/excellent result with the mean Constant score being 92. One patient had fracture of the base of the coracoid after heavy lifting in the early postoperative period which resulted in a poor outcome. Two patients needed an additional operation. In one the lateral end of the clavicle was excised together with removal of the fixation screw, and in the other a subacromial decompression was carried out. The Nottingham Surgilig is a useful alternative for the treatment of chronic acromioclavicular separation, especially in revision reconstruction when the coracoacromial ligament is no longer available.

Effects of reinforcement with the iliotibial tract flap in ACL reconstruction using bone-patellar tendon-bone

INTRODUCTION

We attempted to reinforce the transplanted ligament by wrapping it with the iliotibial tract (ITT) flap to get more volume and to protect the graft from impingement in the intercondylar space postoperatively in reconstruction of the anterior cruciate ligament (ACL) using bone-patellar tendon-bone (BTB), and investigated the results in comparison with those of BTB alone.

MATERIALS AND METHODS

The study included 88 cases (88 knees). Group A comprised 43 knees with the reinforcement and group B 45 knees with BTB alone. Both groups were evaluated by second-look arthroscopy, magnetic resonance imaging (MRI), manual testing, International Knee Documentation Committee (IKDC) score, and histopathological evaluation more than 2 years after the reconstruction.

RESULTS

In the second-look arthroscopic findings, 84% of the reconstructed ACL in group A had good appearance, and no fibrous split was observed. The ratio of fibrous disorder was significantly less in group A in comparison with group B (p=0.0037). Distinct reduction of the tension of the reconstructed ligament was observed in 9% of group A and 36% of group B (p=0.0088). Regarding the results of the Lachman test, the ratio of the negative group was higher in group A (p=0.0067). In the MRI findings fulfilled pictures to the inside of the reconstructed ligament were observed in 77% of the patients photographed in group A. In contrast, the fibrous split was observed in 55% in group B.

CONCLUSIONS

Reinforcement by wrapping with the ITT flap for the BTB autograft was effective in ACL reconstruction. The ratio of fibrous disorder and reduction of tension in the reconstructed ligament decreased.

The accuracy of MRI in assessing graft integrity after anterior cruciate ligament reconstruction

To evaluate the efficacy of MRI in assessing anterior cruciate ligament (ACL) reconstruction graft integrity, we compared MRI findings with arthroscopic findings in 52 patients who had undergone arthroscopically assisted ACL reconstruction using semitendinosus and gracilis tendons augmented by woven polyester. MRI and arthroscopy were carried out 12 months after the operation. The MR appearance of ACL grafts was categorized into 3 types by signal intensity and continuity of the ligament according to Rak's method: 1. well-defined type: the graft was visualized as a smoothly continuous band with low signal over the entire course; 2. intermediate type: signal intensity increased and a low-signal band was visualized only in part of the graft; 3. indiscernible type: the graft was not identified through the joint cavity due to markedly increased signal intensity. When the MR appearance of intermediate or indiscernible types was defined as torn, the grafts were presumed to be torn in 9 patients whose arthroscopic findings were 7 intact and 2 torn grafts. All cases with intact MRI findings were intact on arthroscopic examination. Thus, the sensitivity, specificity and accuracy of MRI as an evaluative tool for ACL graft tears were 100%, 86% and 86.5%, respectively.

Knee functions and a return to sports activity in competitive athletes following anterior cruciate ligament reconstruction

We investigated knee functions and a return to sports in 50 competitive athlete patients treated with arthroscopic anterior cruciate ligament reconstruction using double-looped STG augmented by woven polyester at a 1-year follow-up. There were 25 males and 25 females with a mean age of 24.3 years (range: 19-39 years). The majority of preinjury sports were basketball, volleyball and soccer. Athletic rehabilitation including agility training and sports-specific training was started at 12 weeks. Fourty patients (80%) was rated as normal or nearly normal on the assessment of International Knee Documentation Commitee postoperatively. Fourty-eight patients (96%) obtained full range of motion, and the mean quadriceps muscle strength of the injured side was 91.3%of that of the uninjured side. As for a return to sports, 46 patients (92%) were able to do fully competitive sports at a mean of 8.1 postoperative months. These results suggest that arthroscopic reconstruction using augmented double-looped STG allows early athletic rehabilitation, and lead satisfactory outcome as well as a reliable and early return to preinjury level of sport activity for the majority of the competitive athlete patients.