MRI evaluation of patellar tendon defect after harvesting its central third

Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication

BACKGROUND

This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS).

METHODS

The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design.

RESULTS

We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature.

CONCLUSIONS

This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.

Outcome After Anterior Cruciate Ligament Revision

PURPOSE OF REVIEW

To describe the current literature related to anterior cruciate ligament (ACL) revision in terms of surgical aspects, graft choices, concomitant injuries, patient-reported outcome, return to sport, and objective measurement outcome.

RECENT FINDINGS

An ACL rupture is a common knee injury, and the number of primary ACL reconstructions is increasing, implying a subsequent increase of ACL revisions in the future. It is widely accepted that an ACL revision is surgically challenging with a myriad of graft options to choose from. In many cases, simultaneous injuries to the index limb including meniscal and chondral lesions, respectively, are observed in the setting of a secondary ACL injury. Furthermore, the general understanding is that an ACL revision results in inferior outcome compared with a primary ACL reconstruction. Surgical treatment of an ACL revision can be performed as one-stage or two-stage procedure depending on, for example, the presence of limb malalignments, concomitant injuries, and tunnel widening. Nonirradiated allografts and autologous patella tendon, hamstring tendon, and quadriceps tendon are feasible options for ACL revision. Concomitant injuries to the affected knee such as intraarticular chondral lesions are more common in the setting of an ACL revision compared with primary ACL reconstruction while a lower presence of concomitant meniscal pathology is reported at ACL revision. Patients undergoing ACL revision have lower clinical and patient-reported outcome and lower rates of return to sport when compared with primary ACL surgery cases. However, long-term follow-ups with large study cohorts evaluating outcome of ACL revision are limited. Further research is needed to confirm the present findings of this review.

Compact platelet-rich fibrin scaffold to improve healing of patellar tendon defects and for medial collateral ligament reconstruction

BACKGROUND

Platelets are one of the most biocompatible and cost-effective sources of growth factors. Attention is being paid to autologous platelets and platelet-rich plasma. We developed a novel compact platelet-rich fibrin scaffold (CPFS) that was produced from blood and calcium gluconate only. The objective of this study was to investigate the potential of CPFS as a provisional scaffold in two rabbit models.

METHODS

In the first rabbit model, the central half of the patellar tendon was resected bilaterally. Allogenic CPFS was attached to the defect in the right knee, while the left knee was untreated. In the other model, the medial collateral ligament was removed bilaterally. The ligament of the right knee was reconstructed with allogenic CPFS, whereas the left knee was untreated.

RESULTS

After 12weeks, the ultimate failure load and stiffness were higher for the right patellar tendon than for the left patellar tendon in the former model. It was found that CPFS promoted ligament repair tissue in contrast with that on the untreated side in the latter model. The ultimate failure load of the CPFS repair tissue at 20weeks was 78% of that in healthy controls of the same age.

CONCLUSIONS

CPFS enhanced the healing of tendons and ligaments.

CLINICAL RELEVANCE

CPFS has the potential to accelerate healing of tendons and ligaments as a provisional bioscaffold or a material for graft augmentation.

Anterior cruciate ligament graft reconstruction: clinical, technical, and imaging overview

The anterior cruciate ligament (ACL) is one of the most frequently torn ligaments of the knee. With more than 100,000 ACL reconstructions performed yearly in the United States, evaluation of ACL grafts with magnetic resonance imaging is a common occurrence in daily clinical practice. Anterior cruciate ligament reconstructions vary from single bundle, double bundle, selective bundle, and physeal-sparing techniques. Complications of ACL graft reconstructions include graft tears, graft laxity, arthrofibrosis, and hardware failure or migration. This article offers a comprehensive review of ACL reconstruction for the consulting radiologist.