Arthroscopic BPTB graft reconstruction in ACL ruptures: 15-year results and survival

Evaluation of Serum Albumin-Coated Bone Allograft for Bone Regeneration: A Seven-Year Follow-Up Study of 26 Cases

We have previously reported that serum albumin-coated bone allograft (BoneAlbumin, BA) is an effective bone substitute. It improves bone regeneration at the patellar and tibial donor sites six months after harvesting bone-patellar tendon-bone (BPTB) autografts for primary anterior cruciate ligament reconstruction (ACLR). In the present study, we examined these donor sites seven years after implantation. The study group (N = 10) received BA-enhanced autologous cancellous bone at the tibial and BA alone at the patellar site. The control group (N = 16) received autologous cancellous bone at the tibial and blood clot at the patellar site. We evaluated subcortical density, cortical thickness, and bone defect volume via CT scans. At the patellar site, subcortical density was significantly higher in the BA group at both time points. There was no significant difference in cortical thickness between the two groups at either donor site. The control group's bone defect significantly improved and reached the BA group's values at both sites by year seven. Meanwhile, the bone defects in the BA group did not change significantly and were comparable to the six-month measurements. No complications were observed. There are two limitations in this study: The number of patients recruited is small, and the randomization of the patients could have improved the quality of the study as the control group patients were older compared to the study group patients. Our 7-year results seem to demonstrate that BA is a safe and effective bone substitute that supports faster regeneration of donor sites and results in good-quality bone tissue at the time of ACLR with BPTB autografts. However, studies with a larger number of patients are required to definitively confirm the preliminary results of our study.

Influence of selected plane on the evaluation of tibial tunnel locations using a three-dimensional bone model in double-bundle anterior cruciate ligament reconstruction

BACKGROUND

The purpose of this study was to investigate the influence of a selected plane on the evaluation of tibial tunnel locations following anterior cruciate ligament reconstruction (ACLR) between two planes: the plane parallel to the tibial plateau (Plane A) and the plane perpendicular to the proximal tibial shaft axis (Plane B).

METHODS

Thirty-four patients who underwent double-bundle ACLR were included. Three-dimensional model of tibia was created using computed tomography images 2 weeks postoperatively, and tibial tunnels of the anteromedial bundle (AMB) and posterolateral bundle (PLB) were extracted. To evaluate tibial tunnel locations, two planes (Planes A and B) were created. The locations of the tibial tunnel apertures of each bundle were evaluated using a grid method and compared between Planes A and B. The difference in coronal alignment between Planes A and B were also assessed.

RESULTS

The AMB and PLB tunnel apertures in Plane A were significantly more laterally located than in Plane B (mean difference; AMB, 1.5%; PLB, 1.7%, P < 0.01). There were no significant differences in the anteroposterior direction between the planes. Coronal alignment difference between the planes was 16.8 ± 2.2°; Plane B was more valgus than Plane A.

CONCLUSION

Although tibial tunnel locations were not significantly influenced by the selected planes in the AP direction, subtle but statistically significant differences were found in the ML direction between the Planes A and B in double-bundle anterior cruciate ligament reconstruction. The findings suggest that both Planes A and B can be used in the assessment of tibial tunnel locations after anterior cruciate ligament reconstruction.

Tranexamic acid is effective in decreasing postoperative intraarticular bleeding in arthroscopic knee surgery

: Arthroscopic knee surgery to perform partial meniscectomy and anterior cruciate ligament (ACL) reconstruction is frequent and effective, although a possible complication is postoperative hemarthrosis. When intraarticular bleeding occurs, in addition to the associated pain, the patient usually requires joint aspiration (arthrocentesis) to avoid loss of range of motion (ROM). Sometimes this complication ends up associated with a poor result of surgery due to a loss of ROM. The aim of this narrative review of the literature is to attempt to clarify whether tranexamic acid (TXA) should be utilized in arthroscopic ACL reconstruction and arthroscopic meniscectomy and by what route (intraarticular or intravenous). A number of studies seem to favor the use of intravenous TXA in patients undergoing ACL reconstruction and arthroscopic synovectomy to diminish articular postoperative bleeding and its consequences (pain, swelling, loss of ROM, and the need for arthrocentesis). Regarding the use of intraarticular TXA, one in-vitro study has indicated that TXA in high concentrations is cytotoxic to chondrocytes. Common sense leads me to conclude that until better designed studies can confirm that intraarticular TXA is not cytotoxic to chondrocytes, its use should not be advised. Currently, for patients undergoing arthroscopic ACL reconstruction and arthroscopic meniscectomy, it seems safer to use intravenous TXA.

Quadriceps Tendon-Bone or Patellar Tendon-Bone Autografts When Reconstructing the Anterior Cruciate Ligament: A Meta-analysis

OBJECTIVE

We aimed to quantitatively assess the outcomes of studies, comparing the use of Bone-patellar tendon-bone (BPTB) and the quadriceps tendon-bone (QTB) autografts when reconstructing the anterior cruciate ligament (ACL).

DATA SOURCES

MEDLINE, Embase, and CINAHL databases were searched for relevant articles published between January 1980 and January 2015 for the purpose of identifying studies comparing BPTB and QTB autografts for ACL reconstruction. Included studies were assessed regarding their methodological quality before analysis. Outcomes analyzed were graft failure rates, objective and subjective stability assessments, as well as the presence and severity of donor site morbidity.

MAIN RESULTS

Five studies contributed to the quantitative analysis of 806 patients with 452 patients included in the BPTB group and 354 patients in the QTB group. Graft failure rates were similar between the 2 groups [odds ratio (OR) = 0.61; confidence interval (CI) = 0.17-2.15; Z = 0.78, P = 0.44]. There were no significant differences between the 2 groups when testing anteroposterior stability using an arthrometer (standardized mean difference = 0.07; CI = -0.12-0.25; Z = 0.70, P = 0.48). At 1 year postoperatively, there was no difference in the percentage of patients with a positive pivot shift test between the 2 groups (OR = 1.0; CI = 0.85-1.18; Z = 0.01, P = 0.99). However, significantly less patients had graft site pain 1 year after surgery in the QTB group (OR = 0.10; CI = 0.02-0.43; Z = 3.12, P = 0.002). Similarly, fewer patients reported moderate to severe pain while kneeling, in the QTB group (OR = 0.16; CI = 0.07-0.37; Z = 4.26, P < 0.001).

CONCLUSIONS

This study demonstrates comparable survival rates and joint stability when BPTB and QTB grafts are used. However, fewer adverse donor site symptoms are evident with QTB grafts.

LEVEL OF EVIDENCE

III.