Functional and MRI results after a 7.5 year follow-up of 35 single-stage ACL and PCL reconstructions using gracilis and semitendinosus tendon grafts and LARS artificial ligaments

PURPOSE

The aim of this study was to evaluate the long-term functional and MRI results of 35 patients who underwent bicruciate ligament reconstruction combining an ACL autograft using the gracilis and semitendinosus tendons and double-bundle PCL reconstruction using the LARS artificial ligament.

METHODS

The outcomes were measured using the Lysholm score, the Tegner activity level scale and the International Knee Documentation Committee form (IKDC 2000). KT-1000 was used to assess the clinical anterior knee laxity. Radiographs and Magnetic Resonance Imaging (MRI) was used to evaluate osteoarthritis, the continuity and integrity of ACL autograft and LARS.

RESULTS

This retrospective study examined 35 patients who underwent single-stage bicruciate ligament reconstruction between May 2005 and January 2017 with a follow-up period ranging from 3 to 15 years (a mean of 7.5 years). The mean Lysholm score was 74, mean IKDC 2000 was 71. There was a statistically significant difference with a higher Lysholm score (78.9) in early versus delayed surgical intervention (p = 0.023). Using the Kellgren Lawrence osteoarthritis classification system, radiographic findings showed stage II or III in 83% of the sample population. The MRI results revealed a rupture rate of 22% of the anterior autografted ligament and 28% of the posterior LARS artificial ligament. However, there were no long-term artificial ligament-induced complications. There was no correlation between artificial ligament rupture and poor functional results (Lysholm < 65).

CONCLUSION

The results of this study with a mean follow-up of 7.5 years show satisfactory functional scores considering the initial trauma. It seems reasonable to propose early surgical treatment with double reconstruction of the cruciate ligaments within the first 21 days of the trauma. Post-traumatic osteoarthritis is inevitable in multi-ligament knee injuries despite anatomical reconstruction. The use of a LARS artificial ligament appears to be a valid alternative for PCL reconstruction in the context of multi-ligament injury and in the absence of sufficient autologous transplants.

Midterm results of combined intra- and extra-articular ACL reconstruction compared to historical ACL reconstruction data. Multicenter study of the French Arthroscopy Society

INTRODUCTION

During anterior cruciate ligament (ACL) reconstruction procedures, anterolateral reconstruction (ALR) can also be performed to improve the knee's rotational stability. However, the effectiveness of this supplemental technique and its impact on the risk of retears and on the onset of secondary degenerative changesare controversial.

HYPOTHESIS

ALR improves control over the pivot shift, reduces the retear risk and delays the appearance of secondary degenerative lesions.

MATERIAL AND METHODS

Clinical examination, knee laxity measurements and X-ray evaluations were done in 478 patients with more than 3years' follow-up after combined ACL and ALR from 11 participating hospitals. The mean patient age at the time of surgery was 28years. Eighty-eight percent of the patients participated in pivot sports and 45% were competitive athletes. The findings of this study were compared to historical isolated ACL reconstruction data.

RESULTS

The average follow-up was 6.8years. No detectable pivot shift was found in 83% of patients, while 12.8% of patient had a smooth glide. The side-to-side difference in anteroposterior knee laxity with maximum manual force was less than 3mm in 66% of patients and less than 5mm in 95%. The retear rate was 5.4%, with half of these patients undergoing revision ACL surgery. Secondary meniscus damage requiring surgery occurred in 6.3% of patients; the radiological osteoarthritis rate was 17.5%.

DISCUSSION

When compared to historical ACL reconstruction data, combined intra- and extra-articular reconstruction does not increase the complication rate. At a mean follow-up of 6.8years, it provides better control over the pivot shift along with a low retear rate and low occurrence of secondary meniscus injuries.

LEVEL OF EVIDENCE

IV, multicenter study.

Concept of Combined Femoral and Tibial Osteotomies

Medial knee osteoarthritis is not uncommon, and high tibial osteotomy (HTO) for some surgeons is a unique treatment option for young and active patients. However, the deformity is not always located at the level of proximal part of the tibia and the overcorrection needed to achieve a lasting functional result can lead to an oblique joint line. To avoid this undesirable effect to the joint line, a double-level osteotomy (DLO), one at the distal part of the femur and another one at the proximal part of the tibia, is a viable option. The aim of this article is to present the preoperative radiological assessment, the operative procedure, the indications of HTO, distal femoral osteotomy (DFO), and DLO presenting the rationale behind the treatment options. Long-leg radiographs are mandatory to measure the hip–knee–ankle angle, and the femoral and tibial mechanical axes to plan the location of the osteotomy. The best indication for DLO is a severe varus knee deformity with femoral and tibial mechanical axes in varus. This argument can be applied to a genu valgum deformity, especially when the femur is in valgus as well as the tibia, which is not rare. Although the operative technique is demanding, the biggest challenge is not the procedure itself but rather how to reach the exact degree of overcorrection. Computer-assisted surgery is a good alternative and can improve the accuracy of the surgery.

Results with eight and a half years average follow-up on two hundred and eight e-Motion FP® knee prostheses, fitted using computer navigation for knee osteoarthritis in patients with over ten degrees genu varum

PURPOSE

The aim of this study was to analyse the clinical and radiographic results of 208 e-Motion® posterior cruciate-retaining, mobile bearing prostheses (BBraun-Aesculap, Tuttlingen, Germany) fitted using computer navigation, for knee osteoarthritis with a genu varum greater than 10°.

METHODS

One hundred ninety-two patients were operated on with 208 e-Motion® prostheses fitted, between January 2006 and December 2011, using the OrthoPilot® computer navigation system. Average pre-operative IKS score was 70 ± 27 points (6-143) with a function score of 38 ± 20.5 (0-90) and a knee score of 32.5 ± 13 (0-63). Average flexion was 116.5° ± 13° (65-140°). Average pre-operative HKA angle was 166° ± 3° (154-169°).

RESULTS

2Results are available for 134 patients, with a total of 150 knees operated on (38 lost to follow-up and 20 deceased). Average follow-up was 104.5 months (60-116 months). On last follow-up, the average IKS was 180 ± 22 points (95-200) with 86.5 ± 16 points (25-100) for the function score and 93.5 ± 8 points (55-100) for the knee score. Knee flexion was 116° ± 10.5° (80-135°) and average HKA angle was 179° ± 2° (175-184°). The pre-operative objective was achieved in 90.5% of knees.

CONCLUSION

The e-Motion® mobile bearing posterior cruciate-retaining prosthesis, fitted using computer navigation, offers excellent results after an average of 8.5 years follow-up. These results are at least equivalent, even superior, to those of the posterior-stabilised prostheses usually used for this type of deformity.

A thoracic spinal bone giant cell tumor in a skeletally immature girl. A case report and literature review

PURPOSE

Giant cell tumors (GCT) are benign primary bone tumors, locally aggressive, affecting in long bones in young adults during the third decade. It is rare to experience this lesion in skeletally immature patients. GCT are related to a risk of local recurrence and malignant transformation.

METHOD

We report a rare case of a giant cell tumor of the thoracic spine in a skeletally immature girl presenting with a painful right scoliosis.

RESULTS

MRI, CT scan, and bone scintigraphy were discordant and the percutaneous biopsy non-contributive.

CONCLUSION

A marginal "en bloc" resection was performed and revealed the GCT. Based on a literature review, the diagnosis and the surgical management of this case are discussed.