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Department of Orthopaedics, University of Virginia, 400 Ray C. Hunt Drive, Suite 330, P.O. Box 800159, Charlottesville, VA 22908-0159, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 01/2010; 92(1):250-63. DOI: 10.2106/JBJS.I.01478
Source: PubMed
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    ABSTRACT: We propose a new reverse "Y"-plasty graft for use in anterior cruciate ligament (ACL) reconstruction that involves double tibial tunnels and a single femoral tunnel. With this technique, the hamstrings were used as autografts and fixed separately with bioabsorbable interference screws (group A) or Endobuttons (group B) in femurs. A prospective series of 63 patients underwent primary reconstruction of the ACL; all procedures were performed by the same surgeon. Group A included 35 patients (22 male, 13 female), with a mean age of 25.5 (17-40) years, who were followed up for 28.5 (12-48) months. Group B included 28 patients (17 male, 11 female), with a mean age of 24.3 (18-38) years, who were followed up for 29.5 (12-46) months. Lysholm, International Knee Documentation Committee (IKDC) and Larson scoring were used to compare the therapeutic effects experienced at the knee. Lysholm scores were 93.26±2.67 (group A) and 93.81±2.42 (group B); Larson scores were 91.91±2.29 (group A) and 92.81±2.39 (group B); IKDC scores were 93.89±1.88 (group A) and 94.15±1.77 (group B). None of the scoring differences between groups were statistically significant (T(1)=0.849, P(1)=0.399, T(2)=1.506, P(2)=0.137, T(3)=0.560, P(3)=0.578). The Lachman test was negative in 46 patients (90.2%) and 51 knees, including 25 (89.3%) of the 28 knees in group A and 21 (91.3%) of the 23 knees in group B. Negative Pivot shift was present postoperatively in 49 knees of 51 patients (96.1%), including 27 (96.4%) of the 28 knees in group A and 22 (95.7%) of the 23 knees in group B. All of the patients in both groups achieved full extension and at least 135° of knee flexion. This novel technique involves the creation of double tibial tunnels and a single femoral tunnel. In the tibia, there was a bone bridge, ranging from 2 to 3mm, between the two bundles, which are tensioned at different degrees of flexion to maintain the stability of the knee. In the femur, the grafts were fixed with bioabsorbable interference screws or Endobuttons. The outcomes show that normal function and joint stability were achieved in both groups, as compared with preoperative measurements. Although the outcomes in group A (grafts fixed with the bioabsorbable interference screws in the femur) was better than those observed in group B (grafts fixed with Endobuttons), there was no statistical difference between the groups.
    The Knee 03/2012; 19(2):78-83. DOI:10.1016/j.knee.2010.10.010 · 1.94 Impact Factor
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    ABSTRACT: Multiple ligament-injured knees are a heterogeneous group of knee injuries that lack a clear consensus on optimal treatment. Current areas of controversy include optimal timing of surgery, ligamentous repair vs reconstruction, and combined vs staged procedures. In addition, multiple open, arthroscopic, and arthroscopic-assisted techniques exist for repair and reconstruction of the injured stabilizers of the knee.Many open posterolateral corner reconstruction techniques have been described, and this article represents the first description of an arthroscopic technique for repair of an avulsed popliteus tendon. This was performed with a standard anterolateral portal in addition to anterior and posterior superolateral portals. Nonabsorbable sutures were passed through the avulsed popliteus tendon in an outside-in technique using a suture shuttle. The nonabsorbable sutures were threaded though a tibial Beath pin, which was then passed through the prepared popliteus footprint and brought out medially. The final position of the popliteus was confirmed arthroscopically, and the sutures were tied medially over a screw post with a washer.Arthroscopic popliteus repair has many possible advantages. Because the popliteus tendon insertion is intracapsular, open repair necessitates a capsulotomy, with the potential for complications such as postoperative wound drainage, intra-articular sinus formation, infection, and stiffness. Arthroscopic repair may avoid these complications. The current case was performed in conjunction with an open but extracapsular posterolateral corner repair. Further experience with this technique is required to determine its safety and efficacy.
    Orthopedics 06/2012; 35(6):e973-6. DOI:10.3928/01477447-20120525-46 · 0.96 Impact Factor