[show abstract][hide abstract] ABSTRACT: The purpose of this study was to compare the outcomes after anterior cruciate ligament reconstructive surgery by use of bone-patellar tendon-bone (BPTB) allografts, tibialis anterior tendon (TA) allografts, and hamstring tendon (HA) autografts with respect to objective knee testing measures and second-look arthroscopy.
We analyzed 338 patients who had undergone anterior cruciate ligament reconstruction between March 2000 and February 2006. BPTB allografts were used in 60 cases, TA allografts in 153 cases, and HA autografts in 125 cases. We compared the grade of range of motion (ROM), Lachman test, pivot-shift test, KT-1000 arthrometric test (MEDmetric, San Diego, CA), and International Knee Documentation Committee (IKDC) knee examination form, as well as second-look arthroscopic findings, at least 1 year after reconstruction.
The preoperative ROM was not different among the 3 groups (P > .05), but the BPTB group and TA group showed greater postoperative ROM than the HA group (P = .028 and P < .001, respectively). There was no difference among the 3 groups in the other objective testing measurements (P > .05). Synovial coverage of more than 50% was found in 62.5% cases in the BPTB allograft group, 72.3% cases in the TA allograft group, and 90.7% cases in the HA autograft group. The incidence of synovial coverage of more than 50% was higher in the HA autograft group than that in the BPTB and TA allograft groups (P = .018 and P = .026, respectively). With regard to the IKDC grade, grade A or B was found in 95.2% of the cases with synovial coverage of more than 50% and in 78.3% of the cases with coverage of less than 50% (P = .011).
There was no difference in objective knee testing measures among the 3 different graft groups except that the allograft groups showed greater postoperative ROM than the autograft group. However, the HA autograft group had better synovial coverage on second-look arthroscopy, and the group with better synovial coverage on second-look arthroscopy presented better clinical results on the IKDC objective examination form.
Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2010; 26(1):41-9. · 3.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to analyze differences in injury mechanism, preoperative physical examination findings, combined injury pattern, and postoperative clinical results among arthroscopic anterior cruciate ligament (ACL) reconstruction, anteromedial (AM) augmentation, and posterolateral (PL) augmentation with hamstring autograft. We also evaluated the availability of routine magnetic resonance imaging (MRI) for detection of ACL remnant fibers.
From January 2005 to May 2007, we analyzed 82 cases of ACL reconstruction, 40 cases of AM augmentation, and 42 cases of PL augmentation. We compared injury mechanism, combined injury pattern, and preoperative and postoperative measurements including range of motion, Lachman test, pivot-shift test, KT-1000 arthrometer test (MEDmetric, San Diego, CA), and International Knee Documentation Committee knee examination form. We also analyzed the availability of the routine coronal view on MRI for detecting ACL remnant fibers.
A direct injury mechanism was involved more in the AM augmentation group than in the PL augmentation group (P = .029). MRI diagnosis for the detection of a remnant AM or PL bundle presented excellent intraobserver and interobserver agreement. The incidence of medial meniscus tears was highest in the reconstruction group (P < .001 v AM augmentation group and P = .003 v PL augmentation group), and it was higher in the PL augmentation group than in the AM augmentation group (P = .018). The AM augmentation group had a higher incidence of medial collateral ligament injury than the other groups (P = .006 v reconstruction group and P = .037 v PL augmentation group). The AM augmentation group presented with a lower incidence of a preoperative grade 2 or 3 positive pivot-shift test (P = .008 v reconstruction group and P = .016 v PL augmentation group), but no difference was found in the other clinical assessments.
The AM augmentation group was injured more by a direct injury mechanism, and it presented with a greater incidence of medial collateral ligament tear than the PL augmentation group. The incidence of a preoperative grade 2 or 3 positive pivot-shift test was lower in the AM augmentation group than in the other 2 groups. MRI was useful for detection of remnant ACL fibers.
Level III, retrospective comparative study.
Arthroscopy The Journal of Arthroscopic and Related Surgery 11/2009; 25(11):1265-74. · 3.10 Impact Factor