Background: Double-bundle anterior cruciate ligament (ACL) reconstruction is a technically demand... more Background: Double-bundle anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure; it requires drilling 2 tibial and 2 femoral tunnels. Tunnel communication, whether intraoperative or postoperative, is a serious complication: It jeopardizes knee stability and graft function.
International Journal of Environmental Research and Public Health, Dec 27, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
European Journal of Orthopaedic Surgery & Traumatology
Background A clinical trial comparing MB (mobile-bearing) versus FB (fixed-bearing) in medial par... more Background A clinical trial comparing MB (mobile-bearing) versus FB (fixed-bearing) in medial partial knee arthroplasty (PKA) in octagenarians has been conducted. The focus of the present study was on PROMs, range of motion (ROM), implant positioning and implants survivorship. The hypothesis of the present study was that MB implants performed better than FB in PKA in octogenarians. Methods The first group received FB PKA-PPK®; the second received MB PKA-Oxford. Patients were not randomly allocated. The following PROMs were administered at T0 (pre-operatively), T1 (1 year after surgery), and T2 (3 years after surgery): visual analogue scale (VAS), Knee Society Score (KSS) and Oxford Knee Score (OKS). Data regarding the implant survivorship and ROM were also collected. Furthermore, the following radiographic parameters were measured: Femoral component varus/valgus; Tibial component varus/valgus; Anteroposterior slope. Results At T0, 28 patients were included in the FB and 33 in the MB...
Infection following anterior cruciate ligament (ACL) reconstruction can be one of the most debili... more Infection following anterior cruciate ligament (ACL) reconstruction can be one of the most debilitating complications following ACL reconstruction. Its reported incidence is around 1%. Utilization of vancomycin for presoaking the graft is considered an established method for infection prevention. The role of other agents, such as gentamycin needs further investigation. Staphylococci are the predominant causative pathogens, while particular attention should be paid to fungal infections due to their long-standing, occult process. Recent data demonstrate that hamstrings autograft may be at an elevated risk of being contaminated leading to subsequent septic arthritis. Diagnosis is set by clinical and laboratory findings and is usually confirmed by intraoperative cultures. Treatment varies, mainly depending on the intraoperative assessment. Satisfactory outcomes have been reported with both graft retaining and removal, and the decision is made upon the arthroscopic appearance of the graf...
Osteochondromas are the most common benign bone tumor; nonetheless, the natural history is poorly... more Osteochondromas are the most common benign bone tumor; nonetheless, the natural history is poorly understood as a result of the low threshold for resection and the fact that many of these lesions are asymptomatic and therefore never diagnosed. We present a case of a 17-year-old patient whose routine shoulder X-ray evaluation, due to a minor shoulder injury, revealed spontaneous regression of a previously documented left proximal humerus osteochondroma at six years follow-up. The likelihood of spontaneous regression should be better understood by orthopedic surgeons and taken into account in the decision process of whether to remove osteochondromas surgically or wait.
ACL injuries in football are frequently encountered because of their high-intensity axial and val... more ACL injuries in football are frequently encountered because of their high-intensity axial and valgus forces due to their competitive natural and challenging condition. Despite developing surgical techniques and rehabilitation protocols, approximately two-thirds of the operated athletes, 1 year after the operation, are seen to not be able to turn back their pre-injury sports conditions. Isokinetic force tests, subjective assessment forms, and functional performance tests have been argued generally in the literature to be back-to-sport determinants. Isokinetic tests are used to assess lower extremity strength. Clinical tests including force tests and laxity measurements that are done after the ACL surgery and rehabilitation are found to be poorly compatible with all patients’ functional abilities, and functional tests have been developed to help assess whether the athlete is ready to return to unlimited activity with surgery and treatment results. The back-to-sport criterion includes ...
Purpose The purpose of this study was to compare the maximum load to failure and stiffness of thr... more Purpose The purpose of this study was to compare the maximum load to failure and stiffness of three medial patella-femoral ligament (MPFL) reconstruction techniques: (i) suture anchor fixation (SA), (ii) interference screw fixation (SF), and (iii) suture knot (SK) patellar fixation. The null hypothesis was that the comparison between these three different patella fixation techniques would show no difference in the ultimate failure load and stiffness. Methods Reconstruction of the MPFL with gracilis tendon autograft was performed in 12 pairs of fresh-frozen cadaveric knees (24 knees total; mean age, 63.6 $$\pm $$ ± 8.0 years). The specimens were randomly distributed into 3 groups of 8 specimens; SA reconstruction was completed with two 3.0-mm metal suture anchors; (SF) fixation was accomplished by two 6-mm bio-composite interference screws; SK fixation at the lateral side of the patella was accomplished after drilling two semi-patellar tunnels with a diameter of 4.5 mm. The reconstructions were subjected to cyclic loading for 10 cycles to 30 N and tested to failure at a constant displacement rate of 15 mm/min using a materials-testing machine (MTS 810 Universal Testing System). The final load of failure (N), stiffness (N / mm) and failure mode was recorded in each specimen and followed by statistical analysis. Results There was no significant difference in mean ultimate failure load among the three groups. The SK group failed at a mean ( $$\pm $$ ± SD) ultimate load of 253.5 $$\pm $$ ± 38.2 N, the SA group failed at 243 $$\pm $$ ± 41.9 N and the SF group at 263.2 $$\pm $$ ± 9.06 N. The SF group had a mean stiffness of 37.8 $$\pm $$ ± 5.7 N/mm. This was significantly higher ( p < 0.05) than the mean stiffness value achieved for the SK group 21.4 $$\pm $$ ± 9.5 N/mm and the SA group 18.7 $$\pm $$ ± 3.4 N/mm. The most common mode of failure in the SA group was anchor pullout, and in the SK group was failure at the graft–suture interface. All the reconstructions in the SF group failed due to tendon graft slippage from the tunnel. Conclusion Load to failure was not significantly different between the 3 techniques. However, screw fixation was found to be significantly stronger than the anchor and the suture knot fixation in terms of rigidity of the reconstruction. From a clinical point of view, all methods of fixation can be used reliably for MPFL reconstruction, since they were found to be stronger than the native MPFL.
The arthroscopic findings of knee articular cartilage lesions are reported to be as high as 60%, ... more The arthroscopic findings of knee articular cartilage lesions are reported to be as high as 60%, although only a fragment of these are considered to be symptomatic. Such lesions are believed to accelerate the onset of arthritis. Long-term results of the microfracture technique for chondral and osteochondral defects of the knee cartilage are not satisfactory. The autologous matrix induced chondrogenesis (AMIC) technique offers a promising alternative as an effective cartilage repair procedure in the knee resulting in stable clinical results and with a wide range of indications. An extensive literature review has been performed aiming at providing the rationale behind AMIC, to report clinical results of AMIC and to compare AMIC with other chondrogenesis techniques. Finally, we comment on the appropriate surgical technique and its indications, since the number of onestep arthroscopic procedure proposals is steadily increasing.
Purpose To evaluate the impact of local soaking of the autografts with vancomycin during anterior... more Purpose To evaluate the impact of local soaking of the autografts with vancomycin during anterior cruciate ligament (ACL) reconstruction on postoperative infection rates. Methods Between 2003 and 2014 (first study period), 1,242 patients underwent ACL reconstruction using autografts, without soaking them in vancomycin solution, while between 2014 and 2019 (second study period) all ACL autografts in 593 patients were soaked in a 5-mg/ml vancomycin solution, in a territory University Hospital. The same standard treatment of perioperative IV antibiotics was applied in both groups. Results Postoperative septic arthritis occurred in seven out of 1,242 patients (0.56%) during the first study period. Bone patellar tendon bone autograft was used in 311 (25%) patients, and hamstring tendon autograft was used in the rest 931 (75%) of the study population during this period. All infected cases were male and had a hamstrings graft implanted. There were no postoperative infections (0%) in 593 ACL reconstructions during the second study period. Bone patellar tendon bone autograft was used in 178 (30%) patients while hamstring tendon autograft was used in the rest 415 (70%) of the study population, during this period. Statistical analysis revealed a significantly reduced postoperative infection rate (p = 0.018) between the two reported periods, with the main impact referring to the use of hamstrings autograft (p = 0.031) for the first study period. Conclusions Septic arthritis following ACL reconstruction can be significantly reduced (or even eliminated) by soaking ACL autografts in a 5 mg/ml vancomycin solution. Of note, this strategy seems to be more effective in the setting of hamstring tendon autograft use, since the risk of postoperative knee infection is significantly higher when this type of graft is used.
We studied changes in patellar tendon length after reconstruction of the anterior cruciate ligame... more We studied changes in patellar tendon length after reconstruction of the anterior cruciate ligament using either the medial third of the patellar tendon as a graft (n = 40) or a Leeds-Keio artificial ligament (n = 40). Both types of ligament replacement had been supplemented with a MacIntosh extra-articular lateral substitution. The mean change in length in the tendon graft group was 6% (SD 5.39); in the Leeds-Keio group it was 2.4% (SD 4.93). The change in length was significant in both groups, but shortening was more frequent and more severe in the tendon graft group. There was shortening of 10 % or more in 25 % of knees after patellar tendon graft and 7.5 % after use of a Leeds-Keio prosthesis.
Purpose The purpose of this study was to test whether rotational knee kinematics during dynamic p... more Purpose The purpose of this study was to test whether rotational knee kinematics during dynamic pivoting activities are predictive of subjective functional outcome (IKDC, Lysholm), objective laxity scores (KT max), and activity levels (Tegner) in patients after anterior cruciate ligament reconstruction (ACLR). Methods Thirty-one patients with single-bundle ACLR were evaluated prospectively with 3D-motion analysis during (1) descending a stairway and pivoting and (2) landing from a jump and pivoting. The side-to-side difference of tibial rotation range of motion (SSDTR) between the ACLR and the contralateral intact knee was calculated for the pivoting phase of each task. Linear regression models were applied with SSDTR, for each task predictors of the subjective IKDC score, Lysholm score, anterior tibial translation, and Tegner activity level. Results SSDTR for descending and landing were predictive of the IKDC subjective score (R 2 = 0.46, p \0.001 and R 2 = 0.40, p \ 0.001, respectively) with ''medium'' effect sizes and of the Lysholm score (R 2 = 0.13, p \ 0.05 and R 2 = 0.09, n.s.) with ''small'' to ''none'' effect sizes. SSDTR was not predictive of anterior translation or Tegner activity level (n.s.). Conclusions Restoring rotational kinematics during dynamic pivoting activities after ACLR is predictive of functional outcome. The ability of the athlete after ACLR to control tibial rotation during pivoting activities may be predictive of functional outcome. Level of evidence Case series study. Level IV.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair us... more The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair using the FasT-Fix repair system. Type of Study: Prospective case series. Methods: Sixty-one meniscal repairs with the FasT-Fix meniscal repair system in 58 patients with a mean age of 32.6 years were performed between 2001 and 2002. Concurrent anterior cruciate ligament reconstruction was performed in 36 patients (62%). All tears were longitudinal and located in the red/red or red/white zone. Criteria for clinical success included absence of joint-line tenderness, locking, swelling, and a negative McMurray test. Clinical evaluation also included the Tegner and Lysholm knee scores, and KT-1000 arthrometry. In addition, all patients were evaluated preoperatively with magnetic resonance imaging. Results: The average follow-up was 18 months (range, 14 to 28 months). Six of 61 repaired menisci (9.8%) were considered failures according to our criteria. Therefore, the success rate was 90.2%. Time required for meniscal repair averaged 11 minutes. Postoperatively, the majority of the patients had no restrictions in sports activities. The mean Lysholm significantly improved from 43.6 preoperatively to 87.5 postoperatively (P Ͻ .001). Fifty-one patients (88%) had an excellent or good result according to the Lysholm knee score. Four patients had a restriction of knee joint motion postoperatively, and an arthroscopic arthrolysis was performed in 1 of them. Analysis showed that age, length of tear, simultaneous anterior cruciate ligament reconstruction, chronicity of injury, and location of tear did not affect the clinical outcome. Conclusions: Our results show that arthroscopic meniscal repair with the FasT-Fix repair system provided a high rate of meniscus healing and appeared to be safe and effective in this group of patients. Level of Evidence: Level IV, therapeutic study, case series (no control group).
Purpose: The primary goal of this study was to compare survivorship and functional results in ind... more Purpose: The primary goal of this study was to compare survivorship and functional results in individuals aged 80 and over who underwent total knee arthroplasty (TKA) with cruciate-retaining (CR) or posterior-stabilized (PS) implants. Methods: We prospectively analyzed the clinical records of two consecutive cohorts for a total of 96 implants in patients aged 80 years or over. The first cohort consisted of 59 consecutive cemented PS cases, while the second cohort comprised 37 consecutive cemented CR cases. The decision to either perform a PS or CR arthroplasty was taken based on preoperative magnetic resonance imaging and intraoperative findings. The clinical evaluation entailed evaluating each patient’s visual analogue scale for pain (VAS), range of motion (flexion and extension), Knee Society Score (KSS), and Oxford Knee Score (OKS). Each patient was clinically evaluated the day before surgery (T0) and at two consecutive follow-ups at least 1 (T1) and 2 (T2) years after surgery. I...
The posterior oblique ligament (POL) is the predominant ligamentous structure on the posterior me... more The posterior oblique ligament (POL) is the predominant ligamentous structure on the posterior medial corner of the knee joint. A thorough understanding of the anatomy, biomechanics, diagnosis, treatment and rehabilitation of POL injuries will aid orthopaedic surgeons in the management of these injuries. The resulting rotational instability, in addition to valgus laxity, may not be tolerated by athletes participating in pivoting sports. The most common mechanism of injury – accounting for 72% of cases – is related to sports activity, particularly football, basketball and skiing. Moreover, three different injury patterns have been reported: those associated with injury to the capsular arm of the semimembranosus (SM), those involving a complete peripheral meniscal detachment and those involving disruption of the SM and peripheral meniscal detachment. The hallmark of an injury related to POL lesions is the presence of anteromedial rotatory instability (AMRI), which is defined as ‘exter...
The present study investigates the effect of transosseous low-intensity pulsed ultrasound (LiUS) ... more The present study investigates the effect of transosseous low-intensity pulsed ultrasound (LiUS) on the healing at tendon graft-bone interface, in molecular and histological level. The anterior cruciate ligament (ACL) in both knees of 52 New Zealand White rabbits was excised and replaced with the long digital extensor. A custom-made ultrasound transducer was implanted onto the medial tibial condyle, adjacent to the surface of the bone tunnel at both knees of the rabbits. The LiUS-treated right knees received 200-s bursts of 1 MHz sine waves at a pulse repetition rate of 1 kHz and with 30 mW/cm 2 spatial-average temporal-average intensity for 20 min daily (study group), while the left knee received no LiUS (control group). Thirty-six rabbits were used to perform semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) analysis from both study and control groups for transforming growth factor-1 (TGF-1), biglycan and collagen I. RT-PCR products showed statistically significant upregulation of biglycan and collagen I gene expression in the study group, while TGF-1 gene expression exhibited a bimodal profile. Histological examination performed in 16 rabbits from both groups supported the findings of the molecular analysis, indicating a faster healing rate and a more efficient ligamentization process after ultrasound treatment. These findings suggest that transosseous application of LiUS enhances the healing rate of the tendon graft-bone interface, possibly by affecting the expression levels of genes significant for the tendon to bone healing process.
Background: Double-bundle anterior cruciate ligament (ACL) reconstruction is a technically demand... more Background: Double-bundle anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure; it requires drilling 2 tibial and 2 femoral tunnels. Tunnel communication, whether intraoperative or postoperative, is a serious complication: It jeopardizes knee stability and graft function.
International Journal of Environmental Research and Public Health, Dec 27, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
European Journal of Orthopaedic Surgery & Traumatology
Background A clinical trial comparing MB (mobile-bearing) versus FB (fixed-bearing) in medial par... more Background A clinical trial comparing MB (mobile-bearing) versus FB (fixed-bearing) in medial partial knee arthroplasty (PKA) in octagenarians has been conducted. The focus of the present study was on PROMs, range of motion (ROM), implant positioning and implants survivorship. The hypothesis of the present study was that MB implants performed better than FB in PKA in octogenarians. Methods The first group received FB PKA-PPK®; the second received MB PKA-Oxford. Patients were not randomly allocated. The following PROMs were administered at T0 (pre-operatively), T1 (1 year after surgery), and T2 (3 years after surgery): visual analogue scale (VAS), Knee Society Score (KSS) and Oxford Knee Score (OKS). Data regarding the implant survivorship and ROM were also collected. Furthermore, the following radiographic parameters were measured: Femoral component varus/valgus; Tibial component varus/valgus; Anteroposterior slope. Results At T0, 28 patients were included in the FB and 33 in the MB...
Infection following anterior cruciate ligament (ACL) reconstruction can be one of the most debili... more Infection following anterior cruciate ligament (ACL) reconstruction can be one of the most debilitating complications following ACL reconstruction. Its reported incidence is around 1%. Utilization of vancomycin for presoaking the graft is considered an established method for infection prevention. The role of other agents, such as gentamycin needs further investigation. Staphylococci are the predominant causative pathogens, while particular attention should be paid to fungal infections due to their long-standing, occult process. Recent data demonstrate that hamstrings autograft may be at an elevated risk of being contaminated leading to subsequent septic arthritis. Diagnosis is set by clinical and laboratory findings and is usually confirmed by intraoperative cultures. Treatment varies, mainly depending on the intraoperative assessment. Satisfactory outcomes have been reported with both graft retaining and removal, and the decision is made upon the arthroscopic appearance of the graf...
Osteochondromas are the most common benign bone tumor; nonetheless, the natural history is poorly... more Osteochondromas are the most common benign bone tumor; nonetheless, the natural history is poorly understood as a result of the low threshold for resection and the fact that many of these lesions are asymptomatic and therefore never diagnosed. We present a case of a 17-year-old patient whose routine shoulder X-ray evaluation, due to a minor shoulder injury, revealed spontaneous regression of a previously documented left proximal humerus osteochondroma at six years follow-up. The likelihood of spontaneous regression should be better understood by orthopedic surgeons and taken into account in the decision process of whether to remove osteochondromas surgically or wait.
ACL injuries in football are frequently encountered because of their high-intensity axial and val... more ACL injuries in football are frequently encountered because of their high-intensity axial and valgus forces due to their competitive natural and challenging condition. Despite developing surgical techniques and rehabilitation protocols, approximately two-thirds of the operated athletes, 1 year after the operation, are seen to not be able to turn back their pre-injury sports conditions. Isokinetic force tests, subjective assessment forms, and functional performance tests have been argued generally in the literature to be back-to-sport determinants. Isokinetic tests are used to assess lower extremity strength. Clinical tests including force tests and laxity measurements that are done after the ACL surgery and rehabilitation are found to be poorly compatible with all patients’ functional abilities, and functional tests have been developed to help assess whether the athlete is ready to return to unlimited activity with surgery and treatment results. The back-to-sport criterion includes ...
Purpose The purpose of this study was to compare the maximum load to failure and stiffness of thr... more Purpose The purpose of this study was to compare the maximum load to failure and stiffness of three medial patella-femoral ligament (MPFL) reconstruction techniques: (i) suture anchor fixation (SA), (ii) interference screw fixation (SF), and (iii) suture knot (SK) patellar fixation. The null hypothesis was that the comparison between these three different patella fixation techniques would show no difference in the ultimate failure load and stiffness. Methods Reconstruction of the MPFL with gracilis tendon autograft was performed in 12 pairs of fresh-frozen cadaveric knees (24 knees total; mean age, 63.6 $$\pm $$ ± 8.0 years). The specimens were randomly distributed into 3 groups of 8 specimens; SA reconstruction was completed with two 3.0-mm metal suture anchors; (SF) fixation was accomplished by two 6-mm bio-composite interference screws; SK fixation at the lateral side of the patella was accomplished after drilling two semi-patellar tunnels with a diameter of 4.5 mm. The reconstructions were subjected to cyclic loading for 10 cycles to 30 N and tested to failure at a constant displacement rate of 15 mm/min using a materials-testing machine (MTS 810 Universal Testing System). The final load of failure (N), stiffness (N / mm) and failure mode was recorded in each specimen and followed by statistical analysis. Results There was no significant difference in mean ultimate failure load among the three groups. The SK group failed at a mean ( $$\pm $$ ± SD) ultimate load of 253.5 $$\pm $$ ± 38.2 N, the SA group failed at 243 $$\pm $$ ± 41.9 N and the SF group at 263.2 $$\pm $$ ± 9.06 N. The SF group had a mean stiffness of 37.8 $$\pm $$ ± 5.7 N/mm. This was significantly higher ( p < 0.05) than the mean stiffness value achieved for the SK group 21.4 $$\pm $$ ± 9.5 N/mm and the SA group 18.7 $$\pm $$ ± 3.4 N/mm. The most common mode of failure in the SA group was anchor pullout, and in the SK group was failure at the graft–suture interface. All the reconstructions in the SF group failed due to tendon graft slippage from the tunnel. Conclusion Load to failure was not significantly different between the 3 techniques. However, screw fixation was found to be significantly stronger than the anchor and the suture knot fixation in terms of rigidity of the reconstruction. From a clinical point of view, all methods of fixation can be used reliably for MPFL reconstruction, since they were found to be stronger than the native MPFL.
The arthroscopic findings of knee articular cartilage lesions are reported to be as high as 60%, ... more The arthroscopic findings of knee articular cartilage lesions are reported to be as high as 60%, although only a fragment of these are considered to be symptomatic. Such lesions are believed to accelerate the onset of arthritis. Long-term results of the microfracture technique for chondral and osteochondral defects of the knee cartilage are not satisfactory. The autologous matrix induced chondrogenesis (AMIC) technique offers a promising alternative as an effective cartilage repair procedure in the knee resulting in stable clinical results and with a wide range of indications. An extensive literature review has been performed aiming at providing the rationale behind AMIC, to report clinical results of AMIC and to compare AMIC with other chondrogenesis techniques. Finally, we comment on the appropriate surgical technique and its indications, since the number of onestep arthroscopic procedure proposals is steadily increasing.
Purpose To evaluate the impact of local soaking of the autografts with vancomycin during anterior... more Purpose To evaluate the impact of local soaking of the autografts with vancomycin during anterior cruciate ligament (ACL) reconstruction on postoperative infection rates. Methods Between 2003 and 2014 (first study period), 1,242 patients underwent ACL reconstruction using autografts, without soaking them in vancomycin solution, while between 2014 and 2019 (second study period) all ACL autografts in 593 patients were soaked in a 5-mg/ml vancomycin solution, in a territory University Hospital. The same standard treatment of perioperative IV antibiotics was applied in both groups. Results Postoperative septic arthritis occurred in seven out of 1,242 patients (0.56%) during the first study period. Bone patellar tendon bone autograft was used in 311 (25%) patients, and hamstring tendon autograft was used in the rest 931 (75%) of the study population during this period. All infected cases were male and had a hamstrings graft implanted. There were no postoperative infections (0%) in 593 ACL reconstructions during the second study period. Bone patellar tendon bone autograft was used in 178 (30%) patients while hamstring tendon autograft was used in the rest 415 (70%) of the study population, during this period. Statistical analysis revealed a significantly reduced postoperative infection rate (p = 0.018) between the two reported periods, with the main impact referring to the use of hamstrings autograft (p = 0.031) for the first study period. Conclusions Septic arthritis following ACL reconstruction can be significantly reduced (or even eliminated) by soaking ACL autografts in a 5 mg/ml vancomycin solution. Of note, this strategy seems to be more effective in the setting of hamstring tendon autograft use, since the risk of postoperative knee infection is significantly higher when this type of graft is used.
We studied changes in patellar tendon length after reconstruction of the anterior cruciate ligame... more We studied changes in patellar tendon length after reconstruction of the anterior cruciate ligament using either the medial third of the patellar tendon as a graft (n = 40) or a Leeds-Keio artificial ligament (n = 40). Both types of ligament replacement had been supplemented with a MacIntosh extra-articular lateral substitution. The mean change in length in the tendon graft group was 6% (SD 5.39); in the Leeds-Keio group it was 2.4% (SD 4.93). The change in length was significant in both groups, but shortening was more frequent and more severe in the tendon graft group. There was shortening of 10 % or more in 25 % of knees after patellar tendon graft and 7.5 % after use of a Leeds-Keio prosthesis.
Purpose The purpose of this study was to test whether rotational knee kinematics during dynamic p... more Purpose The purpose of this study was to test whether rotational knee kinematics during dynamic pivoting activities are predictive of subjective functional outcome (IKDC, Lysholm), objective laxity scores (KT max), and activity levels (Tegner) in patients after anterior cruciate ligament reconstruction (ACLR). Methods Thirty-one patients with single-bundle ACLR were evaluated prospectively with 3D-motion analysis during (1) descending a stairway and pivoting and (2) landing from a jump and pivoting. The side-to-side difference of tibial rotation range of motion (SSDTR) between the ACLR and the contralateral intact knee was calculated for the pivoting phase of each task. Linear regression models were applied with SSDTR, for each task predictors of the subjective IKDC score, Lysholm score, anterior tibial translation, and Tegner activity level. Results SSDTR for descending and landing were predictive of the IKDC subjective score (R 2 = 0.46, p \0.001 and R 2 = 0.40, p \ 0.001, respectively) with ''medium'' effect sizes and of the Lysholm score (R 2 = 0.13, p \ 0.05 and R 2 = 0.09, n.s.) with ''small'' to ''none'' effect sizes. SSDTR was not predictive of anterior translation or Tegner activity level (n.s.). Conclusions Restoring rotational kinematics during dynamic pivoting activities after ACLR is predictive of functional outcome. The ability of the athlete after ACLR to control tibial rotation during pivoting activities may be predictive of functional outcome. Level of evidence Case series study. Level IV.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair us... more The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair using the FasT-Fix repair system. Type of Study: Prospective case series. Methods: Sixty-one meniscal repairs with the FasT-Fix meniscal repair system in 58 patients with a mean age of 32.6 years were performed between 2001 and 2002. Concurrent anterior cruciate ligament reconstruction was performed in 36 patients (62%). All tears were longitudinal and located in the red/red or red/white zone. Criteria for clinical success included absence of joint-line tenderness, locking, swelling, and a negative McMurray test. Clinical evaluation also included the Tegner and Lysholm knee scores, and KT-1000 arthrometry. In addition, all patients were evaluated preoperatively with magnetic resonance imaging. Results: The average follow-up was 18 months (range, 14 to 28 months). Six of 61 repaired menisci (9.8%) were considered failures according to our criteria. Therefore, the success rate was 90.2%. Time required for meniscal repair averaged 11 minutes. Postoperatively, the majority of the patients had no restrictions in sports activities. The mean Lysholm significantly improved from 43.6 preoperatively to 87.5 postoperatively (P Ͻ .001). Fifty-one patients (88%) had an excellent or good result according to the Lysholm knee score. Four patients had a restriction of knee joint motion postoperatively, and an arthroscopic arthrolysis was performed in 1 of them. Analysis showed that age, length of tear, simultaneous anterior cruciate ligament reconstruction, chronicity of injury, and location of tear did not affect the clinical outcome. Conclusions: Our results show that arthroscopic meniscal repair with the FasT-Fix repair system provided a high rate of meniscus healing and appeared to be safe and effective in this group of patients. Level of Evidence: Level IV, therapeutic study, case series (no control group).
Purpose: The primary goal of this study was to compare survivorship and functional results in ind... more Purpose: The primary goal of this study was to compare survivorship and functional results in individuals aged 80 and over who underwent total knee arthroplasty (TKA) with cruciate-retaining (CR) or posterior-stabilized (PS) implants. Methods: We prospectively analyzed the clinical records of two consecutive cohorts for a total of 96 implants in patients aged 80 years or over. The first cohort consisted of 59 consecutive cemented PS cases, while the second cohort comprised 37 consecutive cemented CR cases. The decision to either perform a PS or CR arthroplasty was taken based on preoperative magnetic resonance imaging and intraoperative findings. The clinical evaluation entailed evaluating each patient’s visual analogue scale for pain (VAS), range of motion (flexion and extension), Knee Society Score (KSS), and Oxford Knee Score (OKS). Each patient was clinically evaluated the day before surgery (T0) and at two consecutive follow-ups at least 1 (T1) and 2 (T2) years after surgery. I...
The posterior oblique ligament (POL) is the predominant ligamentous structure on the posterior me... more The posterior oblique ligament (POL) is the predominant ligamentous structure on the posterior medial corner of the knee joint. A thorough understanding of the anatomy, biomechanics, diagnosis, treatment and rehabilitation of POL injuries will aid orthopaedic surgeons in the management of these injuries. The resulting rotational instability, in addition to valgus laxity, may not be tolerated by athletes participating in pivoting sports. The most common mechanism of injury – accounting for 72% of cases – is related to sports activity, particularly football, basketball and skiing. Moreover, three different injury patterns have been reported: those associated with injury to the capsular arm of the semimembranosus (SM), those involving a complete peripheral meniscal detachment and those involving disruption of the SM and peripheral meniscal detachment. The hallmark of an injury related to POL lesions is the presence of anteromedial rotatory instability (AMRI), which is defined as ‘exter...
The present study investigates the effect of transosseous low-intensity pulsed ultrasound (LiUS) ... more The present study investigates the effect of transosseous low-intensity pulsed ultrasound (LiUS) on the healing at tendon graft-bone interface, in molecular and histological level. The anterior cruciate ligament (ACL) in both knees of 52 New Zealand White rabbits was excised and replaced with the long digital extensor. A custom-made ultrasound transducer was implanted onto the medial tibial condyle, adjacent to the surface of the bone tunnel at both knees of the rabbits. The LiUS-treated right knees received 200-s bursts of 1 MHz sine waves at a pulse repetition rate of 1 kHz and with 30 mW/cm 2 spatial-average temporal-average intensity for 20 min daily (study group), while the left knee received no LiUS (control group). Thirty-six rabbits were used to perform semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) analysis from both study and control groups for transforming growth factor-1 (TGF-1), biglycan and collagen I. RT-PCR products showed statistically significant upregulation of biglycan and collagen I gene expression in the study group, while TGF-1 gene expression exhibited a bimodal profile. Histological examination performed in 16 rabbits from both groups supported the findings of the molecular analysis, indicating a faster healing rate and a more efficient ligamentization process after ultrasound treatment. These findings suggest that transosseous application of LiUS enhances the healing rate of the tendon graft-bone interface, possibly by affecting the expression levels of genes significant for the tendon to bone healing process.
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