Comparison of Clinical Results in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft and Using Achilles Tendon Allograft / 대한정형외과학회잡지

PURPOSE: To compare clinical outcomes after arthroscopic ACL reconstruction using bone-patellar tendon- bone autograft and using fresh-frozen Achilles tendon allograft. MATERIALS AND METHODS: We enrolled 61 patients who underwent anterior cruciate ligament reconstruction by means of bone-patellar tendon-bone autograft or Achilles tendon allograft between March, 2002 and December, 2006. The bone-patellar tendon-bone group included 29 patients (mean age 30.4 years), and the Achilles tendon allograft group included 32 patients (mean age 32.5 years). The mean follow-up was 18.2 months and 25.7 months in each group, respectively. Preoperative and last follow-up clinical results were evaluated through physical examination, KT-2000 arthrometer, stress roentgenogram, IKDC knee rating system, and Lysholm knee score. RESULTS: The mean side-to-side difference in anterior translation, as measured by KT-2000 arthrometer, was significantly improved from 6.4 mm+/-3.0 to 3.2 mm+/-1.9 in the bone-patellar tendon-bone group, and from 7.6 mm+/-3.1 to 2.9 mm+/-2.0 in the Achilles tendon allograft group (p<0.001). The Achilles tendon allograft group improved more significantly than did the bone-patellar tendon-bone group (p=0.045). The mean side-to-side difference on stress roentgenogram was significantly improved from 5.3 mm+/-2.5 to 2.0 mm+/-2.1 in the bone-patellar tendon-bone group, and from 6.0 mm+/-3.4 to 2.2 mm+/-2.1 in the Achilles tendon allograft group (p<0.001). There was no significant difference between the two groups. According to the IKDC knee rating system at last follow-up, 26 (89.7%) patients in the bone-patellar tendon-bone group and 28 (87.5%) patients in the Achilles allograft group were normal or nearly normal. The mean Lysholm knee score significantly improved from 69.9 to 90.2 in the bone-patellar tendon-bone group, and from 64.4 to 91.4 in the Achilles tendon allograft group (p<0.001). CONCLUSION: Both bone-patellar tendon-bone and Achilles tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. We suggest that both bone-patellar tendon-bone autograft and Achilles tendon allograft be considered as graft substitutes for anterior cruciate ligament reconstruction.

Second-look Arthroscopic Findings after Anterior Cruciate Ligament Reconstruction: Comparison between Achilles allograft and Bone-Patellar tendon-Bone autograft

PURPOSE: The purpose of this study was to compare the arthroscopic findings between autograft group and allograft group minimal 1 year after anterior cruciate ligament reconstruction. MATERIALS AND METHODS: From Jul. 1999 to Feb. 2002, we performed second look arthroscopy to 55 patients(60 knees), who had already received anterior cruciate ligament reconstruction minimal 1 years ago(average 16 months) in our hospital. All patients visited our hospital just for removal of tibial hardware. Among 60 knees, 24 cases had operated using bone-patellar tendon-bone autograft(group 1), 36 cases using Achilles tendon allograft(group 2). We evaluated the clinical results by instability, subjective complaint and level of activity. Also we analyzed the second look arthroscopic findings by graft revascularization, fissuring, laxity and intraarticular general status. RESULTS: There was no differene in clinical results except 2 patients who complained mild anterior knee pain in group 1. At second look arthroscopy, well vascularized cases were 13 cases(54%) in group 1 and 15 cases(41%) in group 2 respectively. Fissuring of graft was more prominent in group 2(5 cases, 14%) rather than group 1(3 cases, 9%). Fibrous tissue formation around graft was found in 3 cases(14%) of group 1 and 7 cases(20%) of group2. According to Outerbridge grading system of articular cartilage, more than grade II change in patellofemoral joint were detected more prominently in group 1(7 cases, 32%) than group 2(7 cases, 21%). CONCLUSION: In clinical results, there was no difference between Achilles allograft and Bone-Patellar tendon-Bone autograft used for reconstruction of anterior cruciate ligament. On second look arthroscopy, patellofemoral arthrosis was more prominent in autograft group, but revascularization of graft and the change of perigraft tissue showed more favorable result.

Arthroscopic ACL Reconstruction using Bone-patellar Tendon-bone Autograft and Bioabsorbable Interference Screw / 대한정형외과학회잡지

PURPOSE: We report the results of arthroscopic ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft and a bioab-sorbable interference screw (Bioscrew, poly L-lactic acid, Linvatec co., USA). MATERIALS AND METHODS: From January 1998 to December 1998, we performed 39 cases of arthroscopic ACL reconstruction using BPTB autograft and a bioabsorbable interference screw. The average follow-up period was 2 years and 8 months. We performed KT-2000 testing and measured the IKDC, Tegner and Lysholm scores preoperatively and compared these with the results of a final evalua-tion. We performed second-look arthroscopy on 4 cases and observed the degree of degradation of the bioabsorbable interference screw. RESULTS: Preoperative evaluation revealed an average range with a KT-2000 of 8.1 +/-3.4 mm, a Lysholm score of 66.2 +/-16.3, an IKDC score below C in all cases and a Tegner score of 3.7 +/-0.9, but final results showed a KT-2000 of 2.8 +/-2.2 mm, a Lysholm score of 91.7 +/-7.5, an IKDC score above B in all except 3 cases and a Tegner score of 6.9 +/-1.1. Second-look arthroscopy at 3 and 12 months post-operatively showed no degradation of the bioabsorbable interference screw, but there was partial degradation of the bioabsorbable inteference screw at 21 and 33 months. CONCLUSION: Bioabsorbable interference screws seems a reasonable alternative to metallic screws in ACL reconstruction. Bioab-sorbablescrew implanted in humans may take much longer to degrade than expected, more study is needed.

Clinical Results of Anterior Cruciate Ligament Reconstruction: Bone-Paterllar-Tendon-Bone vs Hamstring Tendon Autograft

PURPOSE: To compare the clinical and radiologic results of the anterior cruciate ligament(ACL) recon- struction between bone-patellar tendon-bone autograft and doubled semitendinosus and gracilis autograft. MATERIALS AND METHODS: 45 patients out of 235 ACL reconstructions with bone-patellar tendon- bone(BPTB) autograft and 47 patients out of 178 ACL reconstructions with doubled semitendinosus and gracilis were included in this study. Average follow-up period were 19 months in BPTB autograft and 17 months in doubled semitendinosus and gracilis autograft. There were no differences in preoperative parameters(age, sex, instability). RESULTS: There were no significant differences between two groups with respect to functional result(Lysholm knee score), degree of laxity and range of motion at final follow-up. However, the parap- atellar complications, especially anterior knee pain after long distance walking or exercise, and quadriceps weakness were less occurred in doubled semitendinosus and gracilis autograft than in BPTB autograft. CONCLUSION: ACL reconstruction with doubled semitendinosus and gracilis autograft is a good alternative choice in reducing parapatellar complications and in achieving functional stability of knee joint.

Patellar Fracture in ACL Reconstruction with Bone-Patellar Tendon-Bone Autograft: Case Report

Autogenous bone-patellar tendon-bone is popular ligament substitute used in anterior cruciate liga- ment(ACL) reconstructions. Fracture of the patella is a rare but serious complication unique to this type of reconstruction. We report 4 cases of patellar fracture after autogenous bone-patellar tendon-bone ACL reconstruction.

Arthroscopically assisted Anterior Cruciate Ligament Reconstruction using Bone-Patellar tendon-Bone Autograft: 13 to 26-month Follow-up Evaluation / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate arthroscopic anterior cruciate ligament reconstruction (ACLR) using Bone-Patellar tendon-Bone (BPTB) autograft by analyzing its follow up data with subjective, physical and quantitative tests and radiological measurement. MATERIALS AND METHODS: From march 1997 to march 1998, 71 patients who received arthroscopic ACLR using BPTB autograft were followed up for minimum 1 year. RESULTS: A negative pivot shift was noted in 68 patients (95.9%) and there was significant improvement in manual maximum side-to-side differences at a last follow up. Postoperative Tegner scales were similar to preinjury scores and the mean Lysholm score was 55.8 points preoperatively and 94.1 points at the last follow up. Repair of meniscal tears showed significant improvement in Tegner scale compared with menisectomy of meniscal tears group at a last follow up. CONCLUSION: The short-term results of arthroscopic ACLR using BPTB autograft was very satisfactory. Above all, this procedure needs more accurate and skillful surgical technique. Repair of combined meniscal tears improved functional ability of the patients and proved good meniscal healing process.

Postoperative Results and Complications of Arthroscopic Anterior Cruciate Ligament Reconstruction using Bone-Patellar tendon-Bone Autograft

We reviewed the post-reconstructive results and complications of arthroscopic anterior cruciate ligament reconsbuction using the patellar bone-tendon-bone autograft in 91 patients who underwent the index surgery at least one year ago. The changes of Lysholm knee score, limitation of motion, instability of the reconstructed ACL, musc)e strength, presence of anterior knee pain and other complications were evaluated at final fol- low-up(mean, 2.6 year). The results were as follows. 1. The mean Lysholm knee score was 65.5+-15.5 preoperatively and improved to 88.5+-7.4 postoperatively(p<0.05), 2. Of all, nine(9.9%) complained anterior knee pain. 3. Three patients(3.3%) showed limited range of motion. 4. Five(3.5%) showed instability of reconstructed ACL during the followup. Two were caused by trauma. Ln other three, no definite causes were found. 5. In 23 patients, cybex isokinetic thigh muscle strength test was perfornied preoperatively and at post-up. One year. The strength of quadriceps of the operated side at the angular velocity of 60 degrees per second showed mean 41.7% deficit of the normal side at postoperative one year. 6. Other complications were one case of chronic click sound in motion, and one case of the fracture which occurred at the autograft donor site of the proximal tibia.