Factors Affecting the Extent of Graft Tendon Synovialization after Double-Bundle Anterior Cruciate Ligament Reconstruction: Based on Second-Look Arthroscopic Findings

BACKGROUND: We aimed to examine the factors that influence synovialization of the grafted tendon after double-bundle anterior cruciate ligament (ACL) reconstruction based on second-look arthroscopic findings. METHODS: Out of 205 knees that were treated between August 2008 and May 2016 with double-bundle ACL reconstruction using bio-absorbable cross-pins and Endobuttons for femoral tunnel fixation, we enrolled 65 knees (64 patients) that underwent second-look arthroscopy with hardware removal at 1 year postoperatively. Measured clinical outcomes included the Lysholm score and Tegner activity score that were evaluated preoperatively and during the final follow-up. We analyzed the relationship between synovial coverage and patient age, length of the preserved remnant tissue on the tibial side, type of bundle (anteromedial or posterolateral), type of graft (autograft or allograft), and time from injury to surgery. RESULTS: The area of synovial coverage showed a significant statistical correlation with patient age and the length of the preserved remnant tissue on the tibial side. The average synovial coverage was significantly better for the anteromedial bundle than for the posterolateral bundle, better for the autograft than for the allograft reconstruction, and better when treated in the acute stage than in the chronic stage. However, synovialization of grafted tendon did not correlate to clinical outcomes. CONCLUSIONS: While we were able to identify several factors influencing synovialization of the grafted tendon after double-bundle ACL reconstruction, including patient age, length of preserved remnant tissue of the torn ACL, type of bundle, type of graft, and time from injury to surgery, we found no evidence that increased synovialization improves clinical outcomes at 1 year postoperatively.

Clinical and Radiological Short-Term Results after Meniscal Allograft / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical and radiological results after meniscal allograft transplantation (MAT). MATERIALS AND METHODS: From October, 2010 to August, 2013, 45 patients, 47 cases who underwent MAT were reviewed. The mean age was 39.9 years and the mean follow-up period was 24.9 months. The clinical results were evaluated using Lysholm score and International Knee Documentation Committee (IKDC) score. All cases were evaluated by serial postoperative radiograph. And 18 cases were performed postoperative magnetic resonance imaging (MRI). Eighteen cases including the 13 cases that had graft dislocation or subluxation and signal changes in MRI underwent second-look arthroscopy. RESULTS: Lysholm score was elevated from mean 58.4 at preoperative to 92.4 at last follow-up. IKDC score was elevated from mean 50.3 at preoperative to 90.1 at last follow-up. Among the 18 cases who underwent postoperative MRI, subluxation was found in 10 cases (55.6%) and graft dislocation with grade III signal change was found in 3 cases (16.7%). However, the 13 cases showed a well healed state of the graft capsule in second-look arthroscopy. There was no joint space narrowing on radiograph during the follow-up period. CONCLUSION: After MAT, 93.6% of cases showed improved the clinical results above good. Thus, it is effective in relatively young and active patients with meniscus functional deficit and minor meniscal degeneration.

A Comparison of Clinical Results and Second-Look Arthroscopic Findings between Early and Delayed Reconstruction in Acute Anterior Cruciate Ligament Injuries / 대한정형외과학회잡지

PURPOSE: This study was conducted for comparison of clinical and second look arthroscopic results between early and delayed reconstruction of acute anterior cruciate ligament (ACL) injuries. MATERIALS AND METHODS: Thirty-six patients who underwent ACL reconstruction between March 2008 and October 2011 were enrolled in this study. We divided the patients into two groups, those in the early reconstruction group underwent surgery before one week, and those in the delayed reconstruction group underwent surgery after three weeks, before six weeks. We checked clinical results and second look arthroscopic results and analyzed correlation of clinical and second look arthroscopic results. RESULTS: At the final follow up, the Lysholm, International Knee Documentation Committee, and Tegner score were not statistically different between the two groups (p=0.173, p=0.154, p=0.109). No difference for the range of motion (p=0.808, p=0.680), Lachman test (p=0.377), and pivot shift test (p=0.894) was observed between the groups. In the results of second look arthroscopy, there was no difference in graft continuity (p=0.936), tension (p=0.944) and synovial coverage (p=0.789). No statistical clinical correlation was observed between clinical and second look arthroscopic results (p>0.05). CONCLUSION: We obtained satisfactory clinical and second look arthroscopic results in both the early and delayed ACL reconstruction groups. Therefore, early reconstruction of ACL performed before one week could be a treatment options for acute ACL injury.

Comparison of Clinical Results and Second-Look Arthroscopic Findings of Remnant Preserving versus Non-Remnant Preserving Technique after Anterior Cruciate Ligament Reconstruction Using Achilles Allograft / 대한정형외과학회잡지

PURPOSE: This study was conducted for evaluation of clinical uses of anterior cruciate ligament (ACL) reconstruction with an Achilles allograft using the remnant technique by comparison and analysis stability, functional assessment and results of second-look arthroscopy between the remnant technique and the non-remnanat technique. MATERIALS AND METHODS: A total of 48 patients who underwent ACL reconstruction using an Achilles allograft were selected and divided into two groups depending on the presence of remnant. The preserving group included 26 patients and non-preserving group included 22 patients. The two groups were compared and analyzed with regarding to stability (Stress view Lachman test, pivot shift test), functional assessment (International Knee Documentation Committee, Lysholm score, Tegner score, single hoop test, shuttle turn, carioca test), and the result of second-look arthroscopy (study design: prosepective cohort study). RESULTS: In the final result, the remnant group showed significant improvement in the Tegner and carioca tests compared with the non-remnant group (p<0.05). In second-look arthroscopy, the remnant group showed better coverage of synovium (p<0.05). CONCLUSION: ACL reconstruction with an Achilles allograft using the remnant technique showed better results in functional assessment and finding in second-look arthroscopy compared with the non-remnant technique group.

Relation between Second-look Arthroscopic Findings and Clinical Results after Double Bundle Anterior Cruciate Ligament Reconstruction

PURPOSE: This study examined the relationship between the findings of a second-look arthroscopy and clinical results in double bundle anterior cruciate ligament (ACL) reconstruction using hamstring tendons fixed with a Ligament Plate(R). MATERIALS AND METHODS: Twenty eight cases of a double bundle ACL reconstruction using hamstring tendons were retrospectively reviewed. The follow-up period was more than 1 year and all cases were reviewed by second-look arthroscopy. The average follow-up period was 20.6 months (range: 12-34 months). In second-look arthroscopy, the anteromedial (AM) bundle and posterolateral (PL) bundle of the grafts were evaluated based on the tension, rupture and synovial coverage. Clinical evaluation was assessed using the Lysholm score, international knee documentation committee score, Hop test, Lachman test, pivot shift test, KT-2000 arthrometer and anterior drawer stress radiograph using Telos(R) in 30degrees knee flexion. The correlation between the arthroscopic findings of the grafts and the instability tests was evaluated. RESULTS: The AM graft was evaluated as being taut in 89.3% and lax in 10.7%, and the PL graft was assessed as being taut in 71.4% and lax in 28.6% according to the tension. The AM and PL grafts were evaluated as 'no rupture' in 78.6% and 'partial rupture' in 21.4%. There was no 'complete rupture' in any graft. The AM grafts were found to be good in 53.6%, fair in 35.7% and poor in 10.7%; the PL grafts were assessed as good in 50.0%, fair in 28.6% and poor in 21.4% according to the synovial coverage. The AM graft tension showed statistically significant results regarding both the Lachman test (rho=0.743, p<0.001) and degree of rupture (rho=0.438, p=0.020). The PL graft tension showed statistically significant results regarding both the pivot shift test (rho=0.548, p=0.003) and the degree of rupture (rho=0.663, p<0.001). CONCLUSION: Double bundle ACL reconstructions using hamstring tendons show good biological and clinical results. The graft tension and the degree of rupture show a statistically significant relationship to the stability of the reconstructed joint. On the other hand, the synovial coverage did not show a significant result.

Comparison of the Outcomes on Second-Look Arthroscopy after Anterior Cruciate Ligament Reconstruction Using a Hamstring Autograft or a Tibialis Anterior Allograft

PURPOSE: We wanted to evaluate the status and changes of the reconstructed anterior cruciate ligament (ACL) graft by performing second-look arthroscopy after arthroscopic reconstruction of the ACL with a hamstring autograft or a tibialis allograft. MATERIALS AND METHODS: From June 2003 to February 2007, second look arthroscopy was performed on 58 cases and a hamstring autograft was used in 36 cases and a tibialis allograft was used in 22 cases. Second-look arthroscopy was conducted at an average of 19.1 (12~42) months after reconstruction. We measured the graft tension using displacement by probing and the synovial coverage by visual analysis at the time of second-look arthroscopy. The Lysholm score, the Lachman test and a KT-2000 arthrometer were used to evaluate the status of the reconstructed ACL. RESULTS: The hamstring tendon autograft group showed normal tension in 25 cases, lax tension in 7 cases and partial tear in 4 cases. The tibialis anterior allograft group showed normal tension in 12 cases, lax tension in 5 cases and partial tear in 5 cases. In the hamstring tendon autograft group, the synovial coverage was good in 23 cases, there was half coverage in 8 cases and it was pale in 5 cases. In the tibialis anterior allograft group, the synovial coverage was good in 10 cases, there was half in 7 cases and it was pale in 5 cases. There were no significant differences between the two groups on the clinical examination, but on second look arthroscopy, the synovial coverage was better in the hamstring tendon autograft group than that for the tibialis anterior allograft group. CONCLUSION: The hamstring autograft group had superior synovial coverage compared to that of the other group on second look arthroscopy. But there were no significant difference of the clinical outcomes between the groups.

Second-Look Arthroscopy after ACL Reconstruction: Comparison of Patellar Tendon Autografts with Hamstring Tendon Autografts / 대한정형외과학회잡지

PURPOSE: To evaluate the healing status of reconstructed anterior cruciate ligament (ACL) and meniscal repair through second-look arthroscopy after arthroscopic reconstruction of the ACL. MATERIALS AND METHODS: We analyzed 81 cases by second-look arthroscopy among 397 cases that received ACL reconstruction during the period from June 1996 to December 2000. Second-look arthroscopy was conducted on average 18.8 months after reconstruction. 53 cases received a patellar tendon autograft, 28 cases received a hamstring tendon autograft and 29 cases received meniscal repair. We measured graft tension using displacement by probing, and synovial coverage by visual analysis at second-look arthroscopy. The improvements in Lysholm knee scores and KT-2000 arthrometer results were evaluated to compare patellar and hamstring tendons. RESULTS: The patellar tendon group showed normal tension in 41 cases and lax tension in 12 cases. The hamstring tendon group showed normal tension in 22 cases and lax tension in 6 cases. In the patellar tendon group, synovial coverage was good in 38 cases, half in 4 cases, and pale in 11 cases, whereas the hamstring tendon group was good in 25 cases, half in 2 cases, and pale in 1 case. Synovial coverage was better in the hamstring tendon group (p<0.05). Although there was no statistical significance, the hamstring tendon group was superior to the patellar tendon group in terms of graft tension, Lysholm knee scores and KT-2000 arthrometer results. CONCLUSION: The hamstring tendon group with ACL reconstruction was superior to the patellar tendon group, but long term follow-up will be necessary to further evaluate results.

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.