The functional outcome of arthroscopic anterior cruciate ligament reconstruction in patients using different graft tension during tibial fixation

Background@# Anterior Cruciate Ligament (ACL) reconstruction is commonly performed to restore knee kinematics and halt the progression of osteoarthritis. A primary variable that could infl uence the outcome of ACL reconstruction is the tension applied to the graft at the time of fi xation. If the tension is too great, an abnormal compressive force could potentially develop across the tibiofemoral joint, hindering knee motion, and subjecting the articular surfaces to increased stress. If the tension in the graft is too low, the graft will not be effective in restoring normal kinematics. The Tegner Lysholm Knee Scale is a functional scoring for patients with ligamentous injuries. It is a patient-reported measure of knee function and is important for comprehensive assessment conditions in both the clinical and research context. Our objective was to compare which tension technique (15 lbs graft tension using a Mitek Tensioner™ vs maximal sustained two-hand technique) would yield better functional outcome at 6 months and 12 months postoperatively using the Tegner Lysholm Knee Scale. @*Methods @#Twenty-nine patients who underwent arthroscopic ACL reconstruction at the University of Santo Tomas Hospital Private Division were randomly divided equally into two groups (group A or group B). During tibial fi xation, group A would receive 15 lbs graft tension using a Mitek Tensioner and group B would receive graft tension using the maximal sustained two-handed pull technique. The patients underwent a standard rehabilitation protocol at an institution of their choice and a Lysholm Scoring Scale and Tegner activity scale were self-administered at 6 months and 12 months after the surgery in order to assess their functional outcome.@*Results @#The results showed that the functional outcome scores of group A were higher than group B. The yielded p-value was 0.10 (6 months), 0.07 (12 months) for group A and 0.27 (6 months), 0.46 (12 months) for group B. The results showed no suffi cient evidence of a signifi cant difference between the effects of arthroscopic ACL reconstruction with 15 lbs weight using a Mitek Tensioner (group A) and graft tension using the maximal sustained two-handed pull technique (group B) in the knee functional outcome of patients at 6 months and 12 months postoperatively@*Conclusion@#The functional outcome scores of patients who underwent ACL reconstruction using different graft tension did not show signifi cant results. Further re-evaluation of patients’ functional outcome score is necessary after 12 months postoperatively. The desired tensioning technique of the ACL surgeon would be at his/her convenience knowing beforehand the pros and cons of each technique.

Optimal Parameters for Sutures Tied to a Post during Anterior Cruciate Ligament Reconstruction: Thread Numbers, Knot Numbers, Suture Techniques and Stitch Numbers: An Experimental Laboratory Study Using Porcine Tendon / 대한스포츠의학회지

We evaluated the conditions required for sutures tied to a post for tibial fixation during anterior cruciate ligament (ACL) reconstruction. Harvested porcine tendon was used as a graft material and nonabsorbable suture was used for sutures. Samples were tested for ultimate tensile load and elongation according to thread numbers, knot numbers, suture techniques and stitch numbers. As thread numbers were increased, ultimate tensile load was increased and elongation was decreased. However, more than 4 strands of threads provided the sufficient ultimate tensile load more than 454 N of normal ACL for daily activities. As knot numbers were increased, ultimate tensile load was increased, but elongation was decreased. In terms of failure mode, unraveling occurred 100% in 3 and 4 knots, 81.2% in 5 knots, 54.5% in 6 knots, and 0% in 7 knots. Suture techniques and stitch numbers didn't significantly affect the ultimate tensile load and the elongation. For sutures tied to a post for tibial fixation in ACL reconstruction, more than 4 threads, more than 7 knots, and more than 4 stitches provide adequate ultimate tensile load and elongation.

Comparison of Results Between Internal Fixation of Both Bones and Internal Fixation of the Only Tibia for Distal Tibial and Fibular Fractures / 대한정형외과학회잡지

PURPOSE: This study undertaken to evaluate the clinical results between the fixation of both bones and the fixation of the only tibia for extra-articular distal tibial and fibular fracture, and to know if the fixation of both bones could be needed. MATERIALS AND METHODS: In a retrospective study from 1994 to 1999, thirty-seven patients who underwent internal fixation with plate and screws for both bones (Group I : 17 cases) and only tibia (Group II : 20 cases) for extra-articular distal 1/3 tibial and distal 1/4 fibular fractures, which were above distal tibio-fibular syndesmosis, were evaluated the period of union, range of motion and operative time. RESULTS: The union period of tibia was 124 days (Group I) and 126 days (Group II) and the cases of full ROM were 16 / 17 cases (94.1%) in Group I and 18 / 20 cases (90.0%) in Group II. The mean score was 94.6 points in Group I and 91.3 points in Group II by Baird scoring system (P>0.05), and the operative time was 147 minutes (Group I) and 106 minutes (Group II) (P<0.05). CONCLUSION: The clinical results in extra-articular distal tibial and fibular fractures, which were distal 1/4 and above distal tibio-fibular syndemosis, treated with internal fixation of the only tibia were as good as internal fixation of both bones. We thought that there is no need to fix distal fibular fracture in these cases.