Treatment of Massive Defect in Achilles Tendon with Tendon Allograft: A Case Report / 대한족부족관절학회지

Deep infection of Achilles tendon is one of the serious complications that occur after open repair of the tendon. It sometimes leads to a very large tendon defect during the course of treatment. We report on a case of massive defect in Achilles tendon, which was successfully treated with Achilles tendon allograft and flexor hallucis longus tendon transfer.

Anatomical reconstruction of old injury of knee medial collateral ligament by tendon allograft / 重庆医学

Objective To observe the effectiveness of tendon allograft in the treatment of old knee medial collateral ligament in‐jury .Methods Thirty‐two cases of old knee medial collateral ligament injury were treated .Tendon allograft was used to reconstruct old injury of knee medial collateral ligament and was fixed in bone with absorbable screws in operation .Results All incisions were healed by first intention .No infection ,deep vein thrombosis ,or other postoperative complications occurred .Thirty two cases were followed up fro 12 to 58 months with an average of 30 months .At 3 months after operation ,the knee X ray films of valgus stress position showed the medial joint space differences between both knees were less than 1 mm .According to the Lysholm Scale score average (92 .3 ± 4 .2) ,the results were excellent in 20 cases ,good in 11 cases ,and fair in 1 case with excellent rate of 97% at last follow up ,the knee scores were (42 .5 ± 5 .3) before operation and (92 .3 ± 4 .2) after operation ,showed significant difference(P<0 .05) .Conclusion Anatomical reconstruction of old injury of knee medial collateral ligament with tendon allograft is all‐sided and the fixation method was solid .The operation is easy to operate and achieves better effectiveness .

One-stage reconstruction of dorsal hand soft-tissue defects with tendon allograft and free anterolateral thigh flaps / 中华显微外科杂志

Objectives To evaluate the clinical effect of one-stage reconstruction of dorsal hand softtissue defects using tendon allograft and free anterolateral thigh flaps.Methods From July 2006 to July 2011,fifteen cases of complex soft-tissue defects in dorsal hands were repaired using tendon allografts and anterolateral thigh flaps,sizing from 9 cm ×5 cm to 14 cm× 11 cm,in one stage.Two to 4 digital extensor tendons were reconstructed.With a brace on,early finger exercises were started after 2 weeks postoperatively when the flaps had survived.Results All the 15 flaps survived uneventfully.Twelve of the 15 patients were available for follow-up from 12-24 months (averaged 16 months).Two cases received tendolysis due to poor finger movement 6 moths postoperatively.At the end of follow-up,the range of wrist joint active flexion is from 40 to 70degrees and extension is from 25 to 50 degrees.The motion range of the related metacarpophalangeal joints was from 60 to 85 degrees,that of the interphalangeal joints from 80 to 90 degrees.The overall effective rate was 92 percent.Conclusion Simultaneous composite repair using tendon allografts and skin flaps proved to be reliable and cost-effective for complex dorsal hand soft-tissue defects.Allograft tendon reconstruction can not only obliterates new morbidities of autografting but also facilitates timely rehabilitation,avoiding extension loss of hand joints.

Relationship between the Synovialization and the Clinical Results after Anterior Cruciate Ligament Reconstruction Using Tibialis Tendon Allograft / 대한스포츠의학회지

The purpose of this study was to evaluate the relationship between the second-look arthroscopic findings of synovialization and the clinical results after the arthroscopic anterior cruciate ligament (ACL) reconstruction with the fresh-frozen tibialis tendon allograft. Fifty-seven patients could be examined with the second-look arthroscopy after the ACL reconstruction with tibialis tendon allograft. The average duration from reconstruction to second-look arthroscopy was 18.4 months (range, 4-48 months). The patients were classified, according to the extent of synovialization, into 3 groups; 37 cases (64.9%) in group A (good), 15 cases (26.3%) in group B (partial), and 5 cases (8.8%) in group C (poor). The clinical results were compared in each group. The 2000 International Knee Documentation Committee (IKDC) subjective knee score was 80 or more in 31 cases (83.8%) in group A, 9 (60%) in group B, and 1 (20%) in group C respectively. All thirty seven cases (100%) in group A had negative or 1+firm end-point Lachman test and negative pivot shift test, however, only 2 cases (40%) in group C. KT-1000 arthrometer measurement was less than 5 mm in 37 (100%) in group A, 14 (93.3%) in group B, and 2 (40%) in group C. According to the 2000 IKDC knee examination form, 37 (100%) in group A, 14 (93.3%) in group B, and 2 (40%) in group C respectively were normal or nearly normal. The synovialization of the graft had positive correlation with the clinical results after the ACL reconstruction with fresh-frozen allograft.

Preserving Remnant Tissue in Arthroscopic ACL Reconstruction Using Achilles Tendon Allograft

PURPOSE: The purpose of this study was to determine the clinical usefulness of remnant preservation in anterior cruciate ligament (ACL) reconstruction using Achilles tendon graft. MATERIALS AND METHODS: Between April 2004 and June 2007, 26 patients who were followed up for at least 12 months after ACL reconstruction with Achilles tendon were included in this study. They were divided into two groups according to whether the remnant was preserved. The post-reconstruction state was evaluated using pivot-shift test, Telos anterior stress test, International Knee Documentation Committee (IKDC) scale, Lysolm score and single limb standing test. RESULTS: No statistically significant differences in mechanical stability and mean values of IKDC scale and Lysholm test between the two groups were present. In single limb standing test, the remnant-preserving group showed 1.1+/-0.8 cm and the remnant sacrificing group showed 1.8+/-1.2 cm (p=0.04). However, there were no significant differences between the injured knee and the intact knee in the group which the remnant was preserved. CONCLUSION: ACL reconstruction using allo Achilles graft showed satisfactory results in terms of stability and function. Preserving the tibial remnant seems to be helpful to restore knee joint proprioception.

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.

Anterior Cruciate Ligament Reconsruction using Tibialis Tendon Allograft: Comparison of the Results according to the Femoral Fixation Methods / 대한정형외과학회잡지

PURPOSE: To compare the clinical stability and function of two femoral fixation methods after arthroscopic anterior cruciate ligament (ACL) reconstruction using fresh-frozen tibialis tendon allograft. MATERIALS AND METHODS: For femoral fixation, endopearl and bioabsorbable interference screw were used in 31 patients (group I) and RIGIDfix(R), in 36 patients (group II). The mean follow-up period was 30 months. The evaluations included Lysholm knee score, 2000 International Knee Documentation Committee (IKDC) subjective knee score, Lachman test, pivot shift test, KT-1000 arthrometer measurement and 2000 IKDC knee examination. RESULTS: Twenty-eight patients (90.3%) in group I and 33 (91.7%) in group II were good or excellent according to the Lysholm score. Twenty-seven patients (87.1%) in group I and 33 (91.7%) in group II had IKDC subjective knee score >70. Thirty patients (96.8%) in group I and 35 (97.2)% in group II had 1+firm end or negative Lachman test. Twenty-seven patients (87.1%) in group I and 35 (97.2%) in group II had a negative pivot shift. Thirty patients (96.8%) in group I and 36 (100%) in group II had <5 mm of difference according to the KT-1000 arthrometer. Twenty-nine patients (93.5%) in group I and 34 (94.4%) in group II were normal or nearly normal according to the 2000 IKDC knee examination. CONCLUSION: ACL reconstruction with fresh-frozen tibialis tendon allograft produced a reliable and predictable outcome after the short-term follow-up. The two methods used for femoral fixation produced similar outcomes.

Combined Reconstruction of Posterior Cruciate Ligament and Posterolateral Rotatory Instability with Fresh-frozen Achilles Tendon Allograft

PURPOSE: We analyzed the clinical and radiologic results after arthroscopic reconstruction of the posterior cruciate ligament and posterolateral rotatory instability using fresh frozen Achilles tendon allograft. MATERIALS AND METHODS: Nine patients (10 cases) were evaluated. Male was 8 and female 1. Mean age was 38.4 years (23~59) and interval after trauma was 12.4 months (3~25 mo). Mean follow-up period was 14 months (12~21 mo). Posterior cruciate ligament was reconstructed with arthroscopic transtibial, single bundle technique and posterolateral rotatory instability with figure of "8" method using fibular tunnel. Clinical evaluation was done using posterior drawer test, posterolateral drawer test, varus stress test, prone external rotation (dial) test and range of motion. Functional evaluation was done by Lysholm knee score and Tegner activity scale. RESULTS: 90% of cases showed improvement to grade I by posterior drawer and to normal by posterolateral drawer, varus stress and dial test. One case showed flexion limitation more than 10degrees compared to opposite knee. Lysholm knee score and Tegner activity scale have been improved from mean 48.5 and 2.1 preoperatively to mean 80.2 and 4.5 postoperatively (p<0.05). Posterior drawer stress radiographs showed the improvement from mean 17 mm to 4.2 mm(p<0.05). CONCLUSION: Successful results were obtained by combined reconstruction of the posterior cruciate ligament and posterolateral rotatory instability with fresh frozen Achilles allograft.

Short Term Clinical Results of Anatomical Reconstruction in the Posterolateral Corner of the Knee using Achilles Tendon Allograft / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the short term clinical results of the new anatomical reconstruction including 3 major posterolateral structures of the knee using a split Achilles allograft. MATERIALS AND METHODS: Eleven knees with posterolateral rotary instability underwent new anatomical posterolateral reconstruction between January 2002 and June 2003. The clinical results were assessed using the Lysholm score and Tegner activity level scales and physical examinations including posterolateral drawer test, dial tests at 30 and 90 degrees of knee flexion, varus stress tests at 0 and 30 degrees of knee flexion. RESULTS: Follow-up averaged 26 months (range, 12 to 29 months). The mean preoperative Lysholm score was 38.6 and at the time of latest follow-up, the mean score was improved to 72.5. The mean preoperative Tegner activity level was improved from 1.6 points to 3.3. Ten out of 11 patients showed negative conversion of the posterolateral drawer test and varus stress test at 30 degrees of flexion postoperatively. All patients, who showed positive signs on the external rotation-dial test at 30 degrees of knee flexion preoperatively, improved postoperatively. In eight patients, preoperative positive signs of varus stress tests at 0 degrees of knee flexion and the external rotation-dial test at 90 degrees of knee flexion disappeared postoperatively. CONCLUSION: This study suggests that the new anatomical reconstruction of posterolateral corner of knee is a reliable method providing excellent stability and satisfactory short term clinical 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.