Falla de injerto sintético en reconstrucción de ligamento cruzado anterior. Revisión en dos tiempos. Reporte de caso y detalles de técnica / Synthetic graft failure for ACL reconstruction. Revision surgery in two stages

Los injertos sintéticos representan una alternativa a los injertos biológicos para reconstrucción del ligamento cruzado anterior. Ciertas ventajas teóricas apoyan dicha técnica, la principal función del injerto sintético sigue siendo estructural. Las publicaciones respecto a esta alternativa quirúrgica brindan información controversial, y en la literatura no se observa evidencia suficiente aún que avale este sistema como alternativa en reconstrucción de LCA a largo plazo. En la literatura se describen múltiples complicaciones asociadas al injerto sintético. Se presenta un reporte de caso de falla de injerto sintético de LCA, el cual se resolvió con una planificación en dos tiempos quirúrgicos. Se detallan los hallazgos intraoperatorios y los detalles de técnica para dicha revisión quirúrgica.

Synthetic grafts represent an alternative to biological grafts for anterior cruciate ligament reconstruction. Certain theoretical advantages support this technique; the main function of the synthetic graft remains structural. Publications provide controversial information regarding this surgical alternative, and there is not enough data to support this system as an alternative to long-term outcomes ACL reconstruction. Multiple complications associated with synthetic graft are described in the literature. We present a case report of synthetic ACL graft failure, resolved in two stages ACL revision surgery. We describe intraoperative findings and technical details.

Correlation of Second-look Arthroscopy and MR Findings of Anterior Cruciate Ligament Graft

PURPOSE: To evaluate the postoperative MR findings of the healthy anterior cruciate ligament (ACL) grafts which were confirmed by the second-look arthroscopic examination. MATERIALS AND METHODS: Among 419 cases who underwent the arthroscopic ACL reconstruction by one operator between June 1996 and January 2001, we evaluated 33 MR scans of 29 patients who underwent the postoperative MR scan and the second-look arthroscopic examination (4 patients underwent postoperative MRI twice). There were 18 male and 11 female patients, and the patient 's age ranges from 16 to 59 years-old (mean 29.7). There were 15 cases of autogeneous bone-patellar tendon-bone (BPTB) grafts, 13 cases of autogeneous double-loop hamstring grafts, and 1 case of allogeneous BPTB graft. Thirty-three MRIs were divided into 3 groups according to the time interval between operation and postoperative MR examination: less than 6 months, 7 to 12 months, and more than 13 months. The MR findings of ACL grafts - signal intensity, morphology, continuity, orientation, diameter - were analyzed. RESULTS: The increased signal intensity was found in 29 ACL grafts (87.7%) among 33 MR images. The most common pattern of the graft morphology was a longitudinal streak increased signal band (27 cases, 81.8%). The partial rupture was seen in 9 cases (27.3%), and the lax orientation in 4 cases (12.1%). According to Howell 's scoring system, the signal intensity score of the graft tended to decrease with time after operation, and the sagittal diameter of the graft tended to increase with time after operation. CONCLUSION: The main MR finding of the healthy ACL graft was longitudinal streak increased signal band. The graft signal intensity seemed to decrease, and the sagittal diameter of the graft seemed to increase, as time passes after operation.