Quadrupled semitendinosus anterior cruciate ligament reconstruction: 5-year results in patients without meniscus loss.

PURPOSE: The purpose of this study was to determine the mid-term (minimum 5-year) results of isolated primary anterior cruciate ligament (ACL) reconstructions with intact or repaired menisci. TYPE OF STUDY: Case series. METHODS: Of 184 ACL reconstructions from April 1990 to February 1992, 33 initially met the inclusion criteria of primary reconstruction with quadrupled semitendinosus tendon and without extra-articular reconstruction or meniscus removal. Patients with known traumatic rerupture of the graft with revision (1 case) or subsequent meniscectomy (1 case) were excluded from the study. Twenty of the remaining 31 patients were available for follow-up at an average of 5.7 years after surgery. At follow-up, a comprehensive knee examination, KT-1000 arthrometry, radiography, functional testing, and isokinetic strength testing were performed. A subjective questionnaire, Tegner scale, and IKDC evaluation were administered as well. Four patients who were unable to come in for follow-up returned a knee-assessment questionnaire. RESULTS: Arthrometric anterior tibial translation was reduced from a preoperative average of 6.3 +/- 2.8 mm (manual maximum side-to-side difference) to an average of 0.0 +/- 1.3 mm (range, -2.5 to 2 mm). Radiographically, 1 patient experienced mild narrowing in the lateral compartment. Tegner activity level was maintained at the preinjury level in nearly half the patients. Isokinetic strength deficits were less than 10%; 17 (85%) of the patients had a normal or nearly normal result as graded by the IKDC scoring system. CONCLUSIONS: The above data show minimal morbidity, a low reoperation rate, and excellent clinical outcome. Because the stability of the knee persists beyond 5 years after ACL reconstruction, patients are able to maintain preinjury activity levels without reinjury.

Assessment of morbidity of semitendinosus and gracilis tendon harvest for ACL reconstruction.

This study evaluates the morbidity of harvest of both the semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction on nine patients at a minimum of 3 year follow-up. Specifically, the effect on knee function, knee extension and flexion strength, the size of the individual posterior thigh muscles, and the extent of retraction of the semitendinosus and gracilis tendons were evaluated. At final follow-up, each patient was evaluated using the following functional scales: International Knee Documentation Committee (IKDC), Hospital for Special Surgery (HSS), Lysholm, and Tegner. Each patient also had a dynamometer evaluation and a comprehensive magnetic resonance imaging study of both the operated and nonoperated knees. The average functional evaluation scores were: HSS-47.9, Lysholm-88, and Tegner-0.27. The average percent quadriceps and hamstring strength of the operated compared with the nonoperated extremities were 93.7% and 95.3%, respectively; neither decrease was significant. Magnetic resonance imaging evaluation of the cross-sectional areas of the biceps femoris, semimembranosus, and sartorius muscles of both thighs at the same level above the joint were not significantly different. The distal-most insertion of the semitendinosus and gracilis tendons after harvest were always more proximal than the nonoperated side; the average difference was 26.7 mm (range: 11 to 32 mm) for the semitendinosus (unable to calculate in three patients) and 47.1 mm (range: 17 to 72 mm) for the gracilis. We conclude that tendon harvest of the semitendinosus and gracilis muscles does not significantly compromise function and strength despite a more proximal insertion of the retracted tendons. In addition, the majority of cases demonstrated some but never complete regrowth or scar formation of these tendon remnants.

Cartilage synthesizes the serine protease inhibitor PAI-1: support for the involvement of serine proteases in cartilage remodeling.

The work described here demonstrates the synthesis by human articular cartilage of plasminogen activator inhibitor-1 (PAI-1), a potent inhibitor of the serine protease tissue plasminogen activator (tPA). We also present data demonstrating an increase in PAI-1 messenger ribonucleic acid (mRNA) in chondrocytes exposed to the cytokine interleukin-1 (IL-1). Interestingly, this elevation of steady-state mRNA levels does not appear to result in an increase in synthesis of PAI-1 protein. Northern blot analysis reveals that of the two mRNA species (3.4 kb, 2.4 kb) previously reported for PAI-1, only the larger species (3.4 kb) appears to be synthesized by chondrocytes. Our data demonstrate the IL-1-stimulated production by cartilage of tissue plasminogen activator. We also show evidence for the presence of plasminogen in cartilage. A scheme is presented indicating the probable importance of the serine proteases (tPA and plasminogen) and PAI-1 in cartilage degradation.