Transphyseal anterior cruciate ligament reconstruction in patients with open physes: 10-year follow-up study.

BACKGROUND: The treatment of anterior cruciate ligament (ACL) injuries in skeletally immature patients is controversial. Current evidence supports the view that surgical techniques restore knee stability and prevent progressive articular damage. However, most of the studies on this topic are small case series or they have short- or medium-term follow-up times. PURPOSE: To determine the long-term functional outcomes and secondary complications of transphyseal intra-articular ACL reconstruction with hamstring graft in skeletally immature patients. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Transphyseal ACL reconstruction with autograft hamstrings was performed in 27 skeletally immature patients. The average age at surgery was 13 years (range, 12-16 years), and the average follow-up time was 10.6 years (range, 10-13 years). Clinical outcomes were assessed with preoperative and final follow-up Tegner, International Knee Documentation Committee (IKDC) subjective, and Lysholm scores. Surgery details, return to sports, and ACL reconstruction failures were collected. The anteroposterior knee laxity was assessed by arthrometry, and the presence of deformities and lower limb length discrepancies were evaluated by radiographs. The presence of degenerative signs on anteroposterior and lateral knee radiographs at final follow-up was also evaluated. RESULTS: Transphyseal ACL reconstruction was performed with vertically oriented tunnels, 7 to 10 mm in diameter, using semitendinosus-gracilis autograft. The average preoperative Tegner, IKDC, and Lysholm scores were 7, 55, and 40, respectively. Significant differences in these scores were observed at the time of the final assessment (Tegner, 6 [P = .026]; IKDC, 94 [P < .001]; Lysholm, 92 [P < .001]). Two patients reported instability during sports activity. Three patients had a rupture of the ACL graft. No leg length discrepancy, axis malalignment, or degenerative changes were observed. CONCLUSION: The transphyseal ACL reconstruction in skeletally immature patients is a safe option, with high functional and satisfaction results, without significant growth plate damage in this series of patients.

Anterior cruciate ligament reconstruction in patients over 50 years of age.

PURPOSE: To describe the clinical outcomes of patients over 50 years of age with following anterior cruciate ligament (ACL)reconstruction for acute rupture. METHODS: A prospective series of patients over the age of 50 years with a diagnosis of ACL rupture who underwent ACL reconstruction was examined. Lysholm and International Knee Documenting Committee (IKDC) subjective scores were assessed preoperatively and at the final follow-up. All associated injuries were documented, and complications were reported. The patients' satisfaction and return to sports were documented. The statistical analyses were preformed with Student's t-tests for independent samples. RESULTS: Fifty patients with a mean age of 52.12 years (50-64) and a mean follow-up period of 53.17 months (36-68) exhibited a mean postoperative Lysholm score of 93.7 (60-100) and IKDC score of 90.96 (57.5-100). Associated injuries occurred in 90% (45) of the patients and included the following: 76% (38) meniscal tears and 36% (18) osteochondral lesions. Complications occurred in 6% (3) of the patients and included the following: 4% (2) ACL re-ruptures and 2% (1) infections. Among all patients, 88% (44) returned to pre-injury sports levels, and 96% (48) were satisfied. CONCLUSIONS: For patients above the age of 50 years, ACL reconstruction appears to be a safe procedure with good to excellent results that are comparable to those for younger patients, and the possibility for returning to pre-injury sports levels for these patients is high.

Experiencia y manejo en artritis séptica (AS) en cirugía de reconstrucción de ligamento cruzado anterior (LCA) / Septic arthritis after anterior cruciate ligament reconstruction

Objetivo: Identificar la incidencia, factores de riesgo asociados y resultados funcionales en un grupo de pacientes que presentaron una artritis séptica luego de la reconstrucción primaria de ligamento cruzado anterior. Materiales y Métodos: Estudio retrospectivo de una serie de pacientes sometidos a reconstrucción primaria del ligamento cruzado anterior, entre enero del 2000 y mayo del 2011. Se revisaron las fichas clínicas y protocolos operatorios analizando incidencia, presentación, gérmenes involucrados, factores de riesgo, tratamiento y resultados funcionales. Resultados: Analizamos 1.796 casos de reconstrucciones primarias del ligamento cruzado anterior, edad promedio de 26.5 años, identificando 9 casos de infecciones articulares y con una incidencia global de 0,5 %. Siete se presentaron en pacientes con autoinjerto de isquiotibiales, 2 en aloinjerto y ninguna en autoinjerto HTH. Entre los factores de riesgo intraoperatorios evaluados no se encontró correlación significativa. En todos los pacientes se realizó aseo quirúrgico artroscópico, preservando el injerto en el 67% de los casos. El score de Lysholm promedio fue 95 puntos. Conclusiones: La artritis séptica luego de la reconstrucción de ligamento cruzado anterior es una complicación de baja frecuencia. El manejo precoz es fundamental para obtener buenos resultados funcionales, no siendo necesaria la remoción del injerto en la mayoría de los casos. Nivel de Evidencia: IV

Objective: To identify the incidence, associated risk factors and functional outcomes of a group of patients who presented septic arthritis after anterior cruciate ligament reconstruction. Materials and Methods: Retrospective study of a series of patients who underwent anterior cruciate ligament reconstruction between January 2000 and May 2011. Medical and operative charts were reviewed to analyze incidence, presentation, involved microorganisms, intraoperative risk factors, treatment and functional results. Results: We analyzed 1.796 cases of primary ACL reconstructions, mean age 26.5 years, identifying 9 cases of joint infections with an overall incidence rate of 0.5 %. Seven occurred in patients with hamstring autograft, 2 in allograft and none in HTH autograft. Among the intraoperative risk factors evaluated, no significant correlation was found. All patients underwent arthroscopic drainage preserving the graft in 67% of the cases. The average Lysholm score was 95 points. Conclusion: Septic arthritis after anterior cruciate ligament reconstruction is a rare complication. Early management is essential to obtain good functional results, not requiring graft removal in most of the cases. Level of Evidence: IV

Experiencia y manejo en artritis séptica (AS) en cirugía de reconstrucción de ligamento cruzado anterior (LCA) / Septic arthritis after anterior cruciate ligament reconstruction

Objetivo: Identificar la incidencia, factores de riesgo asociados y resultados funcionales en un grupo de pacientes que presentaron una artritis séptica luego de la reconstrucción primaria de ligamento cruzado anterior. Materiales y Métodos: Estudio retrospectivo de una serie de pacientes sometidos a reconstrucción primaria del ligamento cruzado anterior, entre enero del 2000 y mayo del 2011. Se revisaron las fichas clínicas y protocolos operatorios analizando incidencia, presentación, gérmenes involucrados, factores de riesgo, tratamiento y resultados funcionales. Resultados: Analizamos 1.796 casos de reconstrucciones primarias del ligamento cruzado anterior, edad promedio de 26.5 años, identificando 9 casos de infecciones articulares y con una incidencia global de 0,5 %. Siete se presentaron en pacientes con autoinjerto de isquiotibiales, 2 en aloinjerto y ninguna en autoinjerto HTH. Entre los factores de riesgo intraoperatorios evaluados no se encontró correlación significativa. En todos los pacientes se realizó aseo quirúrgico artroscópico, preservando el injerto en el 67% de los casos. El score de Lysholm promedio fue 95 puntos. Conclusiones: La artritis séptica luego de la reconstrucción de ligamento cruzado anterior es una complicación de baja frecuencia. El manejo precoz es fundamental para obtener buenos resultados funcionales, no siendo necesaria la remoción del injerto en la mayoría de los casos. Nivel de Evidencia: IV (AU)

Objective: To identify the incidence, associated risk factors and functional outcomes of a group of patients who presented septic arthritis after anterior cruciate ligament reconstruction. Materials and Methods: Retrospective study of a series of patients who underwent anterior cruciate ligament reconstruction between January 2000 and May 2011. Medical and operative charts were reviewed to analyze incidence, presentation, involved microorganisms, intraoperative risk factors, treatment and functional results. Results: We analyzed 1.796 cases of primary ACL reconstructions, mean age 26.5 years, identifying 9 cases of joint infections with an overall incidence rate of 0.5 %. Seven occurred in patients with hamstring autograft, 2 in allograft and none in HTH autograft. Among the intraoperative risk factors evaluated, no significant correlation was found. All patients underwent arthroscopic drainage preserving the graft in 67% of the cases. The average Lysholm score was 95 points. Conclusion: Septic arthritis after anterior cruciate ligament reconstruction is a rare complication. Early management is essential to obtain good functional results, not requiring graft removal in most of the cases. Level of Evidence: IV (AU)

Septic arthritis in ACL reconstruction surgery with hamstring autografts. Eleven years of experience.

BACKGROUND: Knee joint infection after ACL reconstruction is a rare complication with a low reported incidence, but the consequences can be devastating. The purpose of the study was to determine the incidence of septic arthritis after primary ACL reconstruction with hamstring auto-graft and the risk factors that may be associated. METHOD: A retrospective study of all primary ACL reconstruction from January 2000 to May 2011. Electronic medical records were reviewed to determine the number of infections, operating time, associated procedure, time of presentation after surgery, infection treatment, microbiological cultures and graft retention. At the end of the follow-up (18-108months) a functional assessment of all the infected patients was performed using the Lysholm score with the Lysholm score. RESULTS: We analyzed 1564 cases of primary ACL reconstruction with hamstring autograft, of which seven cases were diagnosed with postoperative joint infection (incidence rate of 0.45%). The infectious agent most frequently isolated was a coagulase-negative Staphylococcus. Neither intraoperative factors nor age correlated with the development of the infection. The average Lysholm score was 95 points (range 89-100 points). All but two patients retained their reconstructed ACL. The results of the five patients in which the graft was preserved were significantly better than the two patients that had their grafts removed (p=0.03). CONCLUSION: We conclude that septic arthritis post ACL reconstruction has a low incidence rate, which if handled at an early stage allows the patients a satisfactory return to their previous activities. Graft retention is important to obtain better functional results. LEVEL OF EVIDENCE: IV.

Osteochondral autografts in full thickness patella cartilage lesions.

The purpose of this study was to evaluate clinical, functional and imaging results of full thickness patella cartilage lesions treated with osteochondral autografts (OCA). We studied a consecutive case series of 10 patients. At follow-up, Lysholm and International Knee Documentation Committee (IKDC) scores were obtained. Magnetic resonance imaging (MRI) evaluation was performed at an average of 8 months post-op. The average cartilage lesion area was 1.2 cm(2). An average of 1.9 grafts was used per patient. The average Lysholm scores were: pre-op 73.8±8.36; post-op 95±4.47 points (p<0.05). The average IKDC post-op score was 95±1.74 points. No postoperative complications were registered. In the MRI analysis we found that in all cases, OCA presented flush characteristics when compared with adjacent cartilage. The majority of cases presented no fissures in the graft-receptor interface (60%). In 80% we observed mild bone marrow edema around the graft. According to the International Cartilage Research Society (ICRS) cartilage lesions classification, all grafts were considered 1A; in the periphery cartilage was classified as 1A in 60%. We conclude that patellar OCA is a good alternative for the treatment of full thickness patellar cartilage lesions, offering good clinical, functional and imaging results at midterm follow-up.