Revision Anterior Cruciate Ligament Reconstruction: Results of a Single-stage Approach Using Allograft Dowel Bone Grafting for Femoral Defects.

INTRODUCTION: The purpose of this study was to present results of single-stage revision anterior cruciate ligament (ACL) reconstruction using an allograft bone dowel for isolated femoral bony deficiency. METHODS: Sixteen patients underwent single-stage revision ACL reconstruction using an allograft bone dowel for isolated femoral bony deficiency between 2007 and 2012. Twelve patients (75%) completed study visits, which included CT scans as well as completion of validated outcomes measures. RESULTS: The average KT-1000 side-to-side difference was 1.0 mm ± 2.9 mm. The average International Knee Documentation Committee score was 70.2 ± 17.8, the Tegner score was 4.8 ± 2.8, and the visual analog scale pain score was 2.8 ± 2.4. An analysis of CT scans showed that all 12 dowels had excellent (>75%) incorporation. CONCLUSIONS: A single-stage approach for revision ACL reconstruction using allograft dowels for isolated femoral bony deficiency yields objective and subjective outcomes comparable to those reported in the literature for two-stage and other single-stage techniques, with good incorporation of the dowels. LEVEL OF EVIDENCE: Retrospective case series, level IV.

Preliminary results of a novel single-stage cartilage restoration technique: particulated juvenile articular cartilage allograft for chondral defects of the patella.

PURPOSE: To evaluate outcomes and magnetic resonance imaging (MRI) findings after use of particulated juvenile cartilage for the treatment of focal Outerbridge grade 4 articular cartilage defects of the patella. METHODS: From 2007 to 2011, 16 patients (2 bilateral) underwent a novel single-stage articular cartilage restoration procedure using particulated juvenile articular cartilage allograft. We enrolled 15 knees (13 patients) in this study. The mean age at surgery was 26.4 ± 9.1 years, and the mean postoperative follow-up was 28.8 ± 10.2 months. A musculoskeletal radiologist evaluated each knee with postoperative MRI for the International Cartilage Repair Society cartilage repair assessment score, graft hypertrophy, bony changes around the graft, and percent fill of the defect. All patients also completed the Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Evaluation, and Kujala clinical outcome survey (scale, 0 to 100), as well as the Tegner activity scale and visual analog pain scale (scale, 0 to 10). RESULTS: The mean International Cartilage Repair Society cartilage repair assessment score on MRI was 8.0 ± 2.8, a nearly normal assessment. Of 15 knees, 11 (73%) were found to have normal or nearly normal cartilage repair. Three patients had mild graft hypertrophy whereas 2 had gross graft hypertrophy, 2 of whom required arthroscopic debridement because of symptoms. The mean fill of the defect at follow-up was 89% ± 19.6%, with 12 of 15 knees (80%) showing at least 90% defect coverage. The mean clinical outcome score at follow-up was 73.3 ± 17.6 for the International Knee Documentation Committee evaluation, and the mean scores for each subdomain of the Knee Injury and Osteoarthritis Outcome Score were as follows: 84.2 ± 14.2 for pain, 85.0 ± 12.3 for symptoms and stiffness, 88.9 ± 12.9 for activities of daily living, 62.0 ± 25.1 for sports and recreation, and 60.8 ± 28.6 for quality of life. The median score for the Kujala survey was 79 (range, 55 to 99). The median score on the Tegner activity scale was 5 (range, 3 to 9), and the mean score on the visual analog scale was 1.9 ± 1.4, indicating minimal pain. CONCLUSIONS: Preliminary results suggest that cartilage restoration using particulated juvenile articular cartilage allograft offers a viable option for patients with focal grade 4 articular cartilage defects of the patella.

Femoral tunnel length in primary anterior cruciate ligament reconstruction using an accessory medial portal.

PURPOSE: The purpose of this study was to evaluate tunnel length during independent femoral tunnel drilling using an accessory medial portal with the knee in maximal hyperflexion, and correlate the tunnel length and flexion angle with anthropometric data. METHODS: During a 1-year period, 106 consecutive patients undergoing primary anterior cruciate ligament (ACL) reconstruction were included in the study. All patients underwent independent femoral tunnel drilling using an accessory medial portal with maximal knee hyperflexion. Tunnel length and maximal intraoperative knee flexion angles were measured. Additionally, height, weight, and body mass index (BMI), plus the width and depth of the lateral femoral condyle (LFC), were recorded to correlate with tunnel length and knee flexion angles. RESULTS: Average tunnel length was 37.0 ± 3.3 mm (range, 26 to 45), with all but one tunnel greater than 30 mm. Average knee flexion angle was 134.4 ± 5.0° (range, 122° to 147°). Height (r = 0.5, P < .001) and weight (r = 0.33, P = .001), but not BMI (r = 0.14, P = .17), correlated positively with tunnel length. Width (r = 0.46, P < .001) and depth (r = 0.38, P < .001) of the LFC also correlated positively with tunnel length. Knee flexion angle was not correlated with tunnel length (r = -0.09, P = .39) or width (r = -0.04, P = .7) and depth (r = -0.01, P = .91) of the LFC. Knee flexion angle was negatively correlated with weight (r = -0.44, P < .001) and BMI (r = -0.46, P < .001). CONCLUSIONS: Using an accessory medial portal for independent femoral tunnel drilling, with maximal knee hyperflexion, in ACL reconstruction consistently produced tunnel lengths greater than 30 mm with no posterior wall fractures. Tunnel lengths tend to be longer with increasing patient height, mass, and larger LFC dimensions. Maximum knee flexion angle achieved intraoperatively tends to be less for patients with increasing weight and BMI. LEVEL OF EVIDENCE: Level IV, therapeutic case series.