ACL reconstruction using a quadruple semitendinosus graft with cortical fixations gives suitable isokinetic and clinical outcomes after 2 years.

PURPOSE: The objective of this single-center randomized single-blinded trial was to assess the hypothesis that anterior cruciate ligament reconstruction (ACLR) using a four-strand semitendinosus (ST) graft with adjustable femoral and tibial cortical fixation produced good outcomes compared to an ST/gracilis (ST/G) graft with femoral pin transfixation and tibial bioscrew fixation. Follow-up was 2 years. METHODS: Patients older than 16 years who underwent primary isolated ACLR included for 1 year until August 2017 were eligible. The primary outcome measures were the subjective International Knee Documentation Committee (IKDC) score, isokinetic muscle strength recovery, and return to work within 2 years. The study was approved by the ethics committee. RESULTS: Of 66 eligible patients, 60 completed the study and were included, 33 in the 4ST group and 27 in the ST/G group. Mean age was 30.5 ± 8.9 years in the 4ST group and 30.3 ± 8.5 in the ST/G group (n.s.). No significant between-group differences were found for mean postoperative subjective IKDC (4ST group, 80.2 ± 12.5; ST/G group, 83.6 ± 13.6; n.s.), side-to-side percentage deficits in isokinetic hamstring strength (at 60°/s: ST group, 17% ± 16%; ST/G group, 14% ± 11%; n.s.) or quadriceps strength (at 60°/s: ST group, 14% ± 12%; ST/G group, 19% ± 17%; n.s.), return to work, pain during physical activities, side-to-side differential laxity, balance, loss of flexion/extension, or surgical complications. CONCLUSION: This trial demonstrates that functional outcomes after 4ST for ACLR with cortical fixations could be as good, although not better, than those obtained using ST/G. The 4ST technique spares the gracilis tendon, which thus preserves the medial sided muscle and thereby could improve function and limit donor-side morbidity. LEVEL OF EVIDENCE: Level I.

Acromial insufficiency in reverse shoulder arthroplasties.

HYPOTHESIS: Reverse shoulder prostheses depend on deltoid function. An injury to the acromion, either fracture or meso-acromion, or deltoid injury, may affect the outcomes of patients after receiving a reverse shoulder prosthesis. METHODS: Four-hundred and fifty-seven consecutive reverse shoulder prostheses were implanted between January 1992 and June 2003 by one of seven surgeons in five separate centers. Forty-one patients were noted to have a pre-operative lesion of the acromion or scapular spine. Twenty-three presented with an os acromiale (meso-acromion). Seventeen had fracture or fragmentation of the acromion. One patient had a pseudarthrosis of the scapular spine. RESULTS: Preoperative acromial pathology, surgical approach, and amount of inferior acromial tilt did not diminished postoperative range of motion, Constant score, or subjective results when compared to patients without acromial pathology. In contrast, the four patients with postoperative acromial spine fractures had inferior results with respect to functional and subjective results. CONCLUSION: Preoperative acromial lesions are not a contraindication to reverse shoulder arthroplasty. Postoperative fracture of the acromial spine has a significant effect on results and treatment is uncertain.