Does anterolateral ligament internal bracing improve the outcomes of anterior cruciate ligament reconstruction in patients with generalized joint hypermobility?

BACKGROUND: Generalized joint hypermobility (GJH) is a risk factor for anterior cruciate ligament (ACL) injury and ACL graft failure and is considered an indication for anterolateral ligament (ALL) reconstruction. The aim of this retrospective study was to compare functional outcomes, rupture rates, and residual instability in patients with GJH undergoing isolated ACL reconstruction or combined ACL reconstruction and ALL augmentation with internal bracing (ALL-IB). METHODS: Sixty-eight patients with GJH and unilateral ACL injury were randomly assigned to undergo either isolated ACL reconstruction (Group 1) or combined ACL reconstruction and ALL-IB (Group 2). The patients were evaluated pre- and postoperatively; their medical histories; physical examination results; anterior knee translation, as measured using the KT-1000 arthrometer; and scores of validated knee assessments were recorded. RESULTS: Groups 1 and 2 consisted of 37 and 31 patients, respectively. The mean follow-up was 30.1±4.1 and 28.1±2.9 months, respectively. In the final evaluation, the patients in Group 2 showed better rotational stability, as evaluated by the pivot-shift test (p=0.013); better anteroposterior stability, as evaluated by KT-1000 arthrometry (p=0.001); similar function (p=0.14 for the Lysholm, p=0.11 for the Cincinnati, and p=0.19 for the International Knee Documentation Committee subjective score); and failure rate (p=0.41). CONCLUSION: The functional outcomes were similar between the groups. The stability outcomes after combined ACL and ALL-IB were better than those after isolated ACL reconstruction in patients with GJH. However, the technique and its results need to be validated in larger patient series and prospective randomized controlled trials.

Osteochondral autologous graft transfer system in the knee; mid-term results.

INTRODUCTION: The purpose of this study was to determine the effectiveness of the osteochondral autologous graft transfer system in the treatment of chondral and osteochondral lesions of the knee. METHODS: Sixty five knees of sixty four patients who underwent autologous osteochondral graft transfer were evaluated with clinical scores and imaging techniques. RESULTS: The average follow up was 82.2 (51-145) months. The patients were evaluated according to Tegner activity scale, Lysholm scale and IKDC subjective knee evaluation form. According to all these scales, all patients showed increasing results in various rates in the last follow up. Accordingly, mean increases of 59.2±15.9 points, 3.6±1.4 points, and 42.6±11.5 points were achieved in Lysholm knee scores, Tegner activity scale scores, and IKDC subjective knee evaluation form, respectively (p≤.0001). Moreover, we found no significant correlation between functional results and age, functional results and localization of osteochondral defect, functional results and additional knee pathologies. CONCLUSION: In our study we achieved significant increases in all the scales in the last follow up. Furthermore, we found no significant correlation between functional results and age, defect localization and additional knee pathologies.