The association of extra-articular tenodesis restores rotational stability more effectively compared to contralateral hamstring tendon autografts ACL reconstruction alone in patients undergoing ACL revision surgery.

BACKGROUND: Recent years have seen a resurgence of interest about lateral extra-articular procedures performed in association with anterior cruciate ligament (ACL) surgery, as they can reduce the positivity to pivot shift test by acting on rotational instability. The purpose of the present study is to compare the postoperative functional outcomes of ACL revision surgery using contralateral hamstring tendon autografts with or without extra-articular tenodesis. HYPOTHESIS: The hypothesis is that combined extra-articular tenodesis gives better rotational stability following revision ACL surgery. PATIENTS AND METHODS: Twenty-four patients who underwent ACL revision surgery were retrospectively reviewed at an average follow-up of 4.5 years; 12 underwent contralateral hamstring tendon autografts reconstruction (group A) while in 12 extra-articular tenodesis was associated (group B). Assessment included Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level and objective evaluation (range of motion, Lachman test, pivot-shift test and KT-1000 instrumented laxity testing). RESULTS: Follow-up examination showed that there were no statistically significant differences in Lysholm, IKDC and Tegner scores between the groups (p=n.s.). Similarly, no differences concerning anterior tibial translation as measured with KT-1000 arthrometer were reported between the groups (p=n.s.); the percentage of positivity to pivot shift test was significantly higher in patients in group A (p<0.05). CONCLUSIONS: The association of extra-articular tenodesis restores rotational stability more effectively compared to contralateral hamstring tendon autografts ACL revision surgery alone. LEVEL OF EVIDENCE: III.

Autograft for anterior cruciate ligament revision surgery : Lateral extra-articular tenodesis in skeletally mature patients under 25 years of age.

BACKGROUND: Lateral extra-articular procedures in association with anterior cruciate ligament (ACL) reconstruction can act as a protection against undesired loads occurring in the early postoperative phase. The purpose of the present study was to retrospectively review the clinical outcome of contralateral hamstring tendon autografts with extra-articular tenodesis for ACL revision surgery in skeletally mature patients under 25 years of age, specifically with respect to patient satisfaction, return to preinjury activity level and postoperative functional outcome. METHODS: In this study 9 patients (<25 years old at surgery) who underwent ACL revision surgery using contralateral hamstring tendon autografts and extra-articular tenodesis were contacted and retrospectively reviewed at an average follow-up of 3.6 years (range 2-7 years). The Tegner activity scale, Lysholm knee score and International Knee Documentation Committee (IKDC) questionnaire were used. Objective evaluation included range of motion, Lachmann test, pivot-shift test and KT-1000 instrumented laxity testing. RESULTS: No cases of re-rupture were observed. The Lysholm knee score as well as the IKDC score improved at follow-up reaching a mean value of 87.9 and 85.6, respectively, with a statistically significant improvement compared to preoperative status (p < 0.001). In terms of knee stability anterior tibial translation has changed from a preoperative mean value of 5.4 mm to a postoperative value of 2.9 mm, which was statistically significant (p < 0.001). No subjective loss of motion or strength of the contralateral knee, rotational injuries following tendon harvesting or significant morbidity at follow-up were reported. CONCLUSION: Revision ACL reconstruction with contralateral hamstrings and associated extra-articular tenodesis provides satisfying subjective outcomes and restores knee stability in skeletally mature patients under 25 years of age. LEVEL OF EVIDENCE:  IV.

Functional outcomes following contralateral hamstring tendon autografts with extra-articular tenodesis for ACL revision surgery.

BACKGROUND: Lateral extra-articular procedure in association with ACL reconstruction can act as a protection against undesired load occurring during early postoperative phases, thus making it useful in revision ACL surgery. The purpose of the present study is to retrospectively review the clinical outcome of contralateral hamstring tendon autografts with extra-articular tenodesis for ACL revision surgery, specifically with regard to patient satisfaction, return to preinjury activity level, and postoperative functional outcomes. The hypothesis was that this combined procedure leads to improved stability and functional outcome in patients affected by ACL re-tear. METHODS: Twelve patients who underwent ACL revision surgery using contralateral hamstring tendon autografts and extra-articular tenodesis were retrospectively reviewed at an average follow-up of 4.1 years (range, 2 to 7 years). All the operations were performed by a single senior surgeon. The Tegner, Lysholm, International Knee Documentation Committee (IKDC) Subjective Knee Form were used. Objective evaluation included range of motion, Lachmann test, pivot-shift test and KT-1000 instrumented laxity testing. Wilcoxon test was utilized to compare the preoperative and follow-up status. Differences with a P value <0.05 were considered statistically significant. RESULTS: Lysholm knee score as well as IKDC score significantly improved at follow-up (P<0.05). No significant differences concerning Tegner activity level were reported (P=0.9). In terms of knee stability, anterior tibial translation according to manual laxity testing and as measured with KT-1000 arthrometer significantly improved after surgery (P<0.05). CONCLUSIONS: The present study shows favorable results for revision ACL reconstruction with contralateral hamstrings and associated extra-articular tenodesis concerning subjective knee function and knee stability as well as ability to resume sport activities.

Is there still a role for threaded acetabular cups?

INTRODUCTION:: Total hip arthroplasty (THA) is 1 of the most common procedures in orthopaedic surgery. Different options and implants are currently available. Uncemented hip cups need primary stability for bone ingrowth, the use of screws is required when the desired stability is not achieved. Another option is the use of a hemispherical threaded cup with enhanced primary stability. The purpose of our study was to compare the results of a 3rd-generation threaded cup versus a press-fit cup with a long track record. MATERIALS AND METHODS:: A consecutive series of 300 THAs performed by 2 surgeons was retrospectively reviewed, 150 press-fit cups and 150 screwed cups. Minimum follow-up 27 months; maximum 78 months (mean 52.5 months). The primary endpoint was a stable and painless THA, secondary endpoints included Hip disability and Osteoarthritis Outcome Score, Junior and radiographic evaluation. RESULTS:: Preliminary results showed no statistically significant differences between the 2 groups for all the evaluated parameters, the number of early mechanical loosening was higher for press-fit cups, but this value was not statistically significant. At a mean follow-up of 52.5 months 1 cup revision (0.3%) was seen in the screwed cup group and 2 (0.6%) in the press-fit cup; these results were not statistically significant. DISCUSSION AND CONCLUSION:: The main concern for screwed cups is the greater bone loss and possible removal difficulties during revision surgery. This study has some limitations, in particular regarding follow-up, but is still ongoing. Our results showed no difference between the 2 systems.