Long-Term Results of ACL Reconstruction Using a Nonanatomic Double-Bundle Technique with Extra-Articular Reinforcement.

Extra-articular procedures for the improvement in rotational stability after anterior cruciate ligament (ACL) reconstruction have gained popularity in the last decade. This surgical gesture hoped to improve resistance to the high tensional forces affecting the ACL graft during cutting and pivoting movements of the lower extremity and eventually prevent ACL reconstruction failure. We performed this study to analyze the long-term results of patients undergoing ACL reconstruction using a nonanatomic double-bundle technique with an additional extra-articular augmentation. All the cases that underwent an ACL reconstruction using a nonanatomic double-bundle technique with an extra-articular reinforcement during the period between 1992 and 1997 were reviewed. The inclusion criteria for this study included a minimum follow-up of 10 years and age between 14 and 45 years at the time of the surgery. Forty patients were included in this series (34 males and 6 females). The mean Lysholm score after a minimum follow-up period of 10 years was 92.3 (standard deviation [SD], 9.4). The average preoperative Tegner score of the participants was 7.0 (SD, 1.1). This score decreased to 5.7 (SD, 1.2) at the end of follow-up. Follow-up X-rays were reviewed to assess the degenerative changes in the three knee compartments. Degenerative changes ≥ Kellgren-Lawrence grade 2 were observed in our six (15%) patients, all of them in the medial knee compartment. With these results, we conclude that double-bundle nonanatomic ACL reconstruction combined with an extra-articular reinforcement resembling the anterolateral ligament offers good overall long-term results, with relatively low rates of osteoarthritis.

Arthroscopic repair of the posterior cruciate ligament: two techniques.

SUMMARY: Isolated posterior cruciate ligament injuries are rare and their treatment is controversial. These lesions have commonly been treated by open reduction and internal fixation using a posterior approach. However, this approach makes it difficult to explore other combined injuries of the knee joint. We report 2 cases of posterior cruciate ligament avulsion of the tibia that were arthroscopically reduced and fixed using 2 different methods, cannulated screws and tension band wire.

Histologic analysis of distraction osteogenesis in the femoral shaft of the immature rabbit.

A study of the distraction callus in the femur of the growing rabbit was performed. Thirty animals separated into 10 groups were used. Distraction between both ends of a femoral osteotomy induced the formation of a connective callus which subsequently ossified. This callus disappeared between the fourth and the eighth week after the lengthening was completed. The osteogenesis model was of a mixed type, intramembranous and endochondral, with a predominance of the former. The bone healing and the initial signs of remodeling in the newly formed bony tissue were seen at the end of the first week of distraction. The original cortex was resorbed during the lengthening and was progressively substituted by a new cortex, whose formation and remodeling was not finished 24 weeks after the completion of the distraction. Experimental conditions could explain some of the findings.

Partial necrosis of the neck of the talus treated with arthroscopy.

An unusual case of an area of necrosis on the talar neck of a girl with a 2-year history of gradually increasing pain following an ankle sprain is presented. Initial radiographs were normal but follow-up radiography showed irregularity in the anterior talar neck. A definitive diagnosis was made by magnetic resonance imaging. Arthroscopic removal of a necrotic fragment from the anterior talar neck that was impinging on the tibia relieved her symptoms. Two years after the operation the patient has normal radiographs and full activity.