Potential applications of hyaluronans in orthopaedics: degenerative joint disease, surgical recovery, trauma and sports injuries.

The use of hyaluronans for the treatment of pain in patients with osteoarthritis of the knee is well established. There are growing data to suggest that they may also alter the rate of disease progression. Reviewed here are preliminary data that also indicate a potential use for hyaluronans in the treatment of inflammatory arthropathies (e.g. acute joint trauma and fractures) that require long periods of immobilisation, and in tissue engineering for chondral defects. Although the trials that have investigated the use of hyaluronan therapy for the management of traumatic and degenerative musculoskeletal disorders seen in sports medicine have limitations in design and patient number, the results have been promising and suggest that larger controlled clinical trials are warranted.

Revision anterior cruciate ligament reconstruction: three- to nine-year follow-up.

PURPOSE: With the increasing number of primary anterior cruciate ligament (ACL) reconstructions, revisions are more frequent. The literature quotes inferior results for revision cases when compared with primary ACL reconstruction. The purpose of the study was to review our institution's experience with revision ACL reconstruction. TYPE OF STUDY: Retrospective case series. METHODS: Thirty-five revision cases were performed between 1993 and 1999. Twenty-nine were available for follow-up. Subjective scores were calculated for Lysholm, Tegner, and International Knee Documentation Committee (IKDC) forms. Objective IKDC scores were determined. KT-1000 measurements were performed as well as isokinetic strength testing of quadriceps and hamstrings. Plain film radiographs were obtained to assess degenerative changes. RESULTS: The average patient age at time of revision was 30.2 years, the average time to revision was 56 months, the follow-up from last revision was 67 months. Twenty-two patients had bone-patellar tendon-bone (BPTB) allograft, 6 had contralateral BPTB autograft, and 1 patient had Achilles allograft. Overall, KT-1000 measurement showed an average of 2.78 mm side-to-side difference of displacement. The allograft versus the autograft group was 3.21 mm versus 1.33 mm, respectively. Prerevision data were unavailable. However, all patients had a positive pivot-shift test before revision. Average postrevision Lysholm, Tegner, and subjective IKDC scores were 86.6, 11.86, and 85.86, respectively. Concerning the IKDC objective scores, 15 patients had an A score, 8 had a B score, and 4 had a C score. All 29 patients available for follow-up reported that they would have the surgery again. The average strength of quadriceps and hamstrings ranged from 82% to 88% of uninvolved side. CONCLUSIONS: This study provides long-term follow-up with good results for revision ACL reconstruction. Attention to principles when performing revision ACL surgery is critical to provide satisfactory results. LEVEL OF EVIDENCE: Level IV.

Clinical outcome of anterior cruciate ligament reconstruction with quadrupled hamstring tendon graft and bioabsorbable interference screw fixation.

BACKGROUND: To date, there has been no publication of clinical follow-up data on patients who have undergone quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable screw fixation. PURPOSE: To report the results of quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation. STUDY DESIGN: Retrospective review. METHODS: Sixty-five patients (66 knees) were retrospectively identified by chart review as having undergone quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation with a minimum 2-year follow-up. RESULTS: Data were collected on 48 knees in 47 patients (73%) at an average 30.2 months (range, 24 to 43) after surgery. Thirty-six patients (37 knees) returned for clinical evaluation (56% return) and subjective follow-up only was obtained in 11 patients (17%). The mean Lysolm knee score was 91 (range, 45 to 98), with a mean of 97 for the uninvolved knee. The mean Tegner activity score was 5.7 (range, 3 to 7). The KT-1000 arthrometer mean side-to-side difference for manual maximum displacement was 2.03 mm (range, -1 to 8). The mean International Knee Documentation Committee knee score was 83 (range, 47 to 100). Patients who underwent associated partial meniscectomy or meniscal repair had significantly lower International Knee Documentation Committee scores than patients without associated procedures (P < 0.01). CONCLUSIONS: Quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation is comparable with other methods of anterior cruciate ligament reconstruction in terms of patient satisfaction, knee stability, and function.

Achilles Tendon Injuries and Disabling Conditions.

In brief Athletes whose Achilles tendon function is impaired need proper treatment so that they may successfully resume their athletic careers. This review details causes, symptoms, and treatment of a variety of disabling tendocalcaneus conditions, most of which are inflammatory in nature. Recommended treatment usually includes rest, medication, heel lifts, and stretching and strengthening programs. Surgery may also be required.