Long-term follow-up of patellar tendon grafts or hamstring tendon grafts in endoscopic ACL reconstructions.

PURPOSE: Several studies compare the short- and long-term results of anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) graft or double-looped semitendinosus and gracilis (DLSG) graft. However, no studies evaluate the long-term results of BPTB grafts fixed with metal interference screws and DLSG grafts fixed with the Bone Mulch Screw and the Washer Loc. This prospective randomized multicentre study has the null hypothesis that there is no difference in long-term outcome between the two procedures. METHODS: A total of 114 patients with a symptomatic ACL rupture were randomized to reconstruction with either a BPTB graft (N = 58) or a DLSG graft (N = 56). Follow-up was conducted after one, two and seven years. At the seven-year follow-up, 102 of the 114 patients (89%) were available for evaluation; however, 16 of these by telephone-interview only. RESULTS: Ten patients in the BPTB group and 19 patients in the DLSG group underwent additional knee surgery (P = 0.048), two and three, respectively, of these were ACL revisions (n.s.). The total flexion work was lower in the DLSG group (P = 0.001). The mean peak flexion torque and extension work, however, showed no difference between the groups. No significant differences were found between the groups regarding the Tegner activity score, the Lysholm functional score, the Knee injury and osteoarthritis outcome score (KOOS), subjective knee function, anterior knee pain or mobility. There was no significant difference in laxity between the groups on the Lachman test or the KT-1,000 maximum manual force test. CONCLUSIONS: Both grafts and fixation methods resulted in satisfactory subjective outcome and objective stability. Both these methods can therefore be considered as suitable alternatives for ACL reconstructions. LEVEL OF EVIDENCE: II.

Long-term results after SLAP repair: a 5-year follow-up study of 107 patients with comparison of patients aged over and under 40 years.

PURPOSE: The aims of this prospective cohort study were to assess the long-term results after isolated superior labral repair and to determine whether the results were associated with age. METHODS: One hundred seven patients underwent repair of isolated SLAP tears. There were 36 women and 71 men with a mean age of 43.8 years (range, 20 to 68 years). Mean follow-up was 5.3 years (range, 4 to 8 years). Of the patients, 62 (57.9%) were aged 40 years or older. Follow-up examinations were performed by an independent examiner; 102 patients (95.3%) had a 5-year follow-up. RESULTS: The Rowe score improved from 62.8 (SD, 11.4) preoperatively to 92.1 (SD, 13.5) at follow-up (P < .001). Satisfaction was rated excellent/good for 90 patients (88%) at 5 years. There was no significant difference in the results for patients aged 40 years or older and those aged under 40 years. Difficulty with postoperative stiffness and pain was reported by 14 patients (13.1%). CONCLUSIONS: Our results suggest that long-term outcomes after isolated labral repair for SLAP lesions are good and independent of age. Postoperative stiffness was registered in 13.1% of the patients. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized multicenter review of different fixation methods.

ACL reconstruction with bone patellar tendon bone (BPTB) grafts has been shown to produce dependable results. Recently, reconstructions with double-looped semitendinosus gracilis (DLSG) grafts have become common. The prevailing opinion is that ACL reconstruction with patellar tendon graft produces a more stable knee with more anterior knee pain than DLSG grafts, while the functional results and knee scores are similar. The present study evaluates BPTB grafts fixed with metallic interference screws and DLSG grafts fixed with Bone Mulch Screw on the femur and WasherLoc fixation on the tibia. All else being the same, there is no difference in the outcome between the two grafts and fixation methods. This is a prospective randomized multicenter study. A total of 115 patients with isolated ACL ruptures were randomized to either reconstruction with BPTB grafts fixed with metal interference screws (58 patients) or DLSG grafts (57 patients) fixed with Bone Mulch Screws and WasherLoc Screws. Follow-up was at one and two years; the latter by an independent observer. At two years, one ACL revision had been performed in each group. Eight patients in the DLSG group and one in the BPTB group underwent meniscus surgery in the follow-up period (P = 0.014). Mean Lysholm score at the two year follow-up was 91 (SD +/- 10.3) in the DLSG group and also 91 (SD +/- 10.2) in the BPTB group. Mean KT-1000 at two years was 1.5 mm in the BPTB group and 1.8 mm in the DLSG group (n.s.). At two years, four patients in the BPTB group and three in the DLSG group had a Lachman test grade 2 or 3 (n.s.). More patients in the BPTB group had pain at the lower pole of the patella (P = 0.04). Peak flexion torque and total flexion work were lower in the DLSG group at one year (P = 0.003 and P = 0.000) and total flexion work also at two years (P = 0.05). BPTB ACL reconstruction fixed with interference screws and DLSG fixed with Bone Mulch Screws on the femur and WasherLoc Screws on the tibia produce satisfactory and nearly identical outcomes. Among our patients in the DLSG group, flexion strength was lower, and more patients underwent meniscus surgery in the follow-up period. The BPTB group has more anterior knee pain.

Treatment of labral tears with associated spinoglenoid cysts without cyst decompression.

BACKGROUND: The treatment of symptomatic spinoglenoid cysts has varied from observation, needle aspiration, and open excision to arthroscopic decompression. The purpose of the present study was to prospectively assess whether labral repair alone would lead to cyst resolution and pain relief. METHODS: Forty-two patients with a posterosuperior labral tear and a ganglion cyst at the spinoglenoid notch were treated with arthroscopic débridement of the glenoid rim and labral repair, either with a resorbable tack or a suture anchor. Patients ranged in age from twenty-three to sixty-eight years. Seven patients had clinical and/or radiographic evidence of atrophy of the infraspinatus muscle; one had atrophy of both the infraspinatus and the teres minor muscles, while two had atrophy of the teres minor muscle. All patients had postoperative magnetic resonance imaging performed twice, at an average of fifteen months and again at an average of forty-three months postoperatively. The clinical outcome, including the Rowe score, was assessed for all patients at a median of forty-three months postoperatively. RESULTS: In thirty-seven (88%) of the forty-two patients, the cysts had resolved completely. In five patients, a cyst was still present but with a clear reduction in size. These five patients had remission of pain and were satisfied with the shoulder function. Three patients with preoperative muscular atrophy without fatty infiltration regained normal appearing muscle, while the seven with preoperative fatty changes continued to demonstrate those changes postoperatively. The median Rowe score improved from 61.5 points preoperatively to 98.0 points at the time of follow-up. Thirty-one patients assessed the result of treatment as excellent; nine, as good; and two, as fair. CONCLUSIONS: Most spinoglenoid cysts resolve, and patient satisfaction can be expected to be high after labral fixation without cyst decompression.