Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections.

BACKGROUND: platelet-rich-plasma is increasingly used in chronic patellar tendinopathy. Ideal number of PRP injections needed is not yet established. This study compares the clinical outcomes of a single versus two consecutive PRP injections. METHOD: between December 2009 and January 2012, 40 athletes with proximal patellar tendinopathy were treated by PRP injection. Patients received single (20 patients) or two PRP injections 2 weeks apart (20 patients). All patients underwent prospective clinical evaluation, including Victorian Institute of Sport Assessment-Patella (VISA-P) score, visual analog scale (VAS) for pain, and Tegner scale before PRP and after a minimum of 2 year follow-up. RESULTS: 9 patients failed PRP treatment and needed surgery. 1 patient was lost to follow-up. For the remaining patients, the VISA-P, VAS, and Tegner scores all significantly improved from 35.2 to 78.5 (p = 0.0001), 6.6 to 2.4 (p = 0.0001), and 4.8 to 6.9 (p = 0.0003). Patients who received two injections had better scores than those who received single injection with VAS of 1.07 versus 3.7 (p = 0.0005), Tegner score of 8.1 versus 5.9 (p = 0.0003) and VISA-P of 93.2 versus 65.7 (p = 0.0001). CONCLUSIONS: two consecutive PRP injections in chronic patellar tendinopathy showed better improvement in outcomes when compared to single injection. LEVEL OF EVIDENCE: randomized prospective consecutive series, Level 2.

Posterolateral Bundle Reconstruction With Anteromedial Bundle Remnant Preservation in ACL Tears: Clinical and MRI Evaluation of 39 Patients With 24-Month Follow-up.

BACKGROUND: Augmentation consisting of a selective reconstruction of the ruptured bundle while preserving the remnant bundle has been proposed as a treatment option for partial anterior cruciate ligament (ACL) tears. Good clinical outcomes after selective anteromedial (AM) bundle augmentation have been reported, whereas little is known about selective reconstruction of the posterolateral (PL) bundle with preservation of the AM bundle remnant. PURPOSE: The purpose of this study was to evaluate the clinical outcomes and the magnetic resonance imaging (MRI) characteristics of selective PL bundle reconstruction with a median follow-up of 24 months. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: In a consecutive series of 741 ACL reconstructions, 44 patients underwent a selective PL bundle reconstruction with preservation of the AM remnant. Four patients with contralateral knee ligament surgery and 1 patient who sustained a traumatic rupture of his graft were excluded, leaving 39 patients for final evaluation. Clinical evaluation of knee function and laxity were recorded preoperatively and at a mean 24.2-month follow-up. Magnetic resonance imaging was performed on 35 patients at a mean 25.9-month follow-up for evaluation of graft and remnant bundle continuity, tunnel enlargement, and graft remodeling status by measuring the signal intensity of the graft (contrast/noise quotient [CNQ]). RESULTS: Tegner and Lysholm knee scores were significantly improved after surgery. The subjective International Knee Documentation Committee (IKDC) score was 43.5 ± 16.6 preoperatively and 89.9 ± 6.6 at the final follow-up (P < .01). The objective IKDC score was "B" for 17 patients, "C" for 21 patients, and "D" for 1 patient preoperatively, while it was "A" for 34 patients and "B" for 5 patients postoperatively (P < .01). The mean side-to-side anteroposterior laxity was 5 mm (range, 4-10 mm) preoperatively and 1.5 mm (range, -1 to 4 mm) at final follow-up (P < .01). On MRI, the graft was visible and continuous in all cases. No cyclops lesions were noted. The average CNQ for the PL graft and the AM remnant bundle was 3.2 ± 1 and 2.9 ± 1.2, respectively. Minimum bone tunnel enlargement was found. CONCLUSION: Selective PL bundle reconstruction restores knee stability and function. At final follow-up, MRI showed continuity of the PL graft without signs of dramatic tunnel enlargement or cyclops syndrome.

Prevalence of septic arthritis after anterior cruciate ligament reconstruction among professional athletes.

BACKGROUND: Septic arthritis of the knee after anterior cruciate ligament (ACL) reconstruction is a rare complication. Its prevalence and characteristics have never been reported among professional athletes. PURPOSE: To report the prevalence and the characteristics of septic arthritis after ACL reconstruction in professional athletes and a general population of patients. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: A retrospective analysis of a consecutive series of 1957 patients who underwent an ACL reconstruction between 2003 and 2008 was performed; 88 patients were professional athletes. The patient demographics, the prevalence of infection, the involved organism, and the method of treatment were reviewed. Three potential risk factors for infection-level of sporting participation, indoor/outdoor sports, and the presence or not of a combined lateral tenodesis-were assessed using univariate and multivariate logistic regression analysis. RESULTS: The prevalence of septic arthritis was 0.37% in the nonprofessional group and 5.7% in the professional athlete population. Being a professional athlete (odds ratio [OR], 16.0; 95% confidence interval [CI], 3.9-59.8; P = .0001) or having a combined lateral tenodesis (OR, 4.8; 95% CI, 1.04-18.04; P = .02) was found to be significantly correlated with septic arthritis after ACL reconstruction. A significant correlation exists between being a professional athlete and having a combined lateral tenodesis (χ(2) = 16.7; P = 4 × 10(-5)), suggesting a potential confounding role is played by one of these variables. All the cases of infection in the professional athletes occurred in those who participated in outdoor sports, although this was not found to be statistically significant (P = .17). CONCLUSION: Participation in professional sports and having a combined lateral tenodesis are risk factors for the development of infection after ACL reconstruction. We hypothesize that professional athletes may be part of a specific group of patients at higher risk of infection after ACL reconstruction.

Activity level recovery after arthroscopic PCL reconstruction: a series of 21 patients with a mean follow-up of 29 months.

Surgical treatment of PCL tears is often indicated after conservative management failure and it is known to be challenging with unpredictable outcomes. This study aims to describe and to evaluate the outcome of an arthroscopic PCL anterolateral bundle reconstruction using a quadriceps tendon autograft. Our hypothesis is that knee stability and function can be restored using this technique allowing patients to resume their pre-injury level of activity. Between 2005 and 2008, 21 consecutive patients underwent an isolated PCL reconstruction and were evaluated after a mean follow-up of 29 months (range 12-48). The mean time from injury to surgery was 28 months. All patients were assessed pre- and post-operatively using IKDC evaluation, Tegner and Lysholm scores. The differential laxity was measured radiologically using the Telos® stress device. Pre-operatively, no patients were classified A or B on the IKDC objective score. At last follow-up, 81% of patients were classified A or B. The average differential anteroposterior laxity was 11.2 mm (range 8-15) in the preoperative evaluation and 3.6 mm (range 0-7) at the final follow-up (p=0.01). The mean subjective IKDC score was 39.5 before surgery and 74.5 at the last follow-up (p<0.01). The Tegner and Lysholm scores were significantly improved (p<0.001). 81% of patients were able to resume the same pre-injury level of activity. Patients with high level activity before injury were found to have the best subjective outcomes. Satisfactory laxity control and clinical outcomes were obtained in this series allowing patients to resume their pre-injury activities and sports.

Preoperative factors correlating with prolonged range of motion deficit after anterior cruciate ligament reconstruction.

BACKGROUND: Impaired postoperative range of motion remains one of the most frequent complications after anterior cruciate ligament reconstruction. PURPOSE: This study was undertaken to determine the preoperative factors associated with prolonged range of motion deficit after anterior cruciate ligament reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between January 2007 and March 2008, a consecutive series of 217 patients underwent anterior cruciate ligament reconstruction and were reviewed at 6 weeks and 3 months after surgery. In this series, all data of patients who required a further surgery for arthrolysis until December 2009 were studied. Goniometric range of motion measurement was performed the day before surgery and at 6 weeks and 3 months postoperatively. Bone contusions were analyzed on preoperative magnetic resonance imaging (MRI). All MRI scans were performed in the 6 months before surgery. Seven potential risk factors-age, sex, limited preoperative range of motion, meniscal lesions, bone contusion(s), operative delay less than 45 days, and rehabilitation-were assessed using univariate analysis. The correlations between the significant factors previously identified were analyzed further using multivariate logistic regression analysis. RESULTS: Limited preoperative range of motion (P < .001), typical bone contusions of the lateral compartment (P < .001), operative delay less than 45 days (P = .003), and female sex (P = .049) were found to be significantly correlated with delayed recovery. The limited preoperative mobility and the presence of typical contusions were strongly correlated (P < .001). In the group of patients who underwent surgery within 45 days, delayed recovery was strongly correlated with limited preoperative mobility (P = .0008) and to the presence of typical contusions (P < .001). Arthrolysis was correlated with delayed range of motion (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.9-50; P =.001) and bone bruise (OR, 7.6; 95% CI, 1.7-46.1; P = .002). CONCLUSION: Preoperative limited range of motion and typical bone bruises of the lateral femoral condyle and tibial plateau are major risk factors for a difficult rehabilitation after anterior cruciate ligament reconstruction.