Does Donor Age of Nonirradiated Achilles Tendon Allograft Influence Mid-Term Results of Revision ACL Reconstruction?

 The purpose of the present study was to investigate if the donor age of nonirradiated Achilles tendon allograft could influence the clinical results of revision anterior cruciate ligament (ACL) reconstruction.  All patients that underwent ACL revision between 2004 and 2008 with at least 4 years of follow-up were included. For all the patients that met the inclusion criteria, the age of the graft donor was obtained from the tissue bank.

Medial Meniscus Radial Tear: A Transtibial 2-Tunnel Technique.

Complete radial tears of the medial meniscus significantly decrease the meniscal tissue's ability to dissipate tibiofemoral loads and have been described as functionally similar to a total meniscectomy, predisposing patients to early osteoarthritis. At present, no consensus exists regarding the optimal surgical treatment of a radial meniscal tear. Current repair techniques have led to a reportedly high rate of incomplete healing or healing of the meniscus in a nonanatomic, gapped position, which compromises its ability to withstand hoop stresses.

Anterolateral Biplanar Proximal Tibial Opening-Wedge Osteotomy.

Proximal tibial anterolateral opening-wedge osteotomies have been reported to achieve successful biplanar lower-extremity realignment. Indications for a proximal tibial anterolateral osteotomy include symptomatic genu recurvatum with genu valgus alignment, usually in patients with a flat sagittal-plane tibial slope. The biplanar approach is able to simultaneously address both components of a patient's malalignment with a single procedure.

Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction.

The posterior cruciate ligament (PCL) is known to be the main posterior stabilizer of the knee. Anatomic single-bundle PCL reconstruction, focusing on reconstruction of the larger anterolateral bundle, is the most commonly performed procedure. Because of the residual posterior and rotational tibial instability after the single-bundle procedure and the inability to restore the normal knee kinematics, an anatomic double-bundle PCL reconstruction has been proposed in an effort to re-create the native PCL footprint more closely and to restore normal knee kinematics.

An In Vitro Robotic Assessment of the Anterolateral Ligament, Part 2: Anterolateral Ligament Reconstruction Combined With Anterior Cruciate Ligament Reconstruction.

Background: Recent biomechanical studies have demonstrated that an extra-articular lateral knee structure, most recently referred to as the anterolateral ligament (ALL), contributes to overall rotational stability of the knee. However, the effect of anatomic ALL reconstruction (ALLR) in the setting of anterior cruciate ligament (ACL) reconstruction (ACLR) has not been biomechanically investigated or validated.

Purpose/hypothesis: The purpose of this study was to investigate the biomechanical function of anatomic ALLR in the setting of a combined ACL and ALL injury.

An In Vitro Robotic Assessment of the Anterolateral Ligament, Part 1: Secondary Role of the Anterolateral Ligament in the Setting of an Anterior Cruciate Ligament Injury.

Background: Recent investigations have described the structural and functional behavior of the anterolateral ligament (ALL) of the knee through pull-apart and isolated sectioning studies. However, the secondary stabilizing role of the ALL in the setting of a complete anterior cruciate ligament (ACL) tear has not been fully defined for common simulated clinical examinations, such as the pivot-shift, anterior drawer, and internal rotation tests.

Hypothesis: Combined sectioning of the ALL and ACL would lead to increased internal rotation and increased axial plane translation during a pivot-shift test when compared with isolated sectioning of the ACL.

A Novel Repair Method for Radial Tears of the Medial Meniscus: Biomechanical Comparison of Transtibial 2-Tunnel and Double Horizontal Mattress Suture Techniques Under Cyclic Loading.

Background: Complete radial tears of the medial meniscus have been reported to be functionally similar to a total meniscectomy. At present, there is no consensus on an ideal technique for repair of radial midbody tears of the medial meniscus. Prior attempts at repair with double horizontal mattress suture techniques have led to a reportedly high rate of incomplete healing or healing in a nonanatomic (gapped) position, which compromises the ability of the meniscus to withstand hoop stresses.

Clinically relevant anatomy and what anatomic reconstruction means.

Background: Within the past 20 years, knee ligament injuries have been increasingly reported in the literature to be treated with anatomic reconstructions over soft tissue advancements or sling-type procedures to recreate the native anatomy and restore knee function. Historically, early clinician scientists published on the qualitative anatomy of the knee, which provided a foundation for the initial knee biomechanical studies in the nineteenth and twentieth centuries. Similarly, the work of early sports medicine orthopaedic clinician scientists in the late twentieth century formed the basis for the quantitative anatomic and functional robotic biomechanical studies found currently in the sports medicine orthopaedic literature.

High rate of implant loosening for uncemented resurfacing-type medial unicompartmental knee arthroplasty.

Purpose: To determine the medium-term implant survivorship, the clinical results and the failure mechanisms of a novel unicompartmental arthroplasty for uncemented resurfacing of the medial tibio-femoral compartment.

Methods: Seventy-six consecutive patients were prospectively evaluated with a mean final follow-up of 6 years (SD 5.3 months).

MRI evaluation of a collagen meniscus implant: a systematic review.

Purpose: Good clinical results have been demonstrated in numerous clinical studies using the collagen meniscus implant (CMI); however, the MRI behaviour of the scaffold, evaluated with Genovese score, is limited to a few cases series. The purpose was to evaluate, using the Genovese score, the MRI behaviour of the CMI at different follow-up periods and investigate possible differences in the behaviour of lateral and medial CMI.

Methods: A comprehensive search was performed on PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases using various combinations of the following keywords: "collagen meniscus implant" or "collagen meniscal implant".

Anatomic and nonanatomic double-bundle anterior cruciate ligament reconstruction: an in vivo kinematic analysis.

Background: There have been no direct in vivo biomechanical comparisons performed between an anatomic double-bundle (ADB) and a nonanatomic double-bundle (NADB) anterior cruciate ligament (ACL) reconstruction.

Hypothesis: There are differences in kinematic outcomes between ADB and NADB ACL reconstruction techniques.

Study Design: Controlled laboratory study.

Minimum thickness of all-poly tibial component unicompartmental knee arthroplasty in patients younger than 60 years does not increase revision rate for aseptic loosening.

Purpose: Management of unicompartmental knee osteoarthritis in middle-aged patients is a challenging problem. Despite its functional advantages, UKA still raises questions concerning implant survivorship and an increased revision risk for aseptic loosening mainly due to polyethylene wear. The main purpose of the present study was to investigate whether using the minimum thickness of an all-poly tibial UKA in patients under 60 years of age increases the revision rate for aseptic loosening.

Anatomic double-bundle anterior cruciate ligament reconstruction leaving hamstrings tibial insertion intact: technical note.

This article describes an anatomic, double-bundle, arthroscopic anterior cruciate ligament reconstruction technique with hamstrings using second-generation out-in retrograde femoral drills, second-generation cortical femoral suspensory fixation devices with adjustable graft loop length, standard out-in tibial drills, and titanium low-profile tibial staples. Grafts choice is autologous gracilis and semitendinosus tendons. They are harvested through the single minimally invasive tibial incision maintaining their tibial insertion.

Can the pivot-shift be eliminated by anatomic double-bundle anterior cruciate ligament reconstruction?

Purpose: To assess the ability of anatomic double-bundle anterior cruciate ligament reconstruction in eliminating the pivot-shift phenomenon when identified by a quantitative measuring system (computer navigation or magnetic resonance imaging).

Methods: Literature review. Medline, Google Scholar and Cochrane Reviews computerized databases research using the keywords "pivot-shift," "anterior cruciate ligament reconstruction" and "double bundle.

Meniscal allograft transplantation without bone plugs: a 3-year minimum follow-up study.

Background: Meniscal allograft transplantation is a viable option for subtotally meniscectomized and totally meniscectomized symptomatic patients and potentially results in pain relief and increased function.

Hypothesis: The use of a single tibial tunnel arthroscopic technique without bone plugs will reduce symptoms (pain) and improve knee function at a minimum 3-year follow-up.

Study Design: Case series; Level of evidence, 4.

Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: comparison of arthroscopic transglenoid suture and open Bankart reconstruction.

Purpose: The purpose of this study is to report long-term outcomes of the arthroscopic modified Caspari technique compared to an open capsular shift surgery to treat post-traumatic anterior shoulder recurrent instability. The hypothesis was that the open surgery group would show higher degenerative changes than to the modified Caspari technique group after a follow-up from 10 to 17 years.

Methods: One hundred and ten nonrandomized consecutive patients who underwent a surgical repair of recurrent unilateral anterior shoulder instability between 1990 and 1999 were retrospectively analyzed.

Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons: a review.

The purposes of this paper are to summarize the concepts relating to the use of a combined intra-articular and extra-articular reconstructive procedure in the arthroscopic treatment of a torn ACL and to review several operative techniques utilizing gracilis and semitendinosus tendons that are currently in use to treat this instability. The highly satisfactory results obtained over the time show that a combination of intra- and extra-articular procedures for ACL reconstruction is a valid surgical option.