Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation. The American journal of sports medicine 26

ABSTRACT We retrospectively reviewed the results of 97 patients with anterior cruciate ligament reconstructions using an arthroscopically assisted two-incision technique without extraarticular augmentation at an intermediate followup of 5 to 9 years postoperatively. Evaluation included detailed history, physical examination, functional testing, KT-1000 arthrometer measurements, multiple scoring systems, and radiographs. The results were compared with those from a previous study that evaluated a smaller patient cohort using the identical surgical technique at a 2-to 4-year followup. The postoperative physical examination and KT-1000 arthrometer results were statistically improved when compared with preoperative findings. A negative pivot shift result was noted in 83% of patients, and a 1ϩ result in 17% of patients. Seventy percent of patients had Ͻ3 mm difference on manual maximum side-to-side testing. Functional testing averaged less than 2% asymmetry for vertical jump, single-legged hop, or timed 6-meter hop. The Tegner activity level was significantly improved from prereconstruction ratings and similar to preinjury ratings. The mean Lysholm score was 87. The modified Hospital for Special Surgery scores resulted in good or excellent results in 82% of the patients (mean, 87 points). The mean Noyes sports function score was 89, and the reoperation rate for a symptomatic knee flexion contracture was 12%. Ninety-seven percent of patients indicated that they would undergo the procedure again. When compared with this same population at 2 to 4 years, we saw no deterioration in scoring scale results. During the past decade arthroscopically assisted techniques have become accepted methods of reconstructing the ACL. 5-7, 13, 14, 19, 23, 24, 27, 31, 36, 45, 46 Despite many ACLrelated articles in the literature, there are few intermediate-or long-term studies evaluating the results of current, commonly performed techniques. The goals for this minimum 5-year follow-up study were to 1) evaluate clinical stability after this technique, 2) assess function, 3) evaluate patient satisfaction, and 4) compare our results at 5 to 9 years with those from an earlier study of 2 to 4 years' followup of this same surgical technique. 7 MATERIALS AND METHODS Patients who underwent two-incision arthroscopically assisted ACL reconstructions using patellar tendon autograft substitution without extraarticular augmentation between June 1987 and January 1991 were retrospectively reviewed. Patients were identified from a computerized data base maintained by the senior author (BRB), who performed all the surgical procedures. During this period, a variety of 189 knee ligament procedures were performed. Exclusionary criteria included concomitant ex

Dynamic function after anterior cruciate ligament ~ . reconstruction with autologous patellar tendon

ABSTRACT The purpose of this study was to dynamically assess the functional outcome of patients who had undergone successful anterior cruciate ligament reconstruction using an autologous patellar tendon technique and to determine whether their dynamic knee function was related to quadriceps and hamstring muscle strength. The knee kinematics and kinetics of 22 subjects who had undergone anterior cruciate ligament reconstruction (mean age, 27 Ϯ 11 years) and of 22 age-and sex-matched healthy control subjects were determined during various dynamic activities using a computerized motion analysis and force plate system. The differences in the sagittal plane angles and external moments between the two groups during light (walking), moderate (climbing and descending stairs), and higher-demand (jogging, jog and cut, jog and stop) activities were related to isokinetic strength measurements. Although patients who are asymptomatic and functioning well after anterior cruciate ligament reconstruction can perform normally in light activities, higher-demand activities reveal persistent functional adaptations that require further study. Injury to the ACL leads to knee instability and functional adaptations. Although many ACL-deficient patients display little or no visible impairment (primarily because of activity modification), previous studies have shown that patients with ACL deficiencies walk and perform more stressful activities differently than do uninjured subjects, with most of the differences occurring in the sagittal plane angles and moments. The purpose of our study was to determine whether functional adaptations during gait and other low-and high-demand activities were present in patients with an ACL bone-patellar tendon reconstruction and, if so, whether they were related to strength. More specifically, we examined how the sagittal plane joint angles and external moments during walking, stair-climbing, and jogging activities differed between healthy subjects and patients with a reconstructed ACL and whether those differences related to isokinetic quadriceps and hamstring muscle strength. MATERIALS AND METHODS Twenty-two subjects (mean age, 27 Ϯ 11 years) who underwent an autogenous patellar tendon reconstruction for ACL deficiency were tested and compared with a group of 22 uninjured control subjects. The ACL-reconstructed group consisted of 13 men and 9 women. Patients in the ACL-reconstructed group underwent surgery at an average of 8 months (range, 1 to 24) after injury and were examined at a mean follow-up of 22 Ϯ 12 months. Excluded from the study were those patients who had meniscal damage in which more than 25% of the meniscus was removed, posterior cruciate or collateral ligament injury, articular surface injury, symptomatic anterior knee pain, or objective instability at latest follow-up examination (positive pivot shift test results, positive Lachman † Address correspondence and reprint requests to Charles A. Bush-Joseph, MD, Rush-Presbyterian-St

Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation

The MARS Group* Background: Osteoarthritis of the knee is commonly diagnosed and monitored with radiography. However, the reliability of radiographic classification systems for osteoarthritis and the correlation of these classifications with the actual degree of confirmed degeneration of the articular cartilage of the tibiofemoral joint have not been adequately studied. Methods: As the Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) Group, we conducted a multicenter, prospective longitudinal cohort study of patients undergoing revision surgery after anterior cruciate ligament reconstruction. We followed 632 patients who underwent radiographic evaluation of the knee (an anteroposterior weight-bearing radiograph, a posteroanterior weight-bearing radiograph made with the knee in 45°of flexion [Rosenberg radiograph], or both) and arthroscopic evaluation of the articular surfaces. Three blinded examiners independently graded radiographic findings according to six commonly used systems-the Kellgren-Lawrence, International Knee Documentation Committee, Fairbank, Brandt et al., Ahlbäck, and Jäger-Wirth classifications. Interobserver reliability was assessed with use of the intraclass correlation coefficient. The association between radiographic classification and arthroscopic findings of tibiofemoral chondral disease was assessed with use of the Spearman correlation coefficient. Results: Overall, 45°posteroanterior flexion weight-bearing radiographs had higher interobserver reliability (intraclass correlation coefficient = 0.63; 95% confidence interval, 0.61 to 0.65) compared with anteroposterior radiographs (intraclass continue

Defining the role of common variation in the genomic and biological architecture of adult human height

Using genome-wide data from 253,288 individuals, we identified 697 variants at genome-wide significance that together explained one-fifth of the heritability for adult height. By testing different numbers of variants in independent studies, we show that the most strongly associated ∼2,000, ∼3,700 and ∼9,500 SNPs explained ∼21%, ∼24% and ∼29% of phenotypic variance. Furthermore, all common variants together captured 60% of heritability. The 697 variants clustered in 423 loci were enriched for genes, pathways and tissue types known to be involved in growth and together implicated genes and pathways not highlighted in earlier efforts, such as signaling by fibroblast growth factors, WNT/β-catenin and chondroitin sulfate-related genes. We identified several genes and pathways not previously connected with human skeletal growth, including mTOR, osteoglycin and binding of hyaluronic acid. Our results indicate a genetic architecture for human height that is characterized by a very large but finite number (thousands) of causal variants