Evaluation of Single-Bundle versus Double-Bundle PCL Reconstructions with More Than 10-Year Follow-Up

Background. Posterior cruciate ligament (PCL) injuries are not rare in acute knee injuries, and several recent anatomical studies of the PCL and reconstructive surgical techniques have generated improved patient results. Now, we have evaluated PCL reconstructions performed by either the single-bundle or double-bundle technique in a patient group followed up retrospectively for more than 10 years. Methods. PCL reconstructions were conducted using the single-bundle (27 cases) or double-bundle (13 cases) method from 1999 to 2002. The mean age at surgery was 34 years in the single-bundle group and 32 years in the double-bundle group. The mean follow-up period was 12.5 years. Patients were evaluated by Lysholm scoring, the gravity sag view, and knee arthrometry. Results. The Lysholm score after surgery was 89.1±5.6 points for the single-bundle group and 91.9±4.5 points for the double-bundle group. There was no significant difference between the methods in the side-to-side differences by gravity sag view or knee arthrometer evaluation, although several cases in both groups showed a side-to-side difference exceeding 5 mm by the latter evaluation method. Conclusions. We found no significant difference between single- and double-bundle PCL reconstructions during more than 10 years of follow-up

Double bundle arthroscopic Anterior Cruciate Ligament reconstruction with remnant preserving technique using a hamstring autograft

<p>Abstract</p> <p>Background</p> <p>Preservation of the Anterior Cruciate Ligament (ACL) remnant is important from the biological point of view as it enhances revascularization, and preserves the proprioceptive function of the graft construct. Additionally, it may have a useful biomechanical function. Double bundle ACL reconstruction has been shown to better replicate the native ACL anatomy and results in better restoration of the rotational stability than single bundle reconstruction.</p> <p>Methods</p> <p>We used the far anteromedial (FAM) portal for creation of the femoral tunnels, with a special technique for its preoperative localization using three dimensional (3D) CT. The central anteromedial (AM) portal was used to make a longitudinal slit in the ACL remnant to allow visualization of the tips of the guide pins during anatomical creation of the tibial tunnels within the native ACL tibial foot print. The use of curved hemostat allow retrieval of the wire loop from the apertures of the femoral tunnels through the longitudinal slit in the ACL remnant thereby, guarding against impingement of the reconstruction graft against the ACL remnant as well as the roof of the intercondylar notch.</p> <p>Conclusion</p> <p>Our technique allows for anatomical double bundle reconstruction of the ACL while maximally preserving the ACL remnant without the use of intra-operative image intensifier.</p

International Olympic Committee consensus statement on pain management in elite athletes

Pain is a common problem among elite athletes and is frequently associated with sport injury. Both pain and injury interfere with the performance of elite athletes. There are currently no evidence-based or consensus-based guidelines for the management of pain in elite athletes. Typically, pain management consists of the provision of analgesics, rest and physical therapy. More appropriately, a treatment strategy should address all contributors to pain including underlying pathophysiology, biomechanical abnormalities and psychosocial issues, and should employ therapies providing optimal benefit and minimal harm. To advance the development of a more standardised, evidence-informed approach to pain management in elite athletes, an IOC Consensus Group critically evaluated the current state of the science and practice of pain management in sport and prepared recommendations for a more unified approach to this important topic

Parsons' knob, the bony landmark of the tibial insertion of the anterior cruciate ligament, evaluated by three-dimensional computed tomography

Background: In recent years, highly detailed evaluations have been performed using three-dimensional computed tomography (3D CT). Very small bony ridges, such as Resident's ridge and the lateral bifurcate ridge can be visualised by 3D CT. The purpose of this study was to ascertain whether Parsons' knob, which was recognised as the bony landmark of the anterior cruciate ligament insertion on the tibia, can be visualised by 3D CT, and, if this is possible, to clarify its location and morphology. Methods: One hundred knees were scanned by CT in this study and 3D models were created using the volume-rendering technique. Parsons' knob was detected on the axial 3D CT view of the tibial plateau. The location of the knob was presented on a grid aligned with the medial-to-lateral and anterior-to-posterior anatomical tibial axes. All measurements were expressed as a percentage of the corresponding maximum dimension. The width and height of Parsons' knob were also measured. Results: Parsons' knob was detected in all 100 knees and was ordinarily found as a ridge that ran obliquely forward from the anterior edge of the medial spine. The knob was located at an average of 22 ± 3.1% of the anterior-to-posterior tibial plateau depth from the anterior edge of the tibia and extended from a mean ± s.d. of 46.9 ± 2.1% to 54 ± 3.6% of the medial-to-lateral tibial plateau width from the medial edge of the tibia. The average width of the knob was 11.5 ± 3.1 mm, and the average height was 1.2 ± 0.3 mm at the most medial portion, 0.2 ± 0.3 mm at the most lateral portion, and 1.2 ± 0.3 mm at the intermediate portion between them. The medial and intermediate portions of the knob were significantly higher than the lateral portion (p < 0.05). Conclusion: The location and morphology of Parsons' knob can be well-visualised using 3D CT

Surgical Reconstruction with the Remnant Ligament Improves Joint Position Sense as well as Functional Ankle Instability: A 1-Year Follow-Up Study

Introduction. Chronic functional instability—characterized by repeated ankle inversion sprains and a subjective sensation of instability—is one of the most common residual disabilities after an inversion sprain. However, whether surgical reconstruction improves sensorimotor control has not been reported to date. The purpose of this study was to assess functional improvement of chronic ankle instability after surgical reconstruction using the remnant ligament. Materials and Methods. We performed 10 cases in the intervention group and 20 healthy individuals as the control group. Before and after surgical reconstruction, we evaluated joint position sense and functional ankle instability by means of a questionnaire. Results and Discussion. There was a statistically significant difference between the control and intervention groups before surgical reconstruction. Three months after surgery in the intervention group, the joint position sense was significantly different from those found preoperatively. Before surgery, the mean score of functional ankle instability in the intervention group was almost twice as low. Three months after surgery, however, the score significantly increased. The results showed that surgical reconstruction using the remnant ligament was effective not only for improving mechanical retensioning but also for ameliorating joint position sense and functional ankle instability

Effects of hyperbaric oxygen at 1.25 atmospheres absolute with normal air on macrophage number and infiltration during rat skeletal muscle regeneration.

Use of mild hyperbaric oxygen less than 2 atmospheres absolute (2026.54 hPa) with normal air is emerging as a common complementary treatment for severe muscle injury. Although hyperbaric oxygen at over 2 atmospheres absolute with 100% O2 promotes healing of skeletal muscle injury, it is not clear whether mild hyperbaric oxygen is equally effective. The purpose of the present study was to investigate the impact of hyperbaric oxygen at 1.25 atmospheres absolute (1266.59 hPa) with normal air on muscle regeneration. The tibialis anterior muscle of male Wistar rats was injured by injection of bupivacaine hydrochloride, and rats were randomly assigned to a hyperbaric oxygen experimental group or to a non-hyperbaric oxygen control group. Immediately after the injection, rats were exposed to hyperbaric oxygen, and the treatment was continued for 28 days. The cross-sectional area of centrally nucleated muscle fibers was significantly larger in rats exposed to hyperbaric oxygen than in controls 5 and 7 days after injury. The number of CD68- or CD68- and CD206-positive cells was significantly higher in rats exposed to hyperbaric oxygen than in controls 24 h after injury. Additionally, tumor necrosis factor-α and interleukin-10 mRNA expression levels were significantly higher in rats exposed to hyperbaric oxygen than in controls 24 h after injury. The number of Pax7- and MyoD- or MyoD- and myogenin-positive nuclei per mm2 and the expression levels of these proteins were significantly higher in rats exposed to hyperbaric oxygen than in controls 5 days after injury. These results suggest that mild hyperbaric oxygen promotes skeletal muscle regeneration in the early phase after injury, possibly due to reduced hypoxic conditions leading to accelerated macrophage infiltration and phenotype transition. In conclusion, mild hyperbaric oxygen less than 2 atmospheres absolute with normal air is an appropriate support therapy for severe muscle injuries

Histological and biomechanical study of impacted cancellous allografts with cement in the femur : a canine model

Introduction An experimental canine model was used for quantitative histological study using bone morphometry and biomechanical study on impacted cancellous allografting with cement in revision total hip arthroplasty. Materials and methods The prosthesis had a collarless polished titanium alloy tapered stem with a head diameter of 15 mm. Twelve Beagle dogs were used. Cancellous bone grafts were obtained aseptically from the femoral condyles of other beagles. Histological examinations were performed up to 1 year after surgery. Biomechanical examinations were performed at 8 weeks after surgery. Results The new bone formation proceeded from the proximal part to the distal site of the femur in the long axis as well as from the host cortical bone to the cement layer. Bone morphometry showed that the mineral apposition rate was higher in the proximal site of the femur than in the distal site at 8 weeks after surgery, but no significant differences were observed at other times. The bone formation rate was higher in the proximal site of the femur at 8 weeks after surgery, while it increased in the distal site at 16 weeks postoperatively but had decreased at 1 year after surgery significantly. The load test at 8 weeks after surgery showed that there was no significant difference at all sites attached strain gauge between impacted cancellous allograft group and control group. Conclusion We concluded that biological replacement of the grafted bone by new bone settled at 1 year after surgery in this experimental model. However, the process was not completed