Retear of anterior cruciate ligament grafts in female basketball players: a case series

<p>Abstract</p> <p>Background</p> <p>Incidence of anterior cruciate ligament (ACL) injuries in young female basketball players is higher than that in male basketball players. Graft retears are more frequent with the increasing number of ACL reconstructions. The present study aimed to examine the incidence of retears in competitive female basketball players.</p> <p>Methods</p> <p>Sixty-four female basketball players (aged 12 to 29 years) who underwent primary anatomic double-bundle ACL reconstruction using hamstring grafts participated in the study. We investigated incidence, mechanism, and patient characteristics of ACL graft retears. Mann-Whitney <it>U </it>test was used for statistical analysis, and the level of significance was determined at <it>P </it>< 0.05.</p> <p>Results</p> <p>Six patients suffered from ACL graft retear (9.4%). Mean duration between primary ACL reconstruction and incidence of retears was 11.7 months. However, there were no other postoperative graft ruptures after 24 months. Primary injury and retear mechanisms varied by patient. At six months after the primary ACL reconstruction surgery, mean quadriceps and hamstring strengths were 81% and 87%, respectively, indicating favorable recovery of muscle strength. However, preoperative quadriceps and hamstring strength in the retear group were 65% and 71%, respectively. In particular, preoperative quadriceps strength in the retear group demonstrated a lower value than that in the uninjured group (<it>P </it>< 0.05).</p> <p>Conclusions</p> <p>We observed a high incidence of ACL graft retears in competitive female basketball players, as previously reported. Considering the timing of graft retear occurrences, an early return to playing basketball should be avoided following ACL reconstruction. Closer attention should be paid to player preoperative condition, as well as muscle strength and postoperative status.</p

An Overview of the Management of Flexor Tendon Injuries

Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor tendon surgery is another area, which has caused extensive debate in hand surgery. The trend to more active mobilisation protocols seems to be favoured but further study in this area is needed to find the protocol, which achieves function and gliding but avoids rupture of the tendons. Lastly despite success following surgery complications commonly still occur post surgery, including adhesion formation, tendon rupture and stiffness of the joints. Therefore, this review aims to discuss the appropriate management of these difficulties post surgery. New techniques in management of flexor tendon will also be discussed including external laser devices, addition of growth factors and cytokines

Augmentation of tendon attachment to porous ceramics by bone marrow stromal cells in a rabbit model

Tendon attachment to interconnected porous calcium hydroxyapatite ceramics (IP-CHA) with cultured bone marrow stromal cells (BMSC) was analysed. The purpose of this study was to evaluate whether BMSC in IP-CHA could augment the tendon attachment to IP-CHA histologically and biomechanically. Eighteen Japanese white rabbits were used. Cultured BMSCs were subcultured in IP-CHA. The grafted tendon and IP-CHA with BMSC complex were implanted in a bone defect of the knee [BMSC(+) group]. In the contralateral knee, a tendon and IP-CHA without BMSC complex were implanted [BMSC(-) group]. Histological findings of the interface between the tendon and IP-CHA were similar in the two groups 3 weeks after the operation. However, 6 weeks after the operation, more abundant bone formation around the tendon was observed in the BMSC(+) group. The direct apposition of the tendon to bone in pores and collagen fibre continuity between the tendon and fibrous tissue in pores were observed. In biomechanical evaluation, the maximum pull-out load of the tendon from the IP-CHA in the BMSC(+) group was significantly higher than that in the BMSC(-) group 6 weeks after the operation. BMSCs cultured in IP-CHA could augment tendon attachment to IP-CHA

The effect of graft choice on functional outcome in anterior cruciate ligament reconstruction

A prospective, randomised, 5-year follow-up study was designed to compare the functional results between patellar tendon and hamstring tendon autografts after anterior cruciate ligament reconstruction. Primary reconstruction was performed in 32 patients using the central third of the patellar ligament and in 32 patients using double-looped semitendinosus and gracilis tendons. All reconstructions were performed by a single surgeon, with identical surgical technique and rehabilitation protocol. Of the total 64 patients in the study, 54 (85%) were available for the 5-year follow-up. No statistically significant differences were seen with respect to Lysholm score, International Knee Documentation Committee (IKDC) classification, clinical and KT-2000 arthrometer laxity testing, single-legged hop test and anterior knee pain. Graft rupture occurred in two patients (8%) in the patellar tendon group and in two patients (7%) in the hamstring tendon group; 23 patients (88%) in the patellar tendon group and 23 patients (82%) in the hamstring tendon group returned to their pre-injury activity level. Good subjective outcome and stability can be obtained by using either graft; no statistically significant differences were found in functional outcome between the grafts

Sutura simples e âncora em quadris de coelhos Simple suture and anchor in rabbit hips

OBJETIVO: Por meio de ensaios biomecânicos, comparar as capsulorrafias com sutura simples e com âncoras, em quadris de coelhos. MÉTODO: Foram utilizados 13 coelhos, 26 quadris, todos machos da raça Nova Zelândia albinos (Oryctolaguscuniculus). Inicialmente, realizamos um projeto piloto em três coelhos (seis quadris). Este experimento constou de 10 coelhos, divididos em 2 grupos: o Grupo 1 submetido à capsulorrafia (quadris direito e esquerdo) com sutura simples utilizando fio absorvível de ácido poliglicólico e o Grupo 2 submetido a capsulorrafia (quadris direito e esquerdo) com âncora de titânio. Após o período de quatro semanas de operados, todos animais foram submetidos à eutanásia e seus quadris congelados. Após um descongelamento prévio das peças, no mesmo dia das análises biomecânicas, foram avaliados os parâmetros de rigidez, força máxima, deformidade máxima e energia. RESULTADOS: Não houve diferença estatisticamente significante em relação à força no limite de proporcionalidade, rigidez e força máxima entre os grupos com sutura simples e com âncora. CONCLUSÃO: Por meio dos ensaios biomecânicos, tendo como parâmetro a rigidez, a força máxima, a deformidade máxima e a energia, ficou demonstrado que as capsulorrafias em quadris de coelhos com sutura simples e com âncora são semelhantes entre si. Nível de Evidência II, Estudo Prospectivo Comparativo.<br>OBJECTIVE: Using biomechanical studies, this research aims to compare hip capsulorrhaphy in rabbits, carried out with two different techniques: capsulorrhaphy with simple sutures and with anchors. METHOD: Thirteen New Zealand Albino (Oryctolaguscuniculus) male rabbits, twenty-six hip joints, were used. First, a pilot project was performed with three rabbits (six hip joints). This experiment consisted of ten rabbits divided into two groups: group 1 underwent capsulorrhaphy on both right and left hips with simple suture using polyglycolic acid absorbable thread, and group 2 underwent capsulorrhaphy with titanium anchors. After a four-week postoperative period, the animals were euthanized and the hip joints were frozen. On the same day of the biomechanical studies, after the hip joints were previously unfrozen, the following parameters were evaluated: rigidity, maximum force, maximum deformity and energy. RESULTS: There was no relevant statistical difference in rigidity, maximum force, maximum deformity and energy between the simple suture and anchor groups. CONCLUSION: Through biomechanical analyses, using parameters of rigidity, maximum force, maximum deformity and energy, it has been shown that capsulorrhaphy with simple suture and with anchors has similar results in rabbit hip joints. Level of Evidence II, Prospective Comparative Study

Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction

This retrospective study compared the results after anterior cruciate ligament (ACL) reconstruction using a four-strand hamstring tendon graft (4SHG) versus Ligament Advanced Reinforcement System (LARS) artificial ligament in 60 patients between January 2003 and July 2004 with a minimum four-year follow-up. The KT-1000 examination, the International Knee Documentation Committee (IKDC) scoring systems and Lysholm knee scoring scale were used to evaluate the clinical results. The mean side-to-side difference was 2.4 ± 0.5 mm and 1.2 ± 0.3 mm in the 4SHG group and LARS group, respectively (P = 0.013). Although other results of ACL reconstruction, measured by IKDC evaluation, Lysholm scores and Tegner scores, showed using a LARS graft clinically tended to be superior to using a 4SHG, there were no significant differences calculated. Our results suggest that four years after ACL reconstruction using a LARS ligament or 4SHG dramatically improves the function outcome, while the patients in the LARS group displayed a higher knee stability than those in the 4SHG group

Recombined bone xenografts enhance tendon graft osteointegration of anterior cruciate ligament reconstruction

The objective of the study was to discover whether recombined bone xenograft (RBX), a porous solid material, could augment healing of the tendon-to-bone interface after anterior cruciate ligament (ACL) reconstruction. ACL reconstruction was performed bilaterally in 25 skeletally mature rabbits using long digital extensor tendon grafts. RBX was implanted into the treated knee, with the contralateral knee serving as control. Three rabbits were killed at postoperative weeks two, six and 12 for routine histology. The remaining 16 rabbits were killed at weeks six and 12, and their femur-graft-tibia complexes were harvested for mechanical testing. The treatment and control groups produced different histological findings at the interface between the tendon and bone. In the treatment group, large areas of chondrocyte-like cells were noted around the tendon-bone interface two weeks after the operation. At six weeks, more abundant bone formation was observed around the tendon. At 12 weeks, an immature neoenthesis structure was seen. In biomechanical evaluation six and 12 weeks after the operation, the ultimate strength of tendon in the bone tunnel was significantly higher in the treatment group than in the control group. RBX can augment the osteointegration of tendon to bone after ACL reconstruction