Paper 285: Does Hamstring Intra- and Extra-Articular ACL Reconstruction Increase Osteoarthritis at long Term Follow-Up?

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  • IKDC scores were 24 and 28 in group S and D, respec-tively (p0.738).Conclusion: Double-bundle ACL reconstruction usingquadriceps tendon-bone autografts provided more satis-factory AP and rotational stability than single-bundleACL reconstruction.Key Words: Anterior cruciate ligament, Double-bundlereconstruction, Quadriceps tendon-bone autograft, Clin-ical outcomes

    Paper 284: Double Bundle Anterior Cruciate Liga-ment Reconstruction Using a Polylactide Carbonate(CALAXO) Osteoconductive Interference Screw ALANMJ GETGOOD, MBCHB, MRCS, DIPSEM, MFSEM(UK),UNITED KINGDOM, PRESENTING AUTHORMATTHEW EDWARD KENT, MBCHB MRCS (ENG), UNITEDKINGDOMALISON DICKINSON, UNITED KINGDOMTONY BHULLAR, UNITED KINGDOM

    ABSTRACTIntroduction: The purpose of this study was to describeour experience of the new Polylactide Carbonate (Cal-axo) Osteoconductive interference screw (Smith &Nephew) when used for both femoral and tibial graftfixation in Double Bundle ACL reconstruction.Methods: Since May 2006, patients with an ACL defi-cient knee were reconstructed using the Double Bundletechnique. All were followed prospectively and outcomedata collected.

    Evidence of fixation failure was established subjec-tively by clinical examination (Pivot Shift) and objec-tively via KT-1000 arthrometer.

    Following ethical approval, post-operative CT scans(immediate and 12-18 months) were performed on five (afurther 5 awaited) patients allowing assessment of tunneldimensions/fill.Results: Twenty nine patients (26 male, 3 female) witha mean age of 30 (range 18-47) were included. At lastfollow-up, no evidence of graft/fixation failure wasfound; KT-1000 mean side-side difference 1.4mm (range3 to 6). All patients had a positive pivot shift preop-eratively which was abolished postoperatively. Subjec-tive IKDC score was significantly improved with a meanof 76.27% (SD 17.38) at last review compared with54.02% (SD 17.86) preoperatively (t (22) 5.37,p0.05) One patient had a postoperative infection withno other complications reported. Radiologically thescrews did not show complete resorption in 2 cases, withsignificant tunnel widening found on 3 cases. Someevidence of new bone formation was noted but not foundto be significant.

    Discussion: We have shown satisfactory clinical resultswith use of the Calaxo screw when used in DoubleBundle ACL Reconstruction. However, radiologicallythe ostoeconductive properties of the screw shown in thepre-clinical animal model were not evident.

    This study helps illustrate that preclinical animal datacannot necessarily be translated into human practice.Surgeons should proceed with caution when using newbiological implants tested purely in animal models. Al-though we have not had any cases of the reported adverselocal soft tissue reaction associated with Calaxo, wesupport Smith & Nephews decision to withdraw thescrew from clinical use.

    Paper 285: Does Hamstring Intra- and Extra-Artic-ular ACL Reconstruction Increase Osteoarthritis atlong Term Follow-Up? MAURILIO MARCACCI, MD, ITALY,PRESENTING AUTHORSTEFANO ZAFFAGNINI, MD, ITALYFRANCESCO IACONO, MD, ITALYGIOVANNI GIORDANO, ITALYDANILO BRUNI, M.D., ITALYGIULIO MARIA MARCHEGIANI MUCCIOLI, ITALYMARIA PIA NERI, ITALY

    ABSTRACTBackground: We analyzed at a mean of 11 (10-13)years follow up the clinical and radiographic outcomesafter hamstrings intra ed extra-articular ACL reconstruc-tion.Hypothesis: We would prove that our technique main-tains good efficacy during time (11 years follow up) andthat the development of osteoarthritis is strictly con-nected with meniscectomies and lack of range of motion.Study Design: Case Series.Methods: We examined 60 consecutive patients oper-ated between 1993 and 1995, involved in sports at highlevel, aged more than 15 and under 50 years. The surgi-cal technique foresees the use of hamstring tendons withtibial insertions intact plus an extra-articular plasty (aug-mentation) performed with their remnant part. IKDC, KT2000, Tegner, Lysholm and subjective scores were usedfor clinical evaluation. Radiographic outcomes were alsoperformed.Results: After 11 years the IKDC showed good-excel-lent results (AB) in 90,7% of patients. KT 2000 dem-onstrated that only two patients had more than 5 mm oflaxity. Tegner mean score was 4,5, the mean Lysholm was97,3 and the mean subjective score was 90,0%. Elevenpatients underwent additional surgical procedure such asmeniscectomy and hardware removal. X-Ray evaluation

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  • demonstrated progressive degenerative changes only formedial meniscectomized patients.Conclusions: Long term results of our original tech-nique have demonstrated highly satisfactory results withno worsening of laxity and subjective score. Statisticalanalysis showed that factors affecting the outcomes arestrictly associated to meniscectomies and laxity. Thelateral augmentation permits maintenance of laxity alsoat long term follow up with single bundle hamstringsgraft, without increasing the risk of knee osteoarthritis onthe lateral compartment.

    Paper 286: The V Lesion: A Posteromedial Capsu-lar Tear of the Knee VICTOR MANUEL NAULA MERINO, MD,ECUADOR, PRESENTING AUTHORRAFAEL EDUARDO VARGAS, MD, ECUADORBOSCO MENDOZA, MD, ECUADORMARLON ALARCON, MD, ECUADORANGEL M. AUAD, MD, ECUADORMIGUEL ANGEL MITE, MD, ECUADORJORGE LUIS ARMIJOS, MD, ECUADORMARLON ALFREDO LAMA, MD, ECUADORFERNANDO LUZURIAGA JARAMILLO, MD, ECUADORSALOMON EFRAIN ZURITA, ORTHOPEDIC SURGEON, ECUADORDANILO ORELLANA, MD, ECUADORMANUEL LOPEZ, MD, ECUADOR

    ABSTRACTPurpose: To describe an arthroscopic find of the pos-teromedial capsule lesion of the knee that we named Vlesion, its treatment, and to present the results of 12cases.Type of Study: Case Series.Methods: Twelve patients (11 males, 1 female) withV Lesion, combined with ACL (6) and with ACL andPCL (2). The mean age was 25 years (range, 18 to 34years). All V Lesions were repaired by side to sideknot with magnum wire #2 (Opus Medical) with out-inside technique. The patients were assessed before sur-gery and at a mean follow up of 12.1 months (range 8months to 2 years) by a physical examination, LysholmII scores, knee range of motion and postoperative stressradiographs obtained with Telos device (Telos, Marburg,Germany).Results: Transoperative and postoperative physicalexamination revealed a reduction of the anterior andposterior drawer test and stress in valgus test: negativein all cases. In the patients with combined lesion(ACL, PCL) the stress in valgus continued positiveafter reconstruction and only became negative whenthe arthroscopic suture of the V Lesion was per-formed. On the Lysholm II knee scoring scale the

    score was excellent in 78% of the cases and good in22% of the cases. The postoperative stress radiographsat six months revealed improvement of the medial,anterior and posterior instability.Conclusion: Treatment of the instability of the kneemust be completed by repairing all lesions: anterior,posterior and medial. The side to side suture of theV Lesion improves the medial stability and candecrease the possibility of damage to ACL or PCLreconstruction.Level of Evidence: Level IV, therapeutic case series.

    Paper 288: 7-10 Years After ACL Reconstructionwith Special Emphasis on Quality of Life and Sub-jective Function. Patellar Tendon Graft vs. Quadru-ple Semitendinosus Graft: A Prospective Random-ized Controlled Trial BJRN BARENIUS, MD, SWEDEN,PRESENTING AUTHORMARTIN NORDLANDER, PT, SWEDENSARI PONZER, MD, PHD, SWEDENJAN TIDERMARK, MD, PHD, SWEDENKARL ERIKSSON, MD, PHD, SWEDEN

    ABSTRACTIn a two-centre RCT 1995 1997, 164 patients with

    anterior cruciate ligament rupture were randomised toarthroscopic reconstruction with Bone-Patellar tendon-Bone (BTB) or quadruple Semitendinosus tendon graft(ST). In previously published results after two years, thegroups showed equal results with no statistically signif-icant differences except better kneeling ability in the STgroup. Early reconstructed patients also tended to dobetter.Materials and Methods: In this 8,4 (7-10) year followup 153 patients were assessed by an independent ob-server, 75 ST and 78 P-BTB. Only 11 patients (7%) werelost to follow-up. The groups were equally distributedregarding age, height and weight. Follow up exami-nation included IKDC, Lysholm, Tegner activity levelscore, Patellofemoral pain score according to Werner,instrumental laxity and one leg hop test. In additionquality of life assessment and subjective function wasalso evaluated with SF 36 and KOOS (Knee Osteoar-thritis Outcome Score). All functional scores were selfassessed.Results: At follow up 10 patients reported a diagnosedrupture of the contra lateral ACL (3 ST and 7 P-BTB).Five of those had been reconstructed. Four patients hadbeen revised because of graft ruptures (2 BTB and 2 ST).Fourteen patients had meniscus surgery during the fol-low up period, (5 ST and 9 BTB). No significant differ-ences were found between the groups regarding laxity,

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