Dimitrios S. Mastrokalos

Donor Site Morbidity and Return to the Preinjury Activity Level After Anterior Cruciate Ligament Reconstruction Using Ipsilateral and Contralateral Patellar Tendon Autograft A Retrospective, Nonrandomized Study

Aim To compare the donor site morbidity after anterior cruciate ligament reconstruction using ipsilateral and contralateral bone–patellar tendon autograft. Study Design Cohort study; Level of evidence, 2 Patients and Method Between 1997 and 1999, 100 patients underwent anterior cruciate ligament reconstruction with autologous bone–patellar tendon graft. The reconstructions were performed using ipsilateral bone–patellar tendon graft in 52 patients (group Ip) and contralateral bone–patellar tendon graft in 48 patients (group Co). Group Co consisted of 2 subgroups: group Co-D consisted of the donor knees (n = 48) and group Co-ACL consisted of the anterior cruciate ligament–reconstructed knees (n = 48). Mean follow-up was 39.2 months. Donor site morbidity was evaluated with a questionnaire, computerized historical data, KT-2000 arthrometer measurements, the Cincinnati score, and the Tegner score. Results KT-2000 arthrometer evaluation showed a mean side-to-side difference of 0.6 mm in both groups. There were no significant differences between the 2 groups concerning the Cincinnati and Tegner scores. With regard to local tenderness, a significantly higher rate was found in group Ip (59.6%) and group Co-D (58.3%) compared with group Co-ACL (6.3%). In groups Ip and Co-D, high statistically significant differences were also found according to kneeling pain (69.2% and 70.8%, respectively) and knee-walking pain (76.9% and 70.8%, respectively) compared with group Co-ACL (6.3% and 10.4%, respectively). With regard to numbness, there was no statistical significance between the rates of all 3 groups: group Ip = 75%, group Co-D = 85.4%, and group Co-ACL = 64.6%. There was one rupture of the patellar tendon and one patient with chronic patellar tendinitis, both in the donor knee of group Co-D. Conclusion The contralateral bone–patellar tendon graft appears to present no advantage over the ipsilateral graft, as all symptoms concerning donor site morbidity are shifted from the injured into the healthy knee, and return to activity is not more rapid.

Endoskopisch assistierte perkutane Achillessehnennaht

| Der Unfallchirurg 10•2001 1020 Nachdem die Entscheidung gefallen ist,eine akute Achillessehnenruptur chirurgisch zu behandeln,sieht sich der Chirurg mit einer Vielzahl von Operationstechniken konfrontiert. Crolla et al. [2] fanden im Rahmen einer Literaturübersicht 60 verschiedene, veröffentlichte Operationstechniken. Die Vielzahl der praktizierten Techniken drückt nicht nur die chirurgische Kreativität für Verbesserungen aus, sondern reflektiert darüber hinaus auch die Angst vor einer möglichen Re-Ruptur. Um die typischen Komplikationsmöglichkeiten einer offenen Naht zu vermeiden, wurden verschiedene perkutane Operationsmethoden entwickelt [1, 3, 4, 5, 6, 7, 8]. Die perkutane Technik, welche durch Ma u. Griffith [8] eingeführt wurde, adressiert in erster Linie das Problem der Wundheilungsstörung der offenen Naht. Eine Modifikation dieser Technik nach Pässler [1] kombiniert die Vorteile der biologischen Sehnenreparatur der primär funktionellen Behandlung und der minimal-invasiven Operation, um die Adaptation der Sehnenstümpfe in der initialen Heilungsperiode zu stabilisieren. Pässler konnte hierdurch das Risiko der Wundheilungsstörung in seiner Serie der perkutanen „Rahmennaht-Methode“ nahezu vollständig eliminieren.Hierbei wird eine 1,3 mm dicke PDS-Kordel durch lediglich 5 kleine Stichinzisionen mit Hilfe einer Ahle perkutan geführt. Die Kordel verbindet die proximale Sehne mit der Insertion am Kalkaneus, kreuzt die Rupturstelle und funktioniert dadurch wie ein „interner Fixateur“. Ein weiterer Vorteil dieser minimal-invasiven Methode ist die Unversehrtheit des Paratenons, welches essenziell zur Sehnenheilung beiträgt. Das potenzielle Risiko einer Verletzung des N. suralis ist der schwerwiegendste Nachteil der perkutanen Operationstechnik [1, 5, 6, 8]. Eine Läsion des N. suralis muss im Zusammenhang mit der Achillessehnennaht als schwere Komplikation angesehen werden, da der Patient oftmals einen initialen, einschießenden Schmerz gefolgt von Taubheit beklagt. Unter diesen Umständen ist eine optimale funktionelle Nachbehandlung der Achillessehnennaht unmöglich. Die nachfolgende Methode wurde eingeführt um diese Komplikation zu vermeiden. Unfallchirurg 2001 · 104: 1020–1021

The Potentially Positive Role of PRPs in Preventing Femoral Tunnel Widening in ACL Reconstruction Surgery Using Hamstrings: A Clinical Study in 51 Patients.

Purpose. In this study, the early and midterm clinical and radiological results of the anterior cruciate ligament (ACL) reconstruction surgery with or without the use of platelet rich plasma (PRP) focusing on the tunnel-widening phenomenon are evaluated. Methods. This is a double blind, prospective randomized study. 51 patients have completed the assigned protocol. Recruited individuals were divided into two groups: a group with and a group without the use of PRPs. Patients were assessed on the basis of MRI scans, which were performed early postoperatively and repeated at least one-year postoperatively. The diameter was measured at the entrance, at the bottom, and at the mid distance of the femoral tunnel. Results. Our study confirmed the existence of tunnel widening as a phenomenon. The morphology of the dilated tunnels was conical in both groups. There was a statistical significant difference in the mid distance of the tunnels between the two groups. This finding may support the role of a biologic response secondary to mechanical triggers. Conclusions. The use of RPRs in ACL reconstruction surgery remains a safe option that could potentially eliminate the biologic triggers of tunnel enlargement. The role of mechanical factors, however, remains important.