P. Meleán

Magnetic Resonance Imaging Evaluation of the Integration and Maturation of Semitendinosus-Gracilis Graft in Anterior Cruciate Ligament Reconstruction Using Autologous Platelet Concentrate

PURPOSE To evaluate integration and maturation of semitendinosus-gracilis (STG) grafts in anterior cruciate ligament (ACL) reconstruction with magnetic resonance imaging (MRI) in patients who underwent ACL reconstruction with STG with and without autologous platelet concentrate (APC). METHODS A randomized single-blinded evaluator prospective study was performed in 2 consecutive series of patients who underwent reconstruction over a 14-month period: 30 with APC use (group A) and 20 as control subjects (group B). At 6 months, an MRI evaluation was performed, with observation of the grafts maturation and presence or absence of synovial fluid at the tunnel-graft interface. To facilitate interpretation, a scoring scale was designed to evaluate graft integration and maturation. RESULTS Regarding the presence of synovial fluid at the bone-graft interface, the test was negative in 86.84% of patients in group A and 94.74% in group B. A disorganized autograft signal pattern was found in 2.63% in group A and 5.26% in group B. Signal intensity was considered hypointense in 63.16% in group A and 42.11% in group B, isointense in 34.21% in group A and 52.63% in group B, and hyperintense in 0% in both groups. The final mean score was 4.45 points in group A and 4.2 points in group B (P ≥ .05). Poor integration was found in 2.63% in group A and 5.26% in group B (P = .214). Good integration was found in 97.37% in group A and 94.74% in group B (P = .784). CONCLUSIONS In our consecutive series of patients who underwent ACL reconstruction with STG grafts, 1 group with intraoperative APC use versus a control group, followed up by MRI at 6 months after reconstruction, we did not find any statistically significant benefit in the APC group in terms of integration assessment and graft maturation (ligamentization). LEVEL OF EVIDENCE Level III, case-control study.

Clinical outcomes after arthroscopic treatment of knee osteoarthritis.

PURPOSE The aim of this study was to describe the clinical outcomes of patients with knee osteoarthritis (OA) treated with arthroscopic surgery, documenting the associated injuries and defining the type of treatment selected for OA patients with different symptoms. HYPOTHESIS Knee arthroscopy is effective for treating patients with symptomatic OA and mechanical symptoms. METHODS This was a prospective, consecutive series of 100 patients with a clinical and radiological diagnosis of OA who were treated with knee arthroscopy. The average follow-up time was 35.9months (25-71), and the average age was 60.1years (50-83). INCLUSION CRITERIA >50years of age, a clinical imaging diagnosis of knee OA with an Ahlbäck I-III classification. EXCLUSION CRITERIA <50years of age, Ahlbäck IV, pathologic lower limb mechanical axis and inflammatory joint diseases. The IKDC and Lysholm scores were assessed before and after surgery. RESULTS The preoperative average scores were as follows: Lysholm, 56.9±13.5 points (22-71); IKDC, 59.4±21.7 points (45-80). The postoperative average scores were as follows: Lysholm, 86.9 points (22-87); IKDC, 79.5 points (45-100). Regarding the Lysholm scores, 76% were good and excellent results and 24% were moderate (p=0.045). The associated injuries included 48% of chondral and 36% of unstable meniscal injuries. Good or excellent results were observed in 76% of the meniscal injury cases according to the Lysholm scores, while only 84.6% of the cases with unstable chondral lesions had good or excellent results (p=0.035). CONCLUSION Most patients with knee OA associated with unstable cartilage or meniscal injuries reported good-to-excellent symptomatic results at the short- and mid-term follow-ups. LEVEL OF EVIDENCE III.

Osteochondral autografts in full thickness patella cartilage lesions

The purpose of this study was to evaluate clinical, functional and imaging results of full thickness patella cartilage lesions treated with osteochondral autografts (OCA). We studied a consecutive case series of 10 patients. At follow-up, Lysholm and International Knee Documentation Committee (IKDC) scores were obtained. Magnetic resonance imaging (MRI) evaluation was performed at an average of 8 months post-op. The average cartilage lesion area was 1.2 cm(2). An average of 1.9 grafts was used per patient. The average Lysholm scores were: pre-op 73.8±8.36; post-op 95±4.47 points (p<0.05). The average IKDC post-op score was 95±1.74 points. No postoperative complications were registered. In the MRI analysis we found that in all cases, OCA presented flush characteristics when compared with adjacent cartilage. The majority of cases presented no fissures in the graft-receptor interface (60%). In 80% we observed mild bone marrow edema around the graft. According to the International Cartilage Research Society (ICRS) cartilage lesions classification, all grafts were considered 1A; in the periphery cartilage was classified as 1A in 60%. We conclude that patellar OCA is a good alternative for the treatment of full thickness patellar cartilage lesions, offering good clinical, functional and imaging results at midterm follow-up.

Effect of tendon tensioning: An in vitro study in porcine extensor tendons

Graft tensioning is a controversial issue in anterior cruciate ligament reconstruction (ACLR) that has not achieved consensus between peers. The purpose of this study is to determine if after tensioning tendon length and resistance to maximal load changes. We performed an in vitro study with 50 porcine extensors tendons. The first group (P=25) was tensioned with 80 N (19.97 lb) for 10 min, using an ACL graft preparation board. The second group (C=25) was used as control and was not tensioned. The average initial (groups P and C) and post tensioning tendon length (group C) were measured; the average initial and post tensioning tendon diameter were measured as well. All samples were fixated in a tube-clamp system connected to a tension sensor. The samples were stressed with continuous and progressive tension until ultimate failure at maximum load (UFML) occurs. The initial mean length was: P before tensioning=13.4 mm+/-1.4 mm (range 10.5-16.5); P after tensioning=13.8 mm+/-1.4 mm (range 11.5-16.5); C=13 mm+/-1.35 mm (p=0.005). The mean diameter was: P=5.6 mm (4.5-6); C=5.5 mm (range 4.5-6) (p>0.05). The UFML was: P=189.7 N (114-336); C=229.9 N (143-365) (p=0.029). Tendon tensioning with 80 N for 10 min produced 3% average elongation. These could be beneficial in ACLR since tendon tensioning decreases elongation of the graft after fixation. Regardless, tendon tensioning is not innocuous since it diminishes their resistance when continuously stressed until complete failure occurs.

Steroids and Platelet-Rich Plasma as Coadjuvants to Microfracture for the Treatment of Chondral Lesions in an Animal Model Can the Healing Be Enhanced?

Objective: The aim of this study was to evaluate the contribution to hyaline cartilage regeneration of the microfracture (MFx) technique plus intraarticular betamethasone (BMS) or platelet-rich plasma (PRP). Design: Full-thickness chondral defects of 3 × 6 mm2 were surgically performed in both femoral condyles of each knee in 13 New Zealand rabbits and then treated with MFx associated with intraarticular BMS or PRP. At 12 weeks postimplantation, the animals were killed and the condyles were characterized macroscopically, molecularly according to collagen type II and I gene expression (quantitative reverse transcriptase–polymerase chain reaction), and histologically (hematoxylin–eosin staining). For the latter, samples were scored using the International Cartilage Repair Society visual histological scale. Data of MFx/BMS-treated and MFx/PRP-treated condyles were compared against untreated, MFx-treated, or normal condyles without lesions. Results: Our macroscopic findings showed that in MFx/BMS-treated and MFx/PRP-treated groups, the defects were filled with an irregular, partially rough tissue similar to the MFx-treated group. No differences in the ratio between collagen type II versus collagen type I expression were observed among groups. Histological changes were observed between MFx/BMS-treated and MFx/PRP-treated groups versus untreated defects mainly in surface regularity and cell distribution. However, International Cartilage Repair Society score analysis did not support statistical differences between MFx/BMS-treated and MFx/PRP-treated groups versus MFx-treated group. Conclusions: These results provide evidence that the use of intraarticular BMS or PRP as coadjuvants to the microfracture technique in the treatment of acute chondral lesions is not associated with a significant improvement of hyaline cartilage regeneration.

Réplica a: Utilidad de la resonancia magnética en la evaluación del mal alineamiento patelar

In relation to your comment, I fully agree that the routine use of magnetic resonance imaging in the study of anterior knee pain can increase the expenditure of healthcare systems. Nevertheless, the article does not aim to establish the use of magnetic resonance imaging as a dogma or guideline; rather, the intention is to assess the usefulness of this test in the diagnosis of patellar malalignment. The