Shijun Gao

Second-Look Arthroscopic Evaluation and Clinical Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction with Autograft and Hybrid Graft: A Retrospective Study

Background Graft choice is very controversial. This study compared the second-look evaluation and clinical outcomes of anatomic ACL-R using a thin autograft versus a thick hybrid graft. Material/Methods Sixty-eight patients who had received ACL-R with hamstring autograft or autograft-allograft hybrid graft accepted second-look arthroscopy were grouped (autograft: n=31, age: 32.8±8.9, Male/Female: 16/15, and hybrid graft: n=37, age: 33.9±8.4, Male/Female: 27/10). Patients were evaluated with the functional score and KT-1000 test before reconstruction. The re-examination and second-look evaluation were performed at 2-year follow-up. Results were compared and further comparisons were made for grafts size >8.5 mm. Results The hybrid group showed thicker graft size and bigger graft occupancy (9.0±0.5 mm vs. 8.5±0.7 mm, P=.003; 80.1±7.0% vs. 69.9±6.9%, P<.001). KT-1000 test, subjective evaluation, and activity level scores increased significantly between pre- and post-reconstruction for both groups (P<.001). There was no significant difference of the second-look evaluation (Graft continuity, Tension and Synovial coverage) between groups. However, from those 2 groups, only grafts size >8.5 mm were selected and compared (autograft, n=16; hybrid, n=29). Graft tension and Synovial coverage showed a significant difference (P=.036 and P=.029). The Lysholm, IKDC, and KT-1000 test were significantly superior for the autograft than the hybrid graft (P=.036, P=.004, and P=.003, respectively). Conclusions A pure autograft is superior to a hybrid graft with same diameter in ACL-R because the augmenting allografts may be null and void. Therefore, a homogenous graft is recommended.

Medial collateral ligament reconstruction using bone-patellar tendon-bone allograft for chronic medial knee instability combined with multi-ligament injuries: a new technique.

BackgroundThe medial collateral ligament (MCL) is the main static stabilizer of the medial knee. The surgical treatment was recommended in cases with serious medial collateral ligament insufficiency combined with multi-ligament injuries and chronic symptomatic medial instability. Several surgical techniques have been described for the MCL reconstruction, while potential problems including donor site morbidity, complicated procedure, and high risk of femoral tunnel collision were reported. In order to minimize such potential limitations, we describe a new medial reconstruction technique for MCL injury using bone-patellar tendon-bone (BPTB) allograft.MethodsA longitudinal incision at the medial knee was made. The centers of femoral and tibial attachments were gained through repeated isometricity test. Then, the bone grooves were made around the femoral and tibial centers. The appropriate BPTB allograft was selected, and both ends were trimmed. The prepared bone blocks were embedded into the grooves and fixed with cancellous screws. The programmed rehabilitation exercises were performed after the operation.ResultsA strong graft and bone-to-bone healing on both femoral and tibial attachment sites were obtained, and femoral tunnel collision during multi-ligament reconstruction was avoided. Satisfactory valgus and rotatory stability were gained.ConclusionsThis novel MCL reconstruction technique using BPTB allograft can be safely performed, and the clinical outcome was favorable with satisfactory valgus and rotatory stability. More cases and additional follow-up results are needed to verify the overall effect of this technique.

Surgical Technique of Total Knee Arthroplasty without Soft Tissue Balance.

Total knee arthroplasty (TKA) without soft tissue balance can create a balanced knee to a mechanical axis of near neutral with bone cuts, and remove osteophytes thoroughly. In this study, the authors present detailed steps for performing TKA. The attached video demonstrates the TKA procedure. The patient is a 77‐year‐old man who had suffered from knee pain for 12 years. Physical examination showed the Apley test to be positive and that the range of motion (ROM) decreased. An X‐ray filmed at the positive lateral of the knee joint and the double lower extremity revealed a progression of degenerative osteoarthritis with genu varum. The key point of no soft tissue release is to make a rectangular extensional space by osteotomy. In addition, the osteophytes, especially syndesmophytes, should be removed thoroughly. As a result, the ligaments can achieve ideal length and the flexion contracture can also be remedied. Moreover, in surgeries without soft tissue release, bone mass and normal tissue are retained. Patients are satisfied to the surgery not only with less blood loss, anterior knee pain and DVT, but also faster rehabilitation. In summary, TKA without soft tissue balance is an efficient procedure for patients with knee osteoarthritis which can result in good prognosis.