Thomas R. Carter

Functional postoperative treatment of Achilles tendon repair

Twenty-one patients with surgically repaired Achilles tendon tears that were treated postoperatively with a functional orthosis rather than routine cast immobiliza tion were evaluated. The orthosis allowed unrestricted plantar flexion and limited dorsiflexion to neutral. Toe- touch weightbearing crutch ambulation was allowed immediately and was gradually increased over the 6 to 8 weeks of treatment. Of the 21 patients, 14 were men and 7 were women; the average age at injury was 35.6 years (range, 19 to 65). The minimum followup was 2 years, with an average of 31 months. The repairs were acute in 18 of the patients and chronic in 3. Subjectively, 16 patients felt they returned to their preinjury level of activity and only 1 was not satisfied with his result. Objectively, there were no significant alterations in ankle range of motion when compared to the contralateral limb, with plantar flexion unchanged and dorsiflexion increased an average of only 2°. The average plantar flexion and dorsiflexion strength, power, and endurance of the ankles as measured by isokinetic testing revealed no significant differences when comparing the operated leg to the nonoperated side: strength, 99% and 93%, respectively; power, 98% and 96%, respectively; and endurance, 93% and 91 %, respectively. The angles at which the peak torques occurred were similarly not statistically different. Two patients had superficial wound infections, and 1 had scar adherence of the skin to the tendon. No one had rerupture of the tendon. In conclusion, while the many benefits of postopera tive early motion are well proven, there has been hesi tation to implement this after Achilles tendon surgery due to the concern of compromising the repair. As shown by this study, early controlled motion can safely and effectively be used following Achilles tendon repair in the motivated, reliable patient.

Radiofrequency Electrothermal Shrinkage of the Anterior Cruciate Ligament

The efficacy of electrothermal collagen shrinkage in the treatment of patients with anterior cruciate ligament laxity was evaluated. Eighteen patients who had continuity of the anterior cruciate ligament but had symptomatic laxity were treated with arthroscopic electrothermal shrinkage of the anterior cruciate ligament using a monopolar radiofrequency probe. The mean length of follow-up in patients whose stability was maintained was 20.5 months. Seven of the patients had undergone previous reconstruction, four with patellar tendon graft and three with quadrupled hamstring tendon graft. Laxity was chronic in nine patients and acute in nine. The KT-1000 arthrometer results at 1 month postoperatively revealed decreased anterior excursion, with an average side-to-side difference of 1.9 mm. However, 11 patients had a failed result at an average 4.0 months. Of the seven patients with successful results, six had native ligaments and had been treated for acute laxity and one had a patellar tendon graft and had been treated for chronic laxity. Even with the short-term follow-up in our study, it is evident that thermal shrinkage using radiofrequency technology has limited application for patients with anterior cruciate ligament laxity. Although it may be useful in treating patients with an acutely injured native anterior cruciate ligament, further study is needed to see if the ligament stretches out over time or is at increased risk of reinjury.

High failure rate for electrothermal shrinkage of the lax anterior cruciate ligament: a multicenter follow-up past 2 years.

PURPOSE The purpose of this study was to prospectively evaluate the midterm results (beyond 2 years) of thermal shrinkage on both lax native anterior cruciate ligament (ACL) and lax reconstructions and determine the effectiveness of this procedure. METHODS This is a multicenter study in which 64 patients from 2 sites underwent electrothermal shrinkage for a lax ACL, both native and previous reconstructions. They were followed up past 2 years with KT-1000 measurements (MEDmetric, San Diego, CA). Failure criteria included subsequent operations for instability or KT-1000 measurements greater than 5 mm. Three patients were lost to follow-up. RESULTS Among the 61 patients followed up past 2 years, failure occurred in 31 (50.8%). The failure rate for lax grafts alone was 78.9%, and there was a failure rate of 38.1% for lax native ligaments. CONCLUSIONS Electrothermal shrinkage of lax native or reconstructed ACLs is not an appropriate treatment.

Anterior cruciate ligament thermal shrinkage.

Heat has been used as a therapeutic form of treatment in the field of medicine since ancient times. Electrothermal energy delivered by radiofrequency has the advantages of being able to be used by even the casual arthroscopist and being relatively inexpensive. One of the expanded uses is treating ligament laxity, including the anterior cruciate.

Allograft Anterior Cruciate Ligament Reconstruction in Patients Younger than 25 Years.

Purpose The purpose of this study was to evaluate the outcomes for patients younger than 25 years who had anterior cruciate ligament (ACL) reconstructions with allograft tissue. Methods A total of 52 ACL reconstructions performed with fresh-frozen, nonirradiated tibialis or Achilles allografts in active patients younger than 25 years. Outcome evaluations included the International Knee Documentation Committee (IKDC) objective and subjective forms, KT-1000 arthrometry and Lysholm. Results Forty-two patients were available for follow-up at an average follow-up of 65 months (range, 33-99 months). The average age at surgery was 17 years and 7 months (range, 11 years 10 months-24 years 8 months). Objective and subjective data were obtained from 37 patients with 1 requiring revision, and 5 patients had only subjective data. IKDC objective results were 29-A and 5-B. KT-1000 differences were 0 mm for 4 patients, 1 mm for 23, 2 mm for 8, 3 mm for 1, and > 5 mm for 1 patient. The average IKDC subjective score was 90.2 ± 15.0 and average Lysholm score was 90.0 ± 11. Conclusion The result of our study found that using nonirradiated Achilles or tibialis tendon allografts for ACL reconstructions in active patients younger than 25 years can achieve good outcomes, with a low rate of failure.