bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Complications with Femoral Transcondylar Pin Fixation for ACL reconstruction
Authors: Kahlenberg Cynthia A. , Deshmane Prashant , Han Brian S. , Edwards Sara L. 
Published: September 2013

Objectives: Bioabsorbable transcondylar fixation has remained a popular femoral fixation option for anterior cruciate ligament (ACL) reconstruction using hamstring graft. We report the incidence of failure and complications related to this particular fixation device in a single surgeon consecutive series of 56 patients. Methods: Fifty-six consecutive arthroscopic ACL reconstructions using hamstring autograft done by single surgeon between March 2010 and Dec 2011 were reviewed retrospectively after IRB approval. Transcondylar femoral fixation was achieved using Bio-Transfix (Arthrex, Naples, FL) pin in all patients. Mean follow up was 18.2 months. Intra-operative and post-operative follow up data were reviewed to assess failure. Failure was categorized as either graft failure due to re-injury or implant related failure due to persistent pain at pin insertion site and/or pin breakage. Results: 13 (23.2%) patients were deemed as failures following surgery. Five patients needed revision surgery (persistent pain at pin insertion site n= 2, and pin breakage n=3). Two additional patients had a pin breakage and refused surgery and five additional patients had pain at the transfix pin site but opted for conservative treatment. One patient had a mid-substance graft failure due to sports injury unrelated to implant type. Remaining 43 patients did not report any symptoms of pain and or instability following surgery. Conclusion: This single surgeon consecutive series of ACL reconstruction using transcondylar pin fixation device demonstrates a slightly higher failure rate (23.2%) as compared to previous isolated reports of pin breakage or pain at insertion site in literature. Further radiographic studies are necessary to understand the natural history of osteointegration of this bio-device, such as implant thinning, tunnel widening by osteolysis, points of stress risers in implant and possible modification in routine accelerated rehabilitation following this implant as method for ACL reconstruction.
Comparison of Two Methods to Measure Return to Sports after Anterior Cruciate Ligament (ACL) Reconstruction
Authors: Yabroudi Mohammad A. , Muller Bart , Lai Chung-Liang , Andrew Lynch , Oostdyk Alicia , Fu Freddie H. , Harner Christopher D. , Irrgang James J. 
Published: September 2013

Objectives: Return to sports (RTS) is a primary goal for ACL reconstruction. Recent studies indicate that return to prior level of sports participation is poor with only 45% of patients having returned to sport.1 The purpose of this study was to evaluate return to pre-injury level of sports participation after ACL reconstruction using a strict comprehensive definition for RTS. Methods: Participants who were 1 to 5 years after ACL reconstruction completed a survey to determine their pre-and post-surgery sports activity levels. Comprehensive return to pre-injury level of sports (comprehensive RTS) was operationally defined as returning to the same type and frequency of sports and same Marx Activity Score (MAS) as before injury. Patients also answered a global question on whether they had returned to their pre-injury level of sports (global RTS). The International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) was used to compare symptoms and function between patients who did and did not meet comprehensive RTS criteria. Results: One hundred sixty eight participants (mean age, 28.8±10.9 years) completed the survey. Using comprehensive RTS criteria, 69 (41.1%) participants returned to their pre-injury level of sports. Based on the global RTS, 79 (47%) reported they had returned to their pre-injury level of sports. Fifty nine (74.7%) of the 79 individuals that reported global RTS met the comprehensive RTS criteria. Patients who met the comprehensive RTS criteria had fewer symptoms and better function based on the IKDC-SKF than those who did not (87.5±10.6 vs. 80.1±13.7, p<0.001). Of the 93 patients who did not meet comprehensive RTS criteria, 46 (49.5%) did not return because of fear of re-injury, 32 (34.4%) due to ongoing problems with their knee, 31 (31.3%) lacked confidence in the knee, 20 (21.5%) work or family obligations, and 6 (6.5%) were no longer eligible for participation in competitive sports. Conclusion: RTS is more common if based on a global RTS question than if measured by strict comprehensive criteria that combine return to the same type and frequency of sports and MAS. Patients who do not meet comprehensive RTS criteria demonstrate poorer function than those that do. A global rating of RTS may overestimate the true RTS rate by 25%. Fear of re-injury, ongoing knee problems, and lack of confidence play a greater role in preventing RTS than lifestyle changes. These issues need to be addressed to improve RTS after ACL reconstruction
ACL Revision Reconstruction
Authors: Gilmore Carl Jan , Hamann Joshua C. , Gaskin Cree M. , Carroll John Joseph , Hart Joseph M. , Miller Mark D. 
Published: September 2013

Objectives: Failure of ACL grafts poses a substantial challenge to both patient and surgeon. Recent studies regarding ACL revision have shown 24% of failures directly attributable to technical error. Previous mal-position of tunnels and anatomic constraints historically necessitate two stage revision including initial tunnel bone grafting followed by remote ACL reconstruction. Staged revision surgery has an inherently higher complication rate, often diminished outcomes and larger financial burden to the healthcare system. The objective of this study was to evaluate the outcomes of the senior author’s novel single staged technique for ACL revision reconstruction using allograft cloward-dowel type bone grafting of previous tunnels and immediate ACL reconstruction. Methods: Study Design: Case Series. We reviewed the charts of patients undergoing ACL revision surgery using the single stage technique from 2002-2012. We were able to contact and enroll 14 patients who had subsequent clinical evaluation including cruciate exam, KT 1000 arthrometry, subjective outcome scores and CT evaluation of bone graft incorporation at a mean of 22 months followup. Means and standard deviations were calculated for descriptive data summary. Results: At a mean follow up of 22.2 months (min 4.5mo), CT scans showed excellent graft incorporation in all patients as determined by an orthopaedic surgeon and musculoskeletal radiologist based on ≥75% integration. KT 1000 arthrometry showed mean side-to-side difference between operative and non-operative knees of 0.8mm, and there were no 2+ pivot shift exams in our series. Subjective measures showed mean VAS of 2.6 (SD 2.4), IKDC and KOOS scores were 61.7 (SD 21) and 72.2 (SD 22.1) respectively. Conclusion: As illustrated by previous studies, our data shows that revision ACL surgery tends to yield inferior subjective outcomes. However, despite the relatively low mean subjective outcomes scores in our series, the objective outcome measures were very good. We had no failures based on the MARS criteria for ACL revision, the allograft dowels fully incorporated in all patients, and the sided to side difference as measured by KT 1000 was within the range of normal for native knees. This illustrates that a single stage approach to ACL revision reconstruction using this technique yields good reproduction of ACL function. It also supports the use of allograft bone dowels and demonstrates their ability to act as partial fixation for ACL hardware and to integrate very well into the native bone as early as 4.5 months post operatively. Although ACL revision surgery poses a substantial challenge to both patient and surgeon, the ability to perform that surgery in a single stage, regardless of previous tunnel position, helps to limit the morbidity and cost of this procedure.
Biomechanical Evaluation of Knee Kinematics after ACL Reconstructions in Anatomic SB and DB - Technique with Additional Medial Meniscus Suture
Authors: Lorbach Olaf , Herbort Mirco , Engelhardt Martin , Kieb Matthias 
Published: September 2013

Objectives: Biomechanical evaluation of knee laxity after single- and double-bundle ACL reconstruction with additional medial meniscus suture. Methods: Kinematics of the intact knee were determined in 12 human cadaver specimens in response to a 134-N anterior tibial load (aTT) and a combined rotatory load of 10 Nm valgus and 4 Nm internal tibial rotation using a robotic/universal force moment sensor testing system. Subsequently, the ACL was resected following the creation of a bucket-handle tear of the medial meniscus. A standard repair of the medial meniscus was performed using 3 inside-out horizontal sutures. Finally, The ACL was reconstructed using an anatomic single-bundle (6) or double-bundle technique (6). Knee kinematics were determined following every sub-step. Results: Significant increase of aTT in the ACL-deficient knee was found with significant increase in the ACL-deficient knee with additional medial meniscal injury (p=.003; p=.009). ACL reconstructions significantly decreased aTT compared to the ACL-deficient knee. No significant differences were found between the intact knee and the ACL reconstructed knee with additional meniscal repair. In response to a simulated pivot shift, aTT in the intact knee significantly increased in the ACL-deficient knee as well as in the meniscus injured/meniscus-sutured knee (p=.003;p=.007). No significant differences were found between the ACL-deficient and ACL reconstructed knee with additional meniscal repair. SB as well as DB ACL reconstruction with additional medial meniscal repair restored knee kinematics compared to the intact knee. Comparison of SB versus DB ACL reconstruction did not reveal any significant differences neither in a simulated Lachman test nor in response to a simulated pivot shift (p=.05). Conclusion: aTT as well as aTT in response to a combined rotatory load significantly increased with ACL deficiency compared to the intact knee, additional medial meniscal injury further increased aTT. Anatomic ACL reconstruction with medial meniscal repair restored knee kinematics compared to the intact knee. Comparison of anatomic SB vs. DB ACL reconstruction with additional repair of the medial meniscus did not reveal significant differences in aTT as well as aTT under a combined rotatory load.
Osteochondral Allografting for Knee Lesions in the Pediatric and Adolescent Population
Authors: Pennock Andrew T. , Murphy Ryan T. , Bugbee William 
Published: September 2013

Objectives: Osteochondral allografting is a useful reconstructive procedure for large ostechondral lesions of the knee. The purpose of this study was to evaluate the clinical outcome of osteochondral allografting in pediatric and adolescent patients. Methods: This IRB-approved study evaluated 39 patients (43 knees) less than 18 years of age who underwent osteochondral allografting between 1983 and 2010. The mean age was 16.4 years (range, 11.1 to 17.9) and 61% were male. The etiology of the lesions were osteochondritis dissecans in 26 knees (60.5%), avascular necrosis in 7 (16.3%), traumatic chondral injury in 6 (14%), degenerative chondral lesion in 2 (4.7%), and fracture in 2 (4.7%). Thirty-four patients (79%) underwent an average of 1.5 previous surgeries on the operative knee. Surgery was preformed using either a dowel or shell technique with fresh allograft tissue. The mean graft area was 8.4 cm2 (range, 2.2 to 20.8). The majority of grafts (76.7%) were located on the femoral condyle. Function and pain were assessed preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score, the Knee Society function (KS-F) score, and the modified Merle d’Aubigné-Postel (18-point) scale. Postoperative assessment included patient satisfaction, reoperations, and allograft survivorship. Failure was defined as any further procedure that resulted in removal of the allograft. Results: The mean follow-up was 8.4 years (range, 1.7-27.1). The IKDC score improved from 42 to 75 and the KS-F score improved from 69.3 to 89.4 (both p<0.05). Using the modified Merle d’Aubigné-Postel (18-point) scale, 87.5% of patients had a “good” or “excellent” score postoperatively, compared to 17% preoperatively. Patient satisfaction was 88.6%. Sixteen of 43 knees (37.2%) had reoperations following the allograft surgery. Kaplan-Meier survivorship was 92.9% at 5 years and 89.8% at 10 years. Five failures (11.6%) occurred, which were all salvaged with revision allografting. Conclusion: Osteochondral allografting was successfully employed to treat complex knee chondral and osteochondral pathology in patients less than 18 years of age. This procedure yielded improved function, decreased pain, and high satisfaction at an average follow-up of 8 years. Failure rates were relatively low, and when they did occur, were successfully revised with a second allograft procedure.
A Predictive Factor in Osteochondritis Dissecans
Authors: Sikka Robby Singh , Wechter John Francis , Alwan Mujtaba , Tompkins Marc 
Published: September 2013

Objectives: Knee alignment is thought to have some bearing on the development of osteochondritis dissecans (OCD) lesions.1 The effect of proximal tibial morphology on the risk of OCD, however, is unknown. The purpose of this study was to evaluate proximal tibial morphology and its relationship to OCD lesions. The null hypothesis was that patients with OCD lesions would have no difference in medial and posterior tibial slope when comparing the affected side to the unaffected side and age matched controls. Methods: Using CPT codes, we identified 61 patients with unilateral OCD lesions of the medial femoral condyle seen at our institution from 2005-2010. On plain radiographs, medial tibial slope and posterior tibial slope were assessed by 2 residents and 1 attending. (Figure 1) Measurements were completed on affected, contralateral normal, and control knees. The controls were height, weight, and gender matched. In addition, a comparison was made between OCD patients requiring surgery and those without surgery. Inter-observer reliability for each measurement was determined using intra-class correlation coefficients (ICCs). A student’s t-test was used to compare the results of the affected and normal sides. Results: The average patient age was 15.1 years. There were 31 right-sided lesions and 30 left- sided lesions. Medial tibial slope of the affected knee averaged 67.81 ± 3.92 (ICC(2,1) =.771, p<.01) compared to 69.44 ±3.63 (ICC(2,1) =.785, p<.01) for the normal side (p=.0070). The average posterior tibial slope for the affected knee was 80.03 ± 3.91 (ICC(2,1) =.783, p<.01) and 79.62 ± 4.37 (ICC(2,1) =.844, p<.01) for the normal side (p=.19). Matched controls had an average medial tibial slope 68.73° ± 5.81° (ICC(2,1) =.732, p<.01) which was statistically different from affected knees (p=.043). Matched controls had an average posterior tibial slope 81.13° ± 2.90° (ICC(2,1) =.797, p<.01), which was also statistically different from affected knees (p=.0068). Thirty-one patients with OCD lesions had undergone surgery while thirty patients were treated non-operatively. In the operative group, the average medial tibial slope was 69.17° ± 4.64° and the average posterior slope was 76.94° ± 3.55°. The nonoperative group had significantly different values, with a medial slope 66.66° ± 9.04 and posterior slope 80.28° ± 3.77. (p=.040 and.0071). Conclusion: For medial OCD lesions, the affected knee had a greater medial tibial slope than the unaffected knee. When compared to matched controls, affected knees had a greater medial and posterior slope. In addition, patients who required surgery for the OCD lesion had greater medial and posterior slopes than did patients who did not require surgery. Future studies will be necessary to determine if these differences are clinically significant.
Acute Complications of Pediatric and Adolescent Knee Arthroscopy
Authors: Ashraf Ali , Christophersen Christy Marie , Hunter Lindsay , Dahm Diane Lynn , McIntosh Amy L. 
Published: September 2013

Objectives: Arthroscopic knee procedures are commonly performed in pediatric/adolescent patients. Reported complications following these procedures are low, however, no childhood specific data exists. Therefore, the purpose of this study is to determine the acute complications (within 6 months) of arthroscopic knee procedures in patients aged 17 years or less. Methods: This is a retrospective review of patients aged 17 years or less who underwent an arthroscopic knee procedure from 1997 to 2009 at a single institution. Demographic and surgical data was collected, in addition to specific data on intra-operative and post-operative complications. Minor complications included peripheral nerve block failure, regional anesthesia failure requiring conversion to general anesthesia, superficial wound infection/dehiscence, persistent knee effusion requiring aspiration, and sensory nerve dysesthesia. Major complications included death, major medical complication, septic arthritis, wound requiring repeat closure, arthrofibrosis, equipment failure, and revision surgery. Results: 1015 patients (555 males (54.7%), 460 females (45.3%)) with average age 15.3 (range 4-17) years were analyzed. The average operative time was 133.9 minutes (range 14-520). 467 (46%) underwent ACL reconstruction, 465 (45.8%) underwent synovectomy, treatment of an OCD lesion, meniscal treatment, or lateral release, 52 (5%) had a medial patellofemoral ligament reconstruction +/- tibial tubercle transfer, 17 (1.7%) arthroscopic fixation of a tibial eminence fracture, and 14 (1.4%) other ligament reconstruction. There were 147 (14.5%) total complications recorded. Major complications occurred in 21 (1.4%) of patients and minor complications in 126 (12.4%) of patients. Major complications included: intra-articular instrument breakage in 1(0.098%), septic arthritis in 4 patients (0.394%), 9 wounds requiring repeat closure (0.886%), arthrofibrosis in 5 patients (0.492%), unplanned subsequent surgical procedure in 3 patients (0.002%), and death in 1 patient (0.098%). 2 patients were readmitted to the hospital (1 DIC, 1 a-fib and syncope). There were no pulmonary emboli or DVTs, and no vascular injuries. No patients developed CRPS. Minor complications included:5 patients (0.492%) sensory nerve paresthesias, 10 (0.985%) patients with failed regional anesthetic, 16 (1.57%) patients with post-operative pain pump that required early discontinuation, 18(1.77%) patients with superficial wound infection/irritation, 60 (5.91%) patients with persistent effusion/hemarthrosis requiring arthrocentesis, and 17(1.67%) patients had medical problems that required intervention (asthma exacerbation, urinary retention). Conclusion: Major complications following knee arthroscopy in children and adolescents are relatively low 1.4%. Minor complications are more common (12.4%) but did not alter the post-operative course or recovery. DVT, PE, and CRPS did not occur in this patient cohort.
Anatomical Dissection and CT Imaging of the Anterior Cruciate and Medial Collateral Ligaments in Skeletally Immature Cadaver Knees
Authors: Shea Kevin G. , Polousky John , Jacobs John C. , Ganley Theodore J. 
Published: September 2013

Objectives: Combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are increasingly recognized in skeletally immature patients. Although most MCL injuries heal, some may require reconstruction. The purpose of this study was to identify the origin and insertion of the ACL and MCL, and determine the attachment locations in relation to the physes in skeletally immature knees. Methods: Seven skeletally immature cadaver knee specimens were dissected. These specimens were divided into two groups: Infants (ages-1, 11, and 11 months), and Children (ages 8, 10, 11, and 11 years). Metallic markers were placed at the midpoint of the femoral origins and tibial insertions of the ACL and MCL. CT scans with 1mm slices were obtained for each specimen and were analyzed using Osirix Imaging Software. The distance from both the ACL and MCL femoral origin midpoints to the distal femoral physis was measured. The distance from the ligaments’ insertion midpoints to the proximal tibial physis was measured. Results: The mean distance from the ACL origin midpoint to the femoral physis was 0.63 cm (0.58-0.68 cm) and 0.85 cm (0.75-0.97 cm) distal to the physis for infants and children, respectively. The mean distance from the MCL origin midpoint to the lowest point of the femoral physis was 0.78 cm distal to the physis for one infant. For 2/3 children, this measurement was 0.60 cm distal to the physis, and 0.37 cm proximal to the physis for one child. In three specimens, this measurement could not be taken. The mean distance from ACL insertion midpoint to the proximal tibial physis was 0.39 cm (0.62-1.15 cm) and 1.74 cm (1.46-2.15 cm) proximal to the physis for infants and children, respectively. The mean distance from the MCL insertion midpoint to the tibial physis was 0.76 cm (0-2.28 cm) and 3.52 cm (2.29-4.60 cm) distal to the physis for infants and children, respectively. Conclusion: Pediatric cadaver tissue is very difficult to obtain for research, and many anatomic studies in skeletally immature patients are based on MRI sequences. This cadaveric dissection with CT scan clarifies the location of the ACL and MCL with respect to the femoral and tibial physes. This information may be useful to help surgeons avoid physeal injury during ACL/MCL reconstructions in skeletally immature patients.