The aim of this study is to present a surgical augmentation technique for partial ACL ruptures in which an isolated, autologous, double-bundle semitendinosus tendon graft is passed over the top of the femur, thus fully preserving the still-intact fibers of the ligament remnant. Between 1992 and 2006, 24 patients underwent ACL semitendinosus autograft reconstruction and were followed up for at least 2 years. The median follow-up was 6.2 years (2-15.6). At the last follow-up examination, the patients were evaluated using the International Knee Documentation Committee scale. Subjective and functional parameters were assessed using the Tegner activity scale and the Lysholm scale. Instrumental evaluation was carried out using the KT-1000 instrument. Sixteen of the 24 patients achieved an IKDC score of A. Of the remaining eight patients, six achieved an IKDC score of B, one an IKDC score of C, and one an IKDC score of D. According to the Tegner activity scale, the median pre-injury sports activity level was seven (5-9) and the median post-injury level was six (4-9), while the mean Lysholm scale score was 95 (90-100). Clinical and biomechanical studies have shown that reconstruction techniques that address both bundles of the ACL provide better rotational stability than techniques that address only a single bundle. Therefore, it seems logical than in patients with a partial rupture of the ACL, the intact bundle could be preserved and only the torn bundle would need to be reconstructed.
In a porcine model of a repaired posterior meniscal root subjected to cyclic loads representative of current rehabilitation protocols in the early post-operative period under restricted loading conditions, suture cutout was not found as a main source of permanent root displacement when using suture thread or tape. Suture cutout progression started at high loading levels close to the ultimate load of the construct. Tape, with a meniscus-suture contact area larger than thread, produced higher ultimate load.
Treatment of posterior meniscal roots tears evolved after biomechanical evidence of increased pressures on the tibiofemoral cartilage produced by this lesion and the subsequent accelerated development of arthritis or osteonecrosis observed clinically. However, little is known about the consequences of the detachment of the anterior roots. This in-vitro study analyzes the biomechanical changes in the tibiofemoral joint caused by avulsion of the anterior root of the lateral meniscus. The effectiveness of surgical root re-insertion to restore the pre-injured conditions is also evaluated. Using cadaveric knees at flexion angles from 0° to 90°, results show that the lesion significantly reduces the contact area and raises the pressure on the tibiofemoral cartilage of the injured compartment at all angles. Said modifications become larger at low flexion angles, which are the most frequent positions adopted by the knee in daily and sports activities, where they result similar to total meniscectomy. In-situ repair partially restores the contact biomechanics. Consequently, careful attention should be paid to proper diagnosis and treatment of detached anterior roots since the observed altered knee contact might induce similar degenerative problems in the cartilage as with completely detached posterior roots.
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