We used our database to evaluate the locations of meniscal tears associated with anterior cruciate ligament injuries. Five hundred seventy-five meniscal tears were seen in 476 patients. Each tear was categorized prospectively according to the side (medial/lateral), the radial zone of the tear, and the circumferential zone of the tear. The different tear locations were then compared for the medial and lateral menisci and evaluated for statistical significance. We found a nearly equal number of tears on the medial (305) and lateral (270) sides. A significantly greater number of tears on the medial side as compared with the lateral side were posterior (99.4% versus 87.8%) and peripheral (75.4% versus 44.1%). Peripheral posterior horn tears of the medial meniscus were the most common type of tear (230 of 575, 40%) by a statistically significant amount.
In this study population, younger patients (≤25 years) demonstrated a higher failure rate compared with the over-25 age group. A statistically significant difference was not found in terms of graft size and activity level correlating with failure rate in ACL reconstruction with hamstring autograft.
Allograft bone-patellar tendon-bone advantages include quicker return to sporting activities; disadvantages include increased laxity and higher incidence of failure. The advantage of autograft bone-patellar tendon-bone is that it appears to be a tighter graft. The authors found that allograft was not a superior graft source in this patient population, leading them to offer both options.
Reconstruction of the anterior cruciate ligament using a hamstring tendon autograft has often been recommended for female athletes. We compared the results of acute, isolated, intraarticular anterior cruciate ligament reconstructions using quadruple-looped hamstring autografts in 39 female and 26 male patients. All reconstructions were performed by the same surgeon using a similar surgical technique and the same postoperative management. In each case, patients had Endobutton femoral fixation and either post or button fixation for the tibial side. The average follow-up was 40.9 months for women and 39.0 months for men. Objective analysis of results included examination for the presence of effusion and crepitus, Lachman and pivot shift testing, and KT-1000 arthrometer testing for side-to-side differences. Subjective analysis consisted of a 15-item visual analog scale completed by patients postoperatively, and pre- and postoperative Tegner and Lysholm scores. The clinical failure rate was 23% (9 of 39) for the female patients and 4% (1 of 26) for the male patients, which was statistically significant. There was also a trend toward increased laxity in female patients. Subjectively, the women also reported a higher frequency and intensity of pain. Based on Tegner activity levels, more of the men returned to their preinjury level of activity than did the women. When compared with the male patients, female patients had a significantly higher failure rate after reconstruction.
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