Apparent regeneration of the tendons of the semitendinosus and gracilis muscles after their use for anterior cruciate ligament reconstruction was noted during routine follow-up of 225 patients. From this group, four patients were selected for thorough examination, including magnetic resonance imaging, electromyographic studies, strength testing, and clinical examination. The results demonstrate that these tendons appear to regrow and are probably functional.
The collateral circulation of ischemic limbs can be augmented and regulated by a connection to an extracorporeal centrifugal pump, with isolation from the systemic circulation provided by balloons and with an access system providing repeatable pump connections. Major amputation may be avoided in selected cases.
ObjectiveInvestigate MRI evidence of anterior cruciate ligament (ACL) healing, patient-reported outcomes and knee laxity in patients with acute ACL rupture managed non-surgically with the Cross Bracing Protocol (CBP).MethodsEighty consecutive patients within 4 weeks of ACL rupture were managed with CBP (knee immobilisation at 90° flexion in brace for 4 weeks, followed by progressive increases in range-of-motion until brace removal at 12 weeks, and physiotherapist-supervised goal-oriented rehabilitation). MRIs (3 months and 6 months) were graded using the ACL OsteoArthritis Score (ACLOAS) by three radiologists. Mann-Whitney U tests compared Lysholm Scale and ACL quality of life (ACLQOL) scores evaluated at median (IQR) of 12 months (7–16 months) post-injury, and χ2tests compared knee laxity (3-month Lachman’s test and 6-month Pivot-shift test), and return-to-sport at 12 months between groups (ACLOAS grades 0–1 (continuous±thickened ligament and/or high intraligamentous signal) versus ACLOAS grades 2–3 (continuous but thinned/elongated or complete discontinuity)).ResultsParticipants were aged 26±10 years at injury, 39% were female, 49% had concomitant meniscal injury. At 3 months, 90% (n=72) had evidence of ACL healing (ACLOAS grade 1: 50%; grade 2: 40%; grade 3: 10%). Participants with ACLOAS grade 1 reported better Lysholm Scale (median (IQR): 98 (94–100) vs 94 (85–100)) and ACLQOL (89 (76–96) vs 70 (64–82)) scores, compared with ACLOAS grades 2–3. More participants with ACLOAS grade 1 had normal 3-month knee laxity (100% vs 40%) and returned to pre-injury sport (92% vs 64%), compared with participants with an ACLOAS grades 2–3. Eleven patients (14%) re-injured their ACL.ConclusionAfter management of acute ACL rupture with the CBP, 90% of patients had evidence of healing on 3-month MRI (continuity of the ACL). More ACL healing on 3-month MRI was associated with better outcomes. Longer-term follow-up and clinical trials are needed to inform clinical practice.
titles with an asterisk were judged for the RACS/?? Research Prize for Trainees.Objective: To report the early human results of H.E.L.P. technology in the prevention of major limb amputation. In the short-term, the aim was to pressure dilate collateral channels and in the long-term to stimulate remodelling and new collateral pathways by increasing endothelial shear stress. Methods: A pilot study consisted of the ischaemic limbs of 15 patients with critical limb ischaemia. These patients had no other option but major amputation as determined by at least two vascular surgeons. The limbs were connected to a commercially available cardiac pump via an access system. The limbs were hyperperfused pancycle at 2-3 times the mean arterial pressure (MAP). This was performed intermittently in sessions of 24-36 hours. The major endpoint was avoidance of major amputation. Results: Given adequate arterial access, 29 of 30 connections developed flows 4-8 times the MAP. There was a progressive decrease in peripheral resistance. All patients developed a pain-free, warm foot or hand whilst on the pump in the short-term. In the longer term, a mean of 10.4 months (range 1-29 months) 50% had avoided major amputation. Pain scores changed from 0.9 ± 0.1 to 1.1 ± 1.3 under the visual analogue scale (V.A.S). The ankle brachial index (A.B.I) changed from 0.06 ± 0.09 to 0.57 ± 0.33, p < 0.05 (t test). Conclusions: The collateral circulation of ischaemic limbs can be augmented and regulated via connection to an extracorporeal cardiac pump. The technique is similar to haemodialysis. Major amputation can be avoided in selective cases. Improvements in the technology are continuing.
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