Drilling of the femoral tunnel with the transtibial (TT) technique is widely used in bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. Recent studies suggest higher knee stability with the use of the anteromedial portal (AMP). The purpose of this study was to compare functional and clinical outcomes of BPTB ACL reconstruction using the TT or the AMP technique for drilling the femoral tunnel. All ACL reconstructions between January 2003 and April 2006 were approached for eligibility. Forty-seven patients met inclusion criteria (21 TT group and 26 AMP group). Blinded assessments of IKDC score, knee stability and range of motion, one-leg hop test, midquadriceps circumference, VAS for satisfaction with surgery, Lysholm and Tegner scores, and SF-12 questionnaire were obtained for both groups. Data on preoperative and postoperative surgical timing were retrospectively reviewed through the charts. The AMP group demonstrated a significantly lower recovery time from surgery to walking without crutches (p<0.01), to return to normal life (p<0.03), to return jogging (p<0.03), to return training (p<0.03), and to return to play (p<0.03). Knee stability values measured with KT-1000, Lachman test, pivot-shift sign, and objective IKDC score assessments were significantly better for the AMP compared to TT group (p<0.002, p<0.03, p<0.02, p< 0.015, respectively). No differences were found for VAS for satisfaction with surgery, Lysholm, Tegner, and SF-12 between both groups. The use of the AMP technique significantly improved the anterior-posterior and rotational knee stability, IKDC scores, and recovery time from surgery compared to the TT technique.

With one remaining intact bundle the application of PRGF-Endoret in instability cases due to partial ACL tear showed high return to sport rates at pre- injury level in professional football players.

Porous three-dimensional tyrosine-derived polycarbonate (TyrPC) scaffolds with a bimodal pore distribution were fabricated to mimic bone architecture using a combination of salt-leaching and phase separation techniques. TyrPC scaffolds degraded in register with bone regeneration during the 6-week study period and compressive moduli of the scaffolds were maintained >0.5 MPa at 6 weeks of incubation in PBS at 37 °C. The TyrPC scaffolds either unsupplemented or supplemented with recombinant human bone morphogenetic protein-2 (rhBMP-2) were implanted in a rabbit calvarial critical-sized defect (CSD) model and the TyrPC scaffolds treated with rhBMP-2 or TyrPC coated with calcium phosphate scaffold alone promoted bone regeneration in a rabbit calvarial CSD at 6 weeks postimplantation. A synthetic TyrPC polymeric scaffold either without a biological supplement or with a minimal dose of rhBMP-2 induced bone regeneration comparable to a commercially available bone graft substitute in a nonrodent CSD animal model.

The osteogenic potential of biomimetic tyrosine-derived polycarbonate (TyrPC) scaffolds containing either an ethyl ester or a methyl ester group combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) was assessed using the preosteoblast cell line MC3T3-E1. Each composition of TyrPC was fabricated into 3D porous scaffolds with a bimodal pore distribution of micropores <20 μm and macropores between 200 and 400 μm. Scanning electron microscopy (SEM) characterization suggested MC3T3-E1 cell attachment on the TyrPC scaffold surface. Moreover, the 3D TyrPC-containing ethyl ester side chains supported osteogenic lineage progression, alkaline phosphatase (ALP), and osteocalcin (OCN) expression as well as an increase in calcium content compared with the scaffolds containing the methyl ester group. The release profiles of rhBMP-2 from the 3D TyrPC scaffolds by 15 days suggested a biphasic rhBMP-2 release. There was no significant difference in bioactivity between rhBMP-2 releasate from the scaffolds and exogenous rhBMP-2. Lastly, the TyrPC containing rhBMP-2 promoted more ALP activity and mineralization of MC3T3-E1 cells compared with TyrPC without rhBMP-2. Consequently, the data strongly suggest that TyrPC scaffolds will provide a highly useful platform for bone tissue engineering.