Prospective comparative cohort study, Level II.

Purpose: The purpose of this pilot study is to clarify the preliminary results of an anatomic double-bundle ACL reconstruction procedure with ligament remnant tissues. Methods:Using the trans-tibial technique, 2 doubled semitendinosus tendons were grafted into 4 tunnels created at the center of each bundle attachment, penetrating the ACL remnant tissue. Forty-four patients (27 men and 17 women) with an isolated ACL injury underwent ACL reconstruction using this procedure. The mean age of subjects was 29 years (range: 17-58). Postoperative clinical evaluations were performed at 16.6 months on average (range: 12 -23). Radiological evaluations were also performed to evaluate the tunnel location in the femur and the tibia. Results:The average operation time was 86 minutes (range: 72 -96) in the cases with ACL reconstruction only. Postoperatively, the mean anterior laxity was 0.7 mm. The postoperative pivot-shift test was negative in 81.8 % of the patients, while there were no patients evaluated as ++. No patients showed any extension or flexion deficit. There were no patients evaluated as "Nearly abnormal" or "Abnormal" under the IKDC evaluation. The tunnel angles of the 4 tunnels were identical to those reported in the previous study. Conclusions:The minimal 1-year clinical results of anatomic double-bundle ACL 3 reconstruction with ligament remnant tissue preservation were comparable to the previously reported results of the anatomic double-bundle reconstruction without remnant tissue preservation.

This study has prompted us to develop a potential innovative strategy to repair cartilage lesions in the field of joint surgery.

AIMTo compare tissue concentrations of flurbiprofen resulting from topical application and oral administration according to the regulatory approved dosing guidelines. METHODSixteen patients were included in this study. Each patient was randomly assigned to the topical application or oral administration group. In each group, a pair of tapes or a tablet, containing a total of 40 mg flurbiprofen, was administered twice at 16 and 2 h before the surgery. RESULTSThe flurbiprofen concentration in the fat, tendon, muscle and periosteum tissues was significantly higher (P < 0.0330) after topical application (992 ng CONCLUSIONTopical application is an effective method to deliver flurbiprofen to the human body, particularly to soft tissues near the body surface.

BackgroundIn the anatomic double-bundle ACL reconstruction, 2 femoral tunnel positions are particularly critical to obtain better clinical results. Recently, a few studies have reported quantitative identification methods for posterolateral (PL) bundle reconstruction. Concerning anteromedial (AM) bundle reconstruction, however, no quantitative clinically available methods to insert a guide wire at the center of the direct attachment of the AM mid-substance fibers have been reported to date.MethodsFirst, we determined the center of the femoral attachment of the AM mid-substance fibers using 38 fresh frozen cadaveric knees. Based on this anatomical sub-study, we developed a quantitative clinical technique to insert a guide wire at the averaged center for anatomic double-bundle ACL reconstruction. In the second clinical sub-study with 63 patients who underwent anatomic ACL reconstruction with this quantitative technique, we determined the center of an actually created AM tunnel. Then, we compared the results of the second sub-study with those of the first sub-study to validate the accuracy of the quantitative technique. In both the sub-studies, we determined the center of the anatomical attachment and the tunnel outlet using the “3-dimensional clock” system. The tunnel outlet was evaluated using the “transparent” 3-dimensional computed tomography.ResultsThe averaged center of the direct attachment of the AM bundle midsubstance fibers was located on the cylindrical surface of the femoral intercondylar notch at “10:37” (or “1:23”) o’clock orientation in the distal view and at 5.0-mm from the proximal outlet of the intercondylar notch (POIN) in the lateral view. The AM tunnel actually created in ACL reconstruction was located at “10:41” (or “1:19”) o’clock orientation in the average and at 5.0-mm from the POIN. There was no significant difference between the 2 center locations.ConclusionsThe quantitative technique enabled us to easily create the femoral AM tunnel at the averaged center of the direct attachment of the AM bundle midsubstance fibers with high accuracy. This study reported information on the geometric location of the femoral attachment of the AM bundle and a clinically useful technique for its anatomical reconstruction.