Clinical Outcomes and Rehabilitation Program After ACL Primary Repair and Bone Marrow Stimulation

Gobbi, Alberto; Boldrini, Lorenzo; Karnatzikos, Georgios; Mahajan, Vivek

doi:10.1007/978-3-642-15630-4_66

Cited by 4 publications

(1 citation statement)

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“…26 The knee was kept in a brace locked in extension for 3 weeks and patients were allowed partial weight bearing with crutches, followed by weight bearing as tolerated. A continuous passive motion machine was used for 4 to 6 hours a day in a range between 20 and 60 degrees.…”

Section: The Surgical Techniquementioning

confidence: 99%

Biological Augmentation of ACL Refixation in Partial Lesions in a Group of Athletes

Gobbi

Karnatzikos

Sankineani

et al. 2013

Techniques in Orthopaedics

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Anterior cruciate ligament (ACL) reconstruction is the current gold standard treatment for ACL lesions; however, higher complication rates in adolescents, loss of proprioception, donor side morbidity, and incomplete return to high-risk sports are potential pitfalls of this procedure. Recent studies have shown that the healing ability of the ruptured ligament can be enhanced by growth factors and bone marrow-derived multipotent mesenchymal stem cells. A primary ACL repair technique offers potential advantages including the preservation of the proprioceptive functions of the ligament and lower harvest site morbidity. Our study included a group of 50 athletes treated with primary ACL repair combined with bone marrow stimulation and growth factors at the 5-year follow-up. The final follow-up showed 78% of the patients returning to their sports activities, a significant decrease in the side-to-side difference in anterior translation (4.1 mm preoperatively to 1.4 mm postoperatively, P < 0.05), a significant improvement in the postoperative Tegner (P < 0.05) and the Single Assessment Numeric Evaluation scores (P < 0.05). Final Marx and Noyes scores were similar to preinjury values and the final IKDC objective was as follows: normal (A) in 39 patients; nearly normal (B) in 10 patients; and severely abnormal (D) in 1 patient (2%). Re-tear of the repaired ligament was seen in 4 patients, and 1 patient had residual laxity resulting in a survival rate of 90% at the 5-year follow-up.Our study demonstrated that this surgical technique of ACL primary repair utilized in selected patients with acute partial ACL lesions can offer good clinical outcomes.L igament injuries around the knee have been on the rise in the past 3 decades following an increase in participation in recreational and competitive sporting activities. According to an ongoing study in the United States, an estimated 200,000 anterior cruciate ligament (ACL) reconstructions are performed annually, and the incidence of ACL injury is roughly 1 in 3000 per year. 1 The treatment of acute rupture of ACL is an area of considerable controversy despite advances in the sports medicine literature. ACL reconstruction with tendon graft is considered as a gold standard treatment with a high success rate of 80%, 2-6 but has some disadvantages. After ACL reconstruction, studies have reported poor proprioception, postoperative muscular weakness, inability to restore normal kinematics, and possible premature osteoarthritis. 7-10 Considering the fact that ACL injury most commonly affects young people, leading to considerable morbidity, other therapeutic options should be investigated to address acute partial ACL lesions effectively. 3,[11][12][13][14][15] Suture repair of the torn portions of the ACL was first described in 1895, but O'Donoghue popularized this technique in the 1950s. 16,17 Long-term follow-up studies showed that these techniques presented failure rates of up to 90% and were therefore abandoned. 11,12 Despite reports of the poor healing potential of the ACL in the pa...

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Section: The Surgical Techniquementioning

confidence: 99%