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Bracing After ACL Reconstruction
Although ACL reconstruction has evolved into a successful operation with low failure rates and a high rate of return to sports activities, the utility of functional bracing after an ACL reconstruction remains controversial. Most patients are familiar with the images of high-profile athletes wearing braces after returning to play after ACL surgery, and many are convinced that these braces are essential to protect the reconstructed knee. However, the science of bracing is not so definitive. In this newsletter, a stimulating point-counterpoint by Drs. Peter Millett and Patrick St. Pierre regarding whether functional bracing is indicated after ACL reconstruction is presented.
Associated Injuries in Pediatric and Adolescent Anterior Cruciate Ligament Tears: Does a Delay in Treatment Increase the Risk of Meniscal Tear?
To evaluate the incidence of associated injuries and meniscal tears in children and adolescents with anterior cruciate ligament (ACL) tears, we performed a retrospective review of patients, age 14 and younger, who were treated surgically at our institution.
Early ACL Reconstruction in Combined ACL–MCL Injuries
The optimal management of combined anterior cruciate ligament–medial collateral ligament (ACL-MCL) injuries is controversial. Recent studies have shown good results with operative management of the ACL tear in conjunction with nonoperative management of the MCL tear. Individuals who underwent ACL reconstruction and conservative management of the MCL had superior range of motion and quicker strength gains in the short-term compared to those who underwent repair of both ligaments. In addition, long-term results show excellent stability and functional outcome in individuals treated conservatively.
Effects of Braiding on Tensile Properties of Four-Strand Human Hamstring Tendon Grafts
Anterior cruciate ligament reconstruction with the use of autogenous hamstring tendon grafts is a well-recognized procedure. Initially, the semitendinosus and gracilis tendons were harvested and used as two-strand autografts for reconstruction of the deficient ACL, but concerns about strength led to the use of four-strand constructs. Creating a four-strand graft, by folding the tendons in half, decreases the length but increases the tensile strength and stiffness of the graft.
Motion Loss after Ligament Injuries to the Knee - Part I: Causes
The purpose of this review is to summarize the current concepts on motion loss of the knee, placing particular emphasis on the causes, prevention, and treatment. The article is in two parts.
This first part will discuss causes of motion loss after ligament injury or surgery. The goals of the first article are to discuss normal and abnormal knee kinematics and to define terminology for motion problems of the knee. Known risk factors, causes, and pathoanatomy will be discussed in detail, summarizing the current and pertinent studies on this difficult clinical problem.
Motion Loss after Ligament Injuries to the Knee - Part II: Prevention and Treatment
This is the second part of a two-part review on motion problems after ligament injuries to the knee. The first part, published in the September/October 2001 issue, discussed normal and abnormal knee motion, terminology, risk factors, and pathoanatomy. The purpose of this article is to review current concepts on prevention and treatment of motion problems, summarizing the recent and pertinent studies that discuss this complicated clinical problem. The first part of this article will discuss the different classification schemes that have been published on motion loss of the knee. Prevention strategies will be discussed next, followed by early recognition. Finally, a discussion of the various treatment options and published results will be presented in detail, together with the authors’ nine-step systematic surgical approach to the stiff knee.
Arthroscopic Treatment of the Arthrofibrotic Knee
The management of motion loss of the knee is challenging. A clear understanding of the pathoanatomic causes of motion loss is necessary to establish a careful and rational approach to treatment. Early recognition and physical therapy are effective for the majority of patients, but when these conservative measures fail, operative intervention is indicated. The purpose of this article is to outline a comprehensive approach to the arthroscopic evaluation and treatment of the arthrofibrotic knee. This technique is designed to allow the surgeon to systematically address the numerous causes of motion loss of the knee. Key Words:
Open Debridement and Soft Tissue Release as a Salvage Procedure for the Severely Arthrofibrotic Knee*
Postoperative loss of knee motion is a well-recognized phenomenon. This paper reports our results with open debridement and soft tissue release as a salvage procedure in the treatment of patients with severe arthrofibrosis on whom arthroscopic surgical techniques had failed.
The Role of Capsular Distention in the Arthroscopic Management of Arthrofibrosis of the Knee: A Technical Consideration
Arthroscopic treatment of arthrofibrosis of the knee is a technically challenging procedure. Capsular distention with fluid before arthroscopy results in easier and safer insertion of arthroscopic instruments with improved arthroscopic visualization. In addition, it stretches the entire capsule, including the difficult to access posterior capsule. This report describes a simple technique for capsular distention before arthroscopic treatment of arthrofibrosis of the knee. Key Words: Knee— Arthrofibrosis—Treatment—Capsular distention.
An assessment of willingness to participate in a randomized trial of arthroscopic knee surgery in patients with osteoarthritis
Identifying barriers to recruitment into a randomized clinical trial can help researchers adjust recruitment strategies to maximize enrollment. To determine barriers to enrollment of patients in trials of knee osteoarthritis treatments, we recruited from three centers patients over age 45 who had both knee osteoarthritis and a meniscal tear. We described a hypothetical randomized trial of arthroscopic partial meniscectomy versus non-operative management and assessed patients’ willingness to participate in such a trial. We elicited preferences for treatment along with information on age, sex, education level, race, work status, and pain. We examined the association between these factors and willingness to participate in the trial.
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