Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction

Randomized Clinical and Magnetic Resonance Imaging Study With 2-Year Follow-up

1. Piia Suomalainen, MD*†,
2. Anna-Stina Moisala, MD, PhD‡,
3. Antti Paakkala, MD, PhD†,
4. Pekka Kannus, MD, PhD§ and
5. Timo Järvelä, MD, PhD‡

+Author Affiliations

1. ^†Tampere University Hospital, Tampere, Finland
2. ^‡Hatanpää Hospital, Tampere, Finland
3. ^§UKK Institute, Tampere, Finland
4. Investigation performed at Tampere University Hospital, Tampere, Finland

1. ↵* Piia Suomalainen, MD, Teiskontie 35, 33520 Tampere, Finland (e-mail:piia.suomalainen@uta.fi).

1. Presented at the 36th annual meeting of the AOSSM, Providence, Rhode Island, July 2010.

Abstract

Background: One aspect of the debate over the reconstruction of the anterior cruciate ligament is whether it should be carried out with the single-bundle or double-bundle technique.

Hypothesis: The double-bundle technique results in fewer graft failures than the single-bundle technique in anterior cruciate ligament reconstruction.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 153 patients were prospectively randomized into 2 groups of anterior cruciate ligament reconstruction with hamstring autografts using aperture interference screw fixation: single-bundle technique (SB group, n = 78) and double-bundle technique (DB group, n = 75). The evaluation methods were clinical examination, KT-1000 arthrometric measurement, the International Knee Documentation Committee (IKDC) and the Lysholm knee scores, and magnetic resonance imaging (MRI) evaluation. All of the operations were performed by 1 experienced orthopaedic surgeon, and all clinical assessments were made by 2 blinded and independent examiners. A musculoskeletal radiologist blinded to the clinical data made the MRI interpretation.

Results: There were no differences between the study groups preoperatively. Ninety percent of patients (n = 138) were available at a minimum 2-year follow-up (range, 24-37 months). Eight patients (7 in the SB group and 1 in the DB group) had graft failure during the follow-up and had anterior cruciate ligament revision surgery (P = .04). In addition, 7 patients (5 in the SB group and 2 in the DB group) had an invisible graft on the MRI assessment at the 2-year follow-up. Also, the anteromedial bundle was partially invisible in 2 patients and the posterolateral bundle in 9 patients. Together, the total number of failures and invisible grafts were significantly higher in the SB group (12 patients, 15%) than the DB group (3 patients, 4%) (P = .024). No significant group differences were found in the knee scores or stability evaluations at the follow-up.

Conclusion: This 2-year randomized trial showed that the revision rate of the anterior cruciate ligament reconstruction was significantly lower with the double-bundle technique than that with the single-bundle technique. However, additional years of follow-up are needed to reveal the long-term results.

For further information: http://ajs.sagepub.com/content/39/8/1615.abstract

One-Year Follow-up of Platelet-Rich Plasma Treatment in Chronic Achilles Tendinopathy

A Double-Blind Randomized Placebo-Controlled Trial

1. Suzan de Jonge, MD*†‡,
2. Robert J. de Vos, MD, PhD‡,
3. Adam Weir, MD‡,
4. Hans T. M. van Schie, DVM, PhD†§,
5. Sita M. A. Bierma-Zeinstra, PhD†‖,
6. Jan A. N. Verhaar, MD, PhD†,
7. Harrie Weinans, PhD†¶ and
8. Johannes L. Tol, MD, PhD‡

+Author Affiliations

1. ^†Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, the Netherlands
2. ^‡Department of Sports Medicine, The Hague Medical Center Antoniushove, Leidschendam, the Netherlands
3. ^§Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
4. ^‖Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands
5. ^¶Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
6. Investigation performed at the Department of Sports Medicine, The Hague Medical Center Antoniushove, Leidschendam, the Netherlands

1. ↵* Suzan de Jonge, MD, Departments of Orthopaedics, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands (e-mail:s.dejonge@erasmusmc.nl).

Abstract

Background: Achilles tendinopathy is a common disease among both athletes and in the general population in which the use of platelet-rich plasma has recently been increasing. Good evidence for the use of this autologous product in tendinopathy is limited, and data on longer-term results are lacking.

Purpose: To study the effects of a platelet-rich plasma injection in patients with chronic midportion Achilles tendinopathy at 1-year follow-up.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: Fifty-four patients, aged 18 to 70 years, with chronic tendinopathy 2 to 7 cm proximal to the Achilles tendon insertion were randomized to receive either a blinded injection containing platelet-rich plasma or saline (placebo group) in addition to an eccentric training program. The main outcome was the validated Victorian Institute of Sports Assessment–Achilles score. Patient satisfaction was recorded and ultrasound examination performed at baseline and follow-up.

Results: The mean Victorian Institute of Sports Assessment–Achilles score improved in both the platelet-rich plasma group and the placebo group after 1 year. There was no significant difference in increase between both groups (adjusted between-group difference, 5.5; 95% confidence interval, −4.9 to 15.8, P= .292). In both groups, 59% of the patients were satisfied with the received treatment. Ultrasonographic tendon structure improved significantly in both groups but was not significantly different between groups (adjusted between-group difference, 1.2%; 95% confidence interval, −4.1 to 6.6, P = .647).

Conclusion: This randomized controlled trial showed no clinical and ultrasonographic superiority of platelet-rich plasma injection over a placebo injection in chronic Achilles tendinopathy at 1 year combined with an eccentric training program.

For further information: http://ajs.sagepub.com/content/39/8/1623.abstract

SPORTS MEDICINE

Posted on the ORTHOSuperSite August 15, 2011

Study identifies patients who should not undergo surgery for snapping psoas tendon

Researchers at Hospital for Special Surgery have identified a group of patients who may not respond favorably to surgery for a snapping psoas tendon, according to a study presented at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine.

“The conclusion from this study is that you should be cautious about releasing the psoas tendon, particularly in cases where there is some structural instability in the hip, specifically decreased femoral anteversion, because although the tendon may be causing pain, it is also providing some dynamic support to the hip so it can cause problems if it is released,” study author Bryan T. Kelly, MD, stated in a Hospital for Special Surgery release.

The study authors investigated 67 patients who underwent arthroscopic lengthening of a symptomatic psoas tendon. Preoperative CT scans on these patients defined proximal femoral morphology. Femoral anteversion was used to categorize patients into two groups — 48 patients with low or normal anteversion (<25°) and 19 patients with high anteversion (>25°).

Modified Harris Hip Scores (HHS) and Hip Outcome Scores (HOS) were used to assess preoperative and postoperative outcomes. The team found significant differences between the groups, with the high anteversion group displaying a strong association with a worse HOS-Sport subscale — but no difference in the HOS-Activities of Daily Living subscale.

The team also found, however, that patients who had high anteversion scored significantly worse on the HHS questionnaire with regard to athletic and daily living activities. Furthermore, twice as many patients who had high anteversion eventually had to undergo revision surgery.

“The results of this study indicate that there are certain groups of patients that respond very favorably to surgical treatment of the psoas tendon; but there are other groups of patients, who due to mechanical reasons, surgeons should exercise extreme caution in proceeding with any tendon release around the hip,” Kelly stated.

For further information: http://www.orthosupersite.com/view.aspx?rid=86618