Aims. To test the hypothesis that reseeded anterior cruciate ligament (ACL)-derived cells have a better ability to survive and integrate into tendon extracellular matrix (ECM) and accelerate the ligamentization process, compared to adipose-derived mesenchymal stem cells (ADMSCs). Methods. Acellularized tibialis allograft tendons were used. Tendons were randomly reseeded with ACL-derived cells or ADMSCs. ACL-derived cells were harvested and isolated from remnants of ruptured ACLs during reconstruction surgery and cultured at passage three. Cell suspensions (200 µl) containing 2 × 10. 6. ACL-derived cells or ADMSCs were prepared for the purpose of reseeding. At days 1, 3, and 7 post-reseeding, graft composites were assessed for repopulation with histological and immunohistochemical analysis. Matrix protein contents and gene expression levels were analyzed. Results. In the graft reseeded with ACL-derived cells, a large number of elongated cells that integrated into the matrix were evident at day 3 and day 7. However, in the graft reseeded with ADMSCs, only a small number of elongated cells were found integrated into the matrix. Immunofluorescence for Ki-67 and type I collagen confirmed the pronounced production of type I collagen by Ki-67-positive ACL-derived cells integrated into the ECM. A messenger RNA (mRNA) expression assay demonstrated significantly higher gene expression levels of types I (p = 0.013) and III (p = 0.050) collagen in the composites reseeded with ACL-derived cells than ADMSCs. Conclusion. ACL-derived cells, when reseeded to acellularized tendon graft, demonstrated earlier better survival and integration in the tendon ECM and resulted in higher gene expression levels of collagen, which may be essential to the normal ligamentization process compared to ADMSCs. Cite this article: Bone Joint Res 2022;11(11):777–786

Objectives. The present study describes a novel technique for revitalising allogenic intrasynovial tendons by combining cell-based therapy and mechanical stimulation in an ex vivo canine model. Methods. Specifically, canine flexor digitorum profundus tendons were used for this study and were divided into the following groups: (1) untreated, unprocessed normal tendon; (2) decellularised tendon; (3) bone marrow stromal cell (BMSC)-seeded tendon; and (4) BMSC-seeded and cyclically stretched tendon. Lateral slits were introduced on the tendon to facilitate cell seeding. Tendons from all four study groups were distracted by a servohydraulic testing machine. Tensile force and displacement data were continuously recorded at a sample rate of 20 Hz until 200 Newton of force was reached. Before testing, the cross-sectional dimensions of each tendon were measured with a digital caliper. Young’s modulus was calculated from the slope of the linear region of the stress-strain curve. The BMSCs were labeled for histological and cell viability evaluation on the decellularized tendon scaffold under a confocal microscope. Gene expression levels of selected extracellular matrix tendon growth factor genes were measured. Results were reported as mean ± SD and data was analyzed with one-way ANOVAs followed by Tukey’s post hoc multiple-comparison test. Results. We observed no significant difference in cross-sectional area or in Young’s modulus among the four study groups. In addition, histological sections showed that the BMSCs were aligned well and viable on the tendon slices after two-week culture in groups three and four. Expression levels of several extracellular matrix tendon growth factors, including collagen type I, collagen type III, and matrix metalloproteinase were significantly higher in group four than in group three (p < 0.05). Conclusion. Lateral slits introduced into de-cellularised tendon is a promising method of delivery of BMSCs without compromising cell viability and tendon mechanical properties. In addition, mechanical stimulation of a cell-seeded tendon can promote cell proliferation and enhance expression of collagen types I and III in vitro. Cite this article: J. H. Wu, A. R. Thoreson, A. Gingery, K. N. An, S. L. Moran, P. C. Amadio, C. Zhao. The revitalisation of flexor tendon allografts with bone marrow stromal cells and mechanical stimulation: An ex vivo model revitalising flexor tendon allografts. Bone Joint Res 2017;6:179–185. DOI: 10.1302/2046-3758.63.BJR-2016-0207.R1

Acromioclavicular joint (ACJ) dislocations is a common disorder amongst our population for which numerous techniques have been described. It is thought that by using this novel technique combining a CC and AC repair with a reconstruction will result in high maintenance of anatomical reduction and functional results. 12 consecutive patients ACJ dislocations were included. An open superior clavicular approach is used. Firstly, the CC ligaments are repaired after which a CC reconstruction is performed using a tendon allograft. Secondly, the AC ligaments are repaired using an internal brace construct combined with a tendon allograft reconstruction (Figure 1). The acute:chronic ratio was 6:6. Only IIIB, IV and V AC-joint dislocations were included. The Constant-Murley Score improved from 27.6 (8.0 – 56.5) up to 61.5 (42.0 – 92.0) at 12 months of follow up. Besides one frozen shoulder from which the patient recovered spontaneously no complications were observed with this technique. The CCD was reduced from 18.7 mm (13.0 – 24.0) to 10.0 mm (6.0 – 16.0) and 10.5 mm (8.0 – 14.0) respectively 12 weeks and 12 months postoperatively. There is some evidence, suggesting to address as well as the vertical (coracoclavicular (CC) ligaments) as the horizontal (acromioclavicular (AC) ligaments) direction of instability. This study supports addressing both entities however comparative studies discriminating chronic as acute cases should be conducted to further clarify this ongoing debate on treating ACJ instability. This study describes a novel technique to treat acute and chronic Rockwood stage IIIB – IV ACJ dislocations with promising short-term clinical and radiological results. This suggests that the combined repair and reconstruction of the AC and CC ligaments is a safe procedure with low complication risk in experienced hands. Addressing the vertical as well as horizontal stability in ACJ dislocation is considered key to accomplish optimal long-term results

Recurrent patellar instability is a common problem and there are multiple demographic and pathoanatomic risk factors that predispose patients to dislocating their patella. The most common of these is trochlear dysplasia. In cases of severe trochlear dysplasia associated with patellar instability, a sulcus deepening trochleoplasty combined with a medial patellofemoral ligament reconstruction (MPFLR) may be indicated. Unaddressed trochlear pathology has been associated with failure and poor post-operative outcomes after stabilization. The purpose of this study is to report the clinical outcome of patients having undergone a trochleoplasty and MPFLR for recurrent lateral patellofemoral instability in the setting of high-grade trochlear dysplasia at a mean of 2 years follow-up. A prospectively collected database was used to identify 46 patients (14 bilateral) who underwent a combined primary MPFLR and trochleoplasty for recurrent patellar instability with high-grade trochlear dysplasia between August 2013 and July 2021. A single surgeon performed a thin flap trochleoplasty using a lateral para-patellar approach with lateral retinaculum lengthening in all 60 cases. A tibial tubercle osteotomy (TTO) was performed concomitantly in seven knees (11.7%) and the MPFLR was performed with a gracilis tendon autograft in 22%, an allograft tendon in 27% and a quadriceps tendon autograft in 57% of cases. Patients were assessed post-operatively at three weeks and three, six, 12 and 24 months. The primary outcome was the Banff Patellar Instability Instrument 2.0 (BPII 2.0) and secondary outcomes were incidence of recurrent instability, complications and reoperations. The mean age was 22.2 years (range, 13 to 45), 76.7% of patients were female, the mean BMI was 25.03 and the prevalence of a positive Beighton score (>4/9) was 40%. The mean follow-up was 24.3 (range, 6 to 67.7) months and only one patient was lost to follow-up before one year post-operatively. The BPII 2.0 improved significantly from a mean of 27.3 pre-operatively to 61.1 at six months (p < 0 .01) and further slight improvement to a mean of 62.1 at 12 months and 65.6 at 24 months post-operatively. Only one patient (1.6%) experienced a single event of subluxation without frank dislocation at nine months. There were three reoperations (5%): one for removal of the TTO screws and prominent chondral nail, one for second-look arthroscopy for persistent J-sign and one for mechanical symptoms associated with overgrowth of a lateral condyle cartilage repair with a bioscaffold. There were no other complications. In this patient cohort, combined MPFLR and trochleoplasty for recurrent patellar instability with severe trochlear dysplasia led to significant improvement of patient reported outcome scores and no recurrence of patellar dislocation at a mean of 2 years. Furthermore, in this series the procedure demonstrated a low rate (5%) of complications and reoperations

Complications involving the knee extensor mechanism occur in 1% to 12% of patients following total knee arthroplasty (TKA), and have negative effects on patient outcomes. While multiple reconstruction options have been described for complete disruption of the extensor mechanism, the results in patients with a prior TKA are inferior to those in patients without a TKA, and frequently have required the use of allograft tendon grafts which can attenuate and stretch over time. However, encouraging results have been reported by Browne and Hanssen in treatment of patellar tendon disruption with the use of a synthetic mesh (knitted monofilament polypropylene). In this technique, a synthetic graft is created by folding a 10 × 14 inch sheet of mesh and securing it with non-absorbable sutures. A burr is then used to create a trough in the anterior aspect of the tibia to accept the mesh graft. The graft is inserted into the trough and secured with cement. After the cement cures, a transfixion screw with a washer is placed. A portal is subsequently created in the soft tissues lateral patellar tendon remnants to allow delivery of the graft from deep to superficial. The patella and quadriceps tendon are mobilised, and the graft is secured with sutures to the lateral retinaculum, vastus lateralis, and quadriceps tendon. The vastus medialis is then mobilised and brought in a pants-over-vest manner over the mesh graft, and secured with additional sutures. Finally, the distal arthrotomy is closed tightly to completely cover the mesh graft with host tissue. In their series, Browne and Hanssen noted that 9 of 13 patients achieved an extensor lag of <10 degrees with preserved knee flexion and significant improvements in the mean Knee Society scores for pain and function. A similar modified method has been used at our institution for chronic quadriceps tendon disruptions as well. The reconstructions have shown less of a tendency to late attenuation, stretch and recurrent extensor lag beyond two years compared to our experience with tendon allograft reconstructions and remains our procedure of choice at our institution for the majority of these challenging problems

Introduction. A deficient abductor mechanism leads to significant morbidity and few studies have been published describing methods for reconstruction or repair. This study reports the reconstruction of hip abductor deficiency using human allograft. Methods. All patients were identified as having deficient abductor mechanisms following total hip arthroplasty through radiographic assessment, MRI, clinical examination and intra-operative exploration. All patients underwent hip abductor reconstruction using a variety of human allografts including proximal humeral, tensor fascia lata, quadriceps and patellar tendon. The type of allograft reconstruction used was customized to each patient, all being attached to proximal femur, allograft bone adjacent to host bone, with cerclage wires. If a mid-substance muscle rupture was identified an allograft tendon to host tendon reconstruction was performed. Results. Allograft reconstruction was performed in 15 patients over 18 months. One patient had an abductor deficiency after a primary total hip. All patients had an abductor lurch gait and positive Trendelenburg test preoperatively. Manual muscle strength testing showed significant weakness with a mean MRC grade of 3+/5. Peri-trochanteric pain was cited as a significant complaint in > 80 % of patients. Proximal humeral allografts, with rotator cuff, were used in 8 patients, 5 had tensor fascia lata and the remainder had patella with attached tendon allograft. The majority of patients had a reduction in pain and 8/15 (53%) increased their abductor strength by almost a full grade. A reduced lurch was observed in 10 (66%) patients and one patient re-dislocated after a failed revision for instability. Conclusion. To our knowledge, this is the largest reported series of allograft reconstruction for a deficient abductor mechanism following hip arthroplasty. A viable solution is demonstrated, with promising early results for a difficult problem, utilizing a straightforward technique with low morbidity

Introduction. Chronic ruptures of the quadriceps tendon after total knee arthroplasty (TKA) are rare but are a devastating complication. The objective of this study was to validate the use of fresh frozen total fresh quadriceps tendon allografts for quadriceps tendon reconstruction. The hypothesis of this work was that the graft was functional in more than 67% of cases, a higher percentage than the results of conventional treatments. Material – methods. We designed a continuous monocentric retrospective study of all patients operated on between 2009 and 2017 for a chronic rupture of the quadriceps tendon after TKA by quadriceps allograft reconstruction. The usual demographic and perioperative data and the rehabilitation protocols followed were collected. Initial and final radiographs were analyzed to measure patellar height variation. The main criterion was the possibility of achieving an active extension of the knee with a quadriceps contraction force greater than or equal to 3/5 or the possibility of lifting the heel off the ground in a sitting position. Results. 29 patients with 33 allografts were included; 3 iterative allografts were performed on ruptures of the initial transplant and 1 patient was grafted on both sides in one step. There were 21 women and 8 men with a mean age of 73 years, and a mean body mass index of 33 kg/m. 2. Ruptures occurred in 22 cases after chronic periprosthetic infection. Walking was allowed immediately in 29 cases, but free mobilization was delayed in 29 cases. Complications affected 22 cases, but the majority of complications were not related to allograft use (including infectious failures and periprosthetic fractures). After a mean follow-up of 52 months, 28 allografts were still in place, and 22 allografts were considered functional. The active quadriceps extension force was rated on average at 3.5/5. The average pre/post-operative patellar height differential was +2 mm. Discussion. This continuous series of 33 allografts is in line with recent publications on the subject. It confirms their negative impact on the functional outcome of the TKA. The complication rate is high but the specific complication rate is not prohibitive. Two thirds of transplants are functional in the long term. Early rehabilitation procedures can be used in these difficult patients with encouraging results. The management of chronic ruptures of the quadriceps tendon after TKA by quadriceps allograft must be part of the current therapeutic options

Combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) disruptions are uncommon orthopaedic injuries. They are usually caused by high- or low-velocity knee dislocations. Because knee dislocations might spontaneously reduce before initial evaluation, the true incidence is unknown. Dislocation involves injury to multiple ligaments of the knee. Both of the cruciate ligaments are usually disrupted, and they are often combined with a third ligamentous disruption (medial collateral ligament or lateral collateral ligament and/or posterior lateral complex). Associated neurovascular, meniscal, and osteochondral injuries are often present and complicate treatment. Classification Knee dislocations are classified by relating the position of the displaced tibia on the femur; anterior, posterior, medial, lateral, or rotational. Both cruciate ligaments might be disrupted in all these injuries. A rotatory knee dislocation occurs around one of the collateral ligaments (LCL) leading to a combined ACL and PCL injury and a tear of the remaining collateral ligament. Knee dislocations that spontaneously reduce are classified according to the direction of instability. Knee dislocations are classified as acute (< 3 weeks) or chronic (> 3 weeks). Initial management The vascular status of the limb must be determined quickly. The knee should be reduced immediately through gentle traction-countertraction with the patient under anesthesia. After reduction, repeat vascular examination. If the limb remains ischemic, emergent surgical exploration and revascularisation is required. If the initial vascular examination is normal, postreduction a formal angiogram should be done especially if the patient has a high velocity injury, is polytraumatized or have altered mental status. Compartment syndrome, open injury, and irreducible dislocation are other indications for emergent surgery. Definitive management Many authors have noted superior results of surgical treatment of bicruciate injuries when compared to nonsurgical treatment. In most cases early ligament surgery (at the second or third week) seems to produce better results compared to late reconstructions. Still the management of knee dislocations remains controversial. Controversies persist regarding surgical timing, technique, graft selection, and rehabilitation. The goal of operative treatment is to retain knee stability, motion, and function. The most common injury patterns include both cruciate ligaments and either medial collateral ligament (MCL) or lateral collateral ligament (LCL) and/or posterolateral structures. Less commonly both collateral ligaments are disrupted. Our policy has been early (from 7 to 21 days) simultaneous reconstruction of both cruciate ligaments and repairing of grade III LCL and posterolateral structures. Most acute grade III MCL tears are successfully treated with brace treatment when ACL and PCL are reconstructed early. Most cruciate ligament injuries are midsubstance tears that need to be reconstructed with autografts or allografts. Repairs can be done in cases of bony avulsion of cruciate ligaments or grade III collateral ligament or capsular injuries. Bone-patellar tendon-bone (BPTB) autograft has mainly used in our clinics to reconstruct the ACL. In some cases BTPB allograft or hamstring tendon autografts has been used. For PCL reconstruction, BPTB allograft (11 mm in diameter) or Achilles tendon allograft has been used. Intrasubstance grade III tears of the LCL can be repaired (in early state) but may need to be augmented with tendon allograft. The LCL and/or the popliteofibular ligament are reconstructed either with an Achilles tendon allograft, hamstring tendon autograft/allograft, tibialis anterior tendon allograft, or the BPTB allograft. Both cruciate ligaments are reconstructed arthroscopically. The ACL tunnels are placed in the center of its anatomic insertion in tibia and in its isometric or anatomic insertion in femur. A transtibial tunnel technique for PCL reconstruction is used. The PCL tibial tunnel is drilled first under arthroscopic guidance using the PCL guide. The ACL tibial guide is drilled at least 2 cm proximal to the PCL tunnel to ensure that wide enough bone bridge remains between these tunnels. Fluoroscopy is used to ensure the right guidewire placement. Sequence of bicruciate ligament reconstruction with BPTB grafts. Drill PCL tibial tunnel first, then ACL tibial tunnel. Drill ACL femoral tunnel, then PCL femoral tunnel. Pass PCL graft through tibial tunnel and fix in femoral tunnel. Pass ACL graft through tibial tunnel and fix in femoral tunnel. Fix PCL graft on tibia at 90° of flexion with anteromedial step off. Fix ACL graft on tibia at extension. Rehabilitation Our protocol after bicruciate ligament reconstruction with MPTB grafts has been very active. Progressive range of motion is started early after the operation with an unlocked functional brace. If simultaneous suturation of a meniscus tear has been performed, motion is limited to 60° of flexion during the first 4 weeks. Progression from partial to full weight bearing is done over the first 6 weeks. Quadriceps exercises are progressed to open-chain knee extension exercises early as well as closed-chain hamstring exercises. Brace is discontinued after 12 weeks

Anterior cruciate ligament (ACL) injuries are being seen with increasing frequency in children. Treatment of the ACL deficient knee in skeletally immature patients is controversial. To determine the outcome of anatomic transphyseal ACL reconstruction in tanner stage 1 and 2 patients with open growth plates at a minimum of 2 years after surgery. Between 2007–2008, 16 prepubescent skeletally immature patients underwent anatomic transphyseal ACL reconstruction using soft tissue grafts. All patients were tanner stage 1 and 2 and all had open growth plates. Outcomes were assessed at a minimum of 2 years after surgery and included: limb alignment, limb length, instrumented testing with KT-1000 and International Knee Documentation Committee (IKDC) score. Mean age at the time of surgery was 12 years (8–14). Graft choices included: living-related donor hamstring tendon allograft (n=14), hamstring tendon autograft (n=1) and fresh frozen allograft (n=1). Mean IKDC subjective score was 96 (84–100). Sixty-two percent of patients had <3mm side-to-side difference on instrumented KT-1000 testing and 88% had a negative pivot shift. At 2 years after surgery, all patients had returned to strenuous activities and normal or nearly normal overall IKDC score was documented in 94% of patients. There were no cases of limb malalignment or growth arrest. We present a large series of anatomic transphyseal ACL reconstruction in tanner stage 1 and 2 patients with open growth plates at a minimum of 2 years following surgery. Excellent clinical outcomes were obtained with high levels of return to desired activities. Importantly, no growth disturbances were seen in this series of patients

Purpose: This study was performed to assess the incidence of generalized ligament laxity in patients undergoing revision ACL reconstruction. Methods and Results: Prospective data was collected for 40 patients undergoing revision ACL reconstruction, between 2004 and 2009 under the care of a single orthopaedic consultant including demographic details, graft used during primary and revision ACL reconstruction and causes of graft failure. Clinical examination was used to assess the ligament laxity using the Beighton score. Laxity is scored on a 0–9 scale. Scores of 4 or above are indicative of generalized ligament laxity. Brighton criteria is used to diagnose Benign Joint Hypermobility Syndrome (BJHS) and use signs and symptoms along with Beighton score. The most common graft used was a quadruple hamstring in 23 patients (57%). The causes of graft failure were trauma in 22 patients (55%), biological in 17 patients (42%) and infection in 1 patient (2.5%). The revision ACL graft was patella tendon in 23 patients (57%), allograft tendon was used in 11 patients (28%) and quadruple hamstring was used in 4 patients (10%). The average Beighton score for these patients was 3 with a range from 0–9. 20 patients (50%) in this group had a Beighton score of 4 or more. Only 6 patients (15%) fulfilled the Brighton criteria for BJHS. Conclusion: We found that there is a high incidence (50%) of generalized ligament laxity in patients undergoing revision ACL reconstruction. Biological failure is common (42%) in these patients after using autogenous tendons. We recommend the use of allograft for primary ACL reconstruction in patients with generalized ligament laxity

Aims: This work analyzed the effects of storage by fresh-freezing at −80°C on the histological, structural and biomechanical properties of the human posterior tibial tendon (PTT), used for ACL reconstruction. Methods: Twenty-two PTTs were harvested from eleven donors. For each donor one tendon was frozen at −80°C and thawed in physiologic solution at 37°C, and the other was tested without freezing (control). Transmission electron microscopy (TEM), differential scanning calorimetry (DSC) and biomechanical analysis were performed. Results: We found the following mean changes in frozen-thawed tendons compared to controls: TEM showed an increase in the mean diameter of collagen fibrils and in fibril non-occupation mean ratio, while the mean number of fibrils decreased; DSC showed a decrease in mean denaturation temperature and denaturation enthalpy. Biomechanical analysis showed a decrease in ultimate load and ultimate stress, an increase in stiffness and a decrease in ultimate strain of tendons. Conclusions: Fresh-freezing brings about significant changes in the biomechanical and structural properties of the human PTT. A high variability exists in the biophysical properties of tendons among individuals and in the effects of storage on tendons. Particular care is required when choosing an allograft tendon and further studies are required to clarify the role of donors’ age and sex, and other factors, in determining the suitability of an allogenic tendon. The future directions could be:. (a) To choose the tendon grafts considering the donors’ characters;. (b) To use fresh tendons;. (c) To test the controlateral tendon from the same donor before use

Purpose: The use of allografts for anterior cruciate ligament (ACL) reconstruction has gained increased popularity. The major benefits of allograft for ACL replacement include decreased morbidity, easier patient rehabilitation and include ease of surgical procedure, decreased harvest site morbidity and easier patient rehabilitation. Further, allografts have improved appeal because of better sterilization techniques, improve graft availability and decreased hospital costs.|The objective of this study was to perform mechanical testing on various types of allograft. Specimens for allograft reconstruction of the anterior cruciate ligament included tibialis anterior tendon, tibialis posterior tendon, Achilles tendon and bone patella tendon tissues. Methods: The allografts tested were used for deployment in patients suffering with anterior cruciate ligament disruptions. A total of fifty grafts were analyzed. The breakdown of graft types included 15 tibialis anterior tendon, 15 tibialis posterior tendon, 10 Achilles tendon and 10 bone patella tendon tissues. The test techniques included: cutting the tendons to a set thickness and length. The tendons were then mounted in a cryogrip and frozen with liquid Nitrogen to below zero. They were mounted into a servo-hydraulic testing machine and pre-loaded and pre-conditioned. The specimens were then stretched to failure at a set strain rate. Results: No difference was found between the mechanical/material properties of the various tendon allografts – these included tensile strength and a high stress linear modulus assessments. The mechanical (structural properties) of the allografts were more dependant on the cross sectional area of the allograft than the type of allograft tissue.The greater the cross-sectional area of the allograft, the greater the strength and stiffness of the graft. Conclusions: These findings have considerable clinical applicability in choosing an allograft for anterior cruciate ligament reconstruction

Purpose: Massive rotator cuff defects are often associated with incapacitating pain and severe functional impairment and pose a difficult management problem. Introduction: Tears of the rotator cuff are a common orthopaedic condition. The surgical treatment for such defects is varied and include simple debridement, “balanced” repair, local musculotendinous transfers, and autograft or allograft tendon grafts. This study was designed to evaluate the mid-term results of porcine dermal xenograft tendon grafts in the treatment of chronic, massive rotator cuff defects. Method: Ten patients with a mean age of 64.9 years (46 – 80), 5 male, 5 female, with mean cuff defects of 4.5 cm, were selected from the waiting list to undergo an open subacromial decompression and grafting of the rotator cuff defect with a PDX patch. The patients were then subjected to the standard post-operative rehabilitation regime. All patients were assessed pre-operatively and at six weeks, three months, six months, and one year using the Constant score and Mini-DASH questionnaire. The study had the approval of the regional ethics committee. Results: All ten patients were followed up and demonstrated excellent pain relief from the procedure. Pain scores improved from 6.7 pre-operatively to 13.9 at 12 months. At the same time intervals function score improved from 12.1 to 15.7, range of movement from 13.6 to 21.4, power from 5.1 to 10.9, Constant score from 39.6 to 56.9 and finally the DASH score from 26 to 17.9. There were no major post-op complications and the graft did not cause any adverse reaction. Subjective and functional results improved to six months from pre-op values, but at one year, with the exception of pain, the results were slightly less good but still improved. Conclusion: This procedure offers an alternative method of managing massive rotator cuff tears. It simplifies the surgery with no tension on the repair and may reduce the requirement for prolonged splintage. Pain relief is excellent and there have been no reported adverse effects to the graft

Introduction: Allograft-Prosthesis Composite represents a reliable option for proximal femur replacement after resection for bone tumor. It provides advantages over megaprostheses because of better soft tissue repair and superior abduction strength, quality of gait, hip stability, and load transfer by healed bone rather than prosthetic stem, with potential impact on implant survival. Purpose of this paper was to review details of the surgical technique and results. Methods: A retrospective study of 62 patients who had resection of the proximal femur because of a bone tumor and reconstruction with an Allograft-Prosthesis Composite was undertaken. The basic surgical technique consisted of an uncemented tapered long stem prosthesis (i.e. Wagner or Wagner-type stem) cemented in the allograft and press-fitted in the host bone, achieving bone-bone contact through a transverse osteotomy. Details of the surgical technique included: 1) accurate preoperative planning, canal sizing and implant selection; 2) under-reaming of the proximal 5–10 mm of the host medullary canal, depending upon bone quality and diameter of the selected stem; 3) allograft preparation and prosthesis cementation in the allograft; 4) introduction of the composite implant, pressfitted in host medullary canal, until bone-bone contact is achieved; 5) careful repair of abductors and iliopsoas to corresponding allograft tendon insertions. Key points for successful fixation are absolute rotational stability and satisfactory circumferential bone-bone contact at the time of surgery. Postoperative regimen consisted of hip, followed by progressive bracing and toe-touch weight-bearing for 6 weeks, weight-bearing. Results: There were 2 septic failures. Two patients developed asymptomatic nonunion. There were no dislocations. Most common complication was fracture of the allograft greater trochanter (30%), which required surgery in only 1 case and never substantially affected function. The incidence of trochanteric fracture decreased from 63% in the first 27 patients to 5% in the following 35 patients by switching implant design from a valgus 145° neck angle to 135° neck angle, improving offset and abductors function. Bone grafting of the allograft-host union was required in 10% of the cases. According to MSTS, results were satisfactory in 90% of the patients, with average score 91% (75%–96%). Discussion and Conclusion: Allograft-Prosthesis Composite is a successful procedure for reconstruction of the proximal femur. Careful surgical technique is the key to excellent function and low complication rate

Aims

To evaluate graft healing of decellularized porcine superflexor tendon (pSFT) xenograft in an ovine anterior cruciate ligament (ACL) reconstruction model using two femoral fixation devices. Also, to determine if pSFT allows functional recovery of gait as compared with the preoperative measurements.

Objectives

This study investigated the biomechanical performance of decellularized porcine superflexor tendon (pSFT) grafts of varying diameters when utilized in conjunction with contemporary ACL graft fixation systems. This aimed to produce a range of ‘off-the-shelf’ products with predictable mechanical performance, depending on the individual requirements of the patient.

The October 2012 Knee Roundup³⁶⁰ looks at: autologous chondrocytes and chondromalacia patellae; drilling the femoral tunnel at ACL reconstruction; whether we repair the radially torn lateral meniscus; factors associated with patellofemoral pain; mechanoreceptors and the allografted ACL; whether high tibial osteotomy can delay the need for knee replacement; return to sport after ACL reconstruction; tissue-engineered cartilage; and the benefits of yoga.