Introduction Reconstruction of the torn anterior cruciate ligament (ACL) allows the patient to resume sporting activity and improves objective knee function scores. We have undertaken a prospective study to describe the results of ACL reconstruction over two years, comparing patella tendon versus semitendinosus tendon autograft reconstruction.

Methods Sixty-eight patients with documented ACL injury were followed-up prospectively for an average of 27 months post surgery. The patients underwent ACL reconstruction either using the quadruple strand semitendinosus/gracilis graft or the central one third ‘bone-patella-tendon’ bone autograft. The study cohort included a total of 34 patients reconstructed with patella tendon autograft and 34 patients reconstructed with semitendinosus autografts. The choice of procedure was based on surgeon preference. All patients were assessed pre-operatively, at three months, six months and 24 months post-operatively using the IKDC knee score, Biodex dynamometer and KT-1000 instrumented test for ligament laxity.

Results Thirty-two patients were evaluated at 24 months. Our study population consists of 32 patients (17 patients with patella tendon reconstruction and 15 patients with semitendinosus reconstruction). All the patients had laxity to anterior translation by KT-1000 arthrometry pre-operatively. An IKDC score of good or excellent was obtained in one percent of patients. Both groups had significant post-operative improvements in knee laxity to anterior translation and IKDC score at p< 0.01. At two years 13 of the 15 semitendinosus graft patients (86.7%) demonstrated normal laxity, compared with 13 of 17 of the patella tendon graft patients (76.5 %). The IKDC score revealed 60% scoring good to excellent in the semitendinosus group versus 46% in the patella tendon group. Of the patients who had meniscectomy, 53% scored poorly by IKDC evaluation compared with 36% in the group which did not undergo meniscectomy. At three months post-reconstruction, the patella tendon group had a larger percentage of patients with knee laxity (86.6%), compared to 53.3% (semitendinosus group). This trend was reversed at two years (76.4% compared to 86.7% respectively). Based on the Biodex strength and endurance testing at two years compared with that done pre-operatively there was weakness of the hamstring muscles post-reconstruction.

Conclusions Reconstruction of the ACL is associated with significantly better outcome at two years. Semitendinosus graft reconstruction is not associated with significantly improved knee score and laxity, but has less donor-site morbidity.

Introduction: Studies have shown steroidal and non-steroidal anti-inflammatory drugs (NSAIDs) suppress bone remodeling. Previous results have indicated that NSAIDs suppress proliferation and induce cell death in cultured osteoblasts and pluripotent stem cells (D1-cells), suggesting these effects might be one of the mechanisms contributing to their inhibitory effects on bone remodeling in vivo. On the other hand, our previous results indicated that dexamethasone treatment shifts the characteristics of osteogenesis into adipogenesis in D1-cells. However, the influences of NSAID on adipogenesis in pluripotent stem cells have rarely been investigated. In this study, we tested the adipogenesis of D1-cells upon long-term treatment of NSAIDs. NSAID influence on the osteocalcin expressions of D1-cells was also examined.

Materials and Methods: The effects of treatments with indomethacin, ketorolac, diclofenac and piroxicam (10⁻⁵ and 10⁻⁴ M) for 2, 4 6 or 8 days were evaluated. Lipid droplets in cultures were detected by oil red staining. Adipsin and osteocalcin mRNA expressions were examined by RT-PCR.

Results: In this study, 10⁻⁴M of NSAID treatment for 4–8 days induced adipogenesis in D1-cells, while shorter duration and lower concentration did not. Mild adipogenesis also occurred in cultures treated with 10⁻⁵M of indomethacin for 6 or 8 days, revealing the strongest effect among the 4 NSAIDs. Piroxicam revealed less effects on adipogenesis in D1-cells. However, despite 2-days of treatment with 10⁻⁵M indomethacin, NSAIDs did not affect the expression of osteocalcin either at 10⁻⁵–10⁻⁴M or during 2–8 days of treatments.

Conclusion: These results suggest that high dose and long term administration of NSAIDs may induce adipogenesis in pluripotent stem cells.