Purpose

To assess the midterm functional results after Medial Patellofemoral Ligament (MPFL) reconstruction with single semitendinosis autograft in patients with patellofemoral instability.

AIMS

The aim of this study was to assess the knee function after MPFL reconstruction with single hamstring autograft.

Introduction

The purpose of this study is to evaluate the early functional outcome and activity level in athletes and soldiers with large full thickness cartilage defects of the knee that underwent either ‘classic’ autologous chondrocyte implantation using periosteal flap coverage (ACI-P) or 3-D matrix-assisted chondrocyte implantation (ACI-M).

Aim

The aim of this study was to compare the diagnostic accuracy of the Magnetic Resonance Imaging with that of Stress views of the ankle in testing the integrity of the lateral ankle ligaments. Arthroscopic diagnosis was used as the gold standard.

Aims: The purpose of the study was to assess the mid-term knee functional results after Medial Patellofemoral Ligament (MPFL) reconstruction with single semitendinosus autograft in patients with patellofemoral instability.

Methods and Results: Knee function was assessed in 45 patients (46 knees) who underwent MPFL reconstruction with semitendinosus autograft. The tibial insertion of the semitendinosus was preserved whereas the free end, after stripping of the tendon from the musculo-tendinus junction was rerouted through the most distal part of the medial intermuscular septum proximally to the adductor tubercle, to the superomedial border of the patella, where it was fixed. Clinical and radiological evidence of patellar instability and MPFL rupture or deficiency was documented prior to surgery. Knee function was assessed preoperatively and postoperatively with the use of Kujala, Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores. There were 34 male and 11 female patients with an average age of 32.5 years, ranging from 17 to 60 years. The minimum follow up was 2 years with an average of 33.5 months (range 24–54 months). Fourteen patients (30%) presented a degree of patellofemoral dysplasia. All knee functional scores significantly improved postoperatively. Kujala score improved from 57.7 to 77.1, Tegner score improved from 3.06 to 5.26, IKDC score improved from 51.2 to 75.44 and Lysholm score improved from 58.7 to 79.3. One of the patients required revision of the MPFL reconstruction due to traumatic redislocation of the patella.

Conclusions: At a midterm follow-up, reconstruction of the MPFL with rerouting of the semitendinosus tendon is an effective method with improved function in all patients. Maximum improvement was achieved within the first six postoperative months. Heterogeneity of our population may have affected some of our results.

The aim of the study was to assess the knee function after MPFL reconstruction with single hamstring autograft.

In this case series 86 patients (87 knees) were treated in total, from July 2002 till December 2008. Clinical and radiological evidence of patellar instability and MPFL rupture or deficiency were documented prior to surgery. The MPFL was reconstructed with semitendinosus autograft. The tibial insertion of the graft was retained whereas its free end was rerouted through the most distal part of the medial intermuscular septum, to the supero-medial border of the patella, where it was fixed. Knee function was assessed preoperatively and postoperatively with the use of Kujala, Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores.

There were 60 male and 26 female patients with an average age of 29.73 years (median age 28) and range 16–54 years. The mean follow-up was 22.4 months (range 6–78 months). All knee functional scores significantly improved postoperatively. Kujala score improved from 61.3 to 84.8, Tegner score improved from 3 to 5.3, IKDC score improved from 52.4 to 73.8 and Lysholm score improved from 58 to 76.5. The comparison was made between the preoperative and the postoperative values at two years after surgery or at the last follow up, if it was shorter than two years. All scores showed significant improvement after the third postoperative month. One of the patients required revision of the MPFL reconstruction following traumatic redislocation of the patella.

Rerouting of the semitendinosus tendon for the reconstruction of the MPFL is an effective method for the treatment of patellofemoral instability. Significant functional improvement is achieved between the third and sixth postoperative months

Background: Stress radiography and more recently magnetic resonance imaging have been used to study the integrity of lateral ankle ligaments in chronic symptomatic instability after injury.

Aim: Our aim was to see if magnetic resonance imaging was as good as examination under anaesthesia and stress radiography, for diagnosing injury to the lateral ankle ligaments.

Study Design: Cross-over study.

Methods: Fifty eight patients, 47 men and 11 women, were included in the study. These were athletes or military personnel with symptomatic instability of the ankle after injury. This cohort of patients had MRI scans, stress radiographs and arthroscopic treatment of their ankle. Integrity of the calcaneo-fibular ligament (CFL) was recorded arthroscopically. The sensitivity, specificity, positive and negative predictive value of MRI and stress views, in assessing integrity of the CFL, were compared against the arthroscopic findings which was considered to be the gold standard.

Results: Stress radiography under anaesthesia and MRI has sensitivities of 94% and 47% and specificities of 98% and 83% for diagnosing injury to the CFL, respectively. Stress radiography has a higher accuracy in diagnosing CFL injuries as compared to MRI.

Conclusion: The results of this study casts doubt on the efficacy of MRI in the diagnosis of serious ankle ligament injuries.

Background & Aim: Recent studies have claimed good results after ACI in athletes. Our aim was to evaluate the early functional outcome and activity level after 2-stage ACI in professional athletes and soldiers.

Methods: Thirteen soldiers and five professional athletes (14 men and 4 women; average age 31 years), with 21 full thickness cartilage defects (ICRS grade-IV) of the knee were treated with 2-stage ACI. Mean interval between injury and surgery was 43.8 months. Average defect size was 6.03 cm² and was located to the MFC in 7 cases, LFC in 7 cases and the femoral trochlea in one case. The functional outcome was evaluated with ICRS form, Tegner activity rating scale and Lysholm score after a mean follow up period of 23.4 (18–32) months.

Results: The ICRS and Lysholm scores were improved from 42.7 and 47.6 pre-operatively to 63.1 and 69.9 respectively. The average Tegner scale was 8.8 pre-injury, 3.7 prior to surgery and 6.4 at the final follow up. Nine patients (50%) underwent second-look arthroscopy for persistent mechanical symptoms. Periosteal flap overgrowth was identified in 6 cases with adequate graft integration while partial failure of the graft was noted in one case and was treated with microfracture.

Conclusions: The early results of ACI in high-performance athletes and professional soldiers are not as good as other studies suggest. Returning to pre-injury performance levels for athletes and military people is by no means assured in the first 24 months after ACI.

Background: The medial patellofemoral ligament (MPFL) is the principle medial stabilizer of the patella. It is damaged after traumatic patella dislocation. We describe a reproducible technique for MPFL reconstruction and our preliminary results at 12 months.

Material-methods: 25 patients (19 men, 6 women; average age 26.9 years-old) with post-traumatic patellar instability underwent MPFL reconstruction at a mean post-injury interval of 22.3 months. Five patients had evidence of generalized laxity, 3 had trochlear dysplasia and 16 (64%) more than two episodes of dislocation. Arthroscopic assessment revealed associated chondral lesions in 88% and marked lateralization. The reconstruction was performed using ipsilateral semitendinosus tendon. With the distal attachment preserved, the proximal end is passed through the medial intermuscular membrane and secured to the medial border of the patella. Clinical pre- and post-operative assessments included IKDC, Tegner, Lysholm and Kujala scores. ICRS documentation recorded the contribution of articular cartilage damage, whereas Merchant views and MRI scans documented the abnormal radiological parameters and the damaged structures of the medial retinaculum respectively.

Results: At a mean follow up period of 12 months (8–18 months) no cases of re-dislocation were recorded. The Tegner and IKDC scores averaged 4.2 and 46.9 pre-injury. Postoperatively they had improved to 7.7 and 86.5. The average postoperative Lyshom- and Kujala scores were 87 and 89 respectively. Re-operation was required in one patient after patellar fracture 8 weeks post reconstruction.

Conclusion: Our preliminary results suggest surgical reconstruction of the MPFL provide a favorable early outcome for the treatment of post-traumatic patellofemoral instability and will form the basis for longer follow up in a larger cohort.

Introduction: The search continues for ideal markers and methods of monitoring cartilage degeneration. Various cartilage components, whole or fragmented, have been measured in synovial fluids. A common problem in quantitating these markers is often the unknown dilution of synovial fluid which can occur in obtaining the samples. In this study we have used urea (ratio in synovial fluid:serum) as a method to correct for the dilution of synovial fluid, and hence to quantify enzyme levels in patients with a spectrum of cartilage degradation, in addition to identifying aggrecan degradation products, many of them for the first time in such samples.

Methods: Forty synovial fluid samples were obtained from 4 groups of individuals (10 in each):

normal,

Levels of matrix metalloproteinases (MMPs) 2 and 3 and the inhibitor, TIMP 1, were measured in the fluids via ELISA assays. Urea levels were measured in blood and synovial fluids and enzymes and their inhibitors were normalized according to the ratio of serum:SF urea, to account for the dilution factor of the SF (Kraus et al 2001). Western blotting was used to identify the presence of aggrecan components (chondroitin-4-sulphate: 2B6 antibody; C-6-S: 3B3 and C-0-S: 1B5; keratan sulphate: BKS-1; the G1 domain: 7D1; interglobular domain: 6B4) and also enzyme degradation products of MMPs (BC14) and aggrecanases (BC3; BC-13).

Results: MMPs 2 and 3 and TIMP 1 were all significantly increased in the synovial fluids from OA patients compared to normals (P< 0.01, 0.001 and 0.01 respectively) and MMP3 was greater in the grade IV chondral and osteochondral defect groups than the normals (P< 0.01). Western blotting demonstrated fragmented aggrecan components with a range of molecular weights. Aggrecanase activity was seen in the OA and grade IV chondral damage groups but not in the osteochondral or normal groups, whereas MMP activity was seen in all 3 groups showing cartilage damage but not in the normals.

Conclusion: Dilution of the synovial fluid, either due to inflammation or joint lavage, is often a problem in quantitating metabolites and markers in joint cavities. This pilot study of a limited number of samples from well characterized patient groups indicates that using urea concentrations in synovial fluid relative to serum provides a mechanism to overcome this. It confirms elevated enzyme activity, both aggrecanase and MMPs, in the joints of patients with degenerate cartilage, compared to normals.