Anterior knee instability associated with rupture of ACL is a disabling clinical problem, especially in the athletic individual. The gracilis and semitendinosus tendon (T4) represent an alternative autograft donor material for reconstruction of the ACL.

The aim of our study was to elaborate a CPG to assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with ACL reconstruction with T4.

The CPG was developed according to international methods of guideline development. To identify “best evidence” a structured search was performed. When no evidence was available, consensus between experts (physiotherapist and orthopaedic surgeons) was achieved to develop the guideline. To identify “best clinical experience” and “physiopathology reasoning” focus group of practicing physiotherapists was used. They reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it.

CPG include three phases determined from the evidence, physiopathology reasoning and the biological process of autograft (weeks after the surgery: 2^a–6^a, 6^a–10^a and 10^a–16^a). The recommendations included: In postoperative weeks (2^a–6^a) physiotherapy focused on early range of motion of the knee; manual therapy (passive range of motion (PROM) 0–120° and miofascial techniques), pulsed ultrasound of low intensity with a power of 0.3w/cm2 (1MHz) during 10min/day in tibial tunnel, early active hamstring beginning with static weight bearing co-contractions (closed-kinetic-chain) and adductors, partial weight bearing with crutches, exercises in the swimming pool and cryotherapy to pain control (30 mi/4 hours). In weeks 6 to 10, full weight bearing, manual therapy (PROM 0–140° and miofascial techniques), hamstring strengthening progress complexity and repetitions of co-contractions, electrotherapy hamstring and quadriceps co-contractions. Starting at week 10, progress to more dynamic activities/movements, proprioceptive work, open-kinetic-chain, stationary bike and Theraband squats. In week 12, progress jogging program and plyometric type activities. The patients performed sports-specific exercises by about 3½ months postoperative.

Introduction: The use of freeze-dried grafts in the treatment of knee instability is a common technique used in rescue surgery of complex knee instabilities.

Purpose: To assess the evolution of patients that undergo complex knee surgery with freeze-dried ligaments.

Materials and methods: We carried out a retrospective study of patients that had undergone knee ligament surgery with freeze-dried grafts between 1999 and 2005. The study was carried out on 89 patients with a minimum follow-up of 18 months. They were all men except for 3 women. The patients were all of working age, from 19–51 years of age. Fifty-five patients underwent ACL surgery due to tears of previous plasties of the semitendinosus and rectus femoris muscle tendons, with an associated meniscectomy during the first operation in most patients. There were isolated posterior cruciate ligament tears in 5 cases and 29 cases of combined instabilities. In almost all cases preoperative Rh is carried out. Patients were immobilized for a period of 2–4 weeks according to the plasty performed. We assessed the patients using the Lyshom scale, VAS scale, MRI at 1 year, x-rays, range of movement, stability and return to normal work and sports activities.

Results: We assessed the results in patients that underwent ACL rescue surgery and obtained the following results: 44% of the patients reported a subjective feeling of instability and up to 15% required repeat stabilization surgery. In those patients for whom an MRI was obtained it was possible to see 29% of plasty resorption. On x-ray a significant increase in the size of the tibial tunnel and permeability was seen in comparison with autologous series. Good postoperative mobility results were obtained. Seventy percent of the patients were able to return to their previous work activity and 44% continued practicing their customary sports activities. Complications: During the postoperative period recurrent effusions were seen in 41% of the patients, which resolved spontaneously in most cases. There were 2 cases of postoperative septic arthritis that required surgical action.

Conclusions: In our series of freeze-dried plasties we had a high rate of complications and graft resorptions which were clearly higher than those of other published series where other types of grafts were used.

Purpose: To analyze the causes of repeat knee arthroscopy in the same knee.

Materials and methods: We reviewed 923 patients that had undergone knee arthroscopy during 2005 and assessed those that had already undergone previous arthroscopy of the same knee that year or in previous years and analyzed the causes.

Results: Of the 923 patients that required knee arthroscopy 169 (18.3%) had undergone previous surgery. Four (2.3%) had undergone 3 previous arthroscopies, 27 (15.9%) two and 138 (81.6%) one. In 59.8% of cases, the symptoms that led to repeat arthroscopy were non-traumatic continuous pain. The other cases required repeat arthroscopy due to new trauma, or meniscal or anterior cruciate ligament (ACL) tears. The patients with affected menisci (104) underwent partial meniscectomy, 31% had a posterior cruciate ligament (PCL) tear and 58% had menisci remains with or without osteochondral lesions.

Repeat arthroscopies of ACL tears treated by ligamentoplasties (41) were due to plasty tears in 46% of cases and adhesions in 27%. In patients that underwent 3 arthroscopies, the main diagnosis was plasty tear in 45% of the total sum of 2^nd and 3^rd arthroscopies. Mean time between first and second arthroscopy was 28 months and between second and third arthroscopy 12 months.

The relative risk of undergoing a new arthroscopy during the same year as meniscectomy was 1.12% and as ACL ligamentoplasty 0.95%.

Conclusions: Not all repeat arthroscopies are caused by previous complications. The main clinical reasons for a repeat arthroscopy can be traumatic or non-traumatic, with a greater frequency of the latter. We found that the risk of repeat arthroscopy was greater during the first year in meniscal tears than in ACL tears.

Introduction: Loss of the meniscus frequently leads to progressive arthritic changes in the involved compartment. Replacement of the lost meniscus with a resorbable collagen scaffold has been proved to allow regeneration of meniscal tissue.

MATERIAL AND Methods: Between June 2001 and September 2004, 42 patients, 38 male and 4 female, underwent arthroscopic placement of a collagen meniscus implant (CMI) to reconstruct the damaged medial meniscus. Their age ranged between 22 and 50 years. All patients had an associated ACL insufficiency, 39 secondary to acute ACL tear and 3 ACL graft failures. ACL reconstruction with hamstrings grafts (39) and ACL revision with allograft (3) was performed at the time of CMI implantation. The interval between ACL injury and surgery ranged between 3 weeks and 6 months. Ten patients also had a lateral meniscus tear. All patients were followed with clinical, weight-bearing radiographs, KT-1000 and magnetic resonance examinations for at least 18 months (range, 18– 84 months). The IKDC form was used to record and evaluate the Results:

Results: The length of the implanted CMI ranged between 3 and 5.5 cm and required 4 to 8 stiches.

The IKDC subjective evaluation was normal in 18 patients, nearly normal in 18, abnormal in 5 and severely abnormal in 1. Range of motion was normal in 28 patients and nearly normal in 14. KT 1000 examination was normal in 32 patients, nearly normal in 7, abnormal in 1 and severely abnormal in 2.

The X ray findings were normal in 28 patients, nearly normal in 6 and abnormal in 8.

Complications included 2 saphenous nerve neuritis, 1 ACL graft tear with CMI implant breakage and 2 knee stiffness that required mobilization.

40 patients returned to work. The average time to resume work was 5.5 months

Conclusion: Simultaneous ACL reconstruction and collagen meniscal implantation is a viable and effective option in young active patients with ACL insufficiency and associated meniscal injuries.

Introduction: Recent clinical, morphological and MRI studies have evidenced a potential for regeneration of the tendons of the semitendinous and medial rectus muscles. This is the first article in the world literature describing how these two tendons have been obtained for the second time and have been used for reconstruction of the ACL.

Materials and methods: The study included two men aged 30 and 38 in whom the ACL had been reconstructed (6 and 9 years before, respectively) using the semitendinous (ST) and medial rectus (MR) tendons. The full length and width of the tendons were harvested using a tenotome. The ACL reconstruction was subsequently broken in both patients in a sporting accident. Preoperative MRI was performed in both patients and confirmed the rupture of the ACL and regeneration of the ST and MR. Both tendons were harvested, the macroscopic findings were noted and samples of the tendons were taken for histological study. The regenerated tendons were used to reconstruct the ACL, maintaining their distal attachment and fixing them proximally with a staple.

Results: Macroscopically the regenerated tendons looked nearly normal. Both had regenerated to their normal thickness and length (the diameter of the tunnels in the ACL revision surgery was the same as in the primary surgery).

The histological study showed normal tendinous tissue with a few areas of disorganised collagen bundles, increased proliferation of fibroblasts and formation of capillaries.

After a follow-up of 14 and 17 months, both patients recovered their prior level of sports activity and their knees were stable.

Conclusions: Harvesting the tendons of the semitendinous and medial rectus muscles leads to regeneration of both tendons. Although the biomechanical properties of this regenerated tissue are unknown, clinically it appears to be an appropriate tissue for ACL reconstruction.