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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 531 - 531
1 Sep 2012
Raposo F Sousa A Valente L Moura Gonçalves A Loureiro M Duarte F São Simão R Freitas J Pinto R
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INTRODUCTION. Patellar tendon (PT) autograft is an excellent choice repairing anterior cruciate ligament (ACL) ruptures. Published studies testing the biomechanical characteristics after plasty usually refer to grafts with 10mm wide. The thickness of PT and geometry of the patella have been overlooked. The purpose of this study was to understand the geometry of PT and patella in our population, regarding their use in Bone - Patellar Tendon - Bone (BTB) technique, in order to evaluate their biomechanical efficiency and study their relationship with anthropometric parameters. MATERIAL. 100 individuals (50/50) who underwent knee MRI (3-Tesla). Ages between 18–65years. METHODS. Retrospective study. Standardized protocol for measuring the PT and patella based in MRI images. Interview to obtain personal data. Statistical analysis using SPSS®. RESULTS. Sample (mean ±SD): age 41 ±14years, weight 73 ±12kg, height 167 ±10cm, BMI 26,04 ±4,13; length PT/patella −41,3 ±6,1mm/29,6 ±4,2 mm, width PT/patella −25,3 ±3,2mm/43,4 ±4,14mm; thickness PT −3,79 ±1,01mm/22,8 ±2,2mm; Men have thicker and wider patella and PT than women (p<0.001). The patella is also longer in males (p<0.001). There is statistical significant relationship between weight and height to width, thickness and length of PT and patella (p<0.01). Body Mass Index (BMI) doesn't have statistical correlation with geometry of the PT and patella. DISCUSSION. The PT remains as an excellent option in ACL repair. The anatomy and quality of the graft are essential to achieving good functional results. The choice of middle third tendon to the BTB plasty does not always correspond to the 10mm width, as used in most biomechanical tests. Also patellar integrity can be at risk (when collecting the bone block) if patella geometry is not considered. To our knowledge, there is only one similar study in literature, preformed in Asian individuals. CONCLUSION. Preoperatively accessing the geometry of Patella and PT can be crucial in obtaining efficient grafts and decreasing morbidity over the extensor mechanism


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 532 - 532
1 Sep 2012
Raposo F Sousa A Valente L Duarte F Loureiro M Monteiro E São Simão R Moura Gonçalves A Pinto R
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Introduction. Interest in platelet-derived growth factors has been increasing as an adjunct in surgical techniques for tissue repair. Its use in ligament injuries repair has been studied mainly in animals. The authors intend to study growth factors influence in ACL repair using BTB graft. Material. 20 individuals underwent ACL rupture BTB arthroscopic repair, using Double Incision Mini-Invasive Technique. MRI (3-Tesla) images. GPSIII ® System to obtain Platelet-Rich Plasma (PRP) thrombin activated. Methods. Prospective study consisting of 2 groups of 10 patients each. Surgical technique, fixation method and postoperative protocol were the same. In the study group (SG-10 patients) graft was imbued with PRP and the remaing plasma was intra-articularly injected. The MRIs took place 6 weeks and 6 months after the procedure with and without gadolinium-DTPA enhancement. Evaluation was performed blindly by independent radiologists concerning femoral tunnel integration, sinovialization process and nonspecific synovitis. Clinical and functional status evaluation: IKDC. Statistical analysis in SPSS®. Results. Radiological evaluation was similar in both groups. In the Study Group at 6 weeks we verified less joint effusion and synovitis. At 6 months: no diference in integration in femoral tunnel, and in granulation tissue around the femoral tunnel in graft sinovialization. IKDC (mean ± SD) with PRP: pre-operative −45,66 ±6,98, post-operative −94,35 ±3,54 (Age-29 ± 10), without PRP: preoperative −48,02 ±12,68, post-operative −91,7 ±6,99 (Age −31 ±10). There are no statistical differences between the groups with and without PRP in clinical and functional assessments and MRI images. Discussion. The use of technology to accelerate and improve the processes of tissue repair and integration is of great interest in repairing the ACL. Studies in humans are rare, with low level of evidence and contradictory results. Although the limitations of this study, it seems to us that the use of growth factors has no advantages in the process of PT graft integration at 6 months. Conclusion. PRP doesn't seem to contribute to enhancement of the ligamentation process and articular rehabilitation when used as a step of BTB technique