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Arthroscopy of reconstructed anterior cruciate ligaments with artificial ligaments
ABSTRACTS
Meniscal lesions were seen in 27 knees (77%) in Group I, 14 knees (70%) in Group II, 10 knees (83%) in Group III, and 16 knees (100%) in Group IV. Chondral lesions were found in 8 knees (23%) in Group I, 9 knees (45%) in Group II, 8 knees (67%) in Group III, and 12 knees (75%) in Group IV. The frequency of meniscal and chondral lesions increased with time after the initial injury, and both the extent and grade of the chondral lesions progressed. Activity after injury, the presence of meniscal lesions or meniscectomy in the same compartment, and frequent reinjury made the frequency of chondral lesions higher and their severity greater. Notch Plasty in Arthroscopic Anterior Cruciate Ligament Reconstruction. Konsei Shine, et al. Osaka, Japan. We studied how frequently grafts of the anterior cruciate ligament (ACL) impinged against the intercondylar notch during arthroscopic ACL reconstruction in 30 knees of Japanese patients. Graft impingement was observed in 16 cases (53%), and notch plasty was required. Roentgenographic measurements in tunnel views were not useful to predict which patients would require the procedure. We concluded that direct intraoperative assessment of the graft-notch relationship throughout the entire range of motion is mandatory if graft impingement is to be eliminated. Arthroscopy of Reconstructed Anterior Cruciate Ligaments with Artificial Ligaments. Hiroshi Yamaga, Kiyoshi Yokoe, Lewis Kei Hayashi, Osamu Ztoh, Hitoshi Zdota, Kouji Hasegawa, Kunio Ida, Takayuki Miura, and Ryotaro Mori. Nagoya, Japan.
Between April 1985 and February 1988, we reconstructed the anterior cruciate ligament (ACL) of 56 knees using the Leeds-Keio artificial ligament (42 knees) or a Dacron artificial ligament (14 knees). Twenty-three of the reconstructions were done arthroscopically. Postoperative arthroscopic evaluation was done in 37 reconstructions (28 Leeds-Keio and 9 Dacron) after 6-17 months (means of 11 and 13 months). Partial laceration was identified in 8 ligaments (1 Leeds-Keio and 7 Dacron), all at the edge of the femoral drill hole. Fibrous adhesion and granulation tissue were more accentuated in patients who had an open reconstruction, and they were more evident at the intercondylar notch area when recon-
403
struction was with the Leeds-Keio ligament. The tissue formed around the Dacron ligament was frayed and could be easily dissected with blunt instruments, but the tissue penetrating the LeedsKeio ligament was firmly attached to the fibers of that ligament. We concluded that although reconstruction of the ACL of these patients had been considered satisfactory, arthroscopy could not show the real status of most cases because of the presence of fibrous adhesions. The high incidence of partial lacerations (mainly with the Dacron ligament) will probably result in failure; more investigation and long-term follow-up are needed. Results of Arthroscopic Men&al Repair. Sakae Yumaguchi, Shiro Tabata, Hiroshi Kida, Mitsuaki Takahara, Hitomitsu Takada, Hironori Hyodo, and Fuji0 Matsumoto.
Since 1984, we have used arthroscopic meniscal repair for meniscus lesions in 26 knees for 25 patients (12 men and 13 women). The mean age of the patients was 21.5 years (range, 1149 years). Seventeen of the tears were of the medial menisci and the others were of the lateral menisci (23 longitudinal peripheral tears, and three hypermobile meniscus). At a mean follow-up 21 months (range, 3-48 months), 21 patients (85%) had clinically good results. One patient with a large bucket-handle tear had a rerupture at the sutured area. Two of the three hypermobile menisci were not improved. Technique for Arthroscopic Meniscus Suture in the Posterior Segment. Nuoki Katayama, Yoshimitsu Ohosawa, Yasuhiro Sakakibara, Tatsuo Matsuda, and Haruo Ohoguchi. Tokyo (NK, YO, YS, TM)
and Nagoya (HO), Japan. We report a technique for treatment of peripheral meniscus tears, but it was impossible to suture the posterior segment complete by arthroscopy. Usually, a semiarthroscopic method is used. The posterior segment can be sutured by a new technique. Four kinds of instruments are necessary: a 19G disposable lumbar puncture needle, an 18G disposable needle, 3-O monofilament nylon thread, 2-O absorbable monofilament thread (polydioxanone suture) for suturing, and a stopper (disposable cock). The key of the technique is that the lumbar Arthroscopy.
Vol. 7. No. 4, 1991
Meniscal lesions were seen in 27 knees (77%) in Group I, 14 knees (70%) in Group II, 10 knees (83%) in Group III, and 16 knees (100%) in Group IV. Chondral lesions were found in 8 knees (23%) in Group I, 9 knees (45%) in Group II, 8 knees (67%) in Group III, and 12 knees (75%) in Group IV. The frequency of meniscal and chondral lesions increased with time after the initial injury, and both the extent and grade of the chondral lesions progressed. Activity after injury, the presence of meniscal lesions or meniscectomy in the same compartment, and frequent reinjury made the frequency of chondral lesions higher and their severity greater. Notch Plasty in Arthroscopic Anterior Cruciate Ligament Reconstruction. Konsei Shine, et al. Osaka, Japan. We studied how frequently grafts of the anterior cruciate ligament (ACL) impinged against the intercondylar notch during arthroscopic ACL reconstruction in 30 knees of Japanese patients. Graft impingement was observed in 16 cases (53%), and notch plasty was required. Roentgenographic measurements in tunnel views were not useful to predict which patients would require the procedure. We concluded that direct intraoperative assessment of the graft-notch relationship throughout the entire range of motion is mandatory if graft impingement is to be eliminated. Arthroscopy of Reconstructed Anterior Cruciate Ligaments with Artificial Ligaments. Hiroshi Yamaga, Kiyoshi Yokoe, Lewis Kei Hayashi, Osamu Ztoh, Hitoshi Zdota, Kouji Hasegawa, Kunio Ida, Takayuki Miura, and Ryotaro Mori. Nagoya, Japan.
Between April 1985 and February 1988, we reconstructed the anterior cruciate ligament (ACL) of 56 knees using the Leeds-Keio artificial ligament (42 knees) or a Dacron artificial ligament (14 knees). Twenty-three of the reconstructions were done arthroscopically. Postoperative arthroscopic evaluation was done in 37 reconstructions (28 Leeds-Keio and 9 Dacron) after 6-17 months (means of 11 and 13 months). Partial laceration was identified in 8 ligaments (1 Leeds-Keio and 7 Dacron), all at the edge of the femoral drill hole. Fibrous adhesion and granulation tissue were more accentuated in patients who had an open reconstruction, and they were more evident at the intercondylar notch area when recon-
403
struction was with the Leeds-Keio ligament. The tissue formed around the Dacron ligament was frayed and could be easily dissected with blunt instruments, but the tissue penetrating the LeedsKeio ligament was firmly attached to the fibers of that ligament. We concluded that although reconstruction of the ACL of these patients had been considered satisfactory, arthroscopy could not show the real status of most cases because of the presence of fibrous adhesions. The high incidence of partial lacerations (mainly with the Dacron ligament) will probably result in failure; more investigation and long-term follow-up are needed. Results of Arthroscopic Men&al Repair. Sakae Yumaguchi, Shiro Tabata, Hiroshi Kida, Mitsuaki Takahara, Hitomitsu Takada, Hironori Hyodo, and Fuji0 Matsumoto.
Since 1984, we have used arthroscopic meniscal repair for meniscus lesions in 26 knees for 25 patients (12 men and 13 women). The mean age of the patients was 21.5 years (range, 1149 years). Seventeen of the tears were of the medial menisci and the others were of the lateral menisci (23 longitudinal peripheral tears, and three hypermobile meniscus). At a mean follow-up 21 months (range, 3-48 months), 21 patients (85%) had clinically good results. One patient with a large bucket-handle tear had a rerupture at the sutured area. Two of the three hypermobile menisci were not improved. Technique for Arthroscopic Meniscus Suture in the Posterior Segment. Nuoki Katayama, Yoshimitsu Ohosawa, Yasuhiro Sakakibara, Tatsuo Matsuda, and Haruo Ohoguchi. Tokyo (NK, YO, YS, TM)
and Nagoya (HO), Japan. We report a technique for treatment of peripheral meniscus tears, but it was impossible to suture the posterior segment complete by arthroscopy. Usually, a semiarthroscopic method is used. The posterior segment can be sutured by a new technique. Four kinds of instruments are necessary: a 19G disposable lumbar puncture needle, an 18G disposable needle, 3-O monofilament nylon thread, 2-O absorbable monofilament thread (polydioxanone suture) for suturing, and a stopper (disposable cock). The key of the technique is that the lumbar Arthroscopy.
Vol. 7. No. 4, 1991