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Revision of failed synthetic ACL reconstructions
ABSTRACTS medial and lateral (UNI). Ninety-six knee joint replacement patients (40 TKR, 36 PFR, and 20 UNI) underwent 142 subsequent arthroscopic surgeries of the effected knee. Fibroarthrosis was the most common diagnosis in the total knee group. Meniscal tears, loose bodies, and progressive osteoarthritis were the most common diagnoses in the other groups. The average time between joint replacement and arthroscopic intervention was 49 months (1-212 months). Follow-up on 83 patients revealed that 33 (40%) felt their symptoms were improved after arthroscopic surgery and were satisfied with their results. Conversely, 50 patients (60%) believed that the arthroscopic surgery was of no benefit and were dissatisfied with the results. Six patients in the dissatisfied group developed the catastrophic complication of joint infection following their arthroscopic procedures. Six percent (6/96) of the patients (4% of the arthroscopic cases 6/142) developed complications. None of these patients had any other known etiology for the infection. Cultures revealed three coagulase negative staph, one coagulase positive staph, and two staph aureus infections. Five of the six infections required removal of components and subsequent revision total knee replacement. We conclude that operative arthroscopy may not be indicated in patients with symptomatic joint replacements of the knee. Conservative modalities should be exhausted before arthroscopic intervention be undertaken.
Revision of Failed Synthetic ACL Reconstructions. Domenick J. Sisto and Debbie L. Cook. Sherman Oaks, California, U.S.A. Synthetic prosthetic graft material has been shown to have an unacceptably high failure rate, causing sterile effusions, increasing laxity, and ultimately rupture. What has not been previously studied are the effects those failed grafts have on the joint in which they were placed. Many of the patients with failed grafts required multiple revision surgical procedures and there is concem that these grafts may have placed the joints at increased risk for synovitis, arthritis, chronic pain. The purpose of this study was to evaluate our results of revision procedures following failed synthetic ACL reconstruction. Between 1975 and 1994, our group performed 42 revision procedures on 36 patients following failed synthetic ACL reconstructions. The patients were an average of 27 years old (16-53), with a 2:1 male:female ratio. The failed grafts consisted of 13 Gore-Tex, 12 Meadox, ! 1 Polyflex, 5 Carbon, and 1 Kennedy LAD. The revision procedures performed included 32 ACL
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reconstruction, 12 with synthetic graft material (8 Gore-Tex, 2 Polyflex, 2 Carbon), 13 with achilles tendon allografts and 7 with autogenous graft material (5 patellar tendon, 1 illiotibial band, 1 semitendinosus/ gracilis). Eight total knee arthroplasties were performed, one above knee amputations and the removal of the synthetic graft in two cases. The average length of survival time for the synthetic grafts was 49 months (range 7-219). Eight of the synthetic graft procedures were themselves revision procedures from primary repairs and 29 synthetic grafts were placed primarily. Our primary grafts survived and average of 48 months. We found that of the revision procedures, 50% of the total knee arthroplasties (4 of 8) were done on knees with failed Polyflex grafts. Intraoperatively it was noted on many occasions that the graft sites showed marked reactive synovitis, adhesions, stenosis of the femoral notch and advanced degenerative changes of the knee. We believe that the failed synthetic grafts, with their particulate synovitis and foreign body reactions did in fact predispose these joints to earlier wear and earlier degenerative changes. We do not recommend the use of synthetic grafts because the revision of a failed synthetic is more difficult, the results are inferior to allograft revisions and the potential for damage to the articular surfaces and synovium following a failed synthetic is unknown.
Long-Term Clinical Follow-Up of Isolated SLAP Lesions of the Shoulder. William B. Stetson, Stephen J. Snyder, Ronald P. Karzel, Michael P. Banas, and Scott E. Rahhal. St. Louis, Missouri, Van Nuys, California, Bethlehem, Pennsylvania, and Tulsa, Oklahoma, U.S.A. Introduction: An injury pattern involving the superior aspect of the glenoid labrum has been termed a SLAP lesion. The purpose of our study is to conduct a clinical review of long term follow-up of isolated SLAP lesions of the shoulder. Methods: In a review of 2,375 shoulder arthroscopies performed, there were 140 SLAP lesions identified, only 26 of which had no other intra-articular pathology. Clinical follow-up was available in 23 patients and averaged 3.8 years with a range from 14 months to 8 years. All 23 patients complained of nonspecific shoulder pain which increased with overhead activities. The one Type I lesion was treated with labral debridement. Six Type II SLAP lesions were treated with debridement and abrasion of the superior glenoid rim, five Type II's were reattached with a Bio-Tak anchor, four Type II's were reattached with a G-2 Mitek anArthroscopy, Vol 12, No 3, 1996
Revision of Failed Synthetic ACL Reconstructions. Domenick J. Sisto and Debbie L. Cook. Sherman Oaks, California, U.S.A. Synthetic prosthetic graft material has been shown to have an unacceptably high failure rate, causing sterile effusions, increasing laxity, and ultimately rupture. What has not been previously studied are the effects those failed grafts have on the joint in which they were placed. Many of the patients with failed grafts required multiple revision surgical procedures and there is concem that these grafts may have placed the joints at increased risk for synovitis, arthritis, chronic pain. The purpose of this study was to evaluate our results of revision procedures following failed synthetic ACL reconstruction. Between 1975 and 1994, our group performed 42 revision procedures on 36 patients following failed synthetic ACL reconstructions. The patients were an average of 27 years old (16-53), with a 2:1 male:female ratio. The failed grafts consisted of 13 Gore-Tex, 12 Meadox, ! 1 Polyflex, 5 Carbon, and 1 Kennedy LAD. The revision procedures performed included 32 ACL
351
reconstruction, 12 with synthetic graft material (8 Gore-Tex, 2 Polyflex, 2 Carbon), 13 with achilles tendon allografts and 7 with autogenous graft material (5 patellar tendon, 1 illiotibial band, 1 semitendinosus/ gracilis). Eight total knee arthroplasties were performed, one above knee amputations and the removal of the synthetic graft in two cases. The average length of survival time for the synthetic grafts was 49 months (range 7-219). Eight of the synthetic graft procedures were themselves revision procedures from primary repairs and 29 synthetic grafts were placed primarily. Our primary grafts survived and average of 48 months. We found that of the revision procedures, 50% of the total knee arthroplasties (4 of 8) were done on knees with failed Polyflex grafts. Intraoperatively it was noted on many occasions that the graft sites showed marked reactive synovitis, adhesions, stenosis of the femoral notch and advanced degenerative changes of the knee. We believe that the failed synthetic grafts, with their particulate synovitis and foreign body reactions did in fact predispose these joints to earlier wear and earlier degenerative changes. We do not recommend the use of synthetic grafts because the revision of a failed synthetic is more difficult, the results are inferior to allograft revisions and the potential for damage to the articular surfaces and synovium following a failed synthetic is unknown.
Long-Term Clinical Follow-Up of Isolated SLAP Lesions of the Shoulder. William B. Stetson, Stephen J. Snyder, Ronald P. Karzel, Michael P. Banas, and Scott E. Rahhal. St. Louis, Missouri, Van Nuys, California, Bethlehem, Pennsylvania, and Tulsa, Oklahoma, U.S.A. Introduction: An injury pattern involving the superior aspect of the glenoid labrum has been termed a SLAP lesion. The purpose of our study is to conduct a clinical review of long term follow-up of isolated SLAP lesions of the shoulder. Methods: In a review of 2,375 shoulder arthroscopies performed, there were 140 SLAP lesions identified, only 26 of which had no other intra-articular pathology. Clinical follow-up was available in 23 patients and averaged 3.8 years with a range from 14 months to 8 years. All 23 patients complained of nonspecific shoulder pain which increased with overhead activities. The one Type I lesion was treated with labral debridement. Six Type II SLAP lesions were treated with debridement and abrasion of the superior glenoid rim, five Type II's were reattached with a Bio-Tak anchor, four Type II's were reattached with a G-2 Mitek anArthroscopy, Vol 12, No 3, 1996