ACL Injury Specialists Baldwinsville NY
SUNY Medical Orthopaedic Surgery
Medical School: Med Coll Of Ohio, Toledo Oh 43699
Graduation Year: 2001
Syracuse Orthopaedic Specialists
Medical School: Univ Of Vt Coll Of Med, Burlington Vt 05405
Graduation Year: 1971
Hospital: St Josephs Hospital Health Cen, Syracuse, Ny; Crouse Hosp, Syracuse, Ny
Group Practice: Syracuse Orthopaedic Specialists; University Orthopedics & Sports Medicine
How's That ACL Repair Workin' For Ya?
Knee injuries resulting in anterior cruciate ligament (ACL) tears are fairly common -- especially in athletes and sports participants. With full tears, ACL reconstruction is usually required. Most athletes are concerned with how soon can they get back into action on the court or in the field. An equally important question is: how well does the new ACL hold up over time? Is osteoarthritis inevitable?
To find out, this group of sports physical therapists and orthopedic surgeons performed a long-term (15-year) study of patients who had an ACL injury. Some of the patients had just the ACL tear. Others had additional damage done at the same time (e.g., meniscal injury, cartilage lesions, other ligament damage).
Everyone in both groups had an ACL reconstruction surgery. The goal of surgery was to restore stability and function of the knee joint. Without the ACL to hold the two bones of the knee together (the femur or thigh bone and the tibia, the lower leg bone), the tibia can slide too far forward away from the femur.
The graft used to replace the ruptured ACL was taken from the patellar tendon (just below the knee cap). This graft procedure is called a bone-patellar tendon bone (BPTB) autograft. Autograft means the graft tissue came from the patient's own knee.
It should be noted that the patients who had additional injuries to the same knee may or may not have had those injuries repaired at the time of the ACL surgery. For example in some cases, meniscal tears were repaired, removed, or left alone. Anyone with chondral (cartilage) lesions may have had the edges shaved down to smooth the area, but full repair was not made.
Results for these two groups were compared in terms of motion, function, strength, and activity level. Everyone was followed early on (six months after surgery, one year later, two years later) and then rechecked at 10 and 15 years after the procedure.
X-rays were used to document any signs of osteoarthritis. Narrowing of the joint space, presence of bone spurs, and deformity of the bones at the joint were evaluated to grade the severity of arthritic changes.
One thing that makes this study different from others like it is the way they looked at osteoarthritis. Most studies just report how many patients developed osteoarthritis down the road after ACL surgery. In this study, they compared how many patients had signs of arthritis on X-ray without symptoms and how many had visible changes with symptoms. Pain was the primary symptom used to say whether or not the patient had symptomatic radiographs (X-rays).
The authors also took a closer look at how additional injuries affected function. In other words, they compared patients with ACL, meniscal, and/or cartilage damage to those who had just an isolated ACL tear. How did their X-rays look 10 to 15 years later? Which group had more symptoms of arthritis?
Because they were looking at so many different findings, it might be easier to show yo...
Infection After ACL Reconstruction Remains Rare
All surgical procedures have some risks. Complications can vary from mild infection to something as serious as death. In this study, the risk of infection after anterior cruciate ligament (ACL) reconstructive surgery is calculated. Surgeons from the Hospital for Special Surgery in New York City present data from a review of over 3000 patients who had ACL surgery in their clinic.
This study helps put into perspective concerns about infection when using tendon grafts to replace the ruptured anterior cruciate ligament in the knee. There is always a niggling concern in the back of the surgeon's mind about this problem.
Four main factors enter into the equation. There are two choices for graft tissue: taking the donor tissue directly from the patient (an autograft) or taking tissue from a donor bank (an allograft). Allografts have become increasingly popular with surgeons based on the fact that these are easy to use, come in a wide variety of sizes to choose from, decrease the time the patient is in surgery, and eliminate pain and problems at the donor site when patients use their own tissue.
But the question arises: is the risk of infection higher with donated tissue? And there are two types of graft collection sites: the hamstring tendon or the patellar tendon. The same question arises: is the risk of infection greater using one type over another?
The authors reviewed the charts of 3126 patients at their facility who had this type of surgery. They separated out these four variables and found that the overall incidence of infection is very low (less than one-half of one per cent). The rate of infection wasn't any higher in the allograft (donor bank) tissue than for patients using their own tissue (autograft).
However, hamstring autografts do seem to have a higher risk of infection than patellar tendon grafts. This result has been reported by other researchers. There is some thought that the way in which the hamstring tendon grafts are sterilized might be the reason for an increased risk of infection with these grafts.
Even though this complication is rare, when it happens, it can still be devastating. The patient experiences fever, pain, and drainage with swelling and redness around the joint. The main danger is that the graft will have to be removed and the surgery done over. Surgeons do everything they can to save the graft and avoid a re-operation.
What can be done? Well, first the infection is confirmed by removing some fluid from the joint and testing it for bacteria. Staphylococcus aureus (staph infection) is the most common organism found. Then the joint is irrigated with a cleansing liquid called saline solution. The surgeon removes any infected tissue through a procedure called debridement. And finally, intravenous (IV) antibiotics are given for at least six weeks.
The process of irrigation and debridement may have to be repeated more than once. In this study, one-third of the patients needed this typ...
Too Old for ACL Surgery? Not Likely
A mere few years ago, most surgeons probably wouldn't have considered doing surgery to reconstruct the anterior cruciate ligament (ACL) in patients over 40. However, with the steady rise of more technically advanced ways to do this surgery, the boundaries of age are being stretched.
But how do "older" patients fare after ACL surgery? Surely they don't do as well as their younger counterparts. Or do they?
Fresh evidence indicates that patients over 40 have results after ACL surgery that are comparable to patients in their early 20s. Two groups of ACL patients were compared before and after surgery. One group included people over the age of 40. The other represented the typical age group for this type of surgery, ages 20 to 24.
Patients had a recheck within 38 weeks after surgery. The final results showed that the older group did nearly as well as the younger group. Researchers measured the patients' knee motion, ability to hop on one leg, and side-to-side slackness in the affected knee. In each instance, the differences were minimal between groups.
Researchers also asked questions about daily activities and knee function. The questions showed only one major difference between the groups. Younger patients tended to return to higher activity levels after the surgery.
When asked about their opinion of the surgery, the people in the middle-aged group reported being more pleased with their results than those in the younger group.
The authors conclude tha...