PubMed · 14763526
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Nicola Santori, Ezio Adriani, Luigi Pederzini. 2004. ACL reconstruction using quadriceps tendon.. https://doi.org/10.3928/0147-7447-20040101-14
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While anterior cruciate ligament (ACL) reconstruction is readily offered to athletes, non-athletes are often treated conservatively. We carried out a retrospective, cross-sectional analysis study to compare the incidence of meniscal and cartilage injuries in an athlete and non-athlete population in relation to time of presentation since injury. The results were used to assess the need and relevance of ACL reconstruction in the non-athlete population. The study included 1375 patients who underwent ACL reconstruction between 1998 and 2004. These patients were initially broadly divided into two categories: athletes (575) and non-athletes (800). Each category was then sub-divided into four subgroups based on time elapsed between the injury and presentation at our clinic (Group A, 3 months; Group B, 3-12 months; Group C, 1-3 years; Group D, more than 3 years). Arthroscopic findings were documented for medial and lateral meniscus and cartilage injuries, and comparisons were made between the incidence of associated injuries in the corresponding groups. There was a statistically significant increase in the incidence of meniscal injuries and cartilage injuries after 1 year in both the groups. There was no difference in the incidence of meniscal and cartilage injuries in athletes and non-athletes among the corresponding groups. (chi-square test, p = 0.05). These results demonstrate that both athletes and non-athletes are equally susceptible for long-term meniscal and cartilage injuries if ACL reconstruction is not carried out early.
Traumatic rupture of the anterior cruciate ligament (ACL) in adulthood is relatively common and surgical reconstruction is frequently required to allow return to high-level activities. There is growing evidence to suggest that ACL rupture in children is more common than previously thought and a poor outcome is associated with conservative management. The site of rupture in childhood is predominantly tibial avulsion, but mid-substance tears have also been reported. We report a case of a proximal ACL avulsion in an 11-year-old athlete and discuss a method of extra-physeal repair. There are very few previous reports of proximal avulsion fractures in skeletally immature patients.
Despite the long lasting research the ideal method of reconstructing the ACL has not been found so far. The last year's attention has shifted to the use of the multistrand hamstring tendon grafts. High ultimate tensile load, multiple-bundle replacement that better approximates the anatomy of the normal ACL and low donor site morbidity are the main advantages of this ACL replacement graft. These theoretical advantages have been multiplied when surprisingly studies have shown that semitendinosus and gracilis tendons actually regenerate after harvesting for use as ACL autografts. In this review article we summarize the current knowledge concerning the hamstring regeneration and we focus on issues that have clinical relevance or issues that have not been answered so far.