RESUMEN
The purpose of this study was to report the outcome of 'isolated' anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft at a mean of 15 years (14.25 to 16.9). A total of 100 consecutive men and 100 consecutive women with 'isolated' ACL rupture underwent four-strand hamstring tendon reconstruction with anteromedial portal femoral tunnel drilling and interference screw fixation by a single surgeon. Details were recorded pre-operatively and at one, two, seven and 15 years post-operatively. Outcomes included clinical examination, subjective and objective scoring systems, and radiological assessment. At 15 years only eight of 118 patients (7%) had moderate or severe osteo-arthritic changes (International Knee Documentation Committee Grades C and D), and 79 of 152 patients (52%) still performed very strenuous activities. Overall graft survival at 15 years was 83% (1.1% failure per year). Patients aged < 18 years at the time of surgery and patients with > 2 mm of laxity at one year had a threefold increase in the risk of suffering a rupture of the graft (p = 0.002 and p = 0.001, respectively). There was no increase in laxity of the graft over time. ACL reconstructive surgery in patients with an 'isolated' rupture using this technique shows good results 15 years post-operatively with respect to ligamentous stability, objective and subjective outcomes, and does not appear to cause osteoarthritis.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior/métodos , Tendones/trasplante , Adolescente , Adulto , Ligamento Cruzado Anterior/cirugía , Artrometría Articular/métodos , Endoscopía/métodos , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/etiología , Osteoartritis de la Rodilla/prevención & control , Radiografía , Rotura/cirugía , Resultado del Tratamiento , Soporte de Peso/fisiología , Adulto JovenRESUMEN
There is little written about the value of revision surgery on lower-limb amputations. We report on 71 revision amputation procedures performed by a single surgeon in this retrospective analysis. The majority of our revisions (61%) were in amputees who had suffered trauma. We judged success from a surgical and a rehabilitation perspective using scoring systems. Revisions for bony and soft-tissue pathology had good outcomes from a surgical (85% and 82%) and a rehabilitation perspective. Revisions for infection had satisfactory results from a surgical perspective (73%) but less so from a rehabilitation perspective (25%). The results of the revisions for pain were poor showing surgical success only 50% of the time where a neuroma was suspected and only 25% when there was no apparent cause. There was little or no improvement in rehabilitation in both the pain groups. Revision surgery for certain pathologies gives a good surgical outcome and can improve pain and mobility status. Patient selection for surgery is key and evaluation by a multidisciplinary team is recommended.