Use of the picture-archiving and communications system-photoshop method enables direct measurement of the height of the osteotomy gap with high reliability.

BackgroundThe purpose of this study was to compare the clinical and radiological results of 2 different tibial fixations performed using bioabsorbable screws with added hydroxyapatite (HA) and pure poly-L-lactic acid (PLLA) screws in anterior cruciate ligament (ACL) reconstruction.MethodsA total of 394 patients who underwent arthroscopic ACL reconstruction between March 2009 and June 2012 were retrospectively reviewed. Of those, 172 patients who took the radiological and clinical evaluations at more than 2 years after surgery were enrolled and divided into 2 groups: PLLA group (n = 86) and PLLA-HA group (n = 86). Both groups were assessed by means of the Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score, and Tegner activity score. Stability was evaluated using the KT-2000 arthrometer. Magnetic resonance imaging was performed to evaluate tibial tunnel widening, screw resorption, osteoingeration, and foreign body reactions.ResultsThe PLLA-HA group showed significant reduction in the extent of tibial tunnel widening and foreign body reactions and significant increase in screw resorption compared to the pure PLLA group (p < 0.001 for both). In contrast, postoperative Lysholm score, Tegner activity score, IKDC score, and side-to-side difference on the KT-2000 arthrometer showed no significant differences between groups (p = 0.478, p = 0.906, p = 0.362, and p = 0.078, respectively). The PLLA group showed more significant widening in the proximal tibial tunnel than the PLLA-HA group (p = 0.001). In the correlation analysis, proximal tibial tunnel widening revealed a positive correlation with knee laxity (r = 0.866) and a negative correlation with Lysholm score (r = −0.753) (p < 0.01 for both).ConclusionsThe HA added PLLA screws would be advantageous for tibial graft fixation by reducing tibial tunnel widening, improving osteointegration, and lowering foreign body reactions. Even though no clinically significant differences were noted between the pure PLLA group and PLLA-HA group, widening of the proximal area of the tibial tunnel showed a tendency to increase knee laxity measured using the KT-2000 arthrometer.

Based on functional performance results, well-synovialized grafts did not yield better functional performance outcomes following ACLR compared to poorly synovialized grafts at 2-year follow-up. The same was true of clinical outcomes. Thus, the success of synovialization does not improve functional performance and clinical outcomes following ACL reconstruction in an all-male population.

Anterior cruciate ligament (ACL) reconstruction is a wellestablished surgical technique to treat ACL injuries.1) Although arthroscopic ACL reconstruction is safe, it may be followed by various complications such as patellofemoral pain, arthrofibrosis, tibial tunnel widening, graft failure, bleeding, and infection. 2,3) There are also a few reports of vessel injuries such as rupture or embolism of the popliteal artery, pseudoaneurysm of the medial inferior genicular artery and avulsion of the middle genicular artery. 4,5) This paper reports a case of a patient who developed a vascular complication after arthroscopic ACL reconstruction. CASE REPORTA 31-year-old male suffered a pivot injury to the left knee during a basketball game 5 days ago. During the patient's initial visit to Inje University Seoul Paik Hospital, a physical examination revealed positive anterior drawer, Lachman, and pivot shift tests. Preoperative X-rays did not show any definite bony abnormalities. On magnetic resonance imaging (MRI), the continuity of the ACL signal was disrupted in the midportion. We decided to perform an arthroscopic anatomic single-bundle ACL reconstruction after allowing 2 weeks to regain the full range of motion. The patient was admitted to the hospital the day before surgery. Under spinal anesthesia, the patient was placed in the lithotomy position, keeping the involved knee in deep flexion. With a 3-cm skin incision over the pes anserinus, the semitendinosus tendon was harvested, and then prepared to form a quadruple-stranded graft. Under arthroscope, the ACL was found to be completely ruptured in the midportion as observed on the MRI. The ruptured ligament was debrided for complete visualization of the femoral ACL footprint. We marked a hole with an awl, at the center of the femoral anatomical footprint where the bifurcate and intercondylar ridges meet. The femoral tunnel was drilled through this point using the transanteromedial portal technique. Drilling was performed with caution, to avoid any neurovascular or cartilage injuries, keeping the

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