Tightening elongated ACL grafts by application of bipolar electromagnetic energy (ligament shrinkage)

Abstract

In ACL transplants showing elongation with functional deficit but no interruption of structure (Marburg Arthroscopic Score type III) there is the possibility of reinsertion, augmentation, or revision ACL reconstruction to stabilize the joint. Bipolar electromagnetic energy can be used to induce the tightening of elongated ACL transplants. We examined 14 patients with a secondary instability after ACL transplantation (mean 23.6 months). During arthroscopy a type III transplant without signs of nonisometric position was found. The elongated transplants were treated by bipolar application probe. All knees where protected by an unlimited orthosis over a period of 12 weeks. Postoperative follow-up took 9.4 months. There was a significant improvement in subjective discomforts (35.9 to 88.5 points on the Lysholm score), and the Rollimeter test showed a reduction of the ventral tibial translation (13.1 to 2.6 mm). There was a correlation between the degree of chondral damage and a Lysholm score but not between subjective discomforts and the degree of instability. Our findings confirm that elongated ACL transplants can be tightened by applying bipolar electromagnetic energy during rearthroscopy, thus avoiding revision ACL reconstruction in some cases.

Retente du ligament croisé antérieur : une technique originale sous contrôle arthroscopique

“…L'alternative à une ligamentoplastie itérative est la remise en tension du ligament croisé. Dans ce but, Carter et al [15], Spahn et Schindler [16] et Halbrecht [17] ont eu recours au shrinkage. Cette technique consiste à appliquer une sonde thermique sur le ligament afin d'obtenir, par brûlure, une rétraction cicatricielle.…”

Long-term Failure of Thermal Shrinkage for Laxity of the Anterior Cruciate Ligament

“…Lysholm scores improved from 35.9 to 88.5, and tibial translation was reduced from 13 to 2 mm. 22 Most recently, Carter et al reported their short-term results on a series of 18 patients, including 7 grafts and 11 partial tears. 4 At 20-month follow-up, 11 of 18 patients had gone on to failure (6/7 grafts and 5/11 partial tears).…”

Thermal modification of the lax anterior cruciate ligament using radiofrequency: efficacy or catastrophe?

“…Spahn and Schindler [23], observed lax but intact ACL grafts in 14 patients undergoing revision arthroscopy after ACL reconstruction (eight patellar tendon grafts, six double bundle semitendinosis reconstructions). The RF treatment was with a bipolar probe at 284 W ''until the ligament was tight'' and for ''approximately 60 s. Central portions of the ligament were treated in the first step and the periphery in the second.''…”