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Document Title: Noyes-AJARS-Feb97.shtml
Article Title: Arthroscopic-Assisted Allograft Anterior Cruciate Ligament Reconstruction in Patients With Symptomatic Arthrosis
Authors: Frank R. Noyes, M.D., and Sue D. Barber-Westin, B.S.
Publication: Arthroscopy: The Journal of Arthroscopic and Related Surgery
Date: February 1997
Volume 13, Number 1, pages 24-32
Keywords: ACL reconstruction via allografting, patellar-tendon allografting, osteoarthritic knee, unstable knee with osteoarthritis, chronic versus acute ACL tearing, anterior cruciate ligament, articular cartilage, allograft, rehabilitation protocol including immediate motion post-operatively.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: In this superbly penetrating study, a chronic ACL tear was defined as being greater than 12 weeks from injury to reconstruction, and advanced articular-cartilage deterioration (as determined via arthroscopic viewing during ACL reconstruction surgery) was defined as gross fissuring/fragmentation of a cartilage surface extending to at least half the depth of the cartilage, or any articular-cartilage damage of greater severity. The authors, who have extensive experience in the field of treating complex ACL-and-other-damage knee situations, note that patellar-tendon autografting (i.e. tissues from the person's own body) is the preferred graft option. Allografting, while indeed usable as a first-time graft, is preferred in cases where suitable autologous graft-harvest sites have been depleted or otherwise compromised.
SUMMARY
We reviewed the results of arthroscopic-assisted anterior cruciate ligament (ACL) allograft reconstructions in 40 patients who had advanced articular cartilage deterioration documented by arthroscopy during the reconstruction. A mean of 7 years had elapsed between the original injury and the reconstruction, and 102 prior operative procedures had been done in 34 of the 40 patients. A total of 64 articular cartilage lesions were noted; 34 knees had lesions in the medial or lateral tibiofemoral compartment. Postoperatively, all had immediate motion and early functional rehabilitation. The results were assessed using the Cincinnati Knee Rating System. At follow-up (mean, 37 months), significant improvements were found for pain, giving-way, and functional limitations with daily and sports activities (P < .01). Fifty-five percent had returned to mostly light athletics (avoiding high impact sports) based on our advice and were asymptomatic. The mean overall rating scores significantly improved (P < .0001, mean improvement 22 points). We concluded that the majority of patients in this study with chronic ACL rupture and post-traumatic arthrosis benefited short-term from arthroscopic-assisted ACL reconstruction.
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