Search Results (3)

Background/Objectives: The aim of this study was to report first experiences with dynamic intraligamentary stabilization (DIS) technique for anterior cruciate ligament (ACL) rupture in children and adolescents. Methods: A case series of 22 children and adolescents with a mean age of 13.3 years underwent primary repair of an ACL rupture using the DIS technique as an off-label use in skeletally immature patients. Patients were evaluated for laxity, strength, range of motion (ROM), and functional tests, as well as Tegner, Lysholm, International Knee Documentation Committee (IKDC), and PedsQL scores after 3 years. A follow up after 11 years was conducted to analyze long-term results, rerupture rates and reinterventions. Results: Three years after surgery, there was no significant difference in laxity, strength, ROM, and in the functional tests comparing the injured to the contralateral knee. The Tegner Index after surgery showed a slight drop of 0.8 points, from 7.1 preoperatively to 6.3. Mean IKDC, Lysholm, and peds-QL scores were 91.17 (range 62.64–98.85, median 94.25), 88.27 (range 58–100, median 93), and 88.78 (range 58.15–100, median 91.30). Overall failure rate of the DIS-repaired knees was 55% (12 of 22 patients). In ten patients, reruptures happened at an average time of 3.2 years after initial surgery; additionally, two patients with chronic instability had to undergo revision ACL reconstruction. Conclusions: DIS repair might help ACL healing with satisfactory functional outcomes. However, given the high failure and reintervention rates, further studies need to show non-inferiority of the DIS technique in children and adolescents before being considered a valid treatment option. Full article

Purpose: Both dynamic intraligamentary stabilization (DIS) and reconstruction (RECO) are common treatment methods for anterior cruciate ligament (ACL) rupture. We report short term outcomes after DIS (Ligamys, Mathys, Bettlach, Switzerland) and RECO using semitendinosus tendon. We compared postoperative complications, deficits of range-of-motion (ROM), and revision rates between the two treatment options. Methods: A total of 690 patients (437 male, 253 female), after either DIS or RECO, were included. Of these, 147 patients (21%) received DIS and 543 (79%) underwent RECO. Follow-up examination focused on clinical examination, complications and revision rates. Anteroposterior instability and ROM deficits were analyzed in order to evaluate our policy of early intervention for all cases of ROM restrictions. Results: Relevant ROM restrictions occurred at a significantly higher rate after DIS than after RECO (4.8% vs. 1.3%; p = 0.008). Flexion was more restricted after DIS than RECO (110° vs. 124°, p < 0.001). Extension deficits also occurred more frequently after DIS compared to RECO (49.7% vs. 24.5%; p < 0.001). Total revision surgery rate was 9.1%, with patients after DIS being significantly more frequently affected (20.4% vs. 6.1%; p < 0.001). Conclusions: Our findings indicate a significantly higher risk for ROM restriction after DIS compared to RECO, resulting in a significantly higher revision rate. Full article

Until the past decade the common thought was that the anterior cruciate ligament (ACL) was not able to heal and restore knee stability. In this manuscript a brief review of studies of the developers and the early adaptors of four different modern ACL repair techniques are presented. The present status and considerations for the future of ACL repair and its research are shared. After promising short- to midterm ACL healing results by the developers, the results of the early adaptors show more variety in terms of rerupture and reintervention for other reasons. Risk factors for failure are a young age, high preinjury sports activity level, midsubstance ruptures and impaired integrity of the ACL bundles and the synovial sheath. There is a call for more clinical data and randomized clinical trials. Conclusion: an important finding of the past decade is that the ACL is able to heal and subsequently restabilize the knee. Patient selection is emphasized: the ideal patient is a non-high athlete older than 25 and has an acute proximal one bundle ACL rupture. Further research will have to show if ACL repair could be a game changer or if history will repeat itself. Full article