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Context: Anterior cruciate ligament (ACL) reconstruction often faces challenges due to poor integration of the tendon with bone. Aims: To evaluate the potential benefits of alendronate and platelet-rich plasma (PRP) in enhancing tendon-to-bone osteointegration in ACL surgery. Methods: This was a post-test only control group experimental study with Ovis aries Linnaeus sheep as experimental animals. The sample was divided into four groups: the control group ACL reconstruction with calcaneal tendons given NaCl, the group given PRP, alendronate, and PRP and alendronate. Bone healing biomarkers (NF-kB, TNF-α, MMP-9, TGF-β1, and COL1A1) were examined through immunohistochemical analysis and histological studies to assess osteoblast counts and inflammatory tissue. Results: There was a statistically significant (p0.05). The intervention did not affect NF-kB and TGF-β1 (p> 0.05). Conclusions: These results show that the administration of alendronate and PRP improves the healing of tendon-calcaneal ACL reconstruction surgery in sheep.

This case study presents the rehabilitation process of professional soccer player M.L. after surgical reconstruction of the anterior cruciate ligament (ACL) using the BTB method. Rehabilitation, lasting 3.5 months, enabled a quick return to the game. The course of treatment was based on an intensive rehabilitation protocol without the use of an orthosis, with early weight-bearing of the limb and focusing on rebuilding strength, stability and proprioception. Evaluation of the effectiveness of rehabilitation was carried out using functional tests and questionnaires KOOS, Kujala, SF-36.

Resumen: Introducción: La reincorporación deportiva es posiblemente el objetivo principal para el paciente tras la cirugía reconstructiva de ligamento cruzado anterior (LCA). El propósito del presente estudio fue determinar la preparación psicológica para la reincorporación deportiva de una cohorte de deportistas aficionados tratados mediante cirugía reconstructiva de LCA. Material y método: Estudio retrospectivo de una base de datos prospectiva de pacientes con rotura de LCA intervenidos entre enero y diciembre de 2017. La preparación psicológica del paciente para la reincorporación deportiva se valoró al final del seguimiento según la versión corta de la escala Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI). Resultados: Se incluyeron en el estudio 43 pacientes con una edad media de 24,7 años. El seguimiento medio de los pacientes fue de 32,5 meses. Todos los pacientes practicaban algún tipo de actividad deportiva al final del seguimiento. La puntuación media en la escala ACL-RSI fue de 71,5 puntos. El miedo a lesionarse nuevamente al practicar deporte persistía en 14 pacientes (32,5%). Veinticuatro pacientes (55,8%) indicaron que no practicaban deporte al mismo nivel que antes de la lesión ligamentosa. La puntuación media en la escala ACL-RSI fue significativamente menor en este grupo de pacientes (59,7 vs. 87,3; p

Las complicaciones en el postoperatorio reciente de la reconstrucción del ligamento cruzado anterior (LCA) son frecuentes. Entre estas: dolor, hemartrosis y dificultad para realizar el movimiento de flexión-extensión de rodilla. El objetivo de este trabajo es evaluar el uso del bicomponente carboximetilcelulosa-polisacárido B intraarticular poco después de la reconstrucción del ligamento cruzado anterior y comparar los resultados obtenidos para el control del dolor, la hemartrosis y la ganancia de movimiento de la rodilla con un grupo de control. Ensayo clínico aleatorizado y prospectivo de treinta y dos pacientes divididos en dos grupos: reconstrucción del ligamento cruzado anterior con inyección intraarticular de un bicomponente carboximetilcelulosa-polisacárido B (n = 16) y sin el bicomponente (n = 16). El dolor, la hemartrosis y la amplitud de movimiento de la rodilla se evaluaron en la primera semana postoperatoria. Resultados: El grupo de intervención (con bicomponente) presentó menos dolor al tercer (p = 0.017) y quinto (p = 0.029) día postoperatorio en comparación con el grupo control. La hemartrosis fue significativamente menor en el primer día postoperatorio (p = 0.001), y hubo una mejora significativa en el rango de movimiento en el séptimo día de la cirugía (p = 0.008) en este mismo grupo. Podemos concluir que el uso de carboximetilcelulosa-polisacárido B intraarticular mostró resultados superiores para el control del dolor, la hemartrosis y la ganancia de movimiento de la rodilla en el período postoperatorio reciente (hasta siete días) después de la reconstrucción del LCA, en comparación con los pacientes del grupo control.

Abstract Background and objectives: Inadequate pain relief after anterior cruciate ligament reconstruction affects mobility leading to development of adhesions, weakened ligament insertion and muscle atrophy. Adductor canal block for postoperative analgesia preserves quadriceps strength. The present study was conducted to compare pain free period in patients undergoing arthroscopic anterior cruciate ligament reconstruction, receiving ultrasound-guided adductor canal block with ropivacaine alone and ropivacaine with clonidine. Methods: A prospective randomized double blinded study was conducted including sixty-three adult, ASA class I, II patients undergoing anterior cruciate ligament reconstruction. They were randomized into three groups: Group S - control group received adductor canal block with 30 mL saline, Group R - ropivacaine group received adductor canal block with 30 mL of 0.375% ropivacaine and Group RC - clonidine group received adductor canal block with 30 mL of 0.375% ropivacaine with clonidine 1 µg.kg-1. The primary aim was to compare the pain free period in patients receiving adductor canal block with ropivacaine alone or ropivacine with clonidine. The secondary outcomes were pain score at rest and movement, total analgesic requirement, sedation score and postoperative nausea and vomiting. Results: The mean pain free periods were 20 min, 384.76 min and 558.09 min for Group S, Group R and Group RC, respectively and this difference was statistically significant (p < 0.001). There was no significant difference between Group R and Group RC in terms of pain scores at rest and movement and total analgesic requirement. Conclusion: Addition of clonidine to ropivacaine in USG guided adductor canal block led to significant prolongation of pain free period though pain score at rest and movement, and rescue analgesic requirement, did not differ.

Introduction: Women carry out a greater risk of anterior cruciate ligament (ACL) rupture. However, outcomes following ACL reconstruction remain unclear. The aim of this study was to analyse the outcomes in women following ACL reconstruction and compare these outcomes with men., Material and Methods: Retrospective study of a prospective database of patients treated with ACL reconstruction between January 2017 and December 2018. Outcome measures included Tegner activity scale, Lysholm scale, EVA scale, and IKDC evaluation form. Clinical significance was measured with minimally clinical important difference, and patient acceptable symptom state., Results: A total of 33 women were matched with 99 men. The mean follow-up was 36 months. Women showed significant improvement from preoperative PROs to the latest follow-up, with no differences between groups. In patients under 25 years old, there was less significant IKDC subjective score in women compared to men. There were no significant differences in frequency of patients achieving MCID and PASS in women compared with men., Conclusions: At 3-year following 4-strand semitendinosus-gracilis anterior ligament reconstruction, women showed significant improvements in PROs, with no differences compared to men., (Copyright © 2022 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Women carry out a greater risk of anterior cruciate ligament (ACL) rupture. However, outcomes following ACL reconstruction remain unclear. The aim of this study was to analyze the outcomes in women following ACL reconstruction and compare these outcomes with men., Material and Methods: Retrospective study of a prospective database of patients treated with ACL reconstruction between January 2017 and December 2018. Outcome measures included Tegner activity scale, Lysholm scale, EVA scale, and IKDC evaluation form. Clinical significance was measured with minimally clinical important difference, and patient acceptable symptom state., Results: A total of 33 women were matched with 99 men. The mean follow-up was 36 months. Women showed significant improvement from preoperative PROs to the latest follow-up, with no differences between groups. In patients under 25 years old, there was less significant IKDC subjective score in women compared to men. There were no significant differences in frequency of patients achieving MCID and PASS in women compared with men., Conclusions: At 3-year following 4-strand semitendinosus-gracilis anterior ligament reconstruction, women showed significant improvements in PROs, with no differences compared to men., (Copyright © 2022 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Return to sports (RTS) is maybe the main expectation for the patient after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to analyze the psychological readiness to RTS in a cohort of amateur sports after ACLR., Material and Methods: Retrospective study of a prospective database of patients treated with ACLR performed between January and December 2017. Psychological readiness to RTS after ACLR was evaluated with the short version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale., Results: A total of 43 patients met the inclusion criteria. The mean age of the patients was 24.7 years. The mean follow-up was 32.5 months. All patients practiced any type of sports at final follow-up. The mean ACL-RSI score was 71.5. Fear of reinjury was mentioned by 14 patients (32.5%). Twenty-four patients (55.8%) pointed out that they did not practice sport at the pre-injury level. The mean ACL-RSI score was statistically significant lower in this group of patients (59.7 vs 87.3; P<.001)., Conclusions: Fear of reinjury keeps after ACLR. Patients that they did not practice sport at the pre-injury level show lower scores in ACL-RSI for RTS., (Copyright © 2021 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: the tibial slope has been identified as one of the factors associated with graft failure after anterior cruciate ligament (ACL) reconstruction; however, its relationship with functional results has been little studied. The main purpose of this study is to determine the effect of the tibial slope on functional recovery in patients undergoing reconstruction of the anterior cruciate ligament., Material and Methods: we included patients with a diagnosis of anterior cruciate ligament injury undergoing primary reconstruction, from May 2018 to May 2019, who had a complete radiographic and clinical record; also, the scores from questionnaires of the International Knee Documentation Committee (IKDC) and Lysholm scores were collected pre surgical procedures and throughout the one-year follow-up. The measurement of the tibial slope was performed in lateral knee X-rays from the electronic clinical record. A descriptive analysis of first intention was done, and to achieve the objectives, we compared 25 patients who had normal tibial slope that were selected randomly with 25 patients who had increased tibial slope., Results: a total of 98 patients were included, 73 had a normal tibial slope (equal to or less than 12 degrees) and 25 with an increased tibial slope (greater than 12 degrees), the average age in both groups was 28.43 years for the group with normal tibial slope and 28.26 for patients with increased tibial slope. Regarding the functional assessment, the IKDC and Lysholm scores at the end of the follow-up were better for patients with normal tibial slope. Graft failure was only identified in the group with increased tibial slope. On the other hand, the comparative analysis with the control group randomly selected who had normal tibial slope, showed a better functional result assessed by IKDC score at the end of the follow-up for the group with normal tibial slope., Conclusion: patients undergoing ACL reconstruction and increased Tibial Slope have an inferior functional result at one year of follow-up assessed by IKDC, when compared with patients with normal tibial slope.

Introduction: Reconstruction of the anterior cruciate ligament attempts to reproduce the native ligament; make independent tunnels optimize the entry points and effectiveness the anatomy. Perform radiographic measurements of the knee, identify position of femoral and tibial tunnels in patients operated for reconstruction of anterior cruciate ligament with anatomical technique., Material and Methods: Patients were identified in the period January 2018 to December 2019. 98 patients were retrospectively evaluated. Radiographic measurements in the femur, the inclination angle of the tunnel, the insertion site with respect to the Blumensaat line and the transosseous distance were determined. In tibia, the location in percentage of the tibial plateau location in anteroposterior and lateral view, tibial tunnel angle., Results: Postoperative patients were 98. (75.5%) male, female (24.5%). Postoperative in 2018 (57.15%) and 2019 (42.85%) Age range: affected group was 21-25 years, right side affected in 57.15%; Radiographic measurements in femur, the angle of inclination of the tunnel was 45o, percentage in the Blumensaat line was 20%, and the transosseous distance was 3.43 cm. In tibia the percentage distance in anteroposterior projection was 44%, and lateral 28%, The angle in tibial tunnel anteroposterior projection of 73 degrees, and lateral 114., Conclusion: The anatomical technique is a good option to perform tunnels with an optimal anatomical position. By making independent tunnels it allows to improve coverage of normal antomic footprint. Increases degrees and inclination of tunnels, causes added injuries.

To achieve in the reconstruction of the anterior cruciate ligament a graft with strength, tension and low comorbidity is fundamental. An emerging concept is that a graft diameter of less than 7mm carries a greater risk of re-rupture and instability. Consequently, different methods are being sought to predict intra-surgical size. The objective is to predict the size of the hamstring graft by measuring the area of the semitendinous and gracilis tendon with magnetic resonance imaging (MRI)., Methodology: We carried out an observational retrospective study of 56 patients. They underwent anterior cruciate ligament reconstruction with 4-GST hamstring graft. The parameters evaluated were anthropometric data, hamstring graft diameter, area of gracilis and semitendinosus tendon in MRI. The measurements were made by three independent evaluators., Results: The mean diameter of the intrasurgical graft was 8.46mm, in the MRI the area of the gracilis was 8,875mm and the semitendinosus area was 13,068mm. Their mean was 22.12 for the automatic measurement and 21.53 for the manual measurement. The interobserver correlation was regular for the automatic measurement (ICC = 0.595) and low for the manual measurement (ICC = 0.446). The result of the intraobserver correlation was excellent (ICC = 0.917). We did not obtain a statistical correlation between the measurement of areas and the increase of the graft diameter (R = 0.069, P = .63)., Conclusion: We determined with our results that the intrasurgical graft size is not predictable with the measurement of the area of the gracilis and semitendinosus tendon on the MRI., (Copyright © 2020 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: When there is injury to both knees of the anterior cruciate ligament (ACL), the surgeon has the option to reconstruct both in a staggered manner or simultaneously. There are some reports and case series where the ACL is performed simultaneously. In this manuscript we present a case and the result with simultaneous reconstruction., Clinical Case: 40-year-old male with no history of importance with bilateral ACL injury; torniquet-free surgery was performed with autograft of hamstrings, secured with endobutton and interference screws. In the postoperative period, and an accelerated program of physical rehabilitation were immediately initiated. At five months of follow-up the patient is painless, with full, symmetrical knee range of motion. No complications reported. WOMACs functional scale dropped from 35 preoperative to 6 in the last visit. Until now, simultaneous reconstruction of the LCA was a safe procedure; however, we know that our follow-up is too short to make any other assertions.

Introduction: ACL injuries are found within the most common ligament injuries. This has led to the development of different surgical techniques to restore knee stability., Material Y Methods: Clinical study, randomized, blind comparing ACL reconstruction techniques with One Band and «U-Two» using clinical scales and arthrometria with KT-1000 and Pivot Shift Meter., Results: Of 36 patients, 52.94% was drawn for the One Band technique and 47.06% for «U-Two». 11.76% of patients had a displacement greater than 11mm in the affected knee with KT-1000. 8.82% showed an equal anterior displacement on both knees. One patient had a major previous displacement after reconstruction surgery with the one band technique, but with improvement on clinical scales. Pivot Shift measurements found a difference in displacement greater than 4,000 m/s on the X axis following the One Band technique compared to the healthy knee calculating integrals, while with U-Two the difference was less than 600 m/s. On the Y axis a difference of 3,500 m/s was found between the healthy and the injured leg, which decreases to less than 2,000 m/s after reconstruction using U-Two technique., Conclusions: Differences have been found throughout the study in patient evolution, indicating that repair using the U-Dos technique has better results in recovering the anteroposterior and rotational stability of the affected limb.

Anterior cruciate ligament injury (ACL) of the knee is a severe traumatic injury that greatly decreases the function and sometimes leaves very important sequelae for the young patient so surgery for ligament reconstruction is the suitable treatment, there are several techniques for the elaboration of tunnels with difference in the portals, the methods of fixation and the different grafts used and each one of the authors defend their techniques giving their advantages and disadvantages and possible complications associated. The objective of this study was to assess the advantages or not of two approaches to the femoral side for the passage of the graft or implants. Material and methods: Two similar groups in this observational, transversal, retrospective and analytical study in patients operated by the same surgeon and assistants. In a period of time of three year, 80 patients were operated, 42 of them by medial portal and 38 of them via trans tibial. Results: The male sex in both groups was the predominant one, the parameters of ease were assessed to observe the passage of the tendon or graft, the passage of the femoral implant, the ease of the implant grip, the tension of the same and the operative time in both groups. The result was conclusive being an p 0.06 contemplating the best result in patients operated by medial portal.

Background: Treatment of ACL injury is surgical reconstruction. It is not known whether the result is better depending on the type of graft used. Insulin-like growth factor type 1(IGF-1) is a powerful stimulant of extracellular matrix and chondrocyte growth., Material and Methods: Experimental, analytical, prospective, longitudinal study in patients with ACL reconstruction in a period from 2016 to 2017. The concentration of IGF-1 in synovial fluid of these patients operated with allograft and autograft was determined, its association with postoperative evolution was determined. For statistical analysis, two-way ANOVA with Mann-Whitney post-hoc U was used., Results: A significant increase in IGF-1 was identified in the allograft group at 90 days of postopertory. In the autograft group, a significant increase in IGF-1 was observed from 30 days of postoperative. The autograft group was found to have significantly higher levels of IGF-1 (3.27 ± 0.09 ng/ml) compared to the allograft group (2.80 ± 0.11 ng/ml; p 0.001) at 90 days after graft placement., Discussion: IGF-1 levels were higher in patients with autologous graft, knee functionality was clinically similar in both groups at 30 and 90 days.

Introduction: Rupture of cruciate ligaments of the knee is a common injury that is repaired by arthroscopic reconstruction, which can give rise to septic arthritis. The objective of this article is to describe the clinical and microbiological aspects of this entity., Methods: Retrospective review of cases of septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee that occurred at a single institution from 2000-2015. According to time elapsed from surgery, infections were classified as acute (< 14 days), subacute (> 14 days and<30 days), and late (> 30 days). A descriptive and comparative analysis stratified by type of infection and causative microorganism was performed., Results: 3,219 patients underwent arthroscopic reconstruction of cruciate ligaments of the knee and 30 (0.9%) developed septic arthritis. Seventeen (57%) were acute infections and 12 (40%) subacute; there was one late infection. The causative microorganisms were coagulase-negative Staphylococci (n=13; 43%), Staphylococcus aureus (n=12; 40%), other grampositive cocci (n=3; 10%), and gramnegative bacilli (n=2; 7%). All patients underwent arthroscopic debridement; no grafts were removed. All patients received antibiotic therapy for a median of 23.5 days (range: 14 - 78 days); all infections were cured. No significant differences were found in any of the variables analysed among the infection type or the causative microorganism., Conclusions: Septic arthritis after arthroscopic reconstruction of cruciate ligaments of the knee is uncommon. It generally presents within 4 weeks of surgery and is caused by Staphylococci. Its treatment consists of arthroscopic debridement (without necessarily removing the graft) and antibiotic therapy., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Background: Reconstruction of the anterior cruciate ligament (ACL) aims to restore the original anatomy. The clinical outcome could be imperfect when graft placement is not in an anatomical position; moreover, the conventional transtibial reconstruction of the ACL often locates the graft away from the anatomical site, leading to abnormal biomechanical behavior and kinematics of the knee. The objective of this work was to assess the importance of the angular reconstruction of the anterior cruciate ligament during arthroscopic replacement and to compare the postoperative functional results., Material and Methods: We studied 21 patients to whom the IKDC 2000 form of objective and subjective evaluation was applied; radiographic evaluation in anteroposterior and lateral bending at 30o. We made an statistical analysis with Pearson P, correlating the anteroposterior and lateral angulation of the graft direction and the subjective projection of the operated knee function, as well as age and time of evolution with the operated knee., Results: We included 21 patients of 18 to 56 years of age; follow-up: one to three years. Objective evaluation: 95.24% normal and 4.76% almost normal. Subjective assessment: average 84.31% (range 70.93 to 97.99%), CI 95%. AP angle: 68.8o, range: 62o to 77o. Average sagittal angle: 64.9o, range: 58o to 75o. Correlations: AP angle and subjective function -0.19, angle in sagittal and subjective function -0.54, age and subjective function -0.77, duration and subjective function -0.74. Function average: 84.31%., Discussion: The anatomical angular reconstruction of the ACL graft is key to the stability of the knee; the evaluated patients got a more similar direction to that of the native ACL, better stability and knee function.

Septic arthritis after knee arthroscopy is an extremely rare condition. A rate of 0.15-0.84% cases of postoperative infection is estimated in several series. The arthroscopy procedure most frequently related with an infectious complication is anterior cruciate ligament (ACL) reconstruction, with a prevalence of 0.3-1.7% cases. Staphylococcus sp. is the pathogen most commonly cultured. We describe a case of septic arthritis after ACL reconstruction. We found no published case of septic arthritis caused by this microorganism after knee arthroscopy. It is probably the first case published in the literature., (Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Evaluate the enlargement effect of the tibial tunnel emergence of 2 different of anterior cruciate ligament reconstruction techniques: antero-medial portal (AMP) vs. transtibial (TT) technique., Methods: A prospective, randomized controlled study was performed in 36 consecutive patients who underwent anterior cruciate ligament reconstruction with autologous hamstring tendon grafts employing the AMP and conventional TT techniques. Lateral and antero-posterior radiographs were obtained for each patient at 6 weeks and 12 months postoperatively. The sclerotic margins of the tibial tunnels were measured at the widest dimension of the tunnel as well as the diameter of the tibial emergence and were compared with the initially drilled tunnel size after correction for radiographic magnification. Statistical analysis was performed to compare the 2 groups by use of the independent-samples t test, with significance set at .05., Results: The mean percentage increase in the diameter of tibial tunnel emergence at 6 weeks after surgery was 8.1%±2.9 for the PAM technique and 21.20%±11.87 for the TT technique on the anteroposterior x-ray view. However, the mean percentage increase in the diameter of the tibial tunnel emergence on the lateral view was 7.1%±4.72 for the medial portal technique and 17.64%±11.48 for the transtibial technique. This difference was statistically significant on both anteroposterior and lateral views., Conclusions: The diameter of the tibial tunnel emergence for hamstring autologous anterior cruciate ligament reconstructions was significantly lower for the medial portal technique when compared with the conventional TT technique., (Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To follow up pain in the immediate postoperative period, using an elastomeric pump in anterior cruciate ligament surgery., Material and Methods: 309 patients who had undergone anterior cruciate ligament repair with bone-tendon-bone allograft. Pain control was assessed with a visual analogue scale (VAS) during the immediate postoperative period, in the postoperative care unit, in the recovery room, and after the first 24-48-72hours following home discharge. The need for rescue medication, adverse effects observed and emergency visits were also registered., Results: 309 patients were assessed (264 males, 45 females), mean age 33 (range: 18 - 55). Postoperative pain was mild in 44.7% of patients, and 38.5% were pain-free. At discharge, 41.1% of patients reported mild pain and 57% were pain-free. At home, mild to moderate levels of pain were maintained and over 97% of patients presented VAS values ≤ 3. Fewer than 3% had adverse effects, 8.7% had to use analgesic medication at some point. Pruritus occurred in less than 1% of patients receiving intravenous analgesia at home, and fewer than 2% had device-related complications., Discussion: There is no consensus regarding the postoperative management of anterior cruciate ligament lesions, although most surgeons use multimode anaesthesia and different combinations of analgesics to reduce postoperative pain., Conclusions: The use of an intravenous elastomeric pump as postoperative analgesia for anterior cruciate ligamentoplasty has yielded good results., (Copyright © 2017. Publicado por Elsevier España, S.L.U.)

Objective: To evaluate and describe the results of a simultaneous reconstruction with minimally invasive technique of the posterolateral complex (PLC) and the anterior cruciate ligament (ACL)., Material and Methods: ACL and PLC reconstruction was performed in seven patients using the technique described, in the period from March to November 2012. All patients were evaluated at six months after the procedure using IKDC and IKSS subjective tests. Their return to work activities and their level of satisfaction were assessed., Results: Six male and one female patients ranging in age between 26 and 46 years were evaluated. The injuries were mostly caused by sports related accidents. All patients were economically active and required an average period of three months of disability. The assessment and outcomes at six months, according to the IKDC scale, were: one patient with IKDC A, four with IKDC B, one patient with C, and one with D. In the subjective scale IKSS, 80% averaged a knee stability of over 90 points, a patient had a 100-point scale and another, of 70 points.

Abstract Background and objectives There are no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia. Method Randomized and controlled clinical trial of patients undergoing reconstruction of the Anterior Cruciate Ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The groups C, M, R0,375 and R0,25 was compared with only the previously described technique, subarachnoid morphine (100░µg), or Femoral Nerve Block (BNF) with 25░mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24░hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated. Results Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24░hours. There was a higher incidence of urinary retention in the M group (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 group (30%) than in the M and C groups (0%), with statistical significance (p░

Anterior cruciate ligament reconstruction is a demanding procedure; complications may arise at any of its stages. This is the report of three cases in which the tibial fixation devices (IntraFix and Bio-IntraFix) led to intraarticular lesions. The complications were detected in one of the cases while the patient was still in the operating room and in the remaining two during the follow-up. All the patients had a stable knee, but all of them sustained chondral lesions resulting from the inadequate placement of the implants used for tibial fixation. Several suggestions to avoid the complications stemming from these devices are provided.

We report the case of a patient who presented a pretibial extra-articular cyst two years after an arthroscopically assisted ACL reconstruction using an autologous bone-patellar tendon-bone graft. The tibial fixation was achieved with a bioabsorbable screw made of poly-L, D-lactic and -tricalcium phosphate (-TCP). A subcutaneous pseudocystic lesion was excised. It consisted of a capsular fibrous tissue with minimal milky fluid (1 ml) centrally. It penetrated into the tibial tunnel but did not communicate with the knee joint space. The histopathological analysis demonstrated fibrous tissue with multinucleated giant cells and refractile particles which suggested a foreign body reaction. After the surgery, the patient recovered perfectly well and he returned to his pre-injury level of physical activity in two months. To the best of our knowledge, this is the first report of this complication in a patient with a biocomposite screw made of poly-L, D-lactic and -tricalcium phosphate (-TCP).

Background: The anterior cruciate ligament (ACL) takes part in the knees articular cinematic regulation, which is why its rupture should be repaired as soon as possible. The surgical treatment is targeted to substitute the ruptured ACL with a graft that recreates the anatomical and biomechanical functions. Nevertheless, there are different factors that may produce a second rupture., Objective: To determine the risk factors and frequency of failure in the ACL reconstruction., Material and Methods: Retrospective study evaluating the frequency and etiology of the failure in the ACL reconstruction in an adult population during a three-year period. Risk factors such as age, gender, trauma background, previous joint injuries, type of the graft previously used, lapse between surgeries, lapse between rupture and surgery and other comorbidities were analyzed., Results: We obtained 34 patients with ACL reconstruction failure and 111 with native ACL rupture (145 patients in total). In the ACL reconstruction failure group, 31 were males with an average age of 33 years, produced by a traumatic mechanism (85.2%) and with other associated injuries (41%)., Conclusions: We found a significant statistical association for graft failure with male patients, traumatic mechanism, isolated cartilage lesions or combined articular injuries.

Background: Arthroscopy of the knee is a surgical performed world-wide considered extremely safe, rates of complication ranging from 0.56 to 8.2%. Vascular complications are even more rare (0.0032%), and generally related to the popliteal artery injury., Clinical Case: We are reporting the cases of two patients who had unsuspected vascular complications after arthroscopy. Both cases presented vascular injuries after elective knee arthroscopy. First case was a patient with thrombosed pseudoaneurysm in the popliteal artery and total section of the popliteal vein, unfortunately the diagnosis was done 72 hrs after knee arthroscopy and finally required amputation, the 2nd case presented popliteal arteriovenous fistula, the diagnosis was done 3 weeks after knee arthroscopy, the patient was successfully treated by resection of the fistula and direct repair of the artery and vein., Conclusions: Although extremely infrequent, the vascular injury after knee arthroscopy should be remembered as a surgical complication, a low index of suspicion may have caused an unfortunate and untimely delay in diagnosis and treatment with potential risk of leg amputation and death.