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MEDICINA DELLO SPORT
A Journal on Sports Medicine
Official Journal of the Italian Sports Medicine Federation
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,163
ORTHOPAEDIC AND TRAUMATOLOGICAL SECTION
Medicina dello Sport 2001 December;54(4):305-17
The ligamentoplasty of the anterior cruciate ligament (LCA) whith patellar tendon from donor. Results of two year follow-up in 21 athletes. Review of the literature
Tamburrini L. R. 1, Bertolin P. 2, Primossi G. 1
1 Scuola di Specializzazione in Medicina dello Sport, Facoltà di Medicina e Chirurgia, Università degli Studi, Trieste;
2 Ortopedia, Casa di Cura Città di Udine, Udine
Background. The authors report a survey concerning 21 athletes that underwent a surgical operation of ligamentoplasty of the anterior cruciate ligament (LCA) utilising a patellar tendon from donor (allograft) at least after two years from the reparing arthroscopy, in spite of the common opinion to use an autologous patellar tendon (autograft) for fear of rejection.
Methods. In this technique the Orthopaedic Ward of Traumatology of the Casa di Cura Città di Udine (Udine) directed by Dr. P. G. Bertolin is conform to most qualified Centres of the United States of America which in the last ten years have demonstrated the usefulness of the allogenic transplantation thus permitting to the athlete to spare his own patellar tendon. The authors describe the conservation procedures and techniques of the allograft tendon i.e. fresh-frozen tissue at a temperature of -70°C, vacuum lyofilized tissue freeze-dried at the temperatures; of -18°C and -70°C and sterilized with ethylene oxide or gamma ray to prevent the transmission of viruses of hepatitis, HIV, syphilis and of the bone tissue without damaging the collagenous fibres. It is described then the destiny of the complex “bone-ligament-bone” with its cylindrical bone plugs with a diameter of 12-13 mm and 30 mm for the tibial part and 11-12 mm and 25 mm for patellar one. The advantages and disadvantages of the allogenic transplant are also listed, as the reliability, the cost, the transmission of diseases that are statistically always possible as rejection to parallel to its indisputable biological utility which allows to maintain the integrity of the extensor apparatus of the knee. The procedures for the allograft tissue are reported too, which is kept in glass bottles or in a double envelope and after their opening the hydration in physiological solution with antibiotics follows.
Results. The results concerning the stability of the knee are tested with the Lacnman test, the Jerk test and also with a manual KT 1000 arthrometer had been all favourable either for the group o athletes that underwent the transplantation for the first time or the other group that had a second transplatation owing to the fact the that precedent ligamentoplasty of the LCA with their own tissue failed. At last two control arthroscopies with hystological takings at the tibial basis of the new tendon ligament in a same number of athletes pointed out a vital tendon perfectly normal at 1 year from the surgery with still twisted fibres as at the implantation phase, the presence of numerous fibroblasts with a cylindric and long nucleus producted by the host’s genoma, and also at 3 years a ligament covered synovial membrane and its main roots spreading in the intercondylic cavum and hystologically the presence of a greater number of ligamentous cells with roundish nucleus in a maturation and proliferative intermediate phase between the tendinous structure and the ligamentous one.
Conclusions. The authors compare their results with those of the literature obtained by the authors of the United States of America to evaluate the improvement noticed in their athletes according to the evaluation criteria of some scales as the Cincinnati Knee Scale, the Lysholm Scale and others. These, improvements concern principally the regain of the stability of the knee and its articular force supported by the Cybex testings.