POSTER ABSTRACTS - ISAKOS

Background: The optimal choice of graft for ACLrevision
surgery is controversial. Reharvesting the
patellar tendon has been suggested as one graft
alternative.
Methods: Thirteen consecutive patients (4 female,
9 male) who underwent anterior cruciate ligament
(ACL) revision surgery using reharvested
ipsilateral patellar tendon grafts were included in
the study. The patients underwent bilateral MRI
evaluations of the patellar tendon and were tested
for clinical outcome after 25 (20 - 35) and 115
months (90 - 127).
Results: The serial MRI evaluations revealed that
the width and thickness of the patellar tendon at
the donor site were significantly increased
compared with the non-harvested normal
contralateral side and that the donor site gap was
still visible. No significant differences were seen
between the 2 year and 10 year MRI evaluations.
Clinical results in terms of the Tegner activity
level, Lysholm score, IKDC evaluation system,
one-leg-hop test and the KT-1000 laxity test
revealed no significant difference between the 2
and 10 year assessments. Over all the clinical
results were considered poor at both occasions.
Two major complications were registered; one
patellar fracture and one patellar tendon rupture.
Conclusion: The patellar tendon at the donor site
had not normalized at 10 years after reharvesting
its central third as seen on MRI. Furthermore, the
clinical results were poor. Reharvesting the central
third of the patellar tendon for ACL revision
surgery can therefore not be recommended.
E-poster w/ Standard #640
Computerized Fluoroscopic Navigation in
Surgical Treatment for Avulsion Fracture of
Posterior Cruciate Ligament: A Report of Two
Cases
Kohei Naito, Ohdashi, Shimane, JAPAN, Presenter
Yuji Uchio, Izumo, Shimane, JAPAN
Masatoshi Tobita, Ohda, Shimane, JAPAN
Junji Iwasa, Izumo, Shimane, JAPAN
Nobuyuki Kumahashi, Izumo, Shimane, JAPAN
Toru Nagatani, Izumo, Shimane, JAPAN
Masato Takao Izumo Shimane, JAPAN
Oda municipal hospital, Oda, Shimane, JAPAN
[Purpose] To report our surgical technique under
computerized fluoroscopic navigation for avulsion
fracture of posterior cruciate ligament in two
patients.
[Surgical technique] We utilized the Stealth-
Station Treatment Guideline Platform System
(Medtronic, Sofamor Danek, Broomfield, CO). A
calibration target with affixed infrared-emitting
diodes (IREDs) is attached to a C-arm
fluoroscope. The reference flame was rigidly
attached to the ipsilateral tibial shaft. After
registration using preliminary fluoroscopic view,
no further fluoroscopic radiation is necessary
during surgery. A cannulated drill guide
containing 4 IREDs transmit infrared light to the
CCD camera, and the camera tracks the position
of the drill guide on the patient’s anatomy and
continuously updates its three-dimensional
position simultaneously on all displayed images.
First, we inserted a PCL guide under arthroscopic
view and reduced the fracture site. Next, we
determined the entry point, direction of screw,
correct length of the screw by means of a virtual
line. After that, we inserted the cancellous screw
and immobilized the fracture site using
conventional cannulated screw system.
[Results] We treated two cases of avulsion fracture
of posterior cruciate ligament. Their Lysholm knee
scoring scales were improved from 29 and 32
point at pre-operation to 94 and 100 at 1 year after
surgery.
[Discussion] Recently, the fluoroscopy based
computerized navigation system has been
improved, and it allows the surgeon to determine
the accurate entry point and direction of the screw
with a little use of fluoroscopic radiation. Our
present cases showed the usefulness of this
system for the surgery of avulsion fracture of
posterior cruciate ligament.
[Conclusion] Computerized fluoroscopic
navigation makes it possible to determine
accurate entry point, direction, and length of the
screw in surgical treatment for avulsion fracture of
posterior cruciate ligament.
E-poster w/ Standard #641
Usefulness of MR Imaging Evaluation and its
Limitations in Medial Collateral Injury of the
Knee
Hisanori Ikuma, Okayama, JAPAN, Presenter
Nobuhiro Abe, Okayama-shi, Okayama, JAPAN
Ikuhi Danura, Fukuyama, Hiroshima, JAPAN
Hiroyuki Hashizume, Okayama, Okayama, JAPAN
Hajime Inoue, Okayama, JAPAN
Okayama University Graduate School of Medicine,
Okayama City, JAPAN
Background context: The American Medical
Association (AMA) classification of the knee
instability, often used to indicate treatment of