The investigators then removed the ACLs and performed the same set of experiments, to replicate an ACL insufficient patient. They then performed all-epiphyseal procedures in five of the legs and over-the-top reconstructions in the other five, performed the same stress and stability experiments, and then reversed the order, so that each leg underwent both procedures.
The goal of ACL reconstruction is to stabilize a joint enough so that an individual can participate in sport without damaging other knee structures, but not to stabilize the knee so much that it overconstrains the knee. "If we overconstrain a joint, whether it is a knee or shoulder, you lose motion, but more importantly, you can develop an arthritic condition," said Dr. Cordasco. "Obviously in a ten year old, if you have an overconstrained joint, that is going to mean that by the time they are 30 or 40, they might need a joint replacement."
The researchers found that the AE and OT performed similarly, but the AE performed better when the knee was at 15 degrees, which is commonly experienced by individuals who are running down a field. In the experiments, the investigators actually used a thicker graft in the OT surgeries than would be used in actual patients, because they wanted to use the same size grafts in both AE and OT surgeries. Thus, in actual patients, OT surgeries would likely have resulted in worse outcomes.
While other studies have compared joint stability (kinematics) of the two procedures, this is the first to study contact stresses. "Both reconstructions i
|Contact: Phyllis Fisher|
Hospital for Special Surgery