Up to a third of total knee replacement (TKR) patients have continued pain and up to 20% are outright dissatisfied. The incidence of knee replacements doubled…
Knee / Acl Surgery
The diameter of single bundle, hamstring autograft does not significantly influence revision rate or clinical outcomes after anterior cruciate ligament reconstruction by Wernicke et al is quite important because it correctly debunks the entire topic of evaluating Hamstring (HS) diameter for Hamstring ACLR. After over 30 years of exclusive use of HS autograft I can conclusively state that our studies have demonstrated that the HS is ALWAYS big enough, when quadrupled, to successfully reconstruct the ACL.
The risk in the past had only been about 1%. However a study from Australia in 2012 showed that soaking the graft in Vancomycin, an antibiotic, during surgery eliminated all post-operative infections
It is well established that Non-Steroidal Anti-inflammatory Drugs (NSAIDs) such as ibuprofen (motrin, advil), naproxen (aleve), aspirin, celebrex, diclofenac, and meloxicam interfere with the healing of ligaments, bones, tendons and other connective tissue. For this reason Orthopaedic Surgeons are cautious in their use after reconstructive surgery and in other applications - although there are few clinical studies showing the effect of NSAIDs on outcomes. However, a recent paper entitled Predictors of Revision Surgery After Anterior Cruciate Ligament Reconstruction from the US Navy published in the American Journal of Sportsmedicine found a significant correlation with the use of NSAIDs and an increased rate of revision, i.e. failure, after ACL reconstruction. This held true for both so-called COX-1 NSAIDs, the vast majority available, and also COX-2 NSAIDs which include Celebrex and Meloxicam. The authors write “Increased odds of revision surgery among active-duty personnel were associated with the perioperative use of NSAIDs and COX-2 inhibitors.” This reinforces the conclusion found in one of the few other papers to look at this topic The effect of ketorolac on anteroposterior knee laxity after anterior cruciate ligament reconstruction. where it was found that “The use of ketorolac during bone-patellar tendon autograft ACL reconstruction was associated with increased AP laxity at 6 weeks postoperatively.”