autograft

Distal tibial allograft

Distal Tibial Allograft

 

Indication

 

Bony defects > 30 %

 

Options

- Latarjet - may be insufficient for lesions in the region of 50%

- Iliac crest - associated with high incidence of OA
- distal tibial allograft - radius of curvature matches glenoid highly

 

Bone Grafts

Bone Healing

 

Bone healing requires 3 things

- osteoconduction - scaffold / matrix

- osteoinduction - growth factors

- osteogenesis - cells  to produce osteoid

 

Osteoconduction

 

Definition

- property of a matrix that supports the attachment of bone forming cells for subsequent bone formation

 

Substances

Acute PLC Management

Scenarios

 

1.  Isolated LCL injury

2.  Isolated Posterolateral Corner

3.  PCL + posterolateral corner

4.  ACL / posterolateral corner

5.  ACL / PLC / posterolateral corner


Repair versus Reconstruction

 

Levy et al. Am J Sports Med 2010

- failure in 4/10 knees treated with acute primary repair

Revison ACL Surgery

Graft selection

 

A.  Synthetic Grafts

 

Good initial results but unacceptably high failure rate with longer follow-up

 

Problems

 

1.   Too stiff (low ultimate strain) 

- poor resistance to abrasion

- ligament failure by attrition most common

 

2.  Recurrent synovitis, infection, loosening and osteolysis

 

B.  Autograft

 

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