title: Monopolar thermal treatment of symptomatic anterior cruciate ligament instability.
abstract: Patients with anterior cruciate ligament instability resulting from incomplete tears or elongation in continuity without ligament detachment historically have been treated conservatively or by graft replacement. The literature is sparse regarding alternative treatments. The current study presents experience using monopolar thermal repair on 28 consecutive knees with partial anterior cruciate ligament tears all symptomatically unstable. All lesions were less than 6 months old (average, 77 days; range, 7-180 days) and with a difference of 6 mm or more (average, 9 mm; range, 6-13 mm) when comparing both knees using KT-1000 evaluation. Incomplete tears of the anterior cruciate ligament were seen at arthroscopic evaluation. The rehabilitation protocol included use of a brace for at least 6 weeks and progressive weightbearing. A 2-year minimum followup (range, 24-35 months) was done in all patients following the International Knee Documentation Committee guidelines. The overall outcome was normal or nearly normal in 96% of the patients. One failure occurred at 8 weeks. Twenty-six knees had a KT-1000 difference between 0 and 2 mm (average, 1.9 mm). Because thermal application causes death to some of the cells directly treated, it should be taken into account in selection and application. Immediately after thermal use, the anterior cruciate ligament, although thicker and tighter, is at first weaker than normal. Rehabilitation and compliance are critical during early ligament healing. This procedure seems to be a reasonable alternative to anterior cruciate ligament grafting in selected patients.
authors.affiliation: Division of Orthopaedic Surgery, Stanford University School of Medicine, CA, USA. pindellimd@hotmail.com
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Indelli
authors.forename: Michael F
authors.initials: MF
authors.lastname: Dillingham
authors.forename: Gary S
authors.initials: GS
authors.lastname: Fanton
authors.forename: David J
authors.initials: DJ
authors.lastname: Schurman
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology / Q000528:radiation effects*; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000503:physiopathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007593:Joint Instability / Q000503:physiopathology / Q000532:radiotherapy*; D007719:Knee Joint / Q000503:physiopathology / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016059:Range of Motion, Articular / Q000502:physiology / Q000528:radiation effects; D020127:Recovery of Function / Q000502:physiology / Q000528:radiation effects; D013997:Time Factors; D015599:Trauma Severity Indices