title: Second-look arthroscopic findings and clinical results after polyethylene terephthalate augmented anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  Based on the revival of artificial ligaments containing polyethylene terephthalate, this study aimed to evaluate objective intra-articular findings within scheduled second-look arthroscopy, patient-reported clinical outcome and stability after isolated augmented ACL reconstruction with polyethylene terephthalate (Trevira®) augmented patella-bone-tendon-bone graft.
  
  
  METHODS
  In a retrospective analysis of our institutional database, we found 126 patients with polyethylene terephthalate (Trevira®) augmented ACL reconstruction. All these patients underwent standardised second-look arthroscopic evaluation when removal of the augmentation became necessary. These second-look arthroscopic analyses focused on graft integration and remodelling in line with the polyethylene terephthalate augmentation. Arthroscopic re-examination comprised a graft evaluation including a structural and functional classification according to the Marburger Arthroscopy Score (MAS). Additional clinical evaluation was performed via the IKDC score and the scores of Tegner and Lysholm. Instrumental anterior laxity testing was carried out with a KT-1000™ arthrometer. Furthermore, a correlation analysis between the clinical parameters, the instrumental stability assessment and the corresponding arthroscopic graft condition was performed.
  
  
  RESULTS
  The arthroscopic evaluation showed rupture of 87 (69 %) of 126 augmentation devices. In 27 (31 %) of these 87 cases, synovial reactions were found particularly in the anterior compartment. An intact synthetic augmentation with signs of graft integration with intact synovial coating was only found in 30 %. Evaluation according to the MAS showed good to excellent structural and functional characteristics in 88 % of patients. Presence of a type III graft (MAS) was found in an additional 11 %. A rudimentary (type IV) graft was only detected once. Eighty-five percent of patients were graded A or B according to IKDC score. The Lysholm score was 92.4 ± 4.8. Correlation analysis demonstrated a significant relationship between clinical outcome according to the IKDC score (p<0.05), instrumental stability performance according to the KT-1000™ assessment (p<0.05) and the corresponding arthroscopic graft evaluation according to the MAS.
  
  
  CONCLUSIONS
  Graft integration and remodelling has complex and multi-factorial origins, particularly with artificial augmentation. Correlation analysis showed a significant relation between clinical condition, instrumental stability performance and arthroscopic graft constitution. The release of polyethylene terephthalate fibres caused inflammation of synovial tissue of the knee. Characteristic sub-clinical graft changes of structural, morphological and functional qualities of the inserted graft appear on second-look arthroscopy despite good clinical results.
authors.affiliation: Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany. struewer@med.uni-marburg.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Struewer
authors.forename: Ewgeni
authors.initials: E
authors.lastname: Ziring
authors.forename: Bernd
authors.initials: B
authors.lastname: Ishaque
authors.forename: Turgay
authors.initials: T
authors.lastname: Efe
authors.forename: Tim
authors.initials: T
authors.lastname: Schwarting
authors.forename: Benjamin
authors.initials: B
authors.lastname: Buecking
authors.forename: Karl F
authors.initials: KF
authors.lastname: Schüttler
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Frangen
mesh_terms: D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D001672:Biocompatible Materials / Q000009:adverse effects*; D050376:Bone-Patellar Tendon-Bone Grafting; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates / Q000009:adverse effects*; D012189:Retrospective Studies; D024162:Second-Look Surgery
chemical_list: D001672:Biocompatible Materials; D011093:Polyethylene Terephthalates