ΑΠΟΚΑΤΑΣΤΑΣΗ ΠΡΟΣΘΙΟΥ ΧΙΑΣΤΟΥ ΜΕ ΣΥΝΘΕΤΙΚΟ ΜΟΣΧΕΥΜΑ

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Η Παρουσίαση έγινε στο 8ο Arthroscopy Surgery Congress στο ΠΕΚΙΝΟ το 2004

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FROM ATHENS TO BEIJING : 

8th Congress of Arthroscopic Surgery Beijing 2004 FROM ATHENS TO BEIJING

ACL RECONSTRUCTION WITH LARS® LIGAMENTS : 

ACL RECONSTRUCTION WITH LARS® LIGAMENTS 548 CASES SINCE 1997 200 CASES REVIEWED FROM 1-7 YEARS Stelios Maheras MD., Dimitris Skordis PT. METROPOLITAN HOSPITAL OF ATHENS

Slide 3: 

8th Congress of Arthroscopic Surgery Beijing 2004 INSTABILITY MENISCAL LESSIONS IRREGULAR KINEMATICS CHONDRAL LESIONS ARTHRITIS

The reconstruction of a rupturedAnterior Cruciate Ligamentis one of the most demanding transplantations : 

8th Congress of Arthroscopic Surgery Beijing 2004 The reconstruction of a rupturedAnterior Cruciate Ligamentis one of the most demanding transplantations

CURRENT TREATMENT TECHNIQUES : 

8th Congress of Arthroscopic Surgery Beijing 2004 CURRENT TREATMENT TECHNIQUES AUTOGRAFTS ALLOGRAFTS SYNTHETICS

AUTOGRAFTS : 

8th Congress of Arthroscopic Surgery Beijing 2004 AUTOGRAFTS DONOR SIDE MORBIDITY PROPRIOCEPTION DESTRUCTION PATELLA FRACTURE LACK OF EXTENSION PATELLO-FEMORAL PROBLEMS PATELLA-BAJA INTERNAL ROTATION (Semi-t) “Don’t rob Peter to pay Paul”

ALLOGRAFTS : 

8th Congress of Arthroscopic Surgery Beijing 2004 ALLOGRAFTS TRANSMITION OF VIRAL DISEASE HAS NOT BEEN FULLY RESOLVED.

Slide 8: 

8th Congress of Arthroscopic Surgery Beijing 2004 THE SO CALLED « gold – standard » SHOW ALSO FAILURES THIS JUSTIFIES RESEARCH OF NEW SOLUTIONS BACK TO INSTABILITY LOSS OF MOTION PAIN LATE OSTEOARTHRITIS NEW DAMAGES TO THE KNEE

SYNTHETIC LIGAMENTSUSED IN THE PAST: : 

8th Congress of Arthroscopic Surgery Beijing 2004 SYNTHETIC LIGAMENTSUSED IN THE PAST: PERMANENT: Gore-Tex, Stryker-Dacron STENT: Kennedy-LAD, Trevira SCAFFOLD: Leeds-Keio

THE POOR CLINICAL RESULTS WITH THE LIGAMENTS DEVELOPED IN U.S. UNDER FDA CONTROL ARE DUE: : 

8th Congress of Arthroscopic Surgery Beijing 2004 THE POOR CLINICAL RESULTS WITH THE LIGAMENTS DEVELOPED IN U.S. UNDER FDA CONTROL ARE DUE: CONCEPTS USED IN OLD DESIGNS MATERIAL USED PROCEDURES USED FOR EVALUATION SURGICAL TECHNIQUES TUNNEL ANGULATION LENGTHENING

COMPARISON OF MATERIALS, DESIGN AND INTENDED USE OF SYNTHETIC LIGAMENTS : 

COMPARISON OF MATERIALS, DESIGN AND INTENDED USE OF SYNTHETIC LIGAMENTS PP:Poly(propylene) PTFE:Poly(tetrafluroethylene) PET:Poly(ethylene terephtalate)

COMPARISON OF MECHANICAL PROPERTIES OF SYNTHETIC LIGAMENTS : 

COMPARISON OF MECHANICAL PROPERTIES OF SYNTHETIC LIGAMENTS

COMPARISON OF CYCLIC CREEP BEHAVIOR OF SYNTHETIC LIGAMENTS : 

COMPARISON OF CYCLIC CREEP BEHAVIOR OF SYNTHETIC LIGAMENTS

QUESTIONS ? : 

8th Congress of Arthroscopic Surgery Beijing 2004 QUESTIONS ? Did the synthetic ligaments failed or we have failed synthetics? Should the bad results of the first artificial ligaments lead us to definitely give up on the concept of their use?

ANSWER : 

ANSWER MUCH MORE CAN BE LEARNED FROM TRIAL AND SUCCESS THAN FROM TRIAL AND ERROR

Metak et al. “Transactions of the European Orthopedic Society” 1995 : 

8th Congress of Arthroscopic Surgery Beijing 2004 Metak et al. “Transactions of the European Orthopedic Society” 1995 THE EVIDENCE OF NERVOUS STRUCTURES IN CRUCIATE LIGAMENT STUMPS UP TO 7 YEARS AFTER THE INJURY RENDERS THE RESECTION OF THESE STUMPS OBSOLETE. “REGARDLESS OF THE TIME OF OPERATIVE CARE, CRUCIATE LIGAMENT STUMPS SHOULD BE INTEGRATED IN THE RECONSTRUCTION”.

Slide 17: 

8th Congress of Arthroscopic Surgery Beijing 2004

PROPRIOCEPTION : 

8th Congress of Arthroscopic Surgery Beijing 2004 PROPRIOCEPTION ESSENTIAL FOR PHYSIOLOGICAL MOTION AND LOADING CAPABILITY OF THE KNEE JOINT EVERY INCISION CAUSES DESTRUCTION OF EFFECTIVE PROPRIOCEPTIVE AREAS ONLY ARTHROSCOPIC AND MINIMALLY INVASIVE METHODS SHOULD BE PERFORMED

Slide 19: 

8th Congress of Arthroscopic Surgery Beijing 2004 THE TORN ACL ITSELF IS THE BEST MATERIAL WHENEVER IT IS AVAILABLE REAL LIGAMENTOUS STRUCTURE ONLY ONE TO HAVE MECHANORECEPTORS FOR PROPRIOCEPTION IT AVOIDS ANY FURTHER DAMAGE AND HARVESTING

OPERATE ACUTELY ON A TORN ACL : 

8th Congress of Arthroscopic Surgery Beijing 2004 OPERATE ACUTELY ON A TORN ACL

OUR CHOICE : 

8th Congress of Arthroscopic Surgery Beijing 2004 OUR CHOICE SYNTHETIC FATIGUE RESISTANT ROUND GRAFT FOR STRESS DISTRIBUTION BIOCOMPATIBLE ARTHROSCOPIC TECHNIQUE STABLE ANCHORING LARS

Slide 22: 

8th Congress of Arthroscopic Surgery Beijing 2004 THE CONCEPT LIGAMENT ADVANCED REINFORCEMENT SYSTEM THE L.A.R.S. ® LIGAMENT IS USED AS A FLEXIBLE INTERNAL FIXATION PERMEABLE TO THE FIBROBLASTIC INGROWTH IT RECENTERS THE KNEE DURING THE HEALING PROCESS AND ALLOWS FULL MOTION

Slide 23: 

HUMAN ACL COLLAGEN FIBERS LARS INTRAARTICULAR FIBERS WARP-KNITTED TEXTILE STRUCTURE RIGHT KNEE LEFT KNEE

LARS® ARTIFICIAL LIGAMENT : 

8th Congress of Arthroscopic Surgery Beijing 2004 LARS® ARTIFICIAL LIGAMENT INTRA-ARTICULAR PART: 2 BUNDLES REPRODUCING THE NATURAL ORIENTATION OF THE ANATOMICAL COLLAGEN FIBERS

LARS® ARTIFICIAL LIGAMENT : 

8th Congress of Arthroscopic Surgery Beijing 2004 LARS® ARTIFICIAL LIGAMENT POLYESTER PET FULLY BIOCOMPATIBLE THE ONLY ONE TESTED IN COMPINED TENSION-FLEXION-TORSION PRESERVES THE STUMP AND THE MECHANORECEPTORS ANATOMIC DESIGN ( FREE FIBERS IN THE INTRAARTICULAR PART PRETWISTED FOR RIGHT AND LEFT KNEE) PURE ARTHROSCOPIC PROCEDURE

Slide 26: 

SYNTHETIC LIGAMENTS DO NOT FORGIVE PRECISE TECHNIQUE

Slide 27: 

8th Congress of Arthroscopic Surgery Beijing 2004 REMINDING SOME BASIC DATAS FOR PERFECT PLACEMENT ISOMETRY 1 / FEMORAL

Slide 28: 

8th Congress of Arthroscopic Surgery Beijing 2004

Slide 29: 

8th Congress of Arthroscopic Surgery Beijing 2004

Slide 30: 

THE CENTER OF THE CIRCLE CAN BE DETERMINED WITH A TEMPLATE ( lars isometer ) HERE THE RADIUS IS 20 mm.

Slide 31: 

I r POINT I IS THE CENTER OF A CIRCLE WITH VARIABLE RADIUS r

SET UP OF THE PATIENT : 

8th Congress of Arthroscopic Surgery Beijing 2004 SET UP OF THE PATIENT

C – ARM IN PLACE : 

8th Congress of Arthroscopic Surgery Beijing 2004 C – ARM IN PLACE

Slide 34: 

8th Congress of Arthroscopic Surgery Beijing 2004 THE PRE-OP. RADIOLAXIMETRY CONFIRMS THE CLINICAL DIAGNOSIS

LARS® INSTRUMENTS : 

8th Congress of Arthroscopic Surgery Beijing 2004 LARS® INSTRUMENTS

VERIFYING THE CORRECT ENTRANCE POINT FOR THE FEMORAL TUNNEL : 

VERIFYING THE CORRECT ENTRANCE POINT FOR THE FEMORAL TUNNEL

Slide 37: 

8th Congress of Arthroscopic Surgery Beijing 2004

3mm K-WIRE GUIDE : 

8th Congress of Arthroscopic Surgery Beijing 2004 3mm K-WIRE GUIDE

Slide 39: 

8th Congress of Arthroscopic Surgery Beijing 2004 REMINDING SOME BASIC DATAS FOR PERFECT PLACEMENT ISOMETRY 2 / TIBIAL

Slide 40: 

8th Congress of Arthroscopic Surgery Beijing 2004

Slide 41: 

8th Congress of Arthroscopic Surgery Beijing 2004

Slide 42: 

P0INT i POINT PW POINT T SLOPE OF THE ROOF DISTANCE C-T(10mm) PRE OP XRAY CHECK UP LAT. VIEW MAX. EXTENSION

Slide 43: 

8th Congress of Arthroscopic Surgery Beijing 2004 THE CENTER OF THE ACL IS AT 42% OF THE MEDIAL PLATEAU AND AT 50% OF THE TOTAL LENGTH

Slide 44: 

8th Congress of Arthroscopic Surgery Beijing 2004

K-WIRE PASSING THE TIBIA : 

8th Congress of Arthroscopic Surgery Beijing 2004 K-WIRE PASSING THE TIBIA

3mm K-WIRE – TUBES – 7mm DRILL : 

8th Congress of Arthroscopic Surgery Beijing 2004 3mm K-WIRE – TUBES – 7mm DRILL

DRILLING THE FEMORAL TUNNEL : 

8th Congress of Arthroscopic Surgery Beijing 2004 DRILLING THE FEMORAL TUNNEL

DRILLING THE TIBIAL TUNNEL : 

DRILLING THE TIBIAL TUNNEL

WIRE LOOP & SCREW GUIDE : 

8th Congress of Arthroscopic Surgery Beijing 2004 WIRE LOOP & SCREW GUIDE

SCREW GUIDE & WIRE LOOP : 

SCREW GUIDE & WIRE LOOP

LIGAMENT PASSAGE : 

8th Congress of Arthroscopic Surgery Beijing 2004 LIGAMENT PASSAGE

FREE FIBERS IN PLACE : 

FREE FIBERS IN PLACE

LARS® TITANIUM SCREWS & STAPLES : 

8th Congress of Arthroscopic Surgery Beijing 2004 LARS® TITANIUM SCREWS & STAPLES

SCREW DRIVER LENGTH = LARGER TUBE LENGTH : 

8th Congress of Arthroscopic Surgery Beijing 2004 SCREW DRIVER LENGTH = LARGER TUBE LENGTH

AUTOMATIC UNLOCK OF THE SCREWDRIVER : 

8th Congress of Arthroscopic Surgery Beijing 2004 AUTOMATIC UNLOCK OF THE SCREWDRIVER

FEMORAL FIXATION : 

FEMORAL FIXATION ALWAYS USE SCREW AT LEAST 1mm GREATER DIAMETER THAN THE DRILL

STAPLE HOLDER – LIGAMENT CUTTER : 

8th Congress of Arthroscopic Surgery Beijing 2004 STAPLE HOLDER – LIGAMENT CUTTER

TIBIAL FIXATION : 

TIBIAL FIXATION FULL FLEXION – FULL EXTENSION / NO IMPINGMENT

FULL FLEXION – FULL EXTENSION : 

8th Congress of Arthroscopic Surgery Beijing 2004 FULL FLEXION – FULL EXTENSION

FINAL RESULT : 

8th Congress of Arthroscopic Surgery Beijing 2004 FINAL RESULT

CASE 1 : 

8th Congress of Arthroscopic Surgery Beijing 2004 CASE 1

CASE 1 : 

8th Congress of Arthroscopic Surgery Beijing 2004 CASE 1

CASE 1 : 

8th Congress of Arthroscopic Surgery Beijing 2004 CASE 1

CASE 1 : 

8th Congress of Arthroscopic Surgery Beijing 2004 CASE 1

CASE 1 : 

8th Congress of Arthroscopic Surgery Beijing 2004 CASE 1

CASE 2 : 

8th Congress of Arthroscopic Surgery Beijing 2004 CASE 2

CASE 2 : 

8th Congress of Arthroscopic Surgery Beijing 2004 CASE 2

CASE 2 : 

8th Congress of Arthroscopic Surgery Beijing 2004 CASE 2

CASE 3 : 

8th Congress of Arthroscopic Surgery Beijing 2004 CASE 3

CASE 3 : 

8th Congress of Arthroscopic Surgery Beijing 2004 CASE 3

LARS LIGAMENT 30 MONTHS POST-OP 2nd LOOK ARTHROSCOPY : 

8th Congress of Arthroscopic Surgery Beijing 2004 LARS LIGAMENT 30 MONTHS POST-OP 2nd LOOK ARTHROSCOPY

LARS LIGAMENT30 MONTHS POST-OP2nd LOOK ARTHROSCOPY : 

8th Congress of Arthroscopic Surgery Beijing 2004 LARS LIGAMENT30 MONTHS POST-OP2nd LOOK ARTHROSCOPY

IN VIVO HUMAN TISSUE INGROWTH STUDIES : 

8th Congress of Arthroscopic Surgery Beijing 2004 IN VIVO HUMAN TISSUE INGROWTH STUDIES CHEMICAL AND STRUCTURAL PROPERTIES LEAD TO AN ENCAPSULATION OF THE IMPLANT BY CONNECTIVE TISSUE. DUE TO ITS HIGH POROSITY AND OPEN FIBERS IN THE INTRA-ARTICULAR PART OF THE LARS LIGAMENT ALLOWS MORE TISSUE INGROWTH.

Slide 74: 

8th Congress of Arthroscopic Surgery Beijing 2004 HISTOLOGICAL EXAMINATION

POST - OP CARE : 

8th Congress of Arthroscopic Surgery Beijing 2004 POST - OP CARE No limits to full motion No brace Full weight bearing Isometric quadriceps exercise Isokinetic close chain 15-20 days proprioception

POST - OP CARE 30-45 day jogging - progressive training : 

8th Congress of Arthroscopic Surgery Beijing 2004 POST - OP CARE 30-45 day jogging - progressive training

POST - OP CARE60 days training with the team (pro) : 

8th Congress of Arthroscopic Surgery Beijing 2004 POST - OP CARE60 days training with the team (pro)

POST - OP CARE60-80 days full contact sports : 

8th Congress of Arthroscopic Surgery Beijing 2004 POST - OP CARE60-80 days full contact sports

MAY 1997- AUGUST 2004685 ACL RECONSTRUCTIONS : 

MAY 1997- AUGUST 2004685 ACL RECONSTRUCTIONS 137 BPTB 548 LARS® 379 ACUTE (LESS THAN 3 WEEKS) 103 CHRONIC (1 MONTH- 5 YRS) 66 REVISIONS FROM AUTOGENOUS GRAFTS

548 PATIENTS WITH LARS® LIGAMENT : 

548 PATIENTS WITH LARS® LIGAMENT ON 19 PATIENTS WE RECONSTRUCT BOTH CRUCIATES: ACL + PCL ON 7 PATIENTS WE RECONSTRUCT BOTH CRUCIATES AND POSTERO-LATERAL CORNER: ACL + PCL + PLI ON 2 PATIENTS WE PERFORMED RECONSTRUCTION OF THE ACL ON BOTH KNEES - AT THE SAME TIME

548 PATIENTS WITH LARS® LIGAMENT : 

548 PATIENTS WITH LARS® LIGAMENT 398 MALE 72,6% (2 with both knees) 150 FEMALE 27,4% 306 RIGHT 55,8% 242 LEFT 44,2% 59 HIGH COMPETITIVE PROFESSIONAL PLAYERS 10,8% 77 PROFFESIONAL PLAYERS 14,1% 285 RECREATIONAL ATHLETS 52,0% 127 INDIVIDUALS 23,1%

548 PATIENTS WITH LARS® LIGAMENT : 

8th Congress of Arthroscopic Surgery Beijing 2004 548 PATIENTS WITH LARS® LIGAMENT 66 REVISION FROM AUTOGENOUS GRAFTS 117 LOST TO FOLLOW UP 365 CASES FOLLOW UP IS IN PROGRESS

ACOMPANYING LESSIONS ON 365 PATIENTS : 

8th Congress of Arthroscopic Surgery Beijing 2004 ACOMPANYING LESSIONS ON 365 PATIENTS ISOLATED ACL 91 24,9% ACL + MCL + M.M. 45 12,3% ACL + M.M. 89 24,4% ACL + L.M. 67 18,4% ACL + M.M. + L.M. 36 9,9% ACL + CHONDRAL LES. 29 7,9% ACL+M.M.+L.M.+CH.LES. 8 2,2%

FOLLOW UP 200 PATIENTS OUT OF 365 : 

8th Congress of Arthroscopic Surgery Beijing 2004 FOLLOW UP 200 PATIENTS OUT OF 365 THE FOLLOW UP OF THE REST 165 PATIENTS IS IN PROGRESS

FOLLOW UP 200 PATIENTS : 

FOLLOW UP 200 PATIENTS FROM 84 UP TO 22 MONTHS MEAN 54 MONTHS

AGE FROM 16 Y.O - TO 45 Y.O.MEAN 27 Y.O. : 

8th Congress of Arthroscopic Surgery Beijing 2004 AGE FROM 16 Y.O - TO 45 Y.O.MEAN 27 Y.O.

200 PATIENTS : 

8th Congress of Arthroscopic Surgery Beijing 2004 200 PATIENTS 85 HIGH COMPETITIVE & PROFESSIONAL PLAYERS 70 RECREATIONAL ATHLETS 45 INDIVIDUALS

We evaluated in all groups : 

8th Congress of Arthroscopic Surgery Beijing 2004 We evaluated in all groups 1. Stability of the knee joint with KT 2000

RESULTSON 200 PATIENTS WITH KT-2000 : 

8th Congress of Arthroscopic Surgery Beijing 2004 RESULTSON 200 PATIENTS WITH KT-2000 NOULIS-LACHMAN TEST < 3mm 164 82% " " " 3-5mm 28 14% " " " > 5mm 8 4% PIVOT SHIFT NEGATIVE 182 91% " " SLIGHTLY POSSITIVE 8 9%

RESULTSI.K.D.C. FORM : 

RESULTSI.K.D.C. FORM

RECONSTRUCTION IS ONLY HALF JOB : 

8th Congress of Arthroscopic Surgery Beijing 2004 RECONSTRUCTION IS ONLY HALF JOB THE OTHER HALF IS REHABILITATION

METHODS & MATERIALS : 

8th Congress of Arthroscopic Surgery Beijing 2004 METHODS & MATERIALS ISOKINETIC EVALUATION BALANCE AND STABILITY KINESTHESIA KIN-COM NEUROCOM MASTER SYSTEM BALANCE ALL THE PATIENTS SIGNED AN AGREEMENT FORM THAT THEY ACCEPT TO PARTICIPATE IN THIS INVESTIGATION

ISOKINETIC COMPUTERIZED DYNAMOMETER : 

8th Congress of Arthroscopic Surgery Beijing 2004 ISOKINETIC COMPUTERIZED DYNAMOMETER

MASTER SYSTEM BALANCE OF NEUROCOM : 

8th Congress of Arthroscopic Surgery Beijing 2004 MASTER SYSTEM BALANCE OF NEUROCOM

CONCENTRIC CONTRACTIONIN MALES : 

8th Congress of Arthroscopic Surgery Beijing 2004 CONCENTRIC CONTRACTIONIN MALES

CONCENTRIC CONTRACTION IN FEMALES : 

8th Congress of Arthroscopic Surgery Beijing 2004 CONCENTRIC CONTRACTION IN FEMALES

ECCENTRIC CONTRACTION IN MALES : 

8th Congress of Arthroscopic Surgery Beijing 2004 ECCENTRIC CONTRACTION IN MALES

ECCENTRIC CONTRACTION IN FEMALES : 

8th Congress of Arthroscopic Surgery Beijing 2004 ECCENTRIC CONTRACTION IN FEMALES

ANGLE 150 : 

8th Congress of Arthroscopic Surgery Beijing 2004 ANGLE 150

ANGLE 450 : 

8th Congress of Arthroscopic Surgery Beijing 2004 ANGLE 450

FUNCTIONAL TEST - FORWARD LUNGE : 

8th Congress of Arthroscopic Surgery Beijing 2004 FUNCTIONAL TEST - FORWARD LUNGE

MODIFIED CTSIB(CLINICAL TEST SENSORY INTERACTION OF BALANCE)IN PROFESSIONAL ATHLETES : 

8th Congress of Arthroscopic Surgery Beijing 2004 MODIFIED CTSIB(CLINICAL TEST SENSORY INTERACTION OF BALANCE)IN PROFESSIONAL ATHLETES WHITHIN NORMAL RANGE

MODIFIED CTSIB(CLINICAL TEST SENSORY INTERACTION OF BALANCE)IN RECREASIONAL ATHLETES AND INDIVIDUALS : 

8th Congress of Arthroscopic Surgery Beijing 2004 MODIFIED CTSIB(CLINICAL TEST SENSORY INTERACTION OF BALANCE)IN RECREASIONAL ATHLETES AND INDIVIDUALS

KINESTHESIA 150 : 

8th Congress of Arthroscopic Surgery Beijing 2004 KINESTHESIA 150

FORWARD LUNGE : 

8th Congress of Arthroscopic Surgery Beijing 2004 FORWARD LUNGE

BALANCE EXERCISE : 

8th Congress of Arthroscopic Surgery Beijing 2004 BALANCE EXERCISE CLOSED CHAIN (BACK-FRONT)

ACCELERATION PARAMETERS : 

8th Congress of Arthroscopic Surgery Beijing 2004 ACCELERATION PARAMETERS 70% of the patients occurring Peak Torque during beginning one third of the upward slope 20% of the patients occurring Peak Torque during in the middle third of the curve 10% of the patients occurring Peak Torque during the final third of the curve

CPM : 

8th Congress of Arthroscopic Surgery Beijing 2004 CPM

CLOSED CHAIN EXERCISE : 

8th Congress of Arthroscopic Surgery Beijing 2004 CLOSED CHAIN EXERCISE

TRAINING IN TREADMILL : 

8th Congress of Arthroscopic Surgery Beijing 2004 TRAINING IN TREADMILL

BALANCE – PROPRIOCEPTION EXERCISE : 

8th Congress of Arthroscopic Surgery Beijing 2004 BALANCE – PROPRIOCEPTION EXERCISE STEP UP / OVER

BALANCE PROPRIOCEPTION EXERCISE : 

8th Congress of Arthroscopic Surgery Beijing 2004 BALANCE PROPRIOCEPTION EXERCISE FIGURE 8ts

EXERCISE IN BALANCE(FOAM) : 

8th Congress of Arthroscopic Surgery Beijing 2004 EXERCISE IN BALANCE(FOAM) SIDE T0 SIDE

TRAINING 45 DAYS POST-OP : 

8th Congress of Arthroscopic Surgery Beijing 2004 TRAINING 45 DAYS POST-OP

TRAINING 45 DAYS POST-OP : 

8th Congress of Arthroscopic Surgery Beijing 2004 TRAINING 45 DAYS POST-OP

60 DAYS POST-OP : 

8th Congress of Arthroscopic Surgery Beijing 2004 60 DAYS POST-OP

MODIFIED NOYES PERSONAL QUESTIONARY : 

MODIFIED NOYES PERSONAL QUESTIONARY FOR SUBJECTIVE RESULTS

IN WHICH LEVEL PAIN IN YOUR KNEE EFFECTS THE LEVEL OF YOUR DAILY ACTIVITIES ? : 

IN WHICH LEVEL PAIN IN YOUR KNEE EFFECTS THE LEVEL OF YOUR DAILY ACTIVITIES ? 5 - I HAVE NO PAIN IN MY KNEE 4 - I HAVE SOME PAIN WITHOUT RESULTS IN MY DAILY ACTIVITIES 3 - THE PAIN EFFECTS MY DAILY ACTIVITES A LITTLE 2 - THE PAIN EFFECTS MY DAILY ACTIVITIES MODERATE 1 - THE PAIN EFFECTS MY DAILY ACTIVITIES A LOT 0 - THE PAIN IN MY KNEE IS SEVERE. I CAN’T DO MY DAILY ACTIVITIES

IN WHICH LEVEL CRACKLE IN YOUR KNEE EFFECTS THE LEVEL OF YOUR DAILY ACTIVITIES ? : 

IN WHICH LEVEL CRACKLE IN YOUR KNEE EFFECTS THE LEVEL OF YOUR DAILY ACTIVITIES ? 5 - I HAVE NO CRACKLE IN MY KNEE 4 - I HAVE SOME BUT DOES NOT EFFECT MY DAILY ACTIVITIES 3 - THE CRACKLE DOES EFFECT MY DAILY ACTIVITIES A LITTLE 2 - THE CRACKLE EFFECTS MY ACTIVITIES MODERATE 1 - THE CRACKLE EFFECTS MY ACTIVITIES A LOT 0 - THE CRACKLE DOES NOT PERMIT ME TO DO MY DAILY ACTIVITIES

IN WHICH LEVEL STIFNESS IN YOUR KNEE EFFECTS YOUR DAILY ACTIVITIES ? : 

IN WHICH LEVEL STIFNESS IN YOUR KNEE EFFECTS YOUR DAILY ACTIVITIES ? 5 - I HAVE NO STIFNESS IN MY KNEE 4 - I HAVE STIFNESS BUT DOES NOT EFFECT MY DAILY ACTIVITIES 3 - THE STIFNESS IN MY KNEE EFFECTS MY DAILY ACTIVITIES A LITTLE 2 - THE STIFNESS IN MY KNEE EFFECTS MODERATE 1 - THE STIFNESS IN MY KNEE EFFECTS A LOT 0 - THE STIFNESS DOES NOT PERMIT ME TO DO MY DAILY ACTIVITIES

IN WHICH LEVEL EDEMA IN YOUR KNEE EFFECTS YOUR DAILY ACTIVITIES ? : 

IN WHICH LEVEL EDEMA IN YOUR KNEE EFFECTS YOUR DAILY ACTIVITIES ? 5 - I HAVE NOT EDEMA IN MY KNEE 4 - I HAVE SOME BUT DOES NOT EFFECT MY DAILY ACTIVITIES 3 - THE EDEMA EFFECTS MY DAILY ACTIVITIES A LITTLE 2 - THE EDEMA EFFECTS MY DAILY ACTIVITIES MODERATE 1 - THE EDEMA EFFECTS MY DAILY ACTIVITIES A LOT 0 - THE EDEMA DOES NOT PERMIT ME TO DO MY DAILY ACTIVITIES

IN WHICH LEVEL “LOCKING”OF YOUR KNEE EFFECTS YOUR DAILY ACTIVITIES ? : 

IN WHICH LEVEL “LOCKING”OF YOUR KNEE EFFECTS YOUR DAILY ACTIVITIES ? 5 - I HAVE NO “LOCKING” IN MY KNEE 4 - I HAVE “LOCKING”BUT DOES NOT EFFECT MY DAILY ACTIVITIES 3 - THE “LOCKING”EFFECTS MY DAILY ACTIVITIES A LITTLE 2 - THE “LOCKING”EFFECTS MY DAILY ACTIVITIES MODERATE 1 - THE “LOCKING”EFFECTS MY DAILY ACTIVITIES A LOT 0 - THE “LOCKING”IN MY KNEE DOES NOT PERMIT ME TO DO MY DAILY ACTIVITIES

IN WHICH LEVEL WEAKNESS IN YOUR LEG EFFECTS YOUR DAILY ACTIVITIES ? : 

IN WHICH LEVEL WEAKNESS IN YOUR LEG EFFECTS YOUR DAILY ACTIVITIES ? 5 - I HAVE NO WEAKNESS IN MY LEG 4 - I FEEL MY LEG WEAK BUT DOES NOT EFFECTS MY DAILY ACTIVITIES 3 - THE WEAKNESS DOES EFEECTS MY DAILY ACTIVITIES A LITTLE 2 - THE WEAKNESS EFFECTS MY DAILY ACTIVITIES MODERATE 1 - THE WEAKNESS EFFECTS MY DAILY ACTIVITIES A LOT 0 - THE WEAKNESS DOES NOT PERMIT ME TO DO MY DAILY ACTIVITIES

DOES YOUR KNEE PERMITS YOU TO STEP ON STAIRS ? : 

DOES YOUR KNEE PERMITS YOU TO STEP ON STAIRS ? 5 - I HAVE NOT ANY PROBLEM 4 - I CAN STEP ON BUT I FEEL PAIN 3 - I CAN STEP ON WHITHOUT PAIN BUT I FEEL THE NEED TO HOLD 2 - I CAN STEP ON WHITHOUT PAIN BUT ONE-ONE AND I HOLD THE RAIL 1 - I NEED SUPPORT TO STEP ON STAIRS 0 - I CAN NOT STEP ON STAIRS

DOES YOUR KNEE PERMITS YOU TO STEP OFF STAIRS? : 

DOES YOUR KNEE PERMITS YOU TO STEP OFF STAIRS? 5 - I CAN STEP OFF STAIRS WITHOUT PROBLEM 4 - I CAN STEP OFF STAIRS BUT I HAVE PAIN 3 - I CAN STEP OFF STAIRS BUT I NEED TO HOLD 2 - I CAN STEP OFF ONE BY ONE THE STAIRS BUT I HOLD THE RAIL 1 - I NEED SUPPORT TO STEP OFF STAIRS 0 - I CAN NOT STEP OFF STAIRS

CAN YOU SQUAT ? : 

CAN YOU SQUAT ? 5 - I CAN SQUAT 4 - I CAN SQUAT BUT I FEEL PAIN 3 - I CAN SQUAT 90 DEGREES 2 - I CAN SQUAT 60 DEGREES 1 - I CAN SQUAT 30 DEGREES 0 - I CAN NOT SQUAT AT ALL

PAIN : 

PAIN 20 - I HAVE NO PAIN IN MY KNEE 16 - I HAVE SOME PAIN FROM TIME TO TIME WHEN I PARTICIPATE IN COMPETITIVE SPORTS OR WHEN I HAVE HEAVY WORK 12 - I HAVE SOME PAIN FROM TIME TO TIME WHEN I’M RUNNING OR WHEN I HAVE MODERATE WORK 8 - I HAVE PAIN EVEN IN LIGHT JOGING 4 - I HAVE PAIN EVEN WHEN I WALK. I CAN NOT PARTICIPATE IN SPORTS 0 - I HAVE PAIN IN MY KNEE DURING ALL MY DAILY ACTIVITIES

EXTRA QUESTIONARY : 

EXTRA QUESTIONARY 85 HIGH COMPETITIVE AND PROFESSIONAL PLAYERS 70 RECREATIONAL ATHLETS

EDEMA : 

8th Congress of Arthroscopic Surgery Beijing 2004 EDEMA 10 - I HAVE NO EDEMA IN MY KNEE 8 - MY KNEE IS SWELLING FROM TIME TO TIME WHEN I PARTICIPATE IN COMPETIVE SPORTS OR WHEN I’M DOING HEAVY WORK 6 - MY KNEE IS SWELLING AFTER SPORTS OR MODERATE WORK 4 - THE EDEMA LIMITS MY SPORTS ACTIVITY. MORE THAN 4 TIMES A YEAR 2 - MY KNEE IS SWELLING AFTER RUNNING. DISAPEARS AFTER RELAXING 0 - MY KNEE IS SWELLING EVEN WHEN I WALK AND REMAINS AFTER RELAXING

STABILITY : 

8th Congress of Arthroscopic Surgery Beijing 2004 STABILITY 20 - I HAVE NO GIVING WAY SIGN 16 - I FELL MY KNEE NOT STABLE WHEN I PARTICIPATE IN CONTACT SPORTS OR DOING A HEAVY WORK 12 - I FELL MY KNEE NOT STABLE WHEN I’M JOGING THAT RESTRICTS MY SPORTS ACTIVITY OR HEAVY WORK 8 - I FEEL MY KNEE NOT STABLE AND I CAN NOT PARTICIPATE IN SPORTS 4 - I HAVE OFTEN GIVING WAY SIGN EVEN WHEN I WALK 0 - I HAVE BIG PROBLEM OF STABILITY WHEN I MUST TURN OR CHANGE SUDDENLY DIRECTION

JOINT STIFNESS : 

8th Congress of Arthroscopic Surgery Beijing 2004 JOINT STIFNESS A – NONE B – SOME TIMES C - OFTEN

CRACKLE : 

8th Congress of Arthroscopic Surgery Beijing 2004 CRACKLE A – NONE B – MILD C – MODERATE D - SEVERE

BLOCK : 

8th Congress of Arthroscopic Surgery Beijing 2004 BLOCK A – NEVER B – RECURRENTLY C - OFTEN

ACTIVITY LEVEL : 

8th Congress of Arthroscopic Surgery Beijing 2004 ACTIVITY LEVEL 20 - I HAVE NO RESTRICTIONS. I HAVE A NORMAL KNEE. I CAN PARTICIPATE IN CONTACT SPORTS 16 - I PARTICIPATE IN SPORTS BUT WITH LOWER DEMANDS 12 - I CAN DO WEEKEND SPORTS WITH SOME SYMPTOMS 8 - I CAN NOT PARTICIPATE IN SPORTS AT ALL. ONLY JOGING WITH SYMPTOMS 4 - I HAVE PROBLEMS IN MY DAILY ACTIVITIES 0 - I HAVE SEVERE PROBLEMS IN MY DAILY ACTIVITIES

RUNNING : 

8th Congress of Arthroscopic Surgery Beijing 2004 RUNNING 10 - NORMAL. I’M TRAINING STEADILY 8 - NEARLY NORMAL. I CAN REACH 50% OF MY SPEED 6 - I HAVE SOME PROBLEMS. I CAN RUN UP TO 2 Km. 4 - SEVERE PROBLEMS 2 - SEVERE PROBLEMS. I CAN ASCEND ONLY SOME STAIRS

JUMPING AND PIVOTING : 

8th Congress of Arthroscopic Surgery Beijing 2004 JUMPING AND PIVOTING 5 - NORMAL. FULL ACTIVITY IN CONTACT SPORTS 4 - NEARLLY NORMAL WITH SOME CAUTION 3 - MODERATE I PARTICIPATE IN SPORTS WITH GREAT CAUTION 2 - I MUST PAY ATTENTION TO ANY KIND OF SPORTS 1 - I CAN PLAY ONLY GOLF

KNEE RATING (1-100)200 PATIENTS SATISFACTION : 

8th Congress of Arthroscopic Surgery Beijing 2004 KNEE RATING (1-100)200 PATIENTS SATISFACTION

COMPLICATIONS ON 365 PATIENTS : 

8th Congress of Arthroscopic Surgery Beijing 2004 COMPLICATIONS ON 365 PATIENTS LACK OF EXTENSION 3 0,8% INFECTION IN THE TIBIA 3 0,8% INFECTION IN THE KNEE JOINT 1 0,3% RUPTURES 5 1,4% (2 due to anterior femoral tunnel causing impigment of the graft and 3 due to new Injury) REVISION OF TIBIAL FIXATION IN FIRST CASES 18 4,9% (Staple removal) * SYNOVITIS 0 0%

Slide 139: 

ADVANTAGES STRAIGHT FORWARD PROCEDURE AND COMPETITIVE RESULTS WITH: LESS DAMAGING AND PURELY ARTHROSCOPIC FASTER RECOVERY NO UNREPAIRABLE COMPLICATIONS IT DOES NOT BURN THE BRIDGES IT IS FINALLY MORE CONSERVATIVE

09-06-1999GREECE vs. ITALY : 77-53 : 

09-06-1999GREECE vs. ITALY : 77-53

12/06/1999 RIGHT KNEEACL RECON. WITH LARS® : 

12/06/1999 RIGHT KNEEACL RECON. WITH LARS® 09/06/1999 05/09/1999 ARIS SALONICA 2000-2001 PAOK SALONICA

MARCH 2001 LEFT KNEE ACL RUPTURE : 

MARCH 2001 LEFT KNEE ACL RUPTURE 26/3/2001 2001- 2002 URAL GREAT (USSR)

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2002- 2003 PAMESA VALENCIA (SPAIN)

2003 – TODAY OLYMPIAKOS (GREECE) : 

8th Congress of Arthroscopic Surgery Beijing 2004 2003 – TODAY OLYMPIAKOS (GREECE) 2 LARS® LIGAMENTS

LARS® LIGAMENT IMPLANTED JULY 2000 : 

8th Congress of Arthroscopic Surgery Beijing 2004 LARS® LIGAMENT IMPLANTED JULY 2000

LARS ® 10 MONTHS POST-OP : 

8th Congress of Arthroscopic Surgery Beijing 2004 LARS ® 10 MONTHS POST-OP

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8th Congress of Arthroscopic Surgery Beijing 2004 THE USE OF THE FREE FIBERS OF THE LARS® AS AN INTERNAL FIXATION IN ACUTES ALLOW THE HEALING OF THE FRESHLY INJURED ACL IN A GOOD PROPORTION OF CASES DUE TO A GOOD PERMEABILITY TO FIBROBLASTIC INGROWTH AND EXCELLENT TOLERANCE THE NEXT STEP WILL BE BROUGHT BY BIOLOGICAL FACTORS CONCLUSION

CONCLUSSION : 

8th Congress of Arthroscopic Surgery Beijing 2004 CONCLUSSION WE BELIVE THAT: THE FUTURE BELONGS TO THE SYNTHETIC GRAFTS (BOB JACKSON - SICOT 1999) THE LARS® LIGAMENT IS THE IDEAL GRAFT TODAY FOR ACL INJURIES IN ACUTE CASES AND IN CHRONIC IF THERE IS STUMP WELL VASCULARIZED

FUTURE ? : 

8th Congress of Arthroscopic Surgery Beijing 2004 FUTURE ? SYNTHETIC COLLAGEN GRAFT

Slide 150: 

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