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Author: search.filters.author.Alex VaismanSubject: search.filters.subject.article

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    Vancomycin presoaking of hamstring autografts to prevent infection in anterior cruciate ligament reconstruction: a narrative review
    (2021)
    FIGUEROA BERRIOS, FRANCISCO JAVIER  
    ;
    Alex Vaisman
    ;
    CALVO RODRIGUEZ, RAFAEL  
    ;
    David Figueroa  
    ;
    João Espregueira-Mendes
    <jats:p> Hamstring autograft use has been linked to an increased risk of infection after anterior cruciate (ACL) reconstruction compared to other grafts. The absolute reason for this remains unclear, with contamination after harvesting and preparation of the graft being the most accepted hypothesis. Using the rationale that a contaminated graft could be the main factor in postoperative septic arthritis and in an effort to maximize the antibiotic efficacy of the graft, the Vancomycin presoaking technique was developed. It has shown success in decreasing the infection rate in ACL reconstruction. In recent years, an important number of research articles using this protocol have appeared, but the technique is still not widely implemented. Recent literature shows that Vancomycin presoaking of the graft has shown a successful decrease in the infection rate after hamstring autograft ACL reconstruction. It has also shown efficacy decreasing the infection rate in other types of grafts (patellar tendon, quadriceps tendon, allograft) and also in patients with concomitant ligament procedures or open surgeries. Despite the positive effects of Vancomycin presoaking reducing the infection rate after ACL reconstruction, the lack of prospective randomized control trials and the heterogeneity of the different studies mean it is not feasible to recommend Vancomycin presoaking of the graft universally for every ACL reconstruction patient. </jats:p><jats:p> Cite this article: EFORT Open Rev 2021;6:211-216. DOI: 10.1302/2058-5241.6.200059 </jats:p>
      1Scopus© Citations 7
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      5Scopus© Citations 9
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    Graft choice in combined anterior cruciate ligament and medial collateral ligament reconstruction
    (2020)
    FIGUEROA BERRIOS, FRANCISCO JAVIER  
    ;
    David Figueroa
    ;
    CALVO RODRIGUEZ, RAFAEL  
    ;
    Alex Vaisman
    ;
    João Espregueira-Mendes
    <jats:p> There is a concern regarding which grafts should be used in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) reconstructions, with a paucity of recommendations focused on this specific topic. Expert opinions suggest the use of allograft-only reconstructions to limit donor-site morbidity or using at least one allograft and one autograft. When a hamstring tendon autograft is harvested, techniques that maintain both the integrity of the sartorius fascia and the gracilis are recommended because of the role that the ST-G-S (semitendinosus-gracilis-sartorius) complex plays in valgus stability in the setting of an MCL-deficient knee. </jats:p><jats:p> Cite this article: EFORT Open Rev 2020;5:221-225. DOI: 10.1302/2058-5241.5.190049 </jats:p>
      2Scopus© Citations 10
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    Meniscus allograft transplantation: indications, techniques and outcomes
    (2019)
    FIGUEROA BERRIOS, FRANCISCO JAVIER  
    ;
    FIGUEROA POBLETE, DAVID HUMBERTO  
    ;
    CALVO RODRIGUEZ, RAFAEL  
    ;
    Alex Vaisman  
    ;
    João Espregueira-Mendes
    <jats:p> New indications for meniscal allograft transplantation (MAT) are being added, but the general expert opinion is that it is still a procedure reserved for symptomatic meniscal loss. Lateral MAT has better clinical outcomes and less failure risk compared to medial MAT. Ideal conditions (low-grade chondral lesions) make MAT a more survivable and successful procedure. Meniscal extrusion after MAT is common and does not seem to alter results. Midterm survivorship of a MAT is reported to be 85–90%, while long-term survivorship decreases to 50–70% depending on chondral status and concomitant procedures. Even if the procedure is a success, there are high possibilities of not being able to resume sports activities. </jats:p><jats:p> Cite this article: EFORT Open Rev 2019;4:115-120. DOI: 10.1302/2058-5241.4.180052 </jats:p>
      2Scopus© Citations 55
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    High-Grade Patellar Chondral Defects: Promising Results From Management With Osteochondral Autografts
    (2020)
    FIGUEROA POBLETE, DAVID HUMBERTO  
    ;
    CALVO RODRIGUEZ, RAFAEL  
    ;
    Rodrigo Donoso
    ;
    Jaime Espinoza
    ;
    Alex Vaisman  
    <jats:sec><jats:title>Background:</jats:title><jats:p>Patellar chondral defects represent up to 34.6% of defects found during routine arthroscopy. Surgical management has evolved during the past 20 years in an effort to develop techniques to replace hyaline cartilage. Currently, the only technique that achieves this is osteochondral autologous transfer (OAT). Although good and excellent results have often been reported at midterm and long-term follow-up for femoral lesions, little is known about isolated patellar defects.</jats:p></jats:sec><jats:sec><jats:title>Purpose:</jats:title><jats:p>To assess clinical and imaging results of patients treated with OAT for high-grade patellar defects.</jats:p></jats:sec><jats:sec><jats:title>Study Design:</jats:title><jats:p>Case series; Level of evidence, 4.</jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p>This was a retrospective study on all patients who received OAT for high-grade symptomatic patellar chondral defects between 2010 and 2018 at our institution. The study included patients younger than 40 years of age with anterior knee pain and a grade 4 International Cartilage Repair Society patellar chondral defect between 1 and 2.5 cm<jats:sup>2</jats:sup>. Patients with surgery in other knee compartments, concomitant anterior cruciate ligament ruptures, infection, rheumatoid arthritis, and degenerative lesions were excluded. Six months postoperatively, all patients underwent magnetic resonance imaging (MRI) to allow assessment of graft integrity via the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score to evaluate morphologic features and integration. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kujala scores were used to assess functional outcomes at final follow-up.</jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p>A total of 26 patients who received a patellar OAT were included. Most patients were male (88.4%), and the mean ± SD age was 28.5 ± 9.7 years. Patellar chondral defects had a median size of 180 mm<jats:sup>2</jats:sup>(range, 64-250 mm<jats:sup>2</jats:sup>), and patients received a median of 1 autograft (range, 1-3). Functional outcomes assessed at a minimum of 1 year after surgery showed a mean Kujala score of 90.42 ± 6.7 and a mean WOMAC score of 95 ± 3.6. MRI revealed a median MOCART score of 75 points (range, 20-90 points).</jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p>To our knowledge, this is the largest series to date regarding isolated patellar OAT. At midterm follow-up, most patients reported good and excellent results regarding symptoms and activity levels. Most autografts showed good osseous integration and excellent filling of the chondral surface, as evidenced on MRI. OAT is a good alternative to treat high-grade patellar chondral defects, especially among young patients.</jats:p></jats:sec>
    Scopus© Citations 11  1
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