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Zhang Q, Kou Y, Yuan Z. A meta-analysis on anterior cruciate ligament reconstruction: Is modified transtibial technique inferior to independent drilling techniques? Exp Ther Med 2018; 16:1790-1799. [PMID: 30186403 PMCID: PMC6122342 DOI: 10.3892/etm.2018.6395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023] Open
Abstract
This report respectively compared the standard transtibial (sTT) technique to the independent drilling (ID) techniques applied to anterior cruciate ligament (ACL) reconstruction. It also made a comparison between the clinical results of the modified transtibial (mTT) technique and of the ID techniques. Prospective studies on transtibial (TT) and ID techniques for ACL reconstruction were retrieved from several databases and a subgroup analysis was performed to compare the sTT technique with the ID techniques and the mTT with the ID techniques. Furthermore, comparison of the Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC) subjective and objective evaluations, Lysholm score and Tegner activity scale were conducted. This report included 12 clinical studies that involved 681 patients having received ACL reconstruction. The study results indicated that in comparison between the sTT and ID techniques, the ID techniques outperformed the sTT technique in the IKDC subjective score (P=0.01) and laxity (P=0.0004). However, there was no significant difference in the IKDC objective score (P=0.34), pivot-shift test (P=0.24), Lachman test (P=0.21), Lysholm score (P=0.14) and Tegner activity scale (P=0.66). The comparison between the new mTT technique and the ID techniques suggested no significant difference in the IKDC objective and subjective scores (P=0.86), laxity (P=0.38), pivot-shift test (P=0.66), Lachman test (P=0.10), Lysholm score (P=0.10) and Tegner activity scale (P=0.55). Compared to the sTT technique, the mTT and ID techniques are more suitable for ACL reconstruction because they can present better subjective feelings. Moreover, considering that the TT technique is familiar to surgeons and the mTT technique can bring favorable subjective feelings and objective clinical outcomes, the mTT technique shows greater utilization potential.
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Affiliation(s)
- Qunhu Zhang
- Department of Orthopedics, Shuyang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suqian Jiangsu 223600, P.R. China
| | - Yu Kou
- Medical College of Soochow University, Suzhou Jiangsu 215123, P.R. China
| | - Zhen Yuan
- Center of Sports Medicine and Rehabilitation, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
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102
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Jiang H, Ma G, Li Q, Hu Y, Li J, Tang X. Cortical Button Versus Cross-pin Femoral Fixation for Hamstring Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2018; 46:2277-2284. [PMID: 28753392 DOI: 10.1177/0363546517717672] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Incidences of graft rupture are associated with postoperative knee laxity after anterior cruciate ligament (ACL) reconstruction. Reports of postoperative knee laxity after ACL reconstruction using different femoral fixation techniques in several studies are controversial. PURPOSE To compare, via meta-analysis of randomized controlled trials (RCTs), the clinical outcomes and postoperative knee laxity of autogenous hamstring ACL reconstruction using cortical button versus cross-pin femoral fixation. STUDY DESIGN Meta-analysis. METHODS This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The online PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched from inception to April 1, 2017. The study included only level 1 or 2 RCTs that compared cortical button and cross-pin femoral fixation for ACL reconstruction with hamstring autografts and that reported clinical outcomes or postoperative knee laxity. The Cochrane Collaboration's risk of bias tool was used to assess the risk of bias for all included studies. For the meta-analysis, the investigators extracted data on clinical outcomes measured by postoperative International Knee Documentation Committee (IKDC) score or Lysholm score and postoperative knee laxity defined as >5 mm side-to-side difference by the arthrometric measurement, Lachman test ≥2+, and pivot-shift test ≥2+. The risk ratio (RR) and its corresponding 95% confidence interval (CI) were computed for dichotomous data. Heterogeneity was assessed by I2 tests. RESULTS A total of 6 RCTs with 445 patients were included. Statistical analysis of pooled data showed no significant difference between the cortical button and cross-pin groups on postoperative IKDC score (RR, 0.94; 95% CI, 0.88-1.02; P = .13; I2 = 4%) and Lysholm score (RR, 0.97; 95% CI, 0.91-1.04; P = .45; I2 = 0%). Postoperative knee laxity was reported in 5 studies, and no significant difference was found between the 2 groups (RR, 1.49; 95% CI, 0.83-2.68; P = .18; I2 = 37%). CONCLUSION Cortical button femoral fixation for autogenous hamstring ACL reconstruction had no significant difference in terms of clinical outcomes and postoperative knee laxity compared with cross-pin femoral fixation.
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Affiliation(s)
- Hai Jiang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guangzhi Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yanqing Hu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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103
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Bodendorfer BM, Kotler JA, Thornley CJ, Postma WF. Tibial Plateau Fracture Following Anterior Cruciate Ligament Reconstruction with a Bone-Patellar Tendon-Bone Allograft: A Case Report. JBJS Case Connect 2018; 8:e34. [PMID: 29794489 DOI: 10.2106/jbjs.cc.17.00233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 36-year-old woman sustained a medial tibial plateau fracture involving a tibial tunnel that had been used 4 years prior for an anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BPTB) allograft in the same knee. At 26 months following open reduction and internal fixation of the tibial plateau fracture (6 years following the index ACL reconstruction), the patient returned to full activity. CONCLUSION To our knowledge, this is the first report of a tibial plateau fracture following ACL reconstruction with a BPTB allograft, which adds to the paucity of literature discussing tibial plateau fractures following ACL reconstruction and discusses the potential predisposing factors to fracture such as ACL graft selection and surgical technique.
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Affiliation(s)
- Blake M Bodendorfer
- Department of Orthopaedic Surgery, Pasquerilla Healthcare Center, Georgetown University, Washington, DC
| | - Joshua A Kotler
- Bone & Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | | | - William F Postma
- Department of Orthopaedic Surgery, Pasquerilla Healthcare Center, Georgetown University, Washington, DC
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104
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Pfeiffer TR, Burnham JM, Hughes JD, Kanakamedala AC, Herbst E, Popchak A, Shafizadeh S, Irrgang JJ, Debski RE, Musahl V. An Increased Lateral Femoral Condyle Ratio Is a Risk Factor for Anterior Cruciate Ligament Injury. J Bone Joint Surg Am 2018; 100:857-864. [PMID: 29762281 DOI: 10.2106/jbjs.17.01011] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to examine the relationship between distal femoral morphology and anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) failure, and contralateral ACL injury. It was hypothesized that increased posterior femoral condylar depth, quantified as the lateral femoral condyle ratio, would correlate with increased risk of primary ACL injuries, ACLR failures, and contralateral ACL injuries. METHODS The charts of consecutive patients who underwent arthroscopic knee surgery at an academic medical center from 2012 to 2016 with minimum follow-up of 24 months were retrospectively reviewed. Patients were stratified into 4 groups: (1) a control group of patients with no ACL injury, (2) patients with primary ACL injury, (3) patients with failed ACLR, and (4) patients with previous ACL injury and subsequent contralateral ACL injury. With use of lateral radiographs, the ratio of posterior femoral condylar depth to total condylar length was defined as the lateral femoral condyle ratio. Differences between study groups were identified with use of analysis-of-variance (ANOVA) and post-hoc testing with significance set at p < 0.05. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff for detecting increased risk of ACL injury. RESULTS Two hundred patients met the inclusion criteria. The mean lateral femoral condyle ratios (and standard deviations) were 61.2% ± 2.4% in the control group, 64.2% ± 3.8% in the primary ACL injury group, 64.4% ± 3.6% in the failed ACLR group, and 66.9% ± 4.3% in the contralateral ACL injury group. Patients who had a primary ACL injury, failed ACLR, or contralateral ACL injury had significantly higher ratios compared with the control group (p < 0.008). ROC curve analysis demonstrated that a lateral femoral condyle ratio of >63% was associated with an increased risk for ACL injury, with a sensitivity of 77% and a specificity of 72%. CONCLUSIONS The data from this study show that increased posterior femoral condylar depth, quantified as the lateral femoral condyle ratio, is associated with an increased risk of ACL injury, including primary and contralateral ACL injuries. The data from this study may help clinicians to identify patients at a greater risk of ACL injury. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thomas R Pfeiffer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajay C Kanakamedala
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany
| | - Adam Popchak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sven Shafizadeh
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Richard E Debski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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105
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MacDonald P, Kim C, McRae S, Leiter J, Khan R, Whelan D. No clinical differences between anteromedial portal and transtibial technique for femoral tunnel positioning in anterior cruciate ligament reconstruction: a prospective randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc 2018; 26:1335-1342. [PMID: 28801704 DOI: 10.1007/s00167-017-4664-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE The anteromedial (AMP) portal technique was introduced to position the femoral tunnel in anterior cruciate ligament (ACL) reconstruction to more closely replicate the original ACL footprint compared to the transtibial (TT) approach. Few randomized trials have evaluated differences in these techniques with respect to clinical outcomes. The purpose of this study was to determine if there are any differences in clinical outcome between the AMP and TT approaches. METHODS This is a single-blinded, prospective, randomized controlled trial. Participants were randomized to undergo ACL reconstruction using the AMP or TT approach. The primary outcome measure was the ACL quality of life (ACL-QOL), and secondary outcomes were the IKDC knee assessment, side-to-side difference in anterior-posterior knee laxity (KT-1000) and tunnel orientation (X-ray findings) at preoperative, 3, 6, 12, and 24 months postoperative. Statistical comparisons were performed using a series of t tests for independent groups with equal variance. RESULTS Ninety-six participants were consented and randomized between 2007 and 2011 with eight excluded postrandomization. Mean (SD) preoperative ACL-QOL was 33 (13) for TT and 36 (17) for AMP and improved significantly (p < 0.001) in both groups to 79 (18) and 78 (18) at 24 months postoperative, respectively. The preoperative median IKDC grade for both groups was C and improved similarly in both groups at 24 months (n.s.). There was no side-to-side difference in knee laxity based on KT-1000 measurements with a mean (SD) 1 (3) mm between affected and unaffected limbs in the TT group compared to 1 (3) mm for the AMP group. A significant difference was found in femoral tunnel orientation with the AMP group at 43° (7) and the TT group 58° (8) in the coronal plane (p < 0.001). CONCLUSION No differences in clinical outcome were found when comparing AMP to TT in primary ACL reconstruction using a STG graft. This prospective randomized controlled trial suggests surgeons can use either method without significantly compromising clinical outcome. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Peter MacDonald
- Department of Surgery, Pan Am Clinic, University of Manitoba, Orthopaedics 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada.
| | - Chris Kim
- Department of Surgery, Pan Am Clinic, University of Manitoba, Orthopaedics 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada
| | - Sheila McRae
- Department of Surgery, Pan Am Clinic, University of Manitoba, Orthopaedics 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada
| | - Jeff Leiter
- Department of Surgery, Pan Am Clinic, University of Manitoba, Orthopaedics 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada
| | - Ryan Khan
- St. Michael's Hospital, St. Michael's Orthpaedic Associates, 55 Queen St E., Suite 800, Toronto, ON, M5C 1R6, Canada
| | - Daniel Whelan
- St. Michael's Hospital, St. Michael's Orthpaedic Associates, 55 Queen St E., Suite 800, Toronto, ON, M5C 1R6, Canada
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106
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Chen H, Chen B, Tie K, Fu Z, Chen L. Single-bundle versus double-bundle autologous anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials at 5-year minimum follow-up. J Orthop Surg Res 2018. [PMID: 29523208 PMCID: PMC5845364 DOI: 10.1186/s13018-018-0753-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Both single-bundle (SB) and double-bundle (DB) techniques were widely used in anterior cruciate ligament (ACL) reconstruction recently. Nevertheless, up to now, no consensus has been reached on whether the DB technique was superior to the SB technique. Moreover, follow-up of the included studies in the published meta-analyses is mostly short term. Our study aims to compare the mid- to long-term outcome of SB and DB ACL reconstruction concerning knee stability, clinical function, graft failure rate, and osteoarthritis (OA) changes. METHODS This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and the Cochrane Library were searched from inception to October 2017. The study included only a randomized controlled trial (RCT) that compared SB and DB ACL reconstruction and that had a minimum of 5-year follow-up. The Cochrane Collaboration's risk of bias tool was used to assess the risk of bias for all included studies. Stata/SE 12.0 was used to perform a meta-analysis of the clinical outcome. RESULTS Five RCTs were included, with a total of 294 patients: 150 patients and 144 patients in the DB group and the SB group, respectively. Assessing knee stability, there was no statistical difference in side-to-side difference and negative rate of the pivot-shift test. Considering functional outcome, no significant difference was found in proportion with International Knee Documentation Committee (IKDC) grade A, IKDC score, Lysholm scores, and Tegner scores. As for graft failure rate and OA changes, no significant difference was found between the DB group and the SB group. CONCLUSION The DB technique was not superior to the SB technique in autologous ACL reconstruction regarding knee stability, clinical function, graft failure rate, and OA changes with a mid- to long-term follow-up.
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Affiliation(s)
- Haitao Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Biao Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Kai Tie
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhengdao Fu
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Liaobin Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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107
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Kim JG, Kang SH, Kim JH, Lim CO, Wang JH. Comparison of Clinical Results, Second-Look Arthroscopic Findings, and MRI Findings Between the Transportal and Outside-In Techniques for Double-Bundle Anatomic Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Trial With a Minimum 2-Year Follow-up. Am J Sports Med 2018; 46:544-556. [PMID: 29293362 DOI: 10.1177/0363546517744535] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although image analysis has shown that the outside-in (OI) technique is associated with different femoral tunnel geometry than the transportal (TP) technique in anatomic anterior cruciate ligament (ACL) reconstruction, it is not known whether clinical results differ between the 2 techniques. PURPOSE To compare clinical results, second-look arthroscopic findings, and magnetic resonance imaging (MRI) findings between the TP and OI techniques in anatomic double-bundle (DB) ACL reconstruction. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS From November 2010 to March 2013, 128 patients were enrolled in this study and were randomly assigned to either the TP group (64 patients) or the OI group (64 patients), and DB ACL reconstructions were performed. At the minimum 2-year follow-up (34.9 ± 10.9 months), 111 patients (86.7%) were evaluated with multiple clinical scores and stability tests (KT-2000 arthrometer, Lachman test, and pivot-shift test). Ninety-three knees were evaluated for graft continuity, graft tension, and synovialization by use of second-look arthroscopy. Seventy-eight knees were evaluated on MRI for graft continuity, femoral graft tunnel healing, and graft signal/noise quotient (SNQ). The primary outcome was KT-2000 arthrometer results. Results were compared between the TP and OI groups. RESULTS No significant differences were found between the 2 groups in terms of KT-2000 arthrometer results, which was the primary outcome, and other clinical results, with the exception of the postoperative functional test of International Knee Documentation Committee (IKDC) objective score. The ratio of grade A and B on the postoperative functional test of IKDC objective score was significantly larger for the OI group (51/58) than the TP group (36/53) ( P = .005). The second-look arthroscopic findings were not significantly different between the 2 groups in either bundle ( P > .05). In addition, MRI findings did not differ significantly between the 2 groups ( P > .05). CONCLUSION With the exception of the functional test of IKDC objective score, we found that clinical results, second-look arthroscopic findings, and MRI findings did not differ significantly between the OI and TP techniques for anatomic ACL reconstruction, although femoral tunnel geometries differed significantly between the 2 techniques.
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Affiliation(s)
- Jae Gyoon Kim
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Seung Hoon Kang
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Chae Ouk Lim
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
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108
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Tanaka Y, Kita K, Takao R, Amano H, Uchida R, Shiozaki Y, Yonetani Y, Kinugasa K, Mae T, Horibe S. Chronicity of Anterior Cruciate Ligament Deficiency, Part 2: Radiographic Predictors of Early Graft Failure. Orthop J Sports Med 2018; 6:2325967117751915. [PMID: 29479543 PMCID: PMC5818097 DOI: 10.1177/2325967117751915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Accumulating evidence suggests that long-term anterior cruciate ligament (ACL) deficiency can give rise to an abnormal tibiofemoral relationship and subsequent intra-articular lesions. However, the effects of chronic ACL deficiency (ACLD) on early graft failure after anatomic reconstruction remain unclear. HYPOTHESIS We hypothesized that patients with long-term ACLD lasting more than 5 years would have a greater rate of early graft failure due to insufficient intraoperative reduction of the tibia and that the preoperative and immediately postoperative abnormal tibiofemoral relationship in the sagittal plane, such as anterior tibial subluxation (ATS), would correlate with the graft status on postoperative magnetic resonance imaging (MRI). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 358 patients who had undergone anatomic ACL reconstruction with hamstring grafts were divided into 5 groups based on chronicity of ACLD: (1) 0 to 6 months, (2) 6 months to 1 year, (3) 1 to 2 years, (4) 2 to 5 years, and (5) longer than 5 years. Preoperatively and immediately postoperatively, lateral radiographs in full extension were taken in all patients to evaluate the tibiofemoral relationship, specifically with regard to ATS, space for the ACL (sACL), and extension angle. All patients underwent MRI at 6 months to reveal graft status. Groups with a high rate of graft failure were further analyzed to compare demographic and radiographic factors between the intact and failure subgroups, followed by multivariate logistic regression analysis to identify predisposing factors. RESULTS Graft failure without trauma was observed in 4 (1.8%), 0 (0%), 1 (3.7%), 3 (9.7%), and 8 patients (17.7%) in groups 1, 2, 3, 4, and 5, respectively. Of the 76 patients in groups 4 and 5, significant differences were noted between the failure and intact subgroups in preoperative ATS (4.9 vs 2.4 mm, respectively; P < .01), side-to-side differences in sACL (sACL-SSD) (4.7 vs 1.9 mm, respectively; P < .01), extension deficit (4.4° vs 1.3°, respectively; P < .01), and chondral lesions (P = .02), while postoperative ATS and sACL-SSD showed no differences. Multivariate logistic regression analysis revealed that of these factors, preoperative sACL-SSD could be a risk factor for early graft failure (odds ratio, 3.2; 95% CI, 1.37-7.46). CONCLUSION Early graft failure at 6 months increased in patients with ACLD longer than 2 years. In this population, preoperative sACL-SSD was the most significant risk factor for early graft failure on MRI. However, immediately postoperative radiographic measurements had no effect on graft failure rates.
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Affiliation(s)
- Yoshinari Tanaka
- Department of Sports Orthopedics, Osaka Rosai Hospital, Sakai, Japan
| | - Keisuke Kita
- Department of Sports Orthopedics, Osaka Rosai Hospital, Sakai, Japan
| | - Rikio Takao
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
| | - Hiroshi Amano
- Department of Sports Orthopedics, Osaka Rosai Hospital, Sakai, Japan
| | - Ryohei Uchida
- Department of Orthopedic Surgery, Seifu Hospital, Sakai, Japan
| | | | - Yasukazu Yonetani
- Department of Orthopedic Surgery, Hoshigaoka Medical Center, Hirakata, Japan
| | - Kazutaka Kinugasa
- Department of Sports Orthopedics, Osaka Rosai Hospital, Sakai, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shuji Horibe
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
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109
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Minzlaff P, Heidt T, Feucht MJ, Plath JE, Hinterwimmer S, Imhoff AB, Saier T. Patient satisfaction with health is substantially improved following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:582-588. [PMID: 28653183 DOI: 10.1007/s00167-017-4623-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/19/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To prospectively monitor health-related quality of life and return to work after arthroscopic anterior cruciate ligament (ACL) reconstruction in patients with isolated ACL tears. METHODS Sixty consecutive patients with isolated ACL tears who underwent arthroscopic ACL reconstruction were prospectively monitored using the "Questions on Life Satisfaction Modules" (FLZM) and "Short-Form 12 (SF-12)" quality-of-life outcome measures. The Lysholm score and Tegner activity index were used as functional outcome measures. Additionally, return to work (months) together with level of physical workload was analysed. Outcome measures were assessed the day before surgery and at 6, 12 weeks and 6, 12, and 24 months post-operatively. Quality-of-life outcomes were correlated with functional outcome scores. RESULTS Satisfaction with health (FLZM) significantly improved within the first 2 years (p < 0.05), and the physical component scale (SF12) showed a significantly higher score after 3, 6, 12 and 24 months as compared with preoperative values (p < 0.05). "General life satisfaction (FLZM)" was initially decreased at 6 weeks (p < 0.05) but increased during the further follow-up period, reaching a score not significantly different from preoperative values. Mean Lysholm score improved from 66 preoperatively to 89 post-operatively (p < 0.05) and the median Tegner activity index improved from four to six points (p < 0.05) at final follow-up. Mean time to return to work was 7 weeks (range 1-34 weeks), and it strongly depended on physical workload. A positive correlation between quality of life and functional outcome (Lysholm score) was observed. CONCLUSION General life satisfaction is impaired during the early post-operative course, but returns to preoperative values after 2 years. Satisfaction with health reaches higher values after 6, 12 and 24 months post-operatively, and the SF-12 physical component scale was seen to improve during the follow-up period. Improved functional outcomes were observed to correlate with quality-of-life measurements. Thus, patients can preoperatively be informed that they will benefit from ACL reconstruction in terms of an improved knee function and satisfaction with health. Heavy physical workload must be considered as a risk factor for prolonged time lost to return to work. These patients have to be identified and informed about realistic expectations. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Philipp Minzlaff
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany
- Department of Orthopedic Sports Medicine, Chirurgisches Klinikum München Süd, Munich, Germany
| | - Thomas Heidt
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany
| | - Matthias J Feucht
- Department Orthopedics and Traumatology, University of Freiburg, Freiburg, Germany
| | - Johannes E Plath
- Department of Trauma Surgery, Klinikum Augsburg, Augsburg, Germany
| | | | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.
| | - Tim Saier
- Department of Orthopedic Sports Medicine, Technische Universität München, Munich, Germany
- Department of Reconstructive Joint Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
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110
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Kosy JD, Mandalia VI. Plain radiographs can be used for routine assessment of ACL reconstruction tunnel position with three-dimensional imaging reserved for research and revision surgery. Knee Surg Sports Traumatol Arthrosc 2018; 26:534-549. [PMID: 28224200 DOI: 10.1007/s00167-017-4462-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/30/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE The position of the osseous tunnels and graft during anterior cruciate ligament (ACL) reconstruction has been the subject of multiple studies aiming for either anatomical placement or an alternative. The assessment of these positions, using post-operative imaging, is therefore of interest to the surgeon in both the evaluation of surgical performance and surveillance of potential complications. The purpose of this review is to identify the optimal use of imaging in both the surveillance of clinical practice and in planning revision surgery. METHODS A comprehensive systematic review was performed using Medline and Pubmed searches to identify radiological methods used to assess ACL reconstruction tunnel position. Commonly used methods were identified with correlation to either native anatomy or clinical results. RESULTS The findings suggest that plain radiographs can be used to assess tunnel position and identify grafts that are positioned non-anatomically and may be at increased risk of complications. Computer tomography (CT) offers additional information about the tunnel aperture shape and size that is of importance for revision surgery and research projects whilst magnetic resonance imaging (MRI) provides further assessment of both graft integrity and associated soft tissue damage. CONCLUSION In the surveillance of routine clinical practice, plain radiographs are sufficient to define tunnel position. The additional information provided by three-dimensional imaging is only required in revision surgery or research studies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jonathan David Kosy
- ST8 Registrar in Trauma and Orthopaedics, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK.
| | - Vipul I Mandalia
- Consultant Orthopaedic Surgeon with Specialist Interest in Knee Surgery, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, EX2 5DW, UK
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111
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Tanaka Y, Kita K, Takao R, Amano H, Uchida R, Shiozaki Y, Yonetani Y, Kinugasa K, Mae T, Horibe S. Chronicity of Anterior Cruciate Ligament Deficiency, Part 1: Effects on the Tibiofemoral Relationship Before and Immediately After Anatomic ACL Reconstruction With Autologous Hamstring Grafts. Orthop J Sports Med 2018; 6:2325967117750813. [PMID: 29383322 PMCID: PMC5784495 DOI: 10.1177/2325967117750813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: It remains unclear whether the tibiofemoral relationship in the sagittal plane is
restored after anatomic anterior cruciate ligament (ACL) reconstruction, particularly in
cases of chronic ACL deficiency (ACLD). Hypothesis: Patients with long-term ACLD will exhibit an anteriorly subluxed tibia both
preoperatively and immediately postoperatively, even after anatomic reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: In total, 358 patients who had undergone anatomic ACL reconstruction with autologous
semitendinosus grafts were divided into 5 groups based on chronicity of ACLD: (1) 0 to 6
months, (2) 6 months to 1 year, (3) 1 to 2 years, (4) 2 to 5 years, and (5) longer than
5 years. Preoperatively and immediately postoperatively, all patients underwent lateral
radiography in extension to evaluate the tibiofemoral relationship, specifically with
regard to anterior tibial subluxation (ATS), space for the ACL (sACL), and extension
angle. Demographic and radiographic factors were compared among the 5 groups. Results: Preoperative ATS values in groups 4 (mean ± SD, 2.9 ± 2.1 mm) and 5 (2.6 ± 1.9 mm) were
significantly greater than in group 1 (1.6 ± 1.9 mm). Postoperatively, the tibia was
posteriorly overconstrained in all groups, and there was no difference in immediately
postoperative ATS among the 5 groups. Further evaluation of the tibiofemoral
relationship in the sagittal plane revealed that the mean preoperative side-to-side
difference in sACL (sACL-SSD) was greater in groups 4 (2.5 ± 1.6 mm) and 5 (2.2 ± 1.7
mm) than in group 1 (1.2 ± 1.5 mm). Immediately after ACL reconstruction, however, there
were no group-dependent differences in sACL-SSD. No significant group-dependent
differences were found for extension deficit. Conclusion: Chronicity of ACLD had an effect on the preoperative tibiofemoral relationship in the
sagittal plane, including ATS and sACL-SSD, especially in patients with ACLD longer than
2 years. However, preoperative extension deficit was not influenced by chronicity.
Immediately postoperatively, chronicity did not affect the ability of anatomic ACL
reconstruction to reduce subluxation.
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Affiliation(s)
- Yoshinari Tanaka
- Department of Sports Orthopedics, Osaka Rosai Hospital, Sakai, Japan
| | - Keisuke Kita
- Department of Sports Orthopedics, Osaka Rosai Hospital, Sakai, Japan
| | - Rikio Takao
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
| | - Hiroshi Amano
- Department of Sports Orthopedics, Osaka Rosai Hospital, Sakai, Japan
| | - Ryohei Uchida
- Department of Orthopedic Surgery, Seifu Hospital, Sakai, Japan
| | | | - Yasukazu Yonetani
- Department of Orthopedic Surgery, Hoshigaoka Medical Center, Hirakata, Japan
| | - Kazutaka Kinugasa
- Department of Sports Orthopedics, Osaka Rosai Hospital, Sakai, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shuji Horibe
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
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Helito CP, Saithna A, Bonadio MB, Daggett M, Monaco E, Demange MK, Sonnery-Cottet B. Anterolateral Ligament Reconstruction: A Possible Option in the Therapeutic Arsenal for Persistent Rotatory Instability After ACL Reconstruction. Orthop J Sports Med 2018; 6:2325967117751348. [PMID: 29376085 PMCID: PMC5777553 DOI: 10.1177/2325967117751348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Adnan Saithna
- Medical Technologies and Advanced Materials, Clifton Campus, Nottingham Trent University, Nottingham, UK.,Renacres Hospital, Lancashire, UK
| | - Marcelo B Bonadio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Matt Daggett
- Kansas City University, Kansas City, Missouri, USA
| | | | - Marco K Demange
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hospital Privé Jean Mermoz, Lyon, France
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Hart A, Sivakumaran T, Burman M, Powell T, Martineau PA. A Prospective Evaluation of Femoral Tunnel Placement for Anatomic Anterior Cruciate Ligament Reconstruction Using 3-Dimensional Magnetic Resonance Imaging. Am J Sports Med 2018; 46:192-199. [PMID: 28972789 DOI: 10.1177/0363546517730577] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The recent emphasis on anatomic reconstruction of the anterior cruciate ligament (ACL) is well supported by clinical and biomechanical research. Unfortunately, the location of the native femoral footprint can be difficult to see at the time of surgery, and the accuracy of current techniques to perform anatomic reconstruction is unclear. PURPOSE To use 3-dimensional magnetic resonance imaging (3D MRI) to prospectively evaluate patients with torn ACLs before and after reconstruction and thereby assess the accuracy of graft position on the femoral condyle. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Forty-one patients with unilateral ACL tears were recruited into the study. Each patient underwent 3D MRI of both the injured and uninjured knees before surgery. The contralateral (uninjured) knee was used to define the patient's native footprint. Patients then underwent ACL reconstruction, and the injured knee underwent reimaging after surgery. The location and percentage overlap of the reconstructed femoral footprint were compared with the patient's native footprint. RESULTS The center of the native ACL femoral footprint was a mean 12.0 ± 2.6 mm distal and 9.3 ± 2.2 mm anterior to the apex of the deep cartilage. The position of the reconstructed graft was significantly different, with a mean distance of 10.8 ± 2.2 mm distal ( P = .02) and 8.0 ± 2.3 mm anterior ( P = .01). The mean distance between the center of the graft and the center of the native ACL femoral footprint (error distance) was 3.6 ± 2.6 mm. Comparing error distances among the 4 surgeons demonstrated no significant difference ( P = .10). On average, 67% of the graft overlapped within the native ACL femoral footprint. CONCLUSION Despite contemporary techniques and a concerted effort to perform anatomic ACL reconstruction by 4 experienced sports orthopaedic surgeons, the position of the femoral footprint was significantly different between the native and reconstructed ACLs. Furthermore, each surgeon used a different technique, but all had comparable errors in their tunnel placements.
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Affiliation(s)
- Adam Hart
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Thiru Sivakumaran
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada
| | - Mark Burman
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Tom Powell
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada
| | - Paul A Martineau
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada
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Similar cost-utility for double- and single-bundle techniques in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:634-647. [PMID: 28939947 PMCID: PMC5794842 DOI: 10.1007/s00167-017-4725-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/15/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim was to estimate the cost-utility of the DB technique (n = 53) compared with the SB (n = 50) technique 2 years after ACL reconstruction. METHODS One hundred and five patients with an ACL injury were randomised to either the Double-bundle (DB) or the Single-bundle (SB) technique. One hundred and three patients (SBG n = 50, DBG n = 53) attended the 2-year follow-up examination. The mean age was 27.5 (8.4) years in the SBG and 30.1 (9.1) years in the DBG. The cost per quality-adjusted life years (QALYs) was used as the primary outcome. Direct costs were the cost of health care, in this case outpatient procedures. Indirect costs are costs related to reduce work ability for health reasons. The cost-utility analysis was measured in terms of QALY gained. RESULTS The groups were comparable in terms of clinical outcome. Operating room time was statistically significantly longer in the DBG (p = 0.001), making the direct costs statistically significantly higher in the DBG (p = 0.005). There was no significant difference in QALYs between groups. In the cost-effectiveness plane, the mean difference in costs and QALYs from the trial data using 1000 bootstrap replicates in order to visualise the uncertainty associated with the mean incremental cost-effectiveness ratio (ICER) estimate showed that the ICERs were spread out over all quadrants. The cost-effectiveness acceptability curve showed that there was a 50% probability of the DB being cost-effective at a threshold of Euro 50,000. CONCLUSION The principal findings are that the DB is more expensive from a health-care perspective. This suggests that the physician may choose individualised treatment to match the patients' expectations and requirements.
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Rezende FC, Moraes VY, Franciozi CES, Debieux P, Luzo MV, Belloti JC. One-incision versus two-incision techniques for arthroscopically assisted anterior cruciate ligament reconstruction in adults. Cochrane Database Syst Rev 2017; 12:CD010875. [PMID: 29243827 PMCID: PMC6486027 DOI: 10.1002/14651858.cd010875.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are serious knee injuries that are frequently treated surgically in the form of arthroscopically assisted reconstruction with grafts from the patella or hamstrings tendons. We reviewed the evidence for the choice of arthroscopically assisted ACL reconstruction technique in terms of whether it should involve one incision (femoral tunnel drilled from inside the knee joint under arthroscopic visualisation) or two incisions (femoral tunnel drilled from outside to inside the knee joint). OBJECTIVES To assess the effects (benefits and harms) of one-incision versus two-incision techniques for arthroscopically assisted ACL reconstruction in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Latin American and Caribbean Health Sciences (LILACS), the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, reference lists, and conference abstracts. The date of the search was 16 August 2017. SELECTION CRITERIA Randomised and quasi-randomised controlled clinical trials evaluating one-incision versus two-incision techniques for arthroscopically assisted ACL reconstruction in adults. DATA COLLECTION AND ANALYSIS Two review authors independently searched and selected studies, and extracted data and assessed the risk of bias of the eligible studies. We undertook limited pooling of data using the fixed-effect model. MAIN RESULTS We included five trials (four randomised and one quasi-randomised) evaluating a total of 320 participants who were mainly in their 20s. All participants underwent ACL reconstruction with patella tendon grafts. All five included trials were at a high risk of bias, particularly performance bias. Based on these limitations and the insufficiency of the available data resulting in imprecision of effect estimates, we judged the quality of the evidence as very low for all outcomes. This means that we are uncertain of the findings of the review.We found very low-quality evidence of no clinically important differences between the two techniques in self reported knee function, measured using the Lysholm knee score (scale 0 to 100: best outcome), at short-term (3 months) (mean difference (MD) 2.73 favours one-incision technique, 95% confidence interval (CI) -2.70 to 8.15; 79 participants, 2 studies), intermediate-term (12 months) (MD -3.68 favours two-incision technique, 95% CI -6.61 to -0.75; 79 participants, 2 studies), and long-term follow-up. The data available for long-term follow-up (2 to 5 years) was expressed in terms of the numbers of participants with excellent Lysholm scores (90 points or more); we found no difference between the two groups (42/45 versus 36/40; risk ratio (RR) 1.04, 95% CI 0.91 to 1.18; 1 study). There were no data for quality of life measures or for overall numbers of participants incurring an adverse event. We found very low-quality evidence of little between-group differences in individual adverse events such as infection, knee stiffness, reoperation, and graft failure.We found very low-quality evidence from one study (59 participants) of little difference between the two groups in activity levels measured using Tegner scores (scale 0 to 10: highest sport activity) at two years (MD -0.80 favours two-incision technique, 95% CI -1.90 to 0.30). There was very low-quality evidence from four studies of minimal between-group difference in the number of participants with normal or nearly normal objectively measured knee function (International Knee Documentation Committee objective assessment grading) at intermediate follow-up (means 12 to 28 months): 56/78 versus 63/89; RR 1.01, 95% CI 0.85 to 1.21; 167 participants). AUTHORS' CONCLUSIONS The very low-quality and often absent evidence means that we are uncertain whether one-incision arthroscopically assisted ACL reconstruction techniques yield better, worse, or equivalent results compared with two-incision techniques in terms of short-, intermediate-, or long-term subjective function, quality of life, adverse outcomes, activity levels, and objectively rated knee function. The evidence was available only for single-bundle ACL reconstruction using patella tendon grafts.When considering priorities for high-quality randomised trials on techniques for ACL reconstruction, it is important to note the insufficiency of the evidence available to inform this key comparison.
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Affiliation(s)
- Fernando C Rezende
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyBorges Lagoa Street, 778São PauloBrazil04045001
| | - Vinícius Y Moraes
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyBorges Lagoa Street, 778São PauloBrazil04045001
| | - Carlos ES Franciozi
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyBorges Lagoa Street, 778São PauloBrazil04045001
| | - Pedro Debieux
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyBorges Lagoa Street, 778São PauloBrazil04045001
| | - Marcus V Luzo
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyBorges Lagoa Street, 778São PauloBrazil04045001
| | - João Carlos Belloti
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyBorges Lagoa Street, 778São PauloBrazil04045001
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Chen H, Tie K, Qi Y, Li B, Chen B, Chen L. Anteromedial versus transtibial technique in single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomized controlled trials. J Orthop Surg Res 2017; 12:167. [PMID: 29115973 PMCID: PMC5678560 DOI: 10.1186/s13018-017-0671-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/28/2017] [Indexed: 12/20/2022] Open
Abstract
Background The aim of this study was to compare the clinical outcome and postoperative complication between single-bundle anterior cruciate ligament (ACL) reconstruction with an anteromedial (AM) technique and a transtibial (TT) technique. Methods The study includes clinical randomized controlled trials comparing the clinical outcomes of ACL reconstruction using the autologous hamstring tendon with an AM method and a TT method published up to September 2017 were retrieved from PubMed, Cochrane Library, and Embase databases. Relevant data were extracted and the Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality. Stata/SE 12.0 was used to perform a meta-analysis of the clinical outcome. Results Five RCTs were included, with a total of 479 patients: 239 patients and 240 patients in the AM group and the TT group, respectively. Assessing postoperative stability, better results were found in the AM group for the negative rate of the Lachman test (P < 0.05), the negative rate of the pivot-shift test (P < 0.05) and the side-to-side difference (P < 0.05). Assessing postoperative functional outcome, the AM group yielded superior results in proportion with International Knee Documentation Committee (IKDC) grade A (P < 0.05) and the Lysholm scores (P < 0.05) but had a comparable IKDC score (P > 0.05). In terms of postoperative complication, no significant difference was found between the AM group and the TT group (P > 0.05). Conclusions The outcome of single-bundle ACL reconstruction with the AM technique is better than that with the TT technique in terms of postoperative stability and functional recovery of the knee.
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Affiliation(s)
- Haitao Chen
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Kai Tie
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yongjian Qi
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Bin Li
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Biao Chen
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Liaobin Chen
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Espejo-Baena A, Espejo-Reina A, Gómez-Cáceres A, Espejo-Reina MJ, Dalla Rosa-Nogales J. Associated Reconstruction of Anterior Cruciate and Anterolateral Ligaments With Single Asymmetric Hamstring Tendons Graft. Arthrosc Tech 2017; 6:e2039-e2046. [PMID: 29430399 PMCID: PMC5799080 DOI: 10.1016/j.eats.2017.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/04/2017] [Indexed: 02/03/2023] Open
Abstract
The anterior cruciate ligament (ACL) rupture is a common disease that accounts for 250,000 cases/year in the United States. The anterolateral ligament (ALL) has been suggested to be an important restraint for rotational instability, and its reconstruction provides a reinforcement to the ACL reconstruction in this aspect, especially in high-demand athletes and in knees with high-grade pivot shift. Different techniques for associated ACL and ALL reconstruction have been described, but the ideal technique remains unclear. Several facts of these techniques may entail a concern to the surgeon, such as the need for several grafts or several bone tunnels. A technique for associated ACL and ALL is presented, using a single hamstring tendons graft, which is prepared asymmetrically, leaving one-third of the length with single diameter and two-thirds with double diameter. A single femoral tunnel is created, using a screw for fixation and differentiation of the grafts. A suspension device is used for tibial fixation, allowing for length adjustment according to the graft's length. The objective of this Technical Note is to provide the orthopaedic surgeon with a resource for ACL and ALL reconstruction even with relatively short grafts, saving bone stock and avoiding the need for allografts.
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Affiliation(s)
- Alejandro Espejo-Baena
- Hospital Vithas Parque San Antonio, Antequera, Málaga, Spain,Clínica Espejo, Antequera, Málaga, Spain,Hospital Universitario Virgen de la Victoria, Antequera, Málaga, Spain
| | - Alejandro Espejo-Reina
- Hospital Vithas Parque San Antonio, Antequera, Málaga, Spain,Clínica Espejo, Antequera, Málaga, Spain,Address correspondence to Alejandro Espejo-Reina, M.D., M.Sc., Clínica Espejo, Paseo Reding 9, 1° C. 29016, Málaga, Spain.Clínica EspejoPaseo Reding 91° C. 29016MálagaSpain
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Abstract
Background: Significant controversy exists regarding the anterolateral structures of the knee. Purpose: To determine the layer-by-layer anatomic structure of the anterolateral complex of the knee. Study Design: Descriptive laboratory study. Methods: Twenty fresh-frozen cadaveric knees (age range, 38-56 years) underwent a layer-by-layer dissection to systematically expose and identify the various structures of the anterolateral complex. Quantitative measurements were performed, and each layer was documented with high-resolution digital imaging. Results: The anterolateral complex of the knee consisted of different distinct layers, with the superficial and deep iliotibial band (ITB) representing layer 1. The superficial ITB had a distinct connection to the distal femoral metaphysis and femoral condyle (Kaplan fibers), and the deep layers of the ITB were identified originating at the level of the Kaplan fibers proximally. This functional unit, consisting of the superficial and deep ITB, was reinforced by the capsulo-osseous layer of the ITB, which was continuous with the fascia of the lateral gastrocnemius and biceps femoris muscles. These 3 components of the ITB became confluent distally, and the insertion spanned from the Gerdy tubercle anteriorly to the lateral tibia posteriorly on a small tubercle (lateral tibial tuberosity). Layer 3 consisted of the anterolateral capsule, in which 35% (7/20) of specimens had a discreet mid-third capsular ligament. Conclusion: The anterolateral complex consists of the superficial and deep ITB, the capsulo-osseous layer of the ITB, and the anterolateral capsule. The anterolateral complex is defined by the part of the ITB between the Kaplan fibers proximally and its tibial insertion, which forms a functional unit. A discrete anterolateral ligament was not observed; however, the anterolateral ligament described in recent studies likely refers to the capsulo-osseous layer or the mid-third capsular ligament. Clinical Relevance: The anterolateral knee structures form a complex functional unit. Surgeons should use caution when attempting to restore this intricate structure with extra-articular procedures designed to re-create a single discreet ligament.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Marcio Albers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Aga C, Kartus JT, Lind M, Lygre SHL, Granan LP, Engebretsen L. Risk of Revision Was Not Reduced by a Double-bundle ACL Reconstruction Technique: Results From the Scandinavian Registers. Clin Orthop Relat Res 2017; 475. [PMID: 28631112 PMCID: PMC5599400 DOI: 10.1007/s11999-017-5409-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Double-bundle anterior cruciate ligament (ACL) reconstruction has demonstrated improved biomechanical properties and moderately better objective outcomes compared with single-bundle reconstructions. This could make an impact on the rerupture rate and reduce the risk of revisions in patients undergoing double-bundle ACL reconstruction compared with patients reconstructed with a traditional single-bundle technique. The National Knee Ligament Registers in Scandinavia provide information that can be used to evaluate the revision outcome after ACL reconstructions. QUESTIONS/PURPOSES The purposes of the study were (1) to compare the risk of revision between double-bundle and single-bundle reconstructions, reconstructed with autologous hamstring tendon grafts; (2) to compare the risk of revision between double-bundle hamstring tendon and single-bundle bone-patellar tendon-bone autografts; and (3) to compare the hazard ratios for the same two research questions after Cox regression analysis was performed. METHODS Data collection of primary ACL reconstructions from the National Knee Ligament Registers in Denmark, Norway, and Sweden from July 1, 2005, to December 31, 2014, was retrospectively analyzed. A total of 60,775 patients were included in the study; 994 patients were reconstructed with double-bundle hamstring tendon grafts, 51,991 with single-bundle hamstring tendon grafts, and 7790 with single-bundle bone-patellar tendon-bone grafts. The double-bundle ACL-reconstructed patients were compared with the two other groups. The risk of revision for each research question was detected by the risk ratio, hazard ratio, and the corresponding 95% confidence intervals. Kaplan-Meier analysis was used to estimate survival at 1, 2, and 5 years for the three different groups. Furthermore, a Cox proportional hazard regression model was applied and the hazard ratios were adjusted for country, age, sex, meniscal or chondral injury, and utilized fixation devices on the femoral and tibial sides. RESULTS There were no differences in the crude risk of revision between the patients undergoing the double-bundle technique and the two other groups. A total of 3.7% patients were revised in the double-bundle group (37 of 994 patients) versus 3.8% in the single-bundle hamstring tendon group (1952 of 51,991; risk ratio, 1.01; 95% confidence interval (CI), 0.73-1.39; p = 0.96), and 2.8% of the patients were revised in the bone-patellar tendon-bone group (219 of the 7790 bone-patellar tendon-bone patients; risk ratio, 0.76; 95% CI, 0.54-1.06; p = 0.11). Cox regression analysis with adjustment for country, age, sex, menisci or cartilage injury, and utilized fixation device on the femoral and tibial sides, did not reveal any further difference in the risk of revision between the single-bundle hamstring tendon and double-bundle hamstring tendon groups (hazard ratio, 1.18; 95% CI, 0.85-1.62; p = 0.33), but the adjusted hazard ratio showed a lower risk of revision in the single-bundle bone-patellar tendon-bone group compared with the double-bundle group (hazard ratio, 0.62; 95% CI, 0.43-0.90; p = 0.01). Comparisons of the graft revision rates reported separately for each country revealed that double-bundle hamstring tendon reconstructions in Sweden had a lower hazard ratio compared with the single-bundle hamstring tendon reconstructions (hazard ratio, 1.00 versus 1.89; 95% CI, 1.09-3.29; p = 0.02). Survival at 5 years after index surgery was 96.0% for the double-bundle group, 95.4% for the single-bundle hamstring tendon group, and 97.0% for the single-bundle bone-patellar tendon-bone group. CONCLUSIONS Based on the data from all three national registers, the risk of revision was not influenced by the reconstruction technique in terms of using single- or double-bundle hamstring tendons, although national differences in survival existed. Using bone-patellar tendon-bone grafts lowered the risk of revision compared with double-bundle hamstring tendon grafts. These findings should be considered when deciding what reconstruction technique to use in ACL-deficient knees. Future studies identifying the reasons for graft rerupture in single- and double-bundle reconstructions would be of interest to understand the findings of the present study. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Cathrine Aga
- Orthopaedic Department, Martina Hansens Hospital, Bærum, Norway.
- Oslo Sports Trauma Research Center, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- Orthopaedic Department, Martina Hansens Hospital, Pb 823, 1306, Sandvika, Norway.
| | - Jüri-Tomas Kartus
- Orthopaedic Department, NU-Hospital Group/Gothenburg University, Trollhättan, Sweden
| | - Martin Lind
- Division of Sportstraumatology, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Stein Håkon Låstad Lygre
- The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lars-Petter Granan
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Oslo Univerity Hospital, Oslo, Norway
- International Olympic Committee, Lausanne, Switzerland
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Clinical outcomes of transtibial versus anteromedial drilling techniques to prepare the femoral tunnel during anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:2751-2759. [PMID: 26077285 DOI: 10.1007/s00167-015-3672-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 06/04/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE The clinical outcomes of transtibial (TT) and anteromedial (AM) drilling techniques for anterior cruciate ligament reconstruction in preparing the femoral tunnel were directly compared by using a systematic literature review. METHODS PubMed, EMBASE, the Cochrane Library, and the ISI Web of Science were searched until 10 May 2014, using the following Boolean operators: transtibial AND (anteromedial OR transportal OR independent OR three portal OR accessory portal) AND anterior cruciate ligament. All prospective and retrospective controlled trials directly comparing physical examination and scoring system results between TT and AM techniques were retrieved. No language or publication year limitations were used in our analysis. RESULTS Of 504 studies retrieved, nine studies involving 769 patients were included. Results suggested that the AM was superior to the TT technique for preparing the femoral tunnel independent of the International Knee Documentation Committee (IKDC) Score (n.s.). A higher proportion of negative Lachman (p = 0.002) and pivot-shift test (p = 0.01) results, lower manual maximum displacement by KT-1000 (p = 0.004), higher Lysholm scores (p = 0.034), a higher incidence of IKDC grade A/B (p = 0.04), and higher visual analogue scale scores (p = 0.00) were observed with the AM compared with the TT technique. CONCLUSION Although the increases in these scores were below the minimal clinically important difference, this systematic review indicated that the AM was superior to the TT drilling technique based on physical examination and scoring system results. LEVEL OF EVIDENCE Therapeutic study (systematic review), Level III.
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121
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Järvelä S, Kiekara T, Suomalainen P, Järvelä T. Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study With 10-Year Results. Am J Sports Med 2017; 45:2578-2585. [PMID: 28661696 DOI: 10.1177/0363546517712231] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A long-term follow-up comparing double-bundle and single-bundle techniques for anterior cruciate ligament (ACL) reconstruction has not been reported before. HYPOTHESIS Double-bundle ACL reconstruction may have fewer graft ruptures, lower rates of osteoarthritis (OA), and better stability than single-bundle reconstruction. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Ninety patients were randomized for double-bundle ACL reconstruction with bioabsorbable screw fixation (DB group; n = 30), single-bundle ACL reconstruction with bioabsorbable screw fixation (SBB group; n = 30), and single-bundle ACL reconstruction with metallic screw fixation (SBM group; n = 30). Evaluation methods consisted of a clinical examination, KT-1000 arthrometer measurements, International Knee Documentation Committee (IKDC) and Lysholm knee scores, and a radiographic examination of both the operated and contralateral knees. RESULTS Eighty-one patients (90%) were available at the 10-year follow-up. Eleven patients (1 in the DB group, 7 in the SBB group, and 3 in the SBM group) had a graft failure during the follow-up and went on to undergo revision ACL surgery ( P = .043). In the remaining 70 patients at 10 years, no significant group differences were found in the pivot-shift test findings, KT-1000 arthrometer measurements, or knee scores. The most OA findings were found in the medial compartment of the knee, with 38% of the patients in the operated knee and 28% of the patients in the contralateral nonoperated knee. However, no significant group difference was found. The most severe OA changes were in the patients who had the longest delay from the primary injury to ACL reconstruction ( P = .047) and in the patients who underwent partial meniscal resection at the time of ACL reconstruction ( P = .024). CONCLUSION Double-bundle ACL reconstruction resulted in significantly fewer graft failures than single-bundle ACL reconstruction during the follow-up. Knee stability and OA rates were similar at 10 years. The most severe OA changes were found in the patients who had the longest delay from the primary injury to ACL reconstruction and in the patients who underwent partial meniscal resection at the time of ACL reconstruction.
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Affiliation(s)
- Sally Järvelä
- Department of Accidents and Emergencies, Tampere University Hospital, Tampere, Finland.,Arthroscopic and Sports Medicine Center, Pohjola Hospital, Tampere, Finland
| | - Tommi Kiekara
- Medical Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Piia Suomalainen
- Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Timo Järvelä
- Arthroscopic and Sports Medicine Center, Pohjola Hospital, Helsinki, Finland
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Imbert P, Belvedere C, Leardini A. Knee laxity modifications after ACL rupture and surgical intra- and extra-articular reconstructions: intra-operative measures in reconstructed and healthy knees. Knee Surg Sports Traumatol Arthrosc 2017; 25:2725-2735. [PMID: 26037545 PMCID: PMC5570784 DOI: 10.1007/s00167-015-3653-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/18/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Quantifying the effects of anterior cruciate ligament (ACL) deficiency on knee joint laxity is fundamental for understanding the outcomes of its reconstruction techniques. The general aim of this study was to determine intra-operatively the main modifications in knee laxity before and after standard isolated intra-articular and additional extra-articular anterolateral reinforcement. Our main hypothesis was that laxity abnormalities, particularly axial rotation, can still result from these ACL reconstruction techniques. METHODS Thirty-two patients with primary ACL deficiency were analysed by a navigation system immediately before and after each of the two reconstructions. Laxity measurements in terms of knee translations and rotations were taken during the anteroposterior drawer test, with internal-external rotation at 20° and 90° of flexion, and varus-valgus and pivot-shift tests. All these laxity measures were also taken originally from the contralateral healthy knee. RESULTS With respect to the contralateral healthy knee, in the ACL-deficient knee significantly increased laxity (expressed in %) was found in the medial compared with that of the lateral compartment, respectively, 115 and 68 % in the drawer test at 20° flexion, and 55 and 46 % at 90° flexion. In the medial compartment, a significant 35 % increment was also observed for the coupled tibial anteroposterior translation during axial knee rotation at 20° of flexion. After isolated intra-articular reconstruction, normal values of anteroposterior laxity were found restored in the pivot-shift and drawer tests in the lateral compartment, but not fully in the medial compartment. After the reinforcement, laxity in the medial compartment was also found restored in the axial rotation test at 20° flexion. CONCLUSION In ACL reconstruction, with respect to the contralateral knee, intra-articular plus additional anterolateral reinforcement procedures do not restore normal joint laxity. This combined procedure over-constrained the lateral compartment, while excessive laxity still persists at the medial one. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pierre Imbert
- Department of Knee Surgery, Clinique Notre Dame De La Merci, 215, Avenue du Maréchal Lyautey, 83700, Saint Raphaël, France.
| | - Claudio Belvedere
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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Varady NH, Kernkamp WA, Li J, Wang L, Koga H, Asnis P, Li G. The biomechanical effect of tunnel placement on ACL graft forces in double-bundle ACL reconstruction - A 3D computational simulation. Int J Med Robot 2017; 13. [DOI: 10.1002/rcs.1840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Nathan H. Varady
- Bioengineering Laboratory; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School; Massachusetts USA
- Department of Mechanical Engineering; Massachusetts Institute of Technology; Cambridge Massachusetts USA
| | - Willem A. Kernkamp
- Bioengineering Laboratory; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School; Massachusetts USA
| | - Jingsheng Li
- Bioengineering Laboratory; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School; Massachusetts USA
| | - Lianxin Wang
- Bioengineering Laboratory; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School; Massachusetts USA
| | - Hiroshi Koga
- Bioengineering Laboratory; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School; Massachusetts USA
| | - Peter Asnis
- Bioengineering Laboratory; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School; Massachusetts USA
| | - Guoan Li
- Bioengineering Laboratory; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School; Massachusetts USA
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Irarrázaval S, Masferrer-Pino A, Ibañez M, Shehata TMA, Naharro M, Monllau JC. Does anatomic single-bundle ACL reconstruction using hamstring autograft produce anterolateral meniscal root tearing? J Exp Orthop 2017; 4:17. [PMID: 28534321 PMCID: PMC5440421 DOI: 10.1186/s40634-017-0093-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/15/2017] [Indexed: 11/13/2022] Open
Abstract
Background To determine if tibial tunnel reaming during anatomic single-bundle anterior cruciate ligament (ACL) reconstruction using hamstring autograft can result in anterolateral meniscal root injury, as diagnosed by magnetic resonance imaging (MRI). Methods A case series of 104 primary anatomic single-bundle ACL reconstructions using hamstring autograft was retrospectively reviewed. Pre- and post-operative (>1 year) MRIs were radiologically evaluated for each patient, with a lateral meniscus extrusion > 3 mm at the level of the medial collateral ligament midportion on a coronal MRI, to establish anterolateral meniscal root injury. Results No patients presented radiological findings of anterolateral meniscal root injury in this case series. Conclusions Examining a single-bundle ACL reconstruction technique using hamstring autograft that considered tibial tunnel positioning in the center of the tibial footprint, this case series found no evidence of anterolateral meniscal root injury in patient MRIs, even more than 1-year post-operation.
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Affiliation(s)
- Sebastián Irarrázaval
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile.
| | | | | | | | - María Naharro
- Complejo Hospitalario Universitario de Pontevedra, Galicia, Spain
| | - Joan C Monllau
- ICATME, Hospital Universitari Dexeus, Barcelona, Spain.,Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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125
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Cury RDPL, Sprey JWC, Bragatto ALL, Mansano MV, Moscovici HF, Guglielmetti LGB. Comparative evaluation of the results of three techniques in the reconstruction of the anterior cruciate ligament, with a minimum follow-up of two years. Rev Bras Ortop 2017; 52:319-324. [PMID: 28702391 PMCID: PMC5497004 DOI: 10.1016/j.rboe.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/12/2016] [Indexed: 01/17/2023] Open
Abstract
Objective To compare the clinical results of the reconstruction of the anterior cruciate ligament by transtibial, transportal, and outside-in techniques. Methods This was a retrospective study on 90 patients (ACL reconstruction with autologous flexor tendons) operated between August 2009 and June 2012, by the medial transportal (30), transtibial (30), and “outside-in” (30) techniques. The following parameters were assessed: objective and subjective IKDC, Lysholm, KT1000, Lachman test, Pivot-Shift and anterior drawer test. Results On physical examination, the Lachman test and Pivot-Shift indicated a slight superiority of the outside-in technique, but without statistical significance (p = 0.132 and p = 0.186 respectively). The anterior drawer, KT1000, subjective IKDC, Lysholm, and objective IKDC tests showed similar results in the groups studied. A higher number of complications were observed in the medial transportal technique (p = 0.033). Conclusion There were no statistically significant differences in the clinical results of patients undergoing reconstruction of the anterior cruciate ligament by transtibial, medial transportal, and outside-in techniques.
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Affiliation(s)
- Ricardo de Paula Leite Cury
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
| | - Jan Willem Cerf Sprey
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
| | - André Luiz Lima Bragatto
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
| | - Marcelo Valentim Mansano
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
| | - Herman Fabian Moscovici
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
| | - Luiz Gabriel Betoni Guglielmetti
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
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126
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Avaliação comparativa dos resultados de três técnicas na reconstrução do ligamento cruzado anterior com seguimento mínimo de dois anos. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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127
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Ciccotti MC, Secrist E, Tjoumakaris F, Ciccotti MG, Freedman KB. Anatomic Anterior Cruciate Ligament Reconstruction via Independent Tunnel Drilling: A Systematic Review of Randomized Controlled Trials Comparing Patellar Tendon and Hamstring Autografts. Arthroscopy 2017; 33:1062-1071.e5. [PMID: 28359669 DOI: 10.1016/j.arthro.2017.01.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/29/2016] [Accepted: 01/05/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To collect the highest level of evidence comparing anatomic anterior cruciate ligament (ACL) reconstruction via independent tunnel drilling using bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts in terms of clinical outcome and failure rate. METHODS We performed a systematic review of clinical trials that randomized patients to ACL reconstruction with either BTB or HT autografts with a minimum 2-year follow-up. Only trials using independent tunnel drilling, including outside-in and anteromedial portal techniques, for both autografts were eligible for inclusion, whereas all transtibial studies were excluded. Study design, demographics, surgical technique, rehabilitation protocol, and clinical outcomes were compiled. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Quality assessment was performed using the Coleman Methodological Scale (CMS). RESULTS Six published studies reporting on 5 randomized controlled trials (RCTs) met the inclusion criteria. No study reported a difference in rerupture rate between BTB and HT. BTB-reconstructed knees experienced a greater incidence of anterior knee pain or crepitus in 2/7 trials and radiographic evidence of degenerative change in 3/7 trials. HT-reconstructed knees had increased instrumented laxity in 2/7 trials and less knee flexion strength postoperatively. CONCLUSIONS This study collects all available Level I and II evidence for anatomic ACL reconstruction using BTB and HT grafts. According to the data presented in these studies, clinical outcome scores and failure rates showed no differences for anatomic reconstruction using either autograft. However, in some studies, BTB-reconstructed knees experienced a greater incidence of anterior knee pain and radiographic evidence of degenerative change, and in others, HT-reconstructed knees had increased laxity and less knee flexion strength. In our opinion, both BTB and HT autografts remain valid options for ACL reconstruction when using anatomic drilling techniques, providing a stable knee with reliable return to activity. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
| | - Eric Secrist
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Fotios Tjoumakaris
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Michael G Ciccotti
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A..
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128
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Converting round tendons to flat tendon constructs: Does the preparation process have an influence on the structural properties? Knee Surg Sports Traumatol Arthrosc 2017; 25:1561-1567. [PMID: 26272060 DOI: 10.1007/s00167-015-3749-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The structural properties of hamstring tendon grafts were evaluated in a porcine model, after processing it to a flat shape, to better replace or augment anatomic flat structures (e.g. ACL, MPFL or MCL). METHODS In this biomechanical study, porcine flexor tendons were used which have a comparable shape to semitendinosus and gracilis tendons. One part of the tendon was prepared to a flat tendon construct by splitting the tendon longitudinally with a knife to half of the diameter of the tendon. The semi-split tendon was scratched out to a flat shape. The other matched part was tested in its original round shape. The tendons (n = 40) have been fixed in a uniaxial testing machine (Zwick/Roell) by cryo-clamps after preparing the fixed ends by 2-0 polyester sutures (2-0 Ethibond® EXCEL, Ethicon, Somerville, NJ). In every specimen, there was a free 60-mm tendon part between both clamps. The tendons have been loaded to failure to evaluate typical biomechanical parameters such as stiffness, yield load and maximum load. RESULTS No statistically significant differences (n.s.) regarding stiffness, yield load and maximum load between natively round and processed flat tendons could be detected. CONCLUSION A prepared flat-shaped tendon does not show any different structural properties compared with an original round tendon. Therefore, a flat tendon seems to be a biomechanical stable graft option for anatomic reconstruction or augmentation of injured natively flat-shaped structures such as MCL, MPFL or ACL.
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Helito CP, Helito PVP, Leão RV, Demange MK, Bordalo-Rodrigues M. Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2017; 25:1140-1148. [PMID: 28293698 DOI: 10.1007/s00167-017-4498-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/27/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Few studies have used MRI to identify the ALL. As it was shown that it is not possible to precisely characterize this ligament in all examination, it is important to identify concomitant lesions that can help in diagnosing ALL abnormalities. It is important to characterise this injury due to its association with anterolateral knee instability. Thus, the present study was performed to determine the frequency of ALL injuries in patients with acute ACL rupture and to analyse its associated knee lesions. METHODS Patients with acute ACL injuries were evaluated by MRI. Among this population, the ALL was classified as non-visualised, injured or normal. The possible abnormalities of the meniscus, collateral ligaments, popliteus tendon, posterior cruciate ligament, Iliotibial band (ITB), anterolateral capsule and osseus injuries were evaluated. The association of an ALL injury with these other knee structures as well as sex and age was calculated. RESULTS Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury. CONCLUSION ALL injuries are present in approximately 40% of ACL injuries, and a minority of these are Segond fractures. These injuries are associated with peripheral ligament injuries, anterolateral structures lesions and bone contusions, but there is no association with meniscal injuries. Surgeons must be aware of these associations to consider an ALL lesion even if it is not completely clear in imaging evaluation, especially if a high degree of anterolateral instability is present on physical examination. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Camilo Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil. .,Knee Surgery Division, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil.
| | - Paulo Victor Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil.,Musculoskeletal Radiology Department, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | | | - Marco Kawamura Demange
- Knee Surgery Division, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Marcelo Bordalo-Rodrigues
- Hospital Sírio-Libanês, São Paulo, Brazil.,Musculoskeletal Radiology Department, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
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Comparison of outcome after anatomic double-bundle and antero-medial portal non-anatomic single-bundle reconstruction in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 2017; 25:1307-1315. [PMID: 27106922 DOI: 10.1007/s00167-016-4132-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to compare anatomic double-bundle anterior cruciate ligament reconstruction with non-anatomic single-bundle reconstruction. METHODS In a prospective consecutive series, 94 unselected patients [45 anatomic double-bundle (ADB) and 49 non-anatomic single-bundle (SB)] underwent ACL reconstruction involving hamstring tendon autograft, interference screw fixation on both the femoral and tibial side and drilling the femoral tunnel(s) through the antero-medial portal in both groups. In the ADB group, the remnants of the ACL were identified and the grafts were placed anatomically. In the SB group, traditional placement of the graft was performed in a less anatomic manner. Pre-operatively, the groups were comparable in terms of age, gender, time between injury and operation and associated injuries. One independent physiotherapist performed all the pre-operative and post-operative assessments. RESULTS The follow-up period was 26 (22-34) and 24 (23-30) months in the ADB and SB groups, respectively (p = 0.005). At follow-up, 78 % in the ADB group and 74 % in the SB group had a negative pivot-shift test (n.s.). The KT-1000 134N measurements were 2 (-5 to 10.5) and 2 (-4 to 7) mm in the ADB and SB groups, respectively (n.s.). At follow-up, the extension deficit was significantly larger in the ADB group than in the SB group (p = 0.001). The Tegner activity scale was significantly higher in the ADB group both pre-operatively and at follow-up (p = 0.03 and p = 0.004). In overall terms, both groups had improved significantly at the two-year follow-up. CONCLUSION In an unselected group of ACL-injured patients, anatomic double-bundle reconstruction did not result in better rotational or antero-posterior stability measurements than antero-medial portal non-anatomic single-bundle reconstruction at the two-year follow-up. LEVEL OF EVIDENCE III.
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Brockmeyer M, Höfer D, Schäfer K, Seil R, Becker K, Paulsen F, Kohn D, Tschernig T. The anterolateral ligament (ALL) of the knee-Part of the iliotibial tract or a truly separate structure? Ann Anat 2017; 212:1-3. [PMID: 28365381 DOI: 10.1016/j.aanat.2017.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 01/24/2023]
Abstract
In this Short Communication, the issue is discussed whether the recently reported anterolateral ligament of the knee is a unique structure or just part of the iliotibial tract. The presented findings from investigations in body donors support the view of a unique structure.
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Affiliation(s)
- Matthias Brockmeyer
- Saarland University Medical Center, Department of Orthopaedics and Orthopaedic Surgery, Kirrberger Straße, Geb. 37/38, 66421 Homburg/Saar, Germany
| | - Denis Höfer
- Saarland University Medical Center, Institute of Anatomy and Cell Biology, Kirrberger Straße, Geb. 61, 66421 Homburg/Saar, Germany
| | - Katja Schäfer
- Saarland University Medical Center, Institute of Anatomy and Cell Biology, Kirrberger Straße, Geb. 61, 66421 Homburg/Saar, Germany
| | - Romain Seil
- Centre Hospitalier de Luxembourg, 78 Rue d'Eich., 1460, Luxembourg
| | - Kurt Becker
- Saarland University Medical Center, Institute of Anatomy and Cell Biology, Kirrberger Straße, Geb. 61, 66421 Homburg/Saar, Germany
| | - Friedrich Paulsen
- Friedrich Alexander University Erlangen-Nürnberg, Department Anatomy II, Universitätsstr. 19, 91054 Erlangen, Germany
| | - Dieter Kohn
- Saarland University Medical Center, Department of Orthopaedics and Orthopaedic Surgery, Kirrberger Straße, Geb. 37/38, 66421 Homburg/Saar, Germany
| | - Thomas Tschernig
- Saarland University Medical Center, Institute of Anatomy and Cell Biology, Kirrberger Straße, Geb. 61, 66421 Homburg/Saar, Germany.
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132
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Syam K, Chouhan DK, Dhillon MS. Outcome of ACL Reconstruction for Chronic ACL Injury in Knees without the Posterior Horn of the Medial Meniscus: Comparison with ACL Reconstructed Knees with An Intact Medial Meniscus. Knee Surg Relat Res 2017; 29:39-44. [PMID: 28231647 PMCID: PMC5336373 DOI: 10.5792/ksrr.16.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 01/14/2023] Open
Abstract
Purpose Cadaveric studies have shown that deficiency of the posterior horn of the medial meniscus (PHMM) increases strain on the anterior cruciate ligament (ACL) graft. However, its influence on the clinical and radiological outcome after ACL reconstruction is less discussed and hence evaluated in this study. Materials and Methods This study included 77 cases of ACL reconstruction with a minimum 18-month follow-up. Of the 77 cases, 41 patients with intact menisci were compared clinically and radiologically with 36 patients with an injury to the PHMM that required various grades of meniscectomy. The knees were evaluated using subjective International Knee Documentation Committee (IKDC) score and Orthopadische Arbeitsgruppe Knie (OAK) score. Results Cases with intact menisci showed better stability (p=0.004) at an average of 44.51 months after surgery. No significant differences were noted in the overall OAK score, subjective IKDC score, and functional OAK score (p=0.082, p=0.526, and p=0.363, respectively). The incidence of radiological osteoarthrosis was significantly higher in the posterior horn deficient knees (p=0.022). Conclusions The tendency toward relatively higher objective instability and increased incidence of osteoarthrosis in the group with absent posterior horn reinforces its importance as a secondary stabiliser of the knee.
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Affiliation(s)
- Kevin Syam
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devendra K Chouhan
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Guglielmetti LGB, Shimba LG, do Santos LC, Severino FR, Severino NR, de Moraes Barros Fucs PM, de Paula Leite Cury R. The influence of femoral tunnel length on graft rupture after anterior cruciate ligament reconstruction. J Orthop Traumatol 2017; 18:243-250. [PMID: 28213787 PMCID: PMC5585089 DOI: 10.1007/s10195-017-0448-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/24/2017] [Indexed: 01/12/2023] Open
Abstract
Background For ACL reconstruction, the minimum length of the femoral tunnel and the flexor tendon graft length needed within the tunnel for proper integration have not been defined. The aim of this study was to assess whether a short tunnel is a risk factor for poor prognosis and re-rupture by comparing the outcomes of patients with short femoral tunnels to those of patients with longer tunnels. Materials and methods A retrospective observational study of 80 patients who underwent ACL reconstruction using flexor tendons via the medial transportal or transtibial technique was performed. Patients were categorized according to the amount of graft within the tunnel: ≤1.5 versus >1.5 cm; ≤2 versus >2 cm; ≤2.5 versus >2.5 cm; and ≤1.5 versus >2.5 cm. Patients were evaluated 2 years after surgery by performing a physical examination (Lachman, pivot shift and anterior drawer tests), using a KT1000 arthrometer, calculating objective and subjective International Knee Documentation Committee scores, conducting the Lysholm score, and recording re-ruptures. Results Of the 80 operated patients, nine were lost to follow-up. Comparative assessment of the patients with different amounts of graft within the tunnel indicated no significant differences in the evaluated outcomes, except for positive Lachman test results, which were more frequent in patients with tunnels with ≤2 cm of graft than in those with tunnels with >2 cm of graft. Conclusion The amount of graft within the femoral tunnel does not appear to be a risk factor for clinical instability of the knee or re-rupture of the graft. Level of evidence: case series, level IV. Level of evidence Case series, level IV.
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Affiliation(s)
- Luiz Gabriel Betoni Guglielmetti
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil. .,, Pascal, 1292, Ap91, Campo Belo, São Paulo, São Paulo, 04616-004, Brazil.
| | - Leandro Girardi Shimba
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
| | - Leonardo Cantarelli do Santos
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
| | - Fabrício Roberto Severino
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
| | - Nilson Roberto Severino
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
| | - Patrícia Maria de Moraes Barros Fucs
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
| | - Ricardo de Paula Leite Cury
- Knee Group of the Department of Orthopedics and Traumatology of Santa Casa de Misericórdia of São Paulo, Santa Casa School of Medical Sciences, São Paulo-Fernandinho Simonsen Pavilion, São Paulo, Brazil
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Ayre C, Hardy M, Scally A, Radcliffe G, Venkatesh R, Smith J, Guy S. The use of history to identify anterior cruciate ligament injuries in the acute trauma setting: the 'LIMP index'. Emerg Med J 2017; 34:302-307. [PMID: 28143813 DOI: 10.1136/emermed-2015-205610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify the injury history features reported by patients with anterior cruciate ligament (ACL) injuries and determine whether history may be used to identify patients requiring follow-up appointments from acute trauma services. METHODS Multisite cross-sectional service evaluation using a survey questionnaire design conducted in the UK. The four injury history features investigated were 'leg giving way at the time of injury', 'inability to continue activity immediately following injury', 'marked effusion' and 'pop (heard or felt) at the time of injury'(LIMP). RESULTS 194 patients with ACL injury were identified, of which 165 (85.5%) attended an acute trauma service. Data on delay was available for 163 (98.8%) of these patients of which 120 (73.6%) had a follow-up appointment arranged. Patients who had a follow-up appointment arranged waited significantly less time for a correct diagnosis (geometric mean 29 vs 198 days; p<0.001) and to see a specialist consultant (geometric mean 61 vs 328 days; p<0.001). Using a referral threshold of any two of the four LIMP injury history features investigated, 95.8% of patients would have had a follow-up appointment arranged. CONCLUSIONS Findings support the value of questioning patients on specific injury history features in identifying patients who may have suffered ACL injury. Using a threshold of two or more of the four LIMP history features investigated would have reduced the percentage of patients inappropriately discharged by 22.2%. Evidence presented suggests that this would significantly reduce the time to diagnosis and specialist consultation minimising the chance of secondary complications.
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Affiliation(s)
- Colin Ayre
- Faculty of Health Studies, University of Bradford, Bradford, UK .,Department of Orthopaedics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Maryann Hardy
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Andrew Scally
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Graham Radcliffe
- Department of Orthopaedics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ram Venkatesh
- Department of Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jon Smith
- Department of Orthopaedics, Mid Yorkshire Hospitals NHS Trust, Dewsbury, UK
| | - Stephen Guy
- Department of Orthopaedics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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135
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Daggett M, Helito C, Cullen M, Ockuly A, Busch K, Granite J, Wright B, Sonnery-Cottet B. The Anterolateral Ligament: An Anatomic Study on Sex-Based Differences. Orthop J Sports Med 2017; 5:2325967116689387. [PMID: 28321423 PMCID: PMC5347435 DOI: 10.1177/2325967116689387] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The anterolateral ligament (ALL) has been shown to have an important role in rotatory stability of the knee. While there is abundant research on sex-based differences related to anterior cruciate ligament (ACL) rupture, there is a paucity of literature related to such differences in the ALL. PURPOSE To define any sex-based differences in the ALL with regard to length, width, and thickness. STUDY DESIGN Descriptive laboratory study. METHODS The ALL was initially evaluated in 165 unpaired knees (92 males and 65 females after exclusion criteria applied). The length, width, and thickness of the ALL were measured using a digital caliper. Width and thickness were measured at the joint line just superior to the lateral meniscus. The Mann-Whitney test and Student t tests were used to compare measurements between males and females. The Pearson product-moment correlation was subsequently used to determine the correlation between height and weight and the statistically different morphometric variables. RESULTS The mean (±SD) thickness of the ALL in males was 2.09 ± 0.56 mm, almost twice as thick as females (1.05 ± 0.49 mm; P = 8.8 × 10-20). There was also a statistically significant difference in ALL length (P = 3.8 × 10-7), but no significant difference was found for width. A moderate association was found between donor height and ALL thickness and length. CONCLUSION The anatomic measurements of the ALL demonstrate a difference between sexes, and the ALL is significantly thicker in males than females. CLINICAL RELEVANCE As the role of the ALL in rotatory stability of the knee becomes better understood, the difference in the thickness of the ALL we have found between the sexes may be another factor why female athletes have an increased incidence of ACL rupture compared with males. This may also help explain why females have issues with knee laxity and rotatory instability.
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Affiliation(s)
- Matt Daggett
- Kansas City University, Kanas City, Missouri, USA
| | | | | | | | - Kyle Busch
- Kansas City University, Kanas City, Missouri, USA
| | | | - Barth Wright
- Kansas City University, Kanas City, Missouri, USA
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Dallo I, Chahla J, Mitchell JJ, Pascual-Garrido C, Feagin JA, LaPrade RF. Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament: A Current Concepts Review. Orthop J Sports Med 2017; 5:2325967116681724. [PMID: 28210653 PMCID: PMC5298533 DOI: 10.1177/2325967116681724] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) has been established as the gold standard for treatment of complete ruptures of the anterior cruciate ligament (ACL) in active, symptomatic individuals. In contrast, treatment of partial tears of the ACL remains controversial. Biologically augmented ACL-repair techniques are expanding in an attempt to regenerate and improve healing and outcomes of both the native ACL and the reconstructed graft tissue. PURPOSE To review the biologic treatment options for partial tears of the ACL. STUDY DESIGN Review. METHODS A literature review was performed that included searches of PubMed, Medline, and Cochrane databases using the following keywords: partial tear of the ACL, ACL repair, bone marrow concentrate, growth factors/healing enhancement, platelet-rich plasma (PRP), stem cell therapy. RESULTS The use of novel biologic ACL repair techniques, including growth factors, PRP, stem cells, and bioscaffolds, have been reported to result in promising preclinical and short-term clinical outcomes. CONCLUSION The potential benefits of these biological augmentation approaches for partial ACL tears are improved healing, better proprioception, and a faster return to sport and activities of daily living when compared with standard reconstruction procedures. However, long-term studies with larger cohorts of patients and with technique validation are necessary to assess the real effect of these approaches.
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Affiliation(s)
| | - Jorge Chahla
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - John A Feagin
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Robert F LaPrade
- The Steadman Philippon Research Institute, Vail, Colorado, USA.; The Steadman Clinic, Vail, CO, USA
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137
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Abstract
Anterior cruciate ligament reconstruction (ACLR) provides an established surgical intervention to control pathological tibiofemoral translational and rotational movement. ACLR is a safe and reproducible intervention, but there remains an underlying rate of failure to return to preinjury sporting activity levels. Postoperative pathological laxity and graft reinjury remain concerns. Previously, unrecognized meniscal lesions, disruption of the lateral capsule, and extracapsular structures offer potential avenues to treat and to therefore improve kinematic outcome and functional results, following reconstruction. Addressing laterally based injuries may also improve the durability of intraarticular ACLR. Improving the anterior cruciate ligament (ACL) graft replication of the normal ACL attachment points on the femur and the tibia, using either double bundle or anatomical single bundle techniques, improves kinematics, which may benefit outcome and functionality, following reconstruction.
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Affiliation(s)
- James Philip Bliss
- Department of Orthopaedics, Guy's and St. Thomas’ NHS Foundation Trust, London SE1 9RT, UK,Address for correspondence: Dr. James Philip Bliss, Department of Orthopaedics, Guy's and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK. E-mail:
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138
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Lord BR, El-Daou H, Sabnis BM, Gupte CM, Wilson AM, Amis AA. Biomechanical comparison of graft structures in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:559-568. [PMID: 27637854 PMCID: PMC5331106 DOI: 10.1007/s00167-016-4316-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/01/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction may offer kinematic restoration superior to anatomic single bundle (SB), but it remains technically challenging. The femoral attachment site has the most effect on ACL graft isometry, so a simplified three-socket (3S) construct which still uses two sockets to cover the femoral ACL attachment is attractive. It was hypothesised that ACL reconstruction using three- and four-socket techniques would more closely restore native knee kinematics compared to anatomic two-socket (SB) surgery. METHODS Nine cadaveric knees were used to evaluate the kinematics of ACL-intact, ACL-deficient, anatomic SB, three-socket, and DB arthroscopic ACL reconstructions. Suspensory fixation was used, and grafts were tensioned to match the anterior draw of the intact knee at 20°. A six-degree-of-freedom robotic system measured knee laxity under 90 N anterior tibial force and rotational laxity under 5 N-m torque. Combined moments were applied to simulate the pivot-shift subluxation: 4 N-m internal rotation and 8 N-m valgus. RESULTS Significant differences between reconstructions were not found during anterior tibial loading, apart from SB being more lax than DB at 60° flexion. All reconstructions produced comparable laxity to the intact state, apart from SB at 60°. Significant differences between reconstructions were not found at any flexion angle during tibial internal/external applied torques. Under combined loading, DB produced significantly less laxity than SB constructs apart from anterior tibial translation at 0° and internal rotation at 45°. 3S and DB were comparable to the native knee throughout. CONCLUSION Although 3S restored laxities to a similar extent to DB, significant superiority over SB surgery was not observed. Although statistically significant differences were found between SB and DB surgery during anterior tibial and simulated pivot-shift loading, both remained similar to the native knee. The clinical relevance is that this study did not support an ACL graft construct more complex than an anatomic single bundle.
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Affiliation(s)
- Breck R. Lord
- 0000 0001 2113 8111grid.7445.2The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ UK ,0000 0004 0400 7883grid.414262.7Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Hadi El-Daou
- 0000 0001 2113 8111grid.7445.2The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ UK
| | - Bhushan M. Sabnis
- 0000 0004 0400 7883grid.414262.7Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Chinmay M. Gupte
- 0000 0001 2113 8111grid.7445.2Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, Charing Cross Hospital, London, UK
| | - Adrian M. Wilson
- 0000 0004 0400 7883grid.414262.7Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Andrew A. Amis
- 0000 0001 2113 8111grid.7445.2The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ UK ,0000 0001 2113 8111grid.7445.2Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, Charing Cross Hospital, London, UK
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139
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Kumar C, Gupta AK, Singh SK, Jain R. Transportal Anterior Cruciate Ligament Reconstruction with Quadrupled Hamstring Tendon Graft: A Prospective Outcome Study. Indian J Orthop 2017; 51:600-605. [PMID: 28966383 PMCID: PMC5609381 DOI: 10.4103/ortho.ijortho_57_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction has been one of the most commonly performed procedures throughout the world. Unsatisfactory outcome with conventional ACL reconstruction has been attributed to nonanatomic graft placement. Researchers have advised placing the graft in the native footprint of ACL to avoid nonanatomic graft placement. The goal of this study was to analyze the outcome of anatomic single bundle ACL reconstruction using transportal technique. MATERIALS AND METHODS This was a prospective outcome study conducted on 85 consecutive patients of ACL reconstruction of which 62 patients met inclusion and exclusion criteria and were analyzed for final results. All the patients underwent ACL reconstruction by quadrupled hamstring tendon graft using transportal technique and the accessory anteromedial (AAM) portal for femoral tunnel creation. The graft was fixed with endobutton on femoral side and bioabsorbable screw on the tibial side. Patients were evaluated for range of motion, International Knee Documentation Committee (IKDC) score, and Lysholm scores at a minimum followup period of 2 years. The mean pre- and postoperative scores were compared using Wilcoxon signed-rank test. RESULTS The mean Lysholm and IKDC scores improved significantly (P < 0.0001) from preoperative value. According to IKDC score, 90.3% (n = 56) were either normal or near normal at final followup. According to Lysholm score, 75.8% of patients had excellent and 13.3% had good results. Preoperatively, pivot shift was present in 85.5% (n = 53) of patients which reduced to 4.8% (n = 3) postoperatively. Infection and knee stiffness occurred in two patients, and femoral tunnel blowout and graft re-rupture occurred in one patient each. CONCLUSION Anatomic ACL reconstruction by AAM portal is a reproducible technique which gives good clinical outcome at short-term followup.
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Affiliation(s)
- Chandan Kumar
- Department of Orthopaedics, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Anil Kumar Gupta
- Department of Orthopaedics, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India,Address for correspondence: Dr. Anil Kumar Gupta, Department of Orthopaedics, G.S.V.M. Medical College, P-6, Medical College Campus, Kanpur - 208 002, Uttar Pradesh, India. E-mail:
| | - Santosh Kumar Singh
- Department of Orthopaedics, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Rohit Jain
- Department of Orthopaedics, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
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Helito CP, do Amaral C, Nakamichi YDC, Gobbi RG, Bonadio MB, Natalino RJM, Pécora JR, Cardoso TP, Camanho GL, Demange MK. Why Do Authors Differ With Regard to the Femoral and Meniscal Anatomic Parameters of the Knee Anterolateral Ligament?: Dissection by Layers and a Description of Its Superficial and Deep Layers. Orthop J Sports Med 2016; 4:2325967116675604. [PMID: 28203587 PMCID: PMC5298406 DOI: 10.1177/2325967116675604] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: No consensus exists regarding the anatomic characteristics of the knee anterolateral ligament (ALL). A critical analysis of the dissections described in previous studies allows the division of the ALL into 2 groups with similar characteristics. The presence of considerable variability suggests that the authors may not be referring to the same structure. Purpose/Hypothesis: To perform a lateral anatomic dissection, by layers, seeking to characterize the 2 variants described for the ALL on the same knee. We hypothesized that we would identify the 2 variants described for the ALL and that these variants would have distinct characteristics. Study Design: Descriptive laboratory study. Methods: Thirteen unpaired cadaveric knees were used in this study. The dissection protocol followed the parameters described in previous studies. Immediately below the iliotibial tract, we isolated a structure designated as the superficial ALL, whereas between this structure and the articular capsule, we isolated a structure designated as the deep ALL. The 2 structures were measured for length at full extension and at 90° of flexion and for distance from the tibial insertion relative to the Gerdy tubercle. Potential contact with the lateral meniscus was also evaluated. After measurements were obtained, the 2 dissected structures underwent histologic analysis. Results: The superficial ALL presented a posterior and proximal origin to the center of the lateral epicondyle, its length increased on knee extension, and it exhibited no contact with the lateral meniscus. The deep ALL was located in the center of the lateral epicondyle, its length increased on knee flexion, and it presented a meniscal insertion. Both structures had a similar tibial insertion site; however, the insertion site of the deep ALL was located more posteriorly. The analysis of the histological sections for both structures indicated the presence of dense and well-organized collagen fibers. Conclusion: This anatomic study clearly identified 2 structures, described as the superficial and deep ALL, which were consistent with previous but conflicting descriptions of the ALL. Clinical Relevance: This study clarifies numerous controversies encountered in anatomic studies of the ALL. Knowledge regarding the existence of 2 distinct structures in the anterolateral knee will allow more accurate evaluation of their functions and characteristics.
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Affiliation(s)
- Camilo Partezani Helito
- Knee Surgery Division, Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology-Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - Carlos do Amaral
- Department of Orthopaedic Surgery, Catholic University of São Paulo, Sorocaba, São Paulo, Brazil
| | - Yuri da Cunha Nakamichi
- Department of Orthopaedic Surgery, Catholic University of São Paulo, Sorocaba, São Paulo, Brazil
| | - Riccardo Gomes Gobbi
- Knee Surgery Division, Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology-Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - Marcelo Batista Bonadio
- Knee Surgery Division, Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology-Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - Renato José Mendonça Natalino
- Knee Surgery Division, Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology-Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - José Ricardo Pécora
- Knee Surgery Division, Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology-Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - Tulio Pereira Cardoso
- Department of Orthopaedic Surgery, Catholic University of São Paulo, Sorocaba, São Paulo, Brazil
| | - Gilberto Luis Camanho
- Knee Surgery Division, Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology-Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - Marco Kawamura Demange
- Knee Surgery Division, Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology-Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
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Tian S, Wang Y, Wang B, Liu L, Ha C, Li Q, Sun K. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With a Hamstring Tendon Autograft and Fresh-Frozen Allograft: A Prospective, Randomized, and Controlled Study. Arthroscopy 2016; 32:2521-2531. [PMID: 27289276 DOI: 10.1016/j.arthro.2016.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/10/2016] [Accepted: 04/18/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcome of anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction with a hamstring tendon autograft versus fresh-frozen allograft. METHODS Between January 2010 and December 2011, in a prospective randomized study, we included 157 patients who were planned to receive anatomic DB ACL reconstruction with a hamstring tendon autograft or fresh-frozen allograft. All surgeries were performed by the same senior surgeon with the DB reconstruction technique. The fixation of femoral side grafts was by means of an EndoButton, and the tibial side grafts were fixed with a bioabsorble interference screw augmented with a staple. The same rehabilitation protocol was applied to all the patients. Patients were evaluated preoperatively and at the follow-up points. Evaluations included detailed history, physical examination, radiograph, functional knee ligament testing, KT-2000 arthrometer testing, Harner's vertical jump and Daniel's one-leg hop tests, Lysholm score, Tegner score, the International Knee Documentation Committee (IKDC) standard evaluation form, and Cincinnati knee score. RESULTS One hundred and twenty-one patients (Auto, 62; Allo, 59) fulfilled complete follow-up and got full clinical evaluations. The mean follow-up was 4.6 years (4.0 to 5.5 years) for both groups. No significant differences were found between the 2 groups according to the evaluations aforementioned except that patients in the Allo group had shorter operation time compared with the Auto group (P = .001). Fifty-three (85.5%) patients in the Auto group and 50 (84.7%) patients in the Allo group had a side-to-side difference of less than 3 mm. Four (6.5%) patients in the Auto group and 4 (6.8%) patients in the Allo group had a side-to-side difference of more than 5 mm. Fifty-nine (95.8%) patients in the Auto group and 55 (93.2%) patients in the Allo group were normal or nearly normal according to the overall IKDC. According to the subjective IKDC, the average scores were 90 and 89 points, respectively, for the Auto and Allo groups. The mean Lysholm and Tegner scores were 90 points and 7.9 points for the Auto group, respectively, and 89 points and 7.8 points for the Allo group, respectively. For the Cincinnati knee score, the average scores were 91 and 90 points, respectively, for the Auto and Allo groups. A total of 11.3% (7 of 62) of patients in the Auto group and 11.9% (7 of 59) of patients in the Allo group had an arthritic progression. There was no statistical difference between the 2 groups at the final follow-up. CONCLUSIONS With the anatomic DB ACL reconstruction technique, comparable objective and subjective clinical results can be achieved with the use of a fresh-frozen hamstring tendon allograft compared with an autograft. LEVEL OF EVIDENCE Level II, prospective randomized clinical trial.
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Affiliation(s)
- Shaoqi Tian
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Yuanhe Wang
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Bin Wang
- Department of Orthopaedics, Qingdao 3rd People's Hospital, Qingdao, Shandong, China
| | - Lun Liu
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chengzhi Ha
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qicai Li
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Kang Sun
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Nakamura K, Koga H, Sekiya I, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Muneta T. Dynamic Evaluation of Pivot-Shift Phenomenon in Double-Bundle Anterior Cruciate Ligament Reconstruction Using Triaxial Accelerometer. Arthroscopy 2016; 32:2532-2538. [PMID: 27296869 DOI: 10.1016/j.arthro.2016.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/12/2016] [Accepted: 04/19/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of initial graft tension on rotational stability and to determine the minimum required tension (MRT) based on the pivot-shift phenomenon in isolated anteromedial bundle (AMB), isolated posteromedial bundle (PLB), and double-bundle anterior cruciate ligament (ACL) reconstructions using a triaxial accelerometer during surgery. METHODS Primary double-bundle ACL reconstructions were included. The pivot-shift test and N-test were performed before and during surgery with the acceleration measurements using a triaxial accelerometer. The pivot-shift test was also manually graded. The AMB and PLB were fixed to a graft tensioning system during surgery with the following settings: (1) AMB only (AMB), (2) PLB only (PLB), and (3) AMB and PLB (A+P). The total graft tension was first set at 20 N and then was increased in increments of 10 N until the pivot-shift test became negative, which was defined as the MRT in each setting. RESULTS Twenty-five patients were evaluated. The MRT in the AMB setting averaged 26 N (range, 20 to 40 N); in the PLB setting, 28 N (range, 20 to 40 N); and in the A+P setting, 24 N (range, 20 to 40 N). The MRT in the A+P setting was significantly smaller than that in the PLB setting (P = .008). The acceleration in the A+P setting was significantly smaller than that in the AMB and PLB settings both in the pivot-shift test (vs AMB: P = .007, vs PLB: P = .011) and in the N-test (vs AMB: P < .001, vs PLB: P < .001). CONCLUSIONS Double-bundle ACL reconstruction better controlled rotational stability with smaller MRT than isolated PLB reconstruction at the time of surgery. In double-bundle reconstruction, the MRT based on the pivot-shift phenomenon could be larger than previously reported MRT based on anteroposterior laxity. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Kaori Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Toshifumi Watanabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Tomoyuki Mochizuki
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Masafumi Horie
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Koji Otabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
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143
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Figueroa D, Calvo R, Figueroa F, Paccot D, Izquierdo G, Morales N. Clinical and arthrometric outcomes of an anatomic outside-in single-bundle anterior cruciate ligament reconstruction using a retrodrill. Knee 2016; 23:1098-1105. [PMID: 27816290 DOI: 10.1016/j.knee.2016.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 05/28/2016] [Accepted: 07/26/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The main option to perform an anatomic anterior cruciate ligament (ACL) reconstruction is the anteromedial portal (AMP) technique. It has several reported complications (iatrogenic chondral injury, posterior-wall blowout, short sockets, increased risk of injury to common peroneal nerve). In an attempt to avoid these complications the outside-in (OI) technique was revived with the addition of a retrodrill. The aim of this study is to evaluate the clinical and arthrometric outcomes of a series of anatomical OI single bundle ACL reconstruction using a retrodrill. METHODS Prospective case series. KT-1000 and Pivot Shift Test were done at 24 months follow-up. International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores preoperatively and at final follow-up. Complications were reported. Statistical analysis was done with t-test. RESULTS 275 knees of 200 (73%) males and 75 (27%) females were enrolled in the study. Mean age 29.1 years (15-54). Mean follow-up 34.5 months (24-49). Mean preoperatively Lysholm Score 62 (25-95) versus 95 (76-100) at final follow-up (p<0.001) Mean preoperatively IKDC score 60 (26.4-90.8) versus 92 (59.8-100) at final follow-up (p<0.001) Mean Tegner activity Score pre injury 5 versus 5 at final follow-up. (p=0.59) Mean KT-1000 side-to-side difference 2mm (1-6). Pivot Shift test negative in 243 patients (90%); positive in 32 (10%) patients. 13 (5%) ACL re-ruptures. 2 (0.7%) infections. No other complications were reported. CONCLUSION OI single bundle anatomic ACL reconstruction using a retrodrill is a valid and safe option that avoids the complications reported with the AMP technique.
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Affiliation(s)
- David Figueroa
- The Knee Surgery Unit, Orthopaedics and Traumatology Department, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile.
| | - Rafael Calvo
- The Knee Surgery Unit, Orthopaedics and Traumatology Department, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Francisco Figueroa
- The Knee Surgery Unit, Orthopaedics and Traumatology Department, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Daniel Paccot
- The Knee Surgery Unit, Orthopaedics and Traumatology Department, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Guillermo Izquierdo
- The Knee Surgery Unit, Orthopaedics and Traumatology Department, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Nelson Morales
- The Knee Surgery Unit, Orthopaedics and Traumatology Department, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
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Zaffagnini S, Signorelli C, Bonanzinga T, Roberti Di Sarsina T, Grassi A, Budeyri A, Marcheggiani Muccioli GM, Raggi F, Bragonzoni L, Lopomo N, Marcacci M. Technical variables of ACL surgical reconstruction: effect on post-operative static laxity and clinical implication. Knee Surg Sports Traumatol Arthrosc 2016; 24:3496-3506. [PMID: 27628740 DOI: 10.1007/s00167-016-4320-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/02/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE The hypothesis was that an alteration of different surgical variables of ACL reconstruction would produce significant changes in post-operative static laxity of knee joint. METHODS Joint laxity was acquired by a surgical navigation system for 17 patients just after graft fixation during single-bundle reconstruction with extra-articular lateral tenodesis. The analysed laxity parameters were: internal/external rotation at 30° (IE30) and 90° (IE90) of flexion, varus/valgus rotation at 0° (VV0) and 30° (VV30) of flexion and anterior/posterior displacement at 30° (AP30) and 90° (AP90) of flexion. As surgical variables, the angles between the tibial tunnel and the three planes were defined as well as the lengths of the tunnel and the relationship between native footprints and tunnels. The same analysis was performed for the femoral side. All surgical variables were combined in a multivariate analysis to assess for predictive factors between them and post-operative laxities values. To quantify the performance of each multivariate model, the correlation ratio (η 2) and the corresponding P value (*P < 0.050) have been evaluated. RESULTS Multivariate analysis underlined statistically significant models for the estimation of: AP30 (η 2 = 0.987; P = 0.014), IE30 (η 2 = 0.995; P = 0.005), IE90 (η 2 = 0.568; P = 0.010), VV0 (η 2 = 0.932; P = 0.003). The parameters that greatly affected the identified models were the orientation of the tibial tunnel with respect to the three anatomical planes. The estimation of AP30, IE30 and IE90 got lower value as the orientation of the tibial tunnel with respect to transverse plane decreases. Considering the orientation to sagittal ([Formula: see text]) and coronal ([Formula: see text]) plane, we found that their reduction provoked a decrease in the estimation of AP30, IE30 and IE90 (except [Formula: see text] that did not appear in the estimation of AP30). The estimation of VV0 got an increase of [Formula: see text], and [Formula: see text] which led to a laxity reduction. CONCLUSION The main finding of the present in vivo study was the possibility to determine significant effects on post-operative static laxity level of different surgical variables of ACL reconstruction. In particular, the present study defined the conditions that minimize the different aspects of post-operative laxity at time-zero after surgery.
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Affiliation(s)
- S Zaffagnini
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy. .,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy. .,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria (PA), Italy. .,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy.
| | - C Signorelli
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy
| | - T Bonanzinga
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - T Roberti Di Sarsina
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - A Grassi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria (PA), Italy
| | - A Budeyri
- Orthopaedics and Traumatology, SANKO University, Gaziantep, Turkey
| | - G M Marcheggiani Muccioli
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy.,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria (PA), Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy
| | - F Raggi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - L Bragonzoni
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy
| | - N Lopomo
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Ingegneria dell'Informazione, Università degli Studi di Brescia, Brescia (BS), Italy
| | - M Marcacci
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy
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145
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Todor A, Predescu V, Codorean B, Prejbeanu R, Roman M, Fleaca R, Russu O, Bățagă T. Primary Anterior Cruciate Ligament Reconstruction. How Do We Do It? JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Anterior cruciate ligament (ACL) tears are frequently seen in current practice mostly affecting the young, active subjects, and usually require ligament reconstruction in order to restore normal knee kinematics. As worldwide interest in anatomic reconstruction grew over the last decade, we have also refined our technique in order to restore the anatomical function as near to the normal as possible. This anatomical restoration concept is believed to prevent the onset of osteoarthritis, which the non-anatomic reconstructions fail to attain. The knowledge gained from the ACL anatomy, function and kinematics has helped in developing the current anatomic methods of reconstruction, which take into account patient anatomy, the rupture pattern, as well as the comorbidities. We present our approach to anatomical single- and double-bundle ACL reconstruction.
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Affiliation(s)
- Adrian Todor
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vlad Predescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Codorean
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Prejbeanu
- “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| | - Mihai Roman
- “Victor Papillan” Faculty of Medicine, “Lucian Blaga” University, Sibiu, Str. Lucian Blaga nr. 2A 550169, Romania
| | - Radu Fleaca
- “Victor Papillan” Faculty of Medicine, “Lucian Blaga” University, Sibiu, Romania
| | - Octav Russu
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Tiberiu Bățagă
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
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146
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Guglielmetti LGB, Cury RDPL, Oliveira VMD, Camargo OPAD, Severino FR, Severino NR, Fucs PMDMB. TRANSTIBIAL VERSUS ANTEROMEDIAL PORTAL TECHNIQUES IN ACL RECONSTRUCTION. REV BRAS MED ESPORTE 2016. [DOI: 10.1590/1517-869220162205159722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Although the results of anterior cruciate ligament (ACL) reconstruction are well documented in many studies, with good to excellent outcomes in most cases, some issues like tunnel positioning are still discussed and studied. Objective: To compare the objective and subjective clinical outcomes of ACL reconstruction using the transtibial and anteromedial portal techniques. Methods: Prospective randomized study of 80 patients undergoing anterior cruciate ligament reconstruction by the same surgeon, with 40 patients operated by the transtibial technique and 40 by anteromedial portal technique. The patients, 34 in the transtibial group and 37 in the anteromedial portal group (nine dropouts), were reassessed during a 2-year follow-up period. The clinical assessment consisted of physical examination, KT-1000TM evaluation, Lysholm score, and objective and subjective International Knee Documentation Committee - IKDC scores. Results: Regarding the Lachman and pivot shift tests, we observed more cases of instability in the transtibial group, but with no statistical significance (p=0.300 and p=0.634, respectively). Regarding the anterior drawer test, the groups presented similar results (p=0.977). Regarding KT-1000TM evaluation, the mean results were 1.44 for the transtibial group and 1.23 for the anteromedial portal group, with no statistical significance (p=0.548). We separated the objective IKDC scores into two groups: Group 1, IKDC A, and Group 2, IKDC B, C, or D, with no statistical significance (p=0.208). Concerning the Lysholm score, the transtibial group had a mean score of 91.32, and the anteromedial portal group had a mean score of 92.81. The mean subjective IKDC scores were 90.65 for the transtibial group and 92.65 for the anteromedial portal group. Three re-ruptures were encountered in the transtibial group and three in the anteromedial portal group. Conclusions: There were no significant differences in the subjective and objective clinical assessments among patients submitted to anterior cruciate ligament reconstruction using the transtibial or anteromedial portal techniques.
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147
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Ferretti A, Monaco E, Ponzo A, Basiglini L, Iorio R, Caperna L, Conteduca F. Combined Intra-articular and Extra-articular Reconstruction in Anterior Cruciate Ligament-Deficient Knee: 25 Years Later. Arthroscopy 2016; 32:2039-2047. [PMID: 27157658 DOI: 10.1016/j.arthro.2016.02.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 01/29/2016] [Accepted: 02/02/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether an anterior cruciate ligament (ACL)-reconstructed knee with hamstring autograft has a greater incidence of degenerative changes when an extra-articular reconstruction is added and to determine the effect of the combined reconstruction on knee stability and function at long-term follow-up. METHODS For this retrospective study, patients who underwent ACL reconstruction between January 2002 and December 2003 were selected and classified into 2 groups, I and II. Group I consisted of patients operated by a standard ACL reconstruction, and group II consisted of patients in whom, owing to the presence of risk factors (severe pivot shift graded +++ or high-risk sports), an extra-articular reconstruction performed with ileo-tibial tract according to McIntosh as modified by Cocker Arnold technique, was used in conjunction with intra-articular ACL reconstruction. At final follow-up, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores were used. An arthrometric KT-1000 evaluation was done. Comparative weight-bearing radiographs were taken, including a skyline view for the patellofemoral joint and analyzed according to Fairbank, Kellgren, and IKDC classification. RESULTS Seventy-two of the 75 (96%) patients in group I and 68 of the 75 patients in group II were available at the final follow-up (minimum 10 years). Subjective scores improved significantly in both groups, with no significant difference. Objectively, the number of patients receiving C and D IKDC objective activity scores in group I (7/56; 12.5%) was significantly higher than in group II (0/60) (P = .01). Considering as a failure a side-to-side arthrometric difference more than 5 mm or a pivot shift test graded as ++ or +++, or any giving way episode occurring postoperatively, we found 8 cases in group I and no cases in group II (P = .01) despite the presence of risk factors that group I did not include. Radiologic evaluation showed less arthritic changes in group II in both tibiofemoral and patellofemoral joints. CONCLUSIONS On the basis of the results of this study, adding an extra-articular reconstruction to an anatomically placed intra-articular ACL reconstruction, followed by a modern rehabilitation protocol, does not increase the risk of osteoarthritis and may be able to reduce the rate of failure. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Andrea Ferretti
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy.
| | - Edoardo Monaco
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| | - Antonio Ponzo
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| | - Luca Basiglini
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| | - Raffaele Iorio
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| | - Ludovico Caperna
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| | - Fabio Conteduca
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
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148
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Caterev S, Nistor DV, Todor A. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With a Free Quadriceps Tendon Autograft. Arthrosc Tech 2016; 5:e1063-e1067. [PMID: 27909676 PMCID: PMC5124427 DOI: 10.1016/j.eats.2016.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/25/2016] [Indexed: 02/03/2023] Open
Abstract
Anatomic double-bundle anterior cruciate ligament (ACL) reconstruction aims to restore the 2 functional bundles of the ACL in an attempt to better reproduce the native biomechanics of the injured knee and promote long-term knee health. However, this concept is not fully accepted and is not performed on a standard basis. In addition, the superiority of this technique over the conventional single-bundle technique has been questioned, especially the long-term clinical results. One of the down sides of the double-bundle reconstruction is the complexity of the procedure, with increased risks, operative time, and costs compared with the single-bundle procedure. Also, the revision procedure, if necessary, is more challenging. We propose a technique that has some advantages over the traditional double-bundle procedure, using a single femoral tunnel, 2 tibial tunnels, and a free quadriceps tendon autograft.
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Affiliation(s)
| | | | - Adrian Todor
- Address correspondence to Adrian Todor, M.D., Ph.D., Department of Orthopaedics, Traumatology and Paediatric Orthopaedics, Iuliu Hatieganu University of Medicine and Pharmacy, Alexandru Radulescu Orthopaedic and Traumatology Clinic, 47 Traian Mosoiu Street, 400132 Cluj Napoca, Romania.Department of Orthopaedics, Traumatology and Paediatric OrthopaedicsIuliu Hatieganu University of Medicine and PharmacyAlexandru Radulescu Orthopaedic and Traumatology Clinic47 Traian Mosoiu Street400132 Cluj NapocaRomania
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149
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Abstract
Anterior cruciate ligament (ACL) reconstruction aims to restore the translational and rotational motion to the knee joint that is lost after injury. However, despite technical advancements, clinical outcomes are less than ideal, particularly in return to previous activity level. A major issue is the inability to standardize treatment protocols due to variations in materials and approaches used to accomplish ACL reconstruction. These include surgical techniques such as the transtibial and anteromedial portal methods that are currently under use and the wide availability of graft types that will be used to reconstruct the ACL. In addition, concomitant soft tissue injuries to the menisci and capsule are frequently present after ACL injury and, if left unaddressed, can lead to persistent instability even after the ACL has been reconstructed. Advances in the field of biomechanics that help to objectively measure motion of the knee joint may provide more precise data than current subjective clinical measurements. These technologies include extra-articular motion capture systems that measure the movement of the tibia in relation to the femur. With data gathered from these devices, a threshold for satisfactory knee stability may be established in order to correctly identify a successful reconstruction following ACL injury.
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150
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Sasaki Y, Chang SS, Fujii M, Araki D, Zhu J, Marshall B, Linde-Rosen M, Smolinski P, Fu FH. Effect of fixation angle and graft tension in double-bundle anterior cruciate ligament reconstruction on knee biomechanics. Knee Surg Sports Traumatol Arthrosc 2016; 24:2892-2898. [PMID: 25726160 DOI: 10.1007/s00167-015-3552-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the effect of graft fixation angle and tension in double-bundle anterior cruciate ligament (ACL) reconstruction on knee biomechanics. METHODS Fourteen cadaver knees were tested using a robotic system under two loadings: (1) an 89-N anterior tibial load (ATL) at full extension (FE), 15°, 30°, 45°, 60°, and 90°, and (2) combined 7 N m valgus and 5 N m internal tibial torques (simulated pivot-shift test) at FE, 15° and 30°. Four graft fixation angles and tensions were used for the anteromedial (AM) and posterolateral (PL) bundles, respectively: (Recon 1) 30°/20N and FE/20N, (Recon 2) 30°/30N and FE/10N, (Recon 3) 45°/20N and 15°/20N, and (Recon 4) 45°/30N and 15°/10N. RESULTS All fixation protocols closely restored the intact knee kinematics under ATL and simulated pivot-shift loading. For the AM bundle under ATL, the in situ force (ISF) with Recon 3 at the FE was significantly lower than that of the intact knee. For the PL bundle under ATL, the ISF with Recon 3 at the FE, 15° and 30° was significantly higher than that of the intact knee. In PL bundle under simulated pivot-shift loading, the ISF with Recon 1 and Recon 2 at FE was lower and the ISF of the PL bundle with Recon 3 at the 15° was higher than that of the intact knee. CONCLUSION The AM-45°/30N and PL-15°/10N fixation most closely matched intact knee kinematics; however, stabilizing the knee during anterior tibial translation may risk an imbalance of the AM and the PL bundle loading. The results indicate that ACL bundle forces may not be restored even if the clinical assessment shows good results with the Lachman test and pivot-shift test. This may alter the loading on other structures of the knee.
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Affiliation(s)
- Yusuke Sasaki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shih-Sheng Chang
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Masataka Fujii
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Daisuke Araki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Junjun Zhu
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brandon Marshall
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Monica Linde-Rosen
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA.
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA.
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