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Vivekanantha P, Kahlon H, Hassan Z, Slawaska-Eng D, Abdel-Khalik H, Johnson J, de Sa D. Hamstring autografts demonstrate either similar or inferior outcomes to quadriceps or bone-patellar tendon-bone autografts in revision anterior cruciate ligament reconstruction: A systematic review of comparative studies. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39015051 DOI: 10.1002/ksa.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 06/26/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE To evaluate the clinical outcomes in patients undergoing revision anterior cruciate ligament reconstruction (r-ACLR) using hamstring tendon (HT) autografts with those using either quadriceps tendon (QT) or bone-patellar tendon-bone (BPTB) autografts or allografts. METHODS Three databases were searched on 8 August 2023. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details, patient-reported outcome measures (PROMs), rates of instability, failure and return to sport (RTS) were extracted. RESULTS Eleven studies comprising 859 patients were included in this review. Five studies compared HT and QT autografts. One study each reported greater IKDC scores (p = 0.04) and Tegner scores (p = 0.04) in the QT group, while one study each reported higher anterior translation (p = 0.04), rates of positive pivot shift (p = 0.03) and rates of failure (p = 0.03) in the HT group. Six studies compared HT and BPTB autografts with one study each reporting greater Lysholm scores (p = 0.02) and less side-to-side anterior laxity (p < 0.01) in the BPTB group. Two studies compared HT autografts with allografts with only one study reporting a faster time to RTS in the HT group than the allograft group (p < 0.001). All other comparisons were not significant. CONCLUSIONS HT autografts result in either similar or inferior outcomes in r-ACLR when compared to QT or BPTB autograft options. Allografts resulted in similar outcomes to HT autografts apart from greater time to RTS for r-ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Harjind Kahlon
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Zackariyah Hassan
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Hassaan Abdel-Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jansen Johnson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Sun B, Vivekanantha P, Khalik HA, Slawaska-Eng D, Kay J, Johnson J, de Sa D. Approximately half of pediatric or adolescent patients undergoing revision anterior cruciate ligament reconstruction return to the same level of sport or higher: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:181-195. [PMID: 38226741 DOI: 10.1002/ksa.12030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE To summarise the surgical techniques and clinical outcomes in paediatric and adolescent patients undergoing revision anterior cruciate ligament reconstruction (r-ACLR). METHODS Three databases (MEDLINE, PubMed and EMBASE) were searched from inception to 29 July 2023. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details, patient-reported outcome measures (PROMs), rates of instability, rupture and return to sport (RTS) were extracted. RESULTS Eight studies comprising 706 (711 knees) patients were included (48.7% female). The mean age at r-ACLR was 17.1 years (range: 16.5-18.0). Autografts (67.5%) were more common than allografts (32.2%) in revision, with bone-patellar tendon-bone (BPTB) being the most prevalent autograft source (59.6%). Bone grafts were used in seven patients (4.8% of 146 patients). The most common femoral and tibial fixation techniques were interference screws (37.6% and 38.1%, of 244 patients, respectively). The most common tunnelling strategy was anatomic (69.1% of 236 patients), and meniscus repairs were performed in 39.7% of 256 patients. The re-rupture rate was 13.0% in 293 patients. RTS at the same level or higher was 51.6% in 219 patients. The mean (SD) Lysholm score was 88.1 (12.9) in 78 patients, the mean (SD) Tegner score was 6.0 (1.6) in 78 patients, and the mean (SD) IKDC score was 82.6 (16.0) in 126 patients. CONCLUSION R-ACLR in paediatric and adolescent patients predominantly uses BPTB autografts and interference screw femoral and tibial fixation with concomitant meniscal procedures. Rates of re-rupture and RTS at the same level or higher were 13.0% and 51.6%, respectively. Information from this review can provide orthopaedic surgeons with a comprehensive understanding of the most commonly used operative techniques and their outcomes for revision ACLR in this population. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Bryan Sun
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Prushoth Vivekanantha
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hassaan A Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jansen Johnson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Vivekanantha P, Nedaie S, Hassan Z, Abdel Khalik H, Carsen S, Nagai K, Hoshino Y, de Sa D. Contralateral hamstring autografts do not provide benefit compared to ipsilateral hamstring autografts in primary or revision anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5641-5651. [PMID: 37864773 DOI: 10.1007/s00167-023-07597-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of primary or revision ACL reconstruction (ACLR) after contralateral hamstring autografts versus ipsilateral hamstring autograft harvest. METHODS Three databases (MEDLINE, PubMed and EMBASE) were searched from inception to April 27th, 2023 for studies investigating contralateral hamstring autografts in primary or revision ACLR. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, strength measures, patient-reported outcome measures (PROMs), and rates of positive Lachman test, positive pivot-shift test and graft rupture were extracted. PROMs included Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores. RESULTS Nine studies comprising 371 patients were included in this review. In primary ACLR, there were no significant differences between contralateral and ipsilateral groups in isokinetic hamstring torque in the non-ACLR limb or isokinetic quadriceps torque in both limbs when tested at 60, 90, 120 or 180 degrees/second. Isokinetic hamstring torque in the non-ACLR limb was significantly weaker in the contralateral group at six months for primary ACLR; however, these deficits did not persist. There were no significant differences in postoperative median Tegner scores and Lysholm scores between contralateral and ipsilateral groups in primary ACLR. There were no significant differences in postoperative median Tegner, mean Lysholm and IKDC scores between groups in revision ACLR. There were no significant differences in positive Lachman, positive pivot-shift and rupture rates in primary ACLR between groups. Rates of positive Lachman and pivot-shift were slightly higher in the contralateral than ipsilateral group for revision ACLR. CONCLUSION Contralateral hamstring autografts results in comparable muscle strength to ipsilateral hamstring autografts, with the exception of weaker hamstring strengths in the early postoperative period. Patient-reported outcome measures were similar between the two groups across both primary and revision ACLR, with rates of instability and failure being similar between groups for primary ACLR. Contralateral hamstring grafts do not provide additional benefit when compared to ipsilateral options for either primary or revision ACLR, and should be used only in select circumstances including insufficient ipsilateral hamstring grafts or situations where quadriceps or patella autografts are not optimal. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Soroush Nedaie
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Zackariyah Hassan
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St West, Hamilton, ON, L8S 4L8, Canada.
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Meena A, Farinelli L, Hoser C, Abermann E, Raj A, Hepperger C, Herbort M, Fink C. Revision ACL reconstruction using quadriceps, hamstring and patellar tendon autografts leads to similar functional outcomes but hamstring graft has a higher tendency of graft failure. Knee Surg Sports Traumatol Arthrosc 2023; 31:2461-2468. [PMID: 36266369 PMCID: PMC10183416 DOI: 10.1007/s00167-022-07200-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the differences in the patient-reported functional outcomes, and graft failure in revision ACL reconstruction using quadriceps tendon (QT), Hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts. METHODS Between 2010 and 2020, 97 patients who underwent revision ACL reconstruction (40 patients received a QT, 26 an HT and 31 a BPTB graft) met the inclusion criteria. Pre-injury and at 2-year postoperatively patients were evaluated for patient-reported functional outcomes; Lysholm knee score, Tegner activity level and VAS (visual analogue scale) for pain; and graft failure. Patient-reported outcomes and graft failure were compared between the QT, HT and BPTB groups. The patients with graft failure were not included for outcome analysis at 2-years of follow-up. RESULTS All three revision groups with QT, HT and BPTB autograft did not differ significantly in terms of age, sex, time from injury to surgery, concomitant injuries and single-stage or double-stage procedures (n.s.). No significant difference was found in the pre-injury patient-reported outcome; Lysholm knee score, Tegner activity and VAS for pain (n.s.) between the three groups. At the 2-year follow-up functional outcomes improved in all three groups and all the patients returned to pre-injury activity level; however, no significant difference was found in functional outcomes at the 2-year follow-up between the three groups (n.s.). Graft failure occurred in 4 (10%), 5 (19%) and 3 (10%) patients of QT, HT and BPTB groups, respectively. However, the rate of failure did not differ significantly between groups. CONCLUSION All three autografts (QT, HT and BPTB) demonstrated satisfactory patient-reported outcomes in revision ACL reconstruction. Compared with QT and BPTB grafts, HT graft showed a higher tendency for failure rates. With the increasing incidence of revision ACL reconstruction, surgeons should be aware of all the available graft options. The findings of this study will assist the surgeons in the graft selection for revision ACL reconstruction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amit Meena
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Christian Hoser
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
| | - Elisabeth Abermann
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
| | - Akshya Raj
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029 India
| | - Caroline Hepperger
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
| | - Mirco Herbort
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
- OCM Clinic, Munich, Germany
| | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
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Kiran M, Javed O, Roy S, Atwal N, Gosal H. Psychological, physical and social factors influence decision to return to sport after revision ACL reconstruction with BPTB graft. Knee Surg Sports Traumatol Arthrosc 2022; 30:1336-1340. [PMID: 33899128 DOI: 10.1007/s00167-021-06582-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE There is limited evidence in literature regarding the patient-reported factors that influence their return to sport (RTS) in revision anterior cruciate ligament reconstruction (ACLR). The medium-term results of a prospective consecutive cohort of patients undergoing single- and two-stage revision ACLR with bone patellar tendon bone graft (BPTB) and patient-reported factors that influence their decision to return to sport are presented in this study. METHODS Seventy-two patients were included in this prospective study. Single- or two-stage revision with BPTB graft was performed based on pre-operative planning. Iliac crest bone graft was used. Pre-operative and follow-up Lysholm and Tegner activity scores and RTS, level of sport and patient-reported factors affecting RTS were recorded. The mean follow-up was 9 years (SD 2.7 years). RESULTS Single-stage revision ACLR was performed in 61 patients. In 11 patients (15%), revision ACLR was performed in two stages. There was a significant improvement in Lysholm score from mean 51.1 to 86.7 (p < 0.001). The incidence of re-rupture in this cohort was 0%. The median Tegner score was 6 (range 2-9). Twenty-five patients (34.7%) did not return to any sport at final follow-up. Twenty-nine (40.2%) patients returned to their pre-injury level of sport. Fear of reinjury (79%, p < 0.001) and persistent knee symptoms (35.8%, p = 0.03) were the most common factors limiting RTS in non-returners. CONCLUSION Psychological and social factors may have an influence on RTS in addition to physical factors. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Manish Kiran
- Gloucestershire Hospitals NHS Foundation Trust, Sandford Rd, Cheltenham, GL53 7AN, UK.
| | - Omar Javed
- Gloucestershire Hospitals NHS Foundation Trust, Sandford Rd, Cheltenham, GL53 7AN, UK
| | - Saswata Roy
- Gloucestershire Hospitals NHS Foundation Trust, Sandford Rd, Cheltenham, GL53 7AN, UK
| | - Navraj Atwal
- Gloucestershire Hospitals NHS Foundation Trust, Sandford Rd, Cheltenham, GL53 7AN, UK
| | - Harminder Gosal
- Gloucestershire Hospitals NHS Foundation Trust, Sandford Rd, Cheltenham, GL53 7AN, UK
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Midttun E, Andersen MT, Engebretsen L, Visnes H, Fenstad AM, Gjertsen JE, Persson A. Good validity in the Norwegian Knee Ligament Register: assessment of data quality for key variables in primary and revision cruciate ligament reconstructions from 2004 to 2013. BMC Musculoskelet Disord 2022; 23:231. [PMID: 35264137 PMCID: PMC8908681 DOI: 10.1186/s12891-022-05183-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Norwegian Knee Ligament Register was founded in 2004 to provide representative and reliable data on cruciate ligament surgery. The aim of this study was to evaluate the validity of key variables in the Norwegian Knee Ligament Register to reveal and prevent systematic errors or incompleteness, which can lead to biased reports and study conclusions. Method We included a stratified cluster sample of 83 patients that had undergone both primary and revision anterior cruciate ligament surgery. A total of 166 medical records were reviewed and compared with their corresponding data in the database of the Norwegian Knee Ligament Register. We assessed the validity of a selection of key variables using medical records as a reference standard to compute the positive predictive values of the register data for the variables. Results The positive predictive values for the variables of primary and revision surgery ranged from 92 to 100% and from 39 to 100% with a mean positive predictive value of 99% and 88% respectively. Data on intraoperative findings and surgical details had high positive predictive values, ranging from 91 to 100% for both primary and revision surgery. The positive predictive value for the variable “date of injury” was 92% for primary surgeries but only 39% for revision surgeries. The positive predictive value for “activity at the time of injury” was 99% for primary surgeries and 52% for revisions. Conclusion Overall, the data quality of the key variables examined in the Norwegian Knee Ligament Register was high, making the register a valid source for research. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05183-2.
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Affiliation(s)
- Espen Midttun
- Department of Neurology, Førde Central Hospital, Svanehaugvegen 2, 6812, Førde, Norway.
| | | | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Håvard Visnes
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Orthopaedic Surgery, The Norwegian Knee Ligament Register, Haukeland University Hospital, Bergen, Norway.,Department of Orthopaedics, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Anne Marie Fenstad
- Department of Orthopaedic Surgery, The Norwegian Knee Ligament Register, Haukeland University Hospital, Bergen, Norway.,The Norwegian National Advisory Unit On Arthroplasty and Hip Fractures, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jan-Erik Gjertsen
- The Norwegian National Advisory Unit On Arthroplasty and Hip Fractures, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Andreas Persson
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Orthopaedic Surgery, The Norwegian Knee Ligament Register, Haukeland University Hospital, Bergen, Norway
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Winkler PW, Vivacqua T, Thomassen S, Lovse L, Lesniak BP, Getgood AMJ, Musahl V. Quadriceps tendon autograft is becoming increasingly popular in revision ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:149-160. [PMID: 33591370 PMCID: PMC8800889 DOI: 10.1007/s00167-021-06478-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/25/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate trends in revision anterior cruciate ligament reconstruction (ACL-R), with emphasis on intra-articular findings, grafts, and concurrent procedures. It was hypothesized that revision ACL-Rs over time show a trend toward increased complexity with increased use of autografts over allografts. METHODS This was a two-center retrospective study including patients undergoing revision ACL-R between 2010 and 2020. Demographic and surgical data including intra-articular findings and concurrent procedures were collected and compared for the time periods 2010-2014 and 2015-2020. All collected variables were compared between three pre-defined age groups (< 20 years, 20-30 years, > 30 years), right and left knees, and males and females. A time series analysis was performed to assess trends in revision ACL-R. RESULTS This study included 260 patients with a mean age of 26.2 ± 9.4 years at the time of the most recent revision ACL-R, representing the first, second, third, and fourth revision ACL-R for 214 (82%), 35 (14%), 10 (4%), and 1 (< 1%) patients, respectively. Patients age > 30 years showed a significantly longer mean time from primary ACL-R to most recent revision ACL-R (11.1 years), compared to patients age < 20 years (2.2 years, p < 0.001) and age 20-30 years (5.5 years, p < 0.05). Quadriceps tendon autograft was used significantly more often in 2015-2020 compared to 2010-2014 (49% vs. 18%, p < 0.001). A high rate of concurrently performed procedures including meniscal repairs (45%), lateral extra-articular tenodesis (LET; 31%), osteotomies (13%), and meniscal allograft transplantations (11%) was shown. Concurrent LET was associated with intact cartilage and severely abnormal preoperative knee laxity and showed a statistically significant and linear increase over time (p < 0.05). Intact cartilage (41%, p < 0.05), concurrent medial meniscal repairs (39%, p < 0.05), and LET (35%, non-significant) were most frequently observed in patients aged < 20 years. CONCLUSION Quadriceps tendon autograft and concurrent LET are becoming increasingly popular in revision ACL-R. Intact cartilage and severely abnormal preoperative knee laxity represent indications for LET in revision ACL-R. The high rate of concurrent procedures observed demonstrates the high surgical demands of revision ACL-R. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Philipp W. Winkler
- grid.21925.3d0000 0004 1936 9000Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA 15203 USA ,grid.15474.330000 0004 0477 2438Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Thiago Vivacqua
- grid.39381.300000 0004 1936 8884Department of Orthopedic Surgery, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - Stephan Thomassen
- grid.39381.300000 0004 1936 8884Department of Orthopedic Surgery, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - Lisa Lovse
- grid.39381.300000 0004 1936 8884Department of Orthopedic Surgery, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - Bryson P. Lesniak
- grid.21925.3d0000 0004 1936 9000Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA 15203 USA
| | - Alan M. J. Getgood
- grid.39381.300000 0004 1936 8884Department of Orthopedic Surgery, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, 15203, USA.
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Marmura H, Bryant DM, Birmingham TB, Kothari A, Spindler KP, Kaeding CC, Spalding T, Getgood AMJ. Same knee, different goals: patients and surgeons have different priorities related to ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:4286-4295. [PMID: 33876273 DOI: 10.1007/s00167-021-06550-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The priorities of patients should be shared by those treating them. Patients and surgeons are likely to have different priorities surrounding anterior cruciate ligament reconstruction (ACLR), with implications for shared decision-making and patient education. The optimal surgical approach for ACLR is constantly evolving, and the magnitude of treatment effect necessary for evidence to change surgical practice is unknown. The aim of this study was to determine (1) the priorities of surgeons and patients when making decisions regarding ACLR and (2) the magnitude of reduction in ACLR graft failure risk that orthopaedic surgeons require before changing practice. METHODS This study followed a cross-sectional survey design. Three distinct electronic surveys were administered to pre-operative ACLR patients, post-operative ACLR patients, and orthopaedic surgeons. Patients and surgeons were asked about the importance of various outcomes and considerations pertaining to ACLR. Surgeons were asked scenario-based questions regarding changing practice for ACLR based on new research. RESULTS Surgeons were more likely to prioritize outcomes related to the surgical knee itself, whereas patients were more likely to prioritize outcomes related to their daily lifestyle and activities. Knee instability and risk of re-injury were unanimous top priorities among all three groups. A mean relative risk reduction in ACLR graft failure of about 50% was required by orthopaedic surgeons to change practice regardless of the type of change, or patient risk profile. CONCLUSION There are discrepancies between the priorities of surgeons and patients, and orthopaedic surgeons appear resistant to changing practice for ACLR. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
| | - Dianne M Bryant
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Trevor B Birmingham
- Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Wolf Orthopaedic Biomechanics Lab, Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
| | - Anita Kothari
- Faculty of Health Sciences, Western University, London, ON, Canada
| | | | | | - Tim Spalding
- Department of Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Alan M J Getgood
- Faculty of Health Sciences, Western University, London, ON, Canada.
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada.
- Bone and Joint Institute, Western University, London, ON, Canada.
- Lawson Research, London Health Sciences Centre, London, ON, Canada.
- Department of Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada.
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蒋 艳, 王 健, 王 永, 刘 佳, 裴 殷, 刘 晓, 敖 英, 马 勇. [Mid-to-long term clinical outcomes and predictors after anterior cruciate ligament revision]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:857-864. [PMID: 34650285 PMCID: PMC8517684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Indexed: 08/20/2024]
Abstract
OBJECTIVE To assess the mid-to-long term clinical outcomes after anterior cruciate ligament (ACL) revision surgery and to analyze their predictors. METHODS The medical records of 235 patients undergoing ACL revision surgery between Jan. 2001 and Dec. 2015 at Department of Sports Medicine, Peking University Third Hospital were reviewed. Data were collected including demographic information, information related to revision surgery (time and cause of graft failure, date of revision surgery, surgical technique, combined injuries and management, etc.), as well as information related to primary ACL reconstruction (time, cause and mechanism of first-time ACL rupture, date of primary ACL reconstruction, surgical technique, combined injuries and management, etc.). Patients were followed up at least 2 years after revision surgery for clinical outcomes [Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) subjective knee score]. Post-revision surgeries on the involved knee and the contralateral knee joint were also documented. Multivariate regression model was used to analyze the predictors of clinical outcomes after ACL revision surgery. RESULTS A total of 166 (70.63%) patients were followed up at a mean of (4.44±2.40) years (2.03-14.63 years). Clinical outcomes improved significantly at the last follow-up from pre-operative level, with the Lysholm, Tegner, and IKDC scores improving from 70.51±21.25, 3.39±1.77, 63.78±15.04 to 88.64±14.36, 4.67±1.739, 80.23±13.31 (P < 0.05), respectively. Three (1.81%) patients experienced infection while 39 (23.49%) patients underwent surgery after revision surgery during the follow-up. Compared with that those occurred during sports, graft failure that occurred during daily activities or due to surgical technical errors that led to poorer clinical outcomes, with the Lysholm, Tegner, and IKDC scores of 9.90 (95%CI: 1.49-18.31), 1.41 (95%CI: 0.10-2.72), 10.35 (95%CI: 0.17-20.54), and 8.53 (95%CI: 1.31-15.75), 1.28 (95%CI: 0.14-2.43), 9.39 (95%CI: 1.03-17.74) lower, respectively. Compared with antero-medial portal, transtibial technique for placement of the femoral bone tunnel showed poorer Lysholm scores of 11.18 (95%CI: 4.73-17.63, P=0.001). Concurrent repair of medial meniscus yielded higher IKDC scores of 11.06 (95%CI: 1.21-20.92, P=0.029) than those with intact medical meniscus. Other factors showed no significant effect. CONCLUSION ACL revision surgery is able to restore knee stability and improve knee function. Graft failure caused by sports, concurrent repair of medical meniscus and antero-medial portal technique predicts better outcomes after revision surgery.
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Affiliation(s)
- 艳芳 蒋
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 健 王
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 永健 王
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 佳 刘
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 殷 裴
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 晓鹏 刘
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 英芳 敖
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 勇 马
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
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蒋 艳, 王 健, 王 永, 刘 佳, 裴 殷, 刘 晓, 敖 英, 马 勇. [Mid-to-long term clinical outcomes and predictors after anterior cruciate ligament revision]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:857-864. [PMID: 34650285 PMCID: PMC8517684 DOI: 10.19723/j.issn.1671-167x.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the mid-to-long term clinical outcomes after anterior cruciate ligament (ACL) revision surgery and to analyze their predictors. METHODS The medical records of 235 patients undergoing ACL revision surgery between Jan. 2001 and Dec. 2015 at Department of Sports Medicine, Peking University Third Hospital were reviewed. Data were collected including demographic information, information related to revision surgery (time and cause of graft failure, date of revision surgery, surgical technique, combined injuries and management, etc.), as well as information related to primary ACL reconstruction (time, cause and mechanism of first-time ACL rupture, date of primary ACL reconstruction, surgical technique, combined injuries and management, etc.). Patients were followed up at least 2 years after revision surgery for clinical outcomes [Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) subjective knee score]. Post-revision surgeries on the involved knee and the contralateral knee joint were also documented. Multivariate regression model was used to analyze the predictors of clinical outcomes after ACL revision surgery. RESULTS A total of 166 (70.63%) patients were followed up at a mean of (4.44±2.40) years (2.03-14.63 years). Clinical outcomes improved significantly at the last follow-up from pre-operative level, with the Lysholm, Tegner, and IKDC scores improving from 70.51±21.25, 3.39±1.77, 63.78±15.04 to 88.64±14.36, 4.67±1.739, 80.23±13.31 (P < 0.05), respectively. Three (1.81%) patients experienced infection while 39 (23.49%) patients underwent surgery after revision surgery during the follow-up. Compared with that those occurred during sports, graft failure that occurred during daily activities or due to surgical technical errors that led to poorer clinical outcomes, with the Lysholm, Tegner, and IKDC scores of 9.90 (95%CI: 1.49-18.31), 1.41 (95%CI: 0.10-2.72), 10.35 (95%CI: 0.17-20.54), and 8.53 (95%CI: 1.31-15.75), 1.28 (95%CI: 0.14-2.43), 9.39 (95%CI: 1.03-17.74) lower, respectively. Compared with antero-medial portal, transtibial technique for placement of the femoral bone tunnel showed poorer Lysholm scores of 11.18 (95%CI: 4.73-17.63, P=0.001). Concurrent repair of medial meniscus yielded higher IKDC scores of 11.06 (95%CI: 1.21-20.92, P=0.029) than those with intact medical meniscus. Other factors showed no significant effect. CONCLUSION ACL revision surgery is able to restore knee stability and improve knee function. Graft failure caused by sports, concurrent repair of medical meniscus and antero-medial portal technique predicts better outcomes after revision surgery.
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Affiliation(s)
- 艳芳 蒋
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 健 王
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 永健 王
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 佳 刘
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 殷 裴
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 晓鹏 刘
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 英芳 敖
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 勇 马
- />北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京 100191Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
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