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Yapali G, Kürklü GB. Effects of the Graft Type Used for Anterior Cruciate Ligament Reconstruction on Isokinetic Muscle Strength and Quality of Life. J Knee Surg 2022; 35:858-861. [PMID: 33389734 DOI: 10.1055/s-0040-1721124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is no consensus about which graft type should be used in patients who will undergo anterior cruciate ligament (ACL) reconstruction so far. In this study, it was aimed to compare the quality of life, knee functions, and isokinetic muscle strength of patients who underwent ACL reconstruction with hamstring tendon (HT) and bone-tendon-bone (BTB) autografts. Total 40 patients with ACL reconstruction (20 in HT group and 20 in BTB group), at least 1 year after the operation, all injured during sports activity were included in this study. Flexor and extensor muscle groups of both affected and unaffected knees at angular velocities of 60 and 180 degrees/s were recorded. Lysholm knee score questionnaire and Short Form (SF)-36 were administered to all patients before the isokinetic tests. No statistically significant differences were found between the groups at any angular velocity in isokinetic evaluation. Furthermore, there was no statistically significant difference between the groups in regard to Lysholm score. However, there was a statistically significant difference between the groups in SF-36 physical function domain score (p < 0.01). The results demonstrated that the SF-36 questionnaire can easily be applied to this patient population. There was only one significant difference in the SF-36 physical function component scores between the two groups. The quality of life, knee functions, and isokinetic muscle strength were similar in patients who underwent ACL reconstruction with HT and BTB.
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Affiliation(s)
- Gökmen Yapali
- Department of Physiotherapy and Rehabilitation, Meram Faculty of Health Science, Necmettin Erbakan University, Konya, Turkey
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Lubis AMT, Menkher MAR, Setyawan R. Medial patellofemoral ligament reconstruction using superficial layer of quadriceps tendon autograft: A case series of three patients. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Combined hamstrings and peroneus longus tendon for undersized graft in anterior cruciate ligament reconstruction: A report of two adolescence female patients. Int J Surg Case Rep 2020; 76:81-84. [PMID: 33017739 PMCID: PMC7533307 DOI: 10.1016/j.ijscr.2020.09.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/20/2020] [Indexed: 11/22/2022] Open
Abstract
Unpredictable graft size for anterior cruciate ligament reconstruction. Plan for graft augmentation is of great importance. Combined graft from hamstring and peroneus longus tendon for undersized graft.
Introduction Anterior cruciate ligament (ACL) rupture is a common injury in young and active population and reconstruction is the mainstay treatment to maintain stability of the knee. Hamstring tendon (HT) is the most popular graft for ACL reconstruction. In certain patient, particularly in women, the size of tendon graft to reconstruct the ACL is unpredictable. In the case of unqualified donor, we need a combined graft from another source to match the size requirement. Case presentation We present two cases of ACL reconstruction using combination of HT and PLT graft in adolescent female. We evaluate knee functional score and ankle donor site morbidity. In the second case we also did second look for the ACL graft integrity arthroscopically. This study has been reported in line with the Surgical Case Report (SCARE) criteria. Discussion One year after surgery, International Knee Documentation Committee (IKDC) score for both cases were improved and no ankle-donor site morbidity with good motoric power and 100% American Orthopedic Foot Ankle Score (AOFAS). Conclusion Additional peroneus longus tendon can be considered as an alternative in undersized hamstring tendon graft without significant donor site morbidity.
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Kuršumović K, Charalambous CP. Relationship of Graft Type and Vancomycin Presoaking to Rate of Infection in Anterior Cruciate Ligament Reconstruction. JBJS Rev 2020; 8:e1900156. [DOI: 10.2106/jbjs.rvw.19.00156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Salem HS, Kraeutler MJ, Carter AH, Tjoumakaris FP, Freedman KB. Anterior Cruciate Ligament Reconstruction in Young Females: A Systematic Review of Patellar Tendon Versus Hamstring Tendon Autografts. Orthopedics 2019; 42:e295-e304. [PMID: 30964537 DOI: 10.3928/01477447-20190403-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/27/2018] [Indexed: 02/03/2023]
Abstract
A systematic review was performed to compare patellar tendon-bone (BTB) and hamstring tendon (HS) autografts following anterior cruciate ligament reconstruction in young females, young patients, or females. One study compared BTB and HS in young females and found a lower rate of graft failure with BTB (P<.02). Of the 11 studies that made this comparison in females, 1 reported decreased laxity in females with BTB (P=.035). Of 4 studies comparing autografts in young patients, 1 reported a decreased rate of graft failure with BTB (P=.036). Further studies making this comparison specifically in young females are warranted. [Orthopedics. 2019; 42(3):e295-e304.].
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Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review. Br J Sports Med 2019; 53:1154-1161. [DOI: 10.1136/bjsports-2018-099982] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2019] [Indexed: 01/12/2023]
Abstract
ObjectiveTo describe the criteria used to clear athletes to return to sport (RTS) following primary ACL reconstruction.DesignScoping review.Data sourcesMEDLINE, Embase, CINAHL and SPORTDiscus electronic databases were searched using keywords related to ACL and RTS.Eligibility criteriaProspective or retrospective studies reporting at least one RTS criterion for athletes who had primary ACL reconstruction with an autograft.ResultsIn total, 209 studies fulfilled the inclusion criteria. RTS criteria were categorised into six domains: time, strength, hop testing, clinical examination, patient-report and performance-based criteria. From the 209 included studies, time was used in 178 studies (85%), and in 88 studies (42%) was the sole RTS criterion. Strength tests were reported in 86 studies (41%). Sixteen different hop tests were used in 31 studies (15%). Clinical examination was used in 54 studies (26%), patient report in 26 studies (12%) and performance-based criteria in 41 studies (20%).SummaryTime and impairment-based measures dominated RTS criteria, despite sport being a complex physical and biopsychosocial activity with demands across all aspects of function. Time was included as a criterion in 85% of studies, and over 80% of studies allowed RTS before 9 months. Whether RTS tests are valid—do they predict successful RTS?—is largely unknown.
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Mediouni M, R Schlatterer D, Madry H, Cucchiarini M, Rai B. A review of translational medicine. The future paradigm: how can we connect the orthopedic dots better? Curr Med Res Opin 2018; 34:1217-1229. [PMID: 28952378 DOI: 10.1080/03007995.2017.1385450] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/21/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Patients with complex medical and surgical problems often travel great distances to prestigious university medical centers in search of solutions and in some cases for nothing more than a diagnosis of their condition. Translational medicine (TM) is an emerging method and process of facilitating medical advances efficiently from the scientist to the clinician. Most established clinicians and those in training know very little about this new discipline. The purpose of this article is to illustrate TM in varied scientific, medical and surgical fields. MATERIALS AND METHODS Anecdotal events in medicine and orthopaedics based upon a practicing orthopaedic surgeon's training and clinical experience are presented. RESULTS TM is rapidly assuming a greater presence in the medical community. The National Institute of Health (NIH) recognizes this discipline and has funded TM projects. Numerous institutions in Europe and the USA offer advanced degrees in TM. Finally there is a European Society for Translational Medicine (EUTMS), an International Society for Translational Medicine, and an Academy of Translational Medical Professionals (ATMP). DISCUSSION The examples of TM presented in this article support the argument for the formation of more TM networks on the local and regional levels. The need for increased participation of researchers and clinicians requires further study to identify the economic and social impact of TM. CONCLUSIONS The examples of TM presented in this article support the argument for the formation of more TM networks on the local and regional levels. Financial constraints for TM can be overcome by pooling government, academic, private, and industry resources in an organized fashion with oversight by a lead TM researcher.
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Affiliation(s)
| | | | - Henning Madry
- c Saarland University Medical Center , Homburg , Germany
| | | | - Balwant Rai
- d JBR Health Education and Research Organization , Copenhagen , Denmark
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Jansson H, Narvy SJ, Mehran N. Perioperative Pain Management Strategies for Anterior Cruciate Ligament Reconstruction. JBJS Rev 2018. [DOI: 10.2106/jbjs.rvw.17.00059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ho-Eckart LK, Seki M, Luizza LM, Kearney MT, Lopez MJ. Joint stability after canine cranial cruciate ligament graft reconstruction varies among femoral fixation sites. Vet Surg 2017; 46:213-225. [PMID: 28075493 DOI: 10.1111/vsu.12609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 09/29/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To quantify stability in cranial cruciate ligament (CrCL) deficient canine stifles with hamstring grafts affixed at 3 femoral locations. STUDY DESIGN Canine stifle motion study using a multi-cohort, repeated measures design. SAMPLE POPULATION 27 canine cadaver stifles. METHODS Hamstring grafts (HG) were affixed at the gracilis-semitendinosus insertion and on the lateral femur (1) proximal trochlear ridge (TR), (2) craniodistal to fabella (F), or (3) condyle center (CC). Total, cranial, and caudal tibial translation and total, medial, and lateral angular displacement, with and without translational load, were quantified with the CrCL intact, transected, and reconstructed. Angular displacement was quantified from points on the distal femur and proximal tibia. Graft strain was calculated from tissue displacement measured at joint angles of 30°, 60°, 90°, and 120°. RESULTS Tibial translation was lowest in F constructs, which also achieved the least difference in tibial translation from intact stifles. Tibial translation was lower in intact stifles than in CrCL transected or reconstructed stifles. Less angular displacement of the proximal tibia was detected in the medial than in the lateral direction, and tibial displacement was lower in the cranial than the caudal direction. Angular displacement was lowest in the F treatment group. F constructs had the lowest graft strain at joint angles greater than 30°. CONCLUSIONS Femoral fixation of a canine hamstring graft craniodistal to the lateral fabella conferred the best joint stability and lowest graft strain in vitro. No fixation method restored joint stability of the intact CrCL.
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Affiliation(s)
- Louisa K Ho-Eckart
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Masahiro Seki
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Lindsey M Luizza
- School of Medicine, New Orleans Health Sciences Center, Louisiana State University, Baton Rouge, Louisiana
| | - Michael T Kearney
- Statistical Services Unit, Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Mandi J Lopez
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
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Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction. J Orthop Sci 2015; 20:854-60. [PMID: 26113009 DOI: 10.1007/s00776-015-0744-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 06/04/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND In some situations, harvested hamstring tendon grafts are not qualified for anterior cruciate ligament (ACL) reconstruction. This study aimed to present a reinforcing method with additional half peroneus longus tendon (half-PLT) graft augmentation. METHODS Eight cases underwent ACL reconstruction with unqualified hamstring tendon grafts (diameter <7 mm) and were salvaged by additional half-PLT graft augmentation. The pivot shift test and KT-1000 tests were performed 3 years after surgery. Functional evaluation of subjective International Knee Documentation Committee (IKDC) and Lysholm scores was also done. In addition, Foot and Ankle Disability Index (FADI) scores were used to evaluate the function of the ankle donor site. RESULTS The diameter of unqualified four-strand hamstring tendon grafts was 6.2 mm on average (range, 6.0-6.5 mm). The average diameter of hamstring grafts with half-PLT augmentation was 9.6 mm (range, 9.5-10.0 mm). The pivot shift test was negative in all patients. No significant differences between normal and abnormal knees were found by KT-1000. The average IKDC score was 86.0 (range, 83 to 89), and the average Lysholm score was 84.4 (range, 80-90). The average FADI score for the donor sites of half-PLT was 135.8 (range, 134-136). CONCLUSIONS Additional half-PLT can successfully and safely reinforce unqualified hamstring tendon grafts for ACL reconstruction.
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Bauer M, Feeley BT, Wawrzyniak JR, Pinkowsky G, Gallo RA. Factors affecting return to play after anterior cruciate ligament reconstruction: a review of the current literature. PHYSICIAN SPORTSMED 2014; 42:71-9. [PMID: 25419890 DOI: 10.3810/psm.2014.11.2093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anterior cruciate ligament reconstruction has been reported to produce normal or near-normal knee results in > 90% of patients. A recent meta-analysis suggested that, despite normal or near-normal knees, many athletes do not return to sports. Rates and timing of return to competitive athletics are quite variable depending on the graft type, the age of the patient, the sport, and the level of play. Even when athletes do return to play, often they do not return to their previous level. Graft failure, subjective physical factors, and psychological factors, including fear of reinjury and lack of motivation, appear to play a large role in patients' ability to return to sporting activities.
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Affiliation(s)
- Matthew Bauer
- Department of Orthopaedic Surgery, Pennsylvania State University College of Medicine, Hershey, PA
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Moon DK, Yoon CH, Park JS, Kang BJ, Cho SH, Jo HS, Hwang SC. Effect of anteromedial portal entrance drilling angle during anterior cruciate ligament reconstruction: a three-dimensional computer simulation. Yonsei Med J 2014; 55:1584-91. [PMID: 25323895 PMCID: PMC4205698 DOI: 10.3349/ymj.2014.55.6.1584] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. MATERIALS AND METHODS Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured. RESULTS In tunnels drilled at a coronal angle of 45°, an axial angle of 45°, and a sagittal angle of 45°, the mean femoral tunnel length was 39.5±3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4±2.6 mm. The tunnel length at a coronal angle of 30°, an axial angle of 60°, and a sagittal angle of 45°, was 34.0±2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7±1.3 mm, which was significantly shorter than the standard angle (p<0.001). CONCLUSION Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal.
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Affiliation(s)
- Dong Kyu Moon
- Department of Orthopaedic Surgery, Military Hospital, Hongcheon, Korea
| | - Chul Ho Yoon
- Department of Rehabilitation Medicine and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin Seung Park
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Bun Jung Kang
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Seong Hee Cho
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Ho Seung Jo
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Sun Chul Hwang
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea.
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Nishimori M, Deie M, Adachi N, Nakamae A, Ishifuro M, Ochi M. Simulated anterior cruciate ligament reconstruction using preoperative three-dimensional computed tomography. Knee Surg Sports Traumatol Arthrosc 2014; 22:1175-81. [PMID: 23824253 DOI: 10.1007/s00167-013-2584-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 06/24/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to ascertain the ideal far anteromedial portal location to avoid damaging the medial femoral condyle in anterior cruciate ligament (ACL) reconstruction. METHODS Forty patients received preoperative computed tomography (CT) scans at 120° of knee flexion. Three-dimensional CT (3D CT) reconstruction of the knee was performed using volume rendering. The insertion of anteromedial (AM) and posterolateral bundle of ACL of the femur was marked on the 3D CT. A line (Line A) was drawn 8-mm proximal and parallel to the anterior ridge of the medial tibial plateau. A tangential line to the medial femoral condyle was drawn from the AM position that was already marked to Line A. The length from the intersection of the lines to the medial edge of the patellar tendon was measured. RESULTS In all 40 patients, the mean length between the medial edge of the patellar tendon and the far anteromedial portal was 27.5 ± 0.7 mm (range 19.8-34.5). In men 29.5 ± 0.7 mm (range 25-34.5); 28.7 ± 0.8 mm in the shorter group (height ≤ 170 cm) and 30.1 ± 1.2 mm in the taller group (height ≥ 170 cm). In women 25.5 ± 1.0 mm (range 19.8-30.5); 22.9 ± 1.0 mm in the shorter group (height ≤ 158 cm) and 29.6 ± 0.5 mm in the taller group (height ≥ 158 cm). CONCLUSIONS An optimum far anteromedial portal position was proposed. Knowing the optimum location of the far anteromedial portal position before surgery allows the surgeons to perform more safety ACL reconstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Makoto Nishimori
- Programs for Applied Biomedicine, Division of Clinical Medical Science, Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan,
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Czuppon S, Racette BA, Klein SE, Harris-Hayes M. Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review. Br J Sports Med 2013; 48:356-64. [PMID: 24124040 DOI: 10.1136/bjsports-2012-091786] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND As one of the purposes of anterior cruciate ligament reconstruction (ACLR) is to return athletes to their preinjury activity level, it is critical to understand variables influencing return to sport. Associations between return to sport and variables representing knee impairment, function and psychological status have not been well studied in athletes following ACLR. PURPOSE The purpose of this review was to summarise the literature reporting on variables proposed to be associated with return to sport following ACLR. STUDY DESIGN Systematic review. METHODS Medline, EMBASE, CINAHL and Cochrane databases were searched for articles published before November 2012. Articles included in this review met these criteria: (1) included patients with primary ACLR, (2) reported at least one knee impairment, function or psychological measure, (3) reported a return to sport measure and (4) analysed the relationship between the measure and return to sport. RESULTS Weak evidence existed in 16 articles suggesting variables associated with return to sport included higher quadriceps strength, less effusion, less pain, greater tibial rotation, higher Marx Activity score, higher athletic confidence, higher preoperative knee self-efficacy, lower kinesiophobia and higher preoperative self-motivation. CONCLUSIONS Weak evidence supports an association between knee impairment, functional and psychological variables and return to sport. Current return to sport guidelines should be updated to reflect all variables associated with return to sport. Utilising evidence-based return to sport guidelines following ACLR may ensure that athletes are physically and psychologically capable of sports participation, which may reduce reinjury rates and the need for subsequent surgery.
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Affiliation(s)
- Sylvia Czuppon
- Program in Physical Therapy, Washington University School of Medicine, , St Louis, Missouri, USA
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Kraeutler MJ, Bravman JT, McCarty EC. Bone-patellar tendon-bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. Am J Sports Med 2013; 41:2439-48. [PMID: 23585484 DOI: 10.1177/0363546513484127] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone-patellar tendon-bone (BPTB) is a common autograft and allograft source used for anterior cruciate ligament (ACL) reconstruction. Although the failure rate is generally higher for allografts, donor site morbidity and anterior knee pain can be issues with BPTB autografts. Controversy exists regarding the functional outcomes, complications, and knee stability of these grafts, previous comparisons of which have been based on smaller samples of case series. PURPOSE To compare BPTB autografts to allografts for ACL reconstruction, specifically with regard to patient satisfaction, return to preinjury activity level, and postoperative functional outcomes. STUDY DESIGN Meta-analysis. METHODS A total of 76 studies published between 1998 and 2012, including a total of 5182 patients, were reviewed. It was not required for studies to be comparative in nature. Outcomes evaluated were graft rupture rate, return to preinjury activity level, overall and subjective International Knee Documentation Committee (IKDC), Lysholm, Tegner activity, Cincinnati Knee Rating System, pivot shift, and single-legged hop tests, as well as KT-1000 arthrometer side-to-side difference and presence of anterior knee pain. Summary odds ratios with 95% confidence intervals were calculated to compare BPTB autografts to allografts for each outcome. RESULTS Outcomes on subjective IKDC, Lysholm, Tegner, single-legged hop, and KT-1000 arthrometer were statistically significantly in favor of autografts. Return to preinjury activity level, overall IKDC, pivot shift, and anterior knee pain were significantly in favor of allografts, although allograft BPTB demonstrated a 3-fold increase in rerupture rates compared with autograft (12.7% vs 4.3%). There was no significant difference between the 2 groups for Cincinnati Knee scores. CONCLUSION Patients undergoing ACL reconstruction with BPTB autografts demonstrate lower rates of graft rupture, lower levels of knee laxity, and improved single-legged hop test results and are more generally satisfied postoperatively compared with patients undergoing reconstruction with allograft BPTB.
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Affiliation(s)
- Matthew J Kraeutler
- Matthew J. Kraeutler, BS, CU Sports Medicine, 311 Mapleton Avenue, Boulder, CO 80304.
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Effect of muscle preserved on tendon graft on intra-articular healing in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21:1862-8. [PMID: 22930192 DOI: 10.1007/s00167-012-2181-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/17/2012] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to determine the impact on intra-articular healing of muscle tissue retained on tendon grafts used for anterior cruciate ligament (ACL) reconstruction. METHODS In an animal study on 40 New Zealand rabbits, a semi-tendon/semi-muscle graft (SSG) and a total tendon graft (TTG) were individually harvested from the Achilles tendons in each animal. After transecting the ACLs in both knees of each rabbit, SSG and TTG were randomly used on bilateral sides of the knee for ACL reconstruction. After 2, 4, and 8 weeks, functional scoring, gross observations, and histological evaluations of the repaired knees were performed (each time point; n = 10). Biomechanical testing was conducted on remaining animals at 8 weeks (n = 10). RESULTS At 2, 4, and 8 weeks after surgery, there were no statistically significant differences in functional scores between the SSG group and TTG group (n.s.). As healing progressed, skeletal muscle on the SSG was gradually absorbed with a corresponding decrease in graft diameter, compared to TTG, at each time point (P < 0.001). However, healing and incorporation of the intra-articular graft in the SSG were more apparent than those in the TTG, based on histology. The vascularity and cellularity in the center of the sample were significantly greater in the SSG group than the TTG group at all the time points (P < 0.01). At 8 weeks, the SSG group's ultimate failure load, yield load, and elongation at failure were significantly less than for the TTG group (P < 0.01). There were no significant differences in stiffness between the two groups with biomechanical testing (n.s.). CONCLUSION Results of this study indicate that muscle left on tendon grafts promotes intra-articular healing and remodeling of the graft in a rabbit model. However, excessive amounts of retained skeletal muscle weaken tendon graft's strength for ACL reconstruction. Preserving small amounts of muscle on tendon grafts is feasible for improving the biological success of ACL reconstruction in humans.
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Double-bundle reconstruction results in superior clinical outcome than single-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21:1085-96. [PMID: 22673793 DOI: 10.1007/s00167-012-2073-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 05/22/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To compare the short- and long-term clinical outcomes of the double-bundle (DB) anterior cruciate ligament (ACL) reconstruction with those of single-bundle (SB) ACL reconstruction. METHODS An electronic search of the database PubMed (1966-September 2011), EMBASE (1984-September 2011), and Cochrane Controlled Trials Register (CENTRAL; 3rd Quarter, 2011) was undertaken to identify relevant studies. Main clinical outcomes were knee stability measurements including KT-1000 arthrometer measurement, Pivot shift test, and Lachman test, and clinical outcome measurements including International Knee Documentation Committee (IKDC), Lysholm knee score, Tegner activity score, and complications. RESULTS Eighteen studies were finally included in this meta-analysis, which were all classified as high risk of bias according to the Collaboration's recommended tool. It is seen that compared to SB ACL reconstruction, DB ACL reconstruction results in a KT-1000 arthrometer outcome 0.63 and 1.00 mm closer to the normal knee in a short- and long-term follow-up, respectively. Our results also reveal that DB-treated patients have a significantly higher negative rate of the pivot shift test (p < 0.00001 and = 0.006 in a short- and long-term follow-up, respectively) and Lachman test (n.s. and p < 0.0001 in a short- and long-term follow-up, respectively) compared to SB-treated patients. As for the clinical outcome measurements, a significant difference is found between SB versus DB ACL reconstruction regarding the IKDC (p = 0.006 and < 0.0001 in a short- and long-term follow-up, respectively) and complications (p = 0.03), while there is no significant difference between the two groups regarding Lysholm knee score (n.s.) and Tegner activity score (n.s.). CONCLUSION Overall, double-bundle ACL reconstruction yields better clinical outcomes when compared to single-bundle ACL reconstruction. LEVELS OF EVIDENCE II.
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Tibor LM, Long JL, Schilling PL, Lilly RJ, Carpenter JE, Miller BS. Clinical outcomes after anterior cruciate ligament reconstruction: a meta-analysis of autograft versus allograft tissue. Sports Health 2012; 2:56-72. [PMID: 23015924 PMCID: PMC3438864 DOI: 10.1177/1941738109347984] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical outcomes of autograft and allograft anterior cruciate ligament (ACL) reconstructions are mixed, with some reports of excellent to good outcomes and other reports of early graft failure or significant donor site morbidity. OBJECTIVE To determine if there is a difference in functional outcomes, failure rates, and stability between autograft and allograft ACL reconstructions. DATA SOURCES Medline, Cochrane Central Register of Controlled Trials (Evidence Based Medicine Reviews Collection), Cochrane Database of Systematic Reviews, Web of Science, CINAHL, and SPORTDiscus were searched for articles on ACL reconstruction. Abstracts from annual meetings of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America were searched for relevant studies. STUDY SELECTION INCLUSION CRITERIA FOR STUDIES WERE AS FOLLOWS: primary unilateral ACL injuries, mean patient age less than 41 years, and follow-up for at least 24 months postreconstruction. Exclusion criteria for studies included the following: skeletally immature patients, multiligament injuries, and publication dates before 1990. DATA EXTRACTION Joint stability measures included Lachman test, pivot-shift test, KT-1000 arthrometer assessment, and frequency of graft failures. Functional outcome measures included Tegner activity scores, Cincinnati knee scores, Lysholm scores, and IKDC (International Knee Documentation Committee) total scores. RESULTS More than 5000 studies were identified. After full text review of 576 studies, 56 were included, of which only 1 directly compared autograft and allograft reconstruction. Allograft ACL reconstructions were more lax when assessed by the KT-1000 arthrometer. For all other outcome measures, there was no statistically significant difference between autograft and allograft ACL reconstruction. For all outcome measures, there was strong evidence of statistical heterogeneity between studies. The sample size necessary for a randomized clinical trial to detect a difference between autograft and allograft reconstruction varied, depending on the outcome. CONCLUSIONS With the current literature, only KT-1000 arthrometer assessment demonstrated more laxity with allograft reconstruction. A randomized clinical trial directly comparing allograft to autograft ACL reconstruction is warranted, but a multicenter study would be required to obtain an adequate sample size.
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Affiliation(s)
| | - Joy L. Long
- Lancaster Orthopaedic Group, Lancaster, Pennsylvania
| | | | | | | | - Bruce S. Miller
- University of Michigan, Ann Arbor, Michigan
- Address correspondence to Bruce S. Miller, MD, MS, MedSport, Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106 (e-mail: )
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Abstract
Failure after anterior cruciate ligament reconstruction is a potentially devastating event that affects a predominantly young and active population. This review article provides a comprehensive analysis of the potential causes of failure, including graft failure, loss of motion, extensor mechanism dysfunction, osteoarthritis, and infection. The etiology of graft failure is discussed in detail with a particular emphasis on failure after anatomic anterior cruciate ligament reconstruction.
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Gobbi A, Mahajan V, Karnatzikos G, Nakamura N. Single- versus double-bundle ACL reconstruction: is there any difference in stability and function at 3-year followup? Clin Orthop Relat Res 2012; 470:824-34. [PMID: 21667181 PMCID: PMC3270186 DOI: 10.1007/s11999-011-1940-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite a number of studies comparing postoperative stability and function after anatomic double-bundle and single-bundle anterior cruciate ligament reconstruction (ACLR), it remains unclear whether double-bundle reconstruction improves stability or function. QUESTIONS/PURPOSES We therefore asked whether patients having single- and double-bundle ACLR using semitendinosus (ST) alone differed with regard to (1) postoperative stability; (2) ROM; and (3) five functional scores. METHODS We prospectively followed 60 patients with an isolated anterior cruciate ligament (ACL) injury. Thirty patients underwent single-bundle and 30 patients underwent double-bundle ACL reconstruction. Clinically we assessed stability and range of motion (ROM); anteroposterior stability was assessed by Rolimeter and rotational stability by a pivot shift test. Function was assessed by IKDC, Noyes, Lysholm, Marx, and Tegner activity scales. The minimum followup was 36 months (mean, 46.2 months; range, 36-60 months). RESULTS Residual anteroposterior laxity at 3 years postoperatively was similar in both groups: 1.4 ± 0.3 mm versus 1.4 ± 0.2 mm, respectively. We observed no difference in the pivot shift test. ROM was similar in both groups, although double-bundle patients required more physical therapy sessions to gain full ROM. IKDC, Noyes, Lysholm, Marx, and Tegner scores were similar at final followup. CONCLUSION Double-bundle reconstruction of the ACL did not improve function or stability compared with single-bundle reconstruction. LEVEL OF EVIDENCE Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alberto Gobbi
- Orthopaedic Arthroscopic Surgery International, Via Amadeo GA 24, 20133 Milano, Italy.
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Barber-Westin SD, Noyes FR. Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. PHYSICIAN SPORTSMED 2011; 39:100-10. [PMID: 22030946 DOI: 10.3810/psm.2011.09.1926] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To review anterior cruciate ligament (ACL) clinical studies to assess the objective functional criteria used to determine when patients can return to athletics postoperatively, and to determine the rates of reinjury to either knee when these criteria are applied. METHODS A literature search was conducted using the Medline database. The inclusionary criteria were the English language, publication between April 2001 and April 2011, original clinical trials, all levels of evidence, primary ACL reconstruction, skeletal maturity, minimum 2 years of follow-up, and ≥1 objective test used to allow release to sports activities. The exclusionary criteria were revision ACL reconstructions or dislocated knees; studies that specifically excluded patients with ACL graft failure or reinjuries; major concomitant procedures such as high tibial osteotomy, meniscus allograft, other knee ligament reconstructions; and case reports, abstracts, review articles, and technical notes. RESULTS Three objective criteria were used to allow release to sports activities. The most common were lower extremity muscle strength, followed by lower limb symmetry, and knee examination parameters of range of knee motion and effusion. Twelve studies listed 1 criterion for release to sports, 8 studies listed 2 criteria, and 1 study recommended 3 criteria. Failure rates of the ACL reconstructions ranged from 0% to 3% in 7 studies, from 4% to 6% in 6 studies, from 7% to 10% in 4 studies, and from 14% to 24% in 4 studies. There were no injuries in the contralateral ACL in 14 studies (67%); in the other 7 studies, contralateral injury was reported in 2% to 15% of patients. CONCLUSIONS Few objective functional criteria are used to determine when patients return to unrestricted sports activities. Clinically feasible recommendations are made for measurement of muscle strength, lower limb symmetry, lower limb neuromuscular control, and ligament function in patients who desire to return to athletics after ACL reconstruction. Future studies are required to determine whether the demonstration of normal lower limb function before return to sports is effective in reducing reinjury rates.
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Affiliation(s)
- Sue D Barber-Westin
- Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, OH, USA.
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Outcome of arthroscopic single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a preliminary 2-year prospective study. Arthroscopy 2010; 26:630-6. [PMID: 20434660 DOI: 10.1016/j.arthro.2009.09.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 09/03/2009] [Accepted: 09/09/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical results of arthroscopic single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS We designed a prospective study that included patients with an isolated ACL injury. From April 2004 to February 2007, of 147 patients who underwent ACL reconstruction, 113 were included in this study. We serially obtained clinical and radiologic data preoperatively and postoperatively. We compared preoperative data and data at 2 years postoperatively in patients who had undergone single-bundle ACL reconstruction versus patients who had undergone double-bundle ACL reconstruction. There were 50 single-bundle reconstructions and 63 double-bundle reconstructions. Anteroposterior stability was assessed objectively by anterior stress radiographs with the telos device (telos, Marburg, Germany) and the maximal manual test with the KT-2000 arthrometer (MEDmetric, San Diego, CA). Rotational stability was determined by lateral pivot-shift test. The clinical results were assessed by International Knee Documentation Committee and Orthopadische Arbeitsgruppe Knie scores and Tegner activity scale. In addition, we evaluated postoperative thigh circumference and range of motion. RESULTS Residual anteroposterior laxity determined at 2 years postoperatively by telos and KT-2000 was 1.74mm +/- 1.67mm and 1.79mm +/- 1.56mm, respectively, in the single-bundle reconstruction group and 1.63mm +/- 1.50mm and 1.61mm +/- 1.22mm, respectively, in the double-bundle reconstruction group. There were no statistically significant differences. For the lateral pivot-shift test done at 2 years postoperatively, there was no statistically significant difference. In addition, clinical results such as International Knee Documentation Committee score, Orthopadische Arbeitsgruppe Knie score, Tegner activity scale, thigh circumference, and range of motion showed no significant differences between the 2 groups. CONCLUSIONS Double-bundle reconstruction of the ACL by a method using 2 femoral tunnel and 2 tibial tunnels showed no differences in stability results or any other clinical aspects or in terms of patient satisfaction. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Siebold R, Benetos IS, Sartory N, He Z, Hariri N, Pässler HH. How to avoid the risk of intraoperative cartilage damage in anatomic four tunnel double bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2010; 18:64-7. [PMID: 19847403 DOI: 10.1007/s00167-009-0967-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 10/05/2009] [Indexed: 11/24/2022]
Abstract
Double bundle (DB) anterior cruciate ligament (ACL) reconstruction is technically demanding. In order to create four anatomical anteromedial (AM) and posterolateral (PL) bone tunnels many surgeons adopt new ways of tibial and femoral bone tunnel drilling. From surgical experience, these technical changes might increase the risk for intraoperative pitfalls. An intraoperative articular cartilage damage to the medial femoral condyle or the medial tibial plateau could be disastrous for the patient. It may be caused by an insufficient anteromedial portal technique for femoral AM and PL bone tunnel drilling or flat tibial AM or PL bone tunnel reaming. Potential pitfalls may be avoided by small modifications to the surgical technique. In this present technical note, a sequence of surgical steps are described, which may help to avoid articular cartilage damage to the medial femoral condyle and medial tibial plateau in anatomical four tunnel DB ACL reconstruction.
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Affiliation(s)
- Rainer Siebold
- ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115 Heidelberg, Germany.
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Stengel D, Klufmöller F, Rademacher G, Mutze S, Bauwens K, Butenschön K, Seifert J, Wich M, Ekkernkamp A. Functional outcomes and health-related quality of life after robot-assisted anterior cruciate ligament reconstruction with patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc 2009; 17:446-55. [PMID: 19132348 DOI: 10.1007/s00167-008-0700-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 11/24/2008] [Indexed: 01/12/2023]
Abstract
During a short period of time, surgical robots had been propagated for automated tunnel placement in anterior cruciate ligament (ACL) reconstruction. Clinical outcome data are currently unavailable. Between 2000 and 2003, 152 patients underwent ACL replacement with the assistance of the Computer Assisted Surgical Planning and Robotics system (CASPAR, OrtoMaquet, Germany) at our hospital. After minimal invasive pin placement in both the tibia and femur, computed tomography was used to register anatomical landmarks and to plan graft tunnel alignment. The robot was used to drill tibial and femoral tunnels in an outside-in fashion according to pre-operative planning. There was one procedure-specific Serious Adverse Event (i.e., an intraoperative transection of the posterior cruciate ligament). After IRB approval, all patients were invited for a follow-up examination. Data from 100 patients (35 women, 65 men, mean age 35 [SD 11] years, median follow-up 61 [range 42-77] months) form the basis of this report. Side-to-side differences in anterior laxity were measured with the KT-1000 arthrometer. Patient-centered outcomes included the Lysholm-Score, the lower extremity functional scale (LEFS), and the Short Form 36 (SF36). The mean KT-1000 side-to-side difference was 0.89 [95% confidence interval (CI) 0.52-1.26] mm. Eight and five patients had a positive Lachman and pivot shift test, respectively. The Lysholm-Score averaged 86 (95% CI 83-89) points. Excellent, good, fair, and poor outcomes were reported by 38, 32, 20, and 10 patients. The LEFS averaged 85 (95% CI 82-88) points. The mean SF36 Physical Component Score was 48.4 (95% CI 46.5-50.3), indicating residual deficits compared to the population norm. All tibial graft tunnels did not cross the Blumensaat line, but were placed slightly anterior to the optimal center of 42% reported in previous studies. Compared to literature data, robot-assisted ACL reconstruction with BTB grafts may lead to higher knee stability, but poorer functional outcomes. The immense additional efforts with the procedure did not pay off in a benefit to patients.
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Affiliation(s)
- Dirk Stengel
- Center for Clinical Research, Unfallkrankenhaus Berlin, Berlin, Germany.
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Heijne A, Ang BO, Werner S. Predictive factors for 12-month outcome after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 2008; 19:842-9. [PMID: 19508651 DOI: 10.1111/j.1600-0838.2008.00852.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is a lack of knowledge regarding predictive factors for a successful clinical outcome after an anterior cruciate ligament (ACL) reconstruction. The aim was to investigate pre-operative factors that may predict good outcomes as measured with the subscales Function in sports and recreation and Quality of life in Knee injury Osteoarthrithis Outcome Score (QOL-KOOS), one-leg hop test and Tegner Activity Scale 12 months after ACL reconstruction. Sixty-four patients, operated with either patellar or hamstring tendon graft, were included. Demographics, range of motion, anterior knee laxity, pivot shift, muscle-torques, anterior knee pain (AKP) and knee function were registered pre-operatively and used in a multiple regression model. Results show less degree of AKP and low influence on knee function to be the most important predictors for good outcome in Sport/Rec-KOOS (explained 31% of variances). Less AKP was in addition the most important predictor for QOL-KOOS (14%). Patellar-tendon graft, in favor of hamstring tendon graft, explained 8% of the improvement in the Tegner Activity Scale. In conclusion, a low degree of AKP was found to be the most important predictor for good clinical outcome 12 months after ACL reconstruction. Future studies, including psychological parameters, should use analyses that have the potential to control for independency between variables.
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Affiliation(s)
- A Heijne
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden.
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Li B, Wen Y, Wu H, Qian Q, Wu Y, Lin X. Arthroscopic single-bundle posterior cruciate ligament reconstruction: retrospective review of hamstring tendon graft versus LARS artificial ligament. INTERNATIONAL ORTHOPAEDICS 2008; 33:991-6. [PMID: 18654776 DOI: 10.1007/s00264-008-0628-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 04/23/2008] [Accepted: 05/24/2008] [Indexed: 11/25/2022]
Abstract
Our objective was to compare the results of reconstruction of isolated chronic posterior cruciate ligament (PCL) injury using a four-strand hamstring graft (4SHG) and a LARS artificial ligament. Thirty-six patients were divided into a 4SHG group (n = 15) and a LARS group (n = 21). The minimum follow-up time was two years. The outcome measures used were KT-1000 measurements, the International Knee Documentation Committee (IKDC) scoring system, Lysholm knee scoring scale and Tegner activity rating. Both groups improved significantly between the preoperative and postoperative assessment in terms of the knee laxity and functional examination (P < 0.01). Meanwhile, knee stability was significantly improved in the LARS group when compared with the 4SHG group (P < 0.05); this was also the case for the Lysholm, Tegner and IKDC scores (P < 0.05). Our study indicates that using a LARS ligament for PCL reconstruction was clinically more useful than using a 4SHG in the treatment of the PCL-deficient knee.
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Affiliation(s)
- Bin Li
- Department of Orthopaedic Surgery, Arthritis Institute Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China.
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Siebold R, Dehler C, Ellert T. Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 2008; 24:137-45. [PMID: 18237696 DOI: 10.1016/j.arthro.2007.11.013] [Citation(s) in RCA: 249] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Revised: 10/30/2007] [Accepted: 11/18/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE Biomechanical studies show increased anterior and rotational stability with double-bundle (DB) compared to single-bundle (SB) anterior cruciate ligament (ACL) reconstruction. The aim of this study was to evaluate the clinical results of four-tunnel DB ACL reconstruction. METHODS Seventy patients undergoing arthroscopic hamstring ACL reconstruction were prospectively randomized to DB (n = 35) or SB (n = 35) groups. Each bundle fixation was by means of a femoral EndoButton CL and a tibial biodegradable interference screw. Demographic data were comparable between groups, and the average age of all patients was 29 years. The average follow-up was 19 months for both groups and included a history, clinical evaluation with knee scores, and radiographs. RESULTS The subjective results were similar in groups. The subjective International Knee Documentation Committee (IKDC) 2000 score was 88 P for DB versus 90 P for SB; the Lysholm score was 90 P for DB versus 93 P for SB; and the Cincinnati knee score was 91 P for DB versus 92 P for SB. The objective IKDC was significantly higher for DB: 78% "A" (P < .000) and 19% "B" compared to 24% "A" and 68% "B" for SB. The average KT-1000 side-to-side difference was 1.0 mm for DB and 1.6 mm for SB (P = .054) and the pivot shift test was negative in 97% for DB (P = .01) and 71% for SB. The range of motion was comparable for both groups. CONCLUSIONS Our study shows a significant advantage in anterior and rotational stability as well as objective IKDC for four-tunnel DB ACL reconstruction compared to SB ACL reconstruction. The subjective Cincinnati knee score, the Lysholm score, and the subjective IKDC 2000 did not show any statistical difference for one or the other technique. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Rainer Siebold
- Orthopaedic Department, ARCUS Sportsclinic, Pforzheim, Germany.
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