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Norris R, Kopkow C, McNicholas MJ. Interpretations of the dial test should be reconsidered. A diagnostic accuracy study reporting sensitivity, specificity, predictive values and likelihood ratios. J ISAKOS 2018. [DOI: 10.1136/jisakos-2018-000197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Slichter ME, Wolterbeek N, Auw Yang KG, Zijl JAC, Piscaer TM. Rater agreement reliability of the dial test in the ACL-deficient knee. J Exp Orthop 2018; 5:18. [PMID: 29900519 PMCID: PMC5999596 DOI: 10.1186/s40634-018-0131-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/17/2018] [Indexed: 01/13/2023] Open
Abstract
Background Posterolateral rotatory instability (PLRI) of the knee can easily be missed, because attention is paid to injury of the cruciate ligaments. If left untreated this clinical instability may persist after reconstruction of the cruciate ligaments and may put the graft at risk of failure. Even though the dial test is widely used to diagnose PLRI, no validity and reliability studies of the manual dial test are yet performed in patients. This study focuses on the reliability of the manual dial test by determining the rater agreement. Methods Two independent examiners performed the dial test in knees of 52 patients after knee distorsion with a suspicion on ACL rupture. The dial test was performed in prone position in 30°, 60° and 90° of flexion of the knees. ≥10° side-to-side difference was considered a positive dial test. For quantification of the amount of rotation in degrees, a measuring device was used with a standardized 6 Nm force, using a digital torque adapter on a booth. The intra-rater, inter-rater and rater-device agreement were determined by calculating kappa (κ) for the dial test. Results A positive dial test was found in 21.2% and 18.0% of the patients as assessed by a blinded examiner and orthopaedic surgeon respectively. Fair inter-rater agreement was found in 30° of flexion, κF = 0.29 (95% CI: 0.01 to 0.56), p = 0.044 and 90° of flexion, κF = 0.38 (95% CI: 0.10 to 0.66), p = 0.007. Almost perfect rater-device agreement was found in 30° of flexion, κC = 0.84 (95% CI: 0.52 to 1.15), p < 0.001. Moderate rater-device agreement was found in 30° and 90° combined, κC = 0.50 (95% CI: 0.13 to 0.86), p = 0.008. No significant intra-rater agreement was found. Conclusions Rater agreement reliability of the manual dial test is questionable. It has a fair inter-rater agreement in 30° and 90° of flexion.
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Affiliation(s)
- Malou E Slichter
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - K Gie Auw Yang
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - Jacco A C Zijl
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - Tom M Piscaer
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands. .,Department of Orthopaedic Surgery, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
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Forsythe B, Saltzman BM, Cvetanovich GL, Collins MJ, Arns TA, Verma NN, Cole BJ, Bach BR. Dial Test: Unrecognized Predictor of Anterior Cruciate Ligament Deficiency. Arthroscopy 2017; 33:1375-1381. [PMID: 28343807 DOI: 10.1016/j.arthro.2017.01.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 01/13/2017] [Accepted: 01/25/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of isolated anterior cruciate ligament (ACL) injury on tibial external rotation as measured by the dial test. METHODS Twenty-seven consecutive patients scheduled to undergo a primary ACL reconstruction were prospectively evaluated. Physical examination and magnetic resonance imaging findings were analyzed to exclude multiligamentous injury. The dial test was performed with the patient under anesthesia with a goniometer on both the affected and unaffected knees at 30° and 90°. Intraoperatively, the arthroscopic posterolateral corner gaps before reconstruction and after reconstruction were documented. Postoperatively, the dial test was again performed on both knees at 30° and 90°. RESULTS At 30°, there was a significantly larger dial test result in the affected knee before ACL reconstruction compared with after ACL reconstruction (27.6° vs 21.0°, P < .0001) and compared with the unaffected knee (27.6° vs 20.5°, P < .0001), but this difference was eliminated after reconstruction (21.0° vs 20.5°, P = .5089). At 90°, there was a significantly larger dial test result in the affected knee before ACL reconstruction compared with after ACL reconstruction (27.6° vs 21.1°, P < .0001) and compared with the unaffected knee (27.6° vs 20.9°, P < .0001), with this difference was eliminated after reconstruction (21.1° vs 20.9°, P = .7831). CONCLUSIONS Incompetence of the ACL accounts for nearly 7° of tibial external rotation found by the dial test. During examination of an injured knee, if the dial test is positive, an isolated ACL injury should not be excluded. Findings of the dial test should thus be interpreted with caution in the setting of ACL injury. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Brian Forsythe
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Bryan M Saltzman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Gregory L Cvetanovich
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michael J Collins
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas A Arns
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Lee HJ, Park YB, Ko YB, Kim SH, Kwon HB, Yu DS, Jung YB. The necessity of clinical application of tibial reduction for detection of underestimated posterolateral rotatory instability in combined posterior cruciate ligament and posterolateral corner deficient knee. Knee Surg Sports Traumatol Arthrosc 2015; 23:3062-9. [PMID: 24962801 DOI: 10.1007/s00167-014-3138-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the usefulness of tibial reduction during dial test for clinical detection of underestimated posterolateral rotatory instability (PLRI) in combined posterior cruciate ligament (PCL)-posterolateral corner (PLC) deficient knee in terms of external rotation laxity and clinical outcomes. METHODS Twenty-one patients who classified as grade I PLRI using dial test with subluxated tibia, but classified as grade II with tibial reduction evaluated retrospectively. The mean follow-up was 39.3 months (range 24-61 months). Each patient was evaluated by the following variables: posterior translation and varus laxity on radiograph, KT-1000 arthrometer, dial test (reduced and subluxated position), International Knee Documentation Committee, Orthopädische Arbeitsgruppe Knie scoring system and Tegner activity scale. RESULTS There were significant improvements in posterior tibial translation (8.6 ± 2.0 to 2.1 ± 1.0 mm; P < 0.001), varus laxity (3.3 ± 1.3 to 1.4 ± 0.5 mm; P < 0.001) and external rotation (13.2° ± 0.8° to 3.6° ± 1.1° at 30°, 13.3° ± 0.9° to 3.6° ± 0.9° at 90°; P < 0.001). The clinical scores were improved significantly at the last follow-up (P < 0.001). The external tibial rotation during dial test with tibial reduction increased from 6.8° ± 0.9 to 13.2° ± 0.8° at 30° of knee flexion, from 7.0° ± 0.8° to 13.3° ± 0.9° at 90° (P < 0.001). CONCLUSIONS The clinical application of reduction of posteriorly subluxated tibia during the dial test was essential for an appropriate treatment of underestimated PLRI in combined PCL-PLC deficient knee. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Han-Jun Lee
- Department of Orthopaedic Surgery, Chung-Ang University School of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, 135-710, Korea.
| | - Young-Bong Ko
- Department of Orthopaedic Surgery, Chung-Ang University School of Medicine, Seoul, Korea
| | - Seong-Hwan Kim
- Department of Orthopaedic Surgery, Chung-Ang University School of Medicine, Seoul, Korea
| | - Hyeok-Bin Kwon
- Department of Orthopaedic Surgery, Chung-Ang University School of Medicine, Seoul, Korea
| | - Dong-Seok Yu
- Department of Orthopaedic Surgery, Guro TnTn Hospital, Seoul, Korea
| | - Young-Bok Jung
- Department of Orthopaedic Surgery, Hyundae General Hospital, Namyangju-si, Korea
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Lee DW, Jang HW, Lee YS, Oh SJ, Kim JY, Song HE, Kim JG. Clinical, Functional, and Morphological Evaluations of Posterior Cruciate Ligament Reconstruction With Remnant Preservation: Minimum 2-Year Follow-up. Am J Sports Med 2014; 42:1822-31. [PMID: 24944294 DOI: 10.1177/0363546514536680] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous posterior cruciate ligament (PCL) reconstruction techniques have evolved and have revealed satisfactory outcomes; however, the optimal operative method for PCL reconstruction remains controversial. HYPOTHESIS Transtibial PCL reconstruction with a remnant preservation technique would result in successful clinical, radiological, functional, and morphological outcomes. In addition, it was hypothesized that the results of combined PCL and posterolateral corner (PLC) reconstruction would be comparable with those of isolated PCL reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 168 patients who underwent arthroscopic PCL reconstruction with or without reconstruction of the PLC between March 2006 and June 2011 were retrospectively reviewed. Ninety-two patients who met the inclusion criteria were enrolled, and 47 of 92 patients who underwent combined PCL and PLC reconstruction were evaluated as a subgroup. The PLC was reconstructed using the single fibular sling method. The patients were assessed by means of the Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score, and Tegner activity score. Stability was evaluated using a KT-2000 arthrometer and Telos device. Proprioception was assessed using the Biodex System. Follow-up magnetic resonance imaging (MRI) was performed in 34 patients, and second-look arthroscopic surgery was conducted in 36 patients. RESULTS The minimum follow-up duration was 24 months in all patients. Clinical outcomes and posterior instability improved significantly. The mean Lysholm score improved from 56.7 ± 7.1 to 89.3 ± 7.3, the mean IKDC subjective knee score improved from 53.3 ± 9.6 to 86.2 ± 6.1, and the mean Tegner activity score was 2.5 ± 0.8 preoperatively and 5.1 ± 1.3 postoperatively (all P < .001). The mean side-to-side difference on posterior stress radiography with the Telos device improved significantly, decreasing from 12.1 ± 2.5 mm to 2.7 ± 1.3 mm (P < .001). The mean side-to-side difference on varus stress radiography was reduced from 5.9 ± 0.8 mm preoperatively to 1.3 ± 1.0 mm after combined PCL and PLC reconstruction (P < .001). Postoperative proprioception recovered to a level similar to that of the uninvolved side, and MRI and second-look arthroscopic surgery showed a high rate of complete healing and synovialization in patients who underwent either isolated PCL reconstruction or combined PLC and PCL reconstruction. CONCLUSION Transtibial PCL reconstruction with remnant preservation resulted in satisfactory clinical, functional, radiological, and morphological outcomes. The results of combined posterolateral rotatory instability were comparable with those for isolated PCL reconstruction with adequate PLC reconstruction.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Hyoung Won Jang
- Department of Orthopedic Surgery, Chung Hospital, Seongnam, Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Bundang Hospital, Seoul National University, Seongnam, Korea
| | - Soo Jin Oh
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Jae Young Kim
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Han Eui Song
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
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Yang BS, Bae WH, Ha JK, Lee DW, Jang HW, Kim JG. Posterolateral corner reconstruction using the single fibular sling method for posterolateral rotatory instability of the knee. Am J Sports Med 2013; 41:1605-12. [PMID: 23720444 DOI: 10.1177/0363546513488866] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recently, posterolateral corner (PLC) reconstruction techniques have been developed based on an anatomic study of cadaveric dissections. However, the best operative method for various anatomic reconstructions remains controversial. HYPOTHESIS The anatomic single fibular sling method for PLC reconstruction would be sufficiently strong to control posterolateral rotatory instability without an additional tibial sling. STUDY DESIGN Case series; Level of evidence, 4. METHODS This retrospective cohort study analyzed 60 knees in 60 patients who underwent anatomic PLC reconstruction using the single fibular sling method with a tibialis anterior allograft, with a minimum follow-up period of 2 years. Ninety percent of the patients had concomitant reconstruction of one or both cruciate ligaments. Preoperative and postoperative dial test, varus stress test, and subjective clinical outcomes including Lysholm score, International Knee Documentation Committee (IKDC) subjective scores, and stress radiographs, including varus and posterior stress, were compared. In addition, intraoperative arthroscopic findings were analyzed. RESULTS The mean length of clinical follow-up was 35.6 months (range, 24-65 months). Forty-two (70%) patients showed no rotational instability postoperatively. Varus laxity improved, with 96.7% of the patients assessed as grade 0 or 1. The mean side-to-side difference in varus stress test was reduced from 2.32 ± 1.33 mm preoperatively to 0.37 ± 1.48 mm postoperatively. Posterior stress radiography in combined posterior cruciate ligament reconstruction showed a mean posterior tibial translation of 14.7 ± 2.83 mm preoperatively and 4.06 ± 1.40 mm at final follow-up. The Lysholm and IKDC subjective scores improved from 52 ± 6.7 to 87.7 ± 12.3 and from 44.8 ± 6.3 to 77.6 ± 14.2 (P < .001), respectively. There were no significant differences in clinical outcome or varus laxity between isolated PLC and combined injuries. CONCLUSION Anatomic PLC reconstruction using a single fibular sling method is an effective and relatively simple procedure for most patients with posterolateral rotatory instability, with the exception of those with severe multiple injuries.
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Affiliation(s)
- Byoung Se Yang
- Department of Orthopedic Surgery, Bundang Chuk Hospital, Gyeonggi-do, Korea
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Shen J, Zhang H, Lv Y, Hong L, Wang X, Zhang J, Feng H. Validity of a novel arthroscopic test to diagnose posterolateral rotational instability of the knee joint: the lateral gutter drive-through test. Arthroscopy 2013; 29:695-700. [PMID: 23375666 DOI: 10.1016/j.arthro.2012.10.031] [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: 04/14/2012] [Revised: 10/28/2012] [Accepted: 10/29/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the validity of a newly developed arthroscopic test, termed the lateral gutter drive-through (LGDT) test, to diagnose posterolateral rotational instability (PLRI) of the knee joint. METHODS Between October 2009 and February 2012, 115 consecutive patients were enrolled into this prospective diagnostic study. The dial test was used as the gold standard for diagnostic reference. According to the dial test, the patients were divided into a study group (35 patients) and a control group (80 patients). The LGDT test was performed on all patients during arthroscopic surgery. The sensitivity and specificity of the LGDT test were calculated. Sensitivities were also calculated in subgroups defined by injury patterns and extents of tibial external rotational instability. RESULTS The sensitivity and specificity of the LGDT test were calculated as 91.4% and 93.8%, respectively. In subgroup analyses the sensitivity of detection for acute PLRI was 90% versus 92% in chronic cases (P = .849). Popliteus femoral "peel-off" lesions were detected with a sensitivity of 100% versus 87.0% in cases of non-peel-off lesions (P = .536). The sensitivity of detecting isolated external rotational instability versus combined instability (rotational and varus) was 90.5% versus 92.8% (P = .805). The sensitivity of the LGDT test was correlated with the extent of tibial external rotational instability (P < .001). CONCLUSIONS This study showed that the LGDT test is a reliable method and can be used for diagnosing PLRI of the knee joint. The highest sensitivity was observed in patients with the femoral peel-off injury pattern. The sensitivity of the LGDT test was correlated with the extent of tibial external rotational instability and was significantly higher in patients with an increase in tibial external rotation by more than 10°. LEVEL OF EVIDENCE Level I, diagnostic study: testing of previously developed criteria in a series of consecutive patients.
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Affiliation(s)
- Jiewei Shen
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
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Dhillon M, Akkina N, Prabhakar S, Bali K. Evaluation of outcomes in conservatively managed concomitant Type A and B posterolateral corner injuries in ACL deficient patients undergoing ACL reconstruction. Knee 2012; 19:769-72. [PMID: 22424688 DOI: 10.1016/j.knee.2012.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 02/15/2012] [Accepted: 02/17/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is paucity of literature regarding the outcomes of ACL reconstruction in ACL deficient knees with concomitant Type A and Type B PLC injuries. MATERIALS AND METHODS A total of 102 patients undergoing isolated ACL reconstruction for an ACL injury were evaluated prospectively in this study. The patients with divided into three groups: group A with isolated ACL injury, group B1 with concomitant Type A PLC injury and group B2 with concomitant Type B PLC injury. The associated PLC injury in all these patients was managed conservatively. Outcome assessment was based on IKDC scores measured preoperatively and at last follow up visits. RESULTS The mean age of the patients was 25.33 years (16-38 years) with 95 males and seven females. The average follow up was almost 2.5 years (13-46 months). Group A had 88 patients while groups B1 and B2 had six and eight patients respectively. The preoperative IKDC scores were comparable for all the groups. The follow up IKDC scores were similar (statistically insignificant, p value: 0.421) for group A and group B1. Group B2 had poorer follow up IKDC scores as compared to group A and this result was found to be statistically significant (p value: 0.0001). CONCLUSION Conservative management of a concomitant Type B PLC injury adversely affects the outcomes of ACL reconstruction in these patients. Type A PLC injuries, on the other, do well without surgery and can be left as such even when associated with a concomitant ACL tear. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Mandeep Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh- 160 012, India
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Can wedge osteotomy correct depression of the lateral tibial plateau mimicking posterolateral rotatory knee instability? Clin Orthop Relat Res 2012; 470:986-92. [PMID: 21403986 PMCID: PMC3293977 DOI: 10.1007/s11999-011-1855-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The literature suggests rotatory knee instability (pseudolaxity) can be associated with depressions of the lateral tibial plateau in patients despite an intact arcuate ligament complex. Correcting this bone deformity by an open-wedge osteotomy of the lateral tibia plateau, elevating the depressed bone may restore knee stability. QUESTIONS/PURPOSES We therefore asked whether: (1) knee stability is restored after this procedure; (2) Lysholm functional scores improve after this treatment; and (3) the limb alignment changes. PATIENTS AND METHODS We retrospectively evaluated 12 patients who underwent a subchondral open-wedge osteotomy of the lateral tibial plateau combined with a knee arthroscopic procedure for the treatment of a knee rotational instability secondary to a lateral compartment bone deficit between 2000 and 2007. Eleven patients with a mean age of 35 years were available for followup at a minimum of 2 years (average, 5.4 years; range, 2-9 years). Preoperatively and at last followup, patients were clinically and radiographically evaluated by the Lysholm score and with comparative knee radiographs. Complications were recorded. RESULTS At last followup all patients rated their knees as stable. All osteotomies healed uneventfully. The Lysholm score improved from 62 to 87. Followup radiographs showed no changes in the femorotibial axis as result of the osteotomy. CONCLUSIONS Patients with chronic depression of the posterolateral tibial plateau may exhibit symptoms of posterolateral knee instability, a sort of pseudolaxity. In these patients, an open-wedge osteotomy of the lateral tibia plateau, elevating the depressed bone, and tensioning posterolateral structures improves this secondary posterolateral knee instability. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Kim JG, Lee YS, Kim NK. Comparison between Single and Dual Femoral Fixation for Anterior Cruciate Ligament Reconstruction with a Hamstring Autograft. Knee Surg Relat Res 2011; 23:159-63. [PMID: 22570828 PMCID: PMC3341833 DOI: 10.5792/ksrr.2011.23.3.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 04/24/2011] [Accepted: 04/28/2011] [Indexed: 01/10/2023] Open
Abstract
Purpose The purpose of this study was to evaluate dual fixation with different fixation mechanisms, determine the advantages, and compare the outcomes between single and dual femoral fixation. Materials and Methods From April 2004 to September 2007, 19 patients who received single femoral fixation and 22 patients who received dual femoral fixation were enrolled in the study. Single femoral fixation was performed using a cross-pin expansion mechanism. Dual femoral fixation was performed using a cross-pin expansion mechanism and an EndoButton CL loop suspensory mechanism. Results No significant differences were found in the incidence of cross-pin problems between the two groups (p=0.35-0.83) or in the stability assessment using a KT-2000 arthrometer and pivot shift test preoperatively (p=0.79 and 0.77, respectively) or postoperatively (p=0.89 and 0.75, respectively). In addition, no significant differences were detected between the two groups in the Lysholm, Tegner activity, or International Knee Documentation Committee knee scores preoperatively (p=0.07-0.47) or postoperatively (p=0.15-0.89). Conclusions This study showed that dual fixation with different fixation mechanisms was not advantageous over the single fixation mechanism. Outcomes using the dual femoral fixation mechanism were not superior to those using the single femoral fixation mechanism.
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Affiliation(s)
- Jin Goo Kim
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Lee YS, Ha JK, Kim YJ, Yang SJ, Lee MY, Kim JG. Comparative outcome analysis of malpositioned and properly positioned fixation groups after hamstring autograft ACL reconstruction with femoral cross-pin fixation. Knee 2011; 18:30-3. [PMID: 21036618 DOI: 10.1016/j.knee.2010.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 08/23/2010] [Accepted: 09/24/2010] [Indexed: 02/02/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction using soft tissue grafts has been gaining in popularity. Cross-pin fixation is used frequently, and its principle of fixation is an expansion mechanism. However, some malpositioned cases have been reported, and these malpositions may cause poor outcomes. Our aim was to compare the stability and clinical results between malpositioned and properly positioned cases. From November 2003 to December 2007, 41 patients were enrolled in this study. We divided these patients into malpositioned and properly positioned subgroups. The malpositioned group was defined by the presence of any finding among the following: posteriorly directed cross-pin to the posterior condylar line upon axial imaging, breakage upon coronal imaging, and outside-positioned cross-pin to the distal femoral posterior cortex upon sagittal imaging. We compared clinical and stability results between the two groups. Twenty-three patients were included in the properly positioned group, and 18 in the malpositioned group. The intra-class correlation coefficient for the intra- and inter-rater agreement ranged from 0.88 to 0.93 (0.88, 0.91, 0.91, and 0.93). No significant differences were found between the two groups in the stability assessment using a KT-2000 arthrometer and pivot-shift test (P=0.93 and 0.78, respectively). No significant differences were found between the two groups in the clinical knee scales (Ps=0.08-0.93). This study showed that some malpositions can occur with cross-pin femoral fixation. However, we obtained comparable good outcomes regardless of the fixation strategies if the initial fixation was correct.
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Affiliation(s)
- Yong Seuk Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ansan, Republic of Korea
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