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Rai P, Puri S, Gupta LM, Singh C, Ghai A, Mishra AK, Prasad M, Padhi PP, Shejale N, Pande A. Comparative study of functional outcomes of arthroscopic anterior cruciate ligament reconstruction using anteromedial portal and translateral all-inside technique. Med J Armed Forces India 2023; 79:S181-S188. [PMID: 38144650 PMCID: PMC10746831 DOI: 10.1016/j.mjafi.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Anterior Cruciate Ligament (ACL) injuries are common in the active population of the Armed Forces. Symptomatic instability prompts individuals to seek a cure or a sheltered appointment. Despite the increasing numbers of ACL reconstructions performed, the outcomes have not been so spectacular with only a meager percentage of our patients returning to preinjury levels of activity. With the premise that an all-inside ACL reconstruction is likely to result in better functional outcomes, the aim of this study was to compare the short-term functional outcomes of a large consecutive series of patients undergoing ACL reconstruction using the translateral all-inside ACL reconstruction technique (AI) and standard anteromedial portal technique (AM) with a minimum follow-up of one year. Methods A total of 240 patients with isolated ACL tear underwent ACL reconstruction via the AI or AM technique. Their preoperative and postoperative scores were compared to look for any significant differences in functional outcomes. Results The two groups were matched for age, BMI, mechanism of injury, and interval from injury to surgery. There was no difference in their preoperative scores. Postoperatively, although there were significant improvements across both groups, there was no significant difference between the groups at any point of time. Conclusion The AI technique has garnered interest in recent literature in addressing ACL injuries. This study found no discernible benefit of the AI technique when compared to the AM technique in terms of functionality following an ACL reconstruction at any point of time up to 1 year following surgery.
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Affiliation(s)
- Pankaj Rai
- Classified Specialist (Orthopaedics), 5 AFH, Air Force Station, Jorhat, India
| | - Sanjay Puri
- Classified Specialist (Orthopaedics), INHS, Asvini, Colaba, Mumbai, India
| | - Lalit Mohan Gupta
- Classified Specialist (Orthopaedics), Command Hospital (Western Command), Chandimandir, India
| | - Chandermohan Singh
- Senior Advisor (Orthopaedics), Command Hospital (Eastern Command), Kolkata, India
| | - Amresh Ghai
- Consultant (Orthopaedics), Base Hospital, Delhi Cantt, India
| | | | - Manish Prasad
- Associate Professor, Department of Orthopaedics, Armed Forces Medical College, Pune, India
| | | | - Naveen Shejale
- Classified Specialist (Orthopaedics), INHS, Asvini, Colaba, Mumbai, India
| | - Ashish Pande
- Classified Specialist (Orthopaedics), Base Hospital, Lucknow, India
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Delaloye JR, Hartog C, Blatter S, Schläppi M, Müller D, Schwenke T, Murar J, Koch PP. Biomechanical Comparison of Anterior Cruciate Ligament Reconstruction Using a Single-Bundle Round or Ribbon-like Hamstring Tendon Graft. Am J Sports Med 2023; 51:1162-1170. [PMID: 36917792 DOI: 10.1177/03635465231159069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Persistent instability of the knee is reported in up to 30% of patients after anterior cruciate ligament (ACL) reconstruction. Based on anatomic findings showing that ACL is a flat ribbon-like structure that twists during knee flexion, a new surgical ACL reconstruction technique using a ribbon-like graft has been developed. However the effect of this surgical technique on knee kinematics has not yet been evaluated. PURPOSE To compare the anteroposterior and rotational stability of the knee after ACL reconstruction using single-bundle (SB) round and ribbon-like grafts in anterolateral-intact/deficient knees. STUDY DESIGN Controlled laboratory study. METHODS Twelve human fresh-frozen cadaveric knees were tested with a 6 degrees of freedom robotic system. Internal rotation and anterior translation of the knee were recorded from 0° to 90° of flexion. A full kinematic assessment was performed in each of the following conditions: (1) intact knee, (2) after sectioning of the ACL, (3) after ACL reconstruction using a SB hamstring tendon graft in a round configuration and a ribbon-like configuration, and (4) after sectioning of the anterolateral structures. One-way analysis of variance and post hoc Tukey tests were used for statistical analyses. RESULTS When compared with the intact knee, the ACL-deficient knee demonstrated a mean ± SD increase in anterior translation and internal rotation of 6.3 ± 2.5 mm (P < .01) and 5.8°± 2.3° (P < .01), respectively. After ACL reconstruction using a SB ribbon-like graft, the mean difference in anterior translation and internal rotation as compared with the intact knee was -0.1 ± 1.5 mm (P = .842) and 0.0°± 1.1° (P = .999). These differences from the intact knee were also not significant after ACL reconstruction using a round graft (-0.1 ± 1.3 mm, P = .999; -0.5°± 1.5°, P = .401). In the ACL-reconstructed knee using either a ribbon-like or round graft, sectioning of the anterolateral structures did not induce a significant increase of anterior translation and internal rotation of the knee. CONCLUSION ACL reconstruction using a SB ribbon-like or round graft restored the kinematics of the intact knee at time zero. Secondary sectioning of the anterolateral structures in the ACL-reconstructed knee using both types of graft did not significantly affect the anterior translation and internal rotation of the knee. CLINICAL RELEVANCE This is the first biomechanical study on the new ACL reconstruction technique using a ribbon-like graft.
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Affiliation(s)
- Jean-Romain Delaloye
- Clinic of Orthopaedics and Traumatology, Department of Surgery, Kantonsspital, Winterthur, Switzerland
| | - Christoph Hartog
- Clinic of Orthopaedics and Traumatology, Department of Surgery, Kantonsspital, Winterthur, Switzerland
| | - Samuel Blatter
- Clinic of Orthopaedics and Traumatology, Department of Surgery, Kantonsspital, Winterthur, Switzerland
| | - Michel Schläppi
- Clinic of Orthopaedics and Traumatology, Department of Surgery, Kantonsspital, Winterthur, Switzerland
| | | | | | - Jozef Murar
- Twin Cities Orthopedics, Edina, Minnesota, USA
| | - Peter P Koch
- Clinic of Orthopaedics and Traumatology, Department of Surgery, Kantonsspital, Winterthur, Switzerland
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Borque KA, Laughlin MS, Pinheiro VH, Jones M, Williams A. Rebranding the 'anatomic' ACL reconstruction: Current concepts. J ISAKOS 2023; 8:23-28. [PMID: 36435433 DOI: 10.1016/j.jisako.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/03/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022]
Abstract
The anterior cruciate ligament (ACL) is a complex ribbon-like structure, which is approximately 3.5 times larger at the tibial and femoral insertions than at the midpoint. Accordingly, it is impossible to recreate with a single cylindrical graft. However, this has not stopped surgeons from using the term "anatomic" to describe multiple ACL reconstruction techniques inserting at a number of different locations within the original ACL footprint, causing confusion. The term "anatomic" should be discarded and replaced by an anatomic description of the tunnel placements on the tibia and femur. Current ACL reconstruction techniques cite anatomical studies that identified "direct and indirect fibres" of the ACL. The "direct fibres" bear 85-95% of the load and provide the main resistance to both anterior tibial translation and internal rotation/pivot shift. On the femur, these fibres insert in a line just posterior to the intercondylar ridge and comprise the portion of the ACL that surgeons should strive to restore. Placement of the graft just posterior to the intercondylar ridge creates a line of placement options from the anteromedial bundle to the "central" position and finally to the posterolateral bundle position. The authors prefer placing the femoral tunnel in the isometric anteromedial position and addressing a high-grade pivot shift at the IT-band with a lateral extra-articular tenodesis. As with the femoral tunnel, the native ACL footprint on the tibia is much larger than the ACL graft and thus can be placed in multiple "anatomic" locations. The authors prefer placement of the tibial tunnel in the anterior most position of the native footprint that does not cause impingement in the femoral notch. Additional research is needed to determine the ideal tunnel positions on the femur and tibia and validating the technique with patient outcomes. However, this cannot be accomplished without describing tunnel placement with specific anatomical locations so other surgeons can replicate the technique.
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Affiliation(s)
- Kyle A Borque
- Houston Methodist Hospital, Houston, TX, 77479, USA.
| | | | | | - Mary Jones
- Fortius Clinic, FIFA Medical Centre of Excellence, London, W1H 6EQ, UK
| | - Andy Williams
- Fortius Clinic, FIFA Medical Centre of Excellence, London, W1H 6EQ, UK
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Yela-Verdú C, Ares O, Albareda D, Oller B, Sallent A, Jornet-Gibert M, Amillo JR. Anterior Cruciate Ligament Reconstruction with Autologous Hamstring Single- versus Double-Bundle Graft: A Prospective Study with 10-Year Follow-up. J Knee Surg 2022. [PMID: 35820434 DOI: 10.1055/s-0042-1748898] [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
The purpose of the present study was to compare the clinical and subjective outcomes of anterior cruciate ligament (ACL) reconstruction using an autologous hamstring double bundle (DB) with a single bundle (SB) after a 10-year follow-up. A prospective comparative cohort study was performed of 47 consecutive patients with ACL rupture included between May 2006 and March 2008. Inclusion criteria were less than 2 years since the injury date, no previous surgery on the affected knee, and having closed growth plates. Patients were divided into two groups: (1) SB group (n = 25) and (2) DB group (n = 22). Patients underwent evaluation before surgery and at 1 and 10 years postoperatively. The clinical evaluation included the International Knee Documentation Committee (IKDC) Questionnaire, pivot shift test, and single hop test, as well as X-rays (anterior drawer X-rays on a Telos stress radiography). Range of motion (ROM) was assessed at 10-year follow-up. Both groups were similar in terms of baseline characteristics. Post hoc power analysis showed that among 30 and 226 patients would be needed for statistical significance, depending on the outcome. With the numbers available, no significant differences were observed in subjective IKDC, anterior stability (measured with Telos), and functional test outcomes (single hop test) between both groups at 1 and 10 years postoperatively. Regarding rotational instability (pivot-shift test), DB group was significantly superior (p = 0.002). Regarding ROM, no significant differences were observed between groups. No failure was registered in any of the groups. ACL reconstruction (ACLR) with an autologous hamstring, both with bundles and DB, shows overall better outcomes compared with the status before surgery. DB ACLR provides better rotational control of the knee, an outcome that is maintained after 10 years.
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Affiliation(s)
- Christian Yela-Verdú
- Department of Orthopedic Surgery and Traumatology, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Oscar Ares
- Department of Orthopedic Surgery and Traumatology, Hospital Clínic, Barcelona, Spain.,School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Albareda
- Department of Orthopedic Surgery and Traumatology, Clínica Albareda, Barcelona, Spain
| | - Bárbara Oller
- Department of Orthopedic Surgery and Traumatology, Hospital de Viladecans, Viladecans, Spain
| | - Andrea Sallent
- Department of Orthopedic Surgery and Traumatology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Juan R Amillo
- Department of Orthopedic Surgery and Traumatology, Hospital de Viladecans, Viladecans, Spain
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Kim BS, Kim JH, Park YB, Ro DH, Jung YB, Pujol N, Kim SH. No Differences In Clinical Outcomes Between Rectangular and Round Tunnel Techniques For Anterior Crucial Ligament Reconstruction. Arthroscopy 2022; 38:1933-1943.e1. [PMID: 34920009 DOI: 10.1016/j.arthro.2021.11.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes between conventional round tunnel and rectangular tunnel in anatomic anterior cruciate ligament (ACL) reconstruction. METHODS This was a retrospective comparative cohort study between March 2015 and September 2018. The primary ACL reconstructions using anteromedial portal technique with minimum of 2 years follow-up were enrolled for this study. The exclusion criteria were patients with revision ACL reconstruction, high tibial osteotomy, multiligament injuries, and associated fractures around the knee. Outcome measures included the subjective International Knee Documentation Committee score, Tegner activity score, knee laxity testing, and measurement of the centers of the femoral and tibial tunnels on postoperative computed tomography (CT) images. RESULTS Forty-seven patients with ACL reconstruction with rectangular tunnel (group 1) and 108 patients with ACL reconstructions with conventional rounded tunnel (group 2) were included consecutively. There were no significant differences between groups in terms of clinical scores or knee laxity, as well as femoral and tibial tunnel positions on CT. One patient in group 2 had ACL failure because of trauma and was treated with revision surgery. Two patients had incomplete tibial fracture, but they healed spontaneously and showed no residual laxity at final follow-up. The intraobserver and interobserver reliability for the radiological measurements ranged from 0.78 to 0.86. CONCLUSIONS There were no differences in radiological and clinical results between rectangular tunnel group and conventional round tunnel group for arthroscopic ACL reconstruction. ACL reconstruction with a rectangular tunnel could be considered as a reliable technique, but care should be taken during tunnel establishment because of risk of fractures and malposition of rectangular tunnel.
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Affiliation(s)
- Boo-Seop Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, South Korea
| | - Jong-Heon Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Du-Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Young-Bok Jung
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, South Korea
| | - Nicolas Pujol
- Orthopedic Department, Centre Hospitalier de Versailles (N.P.), Le Chesnay, France
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, South Korea.
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Musahl V, Nazzal EM, Lucidi GA, Serrano R, Hughes JD, Margheritini F, Zaffagnini S, Fu FH, Karlsson J. Current trends in the anterior cruciate ligament part 1: biology and biomechanics. Knee Surg Sports Traumatol Arthrosc 2022; 30:20-33. [PMID: 34927221 DOI: 10.1007/s00167-021-06826-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022]
Abstract
A trend within the orthopedic community is rejection of the belief that "one size fits all." Freddie Fu, among others, strived to individualize the treatment of anterior cruciate ligament (ACL) injuries based on the patient's anatomy. Further, during the last two decades, greater emphasis has been placed on improving the outcomes of ACL reconstruction (ACL-R). Accordingly, anatomic tunnel placement is paramount in preventing graft impingement and restoring knee kinematics. Additionally, identification and management of concomitant knee injuries help to re-establish knee kinematics and prevent lower outcomes and registry studies continue to determine which graft yields the best outcomes. The utilization of registry studies has provided several large-scale epidemiologic studies that have bolstered outcomes data, such as avoiding allografts in pediatric populations and incorporating extra-articular stabilizing procedures in younger athletes to prevent re-rupture. In describing the anatomic and biomechanical understanding of the ACL and the resulting improvements in terms of surgical reconstruction, the purpose of this article is to illustrate how basic science advancements have directly led to improvements in clinical outcomes for ACL-injured patients.Level of evidenceV.
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Affiliation(s)
- Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA.
| | - Gian Andrea Lucidi
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA.,IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rafael Serrano
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | | | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Freddie H Fu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Jon Karlsson
- The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Burkhart TA, Hoshino T, Batty LM, Blokker A, Roessler PP, Sidhu R, Drangova M, Holdsworth DW, Petrov I, Degen R, Getgood AM. No Difference in Ligamentous Strain or Knee Kinematics Between Rectangular or Cylindrical Femoral Tunnels During Anatomic ACL Reconstruction With a Bone-Patellar Tendon-Bone Graft. Orthop J Sports Med 2021; 9:23259671211009523. [PMID: 34179204 PMCID: PMC8202273 DOI: 10.1177/23259671211009523] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/04/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND As our understanding of anterior cruciate ligament (ACL) anatomy has evolved, surgical techniques to better replicate the native anatomy have been developed. It has been proposed that the introduction of a rectangular socket ACL reconstruction to replace a ribbon-shaped ACL has the potential to improve knee kinematics after ACL reconstruction. PURPOSE To compare a rectangular femoral tunnel (RFT) with a cylindrical femoral tunnel (CFT) in terms of replicating native ACL strain and knee kinematics in a time-zero biomechanical anatomic ACL reconstruction model using a bone-patellar tendon-bone (BTB) graft. STUDY DESIGN Controlled laboratory study. METHODS In total, 16 fresh-frozen, human cadaveric knees were tested in a 5 degrees of freedom, computed tomography-compatible joint motion simulator. Knees were tested with the ACL intact before randomization to RFT or CFT ACL reconstruction using a BTB graft. An anterior translation load and an internal rotation moment were each applied at 0°, 30°, 60°, and 90° of knee flexion. A simulated pivot shift was performed at 0° and 30° of knee flexion. Ligament strain and knee kinematics were assessed using computed tomography facilitated by insertion of zirconium dioxide beads placed within the substance of the native ACL and BTB grafts. RESULTS For the ACL-intact state, there were no differences between groups in terms of ACL strain or knee kinematics. After ACL reconstruction, there were no differences in ACL graft strain when comparing the RFT and CFT groups. At 60° of knee flexion with anterior translation load, there was significantly reduced strain in the reconstructed state ([mean ±standard deviation] CFT native, 2.82 ± 3.54 vs CFT reconstructed, 0.95 ± 2.69; RFT native, 2.77 ± 1.71 vs RFT reconstructed, 1.40 ± 1.76) independent of the femoral tunnel type. In terms of knee kinematics, there were no differences when comparing the RFT and CFT groups. Both reconstructive techniques were mostly effective in restoring native knee kinematics and ligament strain patterns as compared with the native ACL. CONCLUSION In the time-zero biomechanical environment, similar graft strains and knee kinematics were achieved using RFT and CFT BTB ACL reconstructions. Both techniques appeared to be equally effective in restoring kinematics associated with the native ACL state. CLINICAL RELEVANCE These data suggest that in terms of knee kinematics and graft strain, there is no benefit in performing the more technically challenging RFT as compared with a CFT BTB ACL reconstruction.
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Affiliation(s)
- Timothy A. Burkhart
- Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Takashi Hoshino
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
| | | | | | | | - Rajeshwar Sidhu
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
| | - Maria Drangova
- Robarts Research Institute, Western University, London, Ontario, Canada
| | | | - Ivailo Petrov
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Ryan Degen
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
| | - Alan M. Getgood
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
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Abdul W, Guro R, Jawad Z, Kotwal R, Chandratreya A. Clinical outcomes of primary anatomic all-inside Anterior Cruciate Ligament reconstruction using the TransLateral technique: A minimum one-year follow-up study. Knee 2020; 27:1753-1763. [PMID: 33197814 DOI: 10.1016/j.knee.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anatomic all-inside Anterior Cruciate Ligament (ACL) reconstruction using the TransLateral technique is relatively new. This technique utilises single tendon autograft and instruments permitting inside-to-out drilling to create retrograde sockets. Few studies have investigated clinical outcomes following this technique. We investigate clinical outcomes in patients who underwent primary anatomic all-inside ACL reconstruction using the TransLateral technique with a minimum one-year follow-up. METHODS Interrogation of our prospectively maintained database identified patients who underwent surgery from June 2013 to December 2017. Patients were followed up clinically and using patient-reported outcome measures (PROMS) including EQ-5D, KOOS, IKDC and Tegner scores from the National Ligament Registry. Paired two-tailed Student t-test was used to assess for clinical significance. RESULTS One hundred forty-one cases with a mean age of 30 years (range 16.0-60.2) and mean follow-up of 17.4 months (12.1-75.2) were included. Grafts included isolated quadrupled semitendinosus (n = 115) and both quadrupled semitendinosus and gracilis (n = 26). One hundred and two patients (72.3%) had complete peri-operative PROMS. Mean increases in EQ-5D VAS and IKDC scores were 18.9 and 29.2 points (p < 0.001). Significant peri-operative improvements were observed for all KOOS domains (p < 0.001). Median Tegner activity score increased by two levels (p < 0.001). Incidence of graft re-rupture was 5.7% (n = 8), all were following significant knee trauma and seven cases were mid-bundle femoral tunnel placements. CONCLUSIONS All-inside ACL reconstruction using the TransLateral technique demonstrates good clinical and functional outcomes with low complication and failure rate. Mid-bundle femoral tunnel placements have been abandoned in favour of placement deep within the anteromedial bundle footprint.
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Affiliation(s)
- Wahid Abdul
- Department of Trauma & Orthopaedics, Princess of Wales Hospital, Bridgend CF31 1RQ, Wales, United Kingdom.
| | - Randy Guro
- Department of Trauma & Orthopaedics, Princess of Wales Hospital, Bridgend CF31 1RQ, Wales, United Kingdom
| | - Zayd Jawad
- Department of Trauma & Orthopaedics, Princess of Wales Hospital, Bridgend CF31 1RQ, Wales, United Kingdom
| | - Rahul Kotwal
- Department of Trauma & Orthopaedics, Princess of Wales Hospital, Bridgend CF31 1RQ, Wales, United Kingdom
| | - Amit Chandratreya
- Department of Trauma & Orthopaedics, Princess of Wales Hospital, Bridgend CF31 1RQ, Wales, United Kingdom
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9
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Chernchujit B, Agrawal S, Sukhapradit B. Does the position of interference screw in tibial tunnel effect anatomic orientation in single bundle anterior cruciate ligament reconstruction? Asia Pac J Sports Med Arthrosc Rehabil Technol 2020; 22:15-19. [PMID: 33204646 PMCID: PMC7640898 DOI: 10.1016/j.asmart.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/24/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022] Open
Abstract
Background/objective The purpose of the study was to evaluate the change in orientation of the reconstructed ACL with the change in position of the interference screw in the tibial tunnel. Method It was a retrospective review of Magnetic Resonance Imaging (MRI) in which 51 normal and 61 MRI of patients who had undergone ACL reconstruction at our institute were evaluated. Postoperative ACL reconstruction group MRI studies were obtained and evaluated by two sports medicine fellows independently to assess the position of interference screw, distance of the graft from the anterior cortex of tibia and inclination of the graft. The data was collected and compared with MRI data of normal ACL patients. Results There were total 61 patients with ACL reconstruction. 32 patients had anterior screw placement and 29 patients had posterior screw placement in the tibial tunnel. The distance of the graft from the anterior cortex was 39.18% in ACL intact group, 50.35% in anterior screw group and 41.64% in posterior screw group. The inclination angle was 44.49⁰ in intact group, 49.69° and 42.20° in anterior and posterior screw group respectively. The difference between intact group and anterior screw group was statistically significant. Conclusion Posterior position of interference screw in tibial tunnel increases graft obliquity than anterior position and decreases its distance from the anterior tibial cortex. This increased graft obliquity and distance from the anterior tibial cortex is similar to the native ACL.
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Affiliation(s)
| | - Sumit Agrawal
- Corresponding author. Department of Orthopaedics, Trauma Centre, National Academy of Medical Sciences, Kathmandu, Nepal.
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10
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Kim SH, Park YB, Kim DH, Pujol N, Lee HJ. Predictive factors for failure of anterior cruciate ligament reconstruction via the trans-tibial technique. Arch Orthop Trauma Surg 2020; 140:1445-1457. [PMID: 32529386 DOI: 10.1007/s00402-020-03483-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/14/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Factors for graft failure after trans-tibial (TT) ACL reconstruction, including anterolateral ligament (ALL) injury and degree of synovialization, remain unclear. This study is to evaluate the risk factors for graft failures after TT ACL reconstruction including ALL injury and synovialization. MATERIALS AND METHODS A total 391 patients who underwent primary TT ACL reconstruction were included. Failure was defined as greater than grade 2 laxity on the Lachman or pivot shift tests or 5 mm of anterior translation on stress radiograph. After applying inclusion/exclusion criteria, 31 patients with failure were categorized as group 1 and 89 patients without failure were categorized as group 2. Chi-square test and Cox proportional hazard analyses were performed. RESULTS Preoperatively, 64 patients had ALL injuries (53.3%), 58 had medial meniscal (MM) tears (48.3%), and 62 had lateral meniscal (LM) tears (51.6%). Ninety-three patients (77.5%) had acute injuries and 27 had chronic injuries as per 6-weeks duration. Significant risk factors for failure were LM tear (hazard ratio [HR], 4.018; 95% confidence interval [CI] 1.677-9.629; p = 0.002), chronicity (HR, 6.812; 95% CI 2.758-16.824; p = 0.000), presence of ALL injury (HR, 3.655; 95% CI 1.442-9.265; p = 0.006), and poor synovialization (HR, 3.134; 95% CI 1.298-7.566; p = 0.011) in Cox proportional hazard analysis. If combined MM and LM tears were found, an increased risk of failure was also identified (combined tears: HR, 3.951; 95% CI 1.754-8.901; p = 0.001/preoperative high-grade laxity: HR, 4.546; 95% CI 1.875-11.02; p = 0.001). CONCLUSION Chronic ACL injuries, meniscus tear, preoperative ALL injuries, preoperative high-grade laxity and poor synovialization are significant risk factors. Therefore, these factors should be carefully assessed and properly treated in TT ACL reconstruction. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Dong-Hyun Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Nicolas Pujol
- Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
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11
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Trąbka R, Maicki T, Kamiński P, Pawełczyk A, Zieliński P, Wilk-Frańczuk M. Outcomes Following Arthroscopic Single and Double Bundle Anterior Cruciate Ligament (ACL) Reconstruction Supported by the Comprehensive Early Rehabilitation Program (CERP). Med Sci Monit 2020; 26:e921003. [PMID: 32396534 PMCID: PMC7243622 DOI: 10.12659/msm.921003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to compare the level of functional condition in patients who had rehabilitation with the comprehensive early rehabilitation program (CERP) following either single bundle (SB) or double bundle (DB) anterior cruciate ligament reconstruction (ACLR) using semitendinosus-gracilis tendon graft (ST-G) method. We hypothesized that 12 weeks after reconstruction followed by a rehabilitation program, there would be a difference in clinical results and functional activity between patients. Material/Methods This study included 94 patients who had rehabilitation with CERP after knee surgery for a knee injury from a recreational sport. There were 49 patients in Group 1 (mean age, 36.5 years) who had CERP after SB ACLR, and 45 patients in Group 2 (mean age, 35.6 years) who had CERP after DB ACLR. Functional condition was tested using the Lysholm Knee Scoring Scale, and knee stability was measured using KT-2000. The first examination was performed before CERP and the second examination was performed 12 weeks later. Results The level of functional condition in both groups was similar before rehabilitation with CERP, with no significant difference (P<0.958) and was considered relatively low. In the second examination, 12 weeks after starting CERP, the patients improved in both groups. The improvement was larger in the SB ACLR Group 1 than in the DB ACLR Group 2. The difference was significant (P<0.005). However, the patients in Group 2 achieved better knee stability scores in the KT-2000 examination than the patients in Group 1. The difference was significant (P=0.035). Conclusions We found that the patients from both groups after 12 weeks of CERP achieved an improvement in stability and functional activity within normal limits. However, SB ACLR was more effective than DB ACLR in terms of the level of functionality achieved with CERP but was less effective in terms of knee stability.
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Affiliation(s)
- Rafał Trąbka
- Clinic of Rehabilitation, Faculty of Health and Sciences, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Maicki
- Clinic of Rehabilitation, Faculty of Health and Sciences, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Kamiński
- Department of Orthopaedic, Cracow Rehabilitation and Orthopaedic Centre, Cracow, Poland
| | - Agata Pawełczyk
- Clinic of Rehabilitation, Faculty of Health and Sciences, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Zieliński
- Department of Orthopaedic , Cracow Rehabilitation and Orthopaedic Centre, Cracow, Poland
| | - Magdalena Wilk-Frańczuk
- Clinic of Rehabilitation, Faculty of Health and Sciences, Jagiellonian University Medical College, Cracow, Poland.,Department of Orthopaedic, Cracow Rehabilitation and Orthopaedic Centre, Cracow, China (mainland)
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12
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Shah R, Srinivasan S, Hamed Y, Menon DK. Clinico-radiological outcomes following anatomical anterior cruciate ligament reconstruction using the TransLateral, all-inside technique. J Clin Orthop Trauma 2020; 11:S326-S331. [PMID: 32523288 PMCID: PMC7275287 DOI: 10.1016/j.jcot.2019.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 01/02/2023] Open
Abstract
We present early clinical outcomes of patients following anatomical anterior cruciate ligament reconstruction using a TransLateral, single bundle, all-inside technique with a one-year follow-up and radiological evaluation of socket position. Eligible Patients who underwent a primary ACL reconstruction, using the TransLateral, all-inside technique alone, between Jan 2013 and Feb 2016 were included in this study. Of this group, all patients underwent isolated semitendinosus graft harvest. The Lysholm knee scores were measured preoperatively and at one-year follow-up in 40 patients who underwent ACL reconstruction. Postoperatively, antero-posterior and lateral radiographs were obtained to evaluate the position of the femoral socket (using the Bernard and Hertel Grid) and tibial socket (using the Amis-Jakob line). There were 36 males and 4 females with a mean age of 27.1 years (range 16-49). There was a single non-surgical related mortality prior to the one year follow up. We report no postoperative infections or graft failure at one year. The mean preoperative Lysholm score was 68.7 (Range: 29-95). The mean Lysholm score increased to 92.5% (Range: 59-100, p < 0.05). Evaluation of femoral sockets revealed accurate positioning on the Bernard and Hertel Grid with a mean ACL center of 27% along Blumensaat's line and 34% of the height of the intercondylar notch. The mean tibial socket position was 41.8% (Range: 32%-47%) along the Amis-Jakob Line. Our single surgeon case series utilizing the all-inside, TransLateral ACLR technique highlights good early outcomes with no postoperative complications or graft failure at one year.
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13
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Laverdiere C, Harvey E, Schupbach J, Boily M, Burman M, Martineau PA. Effect of Teaching Session on Resident Ability to Identify Anatomic Landmarks and Anterior Cruciate Ligament Footprint: A Study Using 3-Dimensional Modeling. Orthop J Sports Med 2020; 8:2325967120905795. [PMID: 32201706 PMCID: PMC7068746 DOI: 10.1177/2325967120905795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/01/2019] [Indexed: 01/22/2023] Open
Abstract
Background: Femoral tunnel positioning in anterior cruciate ligament reconstruction
(ACLR) is an intricate procedure that requires highly specific surgical
skills. Purpose: To report the ability of residents to identify femoral landmarks and the
native ACL footprint before and after a structured formal teaching session
as a reflection of overall surgical skill training for orthopaedic surgery
residents in Canada. Study Design: Controlled laboratory study. Methods: A total of 13 senior orthopaedic residents were asked to identify a femoral
landmark and an ACL footprint on ten 3-dimensional (3D)–printed knee models
before and after a teaching session during the fall of 2018. The 3D models
were made based on actual patients with different anatomic morphologic
features. ImageJ software was used to quantify the measurements, which were
then analyzed through use of descriptive statistics. Results: Before and after the teaching session, residents attempted to identify a
specific anatomic location (bifurcate and intercondylar ridge intersection)
with a mean error per participant ranging from 5.00 to 10.95 mm and 4.79 to
12.13 mm in magnitude, respectively. Furthermore, before and after the
teaching session, residents identified the specific position to perform the
surgical procedure (ACL femoral footprint), with a mean error per
participant ranging from 4.58 to 8.80 mm and 3.87 to 11.07 mm in magnitude,
respectively. The teaching session resulted in no significant improvement in
identification of either the intersection of the bifurcate and intercondylar
ridges (P = .9343 in the proximal-distal axis and
P = .8133 in the anteroposterior axis) or the center of
the femoral footprint (P = .7761 in the proximal-distal
axis and P = .9742 in the anteroposterior axis). Conclusion: Although a formal teaching session was combined with a hands-on session that
entailed real surgical instrumentation and fresh cadaveric specimens, the
intervention seemed to have no direct impact on senior residents’
performance or their ability to demonstrate the material taught. This puts
into question the format and efficacy of present teaching methods. Also, it
is possible that the 3D spatial perception required to perform these skills
is not something that can be taught effectively through a teaching session
or at all. Further investigation is required regarding the effectiveness and
application of surgical skill laboratories and simulations on the
competencies of orthopaedic residents.
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Affiliation(s)
- Carl Laverdiere
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Eric Harvey
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Justin Schupbach
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Mathieu Boily
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Mark Burman
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Paul A Martineau
- Department of Orthopedic Surgery, McGill University Health Centre, Montréal, Quebec, Canada
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Sánchez-Alepuz E, Miranda I, Miranda FJ. Functional evaluation of patients with anterior cruciate ligament injury. A transversal analytical study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Outcome analysis following arthroscopic augmentation with autologous hamstring graft in partial tear of the anterior cruciate ligament with preservation of an intact bundle: A case series. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Sánchez-Alepuz E, Miranda I, Miranda FJ. Functional evaluation of patients with anterior cruciate ligament injury. A transversal analytical study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:99-107. [PMID: 31780400 DOI: 10.1016/j.recot.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 05/29/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate, by means of biomechanical analysis, functional alterations of gait and balance of patients with anterior cruciate ligament (ACL) injury. MATERIAL AND METHODS Transversal analytical study on 64 people, 27 health subjects and 37 patients with ACL injury. Biomechanical analysis of gait in all individuals was performed by means of four tests: 1) kinematic test, to characterize gait pattern; 2) kinetic test, to characterize forces against the floor, duration of treads, symmetry of both legs, and the reproducibility of the gait; 3) pivot-shift test, to analyze the rotational stability of the knee on the sagittal axis; and 4) equilibrium test. RESULTS alterations in kinematic and kinetic analysis were found in both the injured knee and the healthy knee compared to the control group. In the pivot-shift gait test there is a tendency to increase the forces on the three axes, both in the support leg and in the exit leg in patients with ACL injury, in comparison with healthy subjects. CONCLUSION ACL injury-induced changes in gait pattern, changes in forces against the floor, duration of treads, symmetry of both legs, and the reproducibility of gait and changes in rotational stability of the knee on the sagittal axis.
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Affiliation(s)
- E Sánchez-Alepuz
- Servicio de Cirugía Ortopédica y Traumatología de Unión de Mutuas, Valencia, España; Servicio de Cirugía Ortopédica y Traumatología, Hospital IMED Valencia, Burjassot, Valencia, España
| | - I Miranda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - F J Miranda
- Departamento de Fisiología, Universitat de València, Valencia, España
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CORR Insights®: Does Knee Flexion Influence the Relationship between the Femoral Tunnel and the Lateral Anatomic Structures During ACL Reconstruction? Clin Orthop Relat Res 2019; 477:2240-2242. [PMID: 31389884 PMCID: PMC6999928 DOI: 10.1097/corr.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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18
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Park YB, Lee HJ, Ro DH, Lee GY, Kim S, Kim SH. Anterolateral ligament injury has a synergic impact on the anterolateral rotatory laxity in acute anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 2019; 27:3334-3344. [PMID: 30631908 DOI: 10.1007/s00167-019-05347-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/04/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE To investigate the prevalence of the anterolateral ligament (ALL) injuries and its role in rotatory laxity in acute anterior cruciate ligament (ACL)-injured knees. METHODS Two-hundred and ninety-six consecutive patients with acute ACL injuries were evaluated retrospectively, excluding those with other ligament injury and undetectable path of ALL in MRI. Patients were divided into two groups based on the degree of ACL injury in arthroscopy (complete versus partial group). Logistic regression and discriminant analysis were performed to assess the risk of pivot shift test. RESULTS A total of 169 patients were included (128 with complete and 41 with partial ACL rupture). Overall, 106/169 (62.7%) of ALL injuries were characterized, 87/128 (67.9%) in complete group, and 19/41 (46.3%) in partial group. The incidence of pivot shift was 120/128 (93.8%) and 14/41 (34.1%) in the complete and partial groups, respectively. The odds ratio in the pivot shift of combined ALL injury was found as 3.8 (95% CI 1.8-8.4) with the overall ACL injury, but higher as 17.1 (95% CI 3.1-96.4) with partial group. Higher grade of pivot shift showed a greater incidence of injury of ALL. Degree of ACL injury and ALL injury allowed 87.0% of correct classification of subsequent anterolateral rotatory laxity. CONCLUSION Injury to the ALL could have a synergetic effect on anterolateral rotatory laxity in acute ACL-injured knee, however, its effect might be minor in case of complete tear. Careful assessment about combined ALL injury should be considered, especially in knees with high-grade pivot shift in acute ACL-injured knees. LEVEL OF EVIDENCE Retrospective prognostic study, Level IV.
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Affiliation(s)
- Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Du-Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Geun Young Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea. .,Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France.
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19
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Dung TT, Du HG, Long NH, Son LM, Thanh DX, Son DN, Tuyen NT, Minh DV, Phương NH, Nam VT, Hieu PT, Thanh MN. Arthroscopic fixation of ACL avulsion fracture in the saint pault hospital: A review of treatment outcomes: Cohort study. Ann Med Surg (Lond) 2019; 48:91-94. [PMID: 31737267 PMCID: PMC6849137 DOI: 10.1016/j.amsu.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/04/2019] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this research is to evaluate the results of arthroscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture, and to determine how effective such a technique is when it comes to restoring of knee function. Materials and methods This prospective study involves 28 patients, who underwent arthroscopic fixation of displaced ACL avulsion fractures at Saint Paul Hospital (Hanoi) from January 2014 to March 2018. Results The first three weeks were not marked with any abnormalities associated with post-operative sutures and hematomas, infectious complications were not detected either. Post-operative displacement of fracture fragments did not take place among the patients involved in the study. At the 3-month follow-up, the average IKDC score was 90.7 (range: 76–100), and the average Lysholm score was 93.6 (range 82–100). The percentage of excellent scores was 42.9% (12 patients), good scores accounted for 50% (14 patients), while fair/poor scores accounted for 3.6% each (1 patient on each score). The percentage of excellent/good scores was 92.9% in total. Conclusion This study shows that ACL avulsion fracture can be treated effectively by arthroscopic suture fixation with fiber wires. In fact, this technique may restore knee function and stability. Evaluating the results of arthoscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture. The study involves 28 patients. The ACL avulsion fracture can be treated effectively by arthoscopic suture fixation with fiber wires. It may restore knee function and stabiity.
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Affiliation(s)
- Tran Trung Dung
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA.,Hanoi Medical University Hospital, Viet Nam
| | - Hoang Gia Du
- Hanoi Medical University, Viet Nam.,Bachmai University Hospital, Viet Nam
| | - Nguyen Hoang Long
- Hanoi Medical University, Viet Nam.,Vietduc University Hospital, Viet Nam
| | - Le Manh Son
- Hanoi Medical University, Viet Nam.,Vietduc University Hospital, Viet Nam
| | - Dao Xuan Thanh
- Hanoi Medical University, Viet Nam.,Bachmai University Hospital, Viet Nam
| | - Dinh Ngoc Son
- Hanoi Medical University, Viet Nam.,Vietduc University Hospital, Viet Nam
| | | | - Do Van Minh
- Hanoi Medical University, Viet Nam.,Hanoi Medical University Hospital, Viet Nam
| | - Nguyen Huy Phương
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA
| | - Vu Tu Nam
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA
| | - Pham Trung Hieu
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA
| | - Ma Ngoc Thanh
- Hanoi Medical University, Viet Nam.,Hanoi Medical University Hospital, Viet Nam
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20
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Dung TT, Du HG, Long NH, Son LM, Thanh DX, Son DN, Tuyen NT, Van Minh D, Phương NH, Nam VT, Hieu PT, Thanh MN. Arthroscopic fixation of ACL avulsion fracture in the Saint Paul Hospital: a review of treatment outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1485-1491. [PMID: 31236684 DOI: 10.1007/s00590-019-02466-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/06/2019] [Indexed: 11/26/2022]
Abstract
The purpose of this research is to evaluate the results of arthroscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture, and to determine how effective such a technique is when it comes to restoring of knee function. This prospective study involves 28 patients, who underwent arthroscopic fixation of displaced ACL avulsion fractures at Saint Paul Hospital (Hanoi) from January 2014 to March 2018. The first 3 weeks were not marked with any abnormalities associated with postoperative sutures and hematomas; infectious complications were not detected either. Postoperative displacement of fracture fragments did not take place among the patients involved in the study. At the 3-month follow-up, the average IKDC score was 90.7 (range 76-100), and the average Lysholm score was 93.6 (range 82-100). The percentage of excellent scores was 42.9% (12 patients), good scores accounted for 50% (14 patients), while fair/poor scores accounted for 3.6% each (one patient on each score). The percentage of excellent/good scores was 92.9% in total. This study shows that ACL avulsion fracture can be treated effectively by arthroscopic suture fixation with fiber wires. In fact, this technique may restore knee function and stability.
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Affiliation(s)
- Tran Trung Dung
- Hanoi Medical University, Hanoi, Vietnam.
- Saint Paul University Hospital, Surigao City, Philippines.
- Hanoi Medical University Hospital, Hanoi, Vietnam.
| | - Hoang Gia Du
- Hanoi Medical University, Hanoi, Vietnam
- Bachmai University Hospital, Hanoi, Vietnam
| | - Nguyen Hoang Long
- Hanoi Medical University, Hanoi, Vietnam
- Vietduc University Hospital, Hanoi, Vietnam
| | - Le Manh Son
- Hanoi Medical University, Hanoi, Vietnam
- Vietduc University Hospital, Hanoi, Vietnam
| | - Dao Xuan Thanh
- Hanoi Medical University, Hanoi, Vietnam
- Bachmai University Hospital, Hanoi, Vietnam
| | - Dinh Ngoc Son
- Hanoi Medical University, Hanoi, Vietnam
- Vietduc University Hospital, Hanoi, Vietnam
| | - Nguyen Trung Tuyen
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Do Van Minh
- Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Huy Phương
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Vu Tu Nam
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Pham Trung Hieu
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Ma Ngoc Thanh
- Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi, Vietnam
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21
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Smith PA, Thomas DM, Pomajzl RJ, Bley JA, Pfeiffer FM, Cook JL. A Biomechanical Study of the Role of the Anterolateral Ligament and the Deep Iliotibial Band for Control of a Simulated Pivot Shift With Comparison of Minimally Invasive Extra-articular Anterolateral Tendon Graft Reconstruction Versus Modified Lemaire Reconstruction After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:1473-1483. [PMID: 30926192 DOI: 10.1016/j.arthro.2018.11.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the deep fibers of the iliotibial band (dITB) or the anterolateral ligament (ALL) provides more control of a simulated pivot shift and whether a minimally invasive anterolateral reconstruction (ALR) designed to functionally restore the ALL and dITB is mechanically equivalent to a modified Lemaire reconstruction (MLR). METHODS Six matched pairs of cadaveric knees (N = 12) were subjected to a simulated pivot shift to evaluate anteroposterior translation; internal rotation; and valgus laxity at 0°, 30°, and 90° of flexion. The anterior cruciate ligament (ACL) was sectioned in all specimens, and retesting was performed. Within each pair, sequential sectioning of the ALL and dITB was performed, followed by testing; the contralateral knee was sectioned in reverse order. Knees underwent ACL reconstruction (ACLR) and repeat testing. Then, MLR (n = 6) or ALR (n = 6) was performed on matched pairs for final testing. RESULTS Sectioning of the dITB versus ALL (after ACL sectioning) produced significantly more anterior translation at all flexion angles (P = .004, P = .012, and P = .011 for 0°, 30°, and 90°, respectively). The ACL-plus-dITB sectioned state had significantly more internal rotation at 0° versus ACL plus ALL (P = .03). ACLR plus ALR restored native anterior translation at all flexion angles. ACLR plus MLR restored anterior translation to native values only at 0° (P = .34). We found no statistically significant differences between ACLR plus ALR and ACLR plus MLR at any flexion angle for internal rotation or valgus laxity compared with the native state. CONCLUSIONS ALR of the knee in conjunction with ACLR can return the knee to its native biomechanical state without causing overconstraint. The dITB plays a more critical role in controlling anterior translation and internal rotation at 0° than the ALL. The minimally invasive ALR was functionally equivalent to MLR for restoration of knee kinematics after ACLR. CLINICAL RELEVANCE The dITB is more important than the ALL for control of the pivot shift. A minimally invasive extra-articular tendon allograft reconstruction was biomechanically equivalent to a modified Lemaire procedure for control of a simulated pivot shift.
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Affiliation(s)
- Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Columbia Orthopaedic Group, Columbia, Missouri, U.S.A..
| | - Dimitri M Thomas
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Ryan J Pomajzl
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; SSM Health Medical Group, Bridgeton, Missouri, U.S.A
| | - Jordan A Bley
- Columbia Orthopaedic Group, Columbia, Missouri, U.S.A
| | - Ferris M Pfeiffer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
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22
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Prall WC, Kusmenkov T, Fürmetz J, Haasters F, Mayr HO, Böcker W, Grote S. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. Injury 2019; 50:467-475. [PMID: 30580931 DOI: 10.1016/j.injury.2018.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/29/2018] [Accepted: 12/16/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with widened or misplaced tunnels may require bone grafting prior to revision anterior cruciate ligament (ACL) reconstruction. Utilising reamer-irrigator-aspirator (RIA) harvested bone from the femur showed promising filling rates. Nevertheless, the procedure has neither been validated in a larger population nor been assessed with regards to radiological and clinical outcome of the subsequently conducted revision ACL reconstruction. Therefore, the aim of this study was to evaluate tunnel filling rates, positioning of the revision tunnels and outcome parameters of such two-staged revision ACL reconstructions. MATERIAL AND METHODS A total of 15 consecutive patients were prospectively enrolled in this case series. CT scans were analysed before and after autologous RIA harvested bone grafting. Tunnel volumes and filling rates were calculated based on manual segmentation of axial CT scans. Revision ACL reconstruction was carried out after a mean interval of 6.2 months (±3.7) and positioning of the revision tunnels was assessed by plane radiographs. The mean follow-up was 19.8 months (±8.4) for objective evaluation and 37.1 months (±15.4) for patient reported outcomes. The clinical outcome was assessed by the quantification of the anterior tibial translation, the IKDC objective score, the Tegner activity scale and the Lysholm score. RESULTS Initial CT scans revealed mean tunnel volumes of 3.8cm3 (±2.7) femoral and 6.1cm3 (±2.4) tibial. Filling rates of 76.1% (±12.4) femoral and 87.4% (±5.9) tibial were achieved. Postoperative radiographs revealed significantly improved tunnel positioning with anatomical placement in all but one case at the femur and in all cases at the tibia. At follow up, patients showed significantly improved anterior tibial translations with residual side-to-side differences of 1.7 mm (±0.8) and significantly improved IKDC objective scores. Furthermore, significantly higher values were achieved on the Tegner activity scale (5.3 ± 1.4 vs. 2.8 ± 0.5) and the Lysholm score (85.4 ± 7.9 vs. 62.5 ± 10.5) compared to the preoperative status. CONCLUSION Autologous RIA harvested bone grafting ensures sufficient bone stock consolidation allowing for anatomical tunnel placement of the subsequently conducted revision ACL reconstruction. The two-staged procedure reliably restores stability and provides satisfying subjective and objective outcomes. Thus, RIA harvested bone grafting is an eligible alternative to autologous iliac crest or allogenic bone grafting.
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Affiliation(s)
- W C Prall
- FIFA Medical Center of Excellence, Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany.
| | - T Kusmenkov
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - J Fürmetz
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - F Haasters
- FIFA Medical Center of Excellence, Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - H O Mayr
- FIFA Medical Center of Excellence, Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of Orthopaedics and Trauma Surgery, Freiburg University Hospital, Albert-Ludwigs-University, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - W Böcker
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - S Grote
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany; Department of Orthopaedics and Trauma Surgery, Brothers of Mercy, Hospital St. Elisabeth Straubing, St.-Elisabeth-Straße 23, 94315 Straubing, Germany
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23
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Abstract
Anterolateral rotational laxity of the knee is a persistent problem following anterior cruciate ligament reconstruction (ACLR) that can lead to increased rates of graft failure. Renewed interest in the anterolateral complex of the knee has led to a resurgence in the use of adjunctive techniques such as lateral extra-articular tenodesis and anterolateral ligament reconstruction. Use of these techniques can restore normal knee kinematics and potentially thereby reduce the rate of graft failure. Historically, experience with modified ACLR techniques such as the double-bundle ACLR have shown that improved biomechanics is not always reflected in clinical outcome trials. Additional procedures also come with additional costs and further economic analysis needs to be performed to clarify whether these additional costs are offset by improved clinical and societal outcomes in the longer-term.
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Affiliation(s)
- Ryan Wood
- The Fowler Kennedy Sport Medicine Clinic
| | - Jacquelyn Marsh
- Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
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Borton ZM, Yasen SK, Mumith A, Wilson AJ. Mid-bundle positioning of the femoral socket increases graft rupture in anatomic single bundle anterior cruciate ligament reconstruction. Knee 2018; 25:1122-1128. [PMID: 30224151 DOI: 10.1016/j.knee.2018.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 08/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anatomic anterior cruciate ligament (ACL) reconstructions are superior to non-anatomic graft placements with regard to controlling rotational laxity. Different techniques of anatomic single-bundle reconstruction exist. The femoral tunnel may be placed in a mid-bundle position (MB) or within the anteromedial bundle footprint (AM) with no definitive consensus as to the preferred position. Our institution, reflecting trends in surgical practice, has experience with both techniques. METHODS Interrogation of our prospectively maintained database yielded all primary ACL reconstructions performed using the anatomic TransLateral single-bundle all-inside technique. A two year minimum follow-up was set. The failure rate of the MB and AM cohorts was compared as a primary outcome. Patient-reported outcomes across cohorts at several time-points were analysed as a secondary outcome. RESULTS Two hundred and seventy-nine primary ACL reconstructions were identified at a median follow-up of 49 months. MB positioning was utilised in 113 cases (40.5%) and AM positioning in 166 (59.5%). There were significantly more failures in the MB cohort (p = 0.029). Logistic regression revealed mid-bundle femoral positioning was associated with greater than fourfold increase in graft failure (odds ratio 4.14, p = 0.039). CONCLUSION Data from this case series suggests that amongst anatomic single-bundle ACL reconstructions, grafts with a mid-bundle femoral tunnel are more than four times more likely to fail versus those with a femoral tunnel placed four millimetres deeper within the anteromedial bundle footprint.
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Affiliation(s)
- Zakk M Borton
- Department of Trauma & Orthopaedics, Basingstoke & North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, United Kingdom; Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter Road, Derby, United Kingdom.
| | - Sam K Yasen
- Department of Trauma & Orthopaedics, Basingstoke & North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, United Kingdom; Department of Sports and Exercise, University of Winchester, Sparkford Road, Winchester SO22 4NR, United Kingdom
| | - Aadil Mumith
- Department of Trauma & Orthopaedics, Basingstoke & North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, United Kingdom
| | - Adrian J Wilson
- Department of Trauma & Orthopaedics, Basingstoke & North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, United Kingdom; Department of Sports and Exercise, University of Winchester, Sparkford Road, Winchester SO22 4NR, United Kingdom
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25
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Noailles T, Boisrenoult P, Sanchez M, Beaufils P, Pujol N. Torsional Appearance of the Anterior Cruciate Ligament Explaining "Ribbon" and Double-Bundle Concepts: A Cadaver-based Study. Arthroscopy 2017; 33:1703-1709. [PMID: 28865572 DOI: 10.1016/j.arthro.2017.03.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/27/2017] [Accepted: 03/14/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of the anterior cruciate ligament (ACL) torsion in 90° knee flexion on the morphological appearance of the ACL. METHODS Sixty knees from fresh frozen anatomical specimens were dissected. Eighteen knees were excluded according to selection criteria (torn ACL, mucoid degeneration of the ACL, arthritic lesions of the notch, or knees harboring synovial inflammatory pathologies). After the removal of the synovial membrane, the morphology of the ligamentous fibers of the ACL and the twist were analyzed. Twisting of the ACL was measured using a goniometer in 90° knee flexion and defined by the angle of external rotation of the femur on the axis of the tibia required to visualize a flat ACL. The orientation of tibial and femoral footprint was described in a coronal plane for the tibia and a sagittal plane for the femur. RESULTS In the 42 knees that were finally included, the ACL was always displayed as a single ribbon-like structure. The torsion of the fibers was on average 83.6° (± 9.4°) in 90° knee flexion. The twisting could be explained by the different orientations of the femoral (vertical in a sagittal plane) and tibial (horizontal in a coronal plane) footprints. An intraligamentous proximal cleavage area was encountered in 11 cases (i.e., 26%). CONCLUSIONS The ACL is a twisted structure with 83.6° of external torsion of fibers in 90° knee flexion. It is the torsion in the fibers, due to the relative position of bone insertions, which gives the ACL the appearance of being double bundle. CLINICAL RELEVANCE The concept of the torsional flat structure of the native ACL may be of importance during ACL reconstruction, both in terms of graft choice (flat rather than cylindrical) and of technical positioning (torsion).
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Affiliation(s)
- Thibaut Noailles
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France.
| | - Philippe Boisrenoult
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France
| | - Matthieu Sanchez
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France
| | - Philippe Beaufils
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France
| | - Nicolas Pujol
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France
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26
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Sohn KM, Lee MJ, Hong H, Yoon YC, Park CD, Wang JH. The Bow Tie Shape of the Anterior Cruciate Ligament as Visualized by High-Resolution Magnetic Resonance Imaging. Am J Sports Med 2017; 45:1881-1887. [PMID: 28430526 DOI: 10.1177/0363546517699828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although numerous studies have examined the anatomic characteristics of the anterior cruciate ligament (ACL), its actual shape remains unclear. PURPOSE To determine the average shape of the ACL by analyzing its cross section through the use of high-resolution magnetic resonance imaging (MRI) data. STUDY DESIGN Descriptive laboratory study. METHODS The study included 96 MRIs, conducted using a 3.0-T magnet, to analyze the shape of the ACL. Three-dimensional, curved multiplanar reconstruction was used to obtain cross sections at 7 points (femoral insertion; midsubstance 1, 2, 3, 4, and 5 from the femoral side to the tibial side; and tibial insertion). The width and thickness of cross sections were measured by 2 independent observers, and the ratio of width to thickness was calculated to determine the proportions of each cross section. The 7 cross sections were accumulated and standardized to generate an average model through the use of image analysis software developed by the authors. RESULTS The mean ± SD width (femoral insertion, 17.02 ± 2.17 mm; tibial insertion, 17.33 ± 2.03 mm) and thickness (femoral insertion, 11.03 ± 1.75 mm; tibial insertion, 10.09 ± 1.70 mm) of both insertions were significantly larger than those of midsubstance 4 (width, 9.99 ± 1.87 mm; thickness, 6.53 ± 1.25 mm) ( P < .001). The mean ratios of width to thickness of the 7 cross sections from femoral insertion to tibial insertion were 1.57 ± 0.23, 3.36 ± 0.57, 3.07 ± 0.81, 2.18 ± 0.54, 1.56 ± 0.32, 2.16 ± 0.48, and 1.75 ± 0.28, respectively. The shape of the cross section at midsubstance 4 was an oval isthmus, which was the most narrow and well-balanced shape. It was transformed into a wide band at midsubstance 1 and 5. The shape of the femoral insertion was semicircular, with its anterior side slightly straight and its posterior side convex. The tibial insertion was kidney bean-shaped. CONCLUSION On 3.0-T MRI, the ACL has a "bow tie" shape, including an oval isthmus, with a semicircular femoral insertion and kidney bean-shaped tibial insertion. CLINICAL RELEVANCE The measurement method will allow surgeons to quantitatively diagnose partial injuries of the ACL using a noninvasive system in actual patients.
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Affiliation(s)
- Kang Min Sohn
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Jin Lee
- Department of Multimedia Engineering, Seoul Woman's University, Seoul, Republic of Korea
| | - Helen Hong
- Department of Multimedia Engineering, Seoul Woman's University, Seoul, Republic of Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan Deok Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Norman D, Metcalfe AJ, Barlow T, Hutchinson CE, Thompson PJM, Spalding TJW, Williams MA. Cortical Bony Thickening of the Lateral Intercondylar Wall: The Functional Attachment of the Anterior Cruciate Ligament. Am J Sports Med 2017; 45:394-402. [PMID: 27651395 DOI: 10.1177/0363546516665804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anatomy of the anterior cruciate ligament (ACL) has become the subject of much debate. There has been extensive study into attachment points of the native ligament, especially regarding the femoral attachment. Some of these studies have suggested that fibers in the ACL are of differing functional importance. Fibers with higher functional importance would be expected to exert larger mechanical stress on the bone. According to Wolff's law, cortical thickening would be expected in these areas. PURPOSE To examine cortical thickening in the region of the ACL footprint (ie, the functional footprint of the ACL). STUDY DESIGN Descriptive laboratory study. METHODS Using micro-computed tomography with resolutions ranging from 71 to 91 μm, the cortical thickness of the lateral wall of the intercondylar notch in 17 cadaveric knees was examined, along with surface topography. After image processing, the relationship between the cortical thickening and surface topology was visually compared. RESULTS A pattern of cortical thickening consistent with the functional footprint of the ACL was found. On average, this area was 3 times thicker than the surrounding bone and significantly thicker than the remaining lateral wall ( P < .0001). This thickening was roughly elliptical in shape (with a mean centroid at 23.5 h:31 t on a Bernard and Hertel grid) and had areas higher on the wall where greater thickness was present. The relationship to previously reported osseous landmarks was variable, although the patterns were broadly consistent with those reported in previous studies describing direct and indirect fibers of the ACL. CONCLUSION The findings of this study are consistent with those of recent studies describing fibers in the ACL of differing functional importance. The area in which the thickening was found has been defined and is likely to represent the functional footprint of the ACL. CLINICAL RELEVANCE This information is of value to surgeons when determining the optimal place to position the femoral attachment site of the reconstructed ACL.
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Affiliation(s)
| | - Andrew J Metcalfe
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Timothy Barlow
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
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28
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Clinical outcomes of anatomic, all-inside, anterior cruciate ligament (ACL) reconstruction. Knee 2017; 24:55-62. [PMID: 27692693 DOI: 10.1016/j.knee.2016.09.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 09/02/2016] [Accepted: 09/05/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This paper reports the outcomes of patients undergoing ACL reconstruction using a TransLateral single bundle, all-inside hamstring technique at a minimum of two year follow-up. METHODS The semitendinosus alone is harvested, quadrupled and attached in series to two adjustable suspensory fixation devices. Femoral and tibial sockets are produced using a retrograde drill. The graft is deployed, fixed and tensioned on both tibia and femur. Patients were evaluated preoperatively using the KOOS, Lysholm and Tegner scores and at six, 12 and 24months postoperatively. Objective assessment of knee laxity was performed using the KT-1000 along with goniometric measurement of range or motion. RESULTS One hundred and eight patients, mean age 30.9years (range 15 to 61) were included. Mean follow-up 49.8months (range 30-66). The mean increase in KOOS at two years was 30.3 points; Lysholm, 33.1 points; Tegner Activity scale, 2.0 levels. These were all statistically significant (p<0.001). Range of motion in the reconstructed knee approximated the uninjured knee by 12months and was restored by two years. KT-1000 showed significant reduction in side-side difference to no more than 2.4mm at all postoperative time points (p<0.001). Re-rupture rate in this series was 6.5%, all following episodes of significant additional postoperative trauma to the knee. CONCLUSIONS TransLateral all-inside ACL reconstruction demonstrates good medium term subjective and objective outcomes with a low complication and failure rate.
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Guler O, Mahırogulları M, Mutlu S, Cercı MH, Seker A, Cakmak S. Graft position in arthroscopic anterior cruciate ligament reconstruction: anteromedial versus transtibial technique. Arch Orthop Trauma Surg 2016; 136:1571-1580. [PMID: 27484876 DOI: 10.1007/s00402-016-2532-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Indexed: 01/15/2023]
Abstract
INTRODUCTION When treating anterior cruciate ligament (ACL) injuries, the position of the ACL graft plays a key role in regaining postoperative knee function and physiologic kinematics. In this study, we aimed to compare graft angle, graft position in tibial tunnel, and tibial and femoral tunnel positions in patients operated with anteromedial (AM) and transtibial (TT) methods to those of contralateral healthy knees. MATERIALS AND METHODS Forty-eight patients who underwent arthroscopic ACL reconstruction with ipsilateral hamstring tendon autograft were included. Of these, 23 and 25 were treated by AM and TT techniques, respectively. MRI was performed at 18.4 and 19.7 months postoperatively in AM and TT groups. Graft angles, graft positions in the tibial tunnel and alignment of tibial and femoral tunnels were noted and compared in these two groups. The sagittal graft insertion tibia midpoint distance (SGON) has been used for evaluation of graft position in tunnel. RESULTS Sagittal ACL graft angles in operated and healthy knees of AM patients were 57.78° and 46.80° (p < 0.01). With respect to TT patients, ACL graft angle was 58.87° and 70.04° on sagittal and frontal planes in operated knees versus 47.38° and 61.82° in healthy knees (p < 0.001). ACL graft angle was significantly different between the groups on both sagittal and frontal planes (p < 0.001). Sagittal graft insertion tibia midpoint distance ratio was 0.51 and 0.48 % in the operated and healthy knees of AM group (p < 0.001) and 0.51 and 0.48 % in TT group (p < 0.001). Sagittal tibial tunnel midpoint distance ratio did not differ from sagittal graft insertion tibia midpoint distance of healthy knees in either group. Femoral tunnel clock position was better in AM [right knee 10:19 o'clock-face position (310° ± 4°); left knee 1:40 (50° ± 3°)] compared with TT group [right knee 10:48 (324° ± 5°); left knee 1:04 (32° ± 4°)]. With respect to the sagittal plane, the anterior-posterior position of femoral tunnel was better in AM patients. Lysholm scores and range of motion of operated knees in the AM and TT groups showed no significant difference (p > 0.05). CONCLUSIONS Precise reconstruction on sagittal plane cannot be obtained with either AM or TT technique. However, AM technique is superior to TT technique in terms of anatomical graft positioning. Posterior-placed grafts in tibial tunnel prevent ACL reconstruction, although tibial tunnel is drilled on sagittal plane.
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Affiliation(s)
- Olcay Guler
- Orthopedics and Traumatology Department, Medipol University, Medical Faculty, Atatürk Bulvarı No: 27 Unkapanı, Fatih, 34083, Istanbul, Turkey.
| | - Mahir Mahırogulları
- Orthopedics and Traumatology Department, Medipol University, Medical Faculty, Atatürk Bulvarı No: 27 Unkapanı, Fatih, 34083, Istanbul, Turkey
| | - Serhat Mutlu
- Orthopedics and Traumatology Department, Kanuni Sultan Suleyman Training Hospital, Istanbul, Turkey
| | - Mehmet H Cercı
- Orthopedics and Traumatology Department, Nisa Hospital, Istanbul, Turkey
| | - Ali Seker
- Orthopedics and Traumatology Department, Medipol University, Medical Faculty, Atatürk Bulvarı No: 27 Unkapanı, Fatih, 34083, Istanbul, Turkey
| | - Selami Cakmak
- Orthopedics and Traumatology Department, Gulhane Military Medical Academy Haydarpasa Training Hospital, Istanbul, Turkey
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30
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Ha JK, Lee DW, Kim JG. Single-bundle versus double-bundle anterior cruciate ligament reconstruction: A comparative study with propensity score matching. Indian J Orthop 2016; 50:505-511. [PMID: 27746493 PMCID: PMC5017172 DOI: 10.4103/0019-5413.189605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Numerous studies have elucidated the functional anatomy and biomechanics of the anterior cruciate ligament (ACL), as a result, double-bundle (DB) ACL reconstruction has received much attention and has become a popular choice because it gives better rotational stability. Many other studies, however, found no differences with respect to stability, and/or other clinical outcomes between the DB and single-bundle (SB) techniques. There is still not enough evidence as to whether the anatomical DB anterior cruciate ligament reconstruction (ACLR) is superior to anatomical SB reconstruction. The purpose of this study is to compare various clinical and functional outcomes between SB and DBACLR at 2 years followup. MATERIALS AND METHODS Medical records of patients with ACLR available for at least 2 years followup were reviewed retrospectively. 191 patients (164 males and 25 females) for SB and 48 patients (40 males and 8 females) for DB were selected using the inclusion and exclusion criteria. The mean age of SB and DB was 29.9 and 24.8 years, respectively. Propensity score (PS) was calculated based on age, sex and Tegner activity score and 48 patients in each group were matched by the PS. Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score and Tegneractivity score were investigated. Functional performance tests, isokinetic muscle strength test with Biodex system, pivot shift test and KT-2000 arthrometer test were performed. RESULTS At 2 years followup, there were no significant differences between SB and DB group in Lysholm score (92.9 vs. 90.6, P = 0.224), IKDC subjective knee score (88.7 vs. 87.0, P = 0.524), Tegner activity score (7.3 vs. 8.0, P = 0.059). No significant differences were also found in all functional performance tests, isokinetic muscle strength tests in 60° and 180°/s, KT-2000 arthrometer test and pivot shift test (P > 0.05). CONCLUSIONS There were no significant differences of clinical and functional outcomes between SB and DB ACLR at 2 years followup.
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Affiliation(s)
- Jeong-Ku Ha
- Department of Orthopedic Surgery, College of Medicine, Seoul Paik Hospital, University of Inje, Seoul, Korea
| | - Dhong-Won Lee
- Department of Orthopedic Surgery, Daejeon Military Hospital, Daejeon, Korea
| | - Jin-Goo Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea,Address for correspondence: Prof. Jin-Goo Kim, Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea. E-mail:
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31
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Morey VM, Nag HL, Chowdhury B, Pannu CD, Meena S, Kumar K, Palaniswamy A. Arthroscopic anatomic double bundle anterior cruciate ligament reconstruction: Our experience with follow-up of 4 years. J Clin Orthop Trauma 2016; 7:17-22. [PMID: 26908971 PMCID: PMC4735560 DOI: 10.1016/j.jcot.2015.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 06/27/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Double bundle (DB) anterior cruciate ligament (ACL) reconstruction has been proposed to recreate the natural anatomy of ACL. Reconstruction of the anatomy of both the bundles of ACL has been thought to be able to restore the rotational stability of the knee joint. Nevertheless, it remains unclear whether DB reconstruction has better functional outcome than single bundle (SB) ACL reconstruction. PURPOSE To evaluate the clinical outcomes, patient satisfaction and manual laxity tests of knee in patients treated with DB ACL reconstruction in Indian population. METHODS We prospectively followed 25 patients with an isolated ACL injury operated for DB ACL reconstruction after applying the inclusion and exclusion criteria. Patients were evaluated pre-operatively and in the post-operative period at regular intervals with the minimum follow up of 4 years. Clinical stability was assessed by anterior drawer test, Lachman test and pivot shift test. Functional outcome was assessed by IKDC, Lysholm and Modified Cincinnati scores. RESULTS At the end of 4 years, functional outcome in terms of all subjective scores was satisfactory. Graded stability results of the Lachman, Anterior drawer and pivot shift tests were almost near to that in normal knee. No complication occurred post-operatively. CONCLUSION Anatomical DB ACL reconstruction seems to offer satisfactory results in terms of subjective scores and stability tests to patients with ACL tear. It has been found to be associated with no obvious complications and no failures. However a larger patient pool is desired for conclusive results.
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Affiliation(s)
- Vivek Machhindra Morey
- Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Hira Lal Nag
- Professor, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Buddhadev Chowdhury
- Additional Professor, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Chaitanya Dev Pannu
- Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sanjay Meena
- Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India,Corresponding author. Tel.: +91 9968444612.
| | - Kiran Kumar
- Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Aravindh Palaniswamy
- Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Rezansoff AJ, Caterine S, Spencer L, Tran MN, Litchfield RB, Getgood AM. Radiographic landmarks for surgical reconstruction of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23:3196-201. [PMID: 24934928 DOI: 10.1007/s00167-014-3126-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/04/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE To determine the radiographic landmarks of the anterolateral ligament (ALL) on the femur and tibia to assist in intraoperative graft placement during ALL reconstruction. METHODS The footprints of the ALL, fibular collateral ligament (FCL), popliteus insertion, lateral gastrocnemius insertion, and Gerdy's tubercle were isolated and centrally marked with tantalum beads in thirteen fresh-frozen cadaveric knees. Measurements were taken from the true lateral fluoroscopic images. On the femur, the mean distances from the ALL origin to the FCL origin and from the ALL origin to the popliteus insertion were measured. On the tibia, the mean distances from the ALL insertion to Gerdy's tubercle and from the ALL insertion to the lateral tibial plateau were measured. Furthermore, radiographic descriptions of the ALL origin and insertion were developed. RESULTS The ALL origin on the femur averaged 3.3 ± 1.5 mm anterior-distal to the FCL origin in one anatomical variant and 5.4 ± 1.4 mm posterior-proximal to the FCL origin in a second variant. The ALL origin was 9.9 ± 2.7 mm from the popliteus insertion. The ALL origin is described as overlying the posterior femoral cortical line, between Blumensaat's line and a line from the posterior condylar articular edge parallel to Blumensaat's line. The ALL insertion on the tibia averaged 24.7 ± 4.5 mm posterior to Gerdy's tubercle and 11.5 ± 2.9 mm distal to the lateral tibial plateau. The tibial ALL insertion is described between the posterior tibial cortical line and a parallel line drawn down from the apex of the tibial spine, and overlying a line drawn perpendicular to the posterior tibial cortical line starting from the apex of the posterior tibial condyles. CONCLUSIONS Using direct lateral fluoroscopy, radiographic landmarks of the ALL origin and insertion have been described.
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Affiliation(s)
- Alex J Rezansoff
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Scott Caterine
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Luke Spencer
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Michael N Tran
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Robert B Litchfield
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Alan M Getgood
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
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Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A. A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc 2015; 23:3186-95. [PMID: 24929656 DOI: 10.1007/s00167-014-3117-z] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/01/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to verify and characterize the anatomical properties of the anterolateral capsule, with the aim of establishing a more accurate anatomical description of the anterolateral ligament (ALL). Furthermore, microscopic analysis of the tissue was performed to determine whether the ALL can morphologically be classified as ligamentous tissue, as well as reveal any potential functional characteristics. METHODS Three different modalities were used to validate the existence of the ALL: magnetic resonance imagining (MRI), anatomical dissection, and histological analysis. Ten fresh-frozen cadaveric knee specimens underwent MRI, followed by anatomical dissection which allowed comparison of MRI to gross anatomy. Nine additional fresh-frozen cadaveric knees (19 total) were dissected for a further anatomical description. Four specimens underwent H&E staining to look at morphological characteristics, and one specimen was analysed using immunohistochemistry to locate peripheral nervous innervation. RESULTS The ALL was found in all ten knees undergoing MRI and all nineteen knees undergoing anatomical dissection, with MRI being able to predict its corresponding anatomical dissection. The ALL was found to have bone-to-bone attachment points from the lateral femoral epicondyle to the lateral tibia, in addition to a prominent meniscal attachment. Histological sectioning showed ALL morphology to be characteristic of ligamentous tissue, having dense, regularly organized collagenous bundles. Immunohistochemistry revealed a large network of peripheral nervous innervation, indicating a potential proprioceptive role. CONCLUSION From this study, the ALL is an independent structure in the anterolateral compartment of the knee and may serve a proprioceptive role in knee mechanics.
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Affiliation(s)
- Scott Caterine
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Robert Litchfield
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Marjorie Johnson
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Blaine Chronik
- Department of Physics and Astronomy, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.
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Kennedy MI, Claes S, Fuso FAF, Williams BT, Goldsmith MT, Turnbull TL, Wijdicks CA, LaPrade RF. The Anterolateral Ligament: An Anatomic, Radiographic, and Biomechanical Analysis. Am J Sports Med 2015; 43:1606-15. [PMID: 25888590 DOI: 10.1177/0363546515578253] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent publications have described significant variability in the femoral attachment and overall anatomy of the anterolateral ligament (ALL). Additionally, there is a paucity of data describing its structural properties. PURPOSE Quantitative data characterizing the anatomic and radiographic locations and the structural properties of the ALL may be used to guide graft selection and placement and to facilitate the future development of an evidence-based approach to ALL reconstructions. STUDY DESIGN Descriptive laboratory study. METHODS Identification of the ALL was performed by a combined outside-in and inside-out anatomic dissection of 15 nonpaired fresh-frozen cadaveric knees. Quantitative anatomic relationships were calculated using a 3-dimensional coordinate measuring device. Measurements on anteroposterior (AP) and lateral radiographs were obtained by use of a picture archiving and communications system program. Structural properties were characterized during a single pull-to-failure test using a tensile testing machine. All anatomic, radiographic, and biomechanical measurements were reported as mean values and 95% CIs. RESULTS The ALL was identified as a thickening of the lateral capsule coming under tension with an applied internal rotation at 30° of flexion. Its femoral attachment was located 4.7 mm (95% CI, 3.5-5.9 mm) posterior and proximal to the fibular collateral ligament attachment and coursed anterodistally to its anterolateral tibial attachment approximately midway between the center of the Gerdy tubercle and the anterior margin of the fibular head; the tibial attachment was located 24.7 mm (95% CI, 23.3-26.2 mm) and 26.1 mm (95% CI, 23.9-28.3 mm) from each structure, respectively. On the AP radiographic view, the ALL originated on the femur 22.3 mm (95% CI, 20.7-23.9 mm) proximal to the joint line and inserted on the tibia 13.1 mm (95% CI, 12.3-13.9 mm) distal to the lateral tibial plateau. On the lateral view, the femoral attachment was 8.4 mm (95% CI, 6.8-10.0 mm) posterior and proximal to the lateral epicondyle. The tibial attachment was 19.0 mm (95% CI, 17.1-20.9 mm) posterior and superior to the center of the Gerdy tubercle. The mean maximum load was 175 N (95% CI, 139-211 N) and the stiffness was 20 N/mm (95% CI, 16-25 N/mm). Failure occurred by 4 distinct mechanisms: ligamentous tear at the femoral (n = 4) or tibial (n = 1) attachment, midsubstance tear (n = 4), and bony avulsion of the tibial attachment (Segond fracture; n = 6). CONCLUSION Defined ALL attachment locations can be reproducibly identified with intraoperative landmarks or radiographs. The biomechanical analysis suggests that most traditional soft tissue grafts are sufficient for ALL reconstruction. CLINICAL RELEVANCE The ALL was consistently found in all knees. Segond fractures appear to occur primarily from the avulsion of the ALL.
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Affiliation(s)
| | - Steven Claes
- AZH Hospital, Herentals, Belgium University Hospitals, Leuven, Belgium
| | | | | | | | | | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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The distinct prediction standards for radiological assessments associated with soft tissue injuries in the acute tibial plateau fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:913-20. [PMID: 25749752 DOI: 10.1007/s00590-015-1614-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/03/2015] [Indexed: 12/17/2022]
Abstract
The goal of this study was to assess the incidence of soft tissue injury in the tibial plateau fracture by magnetic resonance image (MRI) and reveal the relationship between the articular widening/depression and the risk of meniscus and ligament disorder. A total of 54 patients with tibial plateau fracture were indicated for operative intervention. Soft tissue injuries were assessed by MRI. Meniscus, anterior/posterior cruciate ligaments and medial/lateral collateral ligaments injuries on MRI were evaluated. The articular widening/depression was measured in picture archiving and communication systems. Schatzker classification of fracture types was not significantly associated with soft tissue injuries. The rates of soft tissue injury in types IV and II (respectively, 85.7 and 74.1 %) were higher than those in other types. The meniscus injury was the most common soft tissue damage, and the incidence of meniscus injury was 55.6 %. When LPDCT and LPWCT were, respectively, about 7.6 mm and 10.1 mm and LPDX-ray and LPWX-ray, respectively, 5.6 and 7.4 mm, more attention should be paid on the collateral and cruciate ligament injuries in types I, II and III. Furthermore, when LPWCT and LPWX-ray were, respectively, about 10.3 and 8.6 mm, the collateral and cruciate ligaments were susceptible to injury in types IV and V. In conclusion, tibial plateau fracture can occur high morbidity of soft tissue injury, including meniscus and ligament disorder. X-ray and CT scan had different predicting standards for soft tissue injury, and the articular widening/depression in the tibial plateau was associated with meniscus and ligament injuries.
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Anatomic anterior cruciate ligament reconstruction: a changing paradigm. Knee Surg Sports Traumatol Arthrosc 2015; 23:640-8. [PMID: 25086574 DOI: 10.1007/s00167-014-3209-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 07/22/2014] [Indexed: 02/07/2023]
Abstract
Injury to the anterior cruciate ligament (ACL) of the knee is potentially devastating for the patient and can result in both acute and long-term clinical problems. Consequently, the ACL has always been and continues to be of great interest to orthopaedic scientists and clinicians worldwide. Major advancements in ACL surgery have been made in the past few years. ACL reconstruction has shifted from an open to arthroscopic procedure, in which a two- and later one-incision technique was applied. Studies have found that traditional, transtibial arthroscopic single-bundle reconstruction does not fully restore rotational stability of the knee joint, and as such, a more anatomic approach to ACL reconstruction has emerged. The goal of anatomic ACL reconstruction is to replicate the knee's normal anatomy and restore its normal kinematics, all while protecting long-term knee health. This manuscript describes the research that has changed the paradigm of ACL reconstruction from traditional techniques to present day anatomic and individualized concepts.
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Lord B, Grice J, Cox G, Yasen S, Wilson A. (iii) Anterior cruciate ligament reconstruction – evolution and current concepts. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.mporth.2014.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Siebold R, Schuhmacher P, Fernandez F, Śmigielski R, Fink C, Brehmer A, Kirsch J. Flat midsubstance of the anterior cruciate ligament with tibial "C"-shaped insertion site. Knee Surg Sports Traumatol Arthrosc 2015; 23:3136-42. [PMID: 24841941 PMCID: PMC4611027 DOI: 10.1007/s00167-014-3058-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 05/02/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE This anatomical cadaver study was performed to investigate the flat appearance of the midsubstance shape of the anterior cruciate ligament (ACL) and its tibial "C"-shaped insertion site. METHODS The ACL midsubstance and the tibial ACL insertion were dissected in 20 cadaveric knees (n = 6 fresh frozen and n = 14 paraffined). Magnifying spectacles were used for all dissections. Morphometric measurements were performed using callipers and on digital photographs. RESULTS In all specimens, the midsubstance of the ACL was flat with a mean width of 9.9 mm, thickness of 3.9 mm and cross-sectional area of 38.7 mm(2). The "direct" "C"-shaped tibial insertion runs from along the medial tibial spine to the anterior aspect of the lateral meniscus. The mean width (length) of the "C" was 12.6 mm, its thickness 3.3 mm and area 31.4 mm(2). The centre of the "C" was the bony insertion of the anterior root of the lateral meniscus overlayed by fat and crossed by the ACL. No posterolateral (PL) inserting ACL fibres were found. Together with the larger "indirect" part (area 79.6 mm(2)), the "direct" one formed a "duck-foot"-shaped footprint. CONCLUSION The tibial ACL midsubstance and tibial "C"-shaped insertion are flat and are resembling a "ribbon". The centre of the "C" is the bony insertion of the anterior root of the lateral meniscus. There are no central or PL inserting ACL fibres. Anatomical ACL reconstruction may therefore require a flat graft and a "C"-shaped tibial footprint reconstruction with an anteromedial bone tunnel for single bundle and an additional posteromedial bone tunnel for double bundle.
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Affiliation(s)
- Rainer Siebold
- HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany.
- Institute for Anatomy and Cell Biology, INF, Ruprecht-Karls University, Heidelberg, Germany.
| | - Peter Schuhmacher
- HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany
| | - Francis Fernandez
- HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany
| | - Robert Śmigielski
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland
| | - Christian Fink
- Sportsclinic Austria, Tivoli Ost, Olympiastr. 39, 6020, Innsbruck, Austria
| | - Axel Brehmer
- Institute for Anatomy Lehrstuhl I, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstr. 9, 91054, Erlangen, Germany
| | - Joachim Kirsch
- Institute for Anatomy and Cell Biology, INF, Ruprecht-Karls University, Heidelberg, Germany
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Śmigielski R, Zdanowicz U, Drwięga M, Ciszek B, Ciszkowska-Łysoń B, Siebold R. Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees. Knee Surg Sports Traumatol Arthrosc 2015; 23:3143-50. [PMID: 24972997 PMCID: PMC4611008 DOI: 10.1007/s00167-014-3146-7] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 05/06/2014] [Indexed: 01/13/2023]
Abstract
PURPOSE Recently, the configuration of the anterior cruciate ligament (ACL) from its direct femoral insertion to midsubstance was found to be flat. This might have an important impact for anatomical ACL reconstruction. The purpose of this anatomical study was to evaluate the macroscopic appearance of the ACL from femoral to midsubstance. METHODS The ACL was dissected in 111 human fresh frozen cadaver knees from its femoral insertion to midsubstance, and the shape was described. The anatomical findings were documented on digital photographs and on video. Thirty knees were sent for computed tomography (CT), magnetic resonance imaging (MRI) and histology of the femoral ACL insertion. RESULTS Two millimetres from its direct femoral insertion, the ACL fibres formed a flat ribbon in all dissected knees without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The width of the ribbon was between 11.43 and 16.18 mm and the thickness of the ACL was only 2.54-3.38 mm. 3D CT, MRI and the histological examination confirmed above findings. CONCLUSION This is a detailed anatomical study describing the ribbon-like structure of the ACL from its femoral insertion to midsubstance. A key point was to carefully remove the surface fibrous membrane of the ACL. A total of 2-3 mm from its bony femoral insertion, the ACL formed a flat ribbon without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The findings of a flat ligament may change the future approach to femoral ACL footprint and midsubstance ACL reconstruction and to graft selection.
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Affiliation(s)
- Robert Śmigielski
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland.
| | - Urszula Zdanowicz
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
| | - Michał Drwięga
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
| | - Bogdan Ciszek
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Chalbinskiego 5, 02-004 Warsaw, Poland
| | | | - Rainer Siebold
- Institute for Anatomy and Cell Biology, INF, Ruprecht-Karls University Heidelberg, Heidelberg, Germany. .,HKF: Center for Spezialised Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.
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Sinha S, Naik AK, Meena D, Jain VK, Arya RK. Creation of femoral tunnel by outside-in technique for ACL reconstruction: an analysis. Arch Orthop Trauma Surg 2014; 134:1709-16. [PMID: 25179894 DOI: 10.1007/s00402-014-2078-5] [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] [Received: 02/18/2014] [Indexed: 02/09/2023]
Abstract
PURPOSE To study the outcome of ACL reconstruction by retrograde outside-in (OI) creation of femoral tunnel. METHODS ACL reconstruction was done in 41 cases by OI technique. The tip of 115° femoral guide was placed at posterior aspect of femoral foot print of ACL. Reaming was done from outside-in over guide pin. The length of femoral tunnel was obtained by measuring guide pin. The location of intra-articular femoral tunnel aperture and graft was recorded. Tibial tunnel was created with 50° guide placed at tibial foot print of ACL. Post-operative digital radiograph was taken. Antero-posterior view was used to calculate coronal inclination of femoral tunnel. On lateral view femoral tunnel location was marked in relation to the intersection of Blumensaat line and posterior femoral cortical line. Lysholm scoring and pivot shift test were performed at follow-up. Objective measurement of anterior tibial translation was done by rolimeter (aircast) at 1 year. RESULTS The mean femoral tunnel length recorded was 39.5 mm (±3.4). There was no incidence of femoral tunnel blow out or graft impingement. All cases had femoral tunnel aperture location posterior to posterior femoral cortical line and inferior to Blumensaat line. The mean coronal angle of femoral tunnel was 30.39° (±4.6). The mean preoperative Lysholm score of 53.5 (±13) increased to 95.2 (±3.5) 1 year after surgery. All the patients had full range of motion. The pivot shift test was negative and instrumented measurement of anterior translation of tibia was near normal in all cases. CONCLUSION OI technique of ACL reconstruction is a simple reproducible technique. The unconstrained placement and angling of femoral guide result in a femoral tunnel which is through footprint of ACL. The graft is placed very low, oblique and as posterior as possible on femoral side mimicking the native ACL. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Skand Sinha
- Department of Orthopaedics, Dr RML Hospital and PGIMER, New Delhi, 110001, India,
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Smith JO, Yasen S, Risebury MJ, Wilson AJ. Femoral and tibial tunnel positioning on graft isometry in anterior cruciate ligament reconstruction: a cadaveric study. J Orthop Surg (Hong Kong) 2014; 22:318-24. [PMID: 25550010 DOI: 10.1177/230949901402200310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess distance changes between the femoral and tibial attachment points of 3 different anterior cruciate ligament (ACL) tunnel entry positions throughout the range of knee motion in cadaveric knees. METHODS The ACLs of 11 fresh-frozen cadaveric knees (from 6 men and 5 women) were removed using radiofrequency. Three tibial tunnel placements were made using a cannulated awl, and three 2.4-mm pilot tunnels were drilled on the lateral femoral condyle. One end of an inelastic suture was inserted from each of the 3 femoral holes and fixed on the femoral cortex using a suture button in turn, whereas the other end of the suture was passed through the cannulated awl and fixed on each of the 3 tibial placements in turn, with constant tension. Distance changes of the suture throughout the range of knee movement (0º, 90º, and 135º of knee flexion) were measured for each combination of tibial and femoral positions. RESULTS The distance was minimum when the knee was in full extension (p < 0.0001). Most of the distance changes occurred during initial flexion (0º-90º). The most isometric position (mean ± standard deviation [SD] distance change, 2.78 ± 0.93 mm; p < 0.0001) was noted when the suture was at the anteromedial bundle placement in the femur and anterior in the tibia. The least isometric position (mean ± SD distance change, 10.37 ± 2.08 mm; p < 0.0001) was noted when the suture was at the mid-bundle position in the femur and at the posterolateral bundle insertion in the tibia. The anatomic position resulted in a mean ± SD distance change of 7.63 ± 2.01 mm (p < 0.0001). The femoral position had a greater influence on distance change than the tibial position. CONCLUSION None of the ACL graft positions was isometric. Anatomic ACL positioning resulted in comparable anisometry to the native ACL. The minimum distance for all graft positions was noted in full extension, in which position the graft should be fixed during anatomic ACL reconstruction.
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Affiliation(s)
- James O Smith
- Department of Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, United Kingdom
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Quantitative topographic anatomy of the femoral ACL footprint: a micro-CT analysis. Med Biol Eng Comput 2014; 52:985-995. [DOI: 10.1007/s11517-014-1196-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 09/17/2014] [Indexed: 01/28/2023]
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Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A. A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY : OFFICIAL JOURNAL OF THE ESSKA 2014. [PMID: 24929656 DOI: 10.1007/s00167-014-3117-z.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to verify and characterize the anatomical properties of the anterolateral capsule, with the aim of establishing a more accurate anatomical description of the anterolateral ligament (ALL). Furthermore, microscopic analysis of the tissue was performed to determine whether the ALL can morphologically be classified as ligamentous tissue, as well as reveal any potential functional characteristics. METHODS Three different modalities were used to validate the existence of the ALL: magnetic resonance imagining (MRI), anatomical dissection, and histological analysis. Ten fresh-frozen cadaveric knee specimens underwent MRI, followed by anatomical dissection which allowed comparison of MRI to gross anatomy. Nine additional fresh-frozen cadaveric knees (19 total) were dissected for a further anatomical description. Four specimens underwent H&E staining to look at morphological characteristics, and one specimen was analysed using immunohistochemistry to locate peripheral nervous innervation. RESULTS The ALL was found in all ten knees undergoing MRI and all nineteen knees undergoing anatomical dissection, with MRI being able to predict its corresponding anatomical dissection. The ALL was found to have bone-to-bone attachment points from the lateral femoral epicondyle to the lateral tibia, in addition to a prominent meniscal attachment. Histological sectioning showed ALL morphology to be characteristic of ligamentous tissue, having dense, regularly organized collagenous bundles. Immunohistochemistry revealed a large network of peripheral nervous innervation, indicating a potential proprioceptive role. CONCLUSION From this study, the ALL is an independent structure in the anterolateral compartment of the knee and may serve a proprioceptive role in knee mechanics.
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Affiliation(s)
- Scott Caterine
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Fowler Kennedy Sport Medicine Clinic, 3M Centre, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Robert Litchfield
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Marjorie Johnson
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Blaine Chronik
- Department of Physics and Astronomy, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.
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Yasen SK, Logan JS, Smith JO, Nancoo T, Risebury MJ, Wilson AJ. TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2013; 3:e13-20. [PMID: 24749016 PMCID: PMC3986474 DOI: 10.1016/j.eats.2013.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/08/2013] [Indexed: 02/03/2023] Open
Abstract
Cadaveric and clinical biomechanical studies show improved kinematic restoration using double-bundle anterior cruciate ligament (ACL) reconstruction techniques. These have been criticized in the past for being technically challenging. We present a novel 3-socket approach for anatomic "all-inside" double-bundle reconstruction using a single hamstring tendon fashioned to create a trifurcate graft: the TriLink technique. The semitendinosus alone is harvested, quadrupled, and attached to 3 suspensory fixation devices in a Y-shaped configuration, creating a 4-stranded tibial limb and 2 double-stranded femoral limbs. A medial viewing/lateral working arthroscopic approach is adopted using specifically designed instrumentation. Anatomic placement of the 2 femoral tunnels is performed by a validated direct measurement technique. A single mid-bundle position is used on the tibia. Both femoral and tibial sockets are created in a retrograde manner using outside-to-in drilling. This is a simplified operative technique for anatomic double-bundle ACL reconstruction that maximizes bone preservation. The TriLink construct replicates the 2 bundles of the ACL, conferring native functional anisometry and improving femoral footprint coverage while avoiding the complexities and pitfalls of double-tibial tunnel techniques. Preservation of the gracilis reduces the morbidity of hamstring harvest and allows greater flexibility in graft choice in cases requiring multiligament reconstruction.
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Affiliation(s)
- Sam K. Yasen
- Address correspondence to Sam K. Yasen, M.B.B.S., B.Sc.(Hons), M.R.C.S., Department of Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, England.
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Pascual-Garrido C, Swanson BL, Swanson KE. Transtibial versus low anteromedial portal drilling for anterior cruciate ligament reconstruction: a radiographic study of femoral tunnel position. Knee Surg Sports Traumatol Arthrosc 2013; 21:846-50. [PMID: 22476526 DOI: 10.1007/s00167-012-1988-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 03/20/2012] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study is to compare femoral tunnel positions after ACL reconstruction by the transtibial (TT) approach versus the low anteromedial approach using radiographs from a single surgeon. METHODS The standard postoperative knee radiographs of 50 patients with an ACL reconstruction were studied. Two groups were determined according to the technique used. The low anteromedial portal group and the transtibial portal group. The femoral bone tunnel was identified radiographically, and its position determined in the lateral and A-P view. Coronal and sagittal obliquity of the tunnel was measured and compared among both groups. RESULTS In the sagittal plane, femoral bone tunnels averaged 54° ± 6° for the TT technique and 59° ± 12° (p = 0.07) for the low anteromedial portal technique. In the coronal plane, the bone tunnels drilled through the low anteromedial portal showed a significantly more oblique femoral tunnel position (50° ± 6°) compared to TT drilling (58° ± 9°), p ≤ 0.05. CONCLUSION Drilling the femoral tunnel through the low anteromedial portal resulted in a more oblique femoral tunnel position compared to the TT technique. Clinically, the low anteromedial portal may allow to better restore the anatomic orientation of the ACL.
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Shoji T, Nakasa T, Yamasaki K, Kodama A, Miyaki S, Niimoto T, Okuhara A, Kamei N, Adachi N, Ochi M. The effect of intra-articular injection of microRNA-210 on ligament healing in a rat model. Am J Sports Med 2012; 40:2470-8. [PMID: 22986296 DOI: 10.1177/0363546512458894] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is known from clinical and experimental studies that the healing potential of the anterior cruciate ligament (ACL) is extremely poor and that early phases of ligament healing require an augmented blood supply. MicroRNA (miRNA) is a type of small, noncoding RNA that negatively regulates gene expression, and miRNA (miR)-210 is reported to be crucial for cell response to hypoxia, vascular endothelial growth factor (VEGF)-driven endothelial cell migration, and formation of capillary-like structures. PURPOSE The purpose of this study was to examine the effect of intra-articular injection of miRNA miR-210 on acceleration of ACL healing. STUDY DESIGN Controlled laboratory study. METHODS Two experiments were performed in this study. The ACLs of 12-week-old male LEW/CrlCrlj rats were partially transected. First, the temporal expression change of miR-210 after ACL injury was analyzed using real-time polymerase chain reaction (PCR) on day zero, and 1, 2, and 4 weeks after injury (n = 5 at each time point). Next, intra-articular injection of double-stranded (ds) miR-210 with atelocollagen was performed soon after injury. The control group was injected with control small interfering RNA (siRNA). Four weeks after injection, biomechanical and histological assessments of samples stained with H&E as well as Masson trichrome, and immunohistochemistry for VEGF, fibroblast growth factor 2 (FGF2), isolectin B4, and collagen type I, were performed. Real-time PCR analysis was also performed for quantitative evaluation of miR-210, VEGF-A, and collagen type I. RESULTS Real-time PCR analysis revealed that miR-210 expression was decreased soon after injury but gradually increased thereafter. Histological analysis confirmed that the transected area was covered with healing tissue in the miR-210 group but remained devoid of any tissue in the control group 4 weeks after injury. Biomechanical analysis confirmed the improvement of biomechanical properties in the miR-210 group; the ultimate failure loads 4 weeks after injection were 30.5 ± 3.1 N in the miR-210 group and 22.8 ± 3.1 N in the control group (P < .05). Real-time PCR analysis showed that endogenous miR-210, VEGF, and collagen type I were highly expressed compared with controls, and immunohistochemistry for VEGF, FGF2, isolectin B4, and collagen type I showed that VEGF and FGF2 were highly upregulated, and there were abundant blood vessels and fibrotic deposition in the miR-210 group. CONCLUSION Injection of ds miR-210 was effective in promoting the healing of partially torn ACLs through enhancement of angiogenesis via upregulation of VEGF and FGF2. CLINICAL RELEVANCE It might represent a potential therapeutic approach for treatment of ACL injury.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Japan
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Dave LYH, Nyland J, Caborn DNM. Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout: a cadaveric study. Arthroscopy 2012; 28:1381-7. [PMID: 22694942 DOI: 10.1016/j.arthro.2012.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 03/08/2012] [Accepted: 03/08/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE This study compared femoral intraosseous "tunnel" length and distance from the posterior femoral cortex (PFC) when straight and flexible guidewires were drilled through an accessory anteromedial portal at 90° and 120° knee flexion. We had 2 study hypotheses: (1) 120° knee flexion would create longer femoral intraosseous tunnels than 90° knee flexion regardless of guidewire type and (2) 120° knee flexion would display a more consistent PFC blowout safety margin than 90° knee flexion regardless of guidewire type. METHODS Straight and flexible guidewires were drilled at 90° and 120° flexion in 8 cadaveric knees. Guidewire intraosseous length and distance from the PFC were measured at both knee flexion angles. Two-way analysis of variance (guidewire type, knee flexion angle) and a Fisher exact test were used to compare group differences. RESULTS Guidewire exit points at 120° knee flexion were located farther from the PFC than at 90° knee flexion regardless of whether flexible guidewires (19.0 ± 5.3 mm v 12.6 ± 3.3 mm) or straight guidewires (12.9 ± 4.5 mm v 5.0 ± 3.3 mm) were used (P < .0001). Straight guidewires drilled at 90° knee flexion were within 3 mm of the PFC in 4 of 8 specimens (50%) compared with 0 of 8 at 120° knee flexion (P = .038). Intraosseous guidewire length was greater at 120° knee flexion regardless of whether straight or flexible guidewires were used (P = .04). CONCLUSIONS Flexible guidewires and a 120° knee flexion angle both decrease the likelihood of PFC blowout. A 120° knee flexion angle is more important to femoral tunnel length than guidewire type. Use of 120° knee flexion even when drilling flexible guidewires increases the safety margin needed to prevent PFC blowout. CLINICAL RELEVANCE When knee flexion is limited, curved guides and flexible guidewires can help reduce PFC blowout risk and achieve longer tunnels.
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Affiliation(s)
- Lee Yee Han Dave
- Division of Sports Medicine, Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky 40202, USA
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Lee YHD, Kuroda R, Zhao J, Chan KM. A tale of 10 European centres - 2010 APOSSM travelling fellowship review in ACL surgery. Sports Med Arthrosc Rehabil Ther Technol 2012; 4:27. [PMID: 22839644 PMCID: PMC3500227 DOI: 10.1186/1758-2555-4-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 07/03/2012] [Indexed: 11/10/2022]
Abstract
The purpose of ESSKA- APOSSM Travelling fellowship is to better understand the epidemiology, management and surgical techniques for sports across continents. There has been a progressive evolution in ACL reconstruction and there is variation in technique in ACL reconstruction amongst the most experienced surgeons in different continents. During this one month fellowship, we saw various ACL reconstruction techniques using different graft sources, with a variety of graft fixation methods, with the common aim of recreating an anatomical ACL reconstruction.
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Affiliation(s)
- Yee Han Dave Lee
- Department of Orthopedic Surgery, Changi General Hospital, 2 Simei St 3, Singapore, 529889, Singapore.
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Getgood A, Spalding T. The evolution of anatomic anterior cruciate ligament reconstruction. Open Orthop J 2012; 6:287-94. [PMID: 22905073 PMCID: PMC3415664 DOI: 10.2174/1874325001206010287] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 03/02/2012] [Accepted: 03/10/2012] [Indexed: 02/08/2023] Open
Abstract
Anterior cruciate ligament reconstruction has evolved significantly since the early 1900's, back when an emphasis was placed on repair and not reconstruction. Over the past century, the technique has evolved from intra-articular non anatomic reconstruction, to extra articular reconstruction, back to intra articular (performed arthroscopically), to now, the advent of anatomic insertion site restoration. This review will aim to illustrate the changes that have occurred, describing the rational for this process, based upon anatomical, radiological, biomechanical and clinical studies, all of which have aimed to improve patient function following ACL injury.
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Affiliation(s)
- Alan Getgood
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK
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Abstract
The first part of The story of anterior cruciate ligament reconstruction, was published in the previous issue of this journal, and the reader is encouraged to study both parts in order to become better acquainted with the subject. Those who have read the first part will remember that it concerned the historical developments surrounding the ligament's discovery, the acknowledgement of its function and the appreciation of the detrimental effects once it becomes damaged. It also described the efforts of the early pioneers who recognised the need to reestablish ligament function by ways of ligament repair or reconstruction with autologous tissue. The second part, presented here, explores the surgeons' quests to find the ideal graft material by experimenting with various synthetic materials, as well as those derived from animals (xenografts) and other human beings (allografts). It looks at historic efforts to stabilise an unstable knee by means of extra-articular reinforcements which were popular until not too long ago and reviews the developments of the various graft fixation methods available today. Furthermore it evaluates the influence of arthroscopy which revolutionised not just the procedure of ACL reconstruction but knee surgery in general, and also focuses on the more recent developments of double bundle techniques and the recreation of the ligament's native anatomy.
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Affiliation(s)
- Oliver S Schindler
- Bristol Arthritis & Sports Injury Clinic, St Mary's Hospital, Bristol, BS8 1JU.
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