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Xu C, Liu T, Wang M, Liu C, Li B, Lian Q, Chen T, Chen F, Qiao S, Wang Z. Comparison of proprioception recovery following anterior cruciate ligament reconstruction using an artificial graft versus an autograft. BMC Musculoskelet Disord 2022; 23:1056. [PMID: 36463165 PMCID: PMC9719127 DOI: 10.1186/s12891-022-06019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/23/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To compare proprioception recovery after anterior cruciate ligament reconstruction (ACLR) with a hamstring tendon autograft versus the artificial Ligament Advanced Reinforcement System (LARS). MATERIAL AND METHODS Forty patients (9 females, 31 males) with anterior cruciate ligament (ACL) rupture were enrolled in this prospective study. Patients were randomized to two groups, 1) ACLR using a hamstring tendon autograft (n = 20) or 2) ACLR using artificial LARS (n = 20). Proprioception was assessed with knee joint position sense (JPS) passive-passive test at 45° and 75° flexions, with the contralateral healthy knee as a control baseline to calculate the JPS error. Knee JPS absolute error was used as the main outcome variable and defined as the absolute difference between the reproduction and target angles. RESULTS JPS error in both groups at 3 months after ACLR was significantly higher than that at 12 months. However, no significant difference in JPS error was detected between the LARS and autograft groups at either 3 or 12 months after ACLR. Analyzing JPS data by grouping patients according to whether ACLR was performed more or less than 1 year following injury regardless of graft type showed a statistically significant difference between the groups at 3 months, but not at 12 months, after ACLR. Patients receiving the graft within 1 year of injury had a lower JPS error than those receiving the graft more than 1 year after injury at 3 months. No complications were associated with either ACLR method. CONCLUSION ACLR with a hamstring tendon autograft or LARS artificial graft is similarly safe and effective for recovering knee proprioception.
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Affiliation(s)
- Changli Xu
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China ,Department of Orthopedics, The Third Affiliated to the Naval Military Medical University, Shanghai, 201805 People’s Republic of China ,The fifth Outpatients Department, The 980th Hospital of Joint Logistic Support Force, Shijiazhuang, 050083 People’s Republic of China
| | - Tianze Liu
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China
| | - Miao Wang
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China ,Department of Orthopedics, The Third Affiliated to the Naval Military Medical University, Shanghai, 201805 People’s Republic of China
| | - Chang Liu
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China ,Department of Orthopedics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian Province 350025 People’s Republic of China
| | - Bo Li
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China
| | - Qiujian Lian
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China
| | - Tongjiang Chen
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China
| | - Fengmei Chen
- Department of Orthopedics, The Third Affiliated to the Naval Military Medical University, Shanghai, 201805 People’s Republic of China
| | - Suchi Qiao
- Department of Orthopedics, The Third Affiliated to the Naval Military Medical University, Shanghai, 201805 People’s Republic of China
| | - Zhiwei Wang
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China ,Department of Orthopedics, The Third Affiliated to the Naval Military Medical University, Shanghai, 201805 People’s Republic of China
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Ikuta Y, Nakamae A, Shimizu R, Ishikawa M, Nakasa T, Ochi M, Adachi N. A Comparison of Central Anatomic Single-Bundle Reconstruction and Anatomic Double-Bundle Reconstruction in Anteroposterior and Rotational Knee Stability: Intraoperative Biomechanical Evaluation. J Knee Surg 2022; 35:273-279. [PMID: 32615614 DOI: 10.1055/s-0040-1713730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Postoperative anterior and rotational stability are still controversial when compared with single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. This study aimed to compare the central anatomical SB and anatomical DB ACL reconstruction in intraoperative knee kinematics during continuous knee flexion-extension. A total of 34 patients who underwent ACL reconstruction using the hamstring tendon were evaluated intraoperatively before and immediately after ACL reconstruction using OrthoPilot ACL Navigation System Version 3.0. The patients were prospectively randomized into the central anatomical SB (17 knees) and the anatomical DB reconstruction (17 knees) groups. The tibial translation and rotation were continuously measured during knee flexion-extension under conventional knee motion, anterior tibial load (100N), and internal-external torque (3 N·m). The anterior tibial translation and total range of tibial rotation were calculated from the measurement values from 20 to 50 degrees at each 5-degree point. The anterior tibial translation (p = 0.59; two-factor repeated measures analysis of variance; η 2G = 0.0077) and total range of tibial rotation (p = 0.95; η 2G = 0.0001) at each knee flexion angle showed no significant difference between the central anatomical SB and anatomical DB reconstruction groups. It is suggested that the central anatomical SB reconstruction is comparable with the anatomical DB reconstruction in biomechanical anteroposterior and rotational knee stability at time 0.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ryo Shimizu
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Nobuo Adachi
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Iriuchishima T, Goto B. Systematic Review of Surgical Technique and Tunnel Target Points and Placement in Anatomical Single-Bundle ACL Reconstruction. J Knee Surg 2021; 34:1531-1538. [PMID: 32480416 DOI: 10.1055/s-0040-1710521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this systematic review was to reveal the trend in surgical technique and tunnel targets points and placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, data collection was performed. PubMed, EMBASE, and Cochran Review were searched using the terms "anterior cruciate ligament reconstruction," "anatomic or anatomical," and "single bundle." Studies were included when they reported clinical results, surgical technique, and/or tunnel placement evaluation. Laboratory studies, technical reports, case reports, and reviews were excluded from this study. From these full article reviews, graft selection, method of creating the femoral tunnel, and femoral and tibial tunnel target points and placement were evaluated. In the 79 studies included for data evaluation, the selected grafts were: bone patella tendon bone autograft (12%), and hamstring autograft (83%). The reported methods of creating the femoral tunnel were: transportal technique (54%), outside-in technique (15%), and transtibial technique (19%). In the 60 studies reporting tunnel target points, the target point was the center of the femoral footprint (60%), and the center of the anteromedial bundle footprint (22%). In the 23 studies evaluating tunnel placement, the femoral tunnel was placed in a shallow-deep direction (32.3%) and in a high-low direction (30.2%), and the tibial tunnel was placed from the anterior margin of the tibia (38.1%). The results of this systematic review revealed a trend in anatomical single-bundle ACL reconstruction favoring a hamstring tendon with a transportal technique, and a tunnel target point mainly at the center of the ACL footprint. The level of evidence stated is Systematic review of level-III studies.
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Affiliation(s)
| | - Bunsei Goto
- Department of Orthopaedic Surgery, Kamimoku Spa Hospital, Minakami, Japan
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Kamitani A, Hara K, Arai Y, Atsumi S, Takahashi T, Nakagawa S, Fuji Y, Inoue H, Takahashi K. Adjustable-Loop Devices Promote Graft Revascularization in the Femoral Tunnel After ACL Reconstruction: Comparison With Fixed-Loop Devices Using Magnetic Resonance Angiography. Orthop J Sports Med 2021; 9:2325967121992134. [PMID: 33738312 PMCID: PMC7934042 DOI: 10.1177/2325967121992134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Hamstring tendon grafts are usually fixed in anterior cruciate ligament (ACL) reconstruction using either an adjustable-loop device (ALD) or a fixed-loop device (FLD). The contact area between the graft and the tunnel wall is different between the 2 devices. Purpose: To determine using magnetic resonance angiography (MRA) whether ALD and FLD result in different blood flow of the graft in the femoral tunnel during the early postoperative period. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2008 and 2018, a total of 42 patients (17 men and 25 women) underwent MRA at 3 months after ACL reconstruction. All surgical procedures were performed using semitendinosus tendon autografts folded into 4 strands. Overall, 23 patients underwent the FLD procedure and 19 patients underwent the ALD procedure. The signal intensity of the superior portion of the graft in the femoral tunnel was evaluated using transverse MRA images perpendicular to the femoral tunnel axis. Results: MRA images showed high signal intensity in the superior portion of the graft in the femoral tunnel in 94.7% and 60.9% of the ALD patients and FLD patients, respectively, a statistically significant difference (P = .03). Conclusion: MRA images at 3 months after surgery revealed that blood flow reached the superior end of the tendon graft in the femoral tunnel in more patients who underwent ACL reconstruction with an ALD compared with an FLD.
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Affiliation(s)
- Aguri Kamitani
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Orthopedics, Japan Community Heath Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Kunio Hara
- Department of Orthopedics, Japan Community Heath Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoru Atsumi
- Department of Orthopedics, Japan Community Heath Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Takeshi Takahashi
- Department of Radiology, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuta Fuji
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Inoue
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Arai Y, Hara K, Inoue H, Kanamura H, Nakagawa S, Atsumi S, Mikami Y. Revascularization to the bone tunnel wall after anterior cruciate ligament reconstruction may relate to the distance from the vessels. Knee Surg Relat Res 2020; 32:53. [PMID: 33023675 PMCID: PMC7541268 DOI: 10.1186/s43019-020-00070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose We use magnetic resonance angiography to evaluate the difference of vascular ingrowth to the bone tunnel on the anterior and posterior walls quantitatively after anterior cruciate ligament reconstruction. Materials and methods One hundred patients underwent anterior cruciate ligament reconstruction with multi-stranded semitendinosus tendons. They were retrospectively divided into those who underwent magnetic resonance angiography 2, 3, 4 to 6, and ≥ 7 months after surgery. The mean signal-to-noise ratios of the bone tunnel walls in the femur and tibia from the digital data were measured and compared for the anterior and posterior walls. Results The signal-to-noise ratio of the posterior wall of the femoral bone tunnel was significantly higher than that of the anterior wall in each group. On the tibial side, the signal-to-noise ratio of the anterior wall was significantly higher than that of the posterior wall at ≥4 months after surgery. Conclusions This study showed that the blood flow after anterior cruciate ligament reconstruction to the femoral bone tunnel is maintained from the posterior wall, and is maintained to the tibial side from the anterior wall 4 months postoperatively. Revascularization to the bone tunnel wall after anterior cruciate ligament reconstruction may relate to the distance from the vessels.
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Affiliation(s)
- Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Kyoto, 602-8566, Japan
| | - Kunio Hara
- Japan Community Health care Organization Kyoto Kuramaguchi Medical Center, 27, Shimofusacho, Koyama, Kita-Ku, Kyoto, Kyoto, 603-8151, Japan
| | - Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Kyoto, 602-8566, Japan.
| | - Hitoshi Kanamura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Kyoto, 602-8566, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Kyoto, 602-8566, Japan
| | - Satoru Atsumi
- Japan Community Health care Organization Kyoto Kuramaguchi Medical Center, 27, Shimofusacho, Koyama, Kita-Ku, Kyoto, Kyoto, 603-8151, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Kyoto, 602-8566, Japan
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Evaluation of the intraoperative kinematics during double-bundle anterior cruciate ligament reconstruction using a navigation system. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 19:11-16. [PMID: 31768329 PMCID: PMC6872809 DOI: 10.1016/j.asmart.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/11/2019] [Indexed: 12/04/2022]
Abstract
Background/objective There is controversy regarding the biomechanical function of the anteromedial (AM) and posterolateral (PL) bundles in isolated tibiofemoral rotation during double-bundle anterior cruciate ligament (ACL) reconstruction. This study aimed to evaluate the biomechanical function of the AM and PL bundles of the ACL using a computer navigation system. Methods This study involved 15 patients who underwent double-bundle ACL reconstruction. Anteroposterior and isolated rotational knee laxity were measured with a navigation system. The measurements were performed four times, namely, before fixation, after temporary PL bundle fixation, after AM bundle fixation, and after double-bundle reconstruction. With knee flexion ranging from 20° to 60°, we continuously measured the anterior tibial displacement under an anterior drawer stress (100 N using a spring balance). The total range of tibial rotation was also measured under an external and internal rotational torque of 3 Nm. Results Fixation of either the AM or the PL bundle significantly reduced the anteroposterior displacement at all knee flexion angles. Although the anteroposterior displacement after AM bundle fixation was relatively similar throughout the range of motion (2.4–3.2 mm), the anteroposterior displacement after PL bundle fixation increased continuously with knee flexion (2.2–4.6 mm). With respect to the total range of tibial rotation under external and internal rotational torque, there was no significant difference between AM and PL bundle fixation throughout the range of motion. The total range of tibial rotation was significantly reduced only on double-bundle reconstruction at 20° and 25° knee flexion compared to the pre-reconstruction range (P = 0.015 and 0.036, respectively). Conclusion The AM and PL bundles function differently for controlling anterior knee laxity throughout the range of motion. The function of the AM and PL bundles was similar for controlling isolated tibiofemoral rotation. Isolated tibiofemoral rotation was significantly controlled only on double-bundle reconstruction at knee flexion angles of 20° and 25°.
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Passive anterior tibia translation in anterior cruciate ligament-injured, anterior cruciate ligament-reconstructed and healthy knees: a systematic review. Musculoskelet Surg 2018; 103:121-130. [PMID: 30328030 PMCID: PMC6656892 DOI: 10.1007/s12306-018-0572-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 10/06/2018] [Indexed: 01/01/2023]
Abstract
Abstract Anterior tibia translation (ATT) is mainly prevented by the anterior cruciate ligament. Passive ATT tests are commonly used to diagnose an anterior cruciate ligament (ACL) injury, to select patients for an ACL reconstruction (ACLR), and as an outcome measure after an ACLR. The aim of this review was to present an overview of possible factors determining ATT. A second purpose was to give a summary of the ATT measured in the literature in healthy, ACL-injured and ACLR knees and a comparison between those groups. A literature search was conducted with PubMed. Inclusion criteria were full-text primary studies published in English between January 2006 and October 2016. Studies included reported ATT in explicit data in healthy as well as ACL-injured or ACLR knees or in ACL-injured as well as ACLR knees. Sixty-one articles met inclusion criteria. Two articles measured the ATT in healthy as well as ACL-injured knees, 51 in ACL-injured as well as in ACLR knees, three in ACLR as well as in healthy knees and three in healthy, ACL-injured and ACLR knees. A difference in ATT is found between healthy, contralateral, ACLR and ACL-injured knees and between chronic and acute ACL injury. Graft choices and intra-articular injuries are factors which could affect the ATT. The mean ATT was lowest to highest in ACLR knees using a bone–patella tendon–bone autograft, ACLR knees using a hamstring autograft, contralateral healthy knees, healthy knees, ACLR knees with an allograft and ACL-injured knees. Factors which could affect the ATT are graft choice, ACL injury or reconstruction, intra-articular injuries and whether an ACL injury is chronic or acute. Comparison of ATT between studies should be taken with caution as a high number of different measurement methods are used. To be able to compare studies, more consistency in measuring devices used should be introduced to measuring ATT. The clinical relevance is that an autograft ACLR might give better results than an allograft ACLR as knee laxity is greater when using an allograft tendon. Level of evidence III.
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Yamamoto Y, Tsuda E, Maeda S, Naraoka T, Kimura Y, Chiba D, Ishibashi Y. Greater Laxity in the Anterior Cruciate Ligament-Injured Knee Carries a Higher Risk of Postreconstruction Pivot Shift: Intraoperative Measurements With a Navigation System. Am J Sports Med 2018; 46:2859-2864. [PMID: 30193083 DOI: 10.1177/0363546518793854] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The presence of pivot shift after anterior cruciate ligament (ACL) reconstruction is correlated with worse clinical outcomes. An orthopaedic navigation system is a useful tool for quantifying laxity in the ACL-deficient knee. PURPOSE To investigate the relationship between preoperative knee laxity measured by a navigation system and postoperative pivot shift (PPS) after ACL reconstruction. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS One hundred patients who underwent primary ACL reconstruction (62 hamstring tendon grafts, 38 patellar tendon grafts) were grouped according to the presence or absence of pivot shift at the 2-year follow-up, and the groups were compared retrospectively. Before surgery, knee laxity was assessed with a navigation system to quantify posterior tibial reduction (PTR) during pivot-shift tests and anterior tibial translation (ATT) during Lachman tests. PTR and ATT cutoff values were determined by receiver operator characteristic (ROC) analysis. RESULTS Preoperative PTR and ATT were significantly larger for patients with PPS (PPS-positive group) than those without (PPS-negative group). In the ROC analysis, the PTR had an area under the curve of 0.871 (95% CI, 0.763-0.979; P < .0001) for predicting a PPS; this was larger than that obtained for the ATT, which had an area under the curve of 0.825 (95% CI, 0.705-0.946; P = .001). Because the ROC curve of the ATT had 2 peaks, the ATT alone was not a suitable predictor for PPS. Based on the ROC curve, the optimal PTR cutoff value was 7 mm, with 88.9% sensitivity and 71.4% specificity for PPS (adjusted odds ratio = 19.7; 95% CI, 2.1-187.9; P = .009). Setting the cutoff value as a combination of the PTR (≧7 mm) and ATT (≧12 mm) improved the specificity (88.9% sensitivity and 84.6% specificity; adjusted odds ratio = 149.8; 95% CI, 5.9-3822.7; P = .002) over that with the PTR alone. CONCLUSION ACL injuries in knees with a large PTR had a higher risk of PPS. When reconstructing the ACL in a knee with a high degree of laxity, surgeons may need to adopt strategies to prevent PPS.
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Affiliation(s)
- Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shugo Maeda
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Naraoka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Jenny JY, Puliero B, Schockmel G, Harnoist S, Clavert P. Experimental validation of the GNRB ® for measuring anterior tibial translation. Orthop Traumatol Surg Res 2017; 103:363-366. [PMID: 28159678 DOI: 10.1016/j.otsr.2016.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/15/2016] [Accepted: 12/30/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The objective of this study was to validate the technique used to measure anterior tibial translation in cadaver knees using the GNRB® device by comparing it with the gold standard, the OrthoPilot® navigation system. HYPOTHESIS Simultaneous measurement of anterior tibial translation by the GNRB® and the OrthoPilot® in the chosen experimental conditions will result in significant differences between devices. MATERIAL AND METHODS Five fresh frozen cadavers were used. The knee was placed in 20° flexion. Four calibrated posterior-anterior forces (134N to 250N) were applied. For each applied force, the anterior tibial translation was measured simultaneously by both devices. Two conditions were analyzed: anterior cruciate ligament (ACL) intact and ACL transected. The primary criterion was anterior tibial translation at 250N. The measurements were compared using a paired Student's t-test and the correlation coefficient was calculated. Agreement between the two methods was determined using Bland-Altman plots. Consistency of the measurements was determined by calculating the intraclass correlation coefficient. RESULTS For all applied forces and ligament conditions, the mean difference between the GNRB® and the navigation system was 0.1±1.7mm (n.s). Out of the 80 measurements taken, the difference between devices was less than ±2mm in 66 cases (82%). There was a strong correlation, good agreement and high consistency between the two measurement methods. DISCUSSION The differences between the measurements taken by the GNRB® and the navigation system were small and likely have no clinical impact. We recommend using the GNRB® to evaluate anterior knee laxity. LEVEL OF EVIDENCE II controlled laboratory study.
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Affiliation(s)
- J-Y Jenny
- Centre de chirurgie orthopédique et de la main (CCOM), hôpitaux universitaires de Strasbourg, 10, avenue Baumann, 67400 Illkirch, France; Université de Strasbourg, 4, rue Blaise-Pascal, 67000 Strasbourg, France.
| | - B Puliero
- Centre de chirurgie orthopédique et de la main (CCOM), hôpitaux universitaires de Strasbourg, 10, avenue Baumann, 67400 Illkirch, France
| | - G Schockmel
- B-Braun medical France, 204, avenue du Maréchal-Juin, 92100 Boulogne-Billancourt, France
| | - S Harnoist
- Genourob, rue de la Gaucherie, 53000 Laval, France
| | - P Clavert
- Centre de chirurgie orthopédique et de la main (CCOM), hôpitaux universitaires de Strasbourg, 10, avenue Baumann, 67400 Illkirch, France; Institut d'anatomie normale, université de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
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Current use of navigation system in ACL surgery: a historical review. Knee Surg Sports Traumatol Arthrosc 2016; 24:3396-3409. [PMID: 27744575 DOI: 10.1007/s00167-016-4356-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/07/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE The present review aims to analyse the available literature regarding the use of navigation systems in ACL reconstructive surgery underling the evolution during the years. METHODS A research of indexed scientific papers was performed on PubMed and Cochrane Library database. The research was performed in December 2015 with no publication year restriction. Only English-written papers and related to the terms ACL, NAVIGATION, CAOS and CAS were considered. Two reviewers independently selected only those manuscripts that presented at least the application of navigation system for ACL reconstructive surgery. RESULTS One hundred and forty-six of 394 articles were finally selected. In this analysis, it was possible to review the main uses of navigation system in ACL surgery including tunnel positioning for primary and revision surgery and kinematic assessment of knee laxity before and after different surgical procedures. In the early years, until 2006, navigation system was mainly used to improve tunnel positioning, but since the last decade, this tool has been principally used for kinematics evaluation. Increased accuracy of tunnel placement was observed using navigation surgery, especially, regarding femoral, 42 of 146 articles used navigation to guide tunnel positioning. During the following years, 82 of 146 articles have used navigation system to evaluate intraoperative knee kinematic. In particular, the importance of controlling rotatory laxity to achieve better surgical outcomes has been underlined. CONLUSIONS Several applications have been described and despite the contribution of navigation systems, its potential uses and theoretical advantages, there are still controversies about its clinical benefit. The present papers summarize the most relevant studies that have used navigation system in ACL reconstruction. In particular, the analysis identified four main applications of the navigation systems during ACL reconstructive surgery have been identified: (1) technical assistance for tunnel placement; (2) improvement in knowledge of the kinematic behaviour of ACL and other structures; (3) comparison of effectiveness of different surgical techniques in controlling laxities; (4) navigation system performance to improve the outcomes of ACL reconstruction and cost-effectiveness. LEVEL OF EVIDENCE IV.
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Signorelli C, Bonanzinga T, Grassi A, Lopomo N, Zaffagnini S, Marcacci M. Predictive mathematical modeling of knee static laxity after ACL reconstruction: in vivo analysis. Comput Methods Biomech Biomed Engin 2016; 19:1610-7. [PMID: 27123692 DOI: 10.1080/10255842.2016.1176152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous studies did not take into consideration such large variety of surgery variables which describe the performed anterior cruciate ligament (ACL) reconstruction and the interaction among them in the definition of postoperative outcome. Seventeen patients who underwent navigated Single Bundle plus Lateral Plasty ACL reconstruction were enrolled in the study. Static laxity was evaluated as the value of anterior/posterior displacement at 30° and at 90° of flexion, internal/external rotation at 30° and 90° of knee flexion, varus/valgus test at 0° and 30° of flexion. The evaluated surgical variables were analyzed through a multivariate analysis defining the following models: AP30estimate, AP90estimate, IE30estimate, IE90estimate, VV0estimate, VV30estimate. Surgical variables has been defined as the angles between the tibial tunnel and the three planes, the lengths of the tunnel and the relationship between native footprints and tunnels. An analogous characterization was performed for the femoral side. Performance and significance of the defined models have been quantified by the correlation ratio (η(2)) and the corresponding p-value (*p < 0.050). The analyzed models resulted to be statistically significant (p < 0.05) for prediction of postoperative static laxity values. The only exception was the AP90estimate model. The η(2) ranged from 0.568 (IE90estimate) to 0.995 (IE30estimate). The orientation of the tibial tunnel resulted to be the most important surgical variable for the performed laxity estimation. Mathematical models for postoperative knee laxity is a useful tool to evaluate the effects of different surgical variables on the postoperative outcome.
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Affiliation(s)
- C Signorelli
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy
| | - T Bonanzinga
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
| | - A Grassi
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
| | - N Lopomo
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,c Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia , Brescia , Italy
| | - S Zaffagnini
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
| | - M Marcacci
- a Istituto Ortopedico Rizzoli , Laboratorio di Biomeccanica e Innovazione Tecnologica , Bologna , Italy.,b Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II , Bologna , Italy
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Quantitative evaluation of revascularization at bone tunnels and grafts with contrast-enhanced magnetic resonance angiography after anterior cruciate ligament reconstruction. INTERNATIONAL ORTHOPAEDICS 2016; 40:1531-6. [PMID: 26744163 DOI: 10.1007/s00264-015-3092-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Quantitative evaluation of vascular ingrowth to the bone tunnel walls and tendon graft after anterior cruciate ligament reconstruction for up to two years post-surgery using magnetic resonance angiography (MRA). METHODS The study population consists of 100 patients that underwent reconstruction with multi-stranded semitendinosus tendons. The patients were retrospectively divided into those that underwent MRA two, three, four to six, and ≥ seven months after surgery (46, 17, 16, and 21 patients, respectively). Digital imaging and communication in medicine (DICOM) MRA images were imported into image processing software (OsiriX®), and the mean signal-to-noise ratio (SNR) of the bone tunnel walls in the femur and tibia and tendon graft parenchyma in the bone tunnels were measured. RESULTS On MRA, the signal intensities of the bone tunnel walls in the femur and tibia (12.6 ± 3.41 and 10.7 ± 3.04) were greater than that in the tendon graft (2.65 ± 1.94 and 2.50 ± 2.02, respectively) at two months after surgery. At three months after surgery, the intensities of the tendon grafts (6.25 ± 2.18 and 5.77 ± 1.57, respectively) were greater than those of the bone tunnel wall (2.56 ± 1.29 and 2.50 ± 1.11, respectively). At four to six months, the intensities in the bone tunnel wall were 1.76 ± 0.73 and 1.62 ± 0.72, respectively, and those in the tendon graft were 5.01 ± 2.11 and 4.01 ± 2.35, respectively. At ≥ seven months after surgery, the intensities in the bone tunnel wall were 1.36 ± 0.63 and 1.21 ± 0.87, respectively, and those in the tendon graft were 4.25 ± 1.87 and 3.44 ± 1.99, respectively. CONCLUSION Blood flow was seen around the bone tunnel on the femoral and tibial sides two months after ACL reconstruction and in the tendon graft parenchyma three months after surgery. The remodeling process continued after seven months.
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Terauchi R, Arai Y, Hara K, Minami G, Nakagawa S, Takahashi T, Ikoma K, Ueshima K, Shirai T, Fujiwara H, Kubo T. Magnetic resonance angiography evaluation of the bone tunnel and graft following ACL reconstruction with a hamstring tendon autograft. Knee Surg Sports Traumatol Arthrosc 2016; 24:169-75. [PMID: 25288337 DOI: 10.1007/s00167-014-3358-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/24/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE In this study, magnetic resonance angiography (MRA) was performed in the early phase after anterior cruciate ligament (ACL) reconstruction to analyse the changes in nutrient blood vessels and blood flow to the femoral and tibial tunnels and the intraosseous tendon grafts. METHODS The subjects were 30 patients who underwent single-bundle ACL reconstruction with an autogenous hamstring tendon. MRA was performed at 2, 3, and 6 months postoperatively (n = 10 at each time point). The mean overall signal-to-noise ratios (SNRs) in the tunnel regions and in the region of the tendon graft were compared in each femur and tibia. RESULTS Blood vessels from arteries reached the femoral and tibial tunnels 2 months postoperatively. The tunnel walls showed high signal intensity, while the intraosseous tendon grafts had lower intensity. SNRs showed significant differences between the femoral and tibial tunnels overall and the intraosseous tendon grafts. At 3 and 6 months postoperatively, the signal intensity of the tunnel walls was decreased significantly, while that of the intraosseous tendon grafts was also decreased, but not significantly. At these times, the SNRs of the femoral and tibial tunnels did not differ significantly, both overall and in the region of the intraosseous tendon grafts. CONCLUSION Revascularization around the femoral and tibial tunnels occurred at 2 months postoperatively, with blood flow subsequently decreasing over time until 6 months. This revascularization may be involved in bone tendon healing and maturation of the tendon graft within the bone tunnels. Evaluations of revascularization by MRA may show the maturation stage of the graft and guide medical rehabilitation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ryu Terauchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuji Arai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Kunio Hara
- Department of Orthopaedics, Social Insurance Kyoto Hospital, Kyoto, Japan
| | - Ginjiro Minami
- Department of Orthopaedics, Social Insurance Kyoto Hospital, Kyoto, Japan
| | - Shuji Nakagawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Takahashi
- Department of Radiology, Social Insurance Kyoto Hospital, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Keiichiro Ueshima
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshiharu Shirai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Computer-assisted anterior cruciate ligament reconstruction. Four generations of development and usage. Sports Med Arthrosc Rev 2015; 22:229-36. [PMID: 25321334 DOI: 10.1097/jsa.0000000000000052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The purpose of this paper is to review the literature about the contribution of navigation in anterior cruciate ligament (ACL) reconstruction. The evolution of computer-assisted surgery (CAS) for ACL reconstruction has undergone several steps. These steps were divided into 4 subsequent developments: (1) positioning of ACL graft placement; (2) laxity measurement of ACL reconstruction (quality control); (3) kinematic evaluation during ACL reconstruction (navigated pivot shift); (4) case-specific individual ACL reconstruction with adjustments and additional reconstruction options. CAS has shown to improve femoral tunnel positioning, even if clinical outcomes do not improve results of manual techniques. CAS technology has helped researchers better understand the effects of different ACL reconstruction techniques and bundles replacements on joint laxity and to describe tunnel positioning in relation to native ACL insertion. CAS in ACL surgery can improve results at time zero and can improve knowledge in this field.
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Stability Outcomes following Computer-Assisted ACL Reconstruction. Minim Invasive Surg 2015; 2015:638635. [PMID: 25883804 PMCID: PMC4391525 DOI: 10.1155/2015/638635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 03/15/2015] [Accepted: 03/17/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. The purpose of this study was to determine whether intraoperative prereconstruction stability measurements and/or patient characteristics were associated with final knee stability after computer-assisted ACL reconstruction. Methods. This was a retrospective review of all patients who underwent computer-assisted single-bundle ACL reconstruction by a single surgeon. Prereconstruction intraoperative stability measurements were correlated with patient characteristics and postreconstruction stability measurements. 143 patients were included (87 male and 56 female). Average age was 29.8 years (SD ± 11.8). Results. Females were found to have significantly more pre- and postreconstruction internal rotation than males (P < 0.001 and P = 0.001, resp.). Patients with additional intra-articular injuries demonstrated more prereconstruction anterior instability than patients with isolated ACL tears (P < 0.001). After reconstruction, these patients also had higher residual anterior translation (P = 0.01). Among all patients with ACL reconstructions, the percent of correction of anterior translation was found to be significantly higher than the percent of correction for internal or external rotation (P < 0.001). Conclusion. Anterior translation was corrected the most using a single-bundle ACL reconstruction. Females had higher pre- and postoperative internal rotation. Patients with additional injuries had greater original anterior translation and less operative correction of anterior translation compared to patients with isolated ACL tears.
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Amano H, Toritsuka Y, Uchida R, Mae T, Ohzono K, Shino K. Outcome of anatomical double-bundle ACL reconstruction using hamstring tendons via an outside-in approach. Knee Surg Sports Traumatol Arthrosc 2015; 23:1222-30. [PMID: 24667940 DOI: 10.1007/s00167-014-2950-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the clinical outcome of anatomical double-bundle anterior cruciate ligament (ACL) reconstruction using multistranded hamstring tendons via an outside-in approach. METHODS One hundred and twenty-one patients (mean age 28 ± 10 years) who underwent ACL reconstruction were examined. Using an outside-in femoral drill guide, an upper femoral tunnel for the anteromedial (AM) graft was created just below the superior articular cartilage margin of the medial wall of the lateral condyle through a small incision. A lower femoral tunnel for the posterolateral (PL) graft was drilled in the centre of the inferior-posterior half of the attachment area behind the resident's ridge in the same manner. Two tibial tunnels were created at the centre of the AM and PL bundle footprints of a normal ACL. Patients were evaluated at 24 months postoperatively. RESULTS According to the IKDC form, 52 knees (43 %) were graded as normal, 64 (53 %) as nearly normal, 1 (1 %) as abnormal and 4 (3 %) as graft rupture due to re-injury. Loss of knee extension of <5° was observed in one patient (1 %). Among 111 patients who were directly evaluated, none showed loss of flexion of <5°. Lachman sign was negative in 103 patients (93 %), while the pivot shift test result was negative or equivalent to that of the contralateral healthy knee in 103 patients (93 %). The mean side-to-side difference in anterior laxity at manual maximum force with the KT-2000 arthrometer(®) was 0.9 ± 1.1 mm, and 94 % of patients showed a range between -1 and +2 mm. CONCLUSION The anatomical double-bundle outside-in ACL reconstruction provided a satisfactory short-term outcome. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Hiroshi Amano
- Department of Orthopaedics, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kitaku, Sakai, Osaka, 591-8025, Japan
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Computer-assisted navigation in ACL reconstruction is attractive but not yet cost efficient. Knee Surg Sports Traumatol Arthrosc 2015; 23:1026-34. [PMID: 24441732 DOI: 10.1007/s00167-013-2831-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/28/2013] [Indexed: 01/30/2023]
Abstract
PURPOSE Conventional reconstruction of the anterior cruciate ligament (ACL) has a high success rate. Computer-assisted navigation systems (CANSs) have been developed to further improve the accuracy of tunnel positioning. What is the economic impact from the hospital perspective? METHODS Patients having a first ACL reconstruction procedure were included in a prospective multicentre open controlled study comparing two groups: CANS versus conventional surgery. The primary clinical efficacy criterion was the objective International Knee Documentation Committee score at 1-2-year follow-up. Costs were collected retrospectively nationwide. RESULTS No significant differences were found for the clinical effectiveness between conventional surgery (100 patients) and CANS (114 patients) at follow-up: ORadjusted 1.01 [0.36-2.84] (n.s). Junior surgeons achieved a significant mean decrease in operating time during the study period: 30 % in the CANS group compared with 10 % in the control group (p < 0.01). The average cost of surgery was 704<euro> for the control group and 1,158<euro> for the CANS group (p < 0.01). The cost of the operating room accounts for >70 % of the total cost. The surgeon's status and the technical CANS learning effect influenced this cost. The cost differential between the two groups decreased with 'CANS' expertise: 238<euro> and 271<euro> in 'expert' centres versus 427<euro> to 731<euro> in other centres. CONCLUSION While our study demonstrates the feasibility and the potential interest of CANS for training in ACL reconstruction, from a hospital perspective it is not cost efficient at present. LEVEL OF EVIDENCE Economic and decision analysis-developing an economic or decision model, Level II.
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Usman MA, Kamei G, Adachi N, Deie M, Nakamae A, Ochi M. Revision single-bundle anterior cruciate ligament reconstruction with over-the-top route procedure. Orthop Traumatol Surg Res 2015; 101:71-5. [PMID: 25530482 DOI: 10.1016/j.otsr.2014.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/18/2014] [Accepted: 09/01/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE In revision anterior cruciate ligament reconstruction (ACLR), the single-stage technique and the over-the-top route (OTTR) procedure were usually selected for cases where the bone tunnel cannot be created at an anatomical position due to tunnel enlargement and overlap with the mal-positioned tunnel of primary reconstruction. The purpose of this study was to evaluate the clinical results of revision single-bundle ACL reconstruction using OTTR procedure and to compare the clinical results of OTTR procedure with those of anatomical single-bundle revision reconstruction (SBR). HYPOTHESIS The results of OTTR procedure are equivalent to that of SBR. METHODS Seventy-six revision ACL reconstruction knees from April 2002 to December 2012 were involved in our study. We focused on 21 knees which underwent surgery with SBR and 22 knees with OTTR using hamstring tendon. The clinical results were evaluated by means of the Lysholm score and the knee stability was assessed by the Lachman test, pivot-shift test and side-to-side difference by KT-2000 pre-operatively and after 1 year post-operatively. AP translation and rotational laxity using a navigation system were evaluated before and after revision ACL reconstruction under anesthesia in 8 cases of OTTR and in 6 cases of SBR. RESULTS There was no statistically significant difference between the OTTR and SBR regarding Lysholm score, Lachman test, pivot-shift test, ATT by KT-2000, and AP translation and rotational laxity with a navigation system. CONCLUSIONS The clinical results of OTTR are almost equivalent to those of SBR. For the cases in which it is impossible to create the femoral tunnel in an anatomical position, OTTR is a valuable revision ACL reconstruction method. LEVEL OF EVIDENCE Case-control study. Level III.
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Affiliation(s)
- M A Usman
- Department of Orthopaedic surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, 734-8551 Hiroshima, Japan; Department of Orthopaedic Traumatology, Faculty of Medicine, Hasanuddin University, Indonesia
| | - G Kamei
- Department of Orthopaedic surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, 734-8551 Hiroshima, Japan.
| | - N Adachi
- Department of Orthopaedic surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - M Deie
- Department of Physical therapy and Occupational therapy, Graduate School of Health Science, Hiroshima University, Hiroshima, Japan
| | - A Nakamae
- Department of Orthopaedic surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - M Ochi
- Department of Orthopaedic surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
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Balance ability and proprioception after single-bundle, single-bundle augmentation, and double-bundle ACL reconstruction. ScientificWorldJournal 2014; 2014:342012. [PMID: 25614884 PMCID: PMC4295594 DOI: 10.1155/2014/342012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/15/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. The present study sought to determine the influences of single-bundle (SB), single-bundle augmentation (SBA), and double-bundle (DB) reconstructions on balance ability and proprioceptive function.
Methods. 67 patients who underwent a single- or double-bundle ACL reconstruction or a SBA using multistranded autologous hamstring tendons were included in this study with a 1-year follow-up. Body sway and knee kinesthesia (using the threshold to detect passive motion test (TTDPM)) were measured to indicate balance ability and proprioceptive function, respectively. Additionally, within-subject differences in anterior-posterior stability of the tibia and lower extremity muscle strength were evaluated before and after surgery. Results. At 6 and 12 months after surgery, DB reconstruction resulted in better balance and proprioceptive function than SB reconstruction (P < 0.05). Although no significant difference was observed in balance ability or proprioceptive function between the SBA and DB reconstructions, knee stability was significantly better with SBA and DB reconstructions than SB reconstruction (P < 0.05). No significant differences were found in quadriceps and hamstrings strength among the three reconstruction techniques. Conclusions. Our findings consider that joint stability, proprioceptive function, and balance ability were superior with SBA and DB reconstructions compared to SB reconstruction at 6 and 12 months after surgery.
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Christino MA, Vopat BG, Waryasz GR, Mayer A, Reinert SE, Shalvoy RM. Adolescent differences in knee stability following computer-assisted anterior cruciate ligament reconstruction. Orthop Rev (Pavia) 2014; 6:5653. [PMID: 25568734 PMCID: PMC4274455 DOI: 10.4081/or.2014.5653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 11/25/2022] Open
Abstract
Anterior cruciate ligament (ACL) surgery is being increasingly performed in the adolescent population. Computer navigation offers a reliable way to quantitatively measure knee stability during ACL reconstruction. A retrospective review of all adolescent patients (<18 years old) who underwent computer-assisted primary single bundle ACL reconstruction by a single surgeon from 2007 to 2012 was performed. The average age was 15.8 years (SD 3.3). Female adolescents were found to have higher internal rotation than male adolescents both pre- (25.6° vs 21.7°, P=0.026) and post-reconstruction (20.1° vs 15.1°, P=0.005). Compared to adults, adolescents demonstrated significantly higher internal rotation both pre- (23.3° vs 21.5°, P=0.047) and post-reconstruction (17.1° vs 14.4°, P=0.003). They also had higher total rotation both pre- (40.9° vs 38.4°, P=0.02) and post-reconstruction when compared to adults (31.56° vs 28.67°, P=0.005). In adolescent patients, anterior translation was corrected more than rotation. Females had higher pre- and residual post-reconstruction internal rotation compared to males. When compared to adults, adolescents had increased internal rotation and total rotation both pre-and post-reconstruction.
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Affiliation(s)
- Melissa A Christino
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University , Providence, RI
| | - Bryan G Vopat
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University , Providence, RI
| | - Gregory R Waryasz
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University , Providence, RI
| | - Alexander Mayer
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University , Providence, RI
| | - Steven E Reinert
- Department of Information Services, Lifespan - Rhode Island Hospital , Providence, RI, USA
| | - Robert M Shalvoy
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University , Providence, RI
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A new technique to avoid articular cartilage injury in anterior cruciate ligament reconstruction through far antero-medial portal. Orthop Traumatol Surg Res 2014; 100:827-30. [PMID: 25281552 DOI: 10.1016/j.otsr.2014.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/27/2014] [Accepted: 06/17/2014] [Indexed: 02/02/2023]
Abstract
Far antero-medial (FAM) portal technique is usually used in our department in anterior cruciate ligament (ACL) reconstruction when drilling the femoral tunnel. Although the FAM portal technique carries potential risks, such as cartilage injury of the lateral femoral condyle, peroneal nerve injury and blow out of the lateral femoral condyle's posterior wall, these problems were resolved in a cadaveric study, in which 110°-120°knee flexion was recommended when drilling the femoral tunnel. However, there is a potential risk of injuring the cartilage of the medial femoral condyle especially when drilling the postero-lateral bundle. A new method is proposed to ensure that the femoral tunnel drilling does not damage the cartilage of the medial femoral condyle.
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Gender differences following computer-navigated single- and double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2014; 22:2145-52. [PMID: 24037261 DOI: 10.1007/s00167-013-2649-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Female patients not only demonstrate an increased risk for injury, but also a poorer response following anterior cruciate ligament (ACL) rupture. However, no study has investigated gender-related differences between computer-navigated single-bundle (SB) and double-bundle (DB) ACL reconstruction. The aim of this study was to evaluate the effects of gender on the outcome of computer-navigated SB and DB ACL reconstruction and to present reference values. METHODS A retrospective review of 55 consecutive patients who underwent SB (15 males, 12 females) and DB (18 males, 10 females) ACL reconstruction with autogenous hamstring tendon grafts and showed a minimum follow-up of 24 months was conducted. Intraoperatively, the anteroposterior and rotational laxity were measured and the follow-up examination included pivot-shift testing, KT-1000 arthrometer testing, International Knee Documentation Committee (IKDC) form, the Lysholm score and Tegner score. RESULTS Pre-operatively, female patients showed a significant higher internal rotation in (p < 0.001) both the SB and DB group. Regarding the post-operative reduction in internal rotation, females in the SB group revealed a greater reduction compared to males (p < 0.001), whereas females in the DB group revealed a significantly greater post-operative reduction in anterior-posterior translation (p = 0.04). Female patients following DB ACL reconstruction presented a significant worse IKDC score, Lysholm score and Tegner score compared to male patients. All score values of the female DB group were worse than in the female SB group. In contrast, male patients showed better results of all examined clinical scores following DB procedure compared to SB technique. CONCLUSION Female patients who underwent computer-navigated DB ACL reconstruction exhibited significantly worse outcome scores than males who underwent DB ACL reconstruction. The gender-based relationship between joint function and outcome after ACL reconstruction remains unclear and requires further investigation. LEVEL OF EVIDENCE Retrospective case-control series, Level III.
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Deie M, Nakasa T, Kamei G, Nakamae A, Ochi M. High flexion knee arthroplasty: the relationship between rotational angles and flexion angle after total knee arthroplasty. Curr Rev Musculoskelet Med 2014; 7:103-7. [PMID: 24658882 PMCID: PMC4012152 DOI: 10.1007/s12178-014-9215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The current patients required high flexion total knee arthroplasty (TKA). We hypothesized the patients who would get the high rotational angle just after TKA could gain high flexion knee 1 year after TKA. Sixty-three patients (average age: 70.6 years) were examined. In order to examine between the intraoperative rotational angles and the gained flexion angles after TKA, the patients were divided into two groups: the H group (more than 120°) and the L groups (less than 120°) by the gained flexion angles. The relationship between the flexion angles at 1 year after surgery and the intraoperative rotational angle had no significant correlation. But the rotational angles in the L group tended to be higher than the ones in the H group, and at only 30°, the L group gained significantly more rotational angle than the H group. These results might show that a tighter rotational stability induces a gain of higher flexion knee after TKA.
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Affiliation(s)
- Masataka Deie
- Institute of Biomechanical and Health Sciences, Laboratory of Musculoskeletal Functional Research and Regeneration, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan, 734-8553,
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Chalmers PN, Mall NA, Yanke AB, Bach BR. Contemporary Anterior Cruciate Ligament Outcomes: Does Technique Really Matter? OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2012.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Colombet P, Jenny JY, Menetrey J, Plaweski S, Zaffagnini S. Current concept in rotational laxity control and evaluation in ACL reconstruction. Orthop Traumatol Surg Res 2012; 98:S201-10. [PMID: 23153665 DOI: 10.1016/j.otsr.2012.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/25/2012] [Indexed: 02/02/2023]
Abstract
Rotation combined with translation; compose the three-dimensional motion of the knee subluxation in anterior cruciate ligament deficient knee. The worldwide scientists were focused initially on the translation part of this complex 3D motion, but since the beginning of the century there was a large interest on knee rotational laxity study. Lot of paper reported new devices and results with an explosion since the beginning of the decade. The purpose of this review is to provide an extensive critical analysis of the literature and clarify the knowledge on this topic. We will start with a dismemberment of different rotational laxities reported: the rotation coupled with translation in 2D tests such as Lachman test and anterior drawer test; the rotational envelope considering the maximum internal external rotation; and the "active rotation" occurring in 3D Pivot-shift (PS) test. Then we will analyze the knee kinematics and the role of different anterior cruciate ligament (ACL) bundle on rotation. A review of different mechanical and radiological devices used to assess the different rotations on ACL deficient knees will be presented. Two groups will be analyzed, dynamic and static conditions of tests. Navigation will be described precisely; it was the starter of this recent interest in rotation studies. Opto electronic and electromagnetic navigation systems will be presented and analyzed. We will conclude with the last generation of rotational laxity assessment devices, using accelerometers, which are very promising.
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Affiliation(s)
- P Colombet
- Clinique du sport, 9, rue Jean-Moulin, 33700 Mérignac, France.
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