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For: Ettinger M, Petri M, Guenther D, Liu C, Krusche C, Liodakis E, Albrecht UV, Krettek C, Jagodzinski M. Anatomic double-bundle ACL reconstruction restricts knee extension in knees with hyperextension. Knee Surg Sports Traumatol Arthrosc 2013;21:2057-62. [PMID: 22945469 DOI: 10.1007/s00167-012-2190-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]

For:	Ettinger M, Petri M, Guenther D, Liu C, Krusche C, Liodakis E, Albrecht UV, Krettek C, Jagodzinski M. Anatomic double-bundle ACL reconstruction restricts knee extension in knees with hyperextension. Knee Surg Sports Traumatol Arthrosc 2013;21:2057-62. [PMID: 22945469 DOI: 10.1007/s00167-012-2190-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]

Number

Cited by Other Article(s)

Guimarães TM, Giglio PN, Sobrado MF, Bonadio MB, Gobbi RG, Pécora JR, Helito CP. Knee Hyperextension Greater Than 5° Is a Risk Factor for Failure in ACL Reconstruction Using Hamstring Graft. Orthop J Sports Med 2021;9:23259671211056325. [PMID: 34820464 PMCID: PMC8606942 DOI: 10.1177/23259671211056325] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022] Open

Abstract

Background:

The degree of knee hyperextension in isolation has not been studied in detail as a risk factor that could lead to increased looseness or graft failure after anterior cruciate ligament (ACL) reconstruction.

Purpose:

To analyze whether more than 5° of passive knee hyperextension is associated with worse functional outcomes and greater risk of graft failure after primary ACL reconstruction with hamstring tendon autograft.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A cohort of patients who had primary ACL reconstruction with hamstring tendon autografts was divided into 2 groups based on passive contralateral knee hyperextension greater than 5° (hyperextension group) and less than 5° (control group) of hyperextension. Groups were matched by age, sex, and associated meniscal tears. The following data were collected and compared between the groups: patient data (age and sex), time from injury to surgery, passive knee hyperextension, KT-1000 arthrometer laxity, pivot shift, associated meniscal injury and treatment (meniscectomy or repair), contralateral knee ligament injury, intra-articular graft size, follow-up time, occurrence of graft failure, and postoperative Lysholm knee scale and International Knee Documentation Committee subjective form scores.

Results:

Data from 358 patients initially included in the study were analyzed; 22 were excluded because the time from injury to surgery was greater than 24 months, and 22 were lost to follow-up. From the cohort of 314 patients, 102 had more than 5° of knee hyperextension. A control group of the same size (n = 102) was selected by matching among the other 212 patients. Significant differences in the incidence of graft failure (14.7% vs 2.9%; P = .005) and Lysholm knee scale score (86.4 ± 9.8 vs 89.6 ± 6.1; P = .018) were found between the 2 groups.

Conclusion:

Patients with more than 5° of contralateral knee hyperextension submitted to single-bundle ACL reconstruction with hamstring tendons have a higher failure rate than patients with less than 5° of knee hyperextension.

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Cooper DE, Dunn WR, Huston LJ, Haas AK, Spindler KP, Allen CR, Anderson AF, DeBerardino TM, Lantz B(BA, Mann B, Stuart MJ, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ, Wright RW. Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort: A Report From the MARS Group. Am J Sports Med 2018;46:2836-2841. [PMID: 29882693 PMCID: PMC6170681 DOI: 10.1177/0363546518777732] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]

Abstract

BACKGROUND

The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Patients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR.

RESULTS

Analyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as "younger" and those above as "older" (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P = .002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P = .003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P = .03).

CONCLUSION

This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 ( ClinicalTrials.gov identifier).

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Affiliation(s)

The MARS Group
Daniel E. Cooper Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Warren R. Dunn Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Laura J. Huston Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Amanda K. Haas Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Kurt P. Spindler Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Christina R. Allen Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Allen F. Anderson Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Thomas M. DeBerardino Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Brett (Brick) A. Lantz Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Barton Mann Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Michael J. Stuart Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
John P. Albright Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Annunziato (Ned) Amendola Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Jack T. Andrish Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Christopher C. Annunziata Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Robert A. Arciero Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Bernard R. Bach Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Champ L. Baker Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Arthur R. Bartolozzi Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Keith M. Baumgarten Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Jeffery R. Bechler Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Jeffrey H. Berg Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Geoffrey A. Bernas Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Stephen F. Brockmeier Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Robert H. Brophy Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Charles A. Bush-Joseph Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
J. Brad Butler V Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
John D. Campbell Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
James L. Carey Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
James E. Carpenter Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Brian J. Cole Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Jonathan M. Cooper Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Charles L. Cox Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
R. Alexander Creighton Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Diane L. Dahm Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Tal S. David Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
David C. Flanigan Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Robert W. Frederick Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Theodore J. Ganley Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Elizabeth A. Garofoli Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Charles J. Gatt Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Steven R. Gecha Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
James Robert Giffin Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Sharon L. Hame Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Jo A. Hannafin Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Christopher D. Harner Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Norman Lindsay Harris Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Keith S. Hechtman Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Elliott B. Hershman Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Rudolf G. Hoellrich Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Timothy M. Hosea Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
David C. Johnson Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Timothy S. Johnson Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Morgan H. Jones Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Christopher C. Kaeding Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Ganesh V. Kamath Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Thomas E. Klootwyk Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Bruce A. Levy Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
C. Benjamin Ma Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
G. Peter Maiers Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Robert G. Marx Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Matthew J. Matava Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Gregory M. Mathien Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
David R. McAllister Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Eric C. McCarty Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Robert G. McCormack Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Bruce S. Miller Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Carl W. Nissen Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Daniel F. O’Neill Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Brett D. Owens Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Richard D. Parker Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Mark L. Purnell Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Arun J. Ramappa Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Michael A. Rauh Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Arthur C. Rettig Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Jon K. Sekiya Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Kevin G. Shea Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Orrin H. Sherman Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
James R. Slauterbeck Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Matthew V. Smith Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Jeffrey T. Spang Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Steven J. Svoboda Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Timothy N. Taft Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Joachim J. Tenuta Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Edwin M. Tingstad Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Armando F. Vidal Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Darius G. Viskontas Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Richard A. White Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
James S. Williams Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Michelle L. Wolcott Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Brian R. Wolf Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
James J. York Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
Rick W. Wright Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA

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Y-reconstruction could be better for ACL reconstruction in knee hyperextension versus double-bundle double-tunnel technique: a retrospective comparative study of 56 patients. Arch Orthop Trauma Surg 2018;138:827-834. [PMID: 29504034 DOI: 10.1007/s00402-018-2909-x] [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: 05/12/2017] [Indexed: 01/25/2023]

Abstract

PURPOSE

To compare the clinical outcomes of double-bundle (DB) single-tibial tunnel technique and double-tunnel technique for ACL reconstruction in patients with knee hyperextension.

METHODS

Defined as having constitutional hyperextension of greater than 10°, 56 patients with knee hyperextension who underwent ACL reconstruction were included in this study. To exclude concomitant lesions, preoperative magnetic resonance imaging (MRI) was performed in all knees. 24 patients (Group A) were treated with the anatomic DB/single-tibial tunnel ACL reconstruction and 32 patients (Group B) were treated with DB/double-tibial tunnel ACL reconstruction, all the included patients had knee hyperextension. Clinical results were evaluated by the extension angle, ROM, IKDC 2000 subjective score, rotational stability, pivot-shift test and anterior-posterior translation test before the operation and at the end of follow-up. MRI scan of the knee positioned in full extension was performed after 6 months post-operation. Location of tibial tunnels and graft signal intensity were assessed according to the MRI.

RESULTS

Postoperative extension deficit was detected in Group B, ROM of the injured knee in Group A was from extension angle 8.91 ± 3.16° to flexion angle 115.58 ± 10.53°. ROM of the injured knee in Group B was from extension angle - 2.13 ± 5.88° to flexion angle 119.25 ± 12.63°. Flexion angles of two groups did not show any significant difference (p = 0.24), while extension angles were quite different (p < 0.0001). Group A was slightly higher than Group B in IKDC subjective scores, but without significant difference (Group A 45.1 ± 6.5, Group B 42.4 ± 4.8, p = 0.09). There was no significant difference between two groups in pivot-shift test. Post-operational MRI showed more anterior located tibial tunnel and higher graft signal intensity in Group B when compared with Group A. One patient in the Group B had ligament retear, and required revision surgery.

CONCLUSION

DB/single-tibial tunnel technique restored the knee stability and overcame the shortcomings (such as knee extension deficit and graft impingement) of DB/double tibial tunnel, which might be more suitable for ACL reconstruction in knees with hyperextension.

LEVEL OF EVIDENCE

Level II to III.

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Feng Y, Tsai TY, Li JS, Liu X, Wang S, Hu H, Zhang C, Li G. In-vivo Elongation Patterns of the Anteromedial and Posterolateral Bundles of the ACL at Low Flexion Angles. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0225-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]

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: 1.9] [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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Intraoperative laxity measurements using a navigation system in anatomical double-bundle posterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015;23:3085-93. [PMID: 25377192 DOI: 10.1007/s00167-014-3418-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]

Abstract

PURPOSE

The objective of this study was to evaluate knee kinematics during double-bundle posterior cruciate ligament reconstruction (DB-PCLR) intraoperatively using a navigation system, and especially assess biomechanical behaviour of the anterolateral bundle (ALB) and posteromedial bundle (PMB) graft in DB-PCLR. Also, clinical results of minimum 2-year follow-up were investigated.

METHODS

Nine patients received DB-PCLR with hamstring graft. Before reconstruction, knee laxities, including posterior tibial translation (PTT) in neutral rotation at 15°, 30°, 45°, 60°, 75° and 90° of knee flexion, were measured using a kinematic-based navigation system. After the PMB or ALB was temporally fixed, the knee laxities were measured in the same manner. Each patient was evaluated pre- and post-operatively with side-to-side difference of tibial position in gravity sag view and Lysholm score.

RESULTS

Both ALB and PMB fixation restrained the PTT compared to PCL deficiency throughout all knee flexion angles. At 90° of knee flexion, ALB fixation significantly decreased PTT compare to PMB fixation (p = 0.014) and DB-PCLR significantly decreased PTT compare to ALB fixation (p = 0.045). The mean side-to-side difference of tibial position in gravity sag view was 12.0 ± 1.7 mm preoperatively and 2.3 ± 1.8 mm at final follow-up, and the mean Lysholm scores were 68.9 ± 20.9 and 96.3 ± 2.9, respectively.

CONCLUSIONS

There were no significant differences in the PTT between ALB and PMB fixations at 0° to 75° of knee flexion, and both ALB and PMB reconstructions are important for restraining PTT. At 90° of knee flexion, the ALB grafts may be more important to control PTT compared to PMB grafts; however, neither single-bundle reconstruction with ALB nor PMB could function as DB-PCLR did. In addition, PTT after DB-PCLR was strongly correlated side-to-side difference in posterior sag view at the final follow-up. The results from this study indicated that both ALB and PMB are important to stabilize PCL-deficient knees.

LEVEL OF EVIDENCE

Therapeutic study, Level III.

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Matsubara H, Okazaki K, Tashiro Y, Toyoda K, Uemura M, Hashizume M, Iwamoto Y. Intercondylar roof impingement after anatomic double-bundle anterior cruciate ligament reconstruction in patients with knee hyperextension. Am J Sports Med 2013;41:2819-27. [PMID: 24099713 DOI: 10.1177/0363546513505073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]

Abstract

BACKGROUND

Although an anatomically placed graft in anterior cruciate ligament (ACL) reconstruction is reported to have a low risk of roof impingement, which may cause deterioration of the graft or an extension deficit, the incidence of roof impingement by these grafts has not been evaluated in hyperextensible knees.

PURPOSE

To evaluate the incidence of roof impingement by the native ACL in hyperextensible knees and to examine the risk of roof impingement by anatomic placement of the ACL graft in hyperextensible knees.

STUDY DESIGN

Controlled laboratory study.

METHODS

Twelve patients were selected for a hyperextensible knee group (group A), defined as having hyperextension of the knee of greater than 10°. Twelve patients were recruited to a normal extension knee group (group B) with normal extension of the knee of less than 5° of hyperextension. Magnetic resonance imaging (MRI) scans of the knee positioned in 30° of flexion and full extension were acquired from all patients. The shape of the native ACL at full extension was compared between the groups. A 3-dimensional (3D) bone model was created from the acquired 2D MRI scans. A virtual anatomic double-bundle ACL reconstruction in each patient and a virtual anatomic single-bundle reconstruction in the patients in group A were performed using the 3D MRI bone models. The volume of the overlap between the graft and roof was calculated to evaluate graft impingement in each instance.

RESULTS

The MRI scans showed posterior bowing of the native ACL in the group A knees. The simulated double-bundle ACL reconstruction showed that the overlapped volume was significantly greater in patients in group A than in patients in group B (P < .05). However, the overlap of the simulated single-bundle ACL reconstruction was significantly less than for the double-bundle ACL reconstruction (P < .05).

CONCLUSION

To reduce the risk of roof impingement by the graft, single-bundle ACL reconstruction with the graft placed at the center of the footprint might be the better method for patients with a hyperextensible knee than an anatomic double-bundle ACL reconstruction.

CLINICAL RELEVANCE

It is recommended that surgeons cautiously consider roof impingement after anatomic double-bundle ACL reconstruction in patients with a hyperextensible knee.

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