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Xu F, Li Y, Yu Y, Wang G, Cai G. Evaluation of biomechanical properties and biocompatibility: are partially absorbable cords eligible for anterior cruciate ligament reconstruction? Front Bioeng Biotechnol 2023; 11:1216937. [PMID: 37854884 PMCID: PMC10580803 DOI: 10.3389/fbioe.2023.1216937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction: Independent augmentation technology based on reinforcing devices has been reported to signifi-cantly reduce the elongation behavior of graft and improve knee stability after anterior cruciate ligament reconstruction (ACLR). Using biodegradable devices could reduce the risk of severe inflammatory reactions due to particle accumulation from foreign bodies. Given the limitations of the mechanical properties of biodegradable materials, partially biodegradable composite devices may offer a compromise strategy. Methods: Three types of partially absorbable core-sheath sutures, including low-absorbable cord (LA-C), medium-absorbable cord (MA-C) and high-absorbable cord (HA-C), were braided using unabsorbable ultra-high molecular weight polyethylene (UHMWPE) yarn and absorbable polydioxanone (PDO) monofil-ament bundle based on the desired configuration. The feasibility of these partially absorbable cords were verified by biomechanical testing, material degradation testing, and cell experiments, all performed in vitro. Results: Reinforcement of an 8 mm graft with the cords decreased dynamic elongation by 24%-76%, was positively related to dynamic stiffness, and increased the failure load by 44%-105%, during which LA-C showed maximum enhancement. Human ligament-derived fibroblasts showed good proliferation and vitality on each cord over 2 weeks and aligned themselves in the direction of the fibers, especially the UHMWPE portion. Discussion: This study supports the potential of partially degradable UHMWPE/PDO cords, particularly LA-C, for graft protection. Nervertheless, a higher proportion of biodegradable material results in lower stiffness, which may impair the protective and lead to mechanical instability during degradation.
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Affiliation(s)
- Fei Xu
- Kunming Medical University, Kunming Yunnan, China
- Department of Pain Treatment, The First People’s Hospital of Yunnan Province, Kunming Yunnan, China
| | - Yanlin Li
- Kunming Medical University, Kunming Yunnan, China
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Yang Yu
- Kunming Medical University, Kunming Yunnan, China
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Guoliang Wang
- Kunming Medical University, Kunming Yunnan, China
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Guofeng Cai
- Kunming Medical University, Kunming Yunnan, China
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
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Chung K, Choi CH, Jung M, Choi J, Kim SJ, Kim SH. Factors Influencing the Initial Constraint Level of the Knee Joint and Its Effect on Clinical Outcomes After ACL Reconstruction With Hamstring Graft. Orthop J Sports Med 2023; 11:23259671221148451. [PMID: 36874051 PMCID: PMC9974630 DOI: 10.1177/23259671221148451] [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: 09/06/2022] [Accepted: 10/21/2022] [Indexed: 03/07/2023] Open
Abstract
Background A force-based tension protocol that uses a certain amount of tension at graft fixation could still give rise to variations in initial constraint levels of the knee joint in terms of side-to-side difference (SSD) in anterior translation. Purpose To investigate the factors influencing the initial constraint level in anterior cruciate ligament (ACL)-reconstructed knees and compare outcomes according to the level of constraint in terms of anterior translation SSD. Study Design Cohort study; Level of evidence, 3. Methods Included were 113 patients who underwent ipsilateral ACL reconstruction using an autologous hamstring graft and had minimum 2-year follow-up outcomes. All grafts were tensioned and fixed at 80 N using a tensioner at the time of graft fixation. The patients were classified into the following 2 groups according to the initial anterior translation SSD, measured using the KT-2000 arthrometer: a physiologic constraint group with restored anterior laxity ≤2 mm (group P; n = 66) and a high-constraint group with restored anterior laxity >2 mm (group H; n = 47). Clinical outcomes were compared between the groups, and preoperative and intraoperative variables were evaluated to identify factors affecting the initial constraint level. Results Between group P and group H, generalized joint laxity (P = .005), posterior tibial slope (P = .022), and anterior translation measured in the contralateral knee (P < .001) were found to differ significantly. Measured anterior translation in the contralateral knee was the only significant predictor of high initial graft tension (P = .001). No significant differences were found between the groups regarding clinical outcomes and subsequent surgery. Conclusion Greater anterior translation measured in the contralateral knee was an independent predictor of a more constrained knee after ACL reconstruction. The short-term clinical outcomes after ACL reconstruction were comparable, regardless of the initial constraint level in terms of anterior translation SSD.
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Affiliation(s)
- Kwangho Chung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Gyeonggi, Republic of Korea
| | - Chong Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeehoon Choi
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jae Kim
- Arthroscopy and Joint Research Institute, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei Sarang Hospital, Seoul, Republic of Korea.,Arthroscopy and Joint Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Huang Z, Cui J, Zhong M, Deng Z, Chen K, Zhu W. Risk factors of cartilage lesion after anterior cruciate ligament reconstruction. Front Cell Dev Biol 2022; 10:935795. [PMID: 36158222 PMCID: PMC9498578 DOI: 10.3389/fcell.2022.935795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Anterior cruciate ligament injury is the most common sports injury in orthopaedics, which can adversely affect knee joint function and exercise of patients. Using arthroscopy to reconstruct the anterior cruciate ligament has become the first choice for treating anterior cruciate ligament rupture. However, different degrees of articular cartilage injury of the knee can be observed in patients after anterior cruciate ligament reconstruction. More importantly, the articular cartilage injury after anterior cruciate ligament reconstruction indicates that it will develop into osteoarthritis in the long term. It is of great significance to fully understand the factors that lead to the occurrence and development of cartilage injury. This article reviews the effects of surgical methods, meniscus status, different grafts, time from injury to surgical intervention, postoperative knee joint stability, postoperative rehabilitation, knee joint anatomical factors, and demographic characteristics of patients on articular cartilage degeneration after anterior cruciate ligament reconstruction. The present review provides insights into the anterior cruciate ligament reconstruction, which can be used to investigate new treatment strategies to delay and prevent the progress of osteoarthritis. At the same time, it provides a holistic understanding of the influence of multiple factors on cartilage lesions after anterior cruciate ligament reconstruction.
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Affiliation(s)
- Zirong Huang
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jiaming Cui
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Jiaming Cui, ; Weimin Zhu,
| | - Mingjin Zhong
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Zhenhan Deng
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Kang Chen
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Weimin Zhu
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Jiaming Cui, ; Weimin Zhu,
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Pandey V, Madi S, Thonse C, Joseph C, Rajan D, Varughese J, Thilak J, Jayaprasad PS, Acharya K, Ramamurthy KG, Reddy R, Amravathi R, Rao S, Gangavarapu S, Srinivas M, Jose S, Sundararjan SR. Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India. Indian J Orthop 2022; 56:1703-1716. [PMID: 36187588 PMCID: PMC9485326 DOI: 10.1007/s43465-022-00719-z] [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: 01/20/2022] [Accepted: 08/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although guidelines from multiple scientific studies decide the general trend in ACLR practice, there is often a variation between scientific guidelines and actual practice. METHODS A 17-member committee comprised of sports surgeons with experience of a minimum of 10 years of arthroscopy surgery finalized a survey questionnaire consisting of concepts in ACL tear management and perioperative trends, intraoperative and post-operative practices regarding single-bundle anatomic ACLR. The survey questionnaire was mailed to 584 registered sports surgeons in six states of south India. A single, non-modifiable response was collected from each member and analyzed. RESULTS 324 responses were received out of 584 members. A strong consensus was present regarding Hamstring tendons preference for ACLR, graft diameter ≥ 7.5 mm, viewing femoral footprint through the anterolateral portal, drilling femoral tunnel from anteromedial portal guided by ridges and remnants of femoral footprint using a freehand technique, suspensory devices to fix the graft in femur and interference screw in the tibia and post-operative bracing. A broad consensus was achieved in using a brace to minimize symptoms of instability of an ACL tear and antibiotic soaking of graft. There was no consensus regarding the timing of ACLR, preferred graft in athletes, pre-tensioning, extra-articular procedure, and return to sports. There was disagreement over hybrid tibial fixation and suture tapes to augment graft. CONCLUSION Diverse practices continue to prevail in the management of ACL injuries. However, some of the consensuses reached in this survey match global practices. Contrasting or inconclusive practices should be explored for potential future research.
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Affiliation(s)
- Vivek Pandey
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Sandesh Madi
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Chirag Thonse
- Vikram Hospital, Millers Road, Bangalore, 560052 India
| | - Clement Joseph
- Arthroscopy and Sports Medicine, SRM Institute for Medical Sciences, Vadapalani, Chennai, Tamil Nadu 600 026 India
| | - David Rajan
- Ortho-One Orthopaedic Speciality Centre, Trichy Road, Singanallur, Coimbatore, Tamil Nadu 641005 India
| | | | - Jai Thilak
- Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala 682 041 India
| | - P. S. Jayaprasad
- Kamineni Hospitals, L.B. Nagar, Bahadurguda, Hyderabad, Telangana 500068 India
| | - Kiran Acharya
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | | | - Raghuveer Reddy
- Krishna Institute of Medical Sciences Secunderabad, Hyderabad, India ,Care Hospitals in Banjara Hills, Hyderabad, India ,Sai Institute of Sports Injury and Arthroscopy in Banjara Hills, Hyderabad, 500 004 India
| | - Rajkumar Amravathi
- St John’s Medical College Hospital, Sarjapur Road, Bangalore, 560034 India
| | - Sharath Rao
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Sridhar Gangavarapu
- Department of Orthopaedics, Medicover Hospitals, Gokhale Rd, Krishna Nagar, Maharani Peta, Visakhapatnam, Andhra Pradesh 530002 India
| | - Moparthi Srinivas
- Nandan Hospital, Suryarao Pet, Vijayawada, Andhra Pradesh 520002 India
| | - Sujit Jose
- Institute of Advanced Orthopaedics at MOSC Hospital and Medical College, Kolenchery, Ernakulam, Kerala 682311 India
| | - S. R. Sundararjan
- Arthroscopy and Sports Medicine, Ganga Hospital, Coimbatore, 641 043 India
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5
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Mediavilla I, Aramberri M, Tiso G, Margalet E, MargAbat F. "Y" Graft Double Bundle Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2021; 10:e2135-e2141. [PMID: 34504753 PMCID: PMC8417341 DOI: 10.1016/j.eats.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/18/2021] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED Single-bundle (SB) anterior cruciate ligament (ACL) reconstruction has been a standard procedure. However, residual rotary instability in approximately 20% of the cases (irrespective of the graft choice and the surgical technique) forces the surgeon to improve the biomechanical quality of the reconstruction. In parallel, adjustable suspensory fixation (ASF) devices have arisen. Biomechanics has defined (both anatomical and functional) the anteromedial (AM) and posterolateral (PL) bundles that work synergistically. In the unsymmetrical "anatomic" SB ACL reconstruction, the distribution of the ACL graft fibers (for AM or PL behavior) is not under the control of the surgeon. Furthermore, different sizes of the original footprints (depending on height) suggest the need to customize the graft footprint. This customization is only possible if distances are measured during surgical procedures. We present an inside-out technique for DB ACL reconstruction ("all-inside" also possible). Semitendinosus is folded to obtain a Y-shaped trifurcate configuration graft, distributing their bundles in two different areas. Used as measuring instruments, we used the "offset" guides as measuring instruments, allowing the surgeon to know the distance between the centers of the AM and PL tunnels. It may be carried out by means of common "offset" guides and any marketed ASF devices, while generating customized footprints. CLASSIFICATION I: knee; II: ACL.
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Affiliation(s)
- Iñaki Mediavilla
- University Hospital of Basurto, Bilbao, Spain,Address correspondence to Iñaki Mediavilla, M.D., Ph.D., University Hospital of Basurto, Montevideo Avenue, 18 48013 Bilbao, Spain.
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Shen X, Qin Y, Zuo J, Liu T, Xiao J. A Systematic Review of Risk Factors for Anterior Cruciate Ligament Reconstruction Failure. Int J Sports Med 2021; 42:682-693. [PMID: 33784786 DOI: 10.1055/a-1393-6282] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Although most studies have introduced risk factors related to anterior cruciate ligament reconstruction failure, studies on combinations of high-risk factors are rare. To provide a systematic review of the risk factors of anterior cruciate ligament reconstruction failure to guide surgeons through the decision-making process, an extensive literature search was performed of the Medline, Embase and Cochrane Library databases. Studies published between January 1, 2009, and September 19, 2019, regarding the existing evidence for risk factors of anterior cruciate ligament reconstruction failure or graft failure were included in this review. Study quality was evaluated with the quality index. Ultimately, 66 articles met our criteria. There were 46 cases classified as technical factors, 21 cases as patient-related risk factors, and 14 cases as status of the knee joint. Quality assessment scores ranged from 14 to 24. This systematic review provides a comprehensive summary of the risk factors for anterior cruciate ligament reconstruction failure, including technical factors, patient-related factors, and the factors associated with the status of the knee joint. Emphasis should be placed on avoiding these high-risk combinations or correcting modifiable risk factors during preoperative planning to reduce the rate of graft rupture and anterior cruciate ligament reconstruction failure.
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Affiliation(s)
- Xianyue Shen
- Department of Orthopedics,The Second Hospital of Jilin University, Changchun, China
| | - Yanguo Qin
- Department of Orthopedics,The Second Hospital of Jilin University, Changchun, China
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tong Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jianlin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
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7
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Marchiori G, Lopomo NF, Bologna E, Spadaro D, Camarda L, Berni M, Visani A, Zito M, Zaffagnini S, Zingales M. How preconditioning and pretensioning of grafts used in ACLigaments surgical reconstruction are influenced by their mechanical time-dependent characteristics: Can we optimize their initial loading state? Clin Biomech (Bristol, Avon) 2021; 83:105294. [PMID: 33667940 DOI: 10.1016/j.clinbiomech.2021.105294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Consensus about a pre-implant preparation protocol adaptable to any graft used in Anterior Cruciate Ligament reconstruction is still lacking. In fact, there is not agreement on reliable metrics that consider both specific graft dimensional characteristics, such as its diameter, and the inherent properties of its constitutive material, i.e. ligaments or tendons. Aim of the present study was to investigate and propose the applied engineering stress as a possible metrics. METHODS Preconditioning and pretensioning protocol involved groups of grafts with different section (10 or 32 mm2) and materials (i.e. human patellar and hamstring tendons, and synthetic grafts). A 140 N load was applied to the grafts and maintained for 100 s. Initial stress and following stress-relaxation (a mechanical characteristic that can be related to knee laxity) were specifically analysed. FINDINGS Initial stress, ranging between 4 and 12 MPa, was affected primarily by the graft cross-section area and secondarily by the choice of the graft material. In terms of loss of the initial stress, stress-relaxation behaviour varied instead on a narrower range, namely 13-17%. INTERPRETATION Engineering stress can be identified as the correct metrics to optimize the initial state of each graft to avoid excessive stiffness, laxity or fatigue rupture phenomena.
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Affiliation(s)
- Gregorio Marchiori
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Scienze e Tecnologie Chirurgiche, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Nicola Francesco Lopomo
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Scienze e Tecnologie Chirurgiche, Via di Barbiano 1/10, 40136 Bologna, Italy; Department of Information Engineering, University of Brescia, Via Branze 38, 25123, Brescia, Italy
| | - Emanuela Bologna
- Engineering Department, University of Palermo, Viale delle Scienze ed.8, 90100 Palermo, Italy; Bio/NanoMechanics for Medical Sciences Laboratory, ATeN-Center, University of Palermo, Viale delle Scienze ed.8, 90100 Palermo, Italy
| | - Doriana Spadaro
- Fallprotec SA, 43-45 ZA Op Zaemer, 4959 Bascharage, Luxembourg
| | - Lawrence Camarda
- Department of Discipline Surgical, Oncology and Dentistry, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
| | - Matteo Berni
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Andrea Visani
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Scienze e Tecnologie Chirurgiche, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Marianna Zito
- Engineering Department, University of Palermo, Viale delle Scienze ed.8, 90100 Palermo, Italy
| | - Stefano Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, IIa Clinica Ortopedica e Traumatologica, Via Pupilli 1/10, 40136 Bologna, Italy
| | - Massimiliano Zingales
- Engineering Department, University of Palermo, Viale delle Scienze ed.8, 90100 Palermo, Italy; Bio/NanoMechanics for Medical Sciences Laboratory, ATeN-Center, University of Palermo, Viale delle Scienze ed.8, 90100 Palermo, Italy.
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Kruppa P, Flies A, Wulsten D, Collette R, Duda GN, Schaser KD, Becker R, Kopf S. Significant Loss of ACL Graft Force With Tibial-Sided Soft Tissue Interference Screw Fixation Over 24 Hours: A Biomechanical Study. Orthop J Sports Med 2020; 8:2325967120916437. [PMID: 32440520 PMCID: PMC7225828 DOI: 10.1177/2325967120916437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Tibial-sided graft fixation is thought to be critical for the success of anterior cruciate ligament (ACL) reconstruction. Nevertheless, little is known about the graft force after fixation during the first 24 hours after surgery or the influence of screw diameter and length during this time. Purpose To investigate the force, over the course of 24 hours, in soft tissue grafts secured with a tibial interference screw and to evaluate the effect of different screw diameters (7, 8, and 9 mm) and lengths (25 and 30 mm) on the force in these grafts. Study Design Controlled laboratory study. Methods Quadruple-strand flexor tendon grafts were fixed with bioabsorbable interference screws in 60 porcine tibiae. Grafts were pretensioned at 80 N over 10 minutes, and screws were inserted outside-in while a preload force of 80 N was applied. Different screw lengths (25 and 30 mm) and diameters (7, 8, and 9 mm), resulting in 6 groups with 10 specimens each, were tested. After release of the preload, graft force was recorded over 24 hours. Results A significant decrease in graft force progressed in all groups over the 24-hour period. In total, a median loss of 75 N (IQR, 68-79 N) compared with the initial loading force was observed. Compared with the loading force of 80 N, this corresponded to a median loss of 91%. No significant differences in the remaining graft force could be found among the 6 different screw length and diameter groups after 10 minutes, 100 minutes, or 24 hours. Conclusion Graft force in soft tissue grafts secured with a tibial interference screw decreased substantially over the first 24 hours after fixation. Neither the screw diameter nor the screw length affected the decrease in graft force. This raises substantial questions regarding the remaining fixation strength in vivo. Clinical Relevance It should not be expected that ACL reconstruction can mechanically restabilize an injured knee as would an intact ACL. Reconstructed knees should be protected from mechanical overload in the early postoperative period.
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Affiliation(s)
- Philipp Kruppa
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany.,Julius-Wolff-Institute, Charité-University Medicine Berlin, Berlin, Germany
| | - Anne Flies
- Julius-Wolff-Institute, Charité-University Medicine Berlin, Berlin, Germany
| | - Dag Wulsten
- Julius-Wolff-Institute, Charité-University Medicine Berlin, Berlin, Germany
| | - Robert Collette
- Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Georg N Duda
- Julius-Wolff-Institute, Charité-University Medicine Berlin, Berlin, Germany
| | - Klaus-Dieter Schaser
- Department of Orthopedic and Trauma Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
| | - Sebastian Kopf
- Julius-Wolff-Institute, Charité-University Medicine Berlin, Berlin, Germany.,Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
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9
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Franciozi CE, de Carvalho RT, Itami Y, McGarry MH, Ingham SJM, Abdalla RJ, Tibone JE, Lee TQ. Bicruciate lesion biomechanics, Part 2-treatment using a simultaneous tensioning protocol: ACL fixation first is better than PCL fixation first to restore tibiofemoral orientation. Knee Surg Sports Traumatol Arthrosc 2019; 27:2936-2944. [PMID: 30267188 DOI: 10.1007/s00167-018-5177-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 09/21/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE An uncommon technique for bicruciate ligament reconstruction involving simultaneous tensioning of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) grafts with ACL graft fixation first has been pointed out as superior to the "gold-standard" PCL graft fixation first. The purpose of this study was to compare tibiofemoral biomechanics between ACL fixation first and PCL fixation first in a simultaneous tensioning protocol for bicruciate ligament reconstruction. METHODS 12 fresh-frozen cadaveric knees (six matched pairs) were tested using a custom testing system. Neutral tibial position representing tibiofemoral orientation, anterior-posterior (AP) tibial translation, varus-valgus laxity, and internal-external rotation were measured using a Microscribe 3DLX at 0°, 30°, 60°, and 90° of knee flexion. The following knee conditions were evaluated: intact, bicruciate deficient and following bicruciate reconstruction. A simultaneous tensioning protocol was used for bicruciate reconstruction and PCL fixation first was compared to ACL fixation first. PCL graft fixation was always performed at 90° of flexion and ACL graft fixation was always performed at full extension. RESULTS ACL fixation first achieved a tibiofemoral orientation closer to the intact knee than PCL fixation first at 90° flexion (1.8 ± 1.6 mm versus 6.1 ± 3.2 mm, p = 0.016). PCL fixation first had a larger decrease in AP translation than ACL fixation first at 30° flexion (64.6 ± 3.5% vs. 58.3 ± 2.4%, p = 0.01). No significant differences were found for varus/valgus, external-internal rotation decrements after bicruciate reconstruction nor for AP translation, varus/valgus and internal/external rotation increase after bicruciate lesion comparing ACL fixation first to PCL fixation first. CONCLUSION Bicruciate ligament reconstruction using a simultaneous tensioning protocol with ACL fixation first resulted in a closer to normal tibiofemoral orientation. This study will help guide surgeons in decision making for the graft tensioning protocol and fixation sequence in a bicruciate ligament reconstruction. LEVEL OF EVIDENCE V therapeutic study.
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Affiliation(s)
- Carlos Eduardo Franciozi
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Borges Lagoa, 783, 5th Floor, Vila Clementino, São Paulo, SP, 04038-032, Brazil. .,Knee Institute, Hospital do Coração (HCor), São Paulo, SP, Brazil. .,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Rogério Teixeira de Carvalho
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Borges Lagoa, 783, 5th Floor, Vila Clementino, São Paulo, SP, 04038-032, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Yasuo Itami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Long Beach VA Healthcare System, Long Beach, CA, USA
| | - Sheila Jean McNeill Ingham
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Borges Lagoa, 783, 5th Floor, Vila Clementino, São Paulo, SP, 04038-032, Brazil.,Knee Institute, Hospital do Coração (HCor), São Paulo, SP, Brazil.,AACD, São Paulo, SP, Brazil
| | - Rene Jorge Abdalla
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Borges Lagoa, 783, 5th Floor, Vila Clementino, São Paulo, SP, 04038-032, Brazil.,Knee Institute, Hospital do Coração (HCor), São Paulo, SP, Brazil
| | - James Eugene Tibone
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Long Beach VA Healthcare System, Long Beach, CA, USA.,Department of Orthopaedic Surgery, University of California at Irvine, Irvine, CA, USA
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10
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Glasbrenner J, Domnick C, Raschke MJ, Willinghöfer T, Kittl C, Michel P, Wähnert D, Herbort M. Adjustable buttons for ACL graft cortical fixation partially fail with cyclic loading and unloading. Knee Surg Sports Traumatol Arthrosc 2019; 27:2530-2536. [PMID: 30368561 DOI: 10.1007/s00167-018-5262-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/23/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE Despite good initial pullout strength, it is unclear whether adjustable button (AB) devices for anterior cruciate ligament (ACL) soft-tissue graft fixation, which are based on the Chinese finger trap technique, resist cyclic loading. Furthermore, they have never been tested in a cyclic protocol including complete unloading. It was hypothesized, that the displacement of AB devices with the Chinese finger trap technique would be greater than that of continuous suture loop devices and other available AB mechanisms in a cyclic loading with complete unloading protocol. METHODS ACL reconstruction was performed in a porcine knee model using three different types of cortical fixation devices: two different AB devices that use the Chinese finger trap design, one AB device that uses a locked suture loop mechanism and two different continuous loop devices as control groups (n = 40). Specimens were mounted in a material-testing machine (Instron Inc.) that permitted 2500 loading and complete unloading cycles to a maximum of 250 N, as well as continuous elongation recording. A one-way ANOVA was performed for statistical analysis. RESULTS The displacement of ABs with a Chinese finger trap loop (mean 8.1; SD 1.5 mm and mean 6.1; SD 1.4 mm) was significantly greater than that of AB with a locked suture loop (mean 4.7; SD 1.0 mm; p < 0.05) and devices with a continuous loop (mean 4.1; SD 0.5 mm and mean 4.4, SD 0.3 mm; p < 0.01). No significant differences were detected between the ABs with a locked suture loop and the continuous loops. CONCLUSION Cyclic loading and unloading of AB using the Chinese finger trap technique leads to significantly greater construct lengthening compared with other devices. Complete unloading of the ACL is very likely to occur during rehabilitation after ACL reconstruction. Lengthening of the AB device due to cyclic loading might be a potential mode of failure of the ACL graft fixation. Therefore, when using an AB femoral fixation technique, a locked suture loop design or a careful rehabilitation protocol should be considered.
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Affiliation(s)
- J Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - C Domnick
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - M J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - T Willinghöfer
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - C Kittl
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - P Michel
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - D Wähnert
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany.
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11
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Morrison L, Haldane C, de Sa D, Findakli F, Simunovic N, Ayeni OR. Device-assisted tensioning is associated with lower rates of graft failure when compared to manual tensioning in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:3690-3698. [PMID: 29687166 DOI: 10.1007/s00167-018-4951-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe (1) the current graft tensioning practices in ACL reconstruction (ACLR) and, (2) the failure rates with the use of manual tensioning, or device-assisted tensioning at the time of graft fixation. METHODS The electronic databases MEDLINE, EMBASE, and PubMed were searched independently by two reviewers from database inception to search date on January 21, 2017. Inclusion criteria were studies reporting graft tensioning method and rate of graft failure. The definition of graft failure used was: (1) side-to-side instrumented laxity > 5 mm, (2) Lachman 2 +, (3) positive pivot-shift testing, (4) MRI-confirmed graft rupture or, (5) need for revision surgery. RESULTS A total of 3379 patients and 3380 knees were treated with ACL reconstruction and followed for an average of 41.7 months (range 4-145 months). ACLR with manual tensioning was performed on 1518 (51.9%) patients and device-assisted tensioning was performed on 1802 (48.1%) patients. The average knee position reported was 29.2° in single-bundle ACLR and 22.9° in double-bundle ACLR. The median amount of tension used in manual tensioning was 'maximum manual tension' and 50 N in device-assisted tensioning. Overall, the failure rate in studies reporting manual tensioning was 8.9% compared to 4.3% in device-assisted tensioning. CONCLUSION Both manual tensioning and device-assisted tensioning are associated with low overall failure rates (< 10%) in ACLR; however, there is a higher rate of reported failure with manual tensioning compared to device-assisted tensioning. These findings highlight the need to investigate variations in graft tensioning practice, such as specific tension devices and their parameters, with high-quality, randomized controlled trials to elucidate details of their clinical impact. LEVEL OF EVIDENCE Level IV, systematic review of level I-IV studies.
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Affiliation(s)
- Laura Morrison
- Michael G. DeGroote School of Medicine, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Chloe Haldane
- Michael G. DeGroote School of Medicine, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Darren de Sa
- UPMC Center for Sports Medicine, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Fawaz Findakli
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
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12
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Noronha JC, Oliveira JP. Inside-out Tibial Tunnel Drilling Technique for All-inside Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2018; 7:e373-e377. [PMID: 29868407 PMCID: PMC5982608 DOI: 10.1016/j.eats.2017.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/15/2017] [Indexed: 02/03/2023] Open
Abstract
All-inside anterior cruciate ligament reconstruction passed through a series of modifications over the past 2 decades, maintaining 2 common factors: half tunnels in both the femur and tibia and introduction of the graft into the knee through an arthroscopic portal. One of the disadvantages noted with this technique is the excessive cost of the instrumentation needed to perform it and its economic impact on the health care system. We describe a modification of the original technique, both maintaining the cortical bone in an intact state and avoiding the retrograde drill aiming device.
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Affiliation(s)
| | - João Pedro Oliveira
- Address correspondence to João Pedro Oliveira, M.D., Ph.D., Trindade Hospital, Rua da Trindade 115, 4000-541 Porto, Portugal.
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13
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Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ. Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? A Meta-analysis of 47,613 Patients. Clin Orthop Relat Res 2017; 475:2459-2468. [PMID: 28205075 PMCID: PMC5599382 DOI: 10.1007/s11999-017-5278-9] [Citation(s) in RCA: 247] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone-patellar tendon-bone (bone-tendon-bone) and four-strand hamstring tendon grafts (hamstring) are the most commonly utilized autografts for primary anterior cruciate ligament (ACL) reconstruction. Existing clinical trials, registry studies, and meta-analyses offer conflicting opinions regarding the most favorable graft choice. QUESTIONS/PURPOSES Which graft type for ACL reconstruction (bone-tendon-bone or hamstring) has a higher risk of (1) graft rupture and/or (2) graft laxity? METHODS We performed a meta-analysis of randomized controlled trials (RCTs), prospective cohort studies, and high-quality national registry studies to compare the outcomes of primary ACL reconstruction with bone-tendon-bone autograft or hamstring autograft. Studies that compared these graft types were identified through a comprehensive search of electronic databases (PubMed, MEDLINE, EMBASE, and the Cochrane Library). Two independent reviewers utilized the Jadad scale for RCT study quality and the Modified Coleman Methodology Score for prospective comparative and registry study quality. The included studies were analyzed for the primary outcome measure of graft rupture with or without revision ACL surgery. In surviving grafts, secondary outcomes of graft laxity were quantified by KT1000/2000™ testing, a positive pivot shift test, and a positive Lachman test. Meta-analysis was performed with Review Manager. A total of 47,613 ACL reconstructions (39,768 bone-tendon-bone and 7845 hamstring) from 14 RCTs, 10 prospective comparative studies, and one high-quality national registry study were included in this meta-analysis. Mean age was 28 years in both groups. Sixty-three percent of patients in the bone-tendon-bone cohort were men versus 57% of patients in the hamstring cohort. Mean followup was 68 ± 55 months. RESULTS Two hundred twelve of 7560 (2.80%) bone-tendon-bone grafts ruptured compared with 1123 of 39,510 (2.84%) in the hamstring group (odds ratio = 0.83, 95% confidence interval, 0.72-0.96; p = 0.01). The number needed to treat analysis found that 235 patients would need to be treated with a bone-tendon-bone graft over a hamstring tendon graft to prevent one graft rupture. Instrumented laxity analysis showed that 22% (318 of 1433) of patients in the bone-tendon-bone group had laxity compared with 18% (869 of 4783) in the hamstring tendon group (odds ratio = 0.86; p = 0.16). Pivot shift analysis showed a positive pivot shift in 19% (291 of 1508) of the bone-tendon-bone group compared with 17% (844 of 5062) in the hamstring group (odds ratio = 0.89; p = 0.51). Lachman testing showed a positive Lachman in 25% (71 of 280) of patients receiving bone-tendon-bone grafts compared with 25% (73 of 288) in the hamstring group (odds ratio = 0.96; p = 0.84). CONCLUSIONS In this meta-analysis of short- to mid-term followup after primary ACL reconstruction, hamstring autografts failed at a higher rate than bone-tendon-bone autografts. However, failure rates were low in each group, the difference observed was small, and we observed few differences between graft types in terms of laxity. Both graft types remain viable options for primary ACL reconstruction, and the difference in failure rate should be one part of a larger conversation with each individual patient about graft selection that should also include potential differences in donor site morbidity, complication rates, and patient-reported outcome measures. Continued prospective collection of patient data will be important going forward as we attempt to further characterize the potential differences in outcomes attributable to graft selection. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Brian T. Samuelsen
- 0000 0004 0459 167Xgrid.66875.3aDepartment of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic and Mayo Foundation, Rochester, MN USA
| | - Kate E. Webster
- 0000 0001 2342 0938grid.1018.8School of Allied Health, La Trobe University, Melbourne, Australia
| | - Nick R. Johnson
- 0000 0004 0459 167Xgrid.66875.3aDepartment of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic and Mayo Foundation, Rochester, MN USA
| | - Timothy E. Hewett
- 0000 0004 0459 167Xgrid.66875.3aDepartment of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic and Mayo Foundation, Rochester, MN USA
| | - Aaron J. Krych
- 0000 0004 0459 167Xgrid.66875.3aDepartment of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic and Mayo Foundation, Rochester, MN USA ,0000 0004 0459 167Xgrid.66875.3aMayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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14
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Zong JC, Ma R, Wang H, Cong GT, Lebaschi A, Deng XH, Rodeo SA. The Effect of Graft Pretensioning on Bone Tunnel Diameter and Bone Formation After Anterior Cruciate Ligament Reconstruction in a Rat Model: Evaluation With Micro-Computed Tomography. Am J Sports Med 2017; 45:1349-1358. [PMID: 28298055 DOI: 10.1177/0363546516686967] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Moderate graft pretensioning in anterior cruciate ligament (ACL) reconstruction is paramount to restore knee stability and normalize knee kinematics. However, little is known about the effect of graft pretensioning on graft-to-bone healing after ACL reconstruction. HYPOTHESIS Moderate graft pretensioning will improve bone formation within the bone tunnel after ACL reconstruction, resulting in superior load to failure. STUDY DESIGN Controlled laboratory study. METHODS 67 male Sprague-Dawley rats underwent unilateral ACL reconstruction with a flexor digitorum longus tendon autograft. The graft was subjected to pretensioning forces of 0 N, 5 N, or 10 N. Custom-made external fixators were used for knee immobilization postoperatively. Rats were euthanized for biomechanical load-to-failure testing (n = 45) and micro-computed tomography (μCT) examination (n = 22) at 3 and 6 weeks after surgery. Three regions of each femoral and tibial bone tunnel (aperture, middle, and tunnel exit) were chosen for measurement of tunnel diameter and new bone formation. RESULTS Biomechanical tests revealed significantly higher load-to-failure in the 5-N graft pretensioned group compared with the 0- and 10-N groups at 3 weeks (8.58 ± 2.67 N vs 3.96 ± 1.83 N and 4.46 ± 2.62 N, respectively) and 6 weeks (16.56 ± 3.50 N vs 10.82 ± 1.97 N and 7.35 ± 2.85 N, respectively) after surgery ( P < .05). The mean bone tunnel diameters at each of the 3 regions were significantly smaller in the 5-N group, at both the femoral and tibial tunnel sites, than in the 0- and 10-N groups ( P < .05). At 3 and 6 weeks postoperatively, the bone mineral density, bone volume fraction, and connectivity density around the aperture and middle regions of the tibial bone tunnels were all significantly higher in the 5-N group compared with the 0- and 10-N groups ( P < .05). In the aperture and middle regions of the femoral bone tunnels, pretensioning at either 5 or 10 N resulted in increased bone formation compared with the nonpretensioned group at 3 weeks postoperatively. No differences were found in bone formation between any of the 3 femoral tunnel regions at 6 weeks. CONCLUSION Graft pretensioning can stimulate new bone formation and improve tendon-to-bone tunnel healing after ACL reconstruction. CLINICAL RELEVANCE Optimal graft pretensioning force in ACL reconstruction can improve bone tunnel healing. Further study is necessary to understand the mechanisms underlying the effect of graft pretensioning on healing at the bone-tunnel interface.
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Affiliation(s)
- Jian-Chun Zong
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Richard Ma
- The Hospital for Special Surgery, New York, New York, USA
| | - Hongsheng Wang
- The Hospital for Special Surgery, New York, New York, USA
| | | | - Amir Lebaschi
- The Hospital for Special Surgery, New York, New York, USA
| | - Xiang-Hua Deng
- The Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- The Hospital for Special Surgery, New York, New York, USA
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15
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High-load preconditioning of human soft tissue hamstring grafts: An in vitro biomechanical analysis. Knee Surg Sports Traumatol Arthrosc 2017; 25:138-143. [PMID: 27624178 DOI: 10.1007/s00167-016-4317-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/01/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE In order to minimize viscoelastic elongation of ACL reconstruction grafts, preconditioning protocols have been employed in clinical practice prior to final graft fixation. The purpose of this study was to evaluate two separate high-load static preconditioning protocols of double-looped semitendinosus-gracilis grafts and compare these results to both a current clinical protocol and a control group with no preconditioning protocol applied. It was hypothesized that a high-load, static preconditioning protocol would minimize graft elongation during a simulated progressive early rehabilitation compared to both the "89 N" clinical protocol and control groups. METHODS Grafts were randomly allocated into four preconditioning study groups: (1) control (no preconditioning), (2) clinical protocol (89 N for 15 min), (3) high-load, short duration (600 N for 20 s), and (4) high-load, long duration (600 N for 15 min). After preconditioning, grafts were cyclically loaded between 10 and 400 N at 0.5 Hz for 450 cycles to simulate early postoperative rehabilitation. Graft displacement (elongation) was recorded during both preconditioning and cyclic loading. RESULTS Increased preconditioning load magnitude and duration significantly reduced graft elongation during cyclic loading (p < 0.05) which corresponded to an inverse relationship with increased elongation during preconditioning. The "600 N for 15 min" protocol resulted in significantly less elongation during simulated early rehabilitation than both the control group and the "89 N for 15 min" protocol (p < 0.001, p < 0.05). CONCLUSIONS Graft elongation during simulated early rehabilitation was significantly reduced by a high-load preconditioning protocol applied for an extended period of time compared to a current common clinical protocol and grafts that were not preconditioned. In addition, the amount of elongation during simulated early rehabilitation was similar between grafts preconditioned using the current clinical practice protocol and the high-load/short-duration protocol, implying that the latter could potentially induce the same viscoelastic changes in soft tissue grafts as the current clinical practice. The "600 N for 20 s" preconditioning protocol may provide similar postoperative results as the clinical protocol, "89 N for 15 min", and also reduce or maintain operative time. A high-load preconditioning protocol that reduces graft elongation may benefit patients undergoing ACL reconstruction, especially for cases of failed primary reconstruction, genu recurvatum, and increased tibial slope, where maintaining graft length is imperative to restore knee stability.
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16
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Fujii M, Furumatsu T, Miyazawa S, Tanaka T, Inoue H, Kodama Y, Masuda K, Seno N, Ozaki T. Features of human autologous hamstring graft elongation after pre-tensioning in anterior cruciate ligament reconstruction. INTERNATIONAL ORTHOPAEDICS 2016; 40:2553-2558. [DOI: 10.1007/s00264-016-3298-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/16/2016] [Indexed: 01/07/2023]
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