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Tang H, Xiao YF, Liu WJ, Meng JH, Wu YM, Xiong YL, Gao SG. Preferences in anterior cruciate ligament reconstruction: A survey among orthopedic surgeons in China. Medicine (Baltimore) 2024; 103:e36482. [PMID: 38363894 PMCID: PMC10869037 DOI: 10.1097/md.0000000000036482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024] Open
Abstract
The purpose of this study was to reveal the current trends and preferences of Chinese orthopedic surgeons regarding anterior cruciate ligament (ACL) reconstruction through a nationwide web-based survey conducted in China. The survey questionnaire was distributed via WeChat to the chairmen of provincial orthopedic and sports medicine organizing committees in China, who then shared it in their respective WeChat workgroups. The questionnaire consisted of 52 multiple-choice questions covering 8 sections. Data collection was implemented by Questionnaire Star. A total of 812 valid questionnaires were returned: 94.21% of the respondents preferred single-bundle reconstruction of ACL, while 61.70% preferred autogenous semitendinosus plus gracilis reconstruction; 76.35% of the respondents preferred establishing the femoral tunnel first, while 47.29% preferred establishing the femoral tunnel through a medial auxiliary approach; and 85.10% of the respondents recommended patients to undergo surgery within 3 months after ligament injury. Besides, the vast majority of respondents chose to retain the ligamentous remnant bundle (92.98%) and recommended routine use of knee braces postoperatively (94.09%). It is recommended to perform arthroscopic single-bundle ACL reconstruction with the remnant preserving technique using a hamstring autograft within 3 months of ACL rupture, with support of postoperative functional braces.
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Affiliation(s)
- Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yi-fan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Wei-jie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Jia-hao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yu-mei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yi-lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Tian B, Zhang M, Kang X. Strategies to promote tendon-bone healing after anterior cruciate ligament reconstruction: Present and future. Front Bioeng Biotechnol 2023; 11:1104214. [PMID: 36994361 PMCID: PMC10040767 DOI: 10.3389/fbioe.2023.1104214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
At present, anterior cruciate ligament (ACL) reconstruction still has a high failure rate. Tendon graft and bone tunnel surface angiogenesis and bony ingrowth are the main physiological processes of tendon-bone healing, and also the main reasons for the postoperative efficacy of ACL reconstruction. Poor tendon-bone healing has been also identified as one of the main causes of unsatisfactory treatment outcomes. The physiological process of tendon-bone healing is complicated because the tendon-bone junction requires the organic fusion of the tendon graft with the bone tissue. The failure of the operation is often caused by tendon dislocation or scar healing. Therefore, it is important to study the possible risk factors for tendon-bone healing and strategies to promote it. This review comprehensively analyzed the risk factors contributing to tendon-bone healing failure after ACL reconstruction. Additionally, we discuss the current strategies used to promote tendon-bone healing following ACL reconstruction.
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Kim BS, Kim JH, Park YB, Ro DH, Jung YB, Pujol N, Kim SH. No Differences In Clinical Outcomes Between Rectangular and Round Tunnel Techniques For Anterior Crucial Ligament Reconstruction. Arthroscopy 2022; 38:1933-1943.e1. [PMID: 34920009 DOI: 10.1016/j.arthro.2021.11.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes between conventional round tunnel and rectangular tunnel in anatomic anterior cruciate ligament (ACL) reconstruction. METHODS This was a retrospective comparative cohort study between March 2015 and September 2018. The primary ACL reconstructions using anteromedial portal technique with minimum of 2 years follow-up were enrolled for this study. The exclusion criteria were patients with revision ACL reconstruction, high tibial osteotomy, multiligament injuries, and associated fractures around the knee. Outcome measures included the subjective International Knee Documentation Committee score, Tegner activity score, knee laxity testing, and measurement of the centers of the femoral and tibial tunnels on postoperative computed tomography (CT) images. RESULTS Forty-seven patients with ACL reconstruction with rectangular tunnel (group 1) and 108 patients with ACL reconstructions with conventional rounded tunnel (group 2) were included consecutively. There were no significant differences between groups in terms of clinical scores or knee laxity, as well as femoral and tibial tunnel positions on CT. One patient in group 2 had ACL failure because of trauma and was treated with revision surgery. Two patients had incomplete tibial fracture, but they healed spontaneously and showed no residual laxity at final follow-up. The intraobserver and interobserver reliability for the radiological measurements ranged from 0.78 to 0.86. CONCLUSIONS There were no differences in radiological and clinical results between rectangular tunnel group and conventional round tunnel group for arthroscopic ACL reconstruction. ACL reconstruction with a rectangular tunnel could be considered as a reliable technique, but care should be taken during tunnel establishment because of risk of fractures and malposition of rectangular tunnel.
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Affiliation(s)
- Boo-Seop Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, South Korea
| | - Jong-Heon Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Du-Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Young-Bok Jung
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, South Korea
| | - Nicolas Pujol
- Orthopedic Department, Centre Hospitalier de Versailles (N.P.), Le Chesnay, France
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, South Korea.
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Philippe C, Marot V, Courtot L, Mesnier T, Reina N, Cavaignac E. One-Stage ACL Revision Using a Bone Allograft Plug for a Semianatomic Tibial Tunnel That Is Too Anterior. Arthrosc Tech 2022; 11:e463-e469. [PMID: 35256992 PMCID: PMC8897652 DOI: 10.1016/j.eats.2021.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023] Open
Abstract
Revision of an anterior cruciate ligament (ACL) reconstruction can be performed as a one-stage or two-stage surgery. Several factors must be taken into consideration when making this choice, especially the size and position of the existing tunnels. When the tibial tunnel is semianatomic, it is difficult to make a new tunnel in the correct position without overlapping the existing tunnel. For this reason, we have developed a one-stage ACL revision surgery that uses a bone allograft plug. When it comes to choosing a reconstruction technique, we believe that combined intra-articular and extra-articular reconstruction with the iliotibial band is suitable when the hamstring tendons are not available, combined with clinical findings of translational and rotational instability. Because the existing tunnels require reorientation, a new femoral tunnel can be created by outside-in drilling to eliminate the risk of overlap, while an allograft bone plug can be used to fill the overly anterior tibial tunnel and allow us to drill the correct tibial tunnel right away. In our hands, this is a safe and effective technique, but longer follow-up is needed to validate its indications.
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Affiliation(s)
- Corentin Philippe
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Vincent Marot
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Louis Courtot
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Timothée Mesnier
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Nicolas Reina
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France,I2R, Institut de Recherche Riquet, Toulouse, France
| | - Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France,I2R, Institut de Recherche Riquet, Toulouse, France,SPS Research, Toulouse, France,Address correspondence to Etienne Cavaignac, M.D., Ph.D., Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse Purpan, 1 Place Baylac, 31000 Toulouse, France.
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Marot V, Valette A, Courtot L, Lucena T, Reina N, Cavaignac E. Outside-In Anterior Cruciate Ligament Revision With Lateral Tenodesis and High-Strength Suture Augmentation Is Easy to Perform With the Iliotibial Band. Arthrosc Tech 2021; 10:e1321-e1326. [PMID: 34141548 PMCID: PMC8185809 DOI: 10.1016/j.eats.2021.01.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/29/2021] [Indexed: 02/03/2023] Open
Abstract
We describe a technique for revision anterior cruciate ligament (ACL) surgery using a 15-cm strip of the iliotibial band as a graft and the gracilis tendon if available. An internal brace is added to augment the graft. The graft is passed through the femur by drilling an outside-in tunnel from the isometric point F9 of Krackow toward the ACL's footprint and is then double fixed at the tibia using an interference screw and a cortical button. This technique makes it possible to perform simultaneous ACL reconstruction and lateral tenodesis with a continuous, rigid, good-diameter graft that is pedicled to the Gerdy tubercle. Good rotational control is achieved, and all the factors that contribute to ligamentization are present.
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Affiliation(s)
- Vincent Marot
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Orthopaedics Unit, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Arnault Valette
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Louis Courtot
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Thibault Lucena
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Nicolas Reina
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- I2R, Institut de Recherche Riquet, Toulouse, France
| | - Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- I2R, Institut de Recherche Riquet, Toulouse, France
- SPS Research, Toulouse, France
- Address correspondence to Etienne Cavaignac, M.D., Musculoskeletal Institute, Hopital Pierre Paul Riquet, CHU Toulouse Purpan, 1 Place Baylac, 31000 Toulouse, France.
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Zhao F, Hu X, Zhang J, Shi W, Ren B, Huang H, Ao Y. A more flattened bone tunnel has a positive effect on tendon-bone healing in the early period after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:3543-3551. [PMID: 30877317 DOI: 10.1007/s00167-019-05420-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/15/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to evaluate whether a flattened bone tunnel has a positive effect on the tendon-bone healing (TBH) process in the early period after anterior cruciate ligament (ACL) reconstruction. METHODS Seventy-two New Zealand White rabbits were randomly allocated into two groups, the flattened tunnel (FT) group and the conventional round tunnel (RT) group. We compared the cross-sectional areas and diameters of the bone tunnels between the two groups through computed tomography (CT) scanning. TBH results between the two groups were assessed by histological analysis, micro-CT scanning and biomechanical tests at 4 weeks, 8 weeks and 12 weeks after operation. RESULTS The cross-sectional areas of the bone tunnels between the two groups were almost the same. However, the shape of bone tunnels in the FT group was more flattened. A faster cellular and collagen remoulding process were found in the FT group. Semiquantitative histological analysis of Safranin O staining showed that there was more fibrocartilage formation in the interface region in the FT group (P < 0.05). Sirius Red staining showed that the tissues in the interface areas were more intense in the FT group. Micro-CT scanning showed that more new bone formation could be found in the interface region in the FT group. The biomechanical tests also showed that FT ACL reconstruction will result in a stronger regenerated tendon-bone interface. CONCLUSIONS Our study found that a flattened bone tunnel accelerated TBH in the early period after ACL reconstruction surgery in a rabbit model, which lays the groundwork for further clinical practice of this ACL reconstruction method.
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Affiliation(s)
- Fengyuan Zhao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jiahao Zhang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Weili Shi
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Bo Ren
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Hongjie Huang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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