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Saithna A. Editorial Commentary: Failure to Regain Full Hyperextension After Anterior Cruciate Ligament Reconstruction Is Associated With Inferior Patient Satisfaction and Lower Functional Outcomes Scores, But the Impact on Graft Rupture Rates and Persistent Instability Is Unclear. Arthroscopy 2024:S0749-8063(24)00565-6. [PMID: 39151708 DOI: 10.1016/j.arthro.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024]
Abstract
Up to one half of patients undergoing anterior cruciate ligament reconstruction demonstrate some degree of knee hyperextension in their contralateral limb. In most cases, this is mild (1°-5°), but it is reported that 9% and 0.8% demonstrate moderate (6°-10°) and severe (>10°) degrees of hyperextension. These characteristics pose challenges and considerations for surgical management. This includes the finding that failure to regain full hyperextension is common and is associated with inferior functional outcomes and patient satisfaction, and the juxtaposition that regaining full hyperextension may increase graft rupture and persistent instability rates. Although the pathophysiology of extension deficit is multifactorial, 2 particularly important and modifiable risk factors in this population are notch impingement and arthrogenic muscle inhibition. Strategies to avoid notch impingement include anterior notchplasty and careful consideration of graft size, graft type, and tibial tunnel placement. Arthrogenic muscle inhibition is clinically characterized by extension deficit and quadriceps activation failure. It is reversible in most patients and therefore an important modifiable risk factor. Since failure to regain full hyperextension is associated with inferior outcomes, abolishing extension deficit should be a key objective of surgical treatment and rehabilitation. Concerns regarding the risks of persistent laxity and graft rupture in knee hyperlaxity/hyperextension patients can be mitigated by the addition of anterolateral ligament reconstruction.
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Simonsson R, Piussi R, Högberg J, Sundberg A, Hamrin Senorski E. Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:513-533. [PMID: 38811125 DOI: 10.1016/j.csm.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Rehabilitation after an anterior cruciate ligament (ACL) reconstruction requires patience, devotion, and discipline. Rehabilitation should be individualized to each patient's specific need and sport. Return to sport is a continuum throughout the rehabilitation, and patients should not return to performance before passing a battery of muscle function tests and patient-reported outcomes, as well as change of direction-specific tests. Return to full participation should be an agreement between the patient, physical therapist, surgeon, and coach. For minimal risk for second ACL injury, patients should continue with maintenance and prevention training even after returning to sport.
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Affiliation(s)
- Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Axel Sundberg
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Capio Ortho Center, Arvid Wallgrens Backe 4a, Gothenburg SE-413 13, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Swedish Olympic Committee, Olympiastadion 114 33, Stockholm, Sweden.
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Helito CP, Moreira da Silva AG, Gomes Gobbi R, Pécora JR. Recovery of Full Hyperextension After Anterior Cruciate Ligament Reconstruction Is Associated With Better Functional Outcomes but Greater Anterior Cruciate Ligament-Related Laxity After a Minimum 24-Month Follow-Up. Arthroscopy 2024:S0749-8063(24)00450-X. [PMID: 38944322 DOI: 10.1016/j.arthro.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/18/2024] [Accepted: 06/10/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE To evaluate patients who had anterior cruciate ligament (ACL) reconstruction with preoperative hyperextension and compare physical examination (KT-1000 and pivot shift) and patient-reported outcome measures of patients who recovered the entire hyperextension with patients who did not. METHODS Patients aged 18 to 60 years with more than 5° of knee hyperextension who had anatomic ACL reconstruction with any graft from June 2013 to June 2021 and at least a 24-month follow-up were evaluated retrospectively. Hamstrings and patellar tendon grafts were fixed around 20° to 30° of flexion and in full extension, respectively. Patients who could recover hyperextension were compared with patients who did not. Preoperative, intraoperative, and postoperative data, including physical examination and patient-reported outcome measures, were evaluated. RESULTS Of the 225 patients evaluated, 48 (21.3%) did not recover hyperextension, and 177 recovered full range of motion. Patients who did not recover hyperextension had a larger graft diameter (8.7 ± 0.7 mm [confidence interval, 8.502-8.898 mm] vs 8.3 ± 0.7 mm [confidence interval, 8.197-8.403 mm]; P = .018). Regarding the postoperative subjective variables, patients who recovered hyperextension showed improvement on all scales (International Knee Documentation Committee, Lysholm, Forgotten Joint Score, and Global Perceived Effect) evaluated compared with patients who did not recover the range of motion. Patients who recovered hyperextension also showed more laxity on physical examination, measured by the KT-1000 (1.8 ± 0.8 vs 1.1 ± 1.0; P = .0006) and the pivot shift (62.1% [grade 0] and 37.9% [grade 1] vs 79.2% [grade 0] and 20.8% [grade 1]; P = .027). CONCLUSIONS Patients with knee hyperextension who regained range of motion after ACL reconstruction have worse knee laxity than patients who regained full extension but not hyperextension. However, patients who recover full range of motion showed higher scores on subjective function scales, including a greater number of patients who achieved patient acceptable symptom state for the International Knee Documentation Committee score. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Hospital Sírio Libanês, São Paulo, SP, Brazil
| | - Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Riccardo Gomes Gobbi
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; HCor Hospital do Coração, São Paulo, SP, Brazil
| | - José Ricardo Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Zsidai B, Kaarre J, Svantesson E, Piussi R, Musahl V, Samuelsson K, Hamrin Senorski E. The days of generalised joint hypermobility assessment in all patients with ACL injury are here. Br J Sports Med 2024:bjsports-2023-107188. [PMID: 38216321 DOI: 10.1136/bjsports-2023-107188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Bálint Zsidai
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
- Institute of Clinical Sciences, Department of Orthopaedics, University of Gothenburg, Mölndal, Sweden
| | - Janina Kaarre
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
- Institute of Clinical Sciences, Department of Orthopaedics, University of Gothenburg, Mölndal, Sweden
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eleonor Svantesson
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
- Institute of Clinical Sciences, Department of Orthopaedics, University of Gothenburg, Mölndal, Sweden
| | - Ramana Piussi
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Volker Musahl
- Institute of Clinical Sciences, Department of Orthopaedics, University of Gothenburg, Mölndal, Sweden
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
- Institute of Clinical Sciences, Department of Orthopaedics, University of Gothenburg, Mölndal, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Gothenburg, Sweden
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Lindskog J, Piussi R, Simonson R, Högberg J, Samuelsson K, Thomeé R, Sundemo D, Hamrin Senorski E. Lower rates of return to sport in patients with generalised joint hypermobility two years after ACL reconstruction: a prospective cohort study. BMC Sports Sci Med Rehabil 2023; 15:100. [PMID: 37573382 PMCID: PMC10422717 DOI: 10.1186/s13102-023-00707-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/24/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Generalised joint hypermobility (GJH) has been associated with an increased risk of suffering an anterior cruciate ligament (ACL) injury. Patients with GJH exhibit lower muscle strength and poorer scores for patient-reported outcomes after ACL reconstruction, compared with patients without GJH. The aim of this study was to examine differences in the percentages of patients who return to sport (RTS) or pre-injury level of activity (RTP), muscle function and patient-reported outcomes at the time of RTS or RTP, as well as the time of RTS or RTP in patients with GJH compared with patients without GJH in the first two years after ACL reconstruction. METHODS This prospective study used data from an ACL- and rehabilitation-specific register located in Gothenburg, Sweden. Patients aged between 16 and 50, who had a primary ACL injury treated with reconstruction, were included. Data up to two years after ACL reconstruction were used and consisted of achieving RTS and RTP, results from isokinetic muscle function tests for knee extension and flexion and patient-reported outcomes (Knee Self-Efficacy Scale, Knee injury and Osteoarthritis Outcome Score and ACL-Return to Sport after Injury scale) at the time of RTS, as well as the time of RTP. A Beighton Score of ≥ 5/9 was used to define GJH. A Tegner Activity Scale of ≥ 6 was used to define RTS, while a Tegner equal to or above pre-injury level was used to define RTP. RESULTS A total of 1,198 patients (54.7% women) with a mean age of 28.5 ± 8.6 years were included. A smaller proportion of patients with GJH achieved RTS compared with patients without GJH (49.2% vs. 57.3%, Odds ratio: 0.720, p = 0.041). Furthermore, patients with GJH were marginally less symmetrical on the knee extension strength test, expressed as a Limb Symmetry Index, at the time of RTP compared with patients without GJH (87.3 ± 13.5 vs. 91.7 ± 14.3, Cohen's d = 0.142, p = 0.022). No further differences were found between groups regarding any muscle function tests or patient-reported outcomes. CONCLUSION A smaller proportion of patients with GJH achieved RTS compared with patients without GJH. Patients with GJH displayed less symmetrical knee extension strength at the time of RTP compared with patients without GJH.
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Affiliation(s)
- Jakob Lindskog
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
| | - Rebecca Simonson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
| | - David Sundemo
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Närhälsan Lerum Primary Health Care Center, Lerum, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden.
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden.
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden.
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Zsidai B, Piussi R, Thomeé R, Sundemo D, Musahl V, Samuelsson K, Hamrin Senorski E. Generalised joint hypermobility leads to increased odds of sustaining a second ACL injury within 12 months of return to sport after ACL reconstruction. Br J Sports Med 2023; 57:972-978. [PMID: 37192830 PMCID: PMC10423474 DOI: 10.1136/bjsports-2022-106183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To determine the 12-month risk of a second anterior cruciate ligament (ACL) injury in a population of patients with and without generalised joint hypermobility (GJH) who return to sports (RTS) at competition level after ACL reconstruction (ACL-R). METHODS Data were extracted from a rehabilitation-specific registry for 16-50-year-old patients treated with ACL-R between 2014 and 2019. Demographics, outcome data and the incidence of a second ACL injury within 12 months of RTS, defined as a new ipsilateral or contralateral ACL, were compared between patients with and without GJH. Univariable logistic regression and Cox proportional hazards regression were performed to determine the influence of GJH and time of RTS on the odds of a second ACL injury, and ACL-R survival without a second ACL injury after RTS. RESULTS A total of 153 patients, 50 (22.2%) with GJH and 175 (77.8%) without GJH, were included. Within 12 months of RTS, 7 (14.0%) patients with GJH and 5 (2.9%) without GJH had a second ACL injury (p=0.012). The odds of sustaining a second ipsilateral or contralateral ACL injury were 5.53 (95% CI 1.67 to 18.29) higher in patients with GJH compared with patients without GJH (p=0.014). The lifetime HR of a second ACL injury after RTS was 4.24 (95% CI 2.05 to 8.80; p=0.0001) in patients with GJH. No between-group differences were observed in patient-reported outcome measures. CONCLUSION Patients with GJH undergoing ACL-R have over five times greater odds of sustaining a second ACL injury after RTS. The importance of joint laxity assessment should be emphasised in patients who aim to return to high-intensity sports following ACL-R.
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Affiliation(s)
- Bálint Zsidai
- Department of Orthopaedics, Göteborgs universitet Institutionen för kliniska vetenskaper, Goteborg, Sweden
| | - Ramana Piussi
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Roland Thomeé
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
| | - David Sundemo
- Institute of Clinical Sciences, Department of Orthopeadics, University of Gothenburg, Gothenburg, Europe, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Gothenburg, Sweden
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Hosseinzadeh N, Mohammadpour M, Moghtadaei M, Farahini H, Khazanchin A, Nasiri S, Khazanchin A. Evaluation of the short-term outcomes of anatomic ACL reconstruction with hamstring autograft in patients with generalized joint laxity: A retrospective case-control study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03390-0. [PMID: 36125587 DOI: 10.1007/s00590-022-03390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The outcomes of anterior cruciate ligament reconstruction (ACLR) in patients with generalized joint laxity (GJL) are not clearly understood. In this study, we compared the outcomes of ACLR with quadruple hamstring autograft between GJL and non-GJL patients. METHODS In a retrospective case-control study, 36 patients with GJL, according to the Beighton and Horan Joint Mobility Index, who underwent ACLR surgery, were included. Forty-four group-matched non-GJL patients were included in the control group. The mean follow-up of the patients was 20.65 ± 6.93 months. The outcomes of ACLR were evaluated by the Lachman test, pivot shift test, anterior tibial translation and KT-1000 side-to-side difference, and International Knee Documentation Committee (IKDC) scale. RESULTS The results of the Lachman and pivot shift test were not significantly different between the GJL and non-GJL patients (P = 0.67 and P = 0.27, respectively). The mean anterior tibial translation was 7.06 ± 1.41 mm in the GJL group and 6.11 ± 1.53 mm in the non-GJL group (P = 0.006). The mean KT-1000 side-to-side difference was 2.25 ± 1.31 mm in the case and 2.5 ± 1.44 mm in the control group (P = 0.42). The mean IKDC score of the patients was not significantly different between the GJL and non-GJL groups (66.1 ± 20.6 vs. 69.9 ± 16.1, P = 0.35). ACLR failure occurred in 2 (5.5%) patients of the GJL group and no patients of the control group (P = 0.21). CONCLUSION The present findings suggest ACLR with quadruple hamstring autograft as an adequate treatment for GJL patients, at least in short-term follow-up.
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Affiliation(s)
- Nima Hosseinzadeh
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Mehdi Mohammadpour
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Mehdi Moghtadaei
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Hossein Farahini
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Ahmad Khazanchin
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Shirin Nasiri
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Amir Khazanchin
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran.
- Shafa Orthopedic Hospital, Baharestan Square, Mojahedin-e-Islam St, Shafa Yahyaian Educational and Medical Center, Iran University of Medical Science, Tehran, 1157637131, Iran.
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Tanaka Y, Tachibana Y, Kinugasa K, Takao R, Kita K, Amano H, Yonetani Y, Shiozaki Y, Uchida R, Horibe S. Rectangular bone-patellar tendon bone grafts reduce early graft failure in chronic ACL-Deficient knees. J Orthop Sci 2022; 28:597-602. [PMID: 35314094 DOI: 10.1016/j.jos.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/25/2022] [Accepted: 02/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to assess early graft failure after anterior cruciate ligament (ACL) reconstruction according to chronicity of ACL deficiency (ACLD) and clarify predisposing factors. METHODS A total of 731 patients who underwent anatomic ACL reconstruction were divided into 3 groups based on chronicity of ACLD: <6 months (Group 1), 6 months to 2 years (Group 2), and >2 years (Group 3). Types of ACL grafts used included single-bundle hamstring tendon (HT), multiple-bundle HT, and rectangular bone-patellar tendon-bone (BTB) grafts. Preoperatively and immediately postoperatively, lateral radiographs in full extension were taken to examine anterior tibial subluxation (ATS). All ACL grafts were evaluated by MRI at 6 months to identify graft failure. The group with the highest failure rate was further examined to compare possible risk factors between the intact and failure subgroups, followed by multivariate logistic regression analysis to identify predisposing factors. RESULTS Early graft failure on MRI without any episode of postoperative trauma was observed in 7 (1.4%), 2 (1.8%), and 11 (9.2%) patients in Groups 1, 2, and 3, respectively, with a significantly higher rate in Group 3 (P < 0.001). Of the 119 patients in Group 3, significant differences were observed between intact and failure subgroups with regard to surgical procedure (P = 0.03), chondral lesions (P < 0.01), and preoperative ATS (P < 0.01). Multivariate logistic regression analysis revealed that surgical procedures (odds ratio, 3.8; 95%CI, 1.16-12.59) and preoperative ATS (odd ratio, 2.4; 95%CI, 1.26-4.38) were predisposing factors of early graft failure. CONCLUSION Patients with ACLD for >2 years experienced early graft failure with an incidence rate of 9.2%. Predisposing factors of early graft failure in these patients included the use of single-bundle HT grafts and preoperative ATS. The use of rectangular BTB grafts resulted in a lower graft failure rate. STUDY DESIGN Case Series.
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Affiliation(s)
- Yoshinari Tanaka
- Investigation Performed at Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 583-8555, Japan.
| | - Yuta Tachibana
- Investigation Performed at Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 583-8555, Japan
| | - Kazutaka Kinugasa
- Investigation Performed at Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 583-8555, Japan
| | - Rikio Takao
- Investigation Performed at Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 583-8555, Japan
| | - Keisuke Kita
- Investigation Performed at Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 583-8555, Japan
| | - Hiroshi Amano
- Investigation Performed at Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 583-8555, Japan
| | - Yasukazu Yonetani
- Investigation Performed at Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 583-8555, Japan
| | - Yoshiki Shiozaki
- Investigation Performed at Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 583-8555, Japan
| | - Ryohei Uchida
- Investigation Performed at Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 583-8555, Japan
| | - Shuji Horibe
- Investigation Performed at Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 583-8555, Japan
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Ma R, Guess T, Echelmeyer D, Stannard JP. Bench to Bedside: A Multidisciplinary Approach toward the Unknowns after ACL Injuries to Drive Individual Success. MISSOURI MEDICINE 2022; 119:136-143. [PMID: 36036042 PMCID: PMC9339398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
ACL injury and surgery are increasing in prevalence. Several challenges exist that can be obstacles to an individual achieving success after ACL surgery. A knowledge of these risk factors alongside a multidisciplinary collaborative team approach can result in a greater likelihood of achieving individual success after ACL surgery.
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Affiliation(s)
- Richard Ma
- Gregory L. And Ann L. Hummel Distinguished Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Missouri - Columbia School of Medicine (DOS UMC SOM) and with the Thompson Laboratory for Regenerative Orthopaedics (TLRO), Columbia, Missouri
| | - Trent Guess
- DOS UMC SOM and the Department of Physical Therapy, UMC SOM, Columbia, Missouri
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Generalized joint hypermobility does not influence 1-year patient satisfaction or functional outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:4173-4180. [PMID: 35676596 PMCID: PMC9668803 DOI: 10.1007/s00167-022-07008-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether generalized joint hypermobility (GJH) influences postoperative results, including return to sport, patientreported outcomes, functional performance (hop tests), muscular strength, and the occurrence of ACL re-injury, in patients 1 year after anterior cruciate ligament (ACL) reconstruction. METHODS Data was extracted from a regional rehabilitation-specific registry containing information on patients with ACL injury. Patients between the ages of 16-50 years previously undergoing ACL reconstruction with available 1 year follow-up data were eligible for inclusion. Generalized joint hypermobility was assessed using the Beighton score (BS). Patients were examined one year postoperatively in terms of return to sport, patient-reported outcome, hop tests, muscular strength and the occurrence of reinjury. For purpose of analysis, patients were allocated into two groups, depending on the existence of GJH. The KOOS subscale of sports and recreation was considered the primary outcome. Analyses were performed both dichotomously and by using adjusted logistic regression, to consider potential confounders. RESULTS A total of 356 patients (41% males) were included, of which 76 (24% male) were categorized as having GJH. Patients with GJH had an inferior limb symmetry index preoperatively in terms of knee extension (mean 81.6 [SD 16.4] vs. 91.4 [SD 15.9], p = 0.02) and flexion strength (mean 91.9 vs. 99.1, p = 0.047) compared to patients without GJH. There was no difference between the groups in terms of the primary outcome, nor in any of the other postoperative outcomes. Nine patients (11.8%) in the group with GJH suffered ACL re-injury, compared with 13 patients (4.6%) in the control group (n.s.). CONCLUSION One year after ACL reconstruction the existence of GJH did not affect postoperative patient satisfaction, strength or functional outcome. No conclusive statements can be made regarding the influence of GJH on the risk of ACL re-injury in this particular study. LEVEL OF EVIDENCE Level II.
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11
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Janani G, Lakshmi S, Prakash A, Suresh P, Parthiban J, Thiagarajan A, Arumugam S. Preoperative Templating of Bone-Patellar Tendon-Bone Graft for Anterior Cruciate Ligament Reconstruction: A Morphometry-Based Graft Harvest Method. Clin Orthop Surg 2022. [DOI: 10.4055/cios21167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Gopalakrishnan Janani
- Centre for Sports Science, Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sankaran Lakshmi
- Centre for Sports Science, Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Ayyadurai Prakash
- Centre for Sports Science, Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Perumal Suresh
- Centre for Sports Science, Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Jeganathan Parthiban
- Centre for Sports Science, Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Alwar Thiagarajan
- Centre for Sports Science, Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sivaraman Arumugam
- Centre for Sports Science, Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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12
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Arnold MP, Calcei JG, Vogel N, Magnussen RA, Clatworthy M, Spalding T, Campbell JD, Bergfeld JA, Sherman SL. ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades. Knee Surg Sports Traumatol Arthrosc 2021; 29:3871-3876. [PMID: 33486558 DOI: 10.1007/s00167-021-06443-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/11/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Anterior cruciate ligament reconstruction (ACLR) aims to restore knee function and stability, allowing patients to return to the activities they enjoy and minimize further injury to the meniscus and cartilage and their ultimate progression to osteoarthritis. This study aims to present the evolution of graft choice over the last three decades according to members of the ACL Study Group (SG). METHODS Prior to the January 2020 ACL SG biannual meeting, a survey was administered consisting of 87 questions and 16 categories, including ACLR graft choice. A similar questionnaire has been administered prior to each meeting and survey results from the past 14 meetings (1992 through 2020, excluding 1994) are included in this work. Survey responses are reported as frequencies in percentages to quantify changes in practice over the surgery period. RESULTS In 1992, the most frequent graft choice for primary ACLR was bone-patellar tendon-bone (BTB) autograft, at nearly 90%. Hamstring tendon (HT) autografts have increased in popularity, currently over 50%, followed by just under 40% BTB autograft. Recently, quadriceps tendon (QT) autograft has increased in popularity since 2014. CONCLUSION Autograft (HT, BTB, QT) is an overwhelming favorite for primary ACLR over allograft. The preference for HT autograft increased over the study period relative to BTB autograft, with QT autograft gaining in popularity in recent years. Graft selection should be individualized for each patient and understanding the global trends in graft choice can help orthopaedic surgeons discuss graft options with their patients and determine the appropriate graft for each case. LEVEL OF EVIDENCE Level V, Expert Opinion.
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Affiliation(s)
- Markus P Arnold
- Practice LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Switzerland
| | - Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Nicole Vogel
- Practice LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Switzerland
| | - Robert A Magnussen
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| | - Mark Clatworthy
- Department of Orthopaedics, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Tim Spalding
- Department of Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - John D Campbell
- Bridger Orthopedics and Sports Medicine, PC, Montana State University, Bozeman, MT, USA
| | - John A Bergfeld
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
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13
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Salem HS, Huston LJ, Zajichek A, McCarty EC, Vidal AF, Bravman JT, Spindler KP, Frank RM, Amendola A, Andrish JT, Brophy RH, Jones MH, Kaeding CC, Marx RG, Matava MJ, Parker RD, Wolcott ML, Wolf BR, Wright RW. Anterior Cruciate Ligament Reconstruction With Concomitant Meniscal Repair: Is Graft Choice Predictive of Meniscal Repair Success? Orthop J Sports Med 2021; 9:23259671211033584. [PMID: 34541016 PMCID: PMC8445540 DOI: 10.1177/23259671211033584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background When meniscal repair is performed during anterior cruciate ligament (ACL) reconstruction (ACLR), the effect of ACL graft type on meniscal repair outcomes is unclear. Hypothesis The authors hypothesized that meniscal repairs would fail at the lowest rate when concomitant ACLR was performed with bone--patellar tendon--bone (BTB) autograft. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent meniscal repair at primary ACLR were identified from a longitudinal, prospective cohort. Meniscal repair failures, defined as any subsequent surgical procedure addressing the meniscus, were identified. A logistic regression model was built to assess the association of graft type, patient-specific factors, baseline Marx activity rating score, and meniscal repair location (medial or lateral) with repair failure at 6-year follow-up. Results A total of 646 patients were included. Grafts used included BTB autograft (55.7%), soft tissue autograft (33.9%), and various allografts (10.4%). We identified 101 patients (15.6%) with a documented meniscal repair failure. Failure occurred in 74 of 420 (17.6%) isolated medial meniscal repairs, 15 of 187 (8%) isolated lateral meniscal repairs, and 12 of 39 (30.7%) of combined medial and lateral meniscal repairs. Meniscal repair failure occurred in 13.9% of patients with BTB autografts, 17.4% of patients with soft tissue autografts, and 19.4% of patients with allografts. The odds of failure within 6 years of index surgery were increased more than 2-fold with allograft versus BTB autograft (odds ratio = 2.34 [95% confidence interval, 1.12-4.92]; P = .02). There was a trend toward increased meniscal repair failures with soft tissue versus BTB autografts (odds ratio = 1.41 [95% confidence interval, 0.87-2.30]; P = .17). The odds of failure were 68% higher with medial versus lateral repairs (P < .001). There was a significant relationship between baseline Marx activity level and the risk of subsequent meniscal repair failure; patients with either very low (0-1 points) or very high (15-16 points) baseline activity levels were at the highest risk (P = .004). Conclusion Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes. Graft type was ranked third, demonstrating that meniscal repairs performed with allograft were 2.3 times more likely to fail compared with BTB autograft. There was no significant difference in failure rates between BTB versus soft tissue autografts. Registration NCT00463099 (ClinicalTrials.gov identifier).
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Affiliation(s)
| | - Laura J Huston
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander Zajichek
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | | | - Kurt P Spindler
- Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA
| | | | | | - Annunziato Amendola
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Jack T Andrish
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Robert H Brophy
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Morgan H Jones
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Christopher C Kaeding
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Robert G Marx
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Matthew J Matava
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Richard D Parker
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Michelle L Wolcott
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Brian R Wolf
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
| | - Rick W Wright
- CU Sports Medicine, Boulder, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA.,Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA; Vanderbilt University, Nashville, Tennessee, USA; and University of Colorado, Boulder, Colorado, USA
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14
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Saithna A, Daggett M, Helito CP, Monaco E, Franck F, Vieira TD, Pioger C, Kim JG, Sonnery-Cottet B. Clinical Results of Combined ACL and Anterolateral Ligament Reconstruction: A Narrative Review from the SANTI Study Group. J Knee Surg 2021; 34:962-970. [PMID: 32023631 DOI: 10.1055/s-0040-1701220] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lateral extraarticular procedures (LEAPs) in the anterior cruciate ligament (ACL)-injured knee were widely abandoned in the 1990s but have seen a recent resurgence. The aim of this review was to demonstrate that anterolateral ligament reconstruction (ALLR) is associated with evidence of significant advantages and no evidence of historical concerns. A narrative review of the literature was performed. Combined ACL + ALLR is associated with improved outcomes when compared against isolated ACL reconstruction, including a significantly lower risk of ACL graft rupture (hazard ratio [HR]: 0.327, 95% CI: 0.130-0.758), a significantly lower risk of reoperation for secondary meniscectomy following medial meniscal repair at the time of ACL reconstruction (HR: 0.443, 95% CI: 0.218-0.866), significantly increased likelihood of return to the preinjury level of sport following primary (odds ratio [OR]: 1.938, 95% CI: 1.174-3.224) and revision ACL reconstruction (57.1 vs. 25.6%, respectively; p = 0.008), and in chronic ACL injuries, less residual pivot shift (9.1 vs. 35.3%, p = 0.011), and better IKDC (92.7 ± 5.9 vs. 87.1 ± 9.0, p = 0.0013) and Lysholm (95.4 ± 5.3 vs. 90.0 ± 7.1, p < 0.0001) scores, and no evidence of historical concerns. Combined ACLR + ALLR is associated with excellent clinical outcomes with no evidence of the adverse events that led to the historical widespread abandonment of other types of LEAP. Specifically, comparative series have demonstrated significant advantages of ALLR when compared against isolated ACLR with respect to reduced rates of ACL graft rupture, secondary meniscectomy, persistent instability, and significantly improved functional outcomes and improved return to sport metrics.
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Affiliation(s)
- Adnan Saithna
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri.,Sano Orthopedics, Overland Park, Kansas.,School of Science and Technology, Nottingham Trent University, Clifton Campus, Nottingham, United Kingdom
| | - Matt Daggett
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri.,Sano Orthopedics, Overland Park, Kansas
| | - Camilo Partezani Helito
- Department of Orthopedic Surgery, Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.,Department of Orthopedic Surgery, Hospital Sírio Libanês, São Paulo, Brazil
| | - Edoardo Monaco
- Department of Orthopedic Surgery, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | - Florent Franck
- Department of Orthopedic Surgery, Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Lyon, France
| | - Thais Dutra Vieira
- Department of Orthopedic Surgery, Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Lyon, France.,Department of Orthopedic Surgery, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
| | - Charles Pioger
- Department of Orthopedic Surgery, Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Lyon, France
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, South Korea
| | - Bertrand Sonnery-Cottet
- Department of Orthopedic Surgery, Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Lyon, France.,Department of Orthopedic Surgery, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
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15
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Krebs NM, Barber-Westin S, Noyes FR. Generalized Joint Laxity Is Associated With Increased Failure Rates of Primary Anterior Cruciate Ligament Reconstructions: A Systematic Review. Arthroscopy 2021; 37:2337-2347. [PMID: 33621648 DOI: 10.1016/j.arthro.2021.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate patients with generalized joint laxity (GJL) after primary anterior cruciate ligament reconstruction (ACLR) as to the risk of ACLR failure, graft selection success rates, and overall clinical outcomes. METHODS A systematic review of the PubMed and EMBASE databases was performed to identify studies published from the inception of the databases through February 4, 2020. The inclusion criteria were original studies written in English involving outcomes of patients with GJL who had undergone primary ACLR. RESULTS Nine studies met the inclusion criteria, which included 1,869 patients. Most underwent isolated bone-patellar tendon-bone (BPTB; n = 1062) or hamstring autograft (n = 696) ACLR. Overall, higher graft failure rates tended to occur in patients with GJL compared with patients without GJL (range per study: 6%-30% vs 0%-12.3%). Inferior results were also found patients with GJL in patient-reported outcome measures and postoperative knee stability determined by KT, Lachman, and pivot-shift tests. BPTB autografts tended to have lower failure rates than hamstring autografts in patients with GJL (range per study: 6%-21% vs 17.6%-30%). Only 1 study determined outcomes of a combined ACLR and extra-articular augmentation in patients with GJL. CONCLUSIONS Patients with GJL are at an increased risk of inferior outcomes and graft failure after primary ACLR. BPTB autografts may have more favorable stability outcomes compared with hamstring autografts in patients with GJL. However, the reported stability parameters and KT results, even with a BPTB autograft, remain inferior to non-GJL published results, and the added benefit of an extra-articular procedure to supplement the primary ACLR deserves consideration. LEVEL OF EVIDENCE Level III, systematic review of Level II and III investigations.
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Affiliation(s)
- Nathan M Krebs
- Cincinnati SportsMedicine & Orthopaedic Center, Cincinnati, Ohio, U.S.A
| | | | - Frank R Noyes
- Cincinnati SportsMedicine & Orthopaedic Center, Cincinnati, Ohio, U.S.A.; Noyes Knee Institute, Cincinnati, Ohio, U.S.A.; Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
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16
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Editorial Commentary: Diagnosis and Treatment of Generalized Joint Hypermobility in Patients With Anterior Cruciate Ligament Injury. Arthroscopy 2021; 37:2348-2350. [PMID: 34226016 DOI: 10.1016/j.arthro.2021.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 02/02/2023]
Abstract
Generalized joint hypermobility (GJH), or laxity, is defined as hyperextensibility of the synovial joints. Hypermobility is caused by alterations in the connective tissues, in turn caused by various factors including impaired function of collagen proteins. For measurement of knee GJH, we highly recommend using the Beighton score, the most frequently used method in both the sports medicine and other literature. Our recommendations on how to treat patients with anterior cruciate ligament (ACL) injury with generalized joint hypermobility include the following: (1) use patellar-tendon or quadriceps tendon autograft for ACL reconstruction; (2) always consider performing a lateral extra-articular tenodesis; and (3) make sure patients pass a return to sport test battery including strength, hop performance, subjective knee function, and movement quality. Delay to return to sport may be as long as 1 year after surgery.
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17
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DeFazio MW, Curry EJ, Gustin MJ, Sing DC, Abdul-Rassoul H, Ma R, Fu F, Li X. Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120964919. [PMID: 33403206 PMCID: PMC7745570 DOI: 10.1177/2325967120964919] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow patients to return to prior levels of athletic performance. While existing literature suggests that patient-reported outcomes are similar between bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts, there is less information comparing return-to-sport (RTS) rates between the 2 graft types. Purpose To compare RTS rates among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft. Study Design Systematic review; Level of evidence, 4. Methods The MEDLINE, Embase, and Cochrane Library databases were searched, and studies that reported on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Studies that utilized ACL repair techniques, quadriceps tendon autografts, graft augmentation, double-bundle autografts, allografts, or revision ACL reconstruction were excluded. RTS information was extracted and analyzed from all included studies. Results Included in the review were 20 articles investigating a total of 2348 athletes. The overall RTS rate in our cohort was 73.2%, with 48.9% returning to preinjury levels of performance and a rerupture rate of 2.4%. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 81.0%, with 50.0% of athletes returning to preinjury levels of performance and a rerupture rate of 2.2%. Patients after primary ACL reconstruction with an HT autograft had an overall RTS rate of 70.6%, with 48.5% of athletes returning to preinjury levels of performance and a rerupture rate of 2.5%. Conclusion ACL reconstruction using BTB autografts demonstrated higher overall RTS rates when compared with HT autografts. However, BTB and HT autografts had similar rates of return to preinjury levels of performance and rerupture rates. Less than half of the athletes were able to return to preinjury sport levels after ACL reconstruction with either an HT or BTB autograft.
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Affiliation(s)
- Matthew W DeFazio
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Michael J Gustin
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David C Sing
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Hussein Abdul-Rassoul
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Richard Ma
- Missouri Orthopaedic Institute, Columbia, Missouri, USA
| | - Freddie Fu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
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18
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Castoldi M, Magnussen RA, Gunst S, Batailler C, Neyret P, Lustig S, Servien E. A Randomized Controlled Trial of Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction With and Without Lateral Extra-articular Tenodesis: 19-Year Clinical and Radiological Follow-up. Am J Sports Med 2020; 48:1665-1672. [PMID: 32368935 DOI: 10.1177/0363546520914936] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) with a bone-patellar tendon-bone graft (BTB) is a reliable surgical option for the control of anterior knee laxity after ACL injury. The addition of a lateral extra-articular tenodesis (LET) may improve control of rotation knee laxity and improve short-term graft survival in high-risk patients. PURPOSE The aims of this study were to compare long-term patient-reported outcomes, graft survival, and risk of osteoarthritis between ACLR with and without LET. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS This study included 121 consecutive knees (120 patients) presenting to a single center with an ACL rupture between 1998 and 1999. In total, 61 knees were randomized to an isolated BTB ACLR, and 60 knees were randomized to a BTB ACLR with an extra-articular lateral tenodesis with gracilis tendon (modified Lemaire). RESULTS Eighty knees in 79 patients (66%) were available for follow-up at a postoperative mean of 19.4 years (range, 19-20.2). Of those patients, 43 had a clinical examination and completed patient-reported outcome questionnaires, and the other 37 patients were evaluated through the questionnaires alone. Standard radiographs were available for 45 patients and laximetry (TELOS) for 42 patients. Mean subjective International Knee Documentation Committee score at last follow-up was 81.8, and no differences were noted between the BTB and BTB-LET groups (P = .7). Two-thirds of patients were still participating in pivoting sports. A total of 17 knees (21%) experienced a graft failure, 5 of which (6%) underwent revision ACLR. There was no significant difference in graft failure risk between the BTB group (29%) and the BTB-LET group (13%; P = .1). Lateral tibiofemoral osteoarthritis was significantly more frequent in the BTB-LET group (59%) as compared with the BTB group (22%; P = .02). Lateral compartment osteoarthritis was correlated with partial lateral meniscectomy. CONCLUSION There were no significant differences in long-term patient-reported outcomes after ACLR with or without an LET. LET may increase the risk of lateral compartment osteoarthritis at long-term follow-up. There was a trend toward decreased graft failure risk with the addition of LET but this study was underpowered to assess this outcome.
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Affiliation(s)
- Marie Castoldi
- Institut Universitaire Locomoteur et du Sport, Department of Orthopaedic Surgery, Centre Hospitalo-Universitaire de Nice, Nice, France
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stanislas Gunst
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | | | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France.,EA 7424-Inter-university Laboratory of Human Movement Science, University Lyon 1, Lyon, France
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19
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Smith PA, Cook CS, Bley JA. All-Inside Quadrupled Semitendinosus Autograft Shows Stability Equivalent to Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction: Randomized Controlled Trial in Athletes 24 Years or Younger. Arthroscopy 2020; 36:1629-1646. [PMID: 32059954 DOI: 10.1016/j.arthro.2020.01.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 12/20/2019] [Accepted: 01/18/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical outcomes of knee anterior cruciate ligament (ACL) autograft reconstruction using all-inside quadrupled semitendinosus (AIST) versus bone-patellar tendon-bone (BPTB) in a high-risk athletic population 24 years or younger. METHODS Skeletally mature candidates younger than 24 years old with an ACL tear were randomized into either the AIST (n = 32) or BPTB (n = 32) group and were followed for 2 years. Magnetic resonance imaging scans were obtained at 1-year follow-up, and radiographs were obtained at 2-year follow-up. All surgeries were performed by a single surgeon using an anteromedial portal to establish the femoral tunnel. The primary outcome measure was KT-1000 stability testing. Secondary outcome measures included International Knee Documentation Committee (IKDC) Knee Evaluation Form, IKDC Subjective Form, Knee Injury and Osteoarthritis Outcome Score, Marx Activity Scale, visual analog pain scale, and SF-12 (Mental and Physical). RESULTS At 2-year follow-up, no statistical difference existed with KT-1000-measured side-to-side laxity between AIST (0.3 ± 0.7 mm, 95% confidence interval 0.0-1.0 mm) and BPTB (0.0 ± 0.8 mm, confidence interval CI -0.3 to 1.1 mm) (P = .197). In addition, no statistical differences between the groups were found for IKDC Subjective Form, Knee Injury and Osteoarthritis Outcome Score, Marx, SF-12 Mental, SF-12 Physical, or with regards to imaging findings. Patients with BPTB reported significantly greater postoperative pain scores at days 2 (P = .049), 3 (P = .004), and 7 (P = .015) and had significantly greater kneeling pain at 2 years (P < .019). A return to sport questionnaire at 2 years revealed no significant difference between the groups for returning to preoperative level of sport activity (83% AIST, 74% BPTB; P = .415). Two graft retears (7%; P = .222) occurred in the AIST group. Three patients in the BPTB group experienced ACL tears in the contralateral knee (9%; P = .239). CONCLUSIONS ACL reconstruction with an all-inside quadrupled semitendinosus autograft construct is equivalent to patellar BPTB autograft based on KT-1000 stability testing in athletes 24 years or younger. LEVEL OF EVIDENCE randomized controlled trial with 92% 2-year follow-up, Level I.
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Affiliation(s)
- Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Columbia Orthopaedic Group, Columbia, Missouri, U.S.A..
| | - Corey S Cook
- Columbia Orthopaedic Group, Columbia, Missouri, U.S.A
| | - Jordan A Bley
- Columbia Orthopaedic Group, Columbia, Missouri, U.S.A
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20
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Murgier J, Hansom D, Clatworthy M. Current evidence around patellar tendon graft in ACLR for high-risk patients: current concepts. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Ode Q, Gonzalez JF, Paihle R, Dejour D, Ollivier M, Panisset JC, Lustig S. Influence of operative technique on anterior cruciate ligament reconstruction in patients older than 50 years. Orthop Traumatol Surg Res 2019; 105:S253-S258. [PMID: 31551194 DOI: 10.1016/j.otsr.2019.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A consequence of the steady growth in the worldwide population of elderly individuals who remain in good health and continue to engage in sports is an increase in the incidence of anterior cruciate ligament (ACL) rupture occurring after 50 years of age. ACL reconstruction was formerly reserved for young athletes but now seems to produce good outcomes in over 50s. The type of graft and graft fixation method were selected empirically until now, given the absence of investigations into potential relationships of these two parameters with the outcomes. The objective of this study was to assess associations linking the type of graft and the method of femoral graft fixation to outcomes in patients older than 50 years at ACL reconstruction. HYPOTHESIS The operative technique is not associated with the clinical outcomes or differential laxity. MATERIAL AND METHODS A multicentre retrospective cohort of 398 patients operated between 1 January 2011 and 31 December 2015 and a multicentre prospective cohort of 228 patients operated between 1 January 2016 and 30 June 2017 were conducted. Mean follow-up was 42.7 months in the retrospective cohort and 14.2 months in the prospective cohort. The primary evaluation criterion was the clinical outcome as assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Score (TAS). Differential laxity was the secondary evaluation criterion. The Wilcoxon rank sum test and Kruskal-Wallis test were used to compare groups, and p-values<0.05 were considered significant. RESULTS In the retrospective and prospective cohorts, hamstring tendons were used in 269 (67.6%) and 197 (86.4%) patients and extensor apparatus tendons in 124 (31.2%) and 31 (13.6%) patients. Femoral fixation in the retrospective cohort was cortical in 81 (20.4%) cases, by press-fit in 112 (28.1%) cases, and by interference screw in 205 (51.5%) cases; corresponding figures in the prospective cohort were 135 (59.2%), 17 (7.5%), and 76 (33.3%). The multivariate analysis of the retrospective data identified no significant associations of graft type or femoral fixation type with the KOOS, TAS, or differential laxity values. In the prospective cohort, hamstring grafts were associated with 0.6mm of additional laxity (p=0.007); compared to cortical fixation, press-fit fixation of patellar tendon grafts was associated with 0.3mm of additional laxity (p=0.029) and a 0.5-point lower TAS value (p=0.033), with no difference in KOOS values. None of these differences were clinically significant. DISCUSSION The various ACL reconstruction techniques used in patients older than 50 years produce similar outcomes. The technique can be chosen based on surgeon preference without regard for patient age. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Quentin Ode
- Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - Jean-François Gonzalez
- Institut universitaire locomoteur et du sport, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Régis Paihle
- Orthopaedics, hôpital Sud, CHU de Grenoble, avenue Kimberley-Echirolles, 38000 Grenoble, France
| | - David Dejour
- Clinique de la Sauvegarde, 8, avenue David-Ben-Gourion, 69009 Lyon, France
| | - Matthieu Ollivier
- Institute of movement and locomotion, orthopedic surgery, boulevard Sainte-Marguerite, 13900 Marseille, France
| | - Jean-Claude Panisset
- Chirurgie orthopédique, clinique des Cèdres, 51, rue Albert-Londres, 38230 Échirolles, France
| | - Sébastien Lustig
- Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Université Claude-Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France.
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22
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Sundemo D, Hamrin Senorski E, Karlsson L, Horvath A, Juul-Kristensen B, Karlsson J, Ayeni OR, Samuelsson K. Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review. BMJ Open Sport Exerc Med 2019; 5:e000620. [PMID: 31798951 PMCID: PMC6863654 DOI: 10.1136/bmjsem-2019-000620] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 01/02/2023] Open
Abstract
Objectives To investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported outcome). Furthermore, we aimed to compare the performance of different grafts in patients with GJH. Methods Databases MEDLINE/PubMed, EMBASE and the Cochrane Library were searched, including 2760 studies. Two reviewers independently screened studies for eligibility. A modified version of the MINORS score was applied for quality appraisal. Studies assessing GJH while reporting the risk of ACL injury and/or postoperative outcome were included. Results Twenty studies were included, using several different methods to determine GJH. There was consistent evidence showing that GJH is a risk factor for unilateral ACL injury in males, while in females, the results were conflicting. There was limited evidence associating GJH with increased knee laxity 5 years postoperatively. There was consistent evidence of inferior postoperative patient-reported outcome in patients with GJH. Moreover, there was limited yet consistent evidence indicating that patellar-tendon autografts are superior to hamstring-tendon autografts in patients with GJH in terms of knee laxity and patient-reported outcome. There was insufficient evidence to draw conclusions regarding the outcomes of bilateral ACL injury and graft failure. Conclusions In men, GJH was associated with an increased risk of unilateral ACL injury. Moreover, GJH was associated with greater postoperative knee laxity and inferior patient-reported outcome. Based on the available evidence, a patellar-tendon autograft appears to be superior to a hamstring-tendon autograft in patients with GJH. However, the included studies were heterogeneous and there is a need for consensus in the assessment of GJH within sports medicine.
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Affiliation(s)
- David Sundemo
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabiltation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Karlsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexandra Horvath
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Denmark
| | - Jon Karlsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kristian Samuelsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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23
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Helito CP, Sobrado MF, Giglio PN, Bonadio MB, Pécora JR, Camanho GL, Demange MK. Combined Reconstruction of the Anterolateral Ligament in Patients With Anterior Cruciate Ligament Injury and Ligamentous Hyperlaxity Leads to Better Clinical Stability and a Lower Failure Rate Than Isolated Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:2648-2654. [PMID: 31421960 DOI: 10.1016/j.arthro.2019.03.059] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/27/2019] [Accepted: 03/30/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare functional outcomes, residual instability, and rupture rates in patients with ligamentous hyperlaxity undergoing isolated anterior cruciate ligament (ACL) reconstruction or combined ACL and anterolateral ligament (ALL) reconstruction. METHODS Two groups of patients were evaluated and compared retrospectively. Both groups consisted of patients with ACL injuries and associated ligamentous hyperlaxity, defined based on the modified Beighton scale with a minimum score of 5. Group 1 patients underwent anatomical ACL reconstruction, and group 2 patients underwent anatomical ACL reconstruction combined with ALL reconstruction. Group 1 consisted of historical controls. The presence of associated meniscal injury, subjective International Knee Documentation Committee and Lysholm functional scores, KT-1000 measurements, the presence of a residual pivot-shift, and the graft rupture rate were evaluated. The study was performed at University of São Paulo in Brazil. RESULTS Ninety patients undergoing ACL reconstruction with ligamentous hyperlaxity were evaluated. The mean follow up was 29.6 ± 6.2 months for group 1 and 28.1 ± 4.2 months for group 2 (P = .51). No significant differences were found between the groups regarding Beighton scale, gender, the duration of injury before reconstruction, follow-up time, preoperative instability, or associated meniscal injuries. The mean age was 29.9 ± 8.1 years in group 1 and 27.0 ± 9.1 years in group 2 (P = .017). In the final evaluation, group 2 patients showed better anteroposterior clinical stability as evaluated by KT-1000 arthrometry (P = .02), better rotational stability as evaluated by the pivot-shift test (P = .03) and a lower reconstruction failure rate (21.7% [group 1] vs 3.3% [group 2]; P = .03). Clinical evaluations of postoperative functional scales showed no differences between the 2 groups (P = .27 for International Knee Documentation Committee; P = .41 for Lysholm). CONCLUSIONS Combined ACL and ALL reconstruction in patients with ligamentous hyperlaxity resulted in a lower failure rate and improved knee stability parameters compared to isolated ACL reconstruction. No differences were found in the functional scales. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Camilo Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil; Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Marcel Faraco Sobrado
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Nogueira Giglio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Batista Bonadio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Ricardo Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gilberto Luis Camanho
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Kawamura Demange
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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24
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Samitier G, Vinagre G. Hamstring Braid Graft Technique for Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2019; 8:e815-e820. [PMID: 31696044 PMCID: PMC6823734 DOI: 10.1016/j.eats.2019.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/19/2019] [Indexed: 02/03/2023] Open
Abstract
Hamstring autograft is one of the most used grafts for anterior cruciate ligament (ACL) reconstruction, although there are several graft preparation techniques. It is extremely difficult to mimic the biomechanical properties of the native ACL; thus, it is important to achieve a proper graft configuration, diameter, and length. To avoid reruptures, an optimal and reproducible hamstring autograft is desired. Hamstring autograft has been traditionally devalued when compared with other options such as bone-patellar tendon-bone autograft. The purpose of this Technical Note is to describe in detail a hamstring braid graft configuration that could potentially overcome the past disadvantages of ACL reconstruction.
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Affiliation(s)
- Gonzalo Samitier
- Department of Orthopaedic Surgery and Traumatology, Hospital General de Villalba, Madrid, Spain
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery and Traumatology, Hospital de Verín, Galicia, Spain
- Address correspondence to Gustavo Vinagre, M.D., Ph.D., Department of Orthopaedic Surgery and Traumatology, Hospital de Verín, Av. de Laza, 0, 32600 Verín, Ourense, Spain.
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25
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Sundemo D, Mikkelsen C, Cristiani R, Forssblad M, Senorski EH, Svantesson E, Samuelsson K, Stålman A. Contralateral knee hyperextension is associated with increased anterior tibial translation and fewer meniscal injuries in the anterior cruciate ligament-injured knee. Knee Surg Sports Traumatol Arthrosc 2018; 26:3020-3028. [PMID: 29974175 PMCID: PMC6154035 DOI: 10.1007/s00167-018-5047-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/27/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the influence of hyperextension of the contralateral healthy knee on anterior tibial translation (ATT) and the presence of associated injuries in the anterior cruciate ligament (ACL)-injured knee. METHODS A local patient data register containing the surgical and clinical data of patients undergoing ACL reconstruction was analyzed. Patients were divided into groups according to the degree of hyperextension of the contralateral knee: normal (Group A ≤ 0°), mild (Group B 1°-5°), moderate (Group C 6°-10°), and severe (Group D > 10°). The ATT was measured in both knees preoperatively and 6 months postoperatively using the KT-1000 arthrometer. The presence of associated meniscal and cartilage injuries was noted. Using multivariate analysis, Groups B, C, and D were compared with Group A, using this group as a reference. RESULTS A total of 10,957 patients were available in the register and 8502 (Group A n = 4335, Group B n = 3331, Group C n = 771, Group D n = 65) were included in the final analysis. Groups B (10.3 mm; 95% CI 0.06-0.042, p < 0.0001) and C (10.6 mm; 95% CI 0.23-0.89, p = 0.006) showed significantly greater preoperative ATT in the injured knee compared with the control group (10.1 mm). Moreover, at the 6-month follow-up, greater ATT was observed for Groups B (8.5 mm; 95% CI 0.13-0.45, p < 0.0001), C (8.5 mm; 95% CI 0.02-0.60, p = 0.035), and D (9.1 mm; 95% CI - 0.08-1.77, p = 0.082) compared with Group A (8.2 mm). Meniscal injuries were less frequent in patients with contralateral hyperextension [Group B 903 (27.1%) p < 0.0001, Group C 208 (27.0%) p = 0.0003, and Group D 12 (18.5%), 0.012] compared with the control group [Group A 1479 (34.1%)]. CONCLUSION Contralateral knee hyperextension is associated with greater pre- and postoperative ATT in the ACL-injured knee. In patients with contralateral knee hyperextension, concomitant injuries to the menisci are less frequent. Surgeons should consider grafts with superior properties regarding postoperative anteroposterior laxity to patients with contralateral knee hyperextension. LEVEL OF EVIDENCE Retrospective cohort study, Level IV.
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Affiliation(s)
- David Sundemo
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Christina Mikkelsen
- Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Riccardo Cristiani
- Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- 0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Eric Hamrin Senorski
- 0000 0000 9919 9582grid.8761.8Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Anders Stålman
- Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
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