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Liu D, Lu W, Vithran DTA, Bi Q, Hong Z, Liu X, Yuan D, Chen C, Xiao W, Li Y. Gradual stabilization and narrowing of bone tunnels following primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39091244 DOI: 10.1002/ksa.12398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/27/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The purpose of this study is to dynamically assess variations in tunnel diameters following anterior cruciate ligament reconstruction (ACLR) and investigate correlations with patient-reported outcomes (PROs) and graft maturity based on signal-to-noise quotient (SNQ). METHODS Tunnel diameter and tunnel position were measured using three-dimensional models derived from computed tomography (CT) data. Postoperative graft maturity and integration were evaluated using magnetic resonance imaging (MRI). Clinical outcomes were assessed through PROs, which included the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Scores and Lysholm scores. The correlation between tunnel enlargement extent, PROs and SNQ values, as well as correlations between confounding factors, tunnel diameter differences and SNQ were analyzed. RESULTS A total of 73 participants underwent primary ACLR and scheduled follow-ups. At the segment of the articular aperture, the femoral tunnel was enlarged by 32.3% to 10.4 ± 1.6 mm (p < 0.05), and the tibial tunnel was widened by 17.2% to 9.6 ± 1.2 mm (p < 0.05) at the 6-month follow-up. At 1 year postoperatively, diameters at the articular aperture were not further increased on the femoral (n.s.) and tibial (n.s.) sides. In early postoperative follow-up, the femoral tunnel was anteriorly and distally shifted, coupled with posterior and lateral deviation involving the tibial side, exhibiting minimal migration at 1-year follow-up. The degree of tunnel widening was not correlated with PROs and SNQ values. Age, gender, body mass index (BMI), time from surgery to follow-up, concomitant injuries and autograft type were not correlated with tunnel diameter differences and SNQ. CONCLUSIONS The femoral and tibial bone tunnels exhibited eccentrical widening and gradually stabilized at 1 year following ACLR. Furthermore, the enlarged bone tunnels were not correlated with unsatisfied PROs and inferior graft maturity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Di Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenhao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Djandan Tadum Arthur Vithran
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Bi
- Department of Sports Medicine, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zheping Hong
- Department of Sports Medicine, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xu Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Dongliang Yuan
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Can Chen
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Zhu S, Li R. All-Inside Anterior Cruciate Ligament Reconstruction Had Clinical Outcome Similar to the Transtibial Technique Except for Improved Side-to-Side Difference and Tegner Activity Scale: A Systematic Review and Meta-analysis. Arthroscopy 2024; 40:2276-2288. [PMID: 38354760 DOI: 10.1016/j.arthro.2024.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE To compare clinical outcomes of the all-inside technique with the transtibial technique in anterior cruciate ligament reconstruction based on available literature on this topic. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, we conducted a systematic search for randomized controlled trials and cohort studies. Our comprehensive search encompassed PubMed, Embase, Cochrane Library, and Web of Science. We included randomized controlled trials (RCTs) and cohort studies that compared the 2 techniques with a minimal 1-year follow-up. Two independent authors assessed RCTs using the risk of bias tool developed by the Cochrane Collaboration and evaluated the quality of cohort studies using the Newcastle-Ottawa Scale for Assessing the Quality of Nonrandomized Comparative Trials. The subjective and objective outcomes, complications, and graft failure were obtained. R software was used to perform the analysis. RESULTS The present analysis enrolled 9 RCTs (n = 687) and 11 cohort studies (n = 910). After a minimal 1-year follow-up in RCTs, functional outcomes such as International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity scale, Knee Society Score, and hop test were found to be similar between 2 techniques. The laxity outcomes, including the IKDC objective grade and pivot-shift test, were suggested to be comparable. There was a significant difference favoring the transtibial technique in terms of side-to-side difference (P = .04; 95% confidence interval [CI], 0.08-0.90). The pooled data from cohort studies indicated equivalent results in terms of IKDC subjective score, Lysholm score, side-to-side difference, IKDC objective grade, complications, and graft failure, with the exception of statistical difference in the Tegner activity scale (P = .03; 95% CI, -0.50 to -0.04). CONCLUSIONS Our findings suggest that there is no difference in most outcome scores between the all-inside and transtibial techniques for anterior cruciate ligament reconstruction. There are statistically significant differences in side-to-side difference and Tegner activity scale favoring the all-inside technique. LEVEL OF EVIDENCE Level IV, meta-analysis of Level I to IV studies.
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Affiliation(s)
- Shuang Zhu
- Department of Orthopaedics, Southern Medical University Zhujiang University, Guangzhou, China
| | - Renbin Li
- Department of Orthopaedics, Southern Medical University Zhujiang University, Guangzhou, China.
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Schwartzberg R. Editorial Commentary: All-Inside Anterior Cruciate Ligament Reconstruction Produces Excellent Results: Adjustable Cortical Suspensory Fixation Provides Rigid Tibial Fixation for All Ages. Arthroscopy 2024; 40:2289-2291. [PMID: 38493934 DOI: 10.1016/j.arthro.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
All-inside anterior cruciate ligament (ACL) reconstruction is the most minimally invasive ACL reconstruction technique available. Systematic review and meta-analysis show equally excellent outcomes for all-inside ACL reconstruction as compared with full tibial tunnel ACL reconstruction. Advantages of the all-inside technique may include improved tibial side fixation, improved stability, less tunnel widening, improved cosmesis, and less postoperative pain. Interference screw fixation using a full tibial tunnel technique can be complicated by inferior proximal tibial bone density. All-inside ACL reconstruction preserves the integrity of the tibial cortex and lends itself to cortical suspension fixation. Given modern adjustable suspensory cortical fixation and excellent clinical outcomes, surgeons should consider all-inside ACL reconstruction as a primary ACL reconstruction technique.
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Sakamoto T, Horii M, Watanabe S, Ito R, Akagi R, Hosokawa H, Kimura S, Yamaguchi S, Ohtori S, Sasho T. Clinical Outcomes of Modified Suture Buttons for Tibial Side Fixation in Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Study. Cureus 2024; 16:e64357. [PMID: 39130981 PMCID: PMC11316669 DOI: 10.7759/cureus.64357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction Restoring knee joint stability and resuming sports activities are important objectives of anterior cruciate ligament (ACL) reconstruction. The maintenance of anterior knee stability after ACL reconstruction is contingent on graft tension. Various devices and techniques have been used to achieve robust tibial graft tendon fixation, and their advantages and disadvantages are established. However, a gold standard has not been established. Therefore, we aimed to determine whether anterior knee joint stability and clinical outcomes of graft tendon fixation could be improved using a recently modified suture button (MSB) compared with using an adjustable suspensory fixator (ASF) at 1 year after double-bundle ACL reconstruction. Methods This study retrospectively analyzed postoperative data derived from 79 patients at a single center between January 2016 and December 2021. The patients were assigned to groups that underwent double-bundle ACL reconstruction with tibial fixation using an MSB (n = 30) that maintains tension while tying sutures, or an ASF (n = 49). We then compared complications, clinical outcomes and knee joint stability at 1 year postoperatively. Rates of postoperative infection, graft rupture, implant removal and residual anterior knee laxity (AKL) were compared between the groups using chi-square tests. Patient-reported outcome measures (PROM) based on Forgot Joint Score-12, Knee Injury and Osteoarthritis Outcome, and Lysholm Knee scores were compared using Mann-Whitney U tests. Results One patient in the MSB group developed postoperative infection. Rates of graft rupture and implant removal in the MSB and ASF groups were 3.3% and 4.1%, and 3.6% and 10.2%, respectively. None of the PROMs differed between the groups. The proportions of postoperative AKL were 3.6% and 14.9% in the MSB and ASF groups, respectively. A trend towards lower postoperative AKL in the MSB group did not reach statistical significance (p = 0.25). Conclusions The incidence of AKL at a year after ACL reconstruction using the MSB was 3%. Postoperative AKL and clinical outcomes were comparable between the MSB and ASF groups. A low AKL rate and positive postoperative outcomes indicated that MSB could be an option for tibial-side fixation in ACL reconstruction.
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Affiliation(s)
- Takuya Sakamoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
- Center for Preventive Medical Sciences, Chiba University, Chiba, JPN
| | - Manato Horii
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Shotaro Watanabe
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN, Chiba, JPN
| | - Ryu Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
- Center for Preventive Medical Sciences, Chiba University, Chiba, JPN
| | - Ryuichiro Akagi
- Department of Orthopedic Surgery, Oyumino Central Hospital, Chiba, JPN
| | - Hiroaki Hosokawa
- Department of Orthopedic Surgery, Toho University Sakura Medical Center, Chiba, JPN
| | - Seiji Kimura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, JPN
| | - Satoshi Yamaguchi
- Department of Orthopedic Surgery, Chiba University Graduate School of Global and Transdisciplinary Studies College of Liberal Arts and Sciences, Chiba, JPN
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University Hospital, Chiba, JPN
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Takahisa Sasho
- Center for Preventive Medical Sciences, Chiba University, Chiba, JPN
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Mo IF, Harlem T, Faleide AGH, Strand T, Vindfeld S, Solheim E, Inderhaug E. ACL Reconstruction Using Quadrupled Semitendinosus Versus Double-Stranded Semitendinosus and Gracilis Autograft: 2-Year Results From a Prospective Randomized Controlled Study. Am J Sports Med 2024; 52:1927-1936. [PMID: 38845474 DOI: 10.1177/03635465241254048] [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] [Indexed: 07/02/2024]
Abstract
BACKGROUND A disadvantage of using hamstring tendon autograft consisting of the semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction is pain from tendon harvesting and persistent hamstring weakness. In the tendon-sparing all-inside technique, a quadrupled semitendinosus graft and adjustable-loop cortical fixation are suggested to give less postoperative flexion deficits while displaying overall similar clinical results to the traditional hamstring technique. However, there are a limited number of high-quality studies comparing these techniques with inconsistent results. PURPOSE To investigate differences between the all-inside (quadrupled semitendinosus) and traditional hamstring (double-stranded semitendinosus and gracilis) technique regarding (1) self-reported function, (2) hamstring strength, and (3) knee laxity. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 98 patients were randomized to either the all-inside or the traditional hamstring technique. Perioperatively, duration of surgery and graft size were obtained. The International Knee Documentation Committee 2000 Subjective Knee Form score, Knee injury and Osteoarthritis Outcome Score, Tegner Activity Scale score, knee laxity (KT-1000 arthrometer side-to-side difference and pivot shift), range of motion, isokinetic knee strength, and hop test score were collected preoperatively and 2 years postoperatively. Return-to-sport readiness was evaluated 9 months postoperatively. RESULTS A total of 89 patients completed 2-year follow-up, 45 patients with the all-inside technique and 44 patients with the traditional hamstring technique. There were no significant differences between groups in any of the outcome measures 2 years after surgery, but there was a tendency in the all-inside group toward having increased anterior translation (mean, 3.6 mm vs 2.7 mm), a higher number of revision surgeries (5 patients vs 2 patients), and more patients having +1 and +2 pivot-shift values (29 vs 18 patients) when compared with the traditional group. CONCLUSION The all-inside technique yields equivalent results to the traditional hamstring technique 2 years after surgery and should be considered a reliable technique to use for ACL reconstruction. Sparing the gracilis tendon does not lead to less persistent hamstring weakness. Long-term follow-up is needed to further determine whether the tendency of increased anterior translation seen at 2 years postoperatively will lead to a higher risk of graft failure.
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Affiliation(s)
- Ingunn Fleten Mo
- University of Bergen, Bergen, Norway
- Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | | | | | - Søren Vindfeld
- University of Bergen, Bergen, Norway
- Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Eirik Solheim
- University of Bergen, Bergen, Norway
- Aleris Hospital Nesttun Bergen, Bergen, Norway
| | - Eivind Inderhaug
- University of Bergen, Bergen, Norway
- Haraldsplass Deaconess Hospital, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
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Xu J, Jia Y, Zhang B, Wang X, Sun R. Comparison of the Clinical Outcomes between All-inside and Standard Technique in Anterior Cruciate Ligament Reconstruction with 6-strand Hamstring Tendon Autograft. Orthop Surg 2024; 16:1034-1041. [PMID: 38506183 PMCID: PMC11062872 DOI: 10.1111/os.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE All-inside and standard techniques with 4-strand hamstrings graft have been widely used in anterior cruciate ligament (ACL) reconstruction. However, the graft diameter of less than 8 mm will significantly increase the rate of surgical failure, and the 6-strand graft can solve this problem. The purpose of this study is to compare all-inside ACL reconstruction using suspensory cortical button fixation on both tibia and femur with standard ACL reconstruction using suspensory femoral fixation and a bioabsorbable tibial interference screw with a 6-strand hamstring tendon autograft in postoperative clinical outcomes. METHODS From January 2020 to December 2020, 48 patients performed ACL reconstruction were divided into the all-side group and the standard group according to the different surgical techniques. Magnetic resonance imaging (MRI) and subjective function scores was used to assess clinical outcomes at least 24 months following ACL reconstruction. MRI was used to measure the value of bone tunnel widening in articular and middle portions. Subjective function scores included the Lysholm knee score, the International Knee Documentation Committee (IKDC) score, the Knee Society Score (KSS) for pain and function, and KT-1000. The t-test was used assuming the distribution of the patients which follows the normal distribution and we used non-parametric tests if these two conditions were not satisfied. RESULTS At the final follow-up, there were 22 patients in the all-inside group and 24 patients in the standard group. No significant differences were found with respect to femoral tunnel widening and subjective function scores. However, a significant increase in tibial tunnel widening was found in the middle portion of the standard group (2.25 ± 0.74) compared to the all-inside group (0.76 ± 0.24) (p < 0.01) and also in the articular portion of the standard group (2.07 ± 0.77) compared to the all-inside group (1.52 ± 0.54) (p = 0.02). In addition, the value of the KT-1000 was 1.81 ± 0.45 for the all-inside group and 2.12 ± 0.44 in the standard group (p = 0.016). CONCLUSION The objective stability of the knee was relatively better in the all-inside group than in the standard group. And tunnel widening after ACL reconstruction was significantly greater in the standard technique when compared to the all-inside technique on the tibia side.
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Affiliation(s)
- Juncai Xu
- Center for Joint SurgerySouthwest Hospital, Army Medical UniversityChongqingChina
| | - Yanfeng Jia
- Department of Orthopaedic SurgeryHebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Boxuan Zhang
- Department of Orthopaedic SurgeryThe Eighth People's Hospital of Hebei ProvinceShijiazhuangChina
| | - Xiaofeng Wang
- Department of Orthopaedic SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Ran Sun
- Department of Orthopaedic SurgeryHebei Medical University Third Affiliated HospitalShijiazhuangChina
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Coppola C, Krost S, Runer A, Raas C, Glodny B, Mayr R. PEEK Interference Screws Show Significant Tunnel Enlargement After ACL Reconstruction and is Comparable to Adjustable-Length Loop Cortical Button Fixation. Indian J Orthop 2024; 58:40-47. [PMID: 38161404 PMCID: PMC10754774 DOI: 10.1007/s43465-023-01029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/19/2023] [Indexed: 01/03/2024]
Abstract
Background It is unclear whether the use of polyetheretherketone (PEEK) interference screws for anterior cruciate ligament (ACL) reconstruction leads to postoperative tunnel enlargement. Femoral tunnel enlargement was further compared with adjustable-length loop cortical fixation. Methods Eighteen patients with ACL reconstruction using hamstring grafts were retrospectively divided into two groups. Eleven patients were treated with the ACL reconstruction technique using a PEEK interference screw for femoral graft fixation. Seven patients received adjustable-length loop cortical buttons for femoral fixation. Tibial ACL graft fixation was performed using PEEK interference screws. Tunnel volume changes were assessed using computed tomography (CT) scans performed after surgery (100%) and after 1 year. The maximal tunnel diameter was measured. Results The group with femoral screw fixation showed a mean tunnel volume change of 108.15 ± 13.7% on the tibial side and 124.07 ± 25.38% on the femoral side. The group with femoral button fixation showed a tunnel volume change of 111.12 ± 12.72% on the tibial side and 130.96 ± 21.71% on the femoral side. The differences in femoral tunnel volume changes were not significant (P = 0.562). Femoral tunnels with PEEK screw fixation showed significantly larger diameter after 12 months in comparison with button fixation (13.02 ± 1.43 mm vs. 10.46 ± 1.29 mm, P < 0.001). Conclusions PEEK interference screws were associated with significant tibial and femoral tunnel enlargement. Femoral tunnel enlargement was comparable between PEEK interference screws and button fixation. Final femoral tunnel diameter was significantly larger with PEEK screw fixation in comparison to button fixation.
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Affiliation(s)
- Christian Coppola
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Krost
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Armin Runer
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Raas
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Glodny
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Raul Mayr
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
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Eichinger M, Ploner M, Degenhart G, Rudisch A, Smekal V, Attal R, Mayr R. Tunnel widening after ACL reconstruction with different fixation techniques: aperture fixation with biodegradable interference screws versus all-inside technique with suspensory cortical buttons. 5-year data from a prospective randomized trial. Arch Orthop Trauma Surg 2023; 143:6707-6718. [PMID: 37542556 PMCID: PMC10541822 DOI: 10.1007/s00402-023-05001-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/18/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND The aim of the present study was to examine tunnel widening and clinical outcomes after anterior cruciate ligament reconstruction (ACLR) using two different fixation methods: aperture fixation with biodegradable interference screws versus all-inside ACLR with suspensory cortical buttons. METHODS Tunnel widening was assessed using volumetric and diameter measurements on magnetic resonance imaging (MRI) scans directly after surgery, as well as 6 months and 2 and 5 years postoperatively. Clinical outcomes were assessed after 5 years with instrumented tibial anteroposterior translation measurement (KT-1000), single-leg hop testing, and the IKDC, Lysholm, and Tegner activity scores. RESULTS At the final follow-up, the study population consisted of 21 patients, 12 of whom underwent screw fixation and 9 of whom had button fixation. 3 patients with all-inside ACLR had sustained early repeat ruptures within 6 months after surgery and had to be excluded from the further analysis. With screw fixation, the tibial tunnel volume changed significantly more over time compared to all-inside button fixation, with a larger initial increase at 6 months (from postoperative 2.9 ± 0.2 to 3.3 ± 0.2 cm3 at 6 months versus 1.7 ± 0.1 to 1.9 ± 0.2 cm3) and a greater final decrease over 2-5 years postoperatively (from 3.1 ± 0.2 to 1.9 ± 0.2 cm3 versus 1.8 ± 0.2 ± 0.1 to 1.3 ± 0.1 cm3) (P < 0.001). The femoral tunnel volume remained comparable between the two groups throughout the follow-up period, with an initial 1.6 ± 0.1 cm3 in both groups and 1.2 ± 0.1 vs. 1.3 ± 0.1 after 5 years in the screw and button groups, respectively (P ≥ 0.314). The maximum tibial and femoral tunnel diameters were significantly larger with screw fixation at all four time points. Tibial diameters measured 11.1 ± 0.2, 12.3 ± 0.3, 12.3 ± 0.4, and 11.2 ± 0.4 mm in the screw group versus 8.1 ± 0.3, 8.9 ± 0.3, 9.1 ± 0.4 and 8.2 ± 0.5 mm in the button group (P < 0.001). Femoral diameters measured 8.6 ± 0.2, 10.5 ± 0.4, 10.2 ± 0.3, and 8.9 ± 0.3 versus 7.3 ± 0.3, 8.4 ± 0.4, 8.4 ± 0.3, 7.5 ± 0.3, respectively (P ≤ 0.007). Four patients (33%) in the screw group exceeded a diameter of 12 mm on the tibial side after 5 years versus none in the button group (not significant, P = 0.104). Tibial anteroposterior translation measurement with KT-1000 after 5 years was 2.3 ± 2.4 mm in the screw group versus 3.2 ± 3.5 mm in the button group (not significant, P = 0.602). There were no significant differences between the groups in any of the other clinical outcomes. CONCLUSION Tibial tunnels in ACLR with screw fixation were associated with a larger increase in tunnel volume within the first 2 years and a greater decrease up to 5 years after surgery, while femoral tunnel volumes did not differ significantly. On the tibial side, the need for staged revision ACLR may be greater after biodegradable interference screw fixation if repeat ruptures occur, especially within the first 2 years after primary ACLR. Concerns may remain regarding a higher graft failure rate with all-inside ACLR. LEVEL OF EVIDENCE II. RCT CONSORT NCT01755819.
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Affiliation(s)
- Martin Eichinger
- Department of Orthopedics and Traumatology, a.ö. Bezirkskrankenhaus St. Johann in Tirol, Tirol, Austria
| | - Martin Ploner
- Department of Orthopedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gerald Degenhart
- Department of Orthopedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ansgar Rudisch
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - René Attal
- Department of Orthopedics and Traumatology, Feldkirch Academic Hospital, Feldkirch, Austria
| | - Raul Mayr
- Department of Orthopedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Lee OS, Kim JI, Han SH, Lee JK. Beneficial Effect of Curved Dilator System for Femoral Tunnel Creation in Preventing Femoral Tunnel Widening after Anterior Cruciate Ligament Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1437. [PMID: 37629727 PMCID: PMC10456963 DOI: 10.3390/medicina59081437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Backgrounds and objectives: A prevalent concern in anterior cruciate ligament (ACL) reconstruction is postoperative tunnel widening. We hypothesized that employing a curved dilator system (CDS) for femoral tunnel creation can reduce this widening after ACL reconstruction compared to the use of a conventional rigid reamer. Materials and Methods: A retrospective study was conducted involving 56 patients who underwent primary ACL reconstruction between January 2012 and July 2013. The patients were categorized into two groups: the reamer group (n = 28) and CDS group (n = 28). All participants were followed up for a minimum of 2 years. Clinical assessment included the Lachman test and pivot-shift test, and the Lysholm score and subjective International Knee Documentation Committee scores. Radiographic evaluation covered the tunnel widening rate, represented as the ratio of the tunnel diameter 2 years after surgery to the tunnel diameter immediately after surgery, and the ratio (A/B) of femoral tunnel (A) to tibial tunnel (B) diameters at respective time points. Results: No significant disparities were found between the two groups in terms of clinical outcomes. However, the reamer group exhibited a greater femoral tunnel widening rate compared to the CDS group (reamer group vs. CDS group: 142.7 ± 22.0% vs. 128.0 ± 19.0% on the anteroposterior (AP) radiograph and 140.8 ± 14.2% vs. 122.9 ± 13.4% on the lateral radiograph; all p < 0.05). Two years post-operation, the A/B ratio rose in the reamer group (0.96 ± 0.05→1.00 ± 0.05 on the AP radiograph and 0.94 ± 0.03→1.00 ± 0.0.04 on the lateral radiograph; all p < 0.05), while it decreased in the CDS group (0.99 ± 0.02→0.96 ± 0.05 on the AP radiograph and 0.97 ± 0.03→0.93 ± 0.06 on the lateral radiograph; all p < 0.05). Conclusion: The use of CDS for femoral tunnel creation in primary ACL reconstruction provides a potential advantage by limiting tunnel widening compared to the conventional rigid-reamer approach.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Uijeongbu-si 11759, Republic of Korea;
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul 07741, Republic of Korea;
| | - Seok Hyeon Han
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
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Flury A, Wild L, Waltenspül M, Zindel C, Vlachopoulos L, Imhoff FB, Fucentese SF. Tibial tunnel enlargement is affected by the tunnel diameter-screw ratio in tibial hybrid fixation for hamstring ACL reconstruction. Arch Orthop Trauma Surg 2023; 143:1923-1930. [PMID: 35287180 PMCID: PMC10030456 DOI: 10.1007/s00402-022-04408-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/27/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION There is no evidence on screw diameter with regards to tunnel size in anterior cruciate ligament reconstruction (ACLR) using hybrid fixation devices. The hypothesis was that an undersized tunnel coverage by the tibial screw leads to subsequent tunnel enlargement in ACLR in hybrid fixation technique. METHODS In a retrospective case series, radiographs and clinical scores of 103 patients who underwent primary hamstring tendon ACLR with a hybrid fixation technique at the tibial site (interference screw and suspensory fixation) were obtained. Tunnel diameters in the frontal and sagittal planes were measured on radiographs 6 weeks and 12 months postoperatively. Tunnel enlargement of more than 10% between the two periods was defined as tunnel widening. Tunnel coverage ratio was calculated as the tunnel diameter covered by the screw in percentage. RESULTS Overall, tunnel widening 12 months postoperatively was 23.1 ± 17.1% and 24.2 ± 18.2% in the frontal and sagittal plane, respectively. Linear regression analysis revealed the tunnel coverage ratio to be a negative predicting risk factor for tunnel widening (p = 0.001). The ROC curve analysis provided an ideal cut-off for tunnel enlargement of > 10% at a tunnel coverage ratio of 70% (sensitivity 60%, specificity 81%, AUC 75%, p < 0.001). Patients (n = 53/103) with a tunnel coverage ratio of < 70% showed significantly higher tibial tunnel enlargement of 15% in the frontal and sagittal planes. The binary logistic regression showed a significant OR of 6.9 (p = 0.02) for tunnel widening > 10% in the frontal plane if the tunnel coverage ratio was < 70% (sagittal plane: OR 14.7, p = 0.001). Clinical scores did not correlate to tunnel widening. CONCLUSION Tibial tunnel widening was affected by the tunnel diameter coverage ratio. To minimize the likelihood of disadvantageous tunnel expansion-which is of importance in case of revision surgery-an interference screw should not undercut the tunnel diameter by more than 1 mm.
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Affiliation(s)
- Andreas Flury
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Linda Wild
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Manuel Waltenspül
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christoph Zindel
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Florian B Imhoff
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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11
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Okutan AE, Gürün E, Surucu S, Kehribar L, Mahiroğulları M. Morphological Changes in the Tibial Tunnel After ACL Reconstruction With the Outside-In Technique and Adjustable Suspensory Fixation. Orthop J Sports Med 2023; 11:23259671231155153. [PMID: 36875338 PMCID: PMC9983096 DOI: 10.1177/23259671231155153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/08/2023] [Indexed: 03/05/2023] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) using the complete tibial tunnel technique and adjustable-loop cortical suspensory fixation is known to leave a "dead space" that holds the loop device in the tibial tunnel. The consequence of the dead space and its effect on graft healing are still uncertain. Purpose To investigate morphological changes in the tibial tunnel and their effect on graft healing, and to identify factors affecting bone healing in the tibial loop tunnel after ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation. Study Design Case series; Level of evidence, 4. Methods Included were 48 patients (34 male, 14 female; mean age, 25.2 ± 5.6 years) who underwent ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation. To evaluate tibial tunnel morphology, computed tomography was performed at 1 day and 6 months postoperatively. At 1 year postoperatively, graft healing was assessed on magnetic resonance imaging using the graft signal-to-noise quotient (SNQ). Multivariate regression and correlation analyses were performed to determine any associations between volumetric changes in bone healing and operative variables. Results At 6 months after ACLR, a mean of 63.2% of the tibial loop tunnel was filled by bone. Multivariate regression analysis showed that remnant preservation was significantly associated with the loop tunnel filling rate (P < .001). At 1 year after ACLR, the tibial loop tunnel was almost completely closed (98.5%). There were no correlations between loop tunnel volume and graft integration or graft SNQ. A significant but weak correlation was found between graft tunnel volume and intratunnel graft SNQ (P = .10) as well as integration grade in the tibial tunnel (P = .30). Conclusion Excellent bone filling in the tibial loop tunnel was seen at 1 year after ACLR. Remnant preservation was significantly associated with the loop tunnel filling rate. A weak correlation was found between graft tunnel volume and intratunnel graft SNQ as well as integration grade in the tibial tunnel.
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Affiliation(s)
- Ahmet Emin Okutan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Samsun University, Samsun, Turkey
| | - Enes Gürün
- Department of Radiology, Faculty of Medicine, Samsun University, Samsun, Turkey
| | - Serkan Surucu
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, Connecticut, USA
| | - Lokman Kehribar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Samsun University, Samsun, Turkey
| | - Mahir Mahiroğulları
- Department of Orthopedics and Traumatology, Memorial Sisli Hospital, Istanbul, Turkey
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12
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Lv X, Wang M, Zhao T, Wang L, Dong S, Tan H. All-inside versus complete tibial tunnel techniques in anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18:127. [PMID: 36810091 PMCID: PMC9945687 DOI: 10.1186/s13018-023-03613-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND All-inside anterior cruciate ligament reconstruction (ACLR) is a novel technique that has gained attention due to its minimally invasive. However, evidence surrounding the efficacy and safety between all-inside and complete tibial tunnel ACLR are lacking. Present work was aimed to compare clinical outcome for ACLR performed with an all-inside versus a complete tibial tunnel technique. METHODS Systematic searches were conducted of published literature on PubMed, Embase, and Cochrane for studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines up to May 10, 2022. The outcomes included KT-1000 arthrometer ligament laxity test, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity scale, and Knee Society Score (KSS) Scale, and tibial tunnel widening. Complications of interest extracted were graft re-ruptures and evaluated the graft re-rupture rate. Data from published RCTs meeting inclusion criteria were extracted and analyzed, and all the extracted data are pooled and analyzed by RevMan 5.3. RESULTS A total of 8 randomized controlled trials involving 544 patients (consisting of 272 all-inside and 272 complete tibial tunnel patients) were included in the meta-analysis. We found clinical outcomes (International Knee Documentation Committee [IKDC] subjective score: mean difference [MD], 2.22; 95% CI, 0.23-4.22; p = 0.03; Lysholm score: MD, 1.09; 95% CI, 0.25-1.93; p = 0.01; Tegner activity scale: MD, 0.41; 95% CI, 0.11-0.71; p < 0.01; Tibial Tunnel Widening: MD = - 1.92; 95% CI, - 3.58 to - 0.25; p = 0.02; knee laxity: MD = 0.66; 95% CI, 0.12-1.20; p = 0.02; and graft re-rupture rate: RR, 1.97;95% CI, 0.50-7.74; P = 0.33) in the all-inside and complete tibial tunnel group. The findings also indicated that all-inside may be more advantageous in tibial tunnel healing. CONCLUSION Our meta-analysis indicated that the all-inside ACLR was superior to complete tibial tunnel ACLR in functional outcomes and tibial tunnel widening. However, the all-inside ACLR was not entirely superior to complete tibial tunnel ACLR in knee laxity measured, and graft re-rupture rate.
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Affiliation(s)
- XiaoYu Lv
- grid.285847.40000 0000 9588 0960Kunming Medical University, Kunming, 650032 Yunnan People’s Republic of China
| | - Ming Wang
- grid.285847.40000 0000 9588 0960Kunming Medical University, Kunming, 650032 Yunnan People’s Republic of China
| | - TianYu Zhao
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming, 650100 Yunnan People’s Republic of China
| | - Ling Wang
- grid.285847.40000 0000 9588 0960Kunming Medical University, Kunming, 650032 Yunnan People’s Republic of China
| | - ShuangBin Dong
- grid.285847.40000 0000 9588 0960Kunming Medical University, Kunming, 650032 Yunnan People’s Republic of China
| | - HongBo Tan
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming, 650100, Yunnan, People's Republic of China.
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Thor J, Han Dave LY, Tapasvi S, Beyzadeoglu T. Short graft anterior cruciate ligament reconstruction: Current concepts. J ISAKOS 2023; 8:29-36. [PMID: 36202296 DOI: 10.1016/j.jisako.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022]
Abstract
Short graft anterior cruciate igament reconstruction is increasing in popularity for performing a primary ACLR. The short graft coupled with the all-inside technique using closed sockets and suspensory fixation at both femoral and tibial ends are its defining features. The outcomes of this technique have been comparable to well established transportal ACLR techniques. It has the benefits of preserved hamstring strength and less pain attributed to transtibial drilling. However, there is a learning curve involved and will require time before mastery of the technique. Furthermore, in combined osteotomy or multiligament surgery, the use of short graft anterior cruciate ligament reconstruction with sockets preserve bone stock and the single tendon harvest spares the other tendons for use in other ligament reconstruction.
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Affiliation(s)
- Jessica Thor
- Department of Orthopaedic Surgery,Changi General Hospital, Singapore.
| | - Lee Yee Han Dave
- Department of Orthopaedic Surgery, National University Hospital, Singapore.
| | | | - Tahsin Beyzadeoglu
- Professor of Orthopedics & Traumatology Halic University & Beyzadeoglu Clinic Istanbul, Turkey.
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14
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Hurwit DJ, Habet NA, Meade JD, Berk AN, Young BL, Odum S, Wang S, Schallmo MS, Fleischli JE, Trofa DP, Saltzman BM. Biomechanical comparison of Tibial-sided supplemental fixation techniques in Bone-Patellar Tendon-Bone anterior cruciate ligament reconstruction. Knee 2023; 41:66-71. [PMID: 36638705 DOI: 10.1016/j.knee.2022.12.005] [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: 06/11/2022] [Revised: 10/03/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to compare the biomechanical properties of a commercially available suture anchor and a screw post for supplemental tibial fixation of a bone-patellar tendon-bone (BTB) graft at time zero. We hypothesized that supplemental fixation using a suture anchor would demonstrate similar biomechanical performance in comparison with a screw post. METHODS Sixteen fresh frozen, healthy human cadaveric knees underwent BTB autograft harvest, placement, and primary tibial-sided interference screw fixation using a standardized technique performed by a single surgeon. Specimens were randomly assigned to one of two tibial-sided supplemental fixation groups (suture anchor or screw post), yielding eight specimens in each group. Each specimen was affixed to a custom loading apparatus, with the tibial tunnel aligned in a vertical position that allowed for parallel "worst-case scenario" loading and eliminated loading variation due to tibial tunnel angle. Grafts were pretensioned to 30 N and biomechanical performance was compared with respect to cyclical loading between 50-250 N for 500 cycles at 0.5 Hz and pull-to-failure loading at 60 mm/min. RESULTS The suture anchor and screw post supplemental constructs demonstrated similar performance with respect to all biomechanical parameters assessed, including yield strength (294.0 N [IQR 267.2-304.2 N] versus 332.1 N [IQR 313.8-350.4 N]; P = 0.079) and ultimate strength (330.1 N [IQR 306.9-418.7 N] versus 374.7 N [IQR 362.0-387.3 N]; P = 0.3798). However, of the eight original specimens in each group, one suture anchor specimen (12.5%) and six metallic screw post specimens (75%) failed during cyclical testing and were unable to undergo displacement and load to failure testing. CONCLUSION This study provides preliminary evidence that supplemental tibial-sided fixation of a BTB ACL graft with a suture anchor has similar loading characteristics or load-to-failure strength when compared to supplemental fixation with a screw post construct. STUDY DESIGN Laboratory Controlled Study. LEVEL OF EVIDENCE Basic Science Study.
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Affiliation(s)
- Daniel J Hurwit
- OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC 28207, USA
| | - Nahir A Habet
- Atrium Health - Musculoskeletal Institute, 1025 Morehead Medical Drive, Charlotte, NC 28204, USA
| | - Joshua D Meade
- OrthoCarolina Research Institute, 2001 Vail Ave Suite #300, Charlotte, NC 28207, USA; Atrium Health - Musculoskeletal Institute, 1025 Morehead Medical Drive, Charlotte, NC 28204, USA
| | - Alexander N Berk
- OrthoCarolina Research Institute, 2001 Vail Ave Suite #300, Charlotte, NC 28207, USA; Atrium Health - Musculoskeletal Institute, 1025 Morehead Medical Drive, Charlotte, NC 28204, USA
| | - Bradley L Young
- Atrium Health, Department of Orthopaedic Surgery, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28207, USA
| | - Susan Odum
- OrthoCarolina Research Institute, 2001 Vail Ave Suite #300, Charlotte, NC 28207, USA; Atrium Health - Musculoskeletal Institute, 1025 Morehead Medical Drive, Charlotte, NC 28204, USA
| | - Schangcheng Wang
- Atrium Health, Department of Orthopaedic Surgery, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28207, USA; Atrium Health - Musculoskeletal Institute, 1025 Morehead Medical Drive, Charlotte, NC 28204, USA
| | - Michael S Schallmo
- Atrium Health, Department of Orthopaedic Surgery, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28207, USA
| | - James E Fleischli
- OrthoCarolina Research Institute, 2001 Vail Ave Suite #300, Charlotte, NC 28207, USA; OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC 28207, USA; Atrium Health - Musculoskeletal Institute, 1025 Morehead Medical Drive, Charlotte, NC 28204, USA
| | - David P Trofa
- Columbia University Medical Center, New York, NY 10032, USA
| | - Bryan M Saltzman
- OrthoCarolina Research Institute, 2001 Vail Ave Suite #300, Charlotte, NC 28207, USA; OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC 28207, USA; Atrium Health - Musculoskeletal Institute, 1025 Morehead Medical Drive, Charlotte, NC 28204, USA.
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15
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de Geofroy B, Ghabi A, Jouvion AX, Limouzin J, de Landevoisin E. Return to duty in military personnel after ACL reconstruction: STG versus ST4 double adjustable-loop device. Orthop Traumatol Surg Res 2022; 108:103378. [PMID: 35907624 DOI: 10.1016/j.otsr.2022.103378] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION ACL ligamentoplasty with a quadruple semitindosus graft (ST4) and double adjustable endobutton (ST4E) allow the preservation of the gracilis, which should allow more rapid recovery of soldiers following ACL reconstruction. However, the literature does not report any superiority of this technique over others in terms of return to duty and sport. HYPOTHESIS The ST4E system allows a return to military duty at least equivalent to the semitendinosus and gracilis graft (STG) with screw fixation. MATERIAL AND METHOD A total of 133 soldiers operated on for ACL were included, 64 by the STG technique and 69 by ST4E, with an average follow-up of 4 years. The return to duty was assessed, with recovery of skills between the first and second postoperative year, as well as the medico-administrative status at the last follow-up, muscle recovery through isokinetic tests, the sports level before/after surgery, and the failure rate. RESULTS No difference was found in the return to the soldier's previous post between the STG (64%) and the ST4E (64%) (p=0.97). No difference was found for the medico-administrative status at the last follow-up, but the short-term muscle recovery, the return to sport, and the failure rate were in favor of the ST4E group. DISCUSSION The ST4E, adjustable double endobutton system, is comparable to the STG technique in terms of return to military duty. On the other hand, it offers faster muscle recovery with better sports results and fewer patients on prolonged sick leave (PSL). This study demonstrated that two-thirds of soldiers operated on for anterior cruciate ligamentoplasty regained their initial aptitude regardless of the technique used, which influences the army's operational capacity and on disability pension requests after service. LEVEL OF EVIDENCE III, single center retrospective comparative study.
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Affiliation(s)
- Bernard de Geofroy
- Department of Orthopaedic surgery and traumatology, Military teaching hospital Laveran, 34, boulevard Laveran, 13013 Marseille, France.
| | - Ammar Ghabi
- Department of Orthopaedic surgery and traumatology, Military teaching hospital Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Arnaud-Xavier Jouvion
- Physical Medicine and Rehabilitation Department, Military teaching hospital Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Jacques Limouzin
- Department of Orthopaedic surgery and traumatology, Military teaching hospital Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Emmanuel de Landevoisin
- Department of Orthopaedic surgery and traumatology, Military teaching hospital Laveran, 34, boulevard Laveran, 13013 Marseille, France; Department of Orthopaedic surgery and traumatology, Hôpital Privé Toulon Hyères-Saint-Roch, 99, avenue Saint-Roch, 83000 Toulon, France
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16
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Toofan H, Tabatabaei Irani P, Ghadimi E, Ayati Firoozabadi M, Mortazavi SMJ. Simultaneous Arthroscopic Anterior Cruciate Ligament Reconstruction Using Double Suspensory Technique and Medial Open-Wedge, High Tibial Osteotomy. Arthrosc Tech 2022; 11:e2357-e2364. [PMID: 36632396 PMCID: PMC9827118 DOI: 10.1016/j.eats.2022.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) is generally performed regardless of knee malalignments. However, there are some indications for either staged or simultaneous ACL reconstruction and realignment procedures, such as high tibial osteotomy (HTO). Simultaneous HTO-ACL reconstruction has the apparent benefit of a single surgical procedure with a faster recovery than a staged procedure, and it produces good clinical outcomes. Several techniques have been described for simultaneous ACLR and medial open wedge HTO. The tibial tunnel preparation and graft fixation are the most challenging part of the procedure. Recent studies on comparison of fixation of tibial tunnel graft using suspensory fixation versus bioabsorbable screws have shown superior results of more bone preservation and less graft rupture. We assumed suspensory fixation on the tibial side with bone preservation might be more reliable in patients who received ACLR and open wedge HTO at the same time. Therefore, we described our technique of simultaneous open-wedge HTO and ACLR using double suspensory graft fixation.
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Affiliation(s)
- Hesam Toofan
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouya Tabatabaei Irani
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Ghadimi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran,Address correspondence to Javad Mortazavi, M.D., Joint Reconstruction Research Center, Tehran University of Medical Sciences, 1419733141, Tehran, Iran.
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Lin TY, Chung CC, Chen WC, Su CW, Fang HW, Lu YC. Complications following all-inside anterior cruciate ligament reconstruction. INTERNATIONAL ORTHOPAEDICS 2022; 46:2569-2576. [PMID: 35859213 DOI: 10.1007/s00264-022-05515-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE We conducted a comprehensive analysis of possible perioperative complications following all-inside anterior cruciate ligament reconstruction (ACLR). Additional techniques and tips are proposed to prevent and manage complications. METHODS Complications following all-inside ACLR performed between December 2015 and December 2020 were retrospectively analysed. Altogether, 348 operations were performed and 275 patients were enrolled with a minimum 12-month follow-up period. Only semitendinosus autograft was utilised in most patients, and semitendinosus-gracilis autograft and allograft were used in five and 31 patients, respectively. Simultaneous meniscal repair, partial meniscectomy, and chondral surgery were performed in 29.5%, 21.1%, and 4.4% of patients, respectively. Complications were observed based on the patient's clinical condition, plain film, and magnetic resonance imaging. Clinical outcomes were assessed pre-operatively and at 12 months post-operatively, using the International Knee Documentation Committee form, Lysholm and Tegner activity scores, and KT1000 side-to-side difference. RESULTS Intraoperative and post-operative complications developed in 65 patients (23.6%). The most common complication was cortical button malposition on the femoral side (19.3%). Intra-operative breakage of the retrograde drill was found in two cases (0.73%), with three cases (1.1%) of over-drilling with destruction of the outer cortex. Post-operatively, four (1.5%), 13 (4.7%), and 16 (5.8%) cases of infection, full-thickness re-rupture, and loss of extension, respectively, were recorded. Functional outcome scales showed significant post-operative improvement. CONCLUSION Cortical button malposition was the most common but easily preventable complication. All-inside ACLR could be safe and promising after the suggested additional operative techniques and proper perioperative management which decrease complication rates and improve favourable outcomes.
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Affiliation(s)
- Tsung-Yu Lin
- Department of Orthopedic Surgery, Mackay Memorial Hospital, No.45, Minsheng Rd, Tamsui Dist., New Taipei City, Taiwan, Republic of China
- Mackay Junior College of Medicine, Nursing and Management, No. 42, Sec. 3, Zhongzheng Rd, Sanzhi Dist., New Taipei City, Taiwan, Republic of China
- Chemical Engineering and Biotechnology Department, National Taipei University of Technology, No. 1, Sec. 3, Jhongsiao E. Rd, Da'an Dist., 106344, Taipei City, Taiwan, Republic of China
| | - Cheng-Chun Chung
- Department of Orthopedic Surgery, Mackay Memorial Hospital, No.45, Minsheng Rd, Tamsui Dist., New Taipei City, Taiwan, Republic of China
| | - Wei-Cheng Chen
- Department of Orthopedic Surgery, Mackay Memorial Hospital, No.45, Minsheng Rd, Tamsui Dist., New Taipei City, Taiwan, Republic of China
| | - Che-Wei Su
- Department of Radiation Oncology, Mackay Memorial Hospital, No. 92, Sec. 2, Chung-San North Rd, Zhongshan Dist., 104, Taipei City, Taiwan, Republic of China
| | - Hsu-Wei Fang
- Biomechanics Research Laboratory, Department of Medical Research, Mackay Memorial Hospital, No. 45, Minsheng Rd, Tamsui Dist., New Taipei City, Taiwan, Republic of China
- Chemical Engineering and Biotechnology Department, National Taipei University of Technology, No. 1, Sec. 3, Jhongsiao E. Rd, Da'an Dist., 106344, Taipei City, Taiwan, Republic of China
| | - Yung-Chang Lu
- Department of Orthopedic Surgery, Mackay Memorial Hospital, No.45, Minsheng Rd, Tamsui Dist., New Taipei City, Taiwan, Republic of China.
- Biomechanics Research Laboratory, Department of Medical Research, Mackay Memorial Hospital, No. 45, Minsheng Rd, Tamsui Dist., New Taipei City, Taiwan, Republic of China.
- Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd, Sanzhi Dist., New Taipei City, Taiwan, Republic of China.
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Elmholt SB, Nielsen TG, Lind M. Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction - a systematic review and meta-analysis. J Exp Orthop 2022; 9:106. [PMID: 36269424 PMCID: PMC9587170 DOI: 10.1186/s40634-022-00544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Simone Birkebæk Elmholt
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Torsten Grønbech Nielsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Martin Lind
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Nair AV, Mohan PK, Jangale A, Kuntwad V, Kumar MP, Goud N, Sreekumar S. Dynamic Anterior Stabilization Using Transosseous Bone Tunnel Technique With the Adjustable Loop Length Cortical Button Incorporating High-Strength Suture Augmentation for Recurrent Shoulder Instability. Arthrosc Tech 2022; 11:e1929-e1935. [PMID: 36457392 PMCID: PMC9705597 DOI: 10.1016/j.eats.2022.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Dynamic anterior stabilization using the long head of the biceps tendon is a recently described technique in the management of recurrent shoulder dislocation with subcritical bone loss. This technique involves the transfer of the long head of the biceps to the glenoid, providing sling and hammock effect. The long head of the biceps (LHB) tendon fixation can be accomplished with a variety of implants. We present a modified fixation technique of LHB tendon using transosseous bone tunnel with the adjustable loop length cortical button, incorporating high-strength suture augmentation device in a patient with recurrent glenohumeral instability with limited glenoid bone loss and an engaging Hill-Sachs defect in the humeral head.
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Affiliation(s)
| | - Pramod Kumar Mohan
- Address correspondence to Pramod Kumar Mohan, M.S., Bangalore Shoulder Institute, 40, 36th Cross, 23rd Main Road, 4th T Block East, Jayanagar, Bangalore, 560041, Karnataka, India.
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20
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Liu D, Cai ZJ, Lu WH, Pan LY, Yang YT, Li YS, Xiao WF. Eccentrically widened bone tunnels after all-inside anterior cruciate ligament reconstruction: a computed tomography and three-dimensional model-based analysis. Knee Surg Sports Traumatol Arthrosc 2022; 31:2374-2385. [PMID: 36138208 PMCID: PMC10183415 DOI: 10.1007/s00167-022-07164-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the extent of tunnel widening after anterior cruciate ligament reconstruction (ACLR) using the all-inside technique and to establish its correlation with patient-reported clinical outcomes and femoral graft bending angle (GBA). METHODS Tunnel widening was evaluated using computed tomography (CT)-based three-dimensional (3D) models, and the femoral GBA was directly measured on CT images using the Picture Archiving and Communication System (PACS) software. Clinical follow-up was routine procedure, and patient-reported clinical outcomes mainly included International Knee Documentation Committee (IKDC), Lysholm, and Knee Injury and Osteoarthritis Outcome Scores (KOOS) scores, and subjective knee stability assessment. RESULTS Fifty-two patients received standard all-inside ACLR, with a median follow-up of 6 months. Reconstructed anterior cruciate ligaments (ACLs) were scanned during the first 3 days and 6 months after surgery. On both the femoral and tibial sides, bone tunnels were most significantly enlarged at the articular aperture segment; the femoral tunnel was 9.2 ± 1.3 mm postoperatively and was significantly enlarged by 32% to a mean tunnel diameter of 12.1 ± 2.0 mm at 6 months after surgery. Moreover, the extent of tunnel enlargement gradually decreased as the measured levels approached those of the bone cortex. The femoral tunnel center was shifted into the anterior and distal direction, and the tibial tunnel center was shifted into the posterior and lateral direction. Additionally, the mean femoral GBA was 105.9° ± 8.1° at the 6-month follow-up. Tunnel enlargement and GBA were not significantly correlated with patient-reported outcomes. CONCLUSIONS Femoral and tibial tunnels were significantly greater and eccentrically shifted at the 6-month follow-up after all-side ACLR. However, the extent of tunnel widening does not markedly affect the short-term clinical outcomes. Meanwhile, the femoral GBA was not significantly correlated with femoral tunnel widening or patient-reported outcomes. Although the tunnel widening following all-inside ACLR was not associated with clinical outcomes, it potentially caused difficulties in revision ACLR. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Di Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Zi-Jun Cai
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Wen-Hao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Lin-Yuan Pan
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Yun-Tao Yang
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Yu-Sheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Wen-Feng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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21
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Nie S, Zhou S, Huang W. Femoral fixation methods for hamstring graft in anterior cruciate ligament reconstruction: A network meta-analysis of controlled clinical trials. PLoS One 2022; 17:e0275097. [PMID: 36137116 PMCID: PMC9499312 DOI: 10.1371/journal.pone.0275097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 09/11/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the clinical effectiveness of cortical button (CB), cross-pin (CP) and compression with interference screws (IS) fixation techniques in anterior cruciate ligament (ACL) reconstruction using hamstring graft. Methods Studies were systematically retrieved from PubMed, Embase, Cochrane Library and Web of Science up to May 20, 2021. Primary outcomes were KT-1000 assessment, International Knee Documentation Committee (IKDC) score A or B, Lachman’s test, pivot-shift test, visual analogue scale (VAS) score, Lysholm score, Tegner score, and Cincinnati Knee Score. Secondary outcomes included reconstruction failures and synovitis. League tables, rank probabilities and forest plots were drawn for efficacy comparison. Results Twenty-six controlled clinical trials (CCTs) with 1,824 patients undergoing ACL reconstruction with hamstring graft were included. No significant differences were found among CB, CP and IS fixation methods regarding the 10 outcomes. For KT-1000 assessment, IKDC score A or B, Lachman’s test, VAS score and pivot-shift test, CP had the greatest probability of becoming the best method, and IS may be the suboptimal method in 4 out of these 5 outcomes except pivot-shift test. Conclusions CP, CB and IS fixations have comparable clinical performance, while CP fixation is most likely to be the optimum fixation technique for hamstring graft in ACL reconstruction. Future larger-sample studies of high quality comparing these techniques in more clinical outcomes are required.
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Affiliation(s)
- Shixin Nie
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
| | - Shuqing Zhou
- Department of Orthopedics, The Centre Hospital of Jiangjin, Chongqing, China
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
- * E-mail:
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22
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Adjustable-Loop Cortical Suspensory Fixation Results in Greater Tibial Tunnel Widening Compared to Interference Screw Fixation in Primary Anterior Cruciate Ligament Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091193. [PMID: 36143870 PMCID: PMC9505006 DOI: 10.3390/medicina58091193] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022]
Abstract
Background: Although the use of adjustable-loop suspensory fixation has increased in recent years, the influence of the shortcomings of suspensory fixation, such as the bungee-cord or windshield-wiper effects, on tunnel widening remains to be clarified. Hypothesis/Purpose: The purpose of this study was to compare adjustable-loop femoral cortical suspensory fixation and interference screw fixation in terms of tunnel widening and clinical outcomes after anterior cruciate ligament reconstruction (ACLR). We hypothesized that tunnel widening in the adjustable-loop femoral cortical suspensory fixation (AL) group would be comparable to that in the interference screw fixation (IF) group. Methods: This study evaluated patients who underwent primary ACLR at our institution between March 2015 and June 2019. The femoral and tibial tunnel diameters were measured using plain radiographs in the immediate postoperative period and 2 years after ACLR. Tunnel widening and clinical outcomes (Lysholm score, 2000 International Knee Documentation Committee subjective score, and Tegner activity level) were compared between the two groups. Results: There were 48 patients (mean age, 29.8 ± 12.0 years) in the AL group and 44 patients (mean age, 26.0 ± 9.5 years) in the IF group. Tunnel widening was significantly greater in the AL group than that in the IF group at the tibia anteroposterior (AP) middle (2.03 mm vs. 1.32 mm, p = 0.017), tibia AP distal (1.52 mm vs. 0.84 mm, p = 0.012), tibia lateral proximal (1.85 mm vs. 1.00 mm, p = 0.001), tibia lateral middle (2.36 mm vs. 1.03 mm, p < 0.001), and tibia lateral distal (2.34 mm vs. 0.85 mm, p < 0.001) levels. There were no significant differences between the two groups with respect to femoral tunnel widening and clinical outcomes. Conclusions: Tibial tunnel widening was significantly greater in the AL group than in the IF group at 2 years after primary ACLR. However, the clinical outcomes in the two groups were comparable at 2 years.
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23
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Biset A, Douiri A, Robinson JR, Laboudie P, Colombet P, Graveleau N, Bouguennec N. Tibial tunnel expansion does not correlate with four-strand graft maturation after ACL reconstruction using adjustable cortical suspensory fixation. Knee Surg Sports Traumatol Arthrosc 2022; 31:1761-1770. [PMID: 35876906 DOI: 10.1007/s00167-022-07051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Anterior cruciate ligament reconstruction (ACLR) using a short, quadrupled semitendinosus (ST-4) autograft, fixed with an adjustable suspensory fixation (ASF), has several potential advantages. However, the construct is suspected to generate micromotion, tunnel widening and poor graft maturation. The aim of this study was to evaluate post-operative tibial tunnel expansion, graft maturation and clinical outcomes for this type of ACLR. METHODS One-hundred and forty-nine patients were reviewed at a minimum of 2 years following 4-ST ACLR, mean 25.6 ± 3.5 months [24-55], with clinical follow-up and MRI scans. Graft maturity of the intra-articular part of the graft and the tibial tunnel portion was assessed using Signal-to-Noise Quotient (SNQ) and Howell score. Tibial tunnel expansion, bone-graft contact and graft volume in the tibial tunnel were calculated from the MRI scans. RESULTS Mean tibial tunnel expansion was 13 ± 16.5% [12-122]. Mean SNQ for graft within the tibial tunnel was 3.8 ± 7.1 [ - 7.7 to 39] and 2.0 ± 3.5 [ - 14 to 17] for the intra-articular portion of the graft. The Howell score for graft within the tibial tunnel was 41% Grade I, 37% Grade 2, 20% Grade 3, 2% grade 4, and for the intra-articular part 61% Grade 1, 26% Grade 2, 13% Grade 3 and 1% Grade 4. The mean tibial tunnel bone-graft contact was 81 ± 23% [0-100] and mean graft volume was 80 ± 22% [0-100]. No correlation was found between tibial tunnel expansion and graft maturity assessed at both locations. Graft maturity was correlated with higher graft-bone contact and graft volume in the tibial tunnel (p < 0.05). CONCLUSIONS ST-4 ACLR with ASF had low levels of tunnel enlargement at 2 years. No correlation was found between graft maturation and tibial tunnel expansion. Graft maturity was correlated with graft-bone contact and graft volume in the tibial tunnel. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Adil Douiri
- MD, Sports Clinic of Bordeaux-Merignac, Merignac, France
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24
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Koyama S, Tensho K, Shimodaira H, Iwaasa T, Kumaki D, Horiuchi H, Saito N, Takahashi J. A new remnant preservation technique reduces bone tunnel enlargement after anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:2020-2028. [PMID: 35122109 DOI: 10.1007/s00167-022-06882-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the effect of a new remnant preservation technique with a focus on remnant continuity on postoperative femoral and tibial tunnel enlargement after anatomical double-bundle anterior cruciate ligament reconstruction (ACLR). METHODS A total of 150 knees were divided into three groups: Preservation Group (Group P: 49 knees), wherein the remnant continuity remained after tunnel creation; Resection Group (Group R: 47 knees), wherein the remaining remnant was resected, and Absent Group (Group A: 54 knees), wherein the remnant had no femoral attachment before tunnel creation. In Group P, the remnant maintained continuity, and the anteromedial (AM) and posterolateral (PL) bundles were positioned anterior and posterior to the remnant, respectively. Computed tomographic scans were performed at 1 week and 1 year after surgery, and the cross-sectional area of each tunnel aperture was measured. Tunnel enlargement was compared among the three groups by one-way analysis of variance (ANOVA) and the Bonferroni test. Univariate and multivariate logistic analyses were performed to identify the risk factors for tunnel enlargement in demographic and radiographic data. RESULT For femoral AM tunnels, the tunnel enlargement of Group P was significantly smaller than Groups R and A (p < 0.001), femoral PL (p < 0.001 vs. R and A), tibial AM (p < 0.001 vs. R, 0.002 vs. A), and tibial PL (p < 0.001 vs. R, 0.002 vs. A). There was no significant difference between Groups R and A. Multivariate logistic analysis showed that remnant preservation was a significant factor in reducing tunnel enlargement in the femoral AM, femoral PL, tibial AM, and tibial PL. CONCLUSION The new remnant-preserving anatomical double-bundle ACLR, which preserves the continuity of the remnant, prevented all bone tunnel enlargement at 1 year postoperatively. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Suguru Koyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tomoya Iwaasa
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Daiki Kumaki
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroshi Horiuchi
- Department of Rehabilitation, Shinshu University Hospital, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Naoto Saito
- Institute for Biomedical Sciences, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
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25
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Schützenberger S, Keller F, Grabner S, Kontic D, Schallmayer D, Komjati M, Fialka C. ACL reconstruction with femoral and tibial adjustable versus fixed-loop suspensory fixation: a retrospective cohort study. J Orthop Surg Res 2022; 17:244. [PMID: 35440030 PMCID: PMC9020032 DOI: 10.1186/s13018-022-03128-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cortical suspensory fixation (CSF) devices gain more and more popularity as a reliable alternative to interference screws for graft fixation in anterior cruciate ligament (ACL) reconstruction. Adjustable-loop fixation may be associated with increased anterior laxity and inferior clinical outcome. The purpose of the study was to compare anterior laxity and clinical outcome after minimally invasive all-inside ACL reconstruction using an adjustable-loop (AL) to a standard technique with a fixed-loop (FL) CSF device. Methods Patients who underwent primary single-bundle ACL reconstruction with a quadrupled hamstring autograft at a single institution between 2012 and 2016 were reviewed. In the AL group minimally invasive popliteal tendon harvesting was performed with an all-inside approach (femoral and tibial sockets). In the FL group a traditional anteromedial approach was used for tendon harvesting and a femoral socket and full tibial tunnel were drilled. An objective clinical assessment was performed with Telos x-rays and the International Knee Documentation Committee (IKDC) Objective Score. Patient-reported outcomes (PRO) included the IKDC Subjective Score, the Lysholm Knee Score, the Knee Injury and Osteoarthritis Score (KOOS) and the Tegner Activity Scale. Results A total of 67 patients were enrolled in this retrospective study with a mean follow-up of 4 (± 1.5) years. The groups were homogenous at baseline regarding age, gender, and the time to surgery. At follow-up, no statistically significant differences were found regarding anterior laxity (AL: 2.3 ± 3 mm vs. FL: 2.3 ± 2.6 mm, p = 0.981). PRO scores were comparable between the AL and FL groups (IKDC score, 84.8 vs. 88.8, p = 0.185; Lysholm 87.3 vs. 89.9, p = 0.380; KOOS 90.7 vs. 91.4, p = 0.720; Tegner 5.5 vs. 6.2, p = 0.085). The rate of saphenous nerve lesions was significantly lower in the AL group with popliteal harvesting of the tendon (8.3% vs. 35.5%, p = 0.014). Conclusion The use of an adjustable-loop device on the femoral and tibial side led to similar stability and clinical results compared to a fixed-loop device.
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Affiliation(s)
- Sebastian Schützenberger
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria.
| | - F Keller
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - S Grabner
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - D Kontic
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - D Schallmayer
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - M Komjati
- Department of Orthopaedic Surgery, Sacred Heart of Jesus Hospital, Vienna, Austria
| | - C Fialka
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria.,Department for Traumatology, Sigmund Freud Medical University, Vienna, Austria
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26
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Lin R, Zhong Q, Wu X, Cui L, Huang R, Deng Q, Zuo J, Jiang C, Li W. Randomized controlled trial of all-inside and standard single-bundle anterior cruciate ligament reconstruction with functional, MRI-based graft maturity and patient-reported outcome measures. BMC Musculoskelet Disord 2022; 23:289. [PMID: 35337306 PMCID: PMC8957124 DOI: 10.1186/s12891-022-05231-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/16/2022] [Indexed: 12/20/2022] Open
Abstract
Background All-inside anterior cruciate ligament reconstruction (ACLR) is a novel technique that has gained attention due to its minimally invasive and graft-saving properties. However, studies comparing MRI-based graft maturity between all-inside and standard ACLR are lacking. Purpose This study focused on the functional, knee laxity, and MRI-based graft maturity characteristics of all-inside and standard single-bundle ACLR. Study Design Randomized controlled trial (RCT). Methods Fifty-four patients were randomly assigned to an all-inside reconstruction group (n = 27) or standard reconstruction group (n = 27). Using the same rehabilitation strategy. The Tegner, International Knee Documentation Committee, and Lysholm scores were recorded at postoperative months 3, 6, and 12 to assess functional recovery. MRI was conducted to measure the signal/noise quotient (SNQ) of the intra-articular graft to assess the maturity. A higher SNQ indicates lower graft maturity. Knee laxity was assessed using GNRB arthrometer at the postoperative month 12. Results The graft SNQ of the all-inside group was significantly higher than that of the standard group at postoperative month 6 (p < 0.05). There was no statistical difference in graft SNQ between the two groups at postoperative months 3 and 12 (p > 0.05). Both groups exhibited the highest SNQ in the middle region of the graft, followed by the proximal region, and the distal region. Functional scores improved significantly for both groups and had no statistical difference (p > 0.05). The knee laxity was higher in the all-inside group (p < 0.05) at postoperative month 12. There was no correlation between the functional scores and graft maturity in both groups (p > 0.05). Conclusions All-inside and standard single-bundle ACLR show good functional outcomes; however, knee laxity was relatively higher in the all-inside ACLR group than in the standard ACLR group. Moreover, both techniques exhibited poor maturity in the middle graft region and the best in the distal region. Graft maturity with all-inside ACLR is inferior to that with standard ACLR in the early postoperative stages. There is no correlation between knee function and graft maturity. Trial registration Clinical trial registration numbers: ChiCTR1800018543. Date of registration: 09/23/2018.
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Affiliation(s)
- Rubing Lin
- Peking University Shenzhen Hospital, Clinical College of Anhui Medical University, Lianhua Road 1120, Futian District, Shenzhen City, Guangdong Province, 518036, People's Republic of China.,Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, ShenZhen City, GuangDong Province, 518036, People's Republic of China
| | - Qiuwen Zhong
- Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, ShenZhen City, GuangDong Province, 518036, People's Republic of China
| | - Xiao Wu
- Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, ShenZhen City, GuangDong Province, 518036, People's Republic of China
| | - Lei Cui
- Peking University Shenzhen Hospital, Clinical College of Anhui Medical University, Lianhua Road 1120, Futian District, Shenzhen City, Guangdong Province, 518036, People's Republic of China.,Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, ShenZhen City, GuangDong Province, 518036, People's Republic of China
| | - Rong Huang
- Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, ShenZhen City, GuangDong Province, 518036, People's Republic of China
| | - Qianhua Deng
- Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, ShenZhen City, GuangDong Province, 518036, People's Republic of China
| | - Jianwei Zuo
- Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, ShenZhen City, GuangDong Province, 518036, People's Republic of China
| | - Changqing Jiang
- Huazhong University of Science and Technology Union Shenzhen Hospital, Taoyuan Road 89, Nanshan District, Shenzhen City, GuangDong Province, 518036, People's Republic of China
| | - Wei Li
- Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, ShenZhen City, GuangDong Province, 518036, People's Republic of China.
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27
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Rahardja R, Love H, Clatworthy MG, Monk AP, Young SW. Suspensory Versus Interference Tibial Fixation of Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction: Results From the New Zealand ACL Registry. Am J Sports Med 2022; 50:904-911. [PMID: 35048720 DOI: 10.1177/03635465211070291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The hamstring tendon is frequently used to reconstruct the anterior cruciate ligament (ACL), but there is a lack of consensus on the optimal method of fixation. Registry studies have shown that the type of femoral fixation device can influence the risk of revision ACL reconstruction (ACLR), but it is unclear whether the type of tibial fixation has an effect. In New Zealand, over 95% of hamstring tendon grafts are fixed with an adjustable loop suspensory device on the femoral side, with variable usage between suspensory and interference devices, with or without a sheath, on the tibial side. PURPOSE To investigate the association between the type of tibial fixation device and the risk of revision ACLR. STUDY DESIGN Cohort Study; Level of evidence, 2. METHODS Prospective data recorded in the New Zealand ACL Registry were analyzed. Only primary ACLRs performed with a hamstring tendon autograft fixed with a suspensory device on the femoral side were included. A Cox regression survival analysis with adjustment for patient factors was performed to analyze the effects of the type of tibial fixation device, the number of graft strands, and graft diameter on the risk of revision. RESULTS A total of 6145 primary ACLRs performed between 2014 and 2019 were analyzed. A total of 59.6% of hamstring tendon autografts were fixed with a suspensory device on the tibial side (n = 3662), 17.6% with an interference screw with a sheath (n = 1079), and 22.8% with an interference screw without a sheath (n = 1404). When compared with suspensory devices, a higher revision risk was observed when using an interference screw with a sheath (adjusted hazard ratio [HR], 2.05; P = .009) and without a sheath (adjusted HR, 1.81; P = .044). The number of graft strands and a graft diameter of ≥8 mm were associated with the rate of revision on the univariate analysis; however, after adjusting for confounding variables on the multivariate analysis, they did not significantly influence the risk of revision. CONCLUSION In this study of hamstring tendon autografts fixed with an adjustable loop suspensory device on the femoral side during primary ACLR, the use of an interference screw, with or without a sheath, on the tibial side resulted in a higher revision rate when compared with a suspensory device.
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Affiliation(s)
- Richard Rahardja
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Mark G Clatworthy
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Andrew P Monk
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland Hospital, Auckland, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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28
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Greif DN, Shallop BJ, Allegra PR, Cade WH, Minesinger KE, Luxenburg D, Kaplan LD, Baraga MG. A Comparison of Two-Year Anterior Cruciate Ligament Reconstruction Clinical Outcomes Using All-Soft Tissue Quadriceps Tendon Autograft With Femoral/Tibial Cortical Suspensory Fixation Versus Tibial Interference Screw Fixation. Arthroscopy 2022; 38:881-891. [PMID: 34252561 DOI: 10.1016/j.arthro.2021.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/04/2021] [Accepted: 06/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To contribute to future quadriceps tendon harvest and fixation guidelines in the setting of anterior cruciate ligament reconstruction by comparing 2-year patient-reported subjective knee outcome scores and incidence of graft-related complications between the shorter harvest all-inside tibial-femoral suspensory fixation (TFSF) approach versus the longer harvest standard tibial interference screw fixation technique. METHODS Patients who underwent primary anterior cruciate ligament reconstruction with all soft tissue quadriceps tendon autograft from January 2017 to May 2019 were identified for inclusion. Patients were matched into 2 cohorts of 62 based on reconstruction technique. All patients completed baseline and minimum 2-year International Knee Documentation Committee, Tegner Activity Level, and Lysholm questionnaires and were queried regarding subsequent procedures and complications to the operative knee. RESULTS Average graft length for the all-inside TFSF was 69.55 (95% confidence interval 68.99-70.19) mm versus 79.27 (95% confidence interval 77.21-81.34) mm in the tibial screw fixation cohort (P = .00001). Two-year Lysholm scores were greater in the TFSF cohort (P = .04) but were not clinically significant. There was no difference in 2-year International Knee Documentation Committee (P = .09) or Tegner (P = .69) scores between cohorts, but more patients in the TFSF cohort returned to or exceeded their baseline activity level compared with the tibial screw fixation cohort (73% vs 61%, P = .25). Seven patients in the TFSF cohort versus 13 in the tibial screw fixation cohort reported anterior knee pain or kneeling difficulty (P = .22). There were no differences in reported complications. CONCLUSIONS All-inside soft-tissue quadriceps tendon autograft with TFSF resulted in clinically comparable subjective outcome scores at 2 years to tibial screw fixation. There were also no differences in complications or reports of anterior knee pain or kneeling difficulty. All-inside TFSF can be a viable alternative to tibial screw fixation for all-soft tissue quadriceps autograft. LEVEL OF EVIDENCE III, comparative therapeutic trial.
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Affiliation(s)
- Dylan N Greif
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, U.S.A..
| | - Brandon J Shallop
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, U.S.A
| | - Paul R Allegra
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, U.S.A
| | - William H Cade
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, U.S.A
| | - Kayla E Minesinger
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, U.S.A
| | - Dylan Luxenburg
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, U.S.A
| | - Lee D Kaplan
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, U.S.A
| | - Michael G Baraga
- University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, U.S.A
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Barret H, Chelli M, Van Der Meijden O, Langlais T, Boileau P. Arthroscopic Latarjet: 2 or 4 Cortical Buttons for Coracoid Fixation? A Case-Control Comparative Study. Am J Sports Med 2022; 50:311-320. [PMID: 35048737 DOI: 10.1177/03635465211059830] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While 2 screws are traditionally used for coracoid bone block fixation, no gold standard technique has yet been established when using cortical buttons. PURPOSE To compare anatomic and clinical outcomes of the arthroscopic Latarjet procedure using either 2 or 4 buttons for coracoid bone block fixation. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 23 patients with 4-button fixation (group 4B) were matched for age at surgery, sex, and follow-up to 46 patients who had 2-button fixation (group 2B). All patients underwent guided arthroscopic Latarjet (using coracoid and glenoid guides), and a tensioning device was used to rigidify the suture button construct and get intraoperative bone block compression. The primary outcome was assessment of bone block positioning and healing using computed tomography scans performed at 2 weeks and at least 6 months after surgery. The mean ± standard deviation follow-up was 49 ± 7 months (range, 24-64 months). RESULTS The bone block healing rate was similar in both groups: 91% in group 4B versus 95.5% in group 2B. The transferred coracoid was flush to the glenoid surface in 21 patients (91%) in group 4B and 44 patients (96%) in group 2B (P = .6); it was under the equator in 22 patients (96%) in group 4B and 44 patients (96%) in group 2B (P≥ .99). There was no secondary bone block displacement; the rate of bone block resorption was similar between the groups: 28% in group 4B and 23% in group 2B (P = .71). Patient-reported outcomes, return to sports, and satisfaction were also similar between the groups. The operating time was significantly longer in group 4B (95 vs 75 minutes; P = .009). CONCLUSION A 4-button fixation technique did not demonstrate any anatomic or clinical advantages when compared with a 2-button fixation technique, while making the procedure more complex and lengthening the operating time by 20 minutes. A 2-button fixation is simple, safe, and sufficient to solidly fix the transferred coracoid bone block. The use of drill guides allows accurate graft placement, while the use of a tensioning device to rigidify the suture button construct provides high rates of bone block healing with both techniques (>90%).
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Affiliation(s)
- Hugo Barret
- ICR-Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
| | - Mikael Chelli
- ICR-Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
| | | | - Tristan Langlais
- ICR-Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
| | - Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
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Li H, Jiang F, Ge Y, Wan F, Li H, Chen S. Differences in artificial ligament graft osseointegration of the anterior cruciate ligament in a sheep model: a comparison between interference screw and cortical suspensory fixation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1370. [PMID: 34733922 PMCID: PMC8506542 DOI: 10.21037/atm-21-1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
Background Interference screws are the most common femoral fixation for anterior cruciate ligament (ACL) reconstruction with polyethylene terephthalate (PET) artificial ligaments. However, interference screws have several disadvantages, such as the risk of one tunnel blowout and damage to the graft. Suspensory fixations have the advantages of high tensile strength and promotion of graft bone contact. The purpose of this study was to compare PET artificial ligament graft osseointegration between interference screw fixation (ISF) and cortical suspensory fixation (CSF) for ACL reconstruction. Methods Forty sheep underwent ACL reconstruction of the right knee with PET artificial ligament. The graft was fixed with ISF or CSF for femoral fixation. Animals were randomly assigned to the ISF (n=20) or the CSF (n=20) groups. The sheep were sacrificed at 3 or 12 months postoperatively for biomechanical tests, micro computed tomography (micro-CT) scans, and histological assessments. Results The mean load-to-failure between the CSF group (836±355 N) appeared higher than that of the ISF group (604±277 N) at 3 months, but no significant difference was detected between the groups (P=0.24). At 12 months, there was also no significant difference in load-to-failure between the CSF and ISF groups (1,194±350 vs. 1,097±764 N; P=0.78). According to the micro-CT scan results, the femoral bone tunnel diameter of the ISF group appeared larger than that of the CSF group at 3 months (12±1 vs. 10±1 mm; P=0.02) and similar to that of the CSF group at 12 months (12±1 vs. 11±2 mm; P=0.38). Furthermore, histological results showed that at the graft-tunnel interface of the femoral tunnel aperture, disoriented fibers formed in the ISF group while oriented and dense fibers formed in the CSF group. Conclusions ACLR with synthetic ligament by cortical suspension devices with adjustable loops demonstrated a better graft-bone healing capacity at the femoral tunnel aperture compared with that from titanium interference screws over 12 months postoperatively. No significant difference was found in biomechanical strength between the two fixation methods during the early healing stage.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fangyi Jiang
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yunsheng Ge
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fang Wan
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
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Takahashi T, Watanabe S, Ito T. Current and future of anterior cruciate ligament reconstruction techniques. World J Meta-Anal 2021; 9:411-437. [DOI: 10.13105/wjma.v9.i5.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/09/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
In recent years, anterior cruciate ligament (ACL) reconstruction has generally yielded favorable outcomes. However, ACL reconstruction has not provided satisfactory results in terms of the rate of returning to sports and prevention of osteoarthritis (OA) progression. In this paper, we outline current techniques for ACL reconstruction such as graft materials, double-bundle or single-bundle reconstruction, femoral tunnel drilling, all-inside technique, graft fixation, preservation of remnant, anterolateral ligament reconstruction, ACL repair, revision surgery, treatment for ACL injury with OA and problems, and discuss expected future trends. To enable many more orthopedic surgeons to achieve excellent ACL reconstruction outcomes with less invasive surgery, further studies aimed at improving surgical techniques are warranted. Further development of biological augmentation and robotic surgery technologies for ACL reconstruction is also required.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Sports and Health Science, Ehime University, Matsuyama 790-8577, Ehime, Japan
| | - Seiji Watanabe
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan
| | - Toshio Ito
- Department of Orthopaedic Surgery, Murakami Memorial Hospital, Saijo 793-0030, Ehime, Japan
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Sun T, Zhang H. Biomechanical Comparison of a Novel Tibial Fixation Technique Versus Interference Screw Fixation for ACL Reconstruction Using Soft Tissue Grafts. Orthop J Sports Med 2021; 9:23259671211028559. [PMID: 34458385 PMCID: PMC8392818 DOI: 10.1177/23259671211028559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Controversy remains regarding the optimal technique for tibial fixation of soft tissue grafts in anterior cruciate ligament (ACL) reconstruction. Purpose/Hypothesis: To compare the biomechanical outcomes of a novel transtibial tubercle fixation technique with those of a commonly utilized interference screw fixation at the tibial site. Our hypothesis was that transtibial tubercle fixation achieves higher ultimate failure loads than interference screw fixation. Study Design: Controlled laboratory study. Methods: We used 24 matched porcine tibias and digital extensor tendons, from which 12 grafts and tibial tunnels were prepared using the novel transtibial tubercle fixation technique and 12 were prepared using the interference screw fixation technique. The specimens underwent a cyclic loading test (50-250 N applied for 1000 cycles at a frequency of 1 Hz), followed by a load-to-failure test. The slippage, stiffness, and ultimate failure loads were compared between the techniques. Results: No differences in slippage were found during the cyclic loading test, and no graft fixation or tibial complex failures occurred during cyclic testing in either group. The transtibial tubercle fixation technique had higher ultimate failure loads (mean ± SD, 756.28 ± 123.43 N) as compared with interference screw fixation (602.15 ± 81.62 N; P < .05). The grafts in the transtibial tubercle fixation group were less stiff than those in the interference screw fixation group (84.43 vs 101.23 N/mm; P < .05). Conclusion: Transtibial tubercle fixation achieved higher ultimate failure loads than interference screw fixation in the load-to-failure test. Clinical Relevance: The novel transtibial tubercle fixation technique compared favorably with interference screw fixation during ACL reconstruction. This technique does not require hardware, has a low cost, theoretically eliminates the risk of complications associated with hardware implantation (eg, graft damage and pain attributed to retained hardware requiring removal), and is relatively easy to perform.
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Affiliation(s)
| | - Hangzhou Zhang
- Department of Orthopedics, Joint Surgery and Sports Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
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Fu CW, Chen WC, Lu YC. Is all-inside with suspensory cortical button fixation a superior technique for anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21:445. [PMID: 32635920 PMCID: PMC7341582 DOI: 10.1186/s12891-020-03471-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/02/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To compare the clinical results of all-inside anterior cruciate ligament reconstruction (ACLR) using suspensory cortical button fixation and full tibial tunnel drilling. METHODS Systematic searches were conducted of published literature up to November 2019 on PubMed, Embase, and Cochrane for studies comparing all-inside ACLR using suspensory cortical button fixation and full tibial tunnel ACLR. Two reviewers independently determined eligibility, extracted the outcome data, and assessed the risk of bias of the eligible studies. The clinical outcome and graft reruptures were pooled by using random effects with mean differences and risk ratios for continuous and dichotomous variables, respectively. RESULT A total of nine studies (five randomized controlled trials and four comparative studies) involving 613 patients were included in the meta-analysis. The postoperative functional outcome, knee laxity measured with arthrometer, and graft reruptures were comparable between patients with all-inside ACLR using suspensory cortical button fixation and full tibial tunnel ACLR. However, a significantly greater thickness of autologous tendon was used and less change in drilling tunnel diameter was noted in patients with suspensory cortical button graft fixation. CONCLUSIONS All-inside ACLR with suspensory cortical button fixation was not clinically superior to full tibial tunnel ACLR with interference screw fixation in functional outcomes, knee laxity measured with arthrometer, or rerupture rate. However, the advantage of using suspensory cortical button fixation was that a thicker graft could be used for reconstruction, and brought less tibia tunnel widening compared with bioabsorbable interference screw fixation.
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Affiliation(s)
- Chun-Wei Fu
- Department of Orthopedic Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104, Taiwan, R. O. C..
| | - Wei-Cheng Chen
- Department of Orthopedic Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104, Taiwan, R. O. C
| | - Yung-Chang Lu
- Department of Orthopedic Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104, Taiwan, R. O. C
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Editorial Commentary: Anatomic or Not, the Tunnel Will Get Wider! Arthroscopy 2020; 36:1112-1113. [PMID: 32247408 DOI: 10.1016/j.arthro.2020.01.031] [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: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 02/02/2023]
Abstract
In our experience, arthroscopic tunnel widening is one of the major complications after anterior cruciate ligament (ACL) reconstruction. Even though this complication doesn't require an acute correction or intervention, patients with failed ACL reconstruction along with tunnel widening may need a 2-stage revision in which we have to fill the gap in the tunnels first. Otherwise, this tunnel widening after ACL reconstruction doesn't affect the clinical outcomes of the primary surgery and it won't affect the success of the surgery in the aspects of clinical and functional outcomes.
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