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Dauty M, Louguet B, Menu P, Grondin J, Crenn V, Daley P, Fouasson-Chailloux A. Enlightenment on Knee Flexors Strength Loss in Cases of Posterior Knee Pain After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2024; 33:317-324. [PMID: 38684207 DOI: 10.1123/jsr.2023-0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024]
Abstract
CONTEXT The persistence and the recurrence of posterior medial knee pain (PKP) after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon graft are often overlooked during rehabilitation. DESIGN Cross-sectional observational study. METHODS The study aimed (1) to evaluate the prevalence of these types of PKP before 4 months post-ACLR, (2) to measure their consequences on the knee flexors strength, and (3) to evaluate the role of the type of ACLR. From a cohort of patients operated on with hamstring tendon procedures, the persistent and the recurrent PKP were sought at 4 months post-ACLR. The evolution of isokinetic muscle strength recovery in PKP subjects was compared with those of nonpainful subjects. The functional deficit was measured at 6/7 months post-ACLR by a hop test. RESULTS Three hundred seventeen subjects (25.8 [6.0] y) were included. At 4 months post-ACLR, 2 populations were identified based on the recurrent onset of PKP (PKP+, n = 40) or the absence of knee pain (PKP-, n = 277). The prevalence of PKP was 8.3%. At the fourth month post-ACLR, the PKP+ group had a higher flexor strength deficit compared with the PKP- group (limb symmetry index at 60°/s: 67.2% [12.4%] vs 84.3% [12.6%]; P < .05). At 6/7 months, the loss of strength persisted (limb symmetry index at 60°/s: 82.3% [13.4%] vs 87.7% [12.8%]; P < .05). The hop test deficit was comparable, and no difference was shown according to the type of graft. CONCLUSIONS Persistent and recurrent PKP during the rehabilitation period were not uncommon and were associated with a worsening of flexors strength loss on the ACLR side.
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Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
| | - Bastien Louguet
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
| | - Jérôme Grondin
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Vincent Crenn
- Clinique Chirugicale Othopédique et Traumatiologique, CHU Nantes, Nantes Université, Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
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Cerciello S, Corona K, Morris BJ, Proietti L, Mercurio M, Cattaneo S, Milano G. Hybrid coracoclavicular and acromioclavicular reconstruction in chronic acromioclavicular joint dislocations yields good functional and radiographic results. Knee Surg Sports Traumatol Arthrosc 2022; 30:2084-2091. [PMID: 34841469 DOI: 10.1007/s00167-021-06790-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Optimal treatment of chronic unstable acromioclavicular (AC) joint dislocations (stage 3-5 according the Rockwood classification) is still debated. Anatomic coracoclavicular (CC) reconstruction is a reliable option in terms of two-dimensional radiographic reduction, clinical outcomes, and return to sports, but there remain concerns regarding anterior-posterior stability of the AC joint with CC ligament reconstruction alone. The aim of the present study was to describe the mid-term results of a new hybrid technique with CC and AC ligament reconstruction for chronic AC joint dislocations. METHODS Twenty-two patients surgically treated for chronic AC joint dislocations (grade 3 to 5) were retrospectively reviewed. All patients were assessed before surgery and at final follow-up with the Constant-Murley score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score. The CC vertical distance (CCD) and the CCD ratio (affected side compared to unaffected side) were measured on Zanca radiographs preoperatively, at 6 months postop and at final follow-up. The same surgical technique consisting in a primary fixation with a suspensory system, coracoclavicular ligaments reconstruction with a double loop of autologous gracilis and acromioclavicular ligaments reconstruction with autologous coracoacromial ligament was performed in all cases. RESULTS Twenty-two shoulders in 22 patients (19 males and 3 females) were evaluated with a mean age of 34.4 ± 9 years at the time of surgery. The mean interval between the injury and surgery was 53.4 ± 36.7 days. The mean duration of postoperative follow-up was 49.9 ± 11.8 months. According to the Rockwood classification, there were 5 (22.6%) type-III and 17 (77.2%) type-V dislocations. Mean preoperative ASES and CMS were 54.4 ± 7.6 and 64.6 ± 7.2, respectively. They improved to 91.8 ± 2.3 (p = 0.0001) and 95.2 ± 3.1 (p = 0.0001), respectively at final FU. The mean preoperative CCD was 22.4 ± 3.2 mm while the mean CCD ratio was 2.1 ± 0.1. At final FU, the mean CCD was 11.9 ± 1.4 mm (p = 0.002) and the mean CCD ratio was 1.1 ± 0.1 (p = 0.009). No recurrence of instability was observed. One patient developed a local infection and four patients referred some shoulder discomfort. Heterotopic ossifications were observed in three patients. CONCLUSIONS The optimal treatment of chronic high-grade AC joint dislocations requires superior-inferior and anterior-posterior stability to ensure good clinical outcomes and return to overhead activities or sports. The present hybrid technique of AC and CC ligaments reconstruction showed good clinical and radiographic results and is a reliable an alternative to other reported techniques. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Simone Cerciello
- A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
- Marrelli Hospital, Crotone, Italy
- Casa Di Cura Villa Betania, Rome, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Brent Joseph Morris
- Baptist Health Medical Group Orthopedics and Sports Medicine, Lexington, KY, USA
| | | | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Stefano Cattaneo
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Giuseppe Milano
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Chillemi M, Abu-Mukh A, Tei MM, Pace V, Bartoli M, Cerulli G, Placella G. Single and double hamstring tendon anterior cruciate ligament reconstruction – A prospective, comparative cohort study. JOURNAL OF MUSCULOSKELETAL SURGERY AND RESEARCH 2022; 6:148-153. [DOI: 10.25259/jmsr_151_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Objectives:
Excellent knee stability is necessary to achieve good postoperative clinical results in anterior cruciate ligament (ACL) reconstruction. However, there is little evidence in the literature regarding hamstring graft choice for ACL reconstruction. Our study intended to debate the best autograft choice for this procedure. We aimed to examine the functional and biomechanical outcomes of three different autografts used in ACL reconstruction, namely, Semitendinosus and Gracilis quadrupled (STGR) autograft, tripled or quadrupled ST autograft, and tripled Gracilis tendon autograft (GR).
Methods:
We conducted an observational, comparative, prospective cohort on 248 ACL reconstructed patients spanning 2 years (2009–2010) and evaluated the primary outcome with KT-1000 knee arthrometer and secondary outcomes with International Knee Documentation Committee (IKDC), Tegner ctivity cale, and Lysholm score.
Results:
The data suggest a statistically significant increase in IKDC score and Lysholm score in the GR group – standing for better subjective outcomes like pain – compared to the STGR and ST groups (P = 0.0018 and P = 0.0034, respectively) and statistically non-significant differences between the STGR and ST groups for all evaluated parameters. KT-1000 side-to-side evaluation demonstrates that STGR autograft offers less structural knee laxity compared to GR autograft in ACL reconstruction (P = 0.044).
Conclusion:
The study found that STGR autograft offers more stability to the knee compared to the GR autograft alone yet is associated with inferior subjective outcomes compared to the GR group. GR autograft is a valid substitute for ACL reconstruction, especially in patients presenting with hyperlaxity or demanding lower functional performance.
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Affiliation(s)
- Marco Chillemi
- Department of Orthopedics and Traumatology, Istituto di Ricerca Traslazionale per l’Apparato Locomotore - Nicola Cerulli, Arezzo, Italy,
| | - Assala Abu-Mukh
- Department of Orthopedics and Traumatology, Vita-Salute San Raffaele University-San Raffaele Hospital, Milan, Lombardy, Italy,
| | - Matteo M. Tei
- Department of Orthopedics and Traumatology, Istituto di Ricerca Traslazionale per l’Apparato Locomotore - Nicola Cerulli, Arezzo, Italy,
| | - Valerio Pace
- Department of Orthopedics and Traumatology, University of Perugia, Orthopedic and Trauma Surgery, Perugia, Italy,
| | - Matteo Bartoli
- Department of Orthopedics and Traumatology, San Raffaele Hospital - Milano, Milano, Lombardy, Italy,
| | - Giuliano Cerulli
- Department of Orthopedics and Traumatology, Istituto di Ricerca Traslazionale per l’Apparato Locomotore - Nicola Cerulli, Arezzo, Italy,
| | - Giacomo Placella
- Department of Orthopedics and Traumatology, San Raffaele Hospital - Milano, Milano, Lombardy, Italy,
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