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Hoffer AJ, Peck GK, Leith J, McConkey M, Lodhia P. Single bundle hamstrings autograft preparation techniques for anterior cruciate ligament reconstruction: current concepts. Arch Orthop Trauma Surg 2024; 144:3185-3196. [PMID: 38953941 DOI: 10.1007/s00402-024-05412-4] [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: 01/23/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopedic procedures, and huge variation exists in the surgical technique. Single bundle hamstrings autograft reconstruction is a common method and has good clinical outcomes. A criticism of the hamstrings autograft is a small graft diameter, often less than 8-mm, which has been associated with increased re-rupture rates. Several graft preparation techniques for single bundle hamstrings autograft exist. Perioperative decisions include the number of tendons utilized, number of graft strands, graft configuration, and femoral and tibial fixation methods. Awareness of the minimum tendon and graft length required to produce each graft variation is necessary to avoid common pitfalls. However, intraoperative graft modification is possible to maximize graft diameter, and obtain proper fixation. The objective of this current concepts review is to describe the indications, surgical anatomy, technique, intraoperative tips, clinical outcomes, and complications for single bundle hamstrings autograft preparation techniques in ACLR.
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Affiliation(s)
- Alexander J Hoffer
- Department of Surgery, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Gina K Peck
- Department of Orthopaedics, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 11th floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jordan Leith
- Department of Orthopaedics, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 11th floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Mark McConkey
- Department of Orthopaedics, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 11th floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Parth Lodhia
- Department of Orthopaedics, University of British Columbia, Gordon and Leslie Diamond Health Care Centre 11th floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- Fraser Orthopaedic Institute, 403-233 Nelson's Crescent, New Westminster, BC, V3L 0E4, Canada.
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Chandanani M, Volpin A. Lateral femoral tunnel preparation and graft fixation for anterior cruciate ligament reconstruction-A discussion. World J Clin Cases 2024; 12:3277-3280. [PMID: 38898836 PMCID: PMC11185389 DOI: 10.12998/wjcc.v12.i17.3277] [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: 12/20/2023] [Revised: 04/12/2024] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction (ACLR), with a focus on the aspects of lateral femoral tunnel preparation and graft fixation techniques. The paper explores and comments on a recently published review by Dai et al, titled "Research progress on preparation of lateral femoral tunnel and graft fixation in ACLR", while providing insight into its relevance within the field of ACLR, and recommendations for future research.
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Affiliation(s)
- Mehak Chandanani
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom
| | - Andrea Volpin
- Department of Trauma and Orthopaedics, National Health Service Grampian, Elgin IV30 1SN, United Kingdom
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Fox MA, Engler ID, Zsidai BT, Hughes JD, Musahl V. Anatomic anterior cruciate ligament reconstruction: Freddie Fu's paradigm. J ISAKOS 2023; 8:15-22. [PMID: 35988888 DOI: 10.1016/j.jisako.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/26/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022]
Abstract
Anterior cruciate ligament (ACL) reconstruction techniques have evolved over the past four decades. There is evidence that non-anatomic reconstruction techniques, such as traditional transtibial drilling, fail to recreate the native anatomy of the ACL, which can lead to increased rotatory knee instability, revision risk, and post-traumatic osteoarthritis. Anatomic ACL reconstruction has emerged as the gold standard, with the goal of restoring the patient's native anatomy and knee kinematics. This review will summarise the relevant anatomy, modern anatomic ACL reconstruction techniques, and literature supporting anatomic ACL reconstruction as the new paradigm. LEVEL OF EVIDENCE: Level V, review article.
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Affiliation(s)
- Michael A Fox
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
| | - Ian D Engler
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Balint T Zsidai
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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Asai K, Nakase J, Yoshimizu R, Kimura M, Tsuchiya H. Does remnant tissue preservation in anterior cruciate ligament reconstruction influence the creation of the rectangular femoral tunnel? J Orthop Surg (Hong Kong) 2022; 29:23094990211061249. [PMID: 34893002 DOI: 10.1177/23094990211061249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE We have previously described anterior cruciate ligament reconstruction with a rounded rectangular femoral tunnel created using a rounded rectangular dilator designed to enable a more anatomical and wider tendon-bone junction. However, the influence of remnant tissue preservation on the creation of the rounded rectangular femoral tunnel is not clear. This study aimed to evaluate the influence of remnant tissue preservation on the creation of the rounded rectangular femoral tunnel. METHODS A total of 198 patients who underwent primary anterior cruciate ligament reconstruction with a rounded rectangular femoral tunnel were evaluated retrospectively. Patients were categorized into a remnant preservation group (group P) and a non-preservation group (group N). Computed tomography images taken 1 week postoperatively were analyzed. The location of the rounded rectangular femoral tunnel evaluated using the quadrant method, its rotation angle, and the graft bending angle were compared between the two groups. The differences and the variance in femoral tunnel assessment were compared using the two-sample t-test and Levene's test. RESULTS Although there was no significant difference in the location of femoral tunnel for the deep/shallow direction along the Blumensaat's line (difference, p = .326; variances, p = .970), the tunnel was significantly lower in group P than in group N, with no variances (difference, p = .001; variances, p = .326). There were no significant differences and no variances in the tunnel rotation angle and the graft bending angle (difference, p = .727 and 0.514, respectively; variances, p = .827 and .445, respectively). Blow out of the posterior wall of the medial aspect of the femoral lateral condyle was an intraoperative complication that occurred in one case in group N. CONCLUSION The remnant preservation approach creates a lower femoral tunnel compared to the non-preservation technique. However, a rounded rectangular femoral tunnel can be created safely and is reproducible with remnant tissue preservation.
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Affiliation(s)
- Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa UniversityKanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa UniversityKanazawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa UniversityKanazawa, Japan
| | - Mitsuhiro Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa UniversityKanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa UniversityKanazawa, Japan
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Laddha MS, Gowtam S, Jain P. Single-Tunnel Double-Bundle-Like Effect With Footprint Enhancing Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2022; 11:e307-e314. [PMID: 35256968 PMCID: PMC8897561 DOI: 10.1016/j.eats.2021.10.023] [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: 09/27/2021] [Accepted: 10/28/2021] [Indexed: 02/03/2023] Open
Abstract
The anterior cruciate ligament (ACL) consists of an anteromedial bundle and a posterolateral bundle giving anteroposterior and rotational stability. It's one of the most commonly injured ligaments and also one of the most commonly performed arthroscopic procedures. Management of ACL injuries is one of the most frequently studied subjects in the literature. Surgical management of ACL injuries varies from extraarticular tenodesis to arthroscopic transtibial reconstruction to double-bundle reconstruction to anatomic single-bundle reconstruction. Although double-bundle ACL reconstruction gives more rotational stability than anatomic single-bundle, functional outcome of both are the same, but the complication rates are much higher for double-bundle reconstruction. Hence, anatomic single-bundle ACL reconstruction has gained popularity. The femoral and tibial footprint of the ACL varies in shape and size; it can be oval, elliptical, rectangular, C-shape, and more. But all available ACL reconstruction techniques prepare a circular tunnel; hence, the footprint coverage of the native ACL is maximum after double-bundle reconstruction and less after anatomic single-bundle reconstruction. So, to have the benefit of double-bundle reconstruction with a single tunnel, we propose our technique of a single-tunnel double-bundle-like effect, with the footprint enhancing ACL reconstruction using our newly designed tunnel dilators.
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Affiliation(s)
| | - S.V. Gowtam
- RNH Hospital, Balraj Marg, Dhantoli, Nagpur, Maharashtra, India
| | - Prakhar Jain
- RNH Hospital, Balraj Marg, Dhantoli, Nagpur, Maharashtra, India
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Skeletally immature patient showed lower graft maturity than skeletally mature patient after ACL reconstruction with a rounded rectangular femoral tunnel. Sci Rep 2021; 11:19968. [PMID: 34620936 PMCID: PMC8497465 DOI: 10.1038/s41598-021-99532-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
To compare the clinical results and ligamentization of anterior cruciate ligament reconstruction (ACLR) between skeletally immature and mature patients. Two-hundred-and-two patients who underwent primary ACLR were evaluated retrospectively. The clinical outcomes were compared between skeletally immature (immature group 1, n = 27) and mature (control group 1, n = 175) groups. Graft ligamentization of the reconstructed anterior cruciate ligament (ACL) using magnetic resonance imaging (MRI) signal intensity at 6 months postoperatively was compared between immature group 2 (n = 16), which included participants from immature group 1, and control group 2 (n = 32), created by recruiting data-matched controls from control group 1. Immature group 1 had significantly higher revision (14.8%) and pivot shift test positive (22.2%) rates than control group 1 (2.9% and 4.0%, respectively) (P = 0.020 and 0.003, respectively). The signal intensity in immature group 2 were significantly higher at the mid-substance and distal site of the reconstructed ACL than those in control group 2 (P = 0.003 and 0.034, respectively). Skeletally immature patients had higher graft revision and residual rotational laxity rates. Reconstructed ACL in skeletally immature patients showed higher signal intensity on MRI at 6 months postoperatively.
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Chen R, Gu X, Xiang X. [Correlation between graft maturity and knee function after anterior cruciate ligament reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:704-709. [PMID: 34142496 PMCID: PMC8218191 DOI: 10.7507/1002-1892.202101100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the correlation between graft maturity and knee function after anterior cruciate ligament (ACL) reconstruction. METHODS A total of 50 patients who underwent ACL reconstruction with autologous tendons between August 2016 and August 2018 were included in the study. There were 28 males and 22 females, with an average age of 31.0 years (range, 18-50 years). At 6 months and 2 years after operation, the signal to noise quotient (SNQ) values of tibial and femoral ends of graft were measured by MRI, and the mean value was taken as the SNQ value of graft. The function of knee joint was evaluated by Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores. The differences in SNQ values between tibial and femoral ends were analyzed at 6 months and 2 years after operation. The correlation between SNQ value at 6 months after operation and knee function score at 2 years after operation was analyzed. According to SNQ value at 6 months after operation, the patients were divided into group A (SNQ value≥12) and group B (SNQ value<12) and the correlation between SNQ value and knee function score was further analyzed. RESULTS All incisions healed primarily without infection or injury of blood vessels and nerves. All patients were followed up 24-28 months (mean, 26.6 months). The IKDC, Lysholm, and Tegner scores at 6 months and 2 years after operation were significantly higher than those before operation ( P<0.05), and all scores at 2 years after operation were also significantly higher than those at 6 months ( P<0.05). The SNQ values at 6 months and 2 years after operation were 12.517±6.272 and 10.900±6.012, respectively, and the difference was significant ( t=1.838, P=0.007). The SNQ values of graft at 6 months after operation were significantly different from those at 2 years after operation ( P<0.05), and the SNQ values of tibial and femoral ends of graft at the same time point were significantly different ( P<0.05). The SNQ value of 50 patients at 6 months after operation was negatively correlated with Lysholm, IKDC, and Tegner scores at 2 years after operation ( r=-0.965, P=0.000; r=-0.896, P=0.000; r=-0.475, P=0.003). The patients were divided into groups A and B according to the SNQ value, each with 25 cases; the SNQ values of the two groups at 6 months after operation were negatively correlated with Lysholm, IKDC, and Tegner scores at 2 years after operation ( P<0.05). CONCLUSION After ACL reconstruction, the knee function scores and graft maturity of patients gradually improved. The lower the SNQ value in the early stage, the higher the knee function score in the later stage. The SNQ value of MRI in the early stage after ACL reconstruction can predict the knee function in the later stage.
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Affiliation(s)
- Rongjin Chen
- Emergency Department of Orthopedics, the Affiliated Chengdu Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu Sichuan, 611130, P.R.China
- Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - Xinyi Gu
- Emergency Department of Orthopedics, the Affiliated Chengdu Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu Sichuan, 611130, P.R.China
| | - Xianxiang Xiang
- Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
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Nakase J, Takata Y, Shimozaki K, Asai K, Yoshimizu R, Kimura M, Tsuchiya H. Clinical study of anatomical ACL reconstruction using a rounded rectangular dilator. BMC Musculoskelet Disord 2021; 22:38. [PMID: 33413257 PMCID: PMC7791683 DOI: 10.1186/s12891-020-03913-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 12/23/2020] [Indexed: 04/09/2023] Open
Abstract
Background The aim of this study was that to compare clinical results between the rounded rectangular femoral tunnel ACL reconstruction (RFTR) and the conventional round femoral tunnel ACL reconstruction using a hamstring tendon. The hypothesis was that ACL reconstruction performed using the rounded rectangular dilator technique was better than that performed using the conventional round femoral tunnel technique in terms of clinical results and bone tunnel enlargement. Methods We conducted retrospective study. After exclusions, 40 patients were included in the conventional anatomical single-bundle ACL reconstruction (ASBR) group and 40 patients were included in the RFTR group. The evaluation items were knee stability, Lysholm knee score, IKDC subjective score at 2 years after surgery and bone tunnel enlargement. Results The RFTR group had a larger femoral tunnel area (average area, 53.1 ± 4.0 mm2 vs. 46.1 ± 7.0 mm2; P < 0.01), better anteroposterior stability, and higher Lysholm scores than the ASBR group (average side-to-side difference for anterior tibial translation, 0.6 ± 0.8 mm vs. 1.6 ± 1.4 mm; P < 0.01; average Lysholm score, 98.5 ± 2.1 vs. 97.5 ± 3.5; P < 0.01). Further, bone tunnel enlargement ratio was significantly lower in the RFTR group (73 ± 38% vs. 107 ± 41%; P < 0.01). Conclusions We designed and developed an original rounded rectangular dilator to perform a novel ACL surgery. This technique can create a larger bone tunnel and improve clinical results than the conventional round anatomical single-bundle ACL reconstruction.
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Affiliation(s)
- Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, 920-0934, Kanazawa, Japan.
| | - Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, 920-0934, Kanazawa, Japan
| | - Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, 920-0934, Kanazawa, Japan
| | - Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, 920-0934, Kanazawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, 920-0934, Kanazawa, Japan
| | - Mitsuhiro Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, 920-0934, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, 920-0934, Kanazawa, Japan
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