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Garra S, Li ZI, Moore MR, Rao N, Eskenazi J, Alaia EF, Alaia MJ, Strauss EJ, Jazrawi LM. Characterization of bone marrow edema patterns among patients with Segond fracture in the setting of acute anterior cruciate ligament injury: A comparative MRI study. Knee 2024; 51:1-10. [PMID: 39236633 DOI: 10.1016/j.knee.2024.08.007] [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: 04/10/2024] [Revised: 06/18/2024] [Accepted: 08/09/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE The purpose of this study is to investigate the anatomic distribution of bone marrow edema on MRI among patients who sustained a Segond fracture compared to those with an isolated ACL tear. METHODS A retrospective cohort study was performed of patients aged 18-40 years old who presented with an acute isolated ACL tear between January 2012 and May 2022. Two blinded readers reviewed all knee MRIs to assess bone marrow edema using the Whole-Organ Magnetic Resonance Imaging Score and the area of each sub-compartment was scored. RESULTS There were 522 patients in the final analysis, of which 28 patients (5.4%) were identified to have a Segond fracture. The Segond group demonstrated significantly greater rates of WORMS grades 2 and 3 in the central lateral femoral condyle, as well as the anterior, central, and posterior lateral tibial plateau. Furthermore, the Segond group demonstrated significantly greater rates of WORMS grades 2 and 3 in the central medial femoral condyle and the anterior medial tibial plateau. Bone edema at the central lateral femoral condyle (R = 0.034, p = 0.019) and central tibial plateau (R = 0.093, p = 0.033) were significantly correlated with lateral meniscus tears, while the edema in the posterior medial femoral condyle was correlated with medial meniscus tears (R = 0.127, p = 0.004). CONCLUSION Patients who present with ACL tear and a concomitant Segond fracture demonstrate significantly more extensive bone marrow edema in both the medial and lateral compartments of the knee compared to patients with an isolated ACL tear.
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Affiliation(s)
- Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, United States.
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, United States
| | - Michael R Moore
- Department of Orthopedic Surgery, New York University Langone Health, United States
| | - Naina Rao
- Department of Orthopedic Surgery, New York University Langone Health, United States
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University Langone Health, United States
| | - Erin F Alaia
- Department of Radiology, New York University Langone Health, United States
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, United States
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, United States
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, United States
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Dreizin D, Edmond T, Zhang T, Sarkar N, Turan O, Nascone J. CT of Periarticular Adult Knee Fractures: Classification and Management Implications. Radiographics 2024; 44:e240014. [PMID: 39146203 DOI: 10.1148/rg.240014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Periarticular knee fractures, which include fractures of the distal femur, tibial plateau, and patella, account for 5%-10% of musculoskeletal injuries encountered in trauma centers and emergency rooms. These injuries are frequently complex, with articular surface involvement. Surgical principles center on reconstruction of the articular surface as well as restoration of limb length, alignment, and rotation to reestablish functional knee biomechanics. Fixation principles are guided by fracture morphology, and thus, CT with multiplanar reformats and volume rendering is routinely used to help plan surgical intervention. Fractures involving the distal femur, tibial plateau, and patella have distinct management considerations. This comprehensive CT primer of periarticular knee fractures promotes succinct and clinically relevant reporting as well as optimized communication with orthopedic trauma surgeon colleagues by tying fracture type and key CT findings with surgical decision making. Fracture patterns are presented within commonly employed fracture classification systems, rooted in specific biomechanical principles. Fracture typing of distal femur fractures and patellar fractures is performed using Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classification schemes. Tibial plateau fractures are graded using the Schatzker system, informed by a newer explicitly CT-based three-column concept. For each anatomic region, the fracture pattern helps determine the surgical access required, whether bone grafting is warranted, and the choice of hardware that achieves suitable functional outcomes while minimizing the risk of articular collapse and accelerated osteoarthritis. Emphasis is also placed on recognizing bony avulsive patterns that suggest ligament injury to help guide stress testing in the early acute period. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- David Dreizin
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., N.S., O.T.) and Division of Orthopaedic Traumatology (T.E., T.Z., J.N.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Tyler Edmond
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., N.S., O.T.) and Division of Orthopaedic Traumatology (T.E., T.Z., J.N.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Tina Zhang
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., N.S., O.T.) and Division of Orthopaedic Traumatology (T.E., T.Z., J.N.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Nathan Sarkar
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., N.S., O.T.) and Division of Orthopaedic Traumatology (T.E., T.Z., J.N.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Ozerk Turan
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., N.S., O.T.) and Division of Orthopaedic Traumatology (T.E., T.Z., J.N.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Jason Nascone
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., N.S., O.T.) and Division of Orthopaedic Traumatology (T.E., T.Z., J.N.), R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
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Ryu DJ, Kim S, Kim M, Kim JH, Kim WJ, Lim D, Wang JH. It is challenging to reproduce both anatomical and functional aspects of anterolateral reconstruction: postoperative 3D-CT analysis of the femoral tunnel position. Knee Surg Relat Res 2024; 36:26. [PMID: 39210443 PMCID: PMC11360883 DOI: 10.1186/s43019-024-00230-9] [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: 03/08/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the femoral tunnel position and fiber length of the anterolateral ligament (ALL) reconstruction compared with the natural anatomy of the ALL. We also evaluated whether the femoral tunnel position would affect residual pivot shift. METHODS This study was a retrospective review of 55 knees that underwent ALL reconstruction considering the anatomical and functional aspects, during primary anterior cruciate ligament (ACL) reconstruction in the presence of a high-grade pivot shift or revisional ACL reconstruction. We determined the position of the femoral tunnel and the length of graft using a three-dimensional (3D)-computed tomography (CT) model after ALL reconstruction. We also measured graft excursion during surgery and examined pivot shift 2 years after surgery. We conducted a subgroup analysis of femoral tunnel position, fiber length, isometricity, and residual pivot shift depending on whether the tunnel was anterior or posterior to the lateral epicondyle (LE). We also performed a subgroup analysis depending on whether the ACL reconstruction was primary or revisional. RESULTS The mean femoral tunnel position was 2.04 mm posterior and 14.5 mm proximal from the center of the LE. The mean lengths of the anterior and posterior fibers were 66.6 and 63.4 mm, respectively. The femoral tunnel was positioned more proximally than the anatomical position, and both anterior and posterior ALL fibers were longer than the natural anatomy. The anteroposterior femoral tunnel position was significantly correlated with anterior (p = 0.045) and posterior (p = 0.037) fiber excursion. In the subgroup analysis, there was no significant difference in the residual pivot shift between the posterior and anterior tunnel positions. However, there were significant differences for proximal position (p < 0.001) and fiber length (p = 0.006). There was no significant difference between primary and revisional ACL regarding femoral tunnel position and fiber lengths. CONCLUSION It is challenging to reproduce both anatomical and functional aspects of ALL reconstruction in both primary and revision ACL reconstruction. Especially for functional reconstruction, the femoral tunnel tended to be positioned more proximally than the anatomical position. However, the femoral tunnel position did not affect functional clinical outcomes at the 2-year follow-up. LEVEL OF EVIDENCE Level IV Case series.
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Affiliation(s)
- Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Seoyeong Kim
- Department of Mechanical Engineering, Sejong University, Seoul, South Korea
| | - Minji Kim
- Department of Mechanical Engineering, Sejong University, Seoul, South Korea
| | - Joo Hwan Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Won Jae Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul, South Korea.
- RNX Co., Ltd, Seoul, South Korea.
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea.
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea.
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Wang H, Yao G, He K, Wang Z, Cheng CK. ACL reconstruction combined with anterolateral structures reconstruction for treating ACL rupture and knee injuries: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1437684. [PMID: 39170062 PMCID: PMC11337200 DOI: 10.3389/fbioe.2024.1437684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/12/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction: The biomechanical indication for combining anterolateral structures reconstruction (ASLR) with ACL reconstruction (ACLR) to reduce pivot shift in the knee remains unclear. This study aims to investigate knee functionality after ACL rupture with different combinations of injuries, and to compare the effectiveness of ALSR with ACLR for treating these injuries. Methods: A validated finite element model of a human cadaveric knee was used to simulate pivot shift tests on the joint in different states, including 1) an intact knee; 2) after isolated ACL rupture; 3) after ACL rupture combined with different knee injuries or defect, including a posterior tibial slope (PTS) of 20°, an injury to the anterolateral structures (ALS) and an injury to the posterior meniscotibial ligament of the lateral meniscus (LP); 4) after treating the different injuries using isolated ACLR; v. after treating the different injuries using ACLR with ALSR. The knee kinematics, maximum von Mises stress (Max.S) on the tibial articular cartilage (TC) and force in the ACL graft were compared among the different simulation groups. Results and discussion: Comparing with isolated ACL rupture, combined injury to the ALS caused the largest knee laxity, when a combined PTS of 20° induced the largest Max.S on the TC. The joint stability and Max.S on the TC in the knee with an isolated ACL rupture or a combined rupture of ACL and LP were restored to the intact level after being treated with isolated ACLR. The knee biomechanics after a combined rupture of ACL and ALS were restored to the intact level only when being treated with a combination of ACLR and ALSR using a large graft diameter (6 mm) for ALSR. However, for the knee after ACL rupture combined with a PTS of 20°, the ATT and Max.S on the TC were still greater than the intact knee even after being treated with a combination of ACLR and ALSR. The finite element analysis showed that ACLR should include ALSR when treating ACL ruptures accompanied by ALS rupture. However, pivot shift in knees with a PTS of 20° was not eliminated even after a combined ACLR and ALSR.
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Affiliation(s)
- Huizhi Wang
- School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Center for Intelligent Medical Equipment and Devices (iMED), University of Science and Technology of China, Suzhou, Jiangsu, China
| | - Gai Yao
- The Fifth Medial Center of Chinese PLA General Hospital, Beijing, China
| | - Kaixin He
- School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Zimin Wang
- Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
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Braz JNPDSV, Alves LFTG, Ferreira FAL, Barros AS, de Sousa AMSN, Gutierres MAP. The presence of a deep lateral femoral notch sign in ACL-injured patients is associated with a 2.7° steeper posterior tibial slope and a 19% higher frequency of lateral meniscal injuries. Knee Surg Sports Traumatol Arthrosc 2024; 32:2003-2012. [PMID: 38751091 DOI: 10.1002/ksa.12262] [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: 11/12/2023] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE The purpose of this study was to study the relationship between the presence of a deep lateral femoral notch sign (DLFNS) in anterior cruciate ligament (ACL)-injured patients and a higher posterior lateral tibial slope (LPTS), a reduced meniscal bone angle (MBA), a higher LPTS/MBA ratio and a higher incidence of concomitant injuries in primary ACL tears. METHODS A retrospective case-control study was performed in patients submitted to primary ACL reconstruction with an available preoperative magnetic resonance imaging (MRI) scan. Patients with ACL tears and a femoral impactation with a depth ≥2 mm were assorted to the DLFNS group and patients with ACL tear and without a DLFNS to the control group. LPTS and MBA were measured in MRI. The presence of concomitant injuries (meniscal, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament and bone injuries) was assessed in MRI. Quantitative data are presented in the median ± interquartile range (IQR). RESULTS There were 206 patients included in the study, with 46 patients assorted to the DLFNS group and 160 patients to the control group. In the DLFNS group, the median LPTS was 6.7° (IQR: 4.0-8.2) versus 4.0° in the control group (IQR: 2.2-6.5) (p = 0.003). The LPTS/MBA ratio was significantly higher in the DLFNS group, with a median of 0.32 (IQR: 0.19-0.44), in comparison to the control group, with a median of 0.19 (IQR: 0.11-0.31) (p < 0.001). The multivariable logistic regression analysis showed that the LPTS is an independent risk factor to having a DLFNS (odds ratio [OR] = 1.161; 95% confidence interval [CI]: 1.042-1.293, p = 0.007). There was a higher incidence of concomitant lateral meniscal injuries in the DLFNS group (67% vs. 48%, p = 0.017). CONCLUSIONS In patients with ACL tears, the presence of a DLFNS is associated with a steeper lateral posterior tibial slope, as well as a higher incidence of concomitant lateral meniscal injuries. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Luís F T G Alves
- Department of Orthopaedics and Traumatology, São João University Hospital, Porto, Portugal
| | | | - António S Barros
- RISE - Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - António M S N de Sousa
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Orthopaedics and Traumatology, São João University Hospital, Porto, Portugal
| | - Manuel A P Gutierres
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Orthopaedics and Traumatology, São João University Hospital, Porto, Portugal
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Sobrado MF, Moreira da Silva AG, Helito PVP, Helito CP. Effect of Preoperative Anterolateral Ligament Injury on Outcomes After Isolated Acute ACL Reconstruction With Hamstring Graft: A Prospective Study With Minimum 5-Year Follow-up. Am J Sports Med 2024; 52:2464-2471. [PMID: 39101609 DOI: 10.1177/03635465241263599] [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: 08/06/2024]
Abstract
BACKGROUND The potential influence of a preoperative anterolateral ligament (ALL) lesion seen on magnetic resonance imaging (MRI) on the mid- and long-term surgical outcomes of anterior cruciate ligament (ACL) reconstruction is still controversial. PURPOSE To evaluate the clinical outcomes and failure rate of isolated ACL reconstruction at a minimum 5-year follow-up in patients with and without ALL injury diagnosed preoperatively using MRI. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL injury group) or absence (control group) of ALL injury on preoperative MRI. This is a longer-term follow-up study of a previously published study that had a minimum 2-year follow-up. Both groups underwent anatomic isolated reconstruction of the ACL. The Lysholm and subjective International Knee Documentation Committee scores, KT-1000 arthrometer and pivot-shift tests, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. The evaluation at the 5-year follow-up was also compared with the same patient's evaluation at 2 years of follow-up. RESULTS A total of 156 patients were evaluated. No significant differences were found between the groups in the preoperative evaluation. In the postoperative evaluation, patients in the ALL injury group had a higher reconstruction failure rate (14.3% vs 4.6% for the control group; P = .049) and worse clinical outcomes according to the Lysholm scores (85.0 ± 10.3 vs 92.3 ± 6.6; P < .00001). Although the pivot-shift test results were similar, anteroposterior translation using the KT-1000 arthrometer revealed worse results for the ALL injury group (2.8 ± 1.4 mm vs 1.9 ± 1.3 mm; P = .00018). Patients in the ALL injury group also had an increase in KT-1000 arthrometer values from 2 to 5 years (2.4 ± 1.6 vs 2.8 ± 1.4; P = .038). Patients in the control group had no differences in outcomes from 2 to 5 years of follow-up. CONCLUSION Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 5 years after isolated ACL reconstruction with hamstring autograft. Patients with concomitant ALL injury showed a higher failure rate and worse functional scores. Also, knee stability tended to slightly worsen from 2 to 5 years in cases of associated ALL injury.
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Affiliation(s)
- Marcel Faraco Sobrado
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, São Paulo, Brazil
| | - Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, São Paulo, Brazil
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Jung SH, Park JS, Jung M, Chung K, Ha TH, Choi CH, Kim SH. Combined Anterolateral Ligament Reconstruction Results in Better Knee Stability and More Satisfactory Subjective Outcomes in Non-Athlete Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction. J Clin Med 2024; 13:4087. [PMID: 39064127 PMCID: PMC11278468 DOI: 10.3390/jcm13144087] [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: 06/06/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Consensus has not yet been reached regarding combined anterior cruciate ligament reconstruction (ALLR) with revisional anterior cruciate ligament reconstruction (RACLR). We aimed to compare the clinical outcomes between patients who underwent isolated RACLR and those who underwent RACLR combined with ALLR. Methods: Between June 2010 and June 2021, 49 patients who underwent RACLR were retrospectively reviewed over a 24-month follow-up. Patients were categorized into the isolated RACLR (n = 37, group 1) or combined ALLR group (n = 12, group 2). Clinical outcomes were evaluated with several patient-reported outcome measures (PROMs) and minimal clinically important differences (MCIDs) for each PROM. The side-to-side difference (SSD) of the anterior instability was measured. The pivot-shift test was performed. Results: Baseline characteristics showed no differences between the groups. PROMs showed no significant differences between the groups at the 2-year follow-up. Group 2 was superior to group 1 in the MCID achievement rate for Lysholm knee and International Knee Documentation Committee (IKDC) subjective scores at 24 months postoperatively. At the final follow-up, the proportion of IKDC grade A in SSD for anterior laxity was higher in group 2 than in group 1 (58.3% versus [vs.] 18.3%, p = 0.009), and the proportion of pivot-shift grade 0 was also higher in group 2 (66.7% vs. 27.0%, p = 0.013). The "near return to activity" rate was also higher in group 2 than in group 1 (83.3% vs. 45.9%, p = 0.043). Conclusions: Combining ALLR with RACLR in non-athletes results in a higher proportion of patients with less mechanical graft failure and satisfactory clinical outcomes.
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Affiliation(s)
- Se-Han Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Ji-Soo Park
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kwangho Chung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea
| | - Tae-Ho Ha
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Chong Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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Helito CP, Moreira da Silva AG, Gomes Gobbi R, Pécora JR. Recovery of Full Hyperextension After Anterior Cruciate Ligament Reconstruction Is Associated With Better Functional Outcomes but Greater Anterior Cruciate Ligament-Related Laxity After a Minimum 24-Month Follow-Up. Arthroscopy 2024:S0749-8063(24)00450-X. [PMID: 38944322 DOI: 10.1016/j.arthro.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/18/2024] [Accepted: 06/10/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE To evaluate patients who had anterior cruciate ligament (ACL) reconstruction with preoperative hyperextension and compare physical examination (KT-1000 and pivot shift) and patient-reported outcome measures of patients who recovered the entire hyperextension with patients who did not. METHODS Patients aged 18 to 60 years with more than 5° of knee hyperextension who had anatomic ACL reconstruction with any graft from June 2013 to June 2021 and at least a 24-month follow-up were evaluated retrospectively. Hamstrings and patellar tendon grafts were fixed around 20° to 30° of flexion and in full extension, respectively. Patients who could recover hyperextension were compared with patients who did not. Preoperative, intraoperative, and postoperative data, including physical examination and patient-reported outcome measures, were evaluated. RESULTS Of the 225 patients evaluated, 48 (21.3%) did not recover hyperextension, and 177 recovered full range of motion. Patients who did not recover hyperextension had a larger graft diameter (8.7 ± 0.7 mm [confidence interval, 8.502-8.898 mm] vs 8.3 ± 0.7 mm [confidence interval, 8.197-8.403 mm]; P = .018). Regarding the postoperative subjective variables, patients who recovered hyperextension showed improvement on all scales (International Knee Documentation Committee, Lysholm, Forgotten Joint Score, and Global Perceived Effect) evaluated compared with patients who did not recover the range of motion. Patients who recovered hyperextension also showed more laxity on physical examination, measured by the KT-1000 (1.8 ± 0.8 vs 1.1 ± 1.0; P = .0006) and the pivot shift (62.1% [grade 0] and 37.9% [grade 1] vs 79.2% [grade 0] and 20.8% [grade 1]; P = .027). CONCLUSIONS Patients with knee hyperextension who regained range of motion after ACL reconstruction have worse knee laxity than patients who regained full extension but not hyperextension. However, patients who recover full range of motion showed higher scores on subjective function scales, including a greater number of patients who achieved patient acceptable symptom state for the International Knee Documentation Committee score. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Hospital Sírio Libanês, São Paulo, SP, Brazil
| | - Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Riccardo Gomes Gobbi
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; HCor Hospital do Coração, São Paulo, SP, Brazil
| | - José Ricardo Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Kang JH, Moon SG, Lee DW. Magnetic Resonance Imaging Features of Anterolateral Ligament in Young Adults without Anterior Cruciate Ligament Injury: Preliminary Evaluation. Diagnostics (Basel) 2024; 14:1226. [PMID: 38928641 PMCID: PMC11202545 DOI: 10.3390/diagnostics14121226] [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: 03/30/2024] [Revised: 06/01/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
This study aimed to characterize the Magnetic Resonance Imaging (MRI) features of the Anterolateral Ligament (ALL) in young adults without Anterior Cruciate Ligament (ACL) injury and evaluate its visibility using MRI. In this retrospective analysis, MRI scans of 66 young adults without ACL injuries were assessed by two radiologists. The ALL was examined from its bone-to-bone attachment between the lateral femoral epicondyle and the lateral tibia. The visibility of the ALL was classified as normal, probably normal, abnormal, or non-visualized, based on ligament continuity and thickness relative to the Meniscotibial Ligament (MTL). A continuous structure with thickness equal to or greater than the MTL was considered normal; continuous but wavy and thin features were categorized as probably normal; discontinuity and angulation were deemed abnormal. The proximal attachment of the ALL was categorized as anterior, central, or posterior to the Fibular Collateral Ligament (FCL), while the distal attachment was noted as either at the same location or distal to the MTL. The ALL was identified in 87.9-95.5% of knees and was non-visualized in 4.5-12.1% of cases. Continuous ligamentous structures were observed in 63.7-71.2% of knees (normal in 30.3-37.9%; probably normal in 27.3-40.9%), whereas 19.7-30.3% exhibited abnormal features. Inter-observer agreement was moderate to substantial (κ = 0.66, 0.56), and intra-observer agreement was substantial to excellent (κ = 0.82, 0.66). Among the 58 visible ALLs, proximal attachments were predominantly anterior (63.8%) or central (32.8%) to the FCL, with a minority posterior (1.7%). In total, 4 of the 19 central insertions were incorporated into the FCL mid-substance, and one case was blended into the meniscofemoral ligament. Distal attachments were equally distributed between the same location (50%) and distal to the MTL (50%) (mean 3.7 mm distal). In conclusion, MRI was feasible for detecting the ALL in most young adults without ACL injury, revealing continuous ligament structures in about two-thirds of cases. Approximately 40% of cases exhibited a thickness equal to or greater than the MTL, with the majority of proximal attachments located anterior to the FCL and distal attachments evenly divided between the same insertion and distal to the MTL.
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Affiliation(s)
- Ji-Hee Kang
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Sung-Gyu Moon
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Dhong-Won Lee
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
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Vind TD, Petersen ET, Sørensen OG, Lindgren L, Stilling M. Dynamic radiostereometry can objectively quantify the kinematic laxity patterns and rotation instability of the knee during a pivot-shift test. Knee Surg Sports Traumatol Arthrosc 2024; 32:1492-1506. [PMID: 38643397 DOI: 10.1002/ksa.12181] [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: 12/13/2023] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE The pivot-shift test is used to clinically assess knee instability in patients with anterior cruciate ligament (ACL) lesions; however, it has low interobserver reliability. Dynamic radiostereometry (dRSA) is a highly precise and noninvasive method for the objective evaluation of joint kinematics. The purpose of this study was to quantify precise knee kinematics during a pivot-shift test using dRSA imaging. METHOD Eight human donor legs, including hemipelvises, were evaluated. Arthroscopic intervention was performed inducing ligament lesions in the ACL, and anterolateral ligament (ALL) section was performed as a capsular incision. The pivot-shift test was recorded with dRSA on knees with intact ligaments, ACL-deficient and ACL + ALL-deficient knees. RESULTS A pivot-shift pattern was identifiable after ligament lesion, as a change in tibial posterior drawer velocity from 7.8 mm/s (95% CI: 3.7; 11.9) in ligament intact knees to 30.4 mm/s (95% CI 23.0; 38.8) after ACL lesion to 35.1 mm/s (95% CI 23.4; 46.7) after combined ACL-ALL lesion. The anterior-posterior drawer excursion increased from 2.8 mm (95% CI 2.1; 3.4) in ligament intact knees to 7.2 mm (95% CI 5.5; 8.9) after ACL lesion to 7.6 mm (95% CI 5.5; 9.8) after combined lesion. A statistically significant increase in tibial external rotation towards the end of the pivot-shift motion was observed when progressing from intact to ACL + ALL-deficient knees (p < 0.023). CONCLUSION This experimental study demonstrates the feasibility of dRSA to objectively quantify the kinematic laxity patterns of the knee during the pivot-shift test. The dynamic parameters obtained through dRSA revealed the kinematic changes from ACL to combined ACL-ALL ligament lesion. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Tobias Dahl Vind
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Emil Toft Petersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Gade Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Lindgren
- Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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11
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Meena A, Das S, Runer A, Tapasvi K, Hegde P, D'Ambrosi R, Hiemstra L, Tapasvi S. Revision ACL reconstruction in female athletes: current concepts. J ISAKOS 2024; 9:464-470. [PMID: 38403190 DOI: 10.1016/j.jisako.2024.02.007] [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: 09/28/2023] [Revised: 01/07/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
The challenge of revision anterior cruciate ligament (ACL) reconstruction lies in its complexity, varied presentation, and technical intricacies. A successful ACL reconstruction should allow patients to safely return to preinjury activities. However, it is only sometimes simple, and many risk factors and concurrent pathologies come into play. Evaluating and analysing the cause of failure and associated conditions is paramount to addressing them effectively. Despite a plethora of research and improvements in knowledge and technology, e gaps exist in issues such as optimal techniques of revision surgery, graft options, fixation, concurrent procedures, rehabilitation and protocol for return to sports of high-level athletes. Female athletes need additional focus since they are at higher risk of re-injury, suboptimal clinical outcomes, and lower rates of return to sport following revision reconstruction. Our understanding about injury prevention and the protection of ACL grafts in female athletes needs to be improved. This review focuses on the current state of revision ACL surgery in female athletes and provides recommendations and future directions for optimising outcomes in this high-risk group.
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Affiliation(s)
- Amit Meena
- Division of Orthopedics, Shalby Multi-Specialty Hospital, Jaipur, 302021, India; Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria.
| | - Saubhik Das
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria
| | - Armin Runer
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Komal Tapasvi
- The Orthopaedic Speciality Clinic, Pune, 411004, India
| | - Prathik Hegde
- The Orthopaedic Speciality Clinic, Pune, 411004, India
| | - Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, 20161, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milan, 20133, Italy
| | - Laurie Hiemstra
- Banff Sport Medicine, University of Calgary, T1W 0L5, Canada
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Guerreiro JPF, Rosa LB, Gonçalves EL, Curcio ARR, Bignardi PR, Danieli MV. Outcomes of Anterior Cruciate Ligament Reconstruction in Patients with Associated Anterolateral Ligament Injury. Rev Bras Ortop 2024; 59:e397-e402. [PMID: 38911889 PMCID: PMC11193583 DOI: 10.1055/s-0044-1785516] [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] [Received: 08/21/2023] [Accepted: 11/06/2023] [Indexed: 06/25/2024] Open
Abstract
Objective To evaluate if there is a significant difference in the outcomes of isolated anterior cruciate ligament (ACL) reconstruction in patients with or without associated anterolateral ligament (ALL) injury. Methods We conducted a retrospective cross-sectional study through the analysis of medical records and the application of the questionnaires of the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) Subjective Knee Form to patients undergoing isolated ACL reconstruction. Results The 52 participants included were divided into two groups: 19 with associated ALL injury and 33 with no associated ALL injury. None of the patients with associated ALL injury suffered an ACL rerupture, and 21.1% presented injuries to other knee structures after surgery. Among the patients with no associated injury, 6.1% suffered ACL rerupture, and 18.2% presented injuries to other structures after surgery ( p = 0.544). Return to activities at the same level as that of the preoperative period occurred in 60% of the patients with associated ALL injury and in 72% of those with no associated injury ( p = 0.309). The mean score on the Lysholm Knee Scoring Scale was of 81.6 points in patients with associated ALL injury, and of 90.1 in those with no associated injury ( p = 0.032). The mean score on the IKDC Subjective Knee Form was of 70.3 points in patients with associated ALL injury and of 76.7 in those with no associated injury ( p = 0.112). Conclusion There was no statistically significant difference regarding graft injuries or new injuries to other structures, satisfaction with the operated knee, or the score on the IKDC Subjective Knee Form. Return to activity was similar in the groups with and without associated ALL injuries. The scores on the Lysholm Knee Scoring Scale were better, with a statistically significant difference in the group with no associated ALL injuries.
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Affiliation(s)
- João Paulo Fernandes Guerreiro
- Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
- Hospital de Ortopedia Uniort.e, Londrina, PR, Brasil
| | - Larissa Baldow Rosa
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
| | | | | | - Paulo Roberto Bignardi
- Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
| | - Marcus Vinicius Danieli
- Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
- Hospital de Ortopedia Uniort.e, Londrina, PR, Brasil
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Pettinari F, Carrozzo A, Saithna A, Ali AA, Alayane A, Barosso M, Vieira TD, Sonnery-Cottet B. Effect of Lateral Extra-Articular Procedures Combined With ACL Reconstruction on the Rate of Graft Rupture in Patients Aged Older Than 30 Years: A Matched-Pair Analysis of 1102 Patients From the SANTI Study Group. Am J Sports Med 2024; 52:1765-1772. [PMID: 38794893 DOI: 10.1177/03635465241247760] [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: 05/26/2024]
Abstract
BACKGROUND Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament (ACL) reconstruction (ACLR) and lateral extra-articular procedures (LEAPs) over isolated ACLR in terms of reducing graft rupture and reoperation rates. However, most of the published studies have included young patients, and no studies have focused on patients aged >30 years. PURPOSE/HYPOTHESIS The purpose of this study was to compare the outcomes of isolated ACLR versus ACLR + LEAP at midterm follow-up in patients aged >30 years. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients >30 years of age who underwent primary ACLR + LEAP between January 2003 and December 2020 were propensity matched at a 1:1 ratio to patients who underwent isolated ACLR. A retrospective analysis of prospectively collected data was performed to determine graft rupture rates, knee stability, reoperation rates, and complications. Graft survivorship was assessed using the Kaplan-Meier method. Risk factors associated with the occurrence of graft failure were analyzed using a Cox proportional hazards model. RESULTS Two groups of 551 patients each were included in the study, and the mean follow-up was 97.19 ± 47.23 months. The overall mean age was 37.01 ± 6.24 years. The LEAP group consisted of 503 (91.3%) patients who had anterolateral ligament reconstruction and 48 (8.7%) patients who had a Lemaire procedure. Overall, 19 (1.7%) patients had graft failure: 15 (2.7%) in the no-LEAP group and 4 (0.7%) in the LEAP group (P = .0116). The risk of graft failure was significantly associated with the absence of LEAP (31 vs 12; hazard ratio, 3.309; 95% CI, 1.088-10.065; P = .0350) and age between 30 and 35 years (hazard ratio, 4.533; 95% CI, 1.484-13.841; P = .0080). A higher rate of reoperation for secondary meniscectomy was found in the no-LEAP group (5.6% vs 2.2%; P = .0031). CONCLUSION Patients aged >30 years who underwent combined ACLR and LEAP experienced a >3-fold lower risk of ACL graft failure compared with those who underwent isolated ACLR. Furthermore, the group without LEAP experienced a higher rate of secondary meniscectomy.
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Affiliation(s)
- Francesco Pettinari
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Alessandro Carrozzo
- University of Rome La Sapienza, Orthopaedics and Traumatology Rome, Lazio, Italy
| | - Adnan Saithna
- AZBSC Orthopedics, Scottsdale, Arizona, USA
- Orthopaedics Department, Arizona State University, Tempe, Arizona, USA
| | - Ahmad Abed Ali
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Ali Alayane
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Marta Barosso
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
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Vasiliadis AV, Chytas D, Giovanoulis V, Troupis T, Noussios G. Anterolateral Ligament Pathological Anatomy and its Associated Injuries: An Infographic. Oman Med J 2024; 39:e643. [PMID: 39015427 PMCID: PMC11247305 DOI: 10.5001/omj.2024.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/06/2024] [Indexed: 07/18/2024] Open
Affiliation(s)
- Angelo V. Vasiliadis
- Department of Orthopaedic Surgery, Sports Trauma Unit, St. Luke's Hospital, Thessaloniki, Greece
- Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Serres, Greece
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Zografou, Greece
| | - Dimitrios Chytas
- Basic Sciences Laboratory, Department of Physiotherapy, University of Peloponnese, Sparta, Greece
- School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Vasileios Giovanoulis
- Department of Orthopedic Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Theodore Troupis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Zografou, Greece
| | - George Noussios
- Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Serres, Greece
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Garra S, Moore MR, Li ZI, Eskenazi J, Jazrawi T, Bi AS, Campbell KA, Alaia MJ, Strauss EJ. Segond fracture: an indicator for increased risk of lateral meniscus injury in patients with acute anterior cruciate ligament ruptures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1883-1891. [PMID: 38448565 DOI: 10.1007/s00590-024-03857-2] [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: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The purpose of this study was to investigate the incidence and anatomic distribution of meniscus injury in patients who have sustained acute ACL injuries with and without concomitant Segond fracture. We hypothesized that patients who have sustained a torn ACL with a concomitant Segond fracture would have a higher incidence of lateral meniscal injuries than patients with an isolated ACL injury. METHODS Patients who underwent ACL reconstruction from 2012 to 2022 were retrospectively reviewed. Segond fractures were identified on knee radiographs. Inclusion criteria were age 18-40, injury during sports activity, and reconstruction within 90 days of injury. Sports activity, anatomic location of meniscus injury, and meniscus treatment were documented. Multivariable regression was used to identify predictors of meniscus injury/treatment. RESULTS There were 25 of 603 (4.1%) patients who had an ACL tear with concomitant Segond fracture. The incidence of lateral meniscus injury in the Segond group (72%) was significantly higher than in the non-Segond cohort (49%; p = 0.024). A significantly smaller proportion of medial meniscus injuries among patients with Segond fractures were repaired (23.1%) compared to the non-Segond group (54.2%; p = 0.043). Multivariate analysis found patients with Segond fractures to have increased odds of lateral meniscus injury (OR 2.68; [1.09, 6.60], p = 0.032) and were less likely to have medial meniscus injuries repaired (OR 0.35; [0.15, 0.81], p = 0.014). Additionally, males had increased odds of lateral meniscus injury (OR 1.54; [1.08 - 2.91], p = 0.017), which were more likely to require repair (OR 1.48; [1.02, 2.14], p = 0.038). CONCLUSIONS Among acute ACL injuries, the incidence of lateral meniscus injury is greater among patients with Segond fractures. Patients with Segond fracture were less likely to undergo repair of medial meniscal injuries.
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Affiliation(s)
- Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA.
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Tel-Aviv University, Ramat Gan, Israel.
| | - Michael R Moore
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Taylor Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Andrew S Bi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
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Tollefson LV, Kennedy MI, Kennedy NI, LaPrade RF. Anatomic Anterolateral Ligament Reconstruction with Iliotibial Band Graft and Concomitant Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2024; 13:102906. [PMID: 38690330 PMCID: PMC11056646 DOI: 10.1016/j.eats.2023.102906] [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: 09/28/2023] [Accepted: 12/05/2023] [Indexed: 05/02/2024] Open
Abstract
Anterior cruciate ligament (ACL) reconstruction (ACLR) attempts to restore native ACL function. Persistent anterolateral instability is a common symptom after ACLR that can lead to worse patient outcomes. Additional surgeries, like anterolateral ligament reconstruction (ALLR), can augment the ACL graft and help increase anterolateral rotational stability. Certain indications for ACLR with ALLR include high-grade pivot shift, increased posterior tibial slope (>12°), revision ACLR, and concomitant ligamentous or meniscal injuries. We describe an anatomic ALLR technique using an 8 cm long × 1 cm wide strip of the inferior aspect of the iliotibial band fixed at the native attachment sites of the ALL.
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Garra S, Li ZI, Eskenazi J, Jazrawi T, Rao N, Campbell KA, Alaia MJ, Strauss EJ, Jazrawi LM. Patients With Segond Fracture Demonstrate Similar Rates of Return to Sport and Psychological Readiness After Anterior Cruciate Ligament Reconstruction: A Matched Cohort Study at Minimum 2-Year Follow-Up. Arthroscopy 2024; 40:1247-1255. [PMID: 37716633 DOI: 10.1016/j.arthro.2023.08.080] [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: 03/28/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To compare clinical outcomes, rate of return to sports, and psychological readiness among patients undergoing anterior cruciate ligament reconstruction (ACLR) with and without concomitant Segond fracture. METHODS We retrospectively identified patients who underwent primary ACLR from January 2012 to December 2020 with minimum 2-year follow-up. Exclusion criteria were additional ligamentous injury, age <16 years, or a concomitant lateral augmentation procedure. Preoperative knee radiographs were reviewed to identify Segond fractures. Identified patients were matched 1:2 to controls by age/sex/body mass index/graft type. Charts were reviewed for pre- and postoperative knee stability. Surveys administered included preinjury sport participation and return status, Lysholm score, Tegner activity scale, and ACL-Return to Sport Index (ACL-RSI), a metric of psychological sport readiness. Multivariable logistic regression was conducted to identify predictors of return to sport. RESULTS There were 120 patients who were included in the final analysis (40 Segond, 80 controls) at a mean follow-up of 5.7 ± 2.4 years. A total of 52.5% of patients received bone-patellar tendon-bone autograft. The overall rate of return to sport was 79.5% in the Segond group compared with an 83.8% rate of return in the control group (P = .569). In total, 48.7% of the Segond group and 56.8% of the control group returned to their preinjury level of sport (P = .415). Lysholm (89.6 ± 10.3 vs 85.4 ± 16.7, P = .296), Tegner (5.7 ± 1.8 vs 6.1 ± 2.2, P = .723), and ACL-RSI (62.2 ± 25.4 vs 56.6 ± 25.4, P = .578) scores were similar between Segond and control groups. There was a single graft failure in the Segond group 5 years' postoperatively. Increasing ACL-RSI score was significantly predictive of return to sport (P < .001). CONCLUSIONS Patients who had an ACL tear and a concomitant Segond fracture who underwent isolated ACLR without lateral augmentation procedures had similar clinical outcomes and rates of return sport compared with a matched isolated ACLR control group at minimum 2-year follow-up. There was no significant difference in psychological readiness between groups as measured by the ACL-RSI. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.; Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Taylor Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Naina Rao
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
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18
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Van de Velde SK, Telfer S, van Arkel ERA, Schmale GA. A lateral extra-articular tenodesis without additional hardware: Surgical technique and biomechanical comparison with an anatomic anterolateral ligament reconstruction in the augmentation of anterior cruciate ligament reconstruction. Knee 2024; 47:112-120. [PMID: 38394990 DOI: 10.1016/j.knee.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/22/2023] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The aims of this study were to describe a lateral extra-articular tenodesis (LET) using no additional hardware and compare the tibiofemoral kinematics of anterior cruciate ligament (ACL) reconstruction augmented with either the LET or a standard anatomic anterolateral ligament (ALL) reconstruction using intra-tunnel fixation. METHODS Ten cadaveric knees were mounted on a robotic testing system and underwent a kinematic assessment of anterior tibial translation and internal tibial rotation under a simulated pivot-shift in the following states: ACL-intact, ACL-sectioned, ACL-sectioned/anterolateral complex (ALC)-sectioned, ACL-reconstructed/ALC-sectioned, ACL-reconstructed/ALL-reconstructed, and ACL-reconstructed/LET. For the LET, an iliotibial autograft was passed under the fibular collateral ligament and secured to the femur with the pull sutures of the ACL reconstruction femoral cortical suspensory fixation device, positioned at the distal ridge of Kaplan's fibers. RESULTS Anterior tibial translation was restored to normal by ACL reconstruction without meaningful benefit of augmentation with LET or ALL. ACL reconstruction restored internal tibial rotation close to normal between 0° and 30°, but increased internal tibial rotation persisted between 45° and 90°. Augmentation of ACL reconstruction with the LET reduced internal rotation close to normal between 45° and 90°, whereas increased internal rotation persisted after ALL reconstruction. CONCLUSION ACL reconstruction and LET are complementary in controlling tibiofemoral kinematics of knees with a combined ACL and ALC injury: ACL reconstruction restored native tibiofemoral kinematics except for internal rotation at flexion greater than 30°. The increased internal rotation at flexion greater than 30° was restored to normal with an LET, but not with an ALL reconstruction.
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Affiliation(s)
- Samuel K Van de Velde
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA; Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA; Department of Orthopedic Surgery, Seattle Children's Hospital, Seattle, WA, USA.
| | - Scott Telfer
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Ewoud R A van Arkel
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Gregory A Schmale
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA; Department of Orthopedic Surgery, Seattle Children's Hospital, Seattle, WA, USA
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Helito CP, da Silva AGM, Sobrado MF, Guimarães TM, Gobbi RG, Pécora JR. Patients With More Than 6.5° of Knee Hyperextension are 14.6 Times More Likely to Have Anterior Cruciate Ligament Hamstring Graft Rupture and Worse Knee Stability and Functional Outcomes. Arthroscopy 2024; 40:898-907. [PMID: 37579954 DOI: 10.1016/j.arthro.2023.07.057] [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: 12/13/2022] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To create a cut-off point for hyperextension that best discriminates retear and to verify whether this cut-off point can predict retear regardless of other characteristics after primary anterior cruciate ligament (ACL) reconstruction with hamstrings autograft. METHODS A cohort of patients submitted to primary isolated ACL reconstruction with hamstrings autografts was retrospectively evaluated. Patients were stratified according to the degree of passive knee hyperextension measured in the normal contralateral knee. The following data were collected: patient age and sex, time from injury to surgery, knee hyperextension, KT-1000 and pivot-shift, associated meniscus injury, intra-articular graft size, follow-up time, graft failure, and postoperative Lysholm and subjective International Knee Documentation Committee scores. RESULTS Data from 457 patients were evaluated. Median age was 31 years. Thirty-two (7.0%) presented with retear. There was a significant difference in hyperextension between patients with and without retear (P < .001), with the cut-off point established by the receiver operating characteristic curve from 6.5°. Patients with greater hyperextension had a statistically greater frequency of women, longer injury time, greater intra-articular graft diameter, greater postoperative KT-1000, and greater frequency of retear, whereas the subjective International Knee Documentation Committee and Lysholm scores were statistically lower in patients with greater hyperextension. Only hyperextension showed a statistically significant association with re-rupture (P < .001). The odds of retear in patients with hyperextension greater than 6.5 was 14.65 times the odds of patients with hyperextension less than 6.5. CONCLUSIONS Patients with more than 6.5° of hyperextension are 14.6 times more likely to have a graft rupture than patients with lower hyperextension when submitted to ACL reconstruction with hamstring tendons. Also, they present worse knee stability by the KT-1000 test and worse functional outcomes. Therefore, patients with this degree of hyperextension should not have isolated reconstruction with hamstrings as their first choice. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP, Brazil; Hospital Sírio Libanês, São Paulo - SP, Brazil
| | - Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP, Brazil.
| | - Marcel Faraco Sobrado
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP, Brazil; Hospital Sírio Libanês, São Paulo - SP, Brazil
| | - Tales Mollica Guimarães
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP, Brazil
| | - Riccardo Gomes Gobbi
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP, Brazil
| | - José Ricardo Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP, Brazil
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Suh DK, Kang MW, Kim TJ, Kim SY, Wang JH. Incidence of Convergence Between Distally and Anteriorly Oriented ALL Femoral Tunnels and ACL Femoral Tunnels in Combined ACL and ALL Reconstruction: 3-Dimensional Computed Tomography Analysis of 227 Patients. Am J Sports Med 2024; 52:902-908. [PMID: 38353108 DOI: 10.1177/03635465241227223] [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: 03/17/2024]
Abstract
BACKGROUND Adjusting the direction of the anterolateral ligament (ALL) femoral tunnel is suggested to avoid tunnel convergence during anterior cruciate ligament (ACL) reconstruction. Yet, there has been no in vivo clinical study reporting the effect of changing the direction of the ALL tunnel on the incidence of convergence with the ACL tunnel. PURPOSE To report the incidence of convergence between the ACL femoral tunnel and a distally and anteriorly directed ALL femoral tunnel and to determine a safe distal angle and anterior angle. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 227 patients undergoing concomitant ALL and anatomic single-bundle ACL reconstruction between January 2020 and December 2022 were retrospectively reviewed. The tunnel convergence rate, angular orientation of the tunnels, and distance between tunnels were obtained using postoperative computed tomography. The patients were grouped based on the direction of the ALL tunnel (transverse vs distal anterior) and the presence of tunnel convergence (convergence vs no convergence). RESULTS The overall tunnel convergence rate was 53.3% (121/227 patients). Tunnel convergence was observed less frequently in the distal anterior group (33.7%) than in the transverse group (65.2%) (P < .001). The no convergence group showed an ALL tunnel oriented more distally (20.2°± 11.1°) and anteriorly (19.5°± 10.2°) compared with the convergence group (8.7°± 6.5° and 6.9°± 5.3°, respectively) (P = .005 and P = .008, respectively). There were no cases of tunnel convergence for ALL tunnels >24.3° distally and >25.5° anteriorly. There was no difference in the angle of the ACL femoral tunnel between all groups. CONCLUSION A distally and anteriorly directed ALL femoral tunnel reduced the incidence of convergence with the ACL femoral tunnel. A distal angle >24.3° and an anterior angle >25.5° of an ALL tunnel are suggested to safely avoid convergence with the ACL tunnel.
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Affiliation(s)
- Dae Keun Suh
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Min Wook Kang
- Department of Orthopaedic Surgery, Incheon Himchan General Hospital, Incheon, Republic of Korea
| | - Tae Jin Kim
- Department of Orthopaedic Surgery, Incheon Himchan General Hospital, Incheon, Republic of Korea
| | - Si Yeon Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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21
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Zhang ZY, Yin Y, Bai WB, Shi WL, Pan XY, Huang HJ, Zhang X, Wang C, Wang JQ. Association of Concomitant MRI-Determined Anterolateral Complex Injury With Quantitative Measurements of Altered Rotational Tibiofemoral Position on MRI in Patients With ACL Injury. Orthop J Sports Med 2024; 12:23259671241230954. [PMID: 38414665 PMCID: PMC10898314 DOI: 10.1177/23259671241230954] [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: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 02/29/2024] Open
Abstract
Background Reduced graft failure rates have been reported after anterior cruciate ligament (ACL) reconstruction combined with anterolateral complex (ALC) augmentation. However, the preoperative diagnosis of concomitant ALC injury remains a clinical challenge. Purpose To identify the altered rotational tibiofemoral position on magnetic resonance imaging (MRI) in ACL-injured patients with concomitant ALC injury. Study Design Cross-sectional study; Level of evidence, 3. Methods Based on the evaluation of ALC abnormalities on MRI scans by experienced surgeons, 123 patients with nonchronic (<3 months) ACL injury confirmed by arthroscopy were included. The patients were divided into 2 groups-an ALC-injured group (n = 57) and an ALC-intact group (n = 66). The altered rotational tibiofemoral position was evaluated and compared by quantitatively measuring internal rotational tibial subluxation (IRTS) and axial internal tibial rotation (ITRa) on MRI. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify the factors associated with concomitant MRI-determined ALC injury. Results The ALC-injured group showed significantly increased IRTS (P < .001), ITRa (P < .001), lateral anterior tibial subluxation (ATS) (P < .001), and global ATS (GATS) (P = .002) compared with the ALC-intact group, while no significant difference in medial ATS (P = .810) was observed. A strong positive correlation was identified between IRTS and ITRa (rP = 0.809; P < .001). Multivariate analyses revealed that IRTS (P < .001) and GATS (P = .016) were associated factors for the presence of concomitant MRI-determined ALC injury. IRTS (area under the curve [AUC] = 0.734) was more strongly associated with the outcome than GATS (AUC = 0.658) in ROC analyses, suggesting a more significant internal rotational subluxation than anterior subluxation of the tibia. An IRTS threshold of 3.1 mm demonstrated a specificity of 84.2% for indicating the presence of concomitant MRI-determined ALC injury. Conclusion The presence of concomitant MRI-determined ALC injury in ACL-injured patients was associated with a significant increase in IRTS and ITRa compared with those with intact ALC, indicating that these MRI measurements of the altered rotational tibiofemoral position could serve as potential quantifiable indicators for identifying concomitant ALC injury in clinical practice.
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Affiliation(s)
- Zhi-Yu Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yu Yin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Wen-Bin Bai
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Wei-Li Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Xiao-Yu Pan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. Z.Z. and Y.Y. contributed equally to this article. C.W. and J.W. contributed equally to this article
| | - Hong-Jie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jian-Quan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
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22
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Bechis M, Rosso F, Blonna D, Rossi R, Bonasia DE. Lateral Extra-Articular Tenodesis with Indirect Femoral Fixation Using an Anterior Cruciate Ligament Reconstruction Suspensory Device. J Clin Med 2024; 13:377. [PMID: 38256513 PMCID: PMC10816928 DOI: 10.3390/jcm13020377] [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: 12/21/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The lateral extra-articular tenodesis (LET) procedure associated with anterior cruciate ligament (ACL) reconstruction can be considered in selected patients to diminish the risk of persistent rotatory instability and achieve a protective effect on the graft. Several techniques have been described in the literature to treat rotatory instability. Usually, a strip of the iliotibial band (ITB) is harvested from its middle while leaving the distal insertion, then passed underneath the lateral collateral ligament and fixed on the lateral aspect of the distal femur with various fixation methods such as staples, screws, anchors or extracortical suspensory devices. Despite their effectiveness, these fixation methods may be associated with complications such as lateral pain, over-constraint and tunnel convergence. METHODS This study presents a detailed surgical description of a new technique to perform an LET during ACL reconstruction with any type of graft fixing the ITB strip with the sutures of the ACL femoral button, comparing its pros and cons in relation to similar techniques found in the literature. CONCLUSIONS This technique represents a reproducible, easy to learn and inexpensive solution to perform a lateral extra-articular tenodesis associated with an ACL reconstruction using the high-resistance sutures of the femoral button.
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Affiliation(s)
- Marco Bechis
- AO Ordine Mauriziano Hospital, Department of Orthopedics and Traumatology, University of Torino, 10124 Turin, Italy
| | | | | | | | - Davide Edoardo Bonasia
- AO Ordine Mauriziano Hospital, Department of Orthopedics and Traumatology, University of Torino, 10124 Turin, Italy
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23
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Dietvorst M, Verhagen S, van der Steen M, van Douveren FMP, Janssen RA. Anterolateral augmentation procedures during anterior cruciate ligament reconstructions in skeletally immature patients: Scoping review of surgical techniques and outcomes. J Exp Orthop 2024; 11:e12012. [PMID: 38455455 PMCID: PMC10915482 DOI: 10.1002/jeo2.12012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose Graft failure rates after anterior cruciate ligament reconstruction (ACLR) in children and adolescents are higher compared to adults. Anterolateral augmentation procedures have recently generated increased focus regarding their ability to reduce graft failure rates. Concerns in skeletally immatures are potential growth disturbances and overconstraint after anterolateral augmentation. The aim of this scoping review is to provide an overview of all current anterolateral augmentation procedures in skeletally immature patients and to discuss surgical techniques, clinical and biomechanical outcomes. Methods This scoping review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement extension for scoping reviews. On 22 December 2022, an information specialist performed a systematic literature search in Cochrane, PubMed (Medline) and EMBASE databases. Inclusion criteria were anterolateral augmentation procedures, including lateral extra-articular tenodesis (LET) and anterolateral ligament reconstruction (ALLR), in combination with ACLR in skeletally immatures. Results Twenty studies were included after screening 1.485 abstracts. Seventeen studies describe LET techniques, four studies ALLR techniques and one study both techniques. Biomechanical data is scarce and shows conflicting results. Two studies compared ACLR with LET to ACLR in skeletally immatures with promising results in favour of the combined procedure. There were no differences in outcomes between LET and ALLR. Conclusions Several LET and ALLR techniques have been described for skeletally immature patients and the first clinical data on LET and ALLR is available, which showed promising results. Further research is necessary to evaluate the risk of growth disturbances and overconstraint in skeletally immatures. Level of Evidence Level IV.
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Affiliation(s)
- Martijn Dietvorst
- Department of Orthopaedic Surgery & TraumaMaxima Medical CentreEindhovenThe Netherlands
| | - Stéphanie Verhagen
- Department of Orthopaedic Surgery & TraumaMaxima Medical CentreEindhovenThe Netherlands
| | - Marieke C. van der Steen
- Department of Orthopaedic Surgery & TraumaMaxima Medical CentreEindhovenThe Netherlands
- Department of Orthopaedic Surgery & TraumaCatharina Hospital EindhovenEindhovenThe Netherlands
| | | | - Rob P. A. Janssen
- Department of Orthopaedic Surgery & TraumaMaxima Medical CentreEindhovenThe Netherlands
- Orthopaedic Biomechanics, Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Chair Value‑Based Health Care, Department of Paramedical SciencesFontys University of Applied SciencesEindhovenThe Netherlands
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24
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da Silva AGM, Macedo RS, Souza MO, Giglio PN, Videira LD, Gobbi RG, Godoy dos Santos AL, Helito CP. Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using a Single Peroneus Longus Tendon Graft. Arthrosc Tech 2024; 13:102823. [PMID: 38312864 PMCID: PMC10837976 DOI: 10.1016/j.eats.2023.08.028] [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: 07/16/2023] [Accepted: 08/27/2023] [Indexed: 02/06/2024] Open
Abstract
The peroneus longus tendon seems a viable graft option for knee ligament reconstructions, with adequate biomechanical properties and low morbidity after harvesting. The objective of this article is to describe a combined anterior cruciate ligament and anterolateral ligament reconstruction technique using a single peroneus longus tendon graft harvested from the infra malleolar region to ensure sufficient length.
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Affiliation(s)
- Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rodrigo Sousa Macedo
- Grupo de Pé e Tornozelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Michel Oliveira Souza
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Nogueira Giglio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Livia Dau Videira
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Riccardo Gomes Gobbi
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alexandre Leme Godoy dos Santos
- Grupo de Pé e Tornozelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital Sírio Libanês, São Paulo, SP, Brazil
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25
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Yao G, Liu Y, Zhou Z, Zhang X, Liu K, Fu X, Hua Z, Wang Z. A Cadaveric Study of the Optimal Isometric Region on the Anterolateral Surface of the Knee in Anterolateral Ligament Reconstruction. Orthop Surg 2024; 16:157-166. [PMID: 38031513 PMCID: PMC10782248 DOI: 10.1111/os.13938] [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: 03/25/2023] [Revised: 10/07/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE Isolated intra-articular anterior cruciate ligament (ACL) reconstruction is not capable of restoring instability in many cases leading some to recommend concomitant anterolateral ligament (ALL) reconstruction. The satisfactory fixation site and graft length change are crucial in ligament reconstruction to restore the ALL function and avoid some unwanted graft behavior. The purpose of this investigation is to determine the optimal isometric region on the anterolateral aspect of the knee for ALL reconstruction using a three-dimensional optical instrument and a suture similar to an intraoperative isometric test. METHODS Six freshly frozen cadaveric human knees were used in this study. Data regarding the anterolateral surface were obtained using an optical measurement system to create a three-dimensional model. Nine points were selected on the femur (F1-F9) and tibia (Ta-Ti) respectively. The three-dimensional length change between each pair of tibial and femoral points was measured during passive knee flexion from 0° to 90° in 15° increments. Subsequently, five femoral points (A-E) were selected from the lateral femur, located in different areas relative to the lateral femoral epicondyle, and three tibial reference points (T1-T3) were selected in the isometric test. The changes in the length between each pair of reference points were measured using sutures. The 95% confidence interval for the rate of length change was estimated using the mean and standard deviation of the maximum rate of length change at different flexion angles, and the data were expressed as the mean (95% confidence interval) and compared with the maximum acceptable rate of change (10%). RESULTS The maximum acceptable change rate for ligament reconstruction is 10%, and the mean maximum rates and the 95% confidence interval (CI) of length change for the point combinations were calculated. Among all the combined points measured using the optical measurement system and the suture, the qualified point combination for reconstruction was F3 (8mm posterior and 8mm proximal to the lateral femoral epicondyle)-Tb (8mm proximal to the midpoint between the center of Gerdy's tubercle and the fibula head), A (posterior and proximal to the lateral femoral epicondyle)-T2 (10mm below the joint line)and A-T3 (15 mm below the joint line). The position of F3-Tb and A-T2 are close to each other. CONCLUSION The most isometric area of the femur for ALL reconstruction was posterior and proximal to the lateral femoral epicondyle. We recommend that the initial location of the femoral point be set at 8 mm posterior and 8 mm proximal to the lateral femoral epicondyle and the tibial point at approximately 10 mm below the joint line, midway between Gerdy's tubercle and fibular head, and subsequently adjusted to the most satisfactory position according to the isometric test.
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Affiliation(s)
- Gai Yao
- The Fifth Medial Center of Chinese PLA General HospitalBeijingChina
| | - Yang Liu
- Department of OsteoarthropathyThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Zhiyou Zhou
- Department of OsteoarthropathyThe Third Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Xuchao Zhang
- Department of OsteoarthropathyThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Kang Liu
- Department of OsteoarthropathyThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Xiawei Fu
- Department of OsteoarthropathyThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Zikai Hua
- Orthotek Laboratory, School of Mechatronics Engineering and AutomationShanghai UniversityShanghaiChina
| | - Zimin Wang
- Department of Orthopedic Surgery, Shanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Suzuki N, Watanabe A, Ninomiya T, Nakajima H, Horii M, Watanabe S, Shiko Y, Sasho T. Lateral meniscal injury without medial meniscal injury indicates the existence of the Segond fracture in ACL-deficient knees. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:59-64. [PMID: 38236496 PMCID: PMC10792093 DOI: 10.1016/j.asmart.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/13/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024] Open
Abstract
Background/Objective The purpose of this study was to find factors indicating the occurrence of the Segond fracture, a specific type of anterolateral ligament injury. Methods From January 2015 to December 2017, we retrospectively reviewed the medical records of patients diagnosed with acute anterior cruciate ligament (ACL) injury who underwent reconstruction within 90 days of injury. Diagnosis of the Segond fracture was determined either by magnetic resonance imaging or plain radiographs. Factors examined were: age at surgery, sex, body mass index (kg/m2), status of menisci, and activities led to ACL injury. After univariate screening, multivariate logistic regression analyses were performed. Patients were divided into four groups based on the presence of lateral meniscal (LM) and/or medial meniscal (MM) injuries and compared with respect to the occurrence of Segond fractures. Results A total of 375 patients were included (163 males, 212 females), with mean age 25.8 years old. Among them, 22 of 375 (5.9 %) had a Segond fracture. We identified injured lateral menisci (adjusted odds ratio (aOR), 3.029; 95 % Confidence Interval (CI), 1.206-7.609; P = 0.018), intact medial menisci (aOR, 0.229; 95 % CI, 0.065-0.810; P = 0.022), and higher body mass index (aOR, 1.102; 95 % CI, 1.008-1.205; P = 0.034) as factors indicative of the occurrence of Segond fracture. LM injury without MM injury suggested the existence of a Segond fracture. Conclusion LM injury without a MM injury indicated the occurrence of a Segond fracture. Higher body mass index also increased the risk for Segond fracture occurrence.
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Affiliation(s)
- Nobutada Suzuki
- Department of Radiology, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Atsuya Watanabe
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Taishi Ninomiya
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, 1-833 Hasamacho, Funabashi, Chiba, 274-0822, Japan
| | - Hirofumi Nakajima
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, 1-833 Hasamacho, Funabashi, Chiba, 274-0822, Japan
| | - Manato Horii
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Shotaro Watanabe
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-0856, Japan
| | - Takahisa Sasho
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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Guo Z, Liu F. Progress in research on and classification of surgical methods of arthroscopic reconstruction of the ACL and ALL using a shared tendon graft through the femoral tunnel. Front Surg 2023; 10:1292530. [PMID: 38186395 PMCID: PMC10766812 DOI: 10.3389/fsurg.2023.1292530] [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] [Received: 09/11/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Anterior cruciate ligament (ACL) tear is a common clinical injury, and ACL reconstruction has reached a very mature stage. However, with the accumulation of cases, scholars have found that isolated ACL reconstruction may not completely solve the problem of knee rotational stability. With the increase in our understanding of knee joint structure, ACL combined with anterolateral ligament (ALL) reconstruction has become accepted by most scholars, and this operation has also achieved good clinical results. At present, there is no unified surgical method for ACL combined with ALL reconstruction. There are differences in bone tunnel location, reconstruction methods, and graft selection. Compared with the independent reconstruction of the ACL and ALL during the operation, shared tendon graft reconstruction of the ACL and ALL has the advantages of preserving tendon and avoiding tunnel convergence. So far, there is no relevant literature summarizing the reconstruction of the ACL and ALL with a shared tendon graft. This paper reviews the anatomic study of the ALL, the study of isometric points, surgical indications, and surgical methods and their classification for shared tendon graft reconstruction of the ACL and ALL.
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Affiliation(s)
- Ziteng Guo
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
- School of Graduate, Hebei Medical University, Shijiazhuang, China
| | - Fei Liu
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
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Farinelli L, Meena A, Sonnery-Cottet B, Vieira TD, Pioger C, Tapasvi S, Abermann E, Hoser C, Fink C. Distal Kaplan fibers and anterolateral ligament injuries are associated with greater intra-articular internal tibial rotation in ACL-deficient knees based on magnetic resonance imaging. J Exp Orthop 2023; 10:113. [PMID: 37943352 PMCID: PMC10635991 DOI: 10.1186/s40634-023-00682-0] [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: 08/24/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE The purpose of the present study was to assess the internal rotation of the tibia on Magnetic Resonance Imaging (MRI) in a series of consecutive athletes with Anterior cruciate Ligament (ACL) tears. METHODS Retrospective analysis of prospectively collected data was performed to include all consecutive patients who had undergone primary ACL reconstruction between January 2022 and June 2022. The angle between surgical epicondylar axes (SEA) of the knee and posterior tibial condyles (PTC) was measured. A negative value was defined as internal torsion. KFs and ALL injuries were reported. Analysis of covariance (ANCOVA) was performed to examine the independent associations between SEA-PTC angle and injuries of KFs and ALL adjusted for physical variables (age, gender and body mass index [BMI]). Statistical significance was set at a p-value of < 0.05. RESULTS A total of 83 eligible patients were included. The result of multiple linear regression analysis showed that internal tibial rotation was associated with KFs and ALL injuries. The estimated average of SEA-PTC angle in relation to ALL injuries controlling the other variables was -5.49 [95%CI -6.79 - (-4.18)] versus -2.99 [95%CI -4.55 - (-1.44)] without ALL injuries. On the other hand, the estimated average of SEA-PTC angle in relation to KFs lesions controlling the other variables was -5.73 [95%CI -7.04 - (-4.43)] versus -2.75 [95%CI -4.31 - (-1.18)] without KFs injuries. CONCLUSIONS KFs and ALL injuries were associated with an increased intra-articular internal tibial rotation in ACL-deficient knees. The measurement of femorotibial rotation on axial MRI could be useful to detect indirect signs of anterolateral complex (ALC) injuries.
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Affiliation(s)
- Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Amit Meena
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Hôpital Mermoz, Groupe Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Hôpital Mermoz, Groupe Ramsay, Lyon, France
| | - Charles Pioger
- Department of Orthopaedic Surgery, Centre Hospitalier de Versailles, 177, Rue de Versailles, Le Chesnay, 78157, France
| | | | - Elisabeth Abermann
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Christian Hoser
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria.
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria.
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MISHRA ABHISHEKKUMAR, CHARMODE SUNDIP, KUSHWAHA SUDHIR, CHAUHAN VISHWA, MEHRA SIMMI, MISHRA VIVEK. Is antero-lateral complex of knee joint of critical importance in restoring rotational instability in patients with anterior cruciate ligament tear? J Public Health Afr 2023; 14:2696. [PMID: 38020268 PMCID: PMC10658464 DOI: 10.4081/jphia.2023.2696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/02/2023] [Indexed: 12/01/2023] Open
Abstract
Antero-lateral ligament complex (ALC) is a vital structure for maintaining rotational stability of the knee. Evaluation of ALC radiologically (MRI) is still unpopular in setting of anterior cruciate ligament injury. A dire necessity exists for the orthopedic surgeons in outdoor patient department settings to rule out involvement of ALC. So, that it can be addressed during operating for Anterior Cruciate Ligament injury. The authors have formulated an algorithm on a personal level and have implemented this screening program and initiated screening of young to middle aged patients reporting with rotational knee instability for ALC involvement before recommending final operative plan. This screening program which uses specifically devised physical tests have significantly reduced the number of underdiagnosed Antero Lateral Ligament tear.
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Affiliation(s)
| | - SUNDIP CHARMODE
- Department of Anatomy, All India Institute of Medical Sciences, Rajkot, Gujarat, India
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Ferretti A, Carrozzo A, Mazza D, Monaco E. Clinical Outcomes After Anterior Cruciate Ligament Reconstruction in Patients With a Concomitant Segond Fracture: Letter to the Editor. Am J Sports Med 2023; 51:NP46-NP48. [PMID: 37777864 DOI: 10.1177/03635465231189231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
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Mostowy M, Ruzik K, Ebisz M, LaPrade RF, Malinowski K. Impaction Fractures of the Lateral Femoral Condyle Related to Anterior Cruciate Ligament Injury: A Scoping Review Concerning Diagnosis, Prevalence, Clinical Importance, and Management. Clin Orthop Surg 2023; 15:781-792. [PMID: 37811510 PMCID: PMC10551676 DOI: 10.4055/cios22278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 10/10/2023] Open
Abstract
Background During pivot-shift anterior cruciate ligament (ACL) injury, bone bruises or impaction fractures of the lateral femoral condyle (LFC-IF) may occur due to impaction between the posterior part of the lateral tibial plateau and anterocentral part of the LFC. The purpose of the study was to systematically review the literature concerning the diagnosis, prevalence, clinical importance, and management of LFC-IF occurring during ACL injuries. Methods Included were studies concerning impaction fractures of the anterocentral part of the LFC occurring during ACL injuries. Studies concerning only bone bruises or cartilage lesions, without subchondral bone impaction, were not included. A search was performed in Medline and Scopus databases, with final search in May 2022. A secondary search was conducted within the bibliographies of included articles and using "Cited In" option. Two authors independently extracted data in three domains: study design, LFC-IF characteristics, and LFC-IF importance and management. Results A total of 35 studies were included for review with several studies reporting on multiple domains. Summarily, 31 studies were on the diagnosis and prevalence, 19 studies reported on the clinical importance, and 4 studies reported on the management of LFC-IF. Conclusions A LFC-IF occurs due to the pivot-shift mechanism of ACL injury. Its radiological feature is defined as an impaction of terminal sulcus deeper than 1 mm and is present in up to 52% of patients with a torn ACL. An LFC-IF causes injury to the cartilage, probably leads to its progressive degeneration, and is significantly associated with an increased risk of a lateral meniscus injury. A large LFC-IF might be associated with greater rotational knee instability. Although several techniques of LFC-IF treatment were proposed, none of them has been evaluated on a large cohort of patients to date.
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Affiliation(s)
- Marcin Mostowy
- Orthopedic and Trauma Department, Veteran's Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Michał Ebisz
- Artromedical Orthopaedic Clinic, Belchatow, Poland
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Wang K, Cheng L, Wang B, He B. Effect of isokinetic muscle strength training on knee muscle strength, proprioception, and balance ability in athletes with anterior cruciate ligament reconstruction: a randomised control trial. Front Physiol 2023; 14:1237497. [PMID: 37795267 PMCID: PMC10546193 DOI: 10.3389/fphys.2023.1237497] [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] [Received: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Objective: This study aimed to investigate the effects of regular isokinetic muscle strength training on knee muscle strength, proprioception, and balance ability in athletes after anterior cruciate ligament (ACL) reconstruction. Methods: Forty-one athletes who underwent ACL reconstruction were randomly divided into the experimental (n = 21) and control (n = 20) groups. The experimental group used an isokinetic muscle strength tester for 4 weeks (five times/ week) of knee flexion and extension isokinetic muscle strength training. The control group used the knee joint trainer (pneumatic resistance) for the same exercise regimen as the experimental group. Results: 1) Four weeks when compared with the baseline. Experimental group: the knee flexion and extension PT (60°/s and 240°/s) increased by 31.7%, 40.3%, 23.4%, and 42.9% (p < 0.01), and the flexion muscular endurance increased by 21.4% and 19.7% (p < 0.01). The flexion and extension kinaesthesia and the 30° and 60° position sense decreased by 36.2%, 32.3%, 40.0%, and 18.9% (p < 0.05). The anterior-posterior and medial-lateral displacement and speed decreased by 30.2%, 44.2%, 38.4%, and 24.0% (p < 0.05). Control group: the knee peak torque (60°/s) increased by 18.8% (p < 0.01). The anterior-posterior and medial-lateral displacement and speed decreased by 14.9%, 40.0%, 26.8%, and 19.5% (p < 0.01). 2) After 4 weeks, compared with the control group, the knee flexion and extension peak torque (60°/s), extension, peak torque (240°/s), and extension muscular endurance of the treatment group increased to varying degrees (p < 0.05). However, the kinaesthesia, 30° position sense, and anterior-posterior displacement decreased to varying degrees (p < 0.05). Conclusion: Adding regular isokinetic muscle strength training to rehabilitation training further improved the knee flexion and extensor strength and extensor endurance of athletes with ACL reconstruction, as well as enhanced the kinaesthesia and 30° position sense and the balance between the anterior and posterior directions. However, the treatment had limited effects on knee flexion kinaesthesia and muscle endurance.
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Affiliation(s)
- Kun Wang
- Post-Doctoral Scientific Research Workstation of Affiliated Sport Hospital, Chengdu Sport University, Chengdu, China
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Liang Cheng
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Bingcheng Wang
- Jinling Hospital, General Hospital of Eastern Theater Command, Nanjing, China
| | - Benxiang He
- Sichuan Academy of Traditional Chinese Medicine, Chengdu, China
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Lucenti L, Testa G, Montemagno M, Sapienza M, Russo A, Di Maria F, de Cristo C, Pavone V. The Anterolateral Ligament of the Knee in Pediatric Patients: What Do We Know? A Scoping Review. J Funct Morphol Kinesiol 2023; 8:126. [PMID: 37754959 PMCID: PMC10531858 DOI: 10.3390/jfmk8030126] [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: 07/12/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
The knowledge on the anatomy, function and biomechanics and the role of surgical procedures on the anterolateral ligament (ALL) of the knee is still controversial. Only a few papers have examined the ALL in children. The aim of this review is to analyze all the available literature about ALL in the pediatric population. Following the PRISMA criteria, the literature was systematically reviewed, examining all the articles about ALL in pediatric patients. Eight articles were involved in this study. Five cadaveric studies, two diagnostic studies, and one cross-sectional study were found. The identification of the ALL is not always possible in diagnostic studies using magnetic resonance (MRI) or in dissecting specimens. A high variability in the presence of the ligament and in its origin and insertion were found among the studies. It is more difficult to identify the ligament in younger patients than in older children, suggesting that its presence may develop at some point during the growth. Further studies are needed for a detailed knowledge of the ALL.
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Affiliation(s)
- Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Marco Montemagno
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Arcangelo Russo
- Orthopaedic and Traumatology Unit, Umberto I Hospital, 94100 Enna, Italy;
| | - Fabrizio Di Maria
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Claudia de Cristo
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
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Zhao D, Pan JK, Lin FZ, Luo MH, Liang GH, Zeng LF, Huang HT, Han YH, Xu NJ, Yang WY, Liu J. Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3053-3075. [PMID: 36189967 DOI: 10.1177/03635465221119787] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The rerupture or need for revision after anterior cruciate ligament reconstruction (ACLR) is a serious complication. Preventive strategies that target the early identification of risk factors are important to reduce the incidence of additional surgery. PURPOSE To perform a systematic review and meta-analysis to investigate risk factors for revision or rerupture after ACLR. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Literature searches were performed in PubMed, Embase, and Web of Science from database inception to November 2021 and updated in January 2022. Quantitative, original studies reporting potential adjusted risk factors were included. Odds ratios (ORs) were calculated for potential risk factors. RESULTS A total of 71 studies across 13 countries with a total sample size of 629,120 met the inclusion criteria. Fifteen factors were associated with an increase in the risk of revision or rerupture after ACLR: male sex (OR, 1.27; 95% CI, 1.14-1.41), younger age (OR, 1.07; 95% CI, 1.05-1.08), lower body mass index (BMI) (OR, 1.03; 95% CI, 1.00-1.06), family history (OR, 2.47; 95% CI, 1.50-4.08), White race (OR, 1.32; 95% CI, 1.08-1.60), higher posterolateral tibial slope (OR, 1.15; 95% CI, 1.05-1.26), preoperative high-grade anterior knee laxity (OR, 2.30; 95% CI, 1.46-3.64), higher baseline Marx activity level (OR, 1.07; 95% CI, 1.02-1.13), return to a high activity level/sport (OR, 2.03; 95% CI, 1.15-3.57), an ACLR within less than a year after injury (OR, 2.05; 95% CI, 1.81-2.32), a concomitant medial collateral ligament (MCL) injury (OR, 1.62; 95% CI, 1.31-2.00), an anteromedial portal or transportal technique (OR, 1.36; 95% CI, 1.22-1.51), hamstring tendon (HT) autografts (vs bone-patellar tendon-bone [BPTB] autografts) (OR, 1.60; 95% CI, 1.40-1.82), allografts (OR, 2.63; 95% CI, 1.65-4.19), and smaller graft diameter (OR, 1.21; 95% CI, 1.05-1.38). The other factors failed to show an association with an increased risk of revision or rerupture after ACLR. CONCLUSION Male sex, younger age, lower BMI, family history, White race, higher posterolateral tibial slope, preoperative high-grade anterior knee laxity, higher baseline Marx activity level, return to a high activity level/sport, an ACLR within less than a year from injury, a concomitant MCL injury, an anteromedial portal or transportal technique, HT autografts (vs BPTB autografts), allografts, and smaller graft diameter may increase the risk of revision or rerupture after ACLR. Raising awareness and implementing effective preventions/interventions for risk factors are priorities for clinical practitioners to reduce the incidence of revision or rerupture after ACLR.
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Affiliation(s)
- Di Zhao
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jian-Ke Pan
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang-Zheng Lin
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-Hui Luo
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gui-Hong Liang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ling-Feng Zeng
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - He-Tao Huang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Hong Han
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nan-Jun Xu
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Yi Yang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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Lee DW, Lee DH, Cho SI, Yang SJ, Kim WJ, Lee JK, Kim JG. Comparison of ACL and Anterolateral Ligament Reconstruction With Isolated ACL Reconstruction Using Hamstring Autograft: Outcomes in Young Female Patients With High-Grade Pivot Shift. Orthop J Sports Med 2023; 11:23259671231178048. [PMID: 37781636 PMCID: PMC10536865 DOI: 10.1177/23259671231178048] [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: 02/25/2023] [Accepted: 03/10/2023] [Indexed: 10/03/2023] Open
Abstract
Background Inferior return to sports (RTS) and functional outcomes have been reported in women after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis The purpose was to evaluate the results of combined ACLR and anterolateral ligament reconstruction (ALLR) in young women with a high-grade pivot shift (grade ≥2). It was hypothesized that combined ACLR and ALLR would result in better RTS and rotational stability than isolated ACLR. Study Design Cohort study; Level of evidence, 3. Methods Two groups were retrospectively evaluated and compared. Group I (n = 39; mean age, 31.1 ± 5.7 years) underwent isolated ACLR using hamstring autografts; group C (n = 39; mean age, 30.4 ± 6.1 years) underwent combined ACLR and ALLR. Subjective outcome measures included the International Knee Documentation Committee subjective form, Lysholm, Tegner, and ACL-Return to Sport after Injury (ACL-RSI). Objective tests included a KT-2000 arthrometer stress test, a pivot-shift test, an isokinetic strength test, a Y-balance test, and a single-leg hop test. A postoperative questionnaire was administered to determine the rates and types of RTS, quality of sports performance, and reinjury and satisfaction rates. Subjective scores and clinical tests were performed at 2 years. Magnetic resonance imaging and second-look arthroscopy were conducted during the 1- and 2-year follow-ups, respectively. Results The mean follow-up for groups I and C were 30.4 ± 3.9 and 29.3 ± 3.5 months, respectively (P = .194). Patients in group C had better anteroposterior (P = .001) and rotational (P = .005) stability and higher ACL-RSI scores (P = .025) than those in group I. Group C had higher composite and posteromedial reach scores on the Y-balance test than group I (P = .014 and P = .010, respectively). A total of 26 (66.7%) patients in group C and 17 (43.6%) in group I returned to their prior level of sports (P = .040). Rerupture of the ACL graft and contralateral ACL rupture occurred in 2 (5.1%) and 2 (5.1%) patients in group I, respectively, compared with no rerupture or contralateral ACL rupture in group C. Conclusion Combined ACLR and ALLR in young women with a high-grade pivot shift was associated with better knee stability parameters, dynamic postural stability, and psychological readiness to RTS than isolated ACLR.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dong Hwan Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seung Ik Cho
- Sports Medical Center, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang Jin Yang
- Department of Health and Exercise Management, Tongwon University, Gwangju-si, Gyeonggi-do, Republic of Korea
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
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Kim YS, Koo S, Kim JH, Tae J, Wang JH, Ahn JH, Jang KM, Jeon J, Lee DK. Greater Knee Rotatory Instability After Posterior Meniscocapsular Injury Versus Anterolateral Ligament Injury: A Proposed Mechanism of High-Grade Pivot Shift. Orthop J Sports Med 2023; 11:23259671231188712. [PMID: 37693803 PMCID: PMC10486219 DOI: 10.1177/23259671231188712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 09/12/2023] Open
Abstract
Background For anterolateral rotatory instability as a result of secondary soft tissue injuries in anterior cruciate ligament (ACL)-deficient knees, there is increasing interest in secondary stabilizers to prevent internal rotation (IR) of the tibia. Purpose To determine which secondary stabilizer is more important in anterolateral rotatory instability in ACL-deficient knees. Study Design Controlled laboratory study. Methods The lower extremities of 10 fresh-frozen cadavers (20 extremities) without anterior-posterior or rotational instability were included. Matched-pair randomization was performed, with each side per specimen assigned to 1 of 2 groups. In group 1, the ACL was sectioned, followed by the anterolateral ligament (ALL); in group 2, the ACL was sectioned, followed by sequential sectioning of the posterolateral meniscocapsular complex (PLMCC) and posteromedial meniscocapsular complex (PMMCC). The primary outcome was the change in relative tibial IR during a simulated pivot-shift test with 5 N·m of IR torque and 8.9 N of valgus force. The secondary outcomes were the International Knee Documentation Committee grade in the pivot-shift test and the incidence of the grade 3 pivot shift. Results In group 1, compared with baseline, the change in relative tibial IR at 0° of knee flexion was 1.4° (95% CI, -0.1° to 2.9°; P = .052) after ALL release. In group 2, it was 2.5° (95% CI, 0.4° to 4.8°; P = .007) after PLMCC release and 4.1° (95% CI, 0.5° to 7.8°; P = .017) after combined PLMCC and PMMCC release. Combined PLMCC and PMMCC release resulted in greater change of tibial IR with statistical significance at 0°, 15°, and 30° of knee flexion (P = .008, .057, and .004, respectively) compared with ALL release. The incidence of grade 3 pivot shifts was 10% in group 1 and 90% in group 2. Conclusion Posterior meniscocapsular laxity caused an increase in relative tibial IR as much as ALL injury in ACL-deficient knees in our simulated laboratory test, and greater anterolateral rotatory instability occurred with posterior meniscocapsular injury compared with ALL injury. Clinical Relevance Repair of the injured posterior meniscocapsular complex may be an important treatment option for reducing anterolateral rotatory instability in the ACL-deficient knee.
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Affiliation(s)
- Yi-Suk Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungbum Koo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Kyunghee University Hospital at Gangdong, Kyunghee University School of Medicine, Seoul, Republic of Korea
| | - Jungyeun Tae
- Konyang University School of Medicine, Daejeon, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Hwan Ahn
- Department of Orthopaedic Surgery, Saeum Hospital, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jongmin Jeon
- Department of Orthopedic Surgery, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Do Kyung Lee
- Department of Orthopedic Surgery, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
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D’Ambrosi R, Meena A, Arora ES, Attri M, Schäfer L, Migliorini F. Reconstruction of the anterior cruciate ligament: a historical view. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:364. [PMID: 37675316 PMCID: PMC10477645 DOI: 10.21037/atm-23-87] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/17/2023] [Indexed: 09/08/2023]
Abstract
Management of anterior cruciate ligament (ACL) tears has continuously evolved since its first description in approximately 170 A.D. by Claudius Galenus of Pergamum and Rome. The initial immobilization using casts was replaced by a variety of surgical and conservative approaches over the past centuries. The first successful case of ACL repair was conducted by Mayo Robson in 1885, suturing cruciate at the femoral site. In the nineteenth century, surgical techniques were focused on restoring knee kinematics and published the first ACL repair. The use of grafts for ACL reconstruction was introduced in 1917 but gained popularity in the late 1900s. The introduction of arthroscopy in the 1980s represented the greatest milestones in the development of ACL surgery, along with the refinements of indications, development of modern strategies, and improvement in rehabilitation methods. Despite the rapid development and multitude of new treatment approaches for ACL injuries in the last 20 years, autografting has remained the treatment of choice. Compared to the initial methods, arthroscopic procedures are mainly performed, and more resistant and safer fixation devices are available. This results in significantly less trauma from the surgery and more satisfactory long-term results. The most commonly used procedures are still patellar tendon or hamstring autograft. Additionally, popular, but less common, is the use of quadriceps tendon (QT) grafts and allografts. In parallel with surgical developments, biological reconstruction focusing on the preservation of ACL remnants through the use of cell culture techniques, partial reconstruction, tissue engineering, and gene therapy has gained popularity. In 2013, Claes reported the discovery of a new ligament [anterolateral ligament (ALL)] in the knee that could completely change the treatment of knee injuries. The intent of these modifications is to significantly improve the primary restriction of rotational laxity of the knee after ACL injury. Kinematic studies have demonstrated that anatomic ACL reconstruction and anterolateral reconstruction are synergistic in controlling pivot displacement. Recently, there has been an increased focus on the application of artificial intelligence and machine learning to improve predictive capability within numerous sectors of medicine, including orthopedic surgery.
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Affiliation(s)
- Riccardo D’Ambrosi
- CASCO Department, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Amit Meena
- Department Orthopaedic Sports Medicine, Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada
| | - Ekjot Singh Arora
- Department of Orthopedic, Fortis Escorts Heart Institute, New Delhi, India
| | - Manish Attri
- Department of Orthopedic, Central Institute of Orthopedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Luise Schäfer
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
- Department of Orthopedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
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Bormann M, Neidlein C, Neidlein N, Ehrl D, Jörgens M, Berthold DP, Böcker W, Holzapfel BM, Fürmetz J. High Prevalence of Persistent Measurable Postoperative Knee Joint Laxity in Patients with Tibial Plateau Fractures Treated by Open Reduction and Internal Fixation (ORIF). J Clin Med 2023; 12:5580. [PMID: 37685647 PMCID: PMC10488731 DOI: 10.3390/jcm12175580] [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: 07/20/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
The development of post-traumatic osteoarthrosis after tibial plateau fracture (TPF) is multifactorial and can only be partially influenced by surgical treatment. There is no standardized method for assessing pre- and postoperative knee joint laxity. Data on the incidence of postoperative laxity after TPF are limited. The purpose of this study was to quantify postoperative laxity of the knee joint after TPF. Fifty-four patients (mean age 51 ± 11.9 years) were included in this study. There was a significant increase in anterior-posterior translation in 78.0% and internal rotation in 78.9% in the injured knee when compared to the healthy knee. Simple fractures showed no significant difference in laxity compared to complex fractures. When preoperative ligament damage and/or meniscal lesions were present and surgically treated by refixation and/or bracing, patients showed higher instability when compared to patients without preoperative ligament and/or meniscal damage. Patients with surgically treated TPF demonstrate measurable knee joint laxity at a minimum of 1 year postoperatively. Fracture types have no influence on postoperative laxity. This emphasizes the importance of recognizing TPF as a multifaceted injury involving both complex fractures and damage to multiple ligaments and soft tissue structures, which may require further surgical intervention after osteosynthesis.
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Affiliation(s)
- Markus Bormann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Claas Neidlein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Niels Neidlein
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Dennis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, LMU Munich, 81377 Munich, Germany
| | - Maximilian Jörgens
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Daniel P. Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Julian Fürmetz
- Department of Trauma Surgery, Trauma Center Murnau, 82418 Murnau am Staffelsee, Germany
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Carvalho A, Novaes M, Sauer J, Demange MK, Helito CP, João SMA. Muscle function, Lysholm score and hop performance in individuals with clinical indications for the combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: A cross-sectional study. Clinics (Sao Paulo) 2023; 78:100267. [PMID: 37597471 PMCID: PMC10460945 DOI: 10.1016/j.clinsp.2023.100267] [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: 12/09/2022] [Revised: 07/05/2023] [Accepted: 07/26/2023] [Indexed: 08/21/2023] Open
Abstract
OBJECTIVE To evaluate hip and knee muscular function, knee patient-reported outcome measures and hop performance in patients with a clinical indication for combined ACL+ALL reconstruction surgery compared to patients with an isolated ACL reconstruction surgery indication (preoperative phase) and to a control group. DESIGN Cross-sectional study. METHODS The sample was composed of male individuals, aged between 18 and 59 years, divided into three groups (ACL, ACL+ALL and Control). Isokinetic dynamometry was performed for the flexor and extensor knee muscles and for the hip abductors and adductors. SLHT, COHT and the Lysholm score were performed. Pain, swelling, and thigh trophism were also measured. RESULTS The study participants were 89 male individuals: 63 in the injury group and 26 in the control group. After applying the criteria for an ALL reconstruction indication, 33 patients were assigned to the ACL Group and 30 patients to the ACL+ALL Group. Regarding knee and hip muscle function, both groups presented worse results when compared to the control group, however, did not show significant differences compared to each other. Regarding the functional variables, the ACL+ALL group showed a significantly shorter distance achieved in the Crossover Hop Test than the other groups, as well as more pain during the tests. CONCLUSION Knee and hip muscular functions are impaired after an ACL injury and do not seem to be influenced or worsened in individuals with greater rotational instability with clinical indications for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee.
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Affiliation(s)
- Adriana Carvalho
- Physical Therapy Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Department of Physical Therapy, Speech and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Marilia Novaes
- Department of Physical Therapy, Speech and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana Sauer
- Department of Physical Therapy, Speech and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Kawamura Demange
- Knee Surgery Division, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Camilo Partezani Helito
- Knee Surgery Division, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvia Maria Amado João
- Department of Physical Therapy, Speech and Occupational Therapy, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Kumar A, Raza K, Krishna H, Narayan RK, Jha RK, Kumari C, Asghar A, Kumar T, Agrawal P. Sharing of proximal fibers by the anterolateral and lateral collateral ligaments in the human knee: a cadaveric study. Sci Rep 2023; 13:12317. [PMID: 37516773 PMCID: PMC10387103 DOI: 10.1038/s41598-023-38211-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/05/2023] [Indexed: 07/31/2023] Open
Abstract
Literature is highly inconsistent in describing the proximal attachment of the anterolateral ligament (ALL) and its relationship with the lateral collateral ligament (LCL) in human knees. This observational study aims to investigate that lacuna. The gross dissection was performed in the lower limbs (n = 83) from the donated adult-age (> 18 years) embalmed cadavers from medical institutions in the north and east India. The dissected knee specimens were first examined macroscopically. Further routine and special staining and microscopic examinations were performed. The ALL was absent in approximately 20.4% of the studied knee specimens (17/83). In remaining, the sharing of ALL and LCL proximal fibers was observed as a consistent finding (~ 97%) with rare exceptions. The mean length of the tibial and meniscal limbs of ALL was 1.57 ± 0.8 cm [Range (R) 0.5-4 cm] and 0.73 ± 0.47 cm [Range (R) 0.1-1.6 cm], respectively. In addition, multiple variations in its presentation were observed. We propose that the proximal sharing of LCL-ALL fibers is a dominant feature in the studied population. The sharing of the fibers may impact the biomechanics and injury mechanisms for both ligaments. The possibility of ethnic variations in the ALL morphology should be a concern during reconstruction surgery.
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Affiliation(s)
- Ashutosh Kumar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, Bihar, 801507, India.
| | - Khursheed Raza
- Department of Anatomy, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Hare Krishna
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravi K Narayan
- Department of Anatomy, Dr. B.C. Roy Multi Speciality Medical Research Center, Indian Institute of Technology, Kharagpur, West Bengal, India
| | - Rakesh K Jha
- Department of Anatomy, All India Institute of Medical Sciences, Patna, Bihar, 801507, India
| | - Chiman Kumari
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Adil Asghar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, Bihar, 801507, India
| | - Tarun Kumar
- Department of Pathology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Prabhat Agrawal
- Department of Orthopedics, All India Institute of Medical Sciences, Patna, Bihar, India
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41
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Oputa TJ, Jain N. Acute knee pain. BMJ 2023; 382:e075577. [PMID: 37414429 DOI: 10.1136/bmj-2023-075577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Tobenna J Oputa
- Lancashire Teaching Hospitals, Royal Preston Hospital, Preston, UK
| | - Neil Jain
- Northern Care Alliance, Fairfield General Hospital, Bury, UK
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Lee JK, Cho SI, Lee DW, Yang SJ, Kim TW, Kim JG. Additional Anterolateral Ligament Reconstruction Helps Patients Improve Dynamic Postural Stability in Revision Anterior Cruciate Ligament Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1242. [PMID: 37512054 PMCID: PMC10386532 DOI: 10.3390/medicina59071242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The goal in treating anterior cruciate ligament (ACL) injury especially in revision cases is return to sports activity by regaining dynamic postural stability. Among various methods to achieve this goal, additional anterolateral ligament reconstruction (ALLR) is gaining attention. The purpose of this study was to evaluate the effects of additional ALLR in revision ACL reconstruction (RACLR). Materials and Methods: Patients who underwent RACLR between July 2015 and June 2018 were enrolled. The exclusion criteria were less than 1-year follow-up, age older than 45 years, concomitant multiple ligament injuries, contralateral knee injury, subtotal or total meniscectomized state, and articular cartilage lesions worse than Outerbridge grade 3. Thirty-nine patients (20 patients; RACLR only (Group A), 19 patients; RACLR with additional ALLR (Group B)) were included. Clinical scores (Lysholm score, subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale), isokinetic strength test, single-leg-hop for distance test (SLHDT), Y-balance test (YBT) were checked preoperatively and 1-year postoperatively. Results: Limb symmetry index values in YBT showed significantly better result in Group B 1-year postoperatively (Group A: 97.2 ± 4.0, Group B: 100.3 ± 2.9, p = 0.010), although there were no differences preoperatively between groups (Group A: 90.4 ± 6.7, Group B: 89.3 ± 5.5, p = 0.594). Regarding clinical scores, isokinetic strength tests, and SLHDT, there were no differences between groups preoperatively nor 1-year postoperatively. Conclusions: Additional ALLR in RACLR helped patients gain better dynamic postural stability at 1-year postoperative follow-up.
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Affiliation(s)
- 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
| | - Seung-Ik Cho
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Dhong-Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Sang-Jin Yang
- Department of Health & Exercise Management, Tongwon University, Gwangju-si 12813, Republic of Korea
| | - Tae-Wook Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Jin-Goo Kim
- Department of Orthopaedic Surgery, Myong-Ji Hospital, Goyang-si 10475, Republic of Korea
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Stranger N, Kaulfersch C, Mattiassich G, Mandl J, Hausbrandt PA, Szolar D, Schöllnast H, Tillich M. Frequency of anterolateral ligament tears and ramp lesions in patients with anterior cruciate ligament tears and associated injuries indicative for these lesions-a retrospective MRI analysis. Eur Radiol 2023; 33:4833-4841. [PMID: 36806565 PMCID: PMC10290041 DOI: 10.1007/s00330-023-09444-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES To assess the frequency of anterolateral ligament (ALL) tears and ramp lesions (RL) detected with MRI in patients with anterior cruciate ligament (ACL) tears and to describe associated injuries indicative for these lesions. METHODS In this retrospective study, 164 patients with surgically verified ACL tears were included. Preoperative MRI scans were reviewed for ALL tears and different types of RL. All coexisting meniscal tears, tears of the medial (MCL) and lateral collateral band (LCL), and posterior-medial tibial bone marrow edema (BME) were recorded. The frequency of ALL tears and RL was assessed and coexisting injuries were correlated using Pearson's chi-square test. A p < 0.05 was defined as statistically significant. In cases of multiple testing, Bonferroni's correction was applied. RESULTS ALL tears and RL combined were detected in 28 patients (17.1%), ALL tears in 48 patients (29.3%), and RL in 54 patients (32.9%) which were significantly associated to each other. ALL tears were significantly associated with tears of the posterior horn of the lateral meniscus (PHLM), BME, and with tears of the LCL and MCL. RL were significantly associated with tears of the posterior horn of the medial (PHMM) and PHLM, with BME, and with tears of the LCL. CONCLUSIONS ACL tears are associated with RL or ALL tears in about one-third of cases and with both lesions combined in about one-fifth of cases. ALL tears and RL are significantly associated with additional posttraumatic injuries, which can thus be indicative of these lesions. KEY POINTS • ACL tears were associated with ramp lesions or ALL tears in about one-third of the cases. • Ramp lesions and ALL tears were significantly associated with each other, tear in the PHLM, tear in the LCL, and BME. • ALL tears were more frequently associated with instable classified ramp lesion type 4b and type 5.
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Affiliation(s)
- Nikolaus Stranger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Christian Kaulfersch
- Department of Trauma Surgery, Klinik Diakonissen Schladming, Schladming, Austria
| | - Georg Mattiassich
- Department of Trauma Surgery, Klinik Diakonissen Schladming, Schladming, Austria
| | | | | | | | - Helmut Schöllnast
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
- Institute of Radiology, LKH Graz II, Göstinger Strasse 22, 8020, Graz, Austria.
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Zanna L, Niccolò G, Matteo I, Malone J, Roberto C, Fabrizio M. Clinical outcomes and return to sport after single-stage revision anterior cruciate ligament reconstruction by bone-patellar tendon autograft combined with lateral extra-articular tenodesis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:1811-1819. [PMID: 35980541 PMCID: PMC10276068 DOI: 10.1007/s00590-022-03352-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The anterior cruciate ligament reconstruction (ACLR) failure rate continues to increase. Involvement of a young population with a desire to return to sport, explains the increased need for ACLR (revACLR) revision. The aim of this study was to evaluate clinical outcome, complications, failure rate and return to sport of a single-stage revACLR using bone patellar tendon-bone (BTBT) combined with lateral extra-articular tenodesis (LET). MATERIAL AND METHODS A retrospective analysis was performed on 36 patients who underwent revACLR. Knee stability was assessed by Lachman and Pivot shift test. Objective anterior laxity was determined by KT-2000 arthrometer. The IKDC subjective, Lysholm, ACL-RSI Scores, level of sport activity and Forgotten Joint Score-12 were recorded. RESULTS Of 36 patients, we collected data from 17 who underwent single-stage revACLR with autologous BTBT combined with LET, performed using an extra-articular MacIntosh procedure as modified by Arnold-Coker. The side-to-side difference in Lachman test and Pivot shift test significantly improved postoperatively. The subjective IKDC, Lysholm and ACL-RSI significantly improved from 71.4 ± 9.03 to 92 ± 6.9, from 58.3 ± 19.3 to 66.8 ± 27.7 and from 50.4 ± 12.2 to 68.6 ± 24.5, respectively during the post-operative follow-up. Ten patients (58.8%) returned to their desired level of sport. One patient was considered a failure because of the postoperative laxity. CONCLUSION Single-stage revACLR with BPTB combined with LET is a safe procedure that shows good objective and subjective outcomes, and a high rate of return to the same level of sport. Reducing rotational instability and strain on intra-articular reconstructed structures results in a low rate of complications and failure.
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Affiliation(s)
- Luigi Zanna
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1, 50139 Florence, Italy
| | - Giabbani Niccolò
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1, 50139 Florence, Italy
| | - Innocenti Matteo
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1, 50139 Florence, Italy
| | - Joseph Malone
- Department of Respiratory Medicine, Medical Clinic, Ullevål Hospital, Oslo University Hospital, Oslo, Norway
| | - Civinini Roberto
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1, 50139 Florence, Italy
| | - Matassi Fabrizio
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1, 50139 Florence, Italy
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Noailles T, Toanen C, Geffroy L, Lopes R, Hardy A. Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction With Pedicular Hamstrings Tendon Graft, Single-Strand Gracilis for ALL and Single Blind Femoral Tunnel. Arthrosc Tech 2023; 12:e1145-e1154. [PMID: 37533915 PMCID: PMC10390882 DOI: 10.1016/j.eats.2023.03.003] [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: 12/30/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 08/04/2023] Open
Abstract
Combined anterior cruciate ligament and anterolateral ligament reconstruction (ACL+ALL r) is a common procedure to treat rotational instability and to prevent ACL graft failure. Recent studies have described numerous combined reconstruction techniques to obtain the most anatomical procedure with the least graft donor site morbidity and the best clinical results. Hamstring (HG) grafts are the most popular graft in literature. Leaving pedicle HG can preserve enough blood supply to improve tendon-bone healing with additional mechanical fixation of the graft on the tibial side. A single femoral tunnel reduces bone loss and prevents convergence of 2 femoral tunnels. We describe an original ACL and ALL reconstruction technique that preserves hamstring tibial insertion with a single blind femoral tunnel.
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Affiliation(s)
- Thibaut Noailles
- Département de Chirurgie Orthopédique, Polyclinique de Bordeaux Nord, Bordeaux, France
| | - Cécile Toanen
- Service de Chirurgie Orthopédique, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | | | - Ronny Lopes
- Département de Chirurgie Orthopédique, Polyclinique de l’Atlantique, Saint Herblain Cedex, France
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Hoveidaei AH, Sattarpour R, Dadgostar H, Razi S, Razi M. Unhappy triad of the knee: What are the current concepts and opinions? World J Orthop 2023; 14:268-274. [PMID: 37304199 PMCID: PMC10251265 DOI: 10.5312/wjo.v14.i5.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/24/2023] [Accepted: 04/06/2023] [Indexed: 05/18/2023] Open
Abstract
The association between injuries to the anterior cruciate ligament, medial collateral ligament, and medial meniscus (MM) has been known to orthopedic surgeons since 1936; O'Donoghue first used the term "unhappy triad" of the knee to describe this condition in 1950. Later studies revealed that involvement of the lateral meniscus is more common than MM in these cases, leading to a change in the definition. Recent studies have revealed that this triad may be primarily linked to knee anterolateral complex injuries. Although there is not a definite management protocol for this triad, we try to mention the most recent concepts about it in addition to expert opinions.
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Affiliation(s)
- Amir Human Hoveidaei
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran 14395-578, Iran
| | - Reza Sattarpour
- School of Medicine, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Haleh Dadgostar
- Department of Sports and Exercise Medicine, School of Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Saeed Razi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran 1545913487, Iran
| | - Mohammad Razi
- Department of Orthopedic Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran 1445613131, Iran
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Suh DK, Cho IY, Noh S, Yoon DJ, Jang KM. Anatomical and Biomechanical Characteristics of the Anterolateral Ligament: A Descriptive Korean Cadaveric Study Using a Triaxial Accelerometer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:419. [PMID: 36837620 PMCID: PMC9964873 DOI: 10.3390/medicina59020419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
Background and Objectives: The anterolateral ligament (ALL) could be the potential anatomical structure responsible for rotational instability after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to investigate the anatomical and biomechanical characteristics of the ALL in Korean cadaveric knee joints. Materials and Methods: Twenty fresh-frozen cadaveric knees were dissected and tested. Femoral and tibial footprints of the ALL were recorded. Pivot shift and Lachman tests were measured with KiRA. Results: The prevalence of ALL was 100%. The average distance of the tibial footprint to the tip of the fibular head was 19.85 ± 3.41 mm; from the tibial footprint to Gerdy's tubercle (GT) was 18.3 ± 4.19 mm; from the femoral footprint to the lateral femoral epicondyle was 10.25 ± 2.97 mm. ALL's footprint distance was the longest at 30° of flexion (47.83 ± 8.05 mm, p < 0.01) in a knee with intact ALL-ACL and neutral rotation. During internal rotation, the footprint distance was the longest at 30° of flexion (50.05 ± 8.88 mm, p < 0.01). Internal rotation produced a significant increase at all three angles after ACL-ALL were transected (p = 0.022), where the footprint distance was the longest at 30° of flexion (52.05 ± 7.60 mm). No significant difference was observed in KiRA measurements between intact ALL-ACL and ALL-transected knees for pivot shift and Lachman tests. However, ACL-ALL-transected knees showed significant differences compared to the intact ALL-ACL and ALL-transected knees (p < 0.01). Conclusions: The ALL was identified as a distinct ligament structure with a 100% prevalence in this cadaveric study. The ALL plays a protective role in internal rotational stability. An isolated ALL transection did not significantly affect the ALL footprint distances or functional stability tests. Therefore, the ALL is thought to act as a secondary supportive stabilizer for rotational stability of the knee joint in conjunction with the ACL.
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Affiliation(s)
- Dae Keun Suh
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Il-Yup Cho
- Joint Center, Seoul Barunsesang Hospital, Seoul 08523, Republic of Korea
| | - Sehyun Noh
- College of Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Dong Joo Yoon
- College of Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
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Combined ACL and anterolateral ligament reconstruction: time to pivot and shift the focus? Knee Surg Sports Traumatol Arthrosc 2023; 31:373-375. [PMID: 35869981 DOI: 10.1007/s00167-022-07072-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 02/07/2023]
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Bouguennec N, Orce A, Laboudie P, Pelletier S, Dexhelet J, Graveleau N. Association of COVID-19 Lockdown With Increased Rate of Cyclops Syndrome in Patients With Unexpected Home-Based Self-Guided Rehabilitation After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671221147869. [PMID: 36890983 PMCID: PMC9986909 DOI: 10.1177/23259671221147869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/11/2022] [Indexed: 03/10/2023] Open
Abstract
Background The risk of cyclops syndrome increases significantly after anterior cruciate ligament (ACL) reconstruction (ACLR) if complete extension is not recovered before the sixth postoperative week. The lockdown in France due to the COVID-19 pandemic led to an absence of supervised rehabilitation, requiring unexpected self-rehabilitation in patients who underwent ACLR just before lockdown. Purpose To determine the rate of cyclops syndrome after ACLR in patients who underwent self-rehabilitation during lockdown. Study Design Cohort study; Level of evidence, 3. Methods A total of 75 patients receiving a hamstring graft for ACLR during the COVID-19 pandemic between February 10, 2022, and March 16, 2020, carried out self-rehabilitation during part of their first 6 postoperative weeks using exercise videos on a dedicated website. Clinical examination was performed at a minimum 1-year follow-up with International Knee Documentation Committee (IKDC), Lysholm, Tegner, and ACL-Return to Sport after Injury (ACL-RSI) scores. This group was compared with a matched-pair control group of 72 patients who underwent surgery in 2019 and completed postoperative supervised rehabilitation with a physical therapist. Rates and reasons for second surgery (arthrolysis, meniscal procedure) were also recorded. Results In the COVID group (n = 72; 3 patients were lost to follow-up), the mean follow-up was 14.5 ± 2.1 months (range, 13-21) and rate of reoperation for clinical cyclops syndrome was 11.1% (n = 8). The rate of cyclops syndrome was significantly lower (1.4%) in the control group (P = .01). In the COVID group, 8 patients underwent anterior arthrolysis at a mean of 8.6 months after the primary surgery, and 4 patients underwent another surgical intervention (meniscal procedure [n = 3], device removal [n = 1]). In the COVID group, mean Lysholm was 86.6 ± 14.1 (range, 38-100), Tegner was 5.6 ± 2.3 (range, 1-10), subjective IKDC was 80.3 ± 14.7 (range, 32-100) and ACL-RSI score was 77.3 ± 19.7 (range, 33-100). Conclusion The rate of cyclops syndrome after ACLR was significantly greater in the COVID group versus the matched controls. The dedicated website was not effective at supporting self-guided rehabilitation and could benefit from interactive improvements so it is at least as effective as supervised rehabilitation.
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Affiliation(s)
| | - Aida Orce
- Sports Clinic of Bordeaux-Merignac, Merignac, France
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Helito PVP, Helito CP, Rodrigues MB. Anterolateral ligament MRI of the knee in ACL injuries: MRI abnormalities association with instability. Eur Radiol 2023; 33:1456-1464. [PMID: 35976397 DOI: 10.1007/s00330-022-09062-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 06/11/2022] [Accepted: 07/24/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate anterolateral ligament abnormalities (ALL) at MRI scans and correlate with data from clinical instability tests (Lachman and pivot shift) performed under anesthesia in patients with acute anterior cruciate ligament (ACL) tears. Furthermore, perform multivariate analysis with other variables to isolate the ALL contribution to instability from other abnormalities. METHODS Retrospective analysis of MRI and instability tests of 95 patients with ACL tears. The ALL was classified as no abnormality, abnormality without discontinuity, and discontinuity. Injuries in other knee ligament structures and menisci were also assessed. Results of instability tests (pivot shift and Lachman) with the patient anesthetized for arthroscopic ACL reconstruction were obtained from the patient database. Statistical analysis was performed using the IBM SPSS 22. RESULTS ALL abnormalities and iliotibial band (ITB), lateral (LCL), and medial (MCL) collateral ligament injuries showed a statistically significant correlation with the pivot shift test. The ALL MRI abnormalities were associated with the high-grade pivot shift results (p < 0.0005), with an odds ratio of 55.9 for high degrees of pivot shift in patients with abnormal ALL. The logistic model for all variables analyzed with the results of the pivot shift test demonstrated that the ALL was the only variable with a statistically significant correlation in the model (p < 0.0005). CONCLUSION MRI ALL abnormalities in patients with ACL injuries have a significant association with pivot shift test results in patients under anesthesia. The logistic model for high - grade pivot shift test results demonstrated that ALL abnormalities were the only variable with significant correlation. KEY POINTS • Evaluating the anterolateral ligament with MRI in acute anterior cruciate ligament injuries is useful to predict higher grades of pivot shift test in the moment of the arthroscopic reconstruction. • An abnormal anterolateral ligament presented an odds ratio of 55 for high degrees of pivot shift. • ALL MRI abnormalities association with knee instability is independent from other internal knee injuries.
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Affiliation(s)
- Paulo Victor Partezani Helito
- Musculoskeletal Radiology Department, Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, 05403-010, Brazil. .,Hospital Sírio-Libanês, São Paulo, Brazil. .,Institute of Radiology; Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Camilo Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil.,Knee Surgery Division, Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, Sâo Paulo, Brazil
| | - Marcelo Bordalo Rodrigues
- Musculoskeletal Radiology Department, Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, 05403-010, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil.,Institute of Radiology; Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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