1
|
Okimura S, Suzuki T, Ikeda Y, Shiwaku K, Teramoto A. Satisfactory outcomes after one-stage revision anterior cruciate ligament reconstruction using rectangular tunnel technique. Knee Surg Sports Traumatol Arthrosc 2023; 31:5690-5697. [PMID: 37898566 DOI: 10.1007/s00167-023-07627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE One-stage revision anterior cruciate ligament reconstruction (ACLR) with the anatomic rectangular tunnel (RT) technique using bone-patellar tendon-bone (BTB) grafts results in anatomically precise tunnel placement and secure graft fixation. This study evaluated knee joint laxity and clinical outcomes in terms of femoral tunnel overlap. It was hypothesised that there would be no significant differences in knee joint laxity or clinical outcomes regardless of femoral tunnel overlap. METHODS Between 2012 and 2021, a single surgeon conducted 196 one-stage revision ACLRs with the RT technique using BTB grafts. Patients were divided based on the presence of femoral tunnel overlap. Knee joint laxity was evaluated using the Lachman test, pivot shift test, and side-to-side difference measured with a KT-1000 arthrometer. Clinical outcomes were assessed using the Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Knee Examination Form 2000. Knee joint laxity and clinical outcomes were compared between groups after a median follow-up of 2.5 years (range 2.0-8.0). RESULTS The study included 30 and 73 patients in the overlap and non-overlap groups, respectively. No significant differences were observed in the results of the Lachman test, pivot shift test, or KT-1000 arthrometer as well as in the Lysholm, KOOS, or IKDC scores between the two groups. Based on the IKDC scores, all patients were graded as normal or nearly normal. CONCLUSION One-stage revision ACLR with the RT technique using BTB grafts improved knee joint laxity and had favourable clinical outcomes regardless of femoral tunnel overlap. To achieve optimal results in one-stage revision ACLR, it is crucial to create a tunnel within the anatomical attachment area and ensure proper graft fixation and tensioning. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Shinichiro Okimura
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, North-7, West-27-1-3, Chuo-ku, Sapporo, Hokkaido, 060-0007, Japan.
| | - Yasutoshi Ikeda
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| |
Collapse
|
2
|
McMellen CJ, Sinkler MA, Calcei JG, Hobson TE, Karns MR, Voos JE. Management of Bone Loss and Tunnel Widening in Revision ACL Reconstruction. J Bone Joint Surg Am 2023; 105:1458-1471. [PMID: 37506198 DOI: 10.2106/jbjs.22.01321] [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] [Indexed: 07/30/2023]
Abstract
➤ Both mechanical and biological factors can contribute to bone loss and tunnel widening following primary anterior cruciate ligament (ACL) reconstruction.➤ Revision ACL surgery success is dependent on graft position, fixation, and biological incorporation.➤ Both 1-stage and 2-stage revision ACL reconstructions can be successful in correctly indicated patients.➤ Potential future solutions may involve the incorporation of biological agents to enhance revision ACL surgery, including the use of bone marrow aspirate concentrate, platelet-rich plasma, and bone morphogenetic protein-2.
Collapse
Affiliation(s)
- Christopher J McMellen
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Margaret A Sinkler
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| | - Taylor E Hobson
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| | - Michael R Karns
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| | - James E Voos
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| |
Collapse
|
3
|
Pediatric Revision Anterior Cruciate Ligament Reconstruction: Current Concepts Review. Clin J Sport Med 2022; 32:139-144. [PMID: 34173782 DOI: 10.1097/jsm.0000000000000953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We present a review of revision anterior cruciate ligament (ACL) reconstruction in pediatric patients, discussing risk factors for rerupture, physical examination and imaging, treatment principles and surgical techniques, postoperative rehabilitation, and clinical outcomes. DATA SOURCES PubMed, Cochrane, and Embase databases were queried for relevant articles about revision ACL topics. All types of manuscripts, including clinical studies, basic science studies, case series, current concepts reviews, and systematic reviews were analyzed for relevant information. Current concepts on risk factors for rerupture, physical examination and imaging, treatment principles and surgical techniques, postoperative rehabilitation, and clinical outcomes were synthesized. MAIN RESULTS Surgical treatment should be individualized, and the graft type, fixation devices, tunnel placement, and complementary procedures (eg, extra-articular tenodesis) should be tailored to the patient's needs and previous surgeries. Rehabilitation programs should also be centered around eccentric strengthening, isometric quadriceps strengthening, active flexion range of motion of the knee, and an emphasis on closed chain exercises. Despite adherence to strict surgical and postoperative rehabilitation principles, graft refailure rate is high, and return to sports rate is low. CONCLUSION Rerupture of the ACL in the pediatric population is a challenging complication that requires special attention. Diagnostic evaluation of repeat ACL ruptures is similar to primary injuries. Although outcomes after revision ACL reconstruction are expectedly worse than after primary reconstruction, athletes do return to sport after proper rehabilitation. Further research is needed to continue to improve outcomes in this high-risk population, aimed at continued knee stability, graft survivorship, and improved quality of life.
Collapse
|
4
|
White NP, Borque KA, Jones MH, Williams A. Single-Stage Revision Anterior Cruciate Ligament Reconstruction: Experience With 91 Patients (40 Elite Athletes) Using an Algorithm. Am J Sports Med 2021; 49:364-373. [PMID: 33332154 DOI: 10.1177/0363546520976633] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The increased prevalence of anterior cruciate ligament (ACL) reconstruction has led to an increased need for revision ACL reconstructions. Despite the growing body of literature indicating that single-stage revision ACL reconstruction can yield good outcomes, there is a lack of data for determining when and how to safely perform a single-stage revision. PURPOSE To assess the outcomes, graft failure rates, and return-to-play rates of a decision-making algorithm for single-stage revision ACL reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS We reviewed a consecutive series of revision ACL reconstructions performed by the senior author between September 2009 and July 2016 with minimum 2-year follow-up. All patients were assessed, and decision making was undertaken according to the algorithm. Outcomes measured were further surgery, graft rerupture, re-revision, Tegner score, and Knee injury and Osteoarthritis Outcome Score (KOOS). For the elite athlete population, return-to-play time, duration, and level of play after surgery as compared with preinjury were also determined. RESULTS During this period, 93 procedures were performed in 92 patients (40 elite athletes). Two 2-stage procedures were undertaken, leaving 91 single-stage procedures (91 patients) to form the basis for further study. At a mean 4.3 years (SD, 2.2 years) after surgery, there had been 2 re-revisions (2.2%) and 2 further instances of graft failure that had not been re-revised (total graft failure rate, 4.4%). There were 17 subsequent procedures, including 6 arthroscopic partial meniscectomies, 5 removals of prominent implants, and 1 total knee arthroplasty. The mean Tegner score was 8.02 before graft rerupture and 7.1 at follow-up. At follow-up, the mean KOOS outcomes were 79.3 for Symptoms, 88.0 for Pain, 94.2 for Activities of Daily Living, 73.6 for Sport, and 68.9 for Quality of Life. Of 40 elite athletes, 35 returned to play at a mean 11.2 months (SD, 3.6 months) after surgery. CONCLUSION Single-stage revision ACL reconstructions can be performed reliably in the majority of patients, with good clinical outcomes, low rerupture rates, and high-return-to play rates, even in the elite athlete population.
Collapse
Affiliation(s)
- Nathan P White
- Park Clinic Orthopaedics, Melbourne Knee Centre, Kew, Australia
| | - Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | | | | |
Collapse
|
5
|
Wang H, Zhang M, Cheng CK. Changing the Diameter of the Bone Tunnel Is More Effective Than Changing the Tunnel Shape for Restoring Joint Functionality After ACL Reconstruction. Front Bioeng Biotechnol 2021; 8:173. [PMID: 33490045 PMCID: PMC7819500 DOI: 10.3389/fbioe.2020.00173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
The clinical implications of changing the shape of the bone tunnel for Anterior cruciate ligament reconstruction (ACLR) is controversial and few studies have reported on the long-term prevalence for osteoarthritis. As such, this study aims to evaluate the effect of tunnel shape on joint biomechanics. Finite element models of an ACLR were constructed with different shapes (circular, oval, rounded rectangular, rectangular, and gourd-shaped) and diameters (7.5, 8.5, and 9.5 mm) for the bone tunnel. A combined loading of 103 N anterior tibial load, 7.5 Nm internal tibial moment and 6.9 Nm valgus tibial moment was applied at a joint flexion angle of 20°. Joint kinematics and the strain energy density (SED) on the articular cartilage were compared among the different groups. The results showed that conventional ACLR (circular tunnel) lead to an increase in joint kinematics over the intact joint, a lower ligament force and a higher SED on the lateral tibial cartilage. ACLR using the other tunnel shapes resulted in even greater joint kinematics, lower graft force and greater SED on the lateral tibial cartilage. Increasing the tunnel diameter better restored joint kinematics, graft force and articular SED, bringing these values closer to those from the intact knee. In conclusion, increasing the tunnel diameter may be more effective than changing the tunnel shape for restoring joint functionality after ACLR.
Collapse
Affiliation(s)
- Huizhi Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Min Zhang
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Cheng-Kung Cheng
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| |
Collapse
|
6
|
Shao J, Niu X, Wang Y, Ao Y. Novel Application of a Rounded-Rectangular Bone Tunnel in Revision ACL Reconstruction: A Report of 2 Patients. Orthop J Sports Med 2020; 8:2325967120944901. [PMID: 32974409 PMCID: PMC7495937 DOI: 10.1177/2325967120944901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/25/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jiayi Shao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, China
| | - Xingyue Niu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, China
| | - Yongjian Wang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, China
| |
Collapse
|
7
|
Zhang JH, Ren S, Shao JY, Niu XY, Hu XQ, Ao YF. [Anatomical and finite element analysis of anterior cruciate ligament reconstruction within biomechanical insertion]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:586-590. [PMID: 31209435 DOI: 10.19723/j.issn.1671-167x.2019.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To provide new concepts of anterior cruciate ligament (ACL) reconstruction by anatomical gross observation of ACL tibial insertion and finite element analysis of distribution of ACL mechanical insertion. METHODS In the anatomical study, ten fresh adult cadaveric knees were dissected, including 6 males and 4 females, all knees were generally observed through standard medial parapatellar approaches, paying attention to the close anatomical relationship of tibial insertion and anterior horn of lateral meniscus, and ACL was exposed and gradually removed from the inside. The shape of tibial insertion of ACL was observed and recorded, and anterior-posterior diameters and left-right diameters of tibial insertion were measured with vernier caliper. For the study of finite element analysis, three-dimensional thin-layer magnetic resonance imaging of normal knee joint was used to establish knee joint model. Three-dimensional reconstruction software MIMICS and finite element analysis software ANSYS were used to establish knee joint model, subsequently, clinical physical examination Lachman test and pivot-shift test were simulated to observe the force distribution of ACL tibial insertion and femoral insertion. RESULTS The ACL tibial mechanical insertion was rather flat and long similar as an arc shape without a clear separation between anterior medial bundle (AMB) and posterolateral bundle (PLB) in gross observation. The dense fibers lies belonged to the medial intercondylar ridge and ended up anterior with the osseous landmark of anterior ridge. Its average anterior-posterior diameter was (13.8±2.0) mm, the average left-right diameter of midsubstance was (5.3±0.6) mm, and the average left-right diameter of anterior margin was (11.5±1.2) mm. The finite element analysis showed that distribution on the femoral side was oval shape mainly below the residents' ridge, while the tibial side was rather flat mainly along the medial intercondylar ridge, which was consistent with the anatomical observation. The biomechanical characteristics of ACL attachments were verified theoretically. CONCLUSION Anatomical study and finite element analysis have confirmed the flat arc shape of ACL tibial insertion. The ideal reconstruction technique of ACL should be based on its biomechanical insertion. Based on anatomical study and biomechanical analysis, we have proposed the idea of ACL biomechanical insertion reconstruction (BIR) and established a surgical model with oval femoral tunnel and rounded-rectangle tibial tunnel.
Collapse
Affiliation(s)
- J H Zhang
- Institute of Sports Medicine, Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - S Ren
- Institute of Sports Medicine, Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - J Y Shao
- Institute of Sports Medicine, Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - X Y Niu
- Institute of Sports Medicine, Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - X Q Hu
- Institute of Sports Medicine, Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - Y F Ao
- Institute of Sports Medicine, Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| |
Collapse
|
8
|
Germann M, Snedeker JG, Stalder M, Nuss KM, Meyer DC, Farshad M. Incorporating BMP-2 and skeletal muscle to a semitendinosus autograft in an oversized tunnel yields robust bone tunnel ossification in rabbits: Toward single-step revision of failed anterior cruciate ligament reconstruction. Knee 2018; 25:765-773. [PMID: 30057249 DOI: 10.1016/j.knee.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 05/10/2018] [Accepted: 07/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bone tunnel widening after anterior cruciate ligament (ACL) reconstruction is a known complication that can lead to graft failure. Subsequent revision surgery typically involves a two-stage procedure. The aim of this study was to test a novel autologous tendon graft retaining muscle tissue combined with Human Recombinant Bone Morphogenetic Protein-2 (rh-BMP-2) leading to rapid ossification of the muscle tissue, simultaneously replenishing bone stock and producing a mechanically stable bone-tendon insertion. METHODS In 12 skeletally mature New Zealand rabbits, the ACL was resected and oversized bone tunnels were drilled to model tunnel widening. The ipsilateral semitendinosus muscle-tendon graft was harvested and folded twice. Muscle tissue was removed in the middle third but retained at both distal ends. One side was wrapped in a collagen sponge loaded with rh-BMP-2 while the other end was used as its own control. RESULTS All animals were euthanized after six weeks. Micro-computed tomography (micro-CT) was used to analyze bone formation in 12 animals, with additional biomechanical testing to failure and histology performed for six animals each. Micro-CT showed that bone densities were higher by a factor of 2.4 in treated graft ends compared with their controls. Biomechanical testing showed a mean overall failure load of 37.5 N. Histology showed that the trabecular bone surrounding the implant was significantly (P = 0.0087) thicker on the treated (85.5 μm) compared with the control side (68.2 μm). CONCLUSIONS We conclude that a semitendinosus graft retaining the muscle tissue stimulated by recombinant Bone Morphogenetic Protein-2 (BMP-2) allows robust osseointegration of the graft within an oversized bone tunnel in an animal model.
Collapse
Affiliation(s)
- Marco Germann
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland.
| | - Jess G Snedeker
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Michael Stalder
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Katja M Nuss
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zürich, Winterthurerstrasse 260, 8057 Zürich, Switzerland
| | - Dominik C Meyer
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Mazda Farshad
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
| |
Collapse
|
9
|
Mehl J, Imhoff AB, Achtnich A. Tunnelauffüllung bei zweizeitiger Revision am vorderen Kreuzband. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-017-0178-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
|
11
|
Suruga M, Horaguchi T, Iriuchishima T, Yahagi Y, Iwama G, Tokuhashi Y, Aizawa S. Morphological size evaluation of the mid-substance insertion areas and the fan-like extension fibers in the femoral ACL footprint. Arch Orthop Trauma Surg 2017; 137:1107-1113. [PMID: 28593582 DOI: 10.1007/s00402-017-2726-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the detailed anatomy of the femoral anterior cruciate ligament (ACL) insertion site, with special attention given to the morphology of the mid-substance insertion areas and the fan-like extension fibers. METHODS Twenty-three non-paired human cadaver knees were used (7 Males, 16 Females, median age 83, range 69-96). All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in macroscopic tension patterns. The ACL was carefully dissected and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibers. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The area of each bundle, including and excluding the fan-like extension fibers, was measured with Image J software (National Institution of Health). The width and length of the mid-substance insertion sites were also evaluated using same image. RESULTS The femoral ACL footprint was divided into four regions (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). The measured areas of the mid-substance insertion sites of the AM and PL bundles were 35.5 ± 12.5, and 32.4 ± 13.8 mm2, respectively. Whole width and length of the mid-substance insertion sites were 5.3 ± 1.4, and 15.5 ± 2.9 mm, respectively. The measured areas of the fan-like extensions of the AM and PL bundles were 27 ± 11.5, and 29.5 ± 12.4 mm2, respectively. CONCLUSION The femoral ACL footprint was divided into quarters of approximately equal size (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). For clinical relevance, to perform highly reproducible anatomical ACL reconstruction, the presence of the fan-like extension fibers should be taken into consideration.
Collapse
Affiliation(s)
- Makoto Suruga
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Takashi Horaguchi
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Takanori Iriuchishima
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan. .,Department of Orthopedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan.
| | - Yoshiyuki Yahagi
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Genki Iwama
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
12
|
Ra HJ, Ha JK, Kim JG, Hwang DY. One stage revision single-bundle anterior cruciate ligament reconstruction with impacted morselized bone graft following a failed double-bundle reconstruction. Indian J Orthop 2017; 51:343-346. [PMID: 28566790 PMCID: PMC5439324 DOI: 10.4103/0019-5413.205676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although double-bundle anterior cruciate ligament (ACL) reconstruction has theoretical benefits such as more accurate reproduction of ACL anatomy, it is technically more demanding surgery. This report describes the case of a one stage revision single-bundle ACL reconstruction after primary double-bundle ACL reconstruction. A professional dancer had an ACL previously reconstructed with a double-bundle technique, but the femoral tunnels were malpositioned resulting in residual laxity and rotational instability. The previous femoral tunnel positions were vertical and widened. The previous vertical tunnels were filled with impacted bone graft and a revision single-bundle ACL reconstruction was performed via the new femoral tunnel with a 2 O'clock position between the previous two tunnels. After 10 months of postoperative rehabilitation, the patient returned to professional dancing with sound bony union and without any residual instability.
Collapse
Affiliation(s)
- Ho Jong Ra
- Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jeong Ku Ha
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Konkuk University Hospital, University of Konkuk, Seoul, Korea,Address for correspondence: Dr. Jin Goo Kim, Department of Orthopedic Surgery, Konkuk University Hospital, University of Konkuk, No. 4-12, Hwayang-dong, Gwangjin-gu, Seoul, Korea. E-mail:
| | - Do-Yon Hwang
- Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| |
Collapse
|
13
|
Koga H, Engebretsen L, Fu FH, Muneta T. Revision anterior cruciate ligament surgery: state of the art. J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
14
|
Iriuchishima T, Ryu K, Aizawa S, Fu FH. The difference in centre position in the ACL femoral footprint inclusive and exclusive of the fan-like extension fibres. Knee Surg Sports Traumatol Arthrosc 2016; 24:254-9. [PMID: 25308156 DOI: 10.1007/s00167-014-3373-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to compare the centre position of each anterior cruciate ligament bundle in its femoral footprint in measurements including and excluding the fan-like extension fibres. METHODS Fourteen non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in tension patterns. The ACL was carefully dissected, and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibres. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The centre position of each bundle, including and excluding the fan-like extension fibres, was measured with ImageJ software (National Institution of Health). Evaluation of the centre position was performed using the modified quadrant method. RESULTS The centre of the femoral AM bundle including the fan-like extension was located at 28.8% in a shallow-deep direction and 37.2% in a high-low direction. When the AM bundle was evaluated without the fan-like extension, the centre was significantly different at 34.6% in a shallow-deep direction (p = 0.000) and 36% in a high-low direction. The centre of the PL bundle including the fan-like extension was found at 37.1% in a shallow-deep direction and 73.4% in a high-low direction. When the PL bundle was evaluated without the fan-like extension, the centre was significantly different at 42.7% in a shallow-deep direction (p = 0.000) and 69.3% in a high-low direction (p = 0.000). CONCLUSION The centre position of the AM and PL bundles in the femoral ACL footprint was significantly different depending on the inclusion or exclusion of the fan-like extension fibres. For the clinical relevance, to reproduce the direct femoral insertion in the anatomical ACL reconstruction, tunnels should be placed relatively shallow and high in the femoral ACL footprint.
Collapse
Affiliation(s)
| | - Keinosuke Ryu
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburg, PA, USA
| |
Collapse
|
15
|
Andriolo L, Filardo G, Kon E, Ricci M, Della Villa F, Della Villa S, Zaffagnini S, Marcacci M. Revision anterior cruciate ligament reconstruction: clinical outcome and evidence for return to sport. Knee Surg Sports Traumatol Arthrosc 2015. [PMID: 26202138 DOI: 10.1007/s00167-015-3702-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE An increasing number of patients undergo revision anterior cruciate ligament (ACL) reconstruction, with the intention of returning to sport being a major indication. The aim of this study is to assess the available evidence for clinical improvement and return to sport, to understand the real potential of this procedure in regaining functional activity, and to facilitate improved counselling of patients regarding the expected outcome after revision ACL reconstruction. METHODS The search was conducted on the PubMed database. Articles reporting clinical results for revision ACL reconstruction were included. A meta-analysis was performed on return to sport, and results were compared to the literature on primary ACL reconstruction. Other specific clinical outcomes (Lysholm, Tegner, IKDC Objective scores) were also included in the meta-analysis. RESULTS Of the 503 identified records, a total of 59 studies involving 5365 patients were included in the qualitative data synthesis. Only 31 articles reported the rate of return to sport. Whereas 73 % of good objective results and satisfactory subjective results were documented, 57 % of patients did not return to the same level of sport activity, significantly inferior to that of a primary procedure. CONCLUSION The real potential of revision ACL reconstruction should not be overestimated due to the low number of patients able to return to their previous activity level, significantly inferior with respect to that reported for primary ACL reconstruction. This finding will help physicians in the clinical practice providing realistic expectations to the patients. Future studies should focus on participation-based outcome measures such as return to sport and in strategies to improve the results in terms of return to previous activities after revision ACL reconstruction. LEVEL OF EVIDENCE Systematic review and meta-analysis including Level IV studies, Level IV.
Collapse
Affiliation(s)
- Luca Andriolo
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
| | - Giuseppe Filardo
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Elizaveta Kon
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.,Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Margherita Ricci
- Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | | | | | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Maurilio Marcacci
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| |
Collapse
|
16
|
Shino K, Mae T, Take Y, Iuchi R, Nakagawa S. One-stage revision anatomic anterior cruciate ligament reconstruction with rectangular tunnel technique. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:43-48. [PMID: 29264239 PMCID: PMC5730639 DOI: 10.1016/j.asmart.2014.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/04/2022]
Abstract
We developed the anatomic rectangular tunnel anterior cruciate ligament reconstruction (ART ACLR) with a bone–patellar tendon–bone graft to mimic fibre arrangement inside the native ACL via tunnels with smaller apertures. With a 10-mm-wide graft, the cross-sectional area of the tunnels of 50 mm2 in ART ACLR is less than that of 79 mm2 in a 10-mm round tunnel one. Because tunnel encroachment would be less of a problem, the ART ACLR technique could be most frequently applied to patients after a failed primary ACLR. In this instructional lecture, the indication and technical considerations for ART ACLR as one-stage revision ACLR are described.
Collapse
Affiliation(s)
- Konsei Shino
- Center for Sports Orthopaedics, Yukioka Hospital, Kita-ku, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Medical School, Suita, Osaka, Japan
| | - Yasuhiro Take
- Department of Orthopaedic Surgery, Osaka University Medical School, Suita, Osaka, Japan
| | - Ryo Iuchi
- Center for Sports Orthopaedics, Yukioka Hospital, Kita-ku, Osaka, Japan
| | - Shigeto Nakagawa
- Center for Sports Orthopaedics, Yukioka Hospital, Kita-ku, Osaka, Japan
| |
Collapse
|
17
|
Anatomic ACL reconstruction: rectangular tunnel/bone-patellar tendon-bone or triple-bundle/semitendinosus tendon grafting. J Orthop Sci 2015; 20:457-68. [PMID: 25753837 PMCID: PMC4518079 DOI: 10.1007/s00776-015-0705-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/30/2014] [Indexed: 12/16/2022]
Abstract
Anatomic ACL reconstruction is the reasonable approach to restore stability without loss of motion after ACL tear. To mimic the normal ACL like a ribbon, our preferred procedures is the anatomic rectangular tunnel (ART) technique with a bone-patellar tendon-bone (BTB) graft or the anatomic triple bundle (ATB) procedure with a hamstring (HS) tendon graft. It is important to create tunnel apertures inside the attachment areas to lessen the tunnel widening. To identify the crescent-shaped ACL femoral attachment area, the upper cartilage margin, the posterior cartilage margin and the resident's ridge are used as landmarks. To delineate the C-shaped tibial insertion, medial intercondylar ridge, Parson's knob and anterior horn of the lateral meniscus are helpful. In ART-BTB procedure which is suitable for male patients engaged in contact sports, the parallelepiped tunnels with rectangular apertures are made within the femoral and tibial attachment areas. In ATB-HS technique which is mainly applied to female athletes engaged in non-contact sports including skiing or basketball, 2 femoral and 3 tibial round tunnels are created inside the attachment areas. These techniques make it possible for the grafts to run as the native ACL without impingement to the notch or PCL. After femoral fixation with an interference screw or cortical fixation devices including Endobutton, the graft is pretensioned in situ by repetitive manual pulls at 15-20° of flexion, monitoring the graft tension with tensioners on a tensioning boot installed on the calf. Tibial fixation with pullout sutures is achieved using Double Spike Plate and a screw at the pre-determined amount of tension of 10-20N. While better outcomes with less failure rate are being obtained compared to those in the past, higher graft tear rate remains a problem. Improved preventive training may be required to avoid secondary ACL injuries.
Collapse
|
18
|
Suzuki T, Shino K, Otsubo H, Suzuki D, Mae T, Fujimiya M, Yamashita T, Fujie H. Biomechanical comparison between the rectangular-tunnel and the round-tunnel anterior cruciate ligament reconstruction procedures with a bone-patellar tendon-bone graft. Arthroscopy 2014; 30:1294-302. [PMID: 25064752 DOI: 10.1016/j.arthro.2014.05.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 05/07/2014] [Accepted: 05/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of 2 anterior cruciate ligament (ACL) reconstruction techniques using a bone-patellar tendon-bone (BPTB) graft with femoral tunnel, either a rectangular tunnel (RET) or a round tunnel (ROT). METHODS For experiment 1, nine fresh-frozen human cadaveric knees were tested with a robotic/universal force-moment sensor system to determine the initial optimal tension: the amount of graft tension at 15° of flexion most closely resembling the anterior laxity of a normal knee. The value was estimated by repeatedly measuring anterior laxity when 100 N of anteroposterior drawer load was applied to the knees at 30° of flexion after RET ACL or ROT ACL reconstruction. For experiment 2, six fresh-frozen human cadaveric knees were selected. On the basis of the initial tension determined in experiment 1, RET ACL reconstruction was conducted with the graft tensioned to 10 N, followed by ROT ACL reconstruction on the same knee at 40 N of initial tension, and the biomechanical efficacy of the 2 methods was compared. RESULTS For experiment 1, the mean laxity match tension at 15° of flexion was 8.6 ± 4.8 N and 34.8 ± 9.2 N for RET- and ROT-reconstructed knees, respectively. For experiment 2, both RET and ROT ACL reconstructions were successful in controlling anterior tibial translation under anterior tibial loads, with the graft initially tensioned to 10 N in the former and to 40 N in the latter. However, the greater tensioning in ROT reconstruction led to proximal, posterior, and lateral displacement of the tibia along with its external and valgus rotation. CONCLUSIONS The RET ACL-reconstructed knee more closely resembled the normal knee in biomechanical behavior. Although ROT reconstruction successfully controlled anterior translation with greater initial tensioning to the graft, the normal positional relation between the tibia and femur was impaired. CLINICAL RELEVANCE Rectangular femoral ACL fixation constructs and grafts may prove more efficacious at restoring in vivo ACL kinematics than round femoral tunnels.
Collapse
Affiliation(s)
- Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Sapporo Medical University, Sapporo, Japan.
| | - Konsei Shino
- Sports Orthopaedic Center, Osaka Yukioka Hospital, Osaka, Japan
| | - Hidenori Otsubo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Sapporo, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mineko Fujimiya
- 2nd Department of Anatomy, Sapporo Medical University, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| |
Collapse
|
19
|
Mahmoud SSS, Odak S, Coogan S, McNicholas MJ. A prospective study to assess the outcomes of revision anterior cruciate ligament reconstruction. INTERNATIONAL ORTHOPAEDICS 2014; 38:1489-94. [PMID: 24687269 DOI: 10.1007/s00264-014-2324-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/10/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Continuously increasing numbers of primary anterior cruciate ligament (ACL) reconstructions invites a parallel increase in graft failures and need for revision ACL reconstruction surgery. High failure rates has previously stigmatised the revision surgery. We performed this study using multiple outcome measures together with clinical examination to offer a full assessment of the outcomes of this procedure. METHODS Twenty patients, with mean age of 29.4 years (17-50 years), were included in this study prior to their revision ACL reconstruction surgery. All patients were followed prospectively collecting the Knee injury and Osteoarthritis Outcome (KOOS), International Knee Documentation Committee (IKDC) and Tegner-Lysholm scores pre- and post-operatively together with clinical assessment of the antero-posterior knee laxity. RESULTS After a mean follow up interval of 30 months (16-60 months) significant post-operative improvement of IKDC, Tegner-Lysholm scores and knee antero-posterior laxity together with the Symptoms, Activities of Daily Living (ADL) and Quality of Life (QOL) components of the KOOS score was noticed (P < 0.05). However, there was no similar improvement in pain and sports components of the KOOS score (P > 0.05). There was no difference in the outcomes of different graft types. CONCLUSION Good outcomes of revision ACL reconstruction surgery are achievable. The use of different graft types did not affect the outcome of the procedure. Most of the patients opted to less aggressive sports participation after the revision procedure.
Collapse
Affiliation(s)
- Samer Samir Sayed Mahmoud
- Department of Trauma and Orthopaedics, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, UK, SW17 0QT,
| | | | | | | |
Collapse
|
20
|
Taketomi S, Inui H, Nakamura K, Hirota J, Takei S, Takeda H, Tanaka S, Nakagawa T. Three-dimensional fluoroscopic navigation guidance for femoral tunnel creation in revision anterior cruciate ligament reconstruction. Arthrosc Tech 2012; 1:e95-9. [PMID: 23766985 PMCID: PMC3678652 DOI: 10.1016/j.eats.2012.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 04/19/2012] [Indexed: 02/03/2023] Open
Abstract
Revision anterior cruciate ligament (ACL) reconstruction is accompanied by several technical challenges that must be addressed, such as a primary malpositioned bone tunnel, pre-existing hardware, or bone defects due to tunnel expansion. We describe a surgical technique used to create an anatomic femoral socket using a 3-dimensional (3D) fluoroscopy-based navigation system in technically demanding revision cases. After a reference frame is rigidly attached to the femur, an intraoperative image of the distal femur is obtained, which is transferred to a navigation system and reconstructed into a 3D image. A navigation computer helps the surgeon to visualize the whole image of the lateral wall of the femoral notch, even if the natural morphology of the intercondylar notch has been destroyed by the primary procedure. In addition, the surgeon can also confirm the position of the previous bone tunnel aperture, the previous exit of the femoral tunnel, and the presence of any pre-existing hardware on the navigation monitor. When a new femoral guidewire for the revision procedure is placed, the virtual femoral tunnel is overlaid on the reconstructed 3D image in real time. At our institution, 12 patients underwent 1-stage revision ACL procedures with the assistance of this computer navigation system, and the grafts were securely fixed in anatomically created tunnels in all cases. This technology can assist surgeons in creating anatomic femoral tunnels in technically challenging revision ACL reconstructions.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Takumi Nakagawa
- Address correspondence to Takumi Nakagawa, M.D., Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| |
Collapse
|