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Lampart M, Park BH, Husi B, Evans R, Pozzi A. Evaluation of the accuracy and intra- and interobserver reliability of three manual laxity tests for canine cranial cruciate ligament rupture-An ex vivo kinetic and kinematic study. Vet Surg 2023. [PMID: 37144831 DOI: 10.1111/vsu.13957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To investigate the accuracy and intra- and interobserver reliability of the cranial drawer test (CD), tibial compression test (TCT), and the new tibial pivot compression test (TPCT) in an experimental setting resembling acute cranial cruciate ligament rupture (CCLR) and to elucidate the ability to subjectively estimate cranial tibial translation (CTT) during testing. STUDY DESIGN Experimental ex vivo study. SAMPLE POPULATION Ten cadaveric hindlimbs of large dogs. METHODS Kinetic and 3D-kinematic data was collected while three observers performed the tests on each specimen with intact (INTACT) and transected cranial cruciate ligament (CCLD) and compared using three-way repeated-measures ANOVA. Subjectively estimated CTT (SCTT), obtained during a separate round of testing, was compared to kinematic data by Pearson correlation. RESULTS CTT was significantly higher for CCLD than for INTACT for all tests, resulting in 100% sensitivity and specificity. TPCT induced the highest CTT and internal rotation. Intra- and interobserver agreement of translation was excellent. For rotation and kinetics, agreement was more variable. SCTT strongly correlated with the objectively measured values. CONCLUSION The CD, TCT and the new TPCT were all accurate and reliable. The high translations and rotations during TPCT are promising, encouraging further development of this test. SCTT was reliable in our experimental setting. CLINICAL SIGNIFICANCE Veterinary manual laxity tests are accurate and reliable in acute CCLR. The TPCT might have potential for the assessment of subtle and rotational canine stifle instabilities. The high reliability of SCTT implies that grading schemes for stifle laxity, similar to human medicine, could be developed.
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Affiliation(s)
- Marina Lampart
- Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Brian H Park
- Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Benjamin Husi
- Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Richard Evans
- Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Antonio Pozzi
- Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Gupta R, Kapoor A, Singhal A, Patil BM, Bansal P. The presence of high-grade pivot shift test preoperatively is associated with inferior functional outcomes. PHYSICIAN SPORTSMED 2022; 50:306-310. [PMID: 33910466 DOI: 10.1080/00913847.2021.1924047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The effect of high-grade preoperative pivot shift test on outcomes of anterior cruciate ligament (ACL) reconstruction surgery is not very well established. The present study was conducted to study the factors associated with high-grade pivot shift test and effect of high-grade preoperative pivot shift test on functional outcomes after ACL reconstruction surgery. METHODS Three hundred and sixty-two patients who underwent primary ACL reconstruction surgery were enrolled in the study. The pivot shift test was performed preoperatively under anesthesia in all patients. Side of the meniscal tear, if present at the time of ACL reconstruction, was documented. Patients were divided into two groups depending upon the grade of pivot shift test: group H, high-grade pivot shift (n = 84/362; 23%); and group L, low-grade pivot shift (n = 278/362; 77%). Patients were further divided into two groups depending upon the duration of injury: acute (<6 months) and chronic (>6 months). The functional assessment was done using Lysholm score and Tegner activity scale. RESULTS The presence of lateral meniscus tear (27/84 vs. 53/278) or both menisci tear (29/84 vs. 60/278) was associated with high-grade pivot shift (p < 0.05). Chronic ACL tears were also observed to be associated with high-grade pivot shift (p = 0.03). The mean Lysholm score in group H and group L patients was 93.8 ± 5.1 and 95.2 ± 5.3, respectively (p = 0.04). The mean post-op Tegner activity scale in group H was 6.8 and in group L was 7.3 (p = 0.0001). Also, 181/253 (71.5%) patients returned to same or higher level of sports activity in group L as compared to 33/72 (46%) patients in group H. The incidence of graft failure in groups H and L was 6.5% (5/77) and 1.6% (4/257; p = 0.03), respectively. CONCLUSIONS The high-grade pivot shift is associated with chronic ACL tear (>6 months) and concomitant lateral meniscus tear. The presence of high-grade pivot shift preoperatively is associated with inferior clinical outcomes and lower rate of return to sports. LEVEL OF EVIDENCE Level IV, case-control study.
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Affiliation(s)
- Ravi Gupta
- Orthopaedics Cum Project Director Sports Injury Centre and Medical Superintendent, Government Medical College Hospital, Chandigarh, India
| | - Anil Kapoor
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Akash Singhal
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Bharath Mali Patil
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Parth Bansal
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
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van der Graaff SJA, Meuffels DE, Bierma-Zeinstra SMA, van Es EM, Verhaar JAN, Eggerding V, Reijman M. Why, When, and in Which Patients Nonoperative Treatment of Anterior Cruciate Ligament Injury Fails: An Exploratory Analysis of the COMPARE Trial. Am J Sports Med 2022; 50:645-651. [PMID: 35048733 DOI: 10.1177/03635465211068532] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimal treatment strategy for patients with an anterior cruciate ligament (ACL) rupture is still under debate. Different determinants of the need for a reconstruction have not been thoroughly investigated before. PURPOSE To investigate why, when, and which patients with an ACL rupture who initially started with rehabilitation therapy required reconstructive surgery. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS In the Conservative versus Operative Methods for Patients with ACL Rupture Evaluation (COMPARE) trial, 167 patients with an ACL rupture were randomized to early ACL reconstruction or rehabilitation therapy plus optional delayed ACL reconstruction. We conducted an exploratory analysis of a subgroup of 82 patients from this trial who were randomized to rehabilitation therapy plus optional delayed ACL reconstruction. The reasons for surgery were registered for the patients who underwent a delayed ACL reconstruction. For these patients, we used the International Knee Documentation Committee (IKDC) subjective knee form, Numeric Rating Scale for pain, and instability question from the Lysholm questionnaire before surgery. To determine between-group differences between the nonoperative treatment and delayed ACL reconstruction group, IKDC and pain scores during follow-up were determined using mixed models and adjusted for sex, age, and body mass index. RESULTS During the 2-year follow-up of the trial, 41 of the 82 patients received a delayed ACL reconstruction after a median time of 6.4 months after inclusion (interquartile range, 3.9-10.3 months). Most reconstructions occurred between 3 and 6 months after inclusion (n = 17; 41.5%). Ninety percent of the patients (n = 37) reported knee instability concerns as a reason for surgery at the moment of planning surgery. Of these patients, 18 had an IKDC score ≤60, 29 had a pain score of ≥3, and 33 patients had knee instability concerns according to the Lysholm questionnaire before surgery. During follow-up, IKDC scores were lower and pain scores were higher in the delayed reconstruction group compared with the nonoperative treatment group. Patients in the delayed reconstruction group had a significantly younger age (27.4 vs 35.3 years; P = .001) and higher preinjury activity level compared with patients in the nonoperative treatment group. CONCLUSION Patients who experienced instability concerns, had pain during activity, and had a low perception of their knee function had unsuccessful nonoperative treatment. Most patients received a delayed ACL reconstruction after 3 to 6 months of rehabilitation therapy. At baseline, patients who required reconstructive surgery had a younger age and higher preinjury activity level compared with patients who did not undergo reconstruction.
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Affiliation(s)
- Sabine J A van der Graaff
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Eline M van Es
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent Eggerding
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Lagae KC, Robberecht J, Athwal KK, Verdonk PCM, Amis AA. ACL reconstruction combined with lateral monoloop tenodesis can restore intact knee laxity. Knee Surg Sports Traumatol Arthrosc 2020; 28:1159-1168. [PMID: 31980844 PMCID: PMC7148266 DOI: 10.1007/s00167-019-05839-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/16/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE An anterior cruciate ligament (ACL) injury is often combined with injury to the lateral extra-articular structures, which may cause a combined anterior and rotational laxity. It was hypothesised that addition of a 'monoloop' lateral extra-articular tenodesis (mLET) to an ACL reconstruction would restore anteroposterior, internal rotation and pivot-shift laxities better than isolated ACL reconstruction in combined injuries. METHOD Twelve cadaveric knees were tested, using an optical tracking system to record the kinematics through 0°-100° of knee flexion with no load, anterior and posterior translational forces (90 N), internal and external rotational torques (5 Nm), and a combination of an anterior translational (90 N) plus internal rotational load (5 Nm). They were tested intact, after sectioning the ACL, sectioning anterolateral ligament (ALL), iliotibial band (ITB) graft harvest, releasing deep ITB fibres, hamstrings tendon ACL reconstruction, mLET combined with ACL reconstruction, and isolated mLET. Two-way repeated-measures ANOVA compared laxity data across knee states and flexion angles. When differences were found, paired t tests with Bonferroni correction were performed. RESULTS In the ACL-deficient knee, cutting the ALL significantly increased anterior laxity only at 20°-30°, and only significantly increased internal rotation at 50°. Additional deep ITB release significantly increased anterior laxity at 40°-90° and caused a large increase of internal rotation at 20°-100°. Isolated ACL reconstruction restored anterior drawer, but significant differences remained in internal rotation at 30°-100°. After adding an mLET there were no remaining differences with anterior translation or internal rotation compared to the intact knee. With the combined injury, isolated mLET allowed abnormal anterior translation and rotation to persist. CONCLUSIONS Cutting the deep fibres of the ITB caused large increases in tibial internal rotation laxity across the range of knee flexion, while cutting the ALL alone did not. With ACL deficiency combined with anterolateral deficiency, ACL reconstruction alone was insufficient to restore native knee rotational laxity. However, combining a 'monoloop' lateral extra-articular tenodesis with ACL reconstruction did restore native knee laxity.
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Affiliation(s)
- Koen C. Lagae
- Antwerp Orthopaedic Centre Monica Hospitals, Antwerp, Belgium ,Galeazzi Orthopaedic Institute, Milan, Italy
| | - Joris Robberecht
- Department of Orthopaedic Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Kiron K. Athwal
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ UK
| | - Peter C. M. Verdonk
- Antwerp Orthopaedic Centre Monica Hospitals, Antwerp, Belgium ,Department of Orthopaedic Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Andrew A. Amis
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ UK ,Musculoskeletal Surgery Group, Imperial College London School of Medicine, Charing Cross Hospital, London, W6 8RF UK
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Svantesson E, Hamrin Senorski E, Mårtensson J, Zaffagnini S, Kuroda R, Musahl V, Karlsson J, Samuelsson K. Static anteroposterior knee laxity tests are poorly correlated to quantitative pivot shift in the ACL-deficient knee: a prospective multicentre study. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Gomes JLE, Leie MA, Marczwski M, Sánchez G, Ferrari MB. Intra-articular Anterior Cruciate Ligament Reconstruction With Extra-articular Lateral Tenodesis of the Iliotibial Band. Arthrosc Tech 2017; 6:e1507-e1514. [PMID: 29354466 PMCID: PMC5709921 DOI: 10.1016/j.eats.2017.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/02/2017] [Indexed: 02/03/2023] Open
Abstract
An increasing concern has been given to the rotation stability of the knee in the setting of an anterior cruciate ligament (ACL) reconstruction. This growing interest stems from a better understanding of the rotational stability of the knee afforded by the identification of the anterolateral ligament. Previously, a residual abnormal pivot-shift test had been found after an anatomic single-band reconstruction of the ACL because of a lack of rotational stability, which may lead to the development of osteoarthritis. Residual instability affects function, especially in high-demand athletes who perform many flexion-rotation movements during sporting activity. The purpose of this Technical Note is to describe our preferred method of intra-articular ACL reconstruction using a hamstring tendon autograft in combination with an extra-articular iliotibial band tenodesis for reinforcement of rotational stability.
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Affiliation(s)
| | | | - Marcos Marczwski
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - George Sánchez
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Reid JC, Yonke B, Tompkins M. The angle of inclination of the native ACL in the coronal and sagittal planes. Knee Surg Sports Traumatol Arthrosc 2017; 25:1101-1105. [PMID: 28246878 DOI: 10.1007/s00167-017-4419-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 01/02/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE The purpose of this cross-sectional study was to evaluate the angle of inclination of the native anterior cruciate ligament (ACL) in both the sagittal and coronal planes and to evaluate these findings based on sex, height, BMI, and skeletal maturity. METHODS Inclusion criteria for the study included patients undergoing routine magnetic resonance imaging (MRI) of the knee at a single outpatient orthopedic center who had an intact ACL on MRI. Measurements of the angle of inclination were made on MRIs in both the sagittal and coronal planes. Patients were compared based on sex, height, BMI, and skeletal maturity. RESULTS One-hundred and eighty-eight patients were included (36 skeletally immature/152 skeletally mature; 98 male/90 female). The overall angle of inclination was 74.3° ± 4.8° in the coronal plane and 46.9° ± 4.9° in the sagittal plane. Skeletally immature patients (coronal: 71.8° ± 6.1°; sagittal: 44.7° ± 5.5°) were significantly different in both coronal and sagittal planes (P = 0.04 and 0.01, respectively) from skeletally mature patients (coronal: 75.3° ± 4.7°; sagittal: 47.4° ± 4.7°). There were no differences based on sex, height, or BMI. CONCLUSIONS There are differences between the angle of inclination findings in this study and other studies, which could be due to MRI and measurement techniques. Clinically, skeletal maturity may be important to account for when using the ACL angle of inclination to evaluate anatomic ACL reconstruction. LEVEL OF EVIDENCE Prognostic retrospective study, Level of evidence III.
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Affiliation(s)
- Jonathan C Reid
- University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Bret Yonke
- TRIA Orthopaedic Center, 8100 Northland Drive, Bloomington, MN, 55431, USA
| | - Marc Tompkins
- University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
- TRIA Orthopaedic Center, 8100 Northland Drive, Bloomington, MN, 55431, USA
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Rahnemai-Azar AA, Sabzevari S, Irarrázaval S, Chao T, Fu FH. Anatomical Individualized ACL Reconstruction. THE ARCHIVES OF BONE AND JOINT SURGERY 2016; 4:291-297. [PMID: 27847839 PMCID: PMC5100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/31/2016] [Indexed: 06/06/2023]
Abstract
The anterior cruciate ligament (ACL) is composed of two bundles, which work together to provide both antero-posterior and rotatory stability of the knee. Understanding the anatomy and function of the ACL plays a key role in management of patients with ACL injury. Anatomic ACL reconstruction aims to restore the function of the native ACL. Femoral and tibial tunnels should be placed in their anatomical location accounting for both the native ACL insertion site and bony landmarks. One main component of anatomical individualized ACL reconstruction is customizing the treatment according to each patient's individual characteristics, considering preoperative and intraoperative evaluation of the native ACL and knee bony anatomy. Anatomical individualized reconstruction surgery should also aim to restore the size of the native ACL insertion as well. Using this concept, while single bundle ACL reconstruction can restore the function of the ACL in some patients, double bundle reconstruction is indicated in others to achieve optimal outcome.
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Affiliation(s)
- Amir Ata Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Soheil Sabzevari
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Sebastián Irarrázaval
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Tom Chao
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
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