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Ma R, Sheth C, Fenkell B, Buyuk AF. The Role of Bracing in ACL Injuries: The Current Evidentiary State of Play. J Knee Surg 2022; 35:255-265. [PMID: 35088398 DOI: 10.1055/s-0042-1742304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anterior cruciate ligament (ACL) injuries and surgeries are both increasing in incidence. A notable rate of reinjury and failure does occur after ACL surgery. As a result, interventions that may reduce ACL injury or reinjury are needed and are active areas of innovation. Knee bracing as a strategy to either prevent primary ACL injury, reduce reinjury, or failure after ACL surgery is common. The evidence for bracing around ACL injuries is not straightforward. Clinicians therefore need to understand the relevant literature on bracing around ACL injuries to make personalized decisions for individuals who may be at risk for ACL injury. The purpose of this review is to provide an overview on bracing for ACL injuries and summarize the current available clinical evidence for its use in ACL injuries.
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Affiliation(s)
- Richard Ma
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri - Columbia, Columbia, Missouri
| | - Chirag Sheth
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri - Columbia, Columbia, Missouri
| | - Blake Fenkell
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri - Columbia, Columbia, Missouri
| | - Abdul Fettah Buyuk
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri - Columbia, Columbia, Missouri
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Suzuki T, Shino K, Yamakawa S, Otsubo H, Suzuki D, Matsumura T, Fujimiya M, Fujie H, Yamashita T. A Biomechanical Comparison of Single-, Double-, and Triple-Bundle Anterior Cruciate Ligament Reconstructions Using a Hamstring Tendon Graft. Arthroscopy 2019; 35:896-905. [PMID: 30733036 DOI: 10.1016/j.arthro.2018.10.124] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The first objective of our cadaveric study was to perform a biomechanical comparison of single-bundle (SB), double-bundle (DB), and triple-bundle (TB) anterior cruciate ligament (ACL) reconstructions using a hamstring tendon graft to determine the laxity match pre-tension (LMP) value, which is the tension within the graft required to re-create the same anterior laxity as the ACL-intact knee. The second objective was to determine the anterior laxity and force distribution during the application of both an anterior force and a simulated pivot-shift test. METHODS Eleven fresh-frozen cadaveric knees were tested using a robotic/universal force-moment sensor system in the intact state, TB-reconstructed knee, DB-reconstructed knee, and SB-reconstructed knee. The LMP in each reconstruction was recorded. Each reconstructed knee was tested with an external load of 100-N anterior drawer and combined rotatory loads of 10-Nm valgus moment and 5-Nm internal rotation. The anterior tibial translation and tensile forces of each graft bundle were measured. RESULTS The LMP values for the TB reconstruction were 1.7 N for the anteromedial-medial graft, 1.7 N for the anteromedial-lateral graft, and 3.4 N for the posterolateral graft (PLG). The LMP value was 5.6 N for the anteromedial graft and PLG in the DB reconstruction. The LMP value was 26.3 N for the whole graft in the SB reconstruction. No statistically significant difference in stability was found between TB and DB reconstructions during the anterior load and the combined rotatory load test. For force distribution, the PLG tension in the TB reconstruction was statistically lower than that in the DB reconstruction. CONCLUSIONS Anatomic TB ACL reconstruction with the lowest initial tension on the graft stabilized the knee equally to DB or SB reconstruction, which required greater initial tension. CLINICAL RELEVANCE Although SB, DB, and TB ACL reconstructions through the anatomic tunnel position could equally restore stability, the initial tension on the graft required to restore stability was less in the latter 2 multi-tunnel reconstructions.
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Affiliation(s)
- Tomoyuki Suzuki
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan.
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Hidenori Otsubo
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Takashi Matsumura
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Mineko Fujimiya
- Second Department of Anatomy, Sapporo Medical University, Sapporo, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
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Sasaki Y, Chang SS, Fujii M, Araki D, Zhu J, Marshall B, Linde-Rosen M, Smolinski P, Fu FH. Effect of fixation angle and graft tension in double-bundle anterior cruciate ligament reconstruction on knee biomechanics. Knee Surg Sports Traumatol Arthrosc 2016; 24:2892-2898. [PMID: 25726160 DOI: 10.1007/s00167-015-3552-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the effect of graft fixation angle and tension in double-bundle anterior cruciate ligament (ACL) reconstruction on knee biomechanics. METHODS Fourteen cadaver knees were tested using a robotic system under two loadings: (1) an 89-N anterior tibial load (ATL) at full extension (FE), 15°, 30°, 45°, 60°, and 90°, and (2) combined 7 N m valgus and 5 N m internal tibial torques (simulated pivot-shift test) at FE, 15° and 30°. Four graft fixation angles and tensions were used for the anteromedial (AM) and posterolateral (PL) bundles, respectively: (Recon 1) 30°/20N and FE/20N, (Recon 2) 30°/30N and FE/10N, (Recon 3) 45°/20N and 15°/20N, and (Recon 4) 45°/30N and 15°/10N. RESULTS All fixation protocols closely restored the intact knee kinematics under ATL and simulated pivot-shift loading. For the AM bundle under ATL, the in situ force (ISF) with Recon 3 at the FE was significantly lower than that of the intact knee. For the PL bundle under ATL, the ISF with Recon 3 at the FE, 15° and 30° was significantly higher than that of the intact knee. In PL bundle under simulated pivot-shift loading, the ISF with Recon 1 and Recon 2 at FE was lower and the ISF of the PL bundle with Recon 3 at the 15° was higher than that of the intact knee. CONCLUSION The AM-45°/30N and PL-15°/10N fixation most closely matched intact knee kinematics; however, stabilizing the knee during anterior tibial translation may risk an imbalance of the AM and the PL bundle loading. The results indicate that ACL bundle forces may not be restored even if the clinical assessment shows good results with the Lachman test and pivot-shift test. This may alter the loading on other structures of the knee.
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Affiliation(s)
- Yusuke Sasaki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shih-Sheng Chang
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Masataka Fujii
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Daisuke Araki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Junjun Zhu
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brandon Marshall
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Monica Linde-Rosen
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA.
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA.
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Kondo E, Yasuda K, Kitamura N, Onodera J, Yokota M, Yagi T, Iwasaki N. Effects of initial graft tension on clinical outcome after anatomic double-bundle anterior cruciate ligament reconstruction: comparison of two graft tension protocols. BMC Musculoskelet Disord 2016; 17:65. [PMID: 26857109 PMCID: PMC4746831 DOI: 10.1186/s12891-016-0909-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In anatomic double-bundle anterior cruciate ligament (ACL) reconstruction, there are great controversies concerning the ideal graft tension protocols. The purpose of this study was to clarify differences in the effect of two graft tension protocols on the clinical outcome after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction by comparing the minimum 2-year clinical results. METHODS Ninety-seven patients with unilateral anatomic double-bundle ACL reconstruction were divided into two groups. In the first 44 patients (Group I), a 40-N tension was applied to each of the two hamstring autografts at 30° of knee flexion, and simultaneously fixed onto the tibia. In the remaining 53 patients (Group II), a 30-N tension was applied to each graft at 10° of knee flexion, and simultaneously fixed onto the tibia. Each patient was examined 2 years after surgery. RESULTS There wasn't a significant difference in the background of the two groups. There was no significant difference in the postoperative anterior laxity between the two groups. The average was 1.1 mm and 0.9 mm in Groups I and II, respectively. There wasn't any differences between the two groups in Lysholm knee score, International Knee Documentation Committee (IKDC) evaluation and muscle strength. Four patients had loss of knee extension in a range of 5° and 10° in Group I and none of the patients in Group II exhibited any loss in knee extension; which was statistically significant (p = 0.025). CONCLUSION The two initial graft tension protocols did not result in any significant differences in the Lysholm knee score and IKDC grade. However, it was noted that the 40-N tension applied to each graft at 30° of knee flexion more significantly induced loss of knee extension in comparison to the 30-N tension applied to each graft at 10°. From a clinical viewpoint, the loss of knee extension is one of the pathological conditions that should be absolutely avoided after ACL reconstruction. Therefore, the 30-N tension applied to each graft at 10° is preferable to the other graft tension protocol.
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Affiliation(s)
- Eiji Kondo
- The Department of Advanced Therapeutic Research for Sports Medicine, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Kazunori Yasuda
- The Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
| | - Nobuto Kitamura
- The Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
| | - Jun Onodera
- The Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
| | - Masashi Yokota
- The Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
| | - Tomonori Yagi
- The Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital, Sapporo, Hokkaido, Japan.
| | - Norimasa Iwasaki
- The Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
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Kawaguchi S, Nagamune K, Nishizawa Y, Oka S, Araki D, Hoshino Y, Matsushita T, Kuroda R, Kurosaka M. A Comparison of Ligament Tensions Between Intra- and Extra-Articular Measurement in Anterior Cruciate Ligament Reconstruction. JOURNAL OF ADVANCED COMPUTATIONAL INTELLIGENCE AND INTELLIGENT INFORMATICS 2015. [DOI: 10.20965/jaciii.2015.p0778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Anterior cruciate ligament (ACL) reconstruction is one of the treatments of ACL injuries. In the surgery, the reconstructed ligament should be properly tensioned to provide a normal ligament behavior. However, the ligament tension has been measured with an extra-articular technique in past studies, while the intra-articular ligament tension is still unknown. The purpose of this study is to compare the ligament tensions between intra- and extra-articular measurements in the ACL reconstruction. Intra-articular measurement employs a micro-force sensor designed with a width and thickness same as those of the reconstructed ligament. This study performed two experiments (i.e., sensor accuracy and cadaveric study). In the sensor accuracy experiment, the accuracy of the sensor was about 3% until an applied force of 100 N. In the cadaveric study, the results of the intra- and extra-articular measurement tensions were 13.6±3.9 N and 18.7±1.3 N (n= 6), respectively. The significant difference in student t-test (p-value was 0.026) between the intra- and extra- articular measurements was observed. The bending angle and friction between the graft and bone tunnel, and the shape of the intra-articular edge of tibial bone tunnel affected the intra-articular measurement in ACL reconstruction.
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Lubowitz JH, Provencher MT, Poehling GG. Do large-diameter hamstring grafts in young patients prevent knee osteoarthritis after ACL reconstruction? Arthroscopy 2012; 28:447-8. [PMID: 22464287 DOI: 10.1016/j.arthro.2012.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 02/02/2012] [Indexed: 02/02/2023]
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