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Dimitriou D, Zou D, Wang Z, Tsai TY, Helmy N. Anterior root of lateral meniscus and medial tibial spine are reliable intraoperative landmarks for the tibial footprint of anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2021; 29:806-813. [PMID: 32419045 DOI: 10.1007/s00167-020-06018-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aims of the present study were (1) to investigate the tibial footprint location of the anterior cruciate ligament (ACL) in both ACL-ruptured and ACL-intact patients, (2) to identify the relationship of the tibial footprint to the anterior root of the lateral meniscus (ARLM) and medial tibial spine (MTS), and (3) to evaluate the reliability of the ARLM and MTS for identifying the center of the tibial ACL footprint. METHODS Magnetic resonance images of 90 knees with ACL rupture and 90 matched-controlled knees were used to create three-dimensional models of the tibia. The tibial ACL footprint was outlined on each model, and its location was measured using an anatomical coordinate system. RESULTS No significant difference in the location of the tibial footprint was found between ACL-ruptured and ACL-intact knees. The tibial ACL footprint was located in very close proximity to the ARLM, especially in the M/L direction. The safe zone of tibial tunnel reaming for avoiding damage to the ARLM was 2.6 mm lateral to the center of the native tibial footprint. Both the ARLM and MTS were reliable intraoperative landmarks for identifying the tibial footprint. CONCLUSIONS Orthopedic surgeons should be aware of the safe zone of tibial tunnel reaming for avoiding injury to the ARLM. Both the ARLM and MTS might be reliable landmarks for identifying the center of the tibial ACL footprint and may facilitate tibial tunnel placement during anatomical single-bundle ACL reconstruction, especially in cases of revision where the tibial ACL stump is not available. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 38, CH-4500, Solothurn, Switzerland
| | - Diyang Zou
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Zhongzheng Wang
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Naeder Helmy
- Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 38, CH-4500, Solothurn, Switzerland
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Golan EJ, Tisherman R, Byrne K, Diermeier T, Vaswani R, Musahl V. Anterior Cruciate Ligament Injury and the Anterolateral Complex of the Knee-Importance in Rotatory Knee Instability? Curr Rev Musculoskelet Med 2019; 12:472-478. [PMID: 31773476 PMCID: PMC6942070 DOI: 10.1007/s12178-019-09587-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW In the setting of rotatory knee instability following anterior cruciate ligament (ACL) reconstruction, there has been a resurgence of interest in knee's anterolateral complex (ALC). Reconstruction or augmentation of the ALC with procedures such as a lateral extra-articular tenodesis (LET) has been proposed to reduce rotatory knee instability in conjunction with ACL reconstruction. The current review investigates the recent literature surrounding the role of the ALC in preventing rotatory knee instability. RECENT FINDINGS The knee's anterolateral complex (ALC) is a complex structure composed of the superficial and deep portions of the iliotibial band, the capsulo-osseous layer, and the anterolateral capsule. Distally, these various layers merge to form a single functional unit which imparts stability to the lateral knee. While the iliotibial band and the capsule-osseous layer have been shown to be primary restraints to rotatory motion after ACL injury, the biomechanical role of the anterolateral capsule remains unclear. Biomechanical studies have shown that the anterolateral capsule and the anterolateral thickening of this capsule act as a sheet of fibrous tissue which does not resist motion around the knee as other longitudinally oriented ligaments do. Augmentation of the ALC, with LET, has been performed globally for over 30 years. This procedure can decrease rotatory knee instability, but long-term studies have found little difference in patient-reported outcomes, osteoarthritis, or ACL reconstruction failure with the addition of LET. Further research is needed to clarify indications for the clinical use of ALC-based procedures.
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Affiliation(s)
- Elan J Golan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
| | - Robert Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA USA
| | - Kevin Byrne
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
| | - Theresa Diermeier
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
- Orthopaedic Sport Medicine, Technical University Munich, Munich, Germany
| | - Ravi Vaswani
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA USA
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Intercondylar Notch Impingement of the Anterior Cruciate Ligament: A Cadaveric In Vitro Study Using Robots. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:8698167. [PMID: 30651948 PMCID: PMC6311805 DOI: 10.1155/2018/8698167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/16/2018] [Accepted: 11/06/2018] [Indexed: 01/13/2023]
Abstract
Background Research has indicated that a smaller intercondylar notch could cause contact between the anterior cruciate ligament and the femoral notch, which may predispose individuals to an increased rate of anterior cruciate ligament injury. Hypothesis Contact between the lateral notch wall and the anterior cruciate ligament does increase the strain past the structural integrity of the ligament. Study Design A descriptive laboratory study. Methods A biomechanical study using robotic manipulators was conducted to investigate the occurrence of impingement in human cadaver specimens. Six cadaveric knees from six donors (three male and three female) were instrumented with a thin force sensor, placed on the lateral wall of the femoral condyle, and a differential variable reluctance transducer (DVRT) was attached to the middle section of the anterior medial bundle of the ACL. The knees were then moved through a series of flexion (5° to 90°), valgus (0 to 7.5°), and external rotation (0 to 7.5°) movements using two interacting robots. Results The results revealed that impingement occurred in both male and female specimens with a maximum impingement force of 28 N. Impingement occurred more prominently in female knees and in the combination loading of valgus and external rotation for both genders. The corresponding strain due to impingement was small or compressive, with the male knee maximum strain less than 1.28% and the female knee strain less than 7.1% in the worse case conditions. Conclusion The lack of increased force or strain when impingement occurred indicates that impingement may not affect the healthy function of the knee with a nonstenotic notch. Additionally, the analysis shows that impingement may not be a major contributing factor to anterior cruciate ligament injury, but rather a common occurrence in healthy knees. Clinical Relevance Impingement within the femoral notch does not appear to be a major contributory factor to ACL injury. Other more severe injuries to the knee would occur before ACL impingement with the femoral notch becoming a contributing factor to ACL injury. The small sample size limits the conclusivity of the results presented in this research; thus, additional large sample size studies are warranted.
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Evaluation of Posterior Cruciate Ligament and Intercondylar Notch in Subjects With Anterior Cruciate Ligament Tear: A Comparative Flexed-Knee 3D Magnetic Resonance Imaging Study. Arthroscopy 2018; 34:557-565. [PMID: 29208323 DOI: 10.1016/j.arthro.2017.08.296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if posterior cruciate ligament (PCL) and intercondylar notch (IN) morphometries and volumetrics act as risk factors for anterior cruciate ligament (ACL) tears. METHODS A prospective case-controlled magnetic resonance imaging (MRI) study was conducted with subjects presenting noncontact knee injuries. Exclusion criteria were previous surgery, PCL tear, osteoarthritis, tumors, or infectious and inflammatory conditions. All participants underwent a flexed-knee 3-dimensional (3D) magnetic resonance imaging (MRI) to uniformly straighten PCL. MR images were independently reviewed by 2 radiologists and assessed for 2D and 3D measurements (bicondylar width; IN angle, depth, width, and cross-sectional area; PCL width, thickness, and cross-sectional area; and IN and PCL volumes). Clinical profiles were tabulated and subjects were divided into cases (ACL tear) and controls (without ACL tear). RESULTS The study was composed of 50 cases versus 52 controls (N = 102), with a mean age of 36.8 years. There was no difference between groups (P > .05) regarding age, gender, body mass index, time from injury, Tegner score, flexion angle, limb side, intensity of injury, or familial or opposite limb history of tear. Agreement between readers ranged from substantial to almost perfect. Subjects with ACL tear presented with lower IN width, lower IN minus PCL widths, lower Notch Width Index, higher PCL/IN width proportion, higher PCL thickness, lower IN depth minus PCL thickness, and higher PCL thickness/IN depth proportion (P < .05). Moreover, higher PCL/IN cross-sectional area proportion, higher PCL volumes (OR = 9.01), and higher PCL/IN volume proportion were also found in cases. CONCLUSIONS Our study shows that subjects with ACL tears present not only reduced IN but also larger PCL dimensions. These findings, isolated and combined, and especially PCL volume, might be suggestive as risk factors for ACL tears owing to the reduction of its space inside the IN. LEVEL OF EVIDENCE Level III, comparative group.
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Anatomic ACL reconstruction: the normal central tibial footprint position and a standardised technique for measuring tibial tunnel location on 3D CT. Knee Surg Sports Traumatol Arthrosc 2017; 25:1568-1575. [PMID: 26130426 DOI: 10.1007/s00167-015-3683-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/19/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to define the normal ACL central tibial footprint position and describe a standardised technique of measuring tibial tunnel location on 3D CT for anatomic single-bundle ACL reconstruction. METHODS The central position of the ACL tibial attachment site was determined on 76 MRI scans of young individuals. The central footprint position was referenced in the anterior-posterior (A-P) and medial-lateral (M-L) planes on a grid system over the widest portion of the proximal tibia. 3D CT images of 26 young individuals had a simulated tibial tunnel centred within the bony landmarks of the ACL footprint, and the same grid system was applied over the widest portion of the proximal tibia. The MRI central footprint position was compared to the 3D CT central footprint position to validate the technique and results. RESULTS The median age of the 76 MRI subjects was 24 years, with 32 females and 44 males. The ACL central footprint position was at 39 (±3 %) and 48 (±2 %), in the A-P and M-L planes, respectively. There was no significant difference in this position between sexes. The median age of the 26 CT subjects was 25.5 years, with 10 females and 16 males. The central position of the bony ACL footprint was at 38 (±2 %) and 48 (±2 %), in the A-P and M-L planes, respectively. The MRI and CT central footprint positions were not significantly different in relation to the medial position, but were different in relation to the anterior position (A-P 39 % vs. 38 %, p = 0.01). The absolute difference between the central MRI and CT reference positions was 0.45 mm. CONCLUSIONS The ACL's normal central tibial footprint reference position has been defined, and the technique of measuring tibial tunnel location with a standardised grid system is described. This study will assist surgeons in evaluating tibial tunnel position in anatomic single-bundle ACL reconstruction. LEVEL OF EVIDENCE III.
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Thein R, Spitzer E, Doyle J, Khamaisy S, Nawabi DH, Chawla H, Lipman JD, Pearle AD. The ACL Graft Has Different Cross-sectional Dimensions Compared With the Native ACL: Implications for Graft Impingement. Am J Sports Med 2016; 44:2097-105. [PMID: 27179055 DOI: 10.1177/0363546516645531] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Impingement of anterior cruciate ligament (ACL) grafts against the femoral notch and the posterior cruciate ligament (PCL) is thought to be influenced primarily by tunnel position and graft orientation. Recent data have implied that the native ACL is ribbon-shaped. PURPOSE To evaluate the 3-dimensional shape and cross-sectional area of the native ACL versus the ACL graft and to compare the degree of impingement against the femoral notch and PCL. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Bilateral knee magnetic resonance images were analyzed for 27 patients with unilateral bone-patellar tendon-bone (BPTB) ACL reconstruction performed via transtibial or anteromedial portal femoral tunneling techniques. Three-dimensional models of the ACL, PCL, femur, and tibia were digitally rendered. The cross-sectional area and dimensions of the native ACL and the reconstructed graft were determined at 3 equally spaced locations and compared via Wilcoxon-Mann-Whitney and Kruskal-Wallis tests. In addition, impingement of the ACL on the PCL and femoral notch was graded in 3 groups. Chi-square or Fisher exact tests were used to compare the proportional differences of impingement of the native and reconstructed ACL on the PCL and femoral notch, respectively. All analyses were performed using 2-sided hypothesis testing, with statistical significance at P < .05. RESULTS Cross-sectional areas at all 3 points on the ACL graft were significantly greater than those of the native ACL (P < .001). The long- to short-axis ratio for the native ACL was significantly greater at each location compared with the corresponding locations along the ACL graft (P < .001), implying that the native ACL is "flatter" than is an ACL graft. There were 19 operated knees (70%) with contact or impingement between the ACL graft and the femoral notch compared with zero knees with a native ACL (P < .001). In addition, 22 operated knees (81%) showed contact or impingement between the ACL graft and the PCL, compared with 7 knees (26%) with a native ACL (P < .001). No significant differences in impingement frequency were noted between the transtibial and anteromedial tunneling techniques for ACL graft specimens (P > .05). CONCLUSION Native ACLs have a smaller cross-sectional area, are "flatter," and experience less incidence of impingement compared with anatomically placed BPTB ACL grafts.
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Affiliation(s)
- Ran Thein
- Department of Orthopedic Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Elad Spitzer
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - John Doyle
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Saker Khamaisy
- Department of Orthopedic Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Danyal H Nawabi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Harshvardhan Chawla
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Joseph D Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D Pearle
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Biswal UK, Balaji G, Nema S, Poduval M, Menon J, Patro DK. Correlation of tunnel widening and tunnel positioning with short-term functional outcomes in single-bundle anterior cruciate ligament reconstruction using patellar tendon versus hamstring graft: a prospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:647-55. [DOI: 10.1007/s00590-016-1809-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/20/2016] [Indexed: 01/20/2023]
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Werner BC, Burrus MT, Gwathmey FW, Miller MD. A prospective evaluation of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement in anterior cruciate ligament (ACL) reconstruction. Knee 2016; 23:478-81. [PMID: 26549778 DOI: 10.1016/j.knee.2015.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/07/2015] [Accepted: 10/14/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The goal of this study was to prospectively evaluate the accuracy and consistency of the anterior horn of the lateral meniscus as a landmark in achieving the desired tibial tunnel location during primary anterior cruciate ligament (ACL) reconstruction. METHODS One hundred consecutive adult patients undergoing primary ACL reconstruction were enrolled in the study. One sports-fellowship trained surgeon performed all ACL reconstructions using independent tunnel drilling with an accessory anteromedial portal for the femoral tunnel. All guide pins for the tibial tunnel were placed using a 55-degree guide using the posterior border of the anterior horn of the lateral meniscus as a landmark. Following pin placement, a true lateral fluoroscopic image was obtained. These were digitally analyzed to measure the location of the pin along the length of the tibial plateau. RESULTS The average anteroposterior (A-P) distance achieved using the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement was 37.0%±5.2% (mean±standard deviation) [range 26.4%-49.2%]. 66% of tibial tunnels were located between 30.0% and 39.9% of the A-P tibial distance. Only 18% of tibial tunnels localized between 40.0% and 44.9%, the area of the anatomic footprint described by Staubli and Rauschning [9] 16% of patients were significant outliers, with tunnels localizing to 25.0%-29.9% (6 patients) or 45.0%-49.9% (10 patients). CONCLUSIONS Use of the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement during anatomic ACL reconstruction yields an inconsistent tunnel location. LEVEL OF EVIDENCE II, Prospective study.
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Affiliation(s)
- Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA.
| | - M Tyrrell Burrus
- Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA
| | - Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA
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Leal MF, Astur DC, Debieux P, Arliani GG, Franciozi CES, Loyola LC, Andreoli CV, Smith MC, Pochini ADC, Ejnisman B, Cohen M. Identification of Suitable Reference Genes for Investigating Gene Expression in Anterior Cruciate Ligament Injury by Using Reverse Transcription-Quantitative PCR. PLoS One 2015; 10:e0133323. [PMID: 26192306 PMCID: PMC4507999 DOI: 10.1371/journal.pone.0133323] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/25/2015] [Indexed: 11/30/2022] Open
Abstract
The anterior cruciate ligament (ACL) is one of the most frequently injured structures during high-impact sporting activities. Gene expression analysis may be a useful tool for understanding ACL tears and healing failure. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) has emerged as an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. Here, we evaluated the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1, and TBP) by using ACL samples of 39 individuals with ACL tears (20 with isolated ACL tears and 19 with ACL tear and combined meniscal injury) and of 13 controls. The stability of the candidate reference genes was determined by using the NormFinder, geNorm, BestKeeper DataAssist, and RefFinder software packages and the comparative ΔCt method. ACTB was the best single reference gene and ACTB+TBP was the best gene pair. The GenEx software showed that the accumulated standard deviation is reduced when a larger number of reference genes is used for gene expression normalization. However, the use of a single reference gene may not be suitable. To identify the optimal combination of reference genes, we evaluated the expression of FN1 and PLOD1. We observed that at least 3 reference genes should be used. ACTB+HPRT1+18S is the best trio for the analyses involving isolated ACL tears and controls. Conversely, ACTB+TBP+18S is the best trio for the analyses involving (1) injured ACL tears and controls, and (2) ACL tears of patients with meniscal tears and controls. Therefore, if the gene expression study aims to compare non-injured ACL, isolated ACL tears and ACL tears from patients with meniscal tear as three independent groups ACTB+TBP+18S+HPRT1 should be used. In conclusion, 3 or more genes should be used as reference genes for analysis of ACL samples of individuals with and without ACL tears.
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Affiliation(s)
- Mariana Ferreira Leal
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, 04038–032, São Paulo, SP, Brazil
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo, 04023–001, São Paulo, SP, Brazil
- * E-mail:
| | - Diego Costa Astur
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, 04038–032, São Paulo, SP, Brazil
| | - Pedro Debieux
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, 04038–032, São Paulo, SP, Brazil
| | - Gustavo Gonçalves Arliani
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, 04038–032, São Paulo, SP, Brazil
| | | | - Leonor Casilla Loyola
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, 04038–032, São Paulo, SP, Brazil
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo, 04023–001, São Paulo, SP, Brazil
| | - Carlos Vicente Andreoli
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, 04038–032, São Paulo, SP, Brazil
| | - Marília Cardoso Smith
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo, 04023–001, São Paulo, SP, Brazil
| | - Alberto de Castro Pochini
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, 04038–032, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, 04038–032, São Paulo, SP, Brazil
| | - Moises Cohen
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, 04038–032, São Paulo, SP, Brazil
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Lord B, Grice J, Cox G, Yasen S, Wilson A. (iii) Anterior cruciate ligament reconstruction – evolution and current concepts. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.mporth.2014.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Smith C, Ajuied A, Wong F, Norris M, Back D, Davies A. The use of the ligament augmentation and reconstruction system (LARS) for posterior cruciate reconstruction. Arthroscopy 2014; 30:111-20. [PMID: 24290790 DOI: 10.1016/j.arthro.2013.09.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/13/2013] [Accepted: 09/23/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review and assess the use of the Ligament Advanced Reinforcement System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France) for posterior cruciate ligament (PCL) reconstruction. METHODS A search of multiple databases was conducted using the following terms: (LARS[All Fields] AND posterior[All Fields]) OR (LARS[All Fields] AND PCL[All Fields]). The methodologic quality of each article was assessed by use of abridged Downs and Black criteria. RESULTS Fifty-four studies were found from the database search, of which 5 were included in the final review (4 case series and 1 case-control study). One hundred twenty-nine PCL reconstructions with LARS were performed. The mean patient age was 32.2 years, with 89 male and 40 female patients included. The mean follow-up time ranged from 10.5 to 44 months. Lysholm scores improved from a mean of 64.8 preoperatively to 89.8 postoperatively. No patients had International Knee Documentation Committee grade 1 or 2 preoperatively, with 93.0% achieving this postoperatively. Only 1 case of synovitis and 1 case of graft rupture were reported. CONCLUSIONS There is little evidence on the effectiveness of PCL reconstructions using LARS ligaments. What data there are show great promise, with short- and medium-term outcome data appearing favorable to autograft reconstruction. Complication rates are encouragingly low. CLINICAL RELEVANCE LARS has great potential for PCL reconstruction. Further studies are needed regarding the use of LARS ligaments during PCL reconstruction, including longer follow-up periods and investigation into the optimal timing for reconstruction. This may be best achieved by way of a multicenter study.
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Affiliation(s)
- Christian Smith
- Guy's and St. Thomas' NHS Foundation Trust, King's Healthcare Partners, and Fortius Clinic London (A.D.), London, England.
| | - Adil Ajuied
- Guy's and St. Thomas' NHS Foundation Trust, King's Healthcare Partners, and Fortius Clinic London (A.D.), London, England
| | - Fabian Wong
- Guy's and St. Thomas' NHS Foundation Trust, King's Healthcare Partners, and Fortius Clinic London (A.D.), London, England
| | - Mark Norris
- Guy's and St. Thomas' NHS Foundation Trust, King's Healthcare Partners, and Fortius Clinic London (A.D.), London, England
| | - Diane Back
- Guy's and St. Thomas' NHS Foundation Trust, King's Healthcare Partners, and Fortius Clinic London (A.D.), London, England
| | - Andrew Davies
- Guy's and St. Thomas' NHS Foundation Trust, King's Healthcare Partners, and Fortius Clinic London (A.D.), London, England
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