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Högberg J, Piussi R, Lövgren J, Wernbom M, Simonsson R, Samuelsson K, Hamrin Senorski E. Restoring Knee Flexor Strength Symmetry Requires 2 Years After ACL Reconstruction, But Does It Matter for Second ACL Injuries? A Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2024; 10:2. [PMID: 38180584 PMCID: PMC10769975 DOI: 10.1186/s40798-023-00666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND It is unknown whether knee flexor strength recovers after anterior cruciate ligament (ACL) reconstruction with a hamstring tendon (HT) autograft and whether persistent knee flexor strength asymmetry is associated to a second ACL injury. OBJECTIVE We aimed to systematically review (1) whether knee flexor strength recovers after ACL reconstruction with HT autografts, and (2) whether it influences the association with a second ACL injury. A third aim was to summarize the methodology used to assess knee flexor strength. DESIGN Systematic review and meta-analysis reported according to PRISMA. METHODS A systematic search was performed using the Cochrane Library, Embase, Medline, PEDRo, and AMED databases from inception to December 2021 and until completion in January 2023. Human clinical trials written in English and conducted as randomized controlled trials, longitudinal cohort, cross-sectional, and case-control studies on patients with index ACL reconstructions with HT autografts harvested from the ipsilateral side were considered. Knee flexor strength was measured isokinetically in both the reconstructed and uninjured limb to enable the calculation of the limb symmetry index (LSI). The Risk of Bias Assessment Tool for Non-Randomized Studies was used to assess risk of bias for non-randomized studies and the revised Cochrane Risk of Bias tool was used for randomized controlled trials. For the meta-analysis, the LSI (mean ± standard error) for concentric knee flexor strength at angular velocities of 60°/second (s) and 180°/s preoperatively and at 3 months, 6 months, 12 months, and 24 months were pooled as weighted means with standard errors. RESULTS The search yielded 64 studies with a total of 8378 patients, which were included for the assessment of recovery of knee flexor strength LSI, and a total of 610 patients from four studies that investigated the association between knee flexor strength and second ACL injuries. At 1 year after ACL reconstruction, the knee flexor strength LSI had recovered to 89.0% (95% CI 87.3; 90.7%) and 88.3% (95% CI 85.5; 91.1%) for the velocities of 60°/s and 180°/s, respectively. At 2 years, the LSI was 91.7% (95% CI 90.8; 92.6%) and 91.2% (95% CI 88.1; 94.2%), for velocities of 60°/s and 180°/s, respectively. For the association between knee flexor strength and second ACL injuries, there was insufficient and contradictory data. CONCLUSIONS There was low to very low certainty of evidence indicating that the recovery of knee flexor strength LSI, defined as ≥ 90% of the uninjured side, takes up to 2 years after ACL reconstruction with HT autografts. Whether knee flexor strength deficits influence the association of second ACL injuries is still uncertain. There was considerable heterogeneity in the methodology used for knee flexor strength assessment, which together with the low to very low certainty of evidence, warrants further caution in the interpretation of our results. REGISTRATION NUMBER CRD42022286773.
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Affiliation(s)
- Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden.
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Johan Lövgren
- Active Physio Sports Medicine Clinic, Brogatan 23, 431 30, Gothenburg, Sweden
| | - Mathias Wernbom
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
- The Rydberg Laboratory for Applied Sciences, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
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Aizawa J, Hirohata K, Ohji S, Mitomo S, Ohmi T, Koga H, Yagishita K. Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) subcategories are affected by subjective running ability and medial single-leg hop distance in postreconstruction patients at 6 months. J Exp Orthop 2024; 11:e12004. [PMID: 38455451 PMCID: PMC10903433 DOI: 10.1002/jeo2.12004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose This study aimed to investigate the intricate relationship between physical function factors and each subcategory score of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale among patients following ACL reconstruction. Methods Participants comprised 59 patients who had undergone primary ACL reconstruction using hamstring tendon. The ACL-RSI was completed 6 months after reconstruction and five physical functions were measured in patients on the same day. Simple linear regression was performed multiple times to investigate the relationship between ACL-RSI subcategory scores as a dependent variable and each independent variable (knee strength, leg anterior reach distance, single-leg hop [SLH] distances, side bridge endurance, and subjective running ability). Multiple regression analysis was performed using a stepwise method, with factors showing a risk rate <0.05 in simple linear regression analyses as independent variables and the ACL-RSI in each subcategory score as the dependent variable. Results Multiple regression analysis showed that subjective running ability affected all subcategories (p ≤ 0.001), and that the limb symmetry index of medial SLH distance affected both the Emotions (p = 0.047) and Confidence (p = 0.009) subcategories. Higher subjective running ability and greater limb symmetry in the medial SLH were thus positively associated with each dimension of psychological readiness. Conclusions This study highlights the differential impact of physical function factors on specific subcategories of the ACL-RSI scale, providing clinicians with insights for designing targeted rehabilitation strategies. This original paper suggests the importance of analysing factors related to subcategory scores in addition to total ACL-RSI score, and could contribute to the understanding of determinants for a successful return to sport following ACL reconstruction. Level of Evidence Level IV.
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Affiliation(s)
- Jun‐ya Aizawa
- Department of Physical TherapyJuntendo UniversityTokyoJapan
- Department of Rehabilitation Medicine, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental UniversityTokyoJapan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental UniversityTokyoJapan
| | - Sho Mitomo
- Department of Rehabilitation Medicine, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
- Japan Sports AgencyTokyoJapan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental UniversityTokyoJapan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental UniversityTokyoJapan
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Scholes C, Ektas N, Harrison-Brown M, Jegatheesan M, Rajesh A, Kirwan G, Bell C. Persistent knee extension deficits are common after anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomised controlled trials. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-022-07299-3. [PMID: 36705690 DOI: 10.1007/s00167-022-07299-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/20/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Knee extension deficits complicate recovery from ACL injury and reconstruction; however, the incidence of knee extension loss is not well defined. The aim of this review was to identify the incidence of loss of extension (LOE) following ACL rupture and reconstruction, explore the definitions of knee extension deficits reported and identify prognostic factors affecting LOE incidence. METHODS A systematic search was conducted in Medline, Cochrane Library and PEDro for studies in publication up to November 2021, with no restrictions on publication year. References were screened and assessed for inclusion using predetermined eligibility criteria. Randomised controlled trials (RCTs) that quantified knee angle, loss of extension or incidence of extension deficit were included for quality assessment and data extraction. Statistical summaries were generated and meta-analyses performed in two parts to examine: (i) the probability of a datapoint being zero incidence compared to a nonzero incidence and (ii) the relationship between the predictors and nonzero LOE incidence. RESULTS A sample of 15,494 studies were retrieved using the search criteria, with 53 studies meeting eligibility criteria. The pooled results from 4991 participants were included for analysis, with 4891 participants who had undergone ACLR. The proportion of included studies judged at an overall low risk of bias was small (7.8%). The observed group and study were the most important predictors for whether a datapoint reported an incidence of extension deficit. Time to follow-up (P < 0.001) and graft type (P = 0.02) were found to have a significant influence on nonzero LOE incidence (%). Covariate adjusted estimates of average LOE indicated 1 in 3 patients presenting with LOE at 12 month follow-up, reducing to 1 in 4 at 2 years. CONCLUSIONS This review examined the definitions for the measurement and interpretation of postoperative knee extension and established the trajectory of knee extension deficit after ACL injury and reconstruction. While factors associated with loss of extension were identified, the exact trajectory of knee extension deficits was difficult to infer due to discrepancies in measurement techniques and patient variation. On average, 1 in 3 patients may present with loss of extension of at least 3 degrees at 12-month follow-up, decreasing to 1 in 4 at 2 years. These results may be used by clinicians as an upper threshold for acceptable complication rates following ACLR. Future work should focus on LOE as a clinically relevant complication of ACL injury and treatment with appropriate attention to standardisation of definitions, measurements and better understanding of natural history. PROSPERO REGISTRATION NUMBER CRD42018092295. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | | | | | - Maha Jegatheesan
- Orthopaedics Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia
| | - Ashwin Rajesh
- Orthopaedics Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia
| | - Garry Kirwan
- Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia
| | - Christopher Bell
- Orthopaedics Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia.
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Balasingam S, Karikis I, Rostgård-Christensen L, Desai N, Ahldén M, Sernert N, Kartus J. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Is Not Superior to Anatomic Single-Bundle Reconstruction at 10-Year Follow-up: A Randomized Clinical Trial. Am J Sports Med 2022; 50:3477-3486. [PMID: 36269582 DOI: 10.1177/03635465221128566] [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 anatomic double-bundle (DB) technique is purported to be a superior technique due to its mimicking of the double-stranded anatomic formation of the anterior cruciate ligament (ACL). Previous studies with 2-, 5- and 10-year follow-up are conflicted as to whether this technique is superior to the previous gold standard method of ACL reconstruction, the anatomic single-bundle (SB) reconstruction. PURPOSE/HYPOTHESIS The aim of this prospective randomized study was to compare the outcomes of the anatomic DB technique and anatomic SB technique with independent drilling at 10 years after anterior cruciate ligament (ACL) reconstruction. We hypothesized that DB ACL reconstruction would result in a better outcome in terms of the pivot-shift test. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 105 patients (33 women, 72 men; median age, 27 years [range, 18-52 years]) were randomized and underwent ACL reconstruction (DB group: n = 53; SB group: n = 52). All reconstruction procedures were performed anatomically by identifying the ACL footprint, using the anteromedial portal for femoral tunnel drilling, and utilizing interference screws for tibial and femoral fixation. One blinded observer examined the patients both preoperatively and at follow-up (median, 120 months [range, 112-134 months]). Multiple subjective and objective clinical evaluations were used to assess the outcomes. Radiographic assessments of osteoarthritis were performed using the Ahlbäck, Kellgren-Lawrence, and Fairbank classification systems early postoperatively and at the final follow-up. RESULTS Preoperatively, no differences were found between the study groups. Overall, 70 patients (67%; DB group: n = 39; SB group: n = 31) were available for analysis at 10-year follow-up. No significant difference could be shown between the groups in terms of the pivot-shift grade, knee laxity measurements using the KT-1000 arthrometer, manual Lachman grade, single-leg hop test result, range of motion measurements, Lysholm knee score, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score (KOOS) score. Correspondingly, no differences were found between the groups regarding the presence of radiographic osteoarthritis at follow-up. Both groups improved at follow-up compared with preoperatively in terms of the pivot-shift grade, knee laxity measurements using the KT-1000 arthrometer, manual Lachman grade, Lysholm knee score, and KOOS score (P < .05 [highest P value for any comparison]). CONCLUSION The anatomic DB technique was not superior to the anatomic SB technique with independent drilling at 10-year follow-up in regard to objective and subjective measurements. As such, one could argue that there is no need for the continued use of the anatomic DB technique in an unselected population.
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Affiliation(s)
| | - Ioannis Karikis
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden
| | | | - Neel Desai
- Ortho Center Gothenburg, Gothenburg, Sweden
| | | | - Ninni Sernert
- Department of Research & Development, NU Hospital Group, Trollhättan, Sweden
| | - Juri Kartus
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden.,Department of Research & Development, NU Hospital Group, Trollhättan, Sweden
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Alomari MS, Ghaddaf AA, Abdulhamid AS, Alshehri MS, Ashraf M, Alharbi HH. Single Bundle Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Indian J Orthop 2022; 56:1669-1684. [PMID: 36187591 PMCID: PMC9485407 DOI: 10.1007/s43465-022-00718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/31/2022] [Indexed: 02/04/2023]
Abstract
Background Anterior cruciate ligament (ACL) tear is considered as one of the most common sport-related musculoskeletal injuries. Double bundle (DB) and single bundle (SB) surgical techniques has been widely adopted for ACL reconstruction. This systematic review aimed to provide updated evidence by comparing the short-term, mid-term, and long-term knee stability and functional outcomes of DB and SB reconstruction techniques. Methods We searched Medline, Web of Science, and CENTRAL. We have selected randomized controlled trials (RCTs) that compared DB and SB ACL reconstruction techniques for primary isolated ACL tear. We have assessed the following outcomes: pivot shift test, Lachman test, KT-1000/2000 knee ligament arthrometer, Lysholm knee function score, Tegner activity score, and graft failure. We have used the standardized mean difference (SMD) was to summarize the continuous outcomes while risk ratio (RR) was used to summarize the dichotomous outcomes. Results A total of 34 RCTs that enrolled 2,992 participants deemed eligible. Overall, DB showed significantly better outcomes in terms of pivot shift test (RR = 0.61, 95% confidence interval (CI) 0.49-0.75), Lachman test (RR = 0.77, 95% CI 0.62 to 0.95), and KT 1000/2000 arthrometer (SMD = - 0.21, 95% CI - 0.34 to - 0.08). No discernible difference was found between DB and SB techniques in the overall Lysholm score (SMD = 0.12, 95% CI - 0.03 to 0.27), Tegner score (SMD = 0.03, 95% CI - 0.17 to 0.24), or graft failure rate (RR = 0.78, 95% CI 0.33 to 1.85). Conclusions Our review suggests that DB ACL reconstruction technique shows significantly better knee stability and functional outcomes than SB at short-term follow-up. However, both techniques exhibit similar outcomes at mid-term and long-term follow-up. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-022-00718-0.
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Affiliation(s)
- Mohammed S. Alomari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A. Ghaddaf
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed S. Abdulhamid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed S. Alshehri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Surgery/Orthopedic Section, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mujeeb Ashraf
- Department of Surgery/Orthopedic Section, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hatem H. Alharbi
- Department of Surgery/Orthopedic Section, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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Aizawa J, Hirohata K, Ohji S, Ohmi T, Mitomo S, Koga H, Yagishita K. Cross-sectional study on relationships between physical function and psychological readiness to return to sport after anterior cruciate ligament reconstruction. BMC Sports Sci Med Rehabil 2022; 14:97. [PMID: 35650622 PMCID: PMC9161472 DOI: 10.1186/s13102-022-00491-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Information about specific factors of physical function that contribute to psychological readiness is needed to plan rehabilitation for a return to sports. The purpose of this study was to identify specific physical functions related to the psychological readiness of patients aiming to return to sports 6 months after reconstruction. We hypothesized that the knee strength is a factor related to the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI) cutoff score for a return to sports. METHODS This was a cross-sectional study. Fifty-four patients who had undergone primary reconstruction using hamstring tendon participated in this study. Psychological readiness was measured using the ACL-RSI in patients at 6 months after reconstruction. To identify specific physical functions related to the ACL-RSI score, participants were divided into groups with ACL-RSI scores of ≥ 60 or < 60. Non-paired t-tests or the Mann-Whitney test were performed to analyze group differences in objective variables in physical function: (1) knee strength in both legs; (2) leg anterior reach distance on both sides; and (3) single-leg hop (SLH) distances in three directions for both legs. RESULTS Significant differences between groups were identified in knee flexion strength (60°/s) for the uninvolved limb, hamstring-to-quadriceps ratio (60°/s) for the uninvolved limb, knee flexion strength (180°/s) for the involved limb, limb symmetry index (LSI) of leg anterior reach distance, the ratio of the distance to the height of the patient and LSI of SLH distances in lateral and medial directions. CONCLUSION This study revealed that at 6 months after reconstruction, increased knee flexion strength (ratio of peak torque measured to body mass of the patient), hamstring-to-quadriceps ratio, leg anterior reach distance LSI, and lateral and medial SLH appear important to exceed the ACL-RSI cutoff for a return to sports. The present results may be useful for planning post-operative rehabilitation for long-term return to sports after reconstruction.
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Affiliation(s)
- Junya Aizawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, 3-2-12 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Mitomo
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
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Double bundle ACL reconstruction leads to better restoration of knee laxity and subjective outcomes than single bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1795-1808. [PMID: 34595573 PMCID: PMC9033716 DOI: 10.1007/s00167-021-06744-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this meta-analysis is to compare arthroscopic single bundle (SB) and double bundle (DB) anterior cruciate ligament (ACL) reconstructions in the light of all available randomised controlled trials (RCTs). A meta-analysis of this well-researched topic was performed and subgroup analyses of the medial portal (MP) technique and the transtibial technique (TT) were added as a new idea. The hypothesis was that the DB technique is superior to the SB technique also in subgroup analyses of the MP and TT techniques. METHODS Instructions of the PRISMA checklist were followed. Systematic literature search from electronic databases, including PubMed, Cochrane library and Scopus was performed to find RCTs that compared the SB and DB techniques. Nine outcomes were used to compare these two techniques. Each study was assessed according to the Cochrane Collaboration's risk of bias tool and three subgroup analyses (minimum 2-years' follow-up, TT technique and MP technique) were performed. RESULTS A total of 40 studies were included in this meta-analysis. When analysing all the included studies, the DB technique was superior to the SB technique in KT-1000/2000 evaluation (p < 0.01), IKDC subjective evaluation (p < 0.05), Lysholm scores (p = 0.02), pivot shift (p < 0.01) and IKDC objective evaluation (p = 0.02). Similar results were also found in the subgroup analyses of minimum 2-years' follow-up and the TT technique. However, there were no differences between the two techniques in a subgroup analysis of the MP technique. CONCLUSION Generally, DB ACL reconstruction leads to better restoration of knee laxity and subjective outcomes than SB ACL reconstruction. The subgroup analysis of the MP technique revealed that surgeons can achieve equally as good results with both techniques when femoral tunnels are drilled through the medial portal. LEVEL OF EVIDENCE II.
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Second Generation of Tissue-Engineered Ligament Substitutes for Torn ACL Replacement: Adaptations for Clinical Applications. Bioengineering (Basel) 2021; 8:bioengineering8120206. [PMID: 34940359 PMCID: PMC8698634 DOI: 10.3390/bioengineering8120206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Abstract
The anterior cruciate ligament (ACL) of the knee joint is one of the strongest ligaments of the body and is often the target of traumatic injuries. Unfortunately, its healing potential is limited, and the surgical options for its replacement are frequently associated with clinical issues. A bioengineered ACL (bACL) was developed using a collagen matrix, seeded with autologous cells and successfully grafted and integrated into goat knee joints. We hypothesize that, in order to reduce the cost and simplify the model, an acellular bACL can be used as a substitute for a torn ACL, and bone plugs can be replaced by endobuttons to fix the bACL in situ. First, acellular bACLs were successfully grafted in the goat model with 18% recovery of ultimate tensile strength 6 months after implantation (94 N/mm2 vs. 520). Second, a bACL with endobuttons was produced and tested in an exvivo bovine knee model. The natural collagen scaffold of the bACL contributes to supporting host cell migration, growth and differentiation in situ post-implantation. Bone plugs were replaced by endobuttons to design a second generation of bACLs that offer more versatility as biocompatible grafts for torn ACL replacement in humans. A robust collagen bACL will allow solving therapeutic issues currently encountered by orthopedic surgeons such as donor-site morbidity, graft failure and post-traumatic osteoarthritis.
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Chuaychoosakoon C, Parinyakhup W, Wiwatboworn A, Purngpiputtrakul P, Wanasitchaiwat P, Boonriong T. Comparing post-operative pain between single bundle and double bundle anterior cruciate ligament reconstruction: a retrospective study. BMC Musculoskelet Disord 2021; 22:753. [PMID: 34479511 PMCID: PMC8418012 DOI: 10.1186/s12891-021-04635-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background In anterior cruciate ligament (ACL) reconstruction, the clinical outcome and level of post-operative pain are important factors. To date there have been no studies evaluating differences in post-operative pain between single bundle and double bundle ACL reconstruction with a hamstring graft. Hypothesis/purpose We hypothesized that post-operative pain in single bundle ACL reconstruction would be less than in double bundle ACL reconstruction. This study was to compare post-operative pain between patients undergoing single bundle versus double bundle ACL reconstruction. Study design Cohort study. Methods This was a retrospective study comparing post-operative pain scores between single bundle and double bundle ACL reconstruction. Each patient was given our standard regimen of oral diclofenac (25 mg/tab) three times per day and paracetamol (500 mg/tab) six times per day for 1 day post-operatively. If the patient complained of moderate to severe pain (pain numeric rating scale (PNRS) > 3), 3 mg of morphine was injected intravenously every 3 h for 24 h and 1 mg of morphine as a rescue medication every 1 h for 24 h. PNRS and morphine consumption were recorded at 4-h intervals for 24 h. Results 209 patients were included in this study of whom 102 and 107 patients received single bundle and double bundle ACL reconstruction, respectively. The average post-operative pain scores of the single bundle group were lower at all time points. Linear mixed effect regression analyses showed that the single bungle group had lower post-operative pain than the double bundle group after adjusting for confounders (beta = − 0.45; 95% CI = − 0.838, − 0.062) but there was no statistically significant difference between numbers of bundle ACL reconstruction with regard to morphine consumption. Conclusion Single bundle ACL reconstruction had significantly lower post-operative pain scores than double bundle ACL reconstruction. Clinical relevance Double bundle ACL reconstruction results in higher post-operative pain, which may slow the start of rehabilitation and reduce patient satisfaction. In middle-aged adult patients with low-demand activities, we suggest performing a single bundle ACL reconstruction.
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Affiliation(s)
- Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
| | - Wachiraphan Parinyakhup
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Arnan Wiwatboworn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Peeranut Purngpiputtrakul
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Pawin Wanasitchaiwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Tanarat Boonriong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
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10
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Subjective assessment reported by patients shows differences between single-bundle and double-bundle anterior cruciate ligament reconstruction, systematic review and meta-analysis. Sci Rep 2021; 11:15385. [PMID: 34321559 PMCID: PMC8319426 DOI: 10.1038/s41598-021-94868-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/15/2021] [Indexed: 01/08/2023] Open
Abstract
To determine the functional recovery, active reincorporation, and anteroposterior and rotational stability of patients undergoing anterior cruciate ligament (ACL) reconstruction using arthroscopy techniques with simple-bundle (SB) or double-bundle (DB). The following databases were searched: PubMed, Embase (Elsevier platform), the Cochrane Central Register of Controlled Trials (Wiley platform), Web of Science, and CINAHL. Level I and II studies involving anterior cruciate ligament arthroscopy were included in the search. Records were screened by title and abstract and assessed the risk of bias of selected studies. Meta-analyses using RevMan 5.3 software were conducted on the following outcomes: knee functionality, objective measurements of knee stability, rotational knee stability and knee anterior stability, sports reincorporation, and subjective assessments. Twenty-four studies of patients undergoing ACL reconstruction were included in the qualitative and quantitative synthesis (1707 patients) for Lysholm score, Subjective International Knee Documentation Committee (IKDC) score, Tegner score, KT-1000/2000, Lachman test, Objective IKDC score, and Pivot-Shift test. A return to pre-injury level showed a significant decrease in the Lysholm score (mean difference, - 0.99; 95% CI - 1.71 to - 0.40; P = 0.007) and Tegner score (mean difference, - 0.07; 95% CI, - 0.13 to - 0.01; P = 0.02) at DB reconstruction, similar to the knee functionality outcome of the subjective IKDC score (mean difference - 1.42; 95% CI - 2.46 to - 0.38; P = 0.007). There is no clear or significant difference in clinical stability and knee function or in sports incorporation with the true difference occurring in the subjective assessment.
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11
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Correlations between isokinetic knee torques and single-leg hop distances in three directions in patients after ACL reconstruction. BMC Sports Sci Med Rehabil 2021; 13:38. [PMID: 33836820 PMCID: PMC8033656 DOI: 10.1186/s13102-021-00265-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022]
Abstract
Background When planning rehabilitation and conditioning for performance enhancement and a return to sports after anterior cruciate ligament reconstruction, identifying the elements of physical function associated with single-leg hop is important. The purpose of this study was to clarify the relationship between single-leg hop distances in three directions and knee extensor and flexor strengths at 6 months after reconstruction. Methods Participants were 47 patients taking part in training sessions for sports involving cutting, pivoting, and jump-landing 6 months after reconstruction using a hamstring tendon. Single-leg hop distances in 3 directions (anterior, lateral, and medial) and isokinetic concentric strengths of knee extension and flexion were assessed at an angular velocity of 60°/s and 180°/s. Simple regression analyses using Spearman’s rank correlation coefficient were performed to assess relationships between single-leg hop distances and knee strengths. Results In the involved limb, correlations between single-leg hop distances in 3 directions and knee strengths were significant (P < 0.01) and correlation coefficients ranged from 0.48 to 0.65. Correlation coefficients between all single-leg hop parameters and knee extension/flexion strengths at an angular velocity of 180°/s were greater than those of 60°/s. Conclusions In this cross-sectional study of patients who participated in sports training sessions that required jump-landings and cutting approximately 6 months after reconstruction using hamstring grafts, isokinetic knee flexor, and extensor torques were moderately to strongly associated with single-leg hop distances in lateral, medial, and anterior directions. Given these relationships, assessments and exercises for knee strength and single-leg hop distances should be planned.
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12
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Beletsky A, Naami E, Lu Y, Polce EM, Nwachukwu BU, Okoroha KR, Chahla J, Yanke AB, Forsythe B, Cole BJ, Verma NN. The Patient Acceptable Symptomatic State in Primary Anterior Cruciate Ligament Reconstruction: Predictors of Achievement. Arthroscopy 2021; 37:600-605. [PMID: 32911006 DOI: 10.1016/j.arthro.2020.08.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/16/2020] [Accepted: 08/21/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify thresholds for patient acceptable symptomatic state (PASS) achievement in a cohort of primary anterior cruciate ligament reconstruction (ACLR) recipients, and to identify factors predictive of PASS achievement. METHODS A prospective clinical registry was queried for primary ACLR patients from January 2014 to April 2017 with serial patient-reported outcome measure (PROM) completion at 6, 12, and 24 months. Exclusion criteria included significant concomitant procedures. Knee-based PROMs included the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores. PASS threshold values were calculated using receiver operating characteristic (ROC) curves with area under the curve (AUC) analysis. A stepwise multivariate regression identified preoperative and operative predictors of PASS achievement. RESULTS A total of 144 primary ACLR patients (30.86 ± 12.78 years, body mass index 25.51 ± 4.64, 41.0% male) were included in the analysis. PASS threshold values were established using ROC curve analysis, all of which exceeded 0.7 on AUC analysis (0.742 to 0.911). Factors impacting odds of PASS achievement in the ACLR cohort included preoperative exercises (odds ratio [OR] 2.95 to 4.74, P = .003 to .038), worker's compensation status (OR 0.25 to 0.28, P = .014 to .033), preoperative scores (OR 1.03 to 1.07, P = .005 to <.001), iliotibial band tenodesis (OR 11.08, P = .010), and anteromedial approach (OR 18.03 to 37.05, P < .001). CONCLUSION Factors predictive of PASS achievement in recipients of primary ACLR include functional status (e.g., preoperative exercise, preoperative KOOS Sport/Recreation score), worker's compensation status, technique (e.g., anteromedial) and preoperative PROMs. The results of our study are important in better informing shared decision-making models and improving evidence-based guidelines to optimize patient outcomes.
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Affiliation(s)
- Alexander Beletsky
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edmund Naami
- University of Illinois College of Medicine, Chicago, Illinois, U.S.A
| | - Yining Lu
- University of Illinois College of Medicine, Chicago, Illinois, U.S.A
| | - Evan M Polce
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kelechi R Okoroha
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Adam B Yanke
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
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13
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Yamasaki S, Hashimoto Y, Iida K, Nishino K, Nishida Y, Takigami J, Takahashi S, Nakamura H. Risk factors for postoperative graft laxity without re-injury after double-bundle anterior cruciate ligament reconstruction in recreational athletes. Knee 2021; 28:338-345. [PMID: 33485163 DOI: 10.1016/j.knee.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/18/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although high activity is a risk factor for graft failure after anterior cruciate ligament (ACL) reconstruction, the risk factors for postoperative laxity after ACL reconstruction in recreational athletes are unknown. METHODS We enrolled 91 patients (40 males, 51 females; mean age 29.2 years; mean follow-up 4.3 years) who scored ≤ 6 on the Tegner activity scale, underwent double-bundle ACL reconstruction between 2010 and 2018, and did not experience re-injury. In the stable group (75 patients, <3.0 mm side-to-side difference (SSD) in anterior translation, grade 0 or 1 pivot shift 1 year after surgery) and unstable group (16 patients, ≥3.0 mm SSD, ≥grade 2 pivot shift), multivariate logistic regression analyses adjusted for factors showing P ≤ 0.3 on univariate analysis assessed risk factors for graft laxity. Lysholm score and graft intensity on MRI (Howell grade) were compared at final follow-up. RESULTS Mean SSD in anterior translation was 0.7 mm (stable group) and 3.3 mm (unstable group). Pivot shift grades were 0 (88%) and 1 (12%) in the stable group, and 0 (12.5%), 1 (50%), and 2 (37.5%) in the unstable group. Multivariate regression analyses showed that younger age and knee hyperextension were significant risk factors for graft laxity (P = 0.018 and 0.0016; cutoffs 18 years old and 8°, respectively). Lysholm scores in both groups were comparable, but graft intensity on MRI demonstrated significantly worse Howell grade in the unstable group (P = 0.002). CONCLUSION Younger age and knee hyperextension were risk factors for postoperative graft laxity without re-injury in recreational athletes.
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Affiliation(s)
- Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, Osaka 583-0875, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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14
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Yang W, Huang X, Wang S, Wang H, Huang W, Shao Z. The long-term outcomes of different grafts in anterior cruciate ligament reconstruction: a network meta-analysis. J Orthop Translat 2021; 26:16-30. [PMID: 33437619 PMCID: PMC7773980 DOI: 10.1016/j.jot.2020.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 03/08/2020] [Accepted: 03/15/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To compare the long-term prognosis of patients with different types of grafts used in anterior cruciate ligament reconstruction (ACLR). METHODS PubMed, Ovid (MEDLINE and Embase) and the Cochrane library were searched up to Feb 2020. Eligible studies about different grafts in ACLR were searched for identifying the evidence comparing the long-term (mean or median follow-up time or the general description of the follow-up time≥2 years) knee outcomes of different grafts for ACLR. The final included articles and evaluation criteria were confirmed by the authors and senior clinicians to ensure the validity of the included articles. Lysholm score, the results of pivot shift test, Lachman test and International Knee Documentation Committee (IKDC) evaluation were selected as prognostic indicators. A Bayesian network meta-analysis was conducted. RESULTS A total of 30 articles were included in our network meta-analysis. Finally, we found that artificial graft or augmentation can provide the not bad Lysholm score but the worse result of IKDC evaluation for patients with ACLR compared with other types of grafts. Double-bundle hamstring autograft can provide a good Lysholm score as well as lower positive rate of pivot shift test and Lachman test. Patellar tendon autograft can provide the better result of IKDC evaluation. The patients with allogeneic tendon graft may get the higher positive rate of pivot shift test and Lachman test. Patients with single-bundle hamstring autograft may get the ordinary result of IKDC evaluation and Lysholm score. CONCLUSIONS Double-bundle hamstring autograft may be a better choice because of more items of good prognosis for the patients with ACLR. Patellar tendon autograft is a right choice which only shows the disadvantage on the Lysholm score. The prognosis of patients with single-bundle hamstring autograft is ordinary. The effect of artificial graft or augmentation needs more evidence to prove. Allogeneic tendon graft is not a better choice when compared with other grafts referred in our network meta-analysis. TRANSLATIONAL POTENTIAL STATEMENT In this study, we made a comprehensive comparison of the grafts commonly used in anterior cruciate ligament reconstruction. The evidence presented in this study provides a reference for clinicians to select a suitable anterior cruciate ligament graft.
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Affiliation(s)
| | | | | | - Hong Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wei Huang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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15
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Aizawa J, Hirohata K, Ohji S, Ohmi T, Koga H, Yagishita K. Factors Associated With Psychological Readiness to Return to Sports With Cutting, Pivoting, and Jump-Landings After Primary ACL Reconstruction. Orthop J Sports Med 2020; 8:2325967120964484. [PMID: 33244476 PMCID: PMC7678401 DOI: 10.1177/2325967120964484] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/11/2020] [Indexed: 12/20/2022] Open
Abstract
Background: High psychological readiness is an important element for returning to sports after anterior cruciate ligament (ACL) reconstruction. Identifying factors that contribute to psychological readiness is essential for planning interventions to return to play. No studies have used multivariate analysis to clarify factors associated with psychological readiness to return to specific sports. Hypothesis: To identify factors that contribute to an athlete’s psychological readiness to return after ACL reconstruction to sports that require cutting, pivoting, and jump-landings. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Study participants were athletes who before injury had participated in sports with limited contact that required cutting, pivoting, and jump-landings (basketball, soccer, futsal, volleyball, badminton, tennis, and frisbee) and hoped to return to the same sport after reconstruction. Psychological readiness was measured using the Anterior Cruciate Ligament–Return to Sport After Injury Scale (ACL-RSI) in athletes more than 6 months after primary ACL reconstruction. To clarify factors associated with the ACL-RSI, univariate regression analysis and multivariate regression analysis were performed using the following independent variables: age, sex, body mass index, time from injury to reconstruction, time from reconstruction to testing, meniscal surgery, modified Tegner activity scale before injury, kinesiophobia, limb symmetry index of knee strength, limb symmetry indices of single-leg hop (SLH) distances, and subjective running ability. Results: Higher subjective running ability, a lower kinesiophobia score, and greater limb symmetry in the lateral SLH were positively associated with psychological readiness. Conclusion: The psychological readiness of athletes aiming to return after ACL reconstruction to limited-contact sports that require cutting, pivoting, and jump-landings was affected by subjective running ability, kinesiophobia, and asymmetry of lateral SLH distance. This information may be useful in planning appropriate interventions and thereby increasing the likelihood of an athlete’s returning to such sports.
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Affiliation(s)
- Junya Aizawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan.,Clinical Center for Sports Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenji Hirohata
- Clinical Center for Sports Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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16
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Yoon KH, Kim JS, Kim SJ, Park M, Park SY, Park SE. Eight-year results of transtibial nonanatomic single-bundle versus double-bundle anterior cruciate ligament reconstruction: Clinical, radiologic outcomes and survivorship. J Orthop Surg (Hong Kong) 2020; 27:2309499019840827. [PMID: 30955412 DOI: 10.1177/2309499019840827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the long term outcomes of transtibial nonanatomic single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. METHODS Between January 2008 and September 2010, we retrospectively evaluated 377 patients who underwent primary ACL reconstruction and who were available at 8 years of follow-up. Patients who received transtibial nonanatomic SB ACL reconstruction ( n = 263) were assigned to group SB and DB ACL reconstruction ( n = 114) to group DB. The patients were assessed with the International Knee Documentation Committee (IKDC), the Lysholm scores, Tegner activity score, knee joint stability tests, and patellofemoral osteoarthritis (OA) findings using the Kellgren-Lawrence (K-L) classification. Contralateral ACL (CACL) injury was also evaluated. RESULTS Thirteen patients underwent revision ACL surgery during the follow-up. Ultimately, 256 patients in group SB and 108 patients in group DB were available at the 8-year follow-up. At final follow-up, the IKDC subjective score ( p = 0.04) and Lysholm score ( p = 0.02) showed significantly superior results in group DB compared to group SB. However, there was no significant difference of Tegner activity score ( p = 0.30), range of motion ( p = 0.81), and knee joint stability tests. There was significant progression of patellofemoral OA between preoperative and final follow-up in ipsilateral knee of both groups but not significant progression in contralateral knee. However, there was no significant difference between the two groups at the follow-up. There were 2.7% ipsilateral ACL graft failure in group SB, compared with 5.2% in group DB ( p = 0.12) and 6.4% CACL tear in group SB, compared with 5.2% in group DB ( p = 0.65). The mean survivorship of ACL graft was 9.47 ± 0.05 years (95% confidence interval (CI), 9.36-9.58) in group SB and 9.87 ± 0.16 years (95% CI, 9.54-10.20) in group DB, and there was no significant difference ( p = 0.25). CONCLUSION DB ACL reconstruction resulted in significantly better clinical IKDC subjective scores and Lysholm scores. However, most of the differences in clinical scores were small, and the clinical relevance of this difference is unknown. In addition, there was no significant difference in Tegner activity score, knee joint stability tests, patellofemoral OA, and survivor rate of the ACL graft and CACL after reconstruction after a minimum of 8-year follow-up. Level of Evidence: Cohort study; level of evidence, 3.
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Affiliation(s)
- Kyoung Ho Yoon
- 1 Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Jung Suk Kim
- 1 Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sang Jun Kim
- 1 Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Moonsu Park
- 1 Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Soo Yeon Park
- 2 Department of Physical Education, Graduate School of Education, Yongin University, Yongin, Korea
| | - Sang Eon Park
- 1 Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
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Nagai K, Rothrauff BB, Li RT, Fu FH. Over-the-top ACL reconstruction restores anterior and rotatory knee laxity in skeletally immature individuals and revision settings. Knee Surg Sports Traumatol Arthrosc 2020; 28:538-543. [PMID: 31549207 DOI: 10.1007/s00167-019-05719-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/11/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the objective outcomes following anterior cruciate ligament reconstruction (ACLR) with the over-the-top (OTT) technique. METHODS Thirty-five ACL-deficient patients with mean follow-up of 2.2 years were retrospectively reviewed. This included 14 skeletally immature individuals (age: 14 ± 1 years) who underwent primary OTT ACLR (adolescent group) and 21 skeletally mature individuals (age: 25 ± 8 years) who underwent OTT revision ACLR (revision group). The tibial tunnel was created at the anatomic position for all cases. No lateral extra-articular tenodesis was performed. Before and after surgery, the side-to-side difference (SSD) in anterior laxity was measured using KT-1000 arthrometer. Lachman and pivot-shift tests were assessed according to IKDC grade. The graft failure rate was assessed. RESULTS The post-operative SSD in anterior laxity was significantly reduced in the adolescent (pre-op, 3.9 ± 1.8 mm; post-op, 1.2 ± 0.8 mm; p = 0.040) and revision groups (pre-op, 4.2 ± 1.7 mm; post-op, 1.2 ± 1.4 mm; p < 0.001). Postoperative knee laxity measured by Lachman and pivot-shift tests were also significantly improved in both groups. Graft rupture occurred in two patients in the adolescent group (14.3%), and one patient in the revision group (4.8%). CONCLUSION ACLR with the OTT technique restored anterior and rotatory knee laxity in skeletally immature individuals and in revision settings. This one-step procedure may be a good option for skeletally immature individuals and revision settings. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kanto Nagai
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Ryan T Li
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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18
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Ekås GR, Ardern CL, Grindem H, Engebretsen L. Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury. Br J Sports Med 2020; 54:520-527. [PMID: 31959673 DOI: 10.1136/bjsports-2019-100956] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction. DESIGN Prognosis systematic review (PROSPERO registration number CRD42016036788). METHODS We searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google Scholar from inception to 3rd May 2018. Eligible articles included patients with ACL injury (diagnosis confirmed by MRI and/or diagnostic arthroscopy), reported the number of meniscal tears at the time of ACL injury diagnosis/start of treatment and reported the number of new meniscal tears that subsequently occurred. Articles with fewer than 20 patients at follow-up, and articles limited to ACL revision surgery or multi-ligament knee injuries were excluded. Two independent reviewers screened articles, assessed eligibility, assessed risk of bias and extracted data. We judged the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology. RESULTS Of 75 studies included in the systematic review, 54 studies with 9624 patients and 501 new meniscal tears were appropriate for quantitative analysis. Heterogeneity precluded data pooling. The risk of new meniscal tears was 0%-21% when follow-up was <2 years, 0%-29% when follow-up was 2 to 5 years, 5%-52% when follow-up was 5 to 10 years and 4%-31% when follow-up was longer than 10 years. The proportion of studies with high risk of selection, misclassification and detection bias was 84%, 69% and 68%, respectively. Certainty of evidence was very low. CONCLUSION New meniscal tears occurred in 0%-52% of patients between 4 months and 20 years (mean 4.9±4.4 years) following treatment for ACL injury. The certainty of evidence was too low to guide surgical treatment decisions. This review cannot conclude that the incidence of new meniscal tears is lower if ACL injury is treated with surgery compared with treatment with rehabilitation only.
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Affiliation(s)
- Guri Ranum Ekås
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Clare L Ardern
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,Unit of Physiotherapy, Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Hege Grindem
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.,Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lars Engebretsen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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19
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Santos ADA, Carneiro-Filho M, e Albuquerque RFDM, de Moura JPFM, Franciozi CE, Luzo MVM. Mechanical evaluation of tibial fixation of the hamstring tendon in anterior cruciate ligament double-bundle reconstruction with and without interference screws. Clinics (Sao Paulo) 2020; 75:e1123. [PMID: 32556055 PMCID: PMC7196727 DOI: 10.6061/clinics/2020/e1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/29/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare two postero-lateral bundle (PLB) tibial fixation techniques for the reconstruction of the anterior cruciate ligament with double bundle: a technique without the use of an interference screw, preserving the native tibial insertion of the tendons of the gracilis and semitendineous muscles, and a technique with the use of an interference screw and without preserving the insertion of the tendons. METHODS A comparative study was conducted in cadavers with a universal mechanical test machine. In total, 23 cadaver knees were randomized for tibial fixation of the PLB using the two techniques: Maintaining the tibial insertion of the tendons during reconstruction, without the use of an interference screw (group A, 11 cases); and fixating the graft with an interference screw, without maintaining the insertion of the tendons (group B, 12 cases). A continuous traction was performed (20 mm/min) in the same direction as the produced tunnel, and force (N), elongation (mm), rigidity (N/mm), and tension (N/mm2) were objectively determined in each group. RESULTS Group A exhibited a maximum force (MF) of 315.4±124.7 N; maximum tension of 13.57±3.65 N/mm2; maximum elongation of 19.73±4.76 mm; force at the limit of proportionality (FLP) of 240.6±144.0 N; and an elongation at the limit of proportionality of 14.37±6.58 mm. Group B exhibited a MF of 195.7±71.8 N; maximum tension of 8.8±3.81 N/mm2; maximum elongation of 15.3±10.73 mm; FLP of 150.1±68.7 N; and an elongation at the limit of proportionality of 6.86±2.42 mm. When comparing the two groups, significant differences were observed in the variables of maximum force (p=0.016), maximum tension (p=0.019), maximum elongation (p=0.007), and elongation at the limit of proportionality (p=0.003). CONCLUSION The use of the native insertion of the semitendineous and gracilis tendons, without an additional fixation device, presented mechanical superiority over their fixation with interference screws.
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Affiliation(s)
- Anderson de Aquino Santos
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Mario Carneiro-Filho
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Roberto Freire da Mota e Albuquerque
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Carlos Eduardo Franciozi
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Marcus Vinícius Malheiros Luzo
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
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Janko M, Verboket RD, Plawetzki E, Geiger EV, Lustenberger T, Marzi I, Nau C. Vergleichbare Ergebnisse nach arthroskopischem Ersatz des vorderen Kreuzbandes. Chirurg 2019; 91:67-75. [DOI: 10.1007/s00104-019-01050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Mohtadi NG, Chan DS. A Randomized Clinical Trial Comparing Patellar Tendon, Hamstring Tendon, and Double-Bundle ACL Reconstructions: Patient-Reported and Clinical Outcomes at 5-Year Follow-up. J Bone Joint Surg Am 2019; 101:949-960. [PMID: 31169571 DOI: 10.2106/jbjs.18.01322] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This randomized clinical trial evaluated the 5-year, disease-specific quality-of-life outcomes of patients treated for anterior cruciate ligament (ACL) deficiency with use of a patellar tendon, single-bundle quadruple-stranded hamstring, or double-bundle hamstring reconstruction. METHODS Patients (n = 110 per group; 183 male; 14 to 50 years of age) were randomly allocated to anatomically positioned ACL reconstruction with use of a patellar tendon graft (patellar tendon group; mean age, 28.7 years), quadruple-stranded hamstring tendon construct (hamstring tendon group; mean age, 28.5 years), or double-bundle hamstring tendon construct (double-bundle group; mean age, 28.3 years). Computer-generated allocation with varied block randomization was performed intraoperatively. The 5-year primary outcome measure was the Anterior Cruciate Ligament-Quality of Life (ACL-QOL) score, and secondary outcome measures included the International Knee Documentation Committee (IKDC) subjective score and objective grades, pivot shift assessment, range of motion, kneeling pain, Tegner activity scale, Cincinnati Occupational Rating Scale, complete traumatic reruptures, partial traumatic tears, total traumatic reinjuries, and atraumatic graft failures. RESULTS Three hundred and fifteen patients (95%) completed the 5-year follow-up (4 withdrawals, and 11 lost to follow-up). ACL-QOL scores increased significantly from baseline for all groups (p < 0.0001), but mean scores at 5 years did not differ among the groups (p = 0.548): mean (and standard deviation) of 82.5 ± 17.9 (95% confidence interval [CI], 79.0 to 86.0) for patellar tendon, 83.9 ± 18.2 (95% CI, 80.3 to 87.4) for hamstring tendon, and 81.1 ± 19.3 (95% CI, 77.4 to 84.8) for double-bundle. The proportions of patients at 5 years with a pivot shift grade of ≥2 (12% for patellar tendon, 16% for hamstring tendon, and 22% for double-bundle; p = 0.149) and with normal and nearly normal knees per IKDC grade (87%, 82%, and 75% for the 3 groups, respectively; p = 0.093) trended in favor of patellar tendon reconstruction. No differences were seen for the IKDC subjective scores, knee range of motion including passive extension deficits, the single leg hop test, Cincinnati Occupational Rating scores, and Tegner activity levels. Kneeling pain was more common with patellar tendon reconstruction (10% of patients compared with 4% for hamstring tendon and 2% for double-bundle; p = 0.029). For hamstring tendon and double-bundle reconstructions, there were trends toward more complete traumatic reruptures (4% for patellar tendon, 10% for hamstring tendon, and 10% for double-bundle; p = 0.145) and partial traumatic tears (0%, 5%, and 6%, respectively; p = 0.059), with significantly fewer combined traumatic reinjuries in the patellar tendon group (4 patients compared with 16 for hamstring tendon and 17 for double-bundle; p = 0.010). Atraumatic graft failure (pivot shift grade of ≥2) was found for 10% of the patients. CONCLUSIONS At 5 years, we found no significant difference in the quality-of-life outcome among the patellar tendon, hamstring tendon, and double-bundle techniques for ACL reconstruction. Significantly more patients in the hamstring tendon and double-bundle groups experienced traumatic graft reinjury compared with the patellar tendon group. There was a trend toward a higher percentage with normal and nearly normal IKDC grades in the patellar tendon group compared with hamstring tendon and double-bundle groups. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nicholas G Mohtadi
- University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
| | - Denise S Chan
- University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada
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Jorge PB, Escudeiro D, Severino NR, Santili C, de Paula Leite Cury R, Junior AD, Guglielmetti LGB. Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction. BMJ Open Sport Exerc Med 2018; 4:e000420. [PMID: 30305927 PMCID: PMC6173259 DOI: 10.1136/bmjsem-2018-000420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to review and update the literature in regard to the anatomy of the femoral origin of the ACL, the concept of the double band and its respective mechanical functions, and the concept of direct and indirect fibres in the ACL insertion. These topics will be used to help determine which might be the best place to position the femoral tunnel and how this should be achieved, based on the idea of functional positioning, that is, where the most important ACL fibres in terms of knee stability are positioned. Low positioning of the femoral tunnel, reproducing more of the posterolateral band, and positioning the tunnel away from the lateral intercondylar ridge, that is, in the indirect fibres, would theoretically rebuild a ligament that is less effective in relation to knee stability. The techniques described to determine the femoral tunnel's centre point all involve some degree of subjectivity; the point is defined manually and depends on the surgeon's expertise. The centre of the ACL insertion in the femur should be used as a parameter. Once the centre of the ligament in its footprint is marked, the centre of the tunnel must be defined, drawing the marking toward the intercondylar ridge and anteromedial band. This will allow the femoral tunnel to occupy the region containing the most important original ACL fibres in terms of this ligament's function.
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Affiliation(s)
- Pedro Baches Jorge
- Departamento de Ortopedia e Traumatologia da, Irmandade da Santa Casa de Misericórdia de, São Paulo, Brazil
| | - Diego Escudeiro
- Departamento de Ortopedia e Traumatologia da, Irmandade da Santa Casa de Misericórdia de, São Paulo, Brazil
| | - Nilson Roberto Severino
- Departamento de Ortopedia e Traumatologia da, Irmandade da Santa Casa de Misericórdia de, São Paulo, Brazil
| | - Cláudio Santili
- Departamento de Ortopedia e Traumatologia da, Irmandade da Santa Casa de Misericórdia de, São Paulo, Brazil
| | | | - Aires Duarte Junior
- Departamento de Ortopedia e Traumatologia da, Irmandade da Santa Casa de Misericórdia de, São Paulo, Brazil
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Mayr HO, Bruder S, Hube R, Bernstein A, Suedkamp NP, Stoehr A. Single-Bundle Versus Double-Bundle Anterior Cruciate Ligament Reconstruction-5-Year Results. Arthroscopy 2018; 34:2647-2653. [PMID: 29937346 DOI: 10.1016/j.arthro.2018.03.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare anatomic single-bundle (SB) with double-bundle (DB) anterior cruciate ligament reconstruction (ACL-R) and to evaluate the respective clinical outcome results. METHODS In a prospective randomized study, 64 patients were included and separated into 2 groups. Anatomic SB and DB ACL-Rs were performed with hamstring tendons. Five years after surgery, the follow-up (FU) examination comprised International Knee Documentation Committee (IKDC) 2000, Laxitester (ORTEMA Sport Protection, Markgroeningen, Germany) measurement, and radiograph evaluation. Power calculation was performed to achieve a 95% confidence interval and 80% power on the base of 7-point IKDC subjective difference between the groups. RESULTS A total of 53 patients (83% FU) were examined at 63.2 ± 4.7 months after surgery: 28 patients in the DB group and 25 patients in the SB group. IKDC subjective (SB: 92.8 ± 6.2, DB: 91.6 ± 7.1; P = .55) and objective scores (grade A SB/DB 20%/25%, B SB/DB 72%/57%, C SB/DB 8%/18%, D SB/DB 4%/0%; P = .45) showed no differences comparing both groups. The Laxitester measurements showed no significant difference in regard to anterior-posterior translation in neutral, internal, and external rotation or to rotation angles (P = .79). No difference was seen between the groups regarding osteoarthritic changes and tunnel widening. CONCLUSIONS At the 5-year FU, no advantage for either the DB or SB technique in ACL-R can be seen with regard to patient-related and objective outcome measures. LEVEL OF EVIDENCE Level I, prospective randomized controlled clinical trial.
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Affiliation(s)
- Hermann O Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; Department of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Munich, Germany.
| | - Silvia Bruder
- Department of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Munich, Germany
| | - Robert Hube
- Department of Orthopedic Surgery, OCM-Clinic, Munich, Germany
| | - Anke Bernstein
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Norbert P Suedkamp
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Amelie Stoehr
- Department of Orthopedic Surgery, OCM-Clinic, Munich, Germany
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Kidera K, Yonekura A, Miyaji T, Nakazoe Y, Gamada K, Yoneta K, Ikuta F, Tomita M, Miyamoto T, Kajiyama S, Hozumi A, Chiba K, Okazaki N, Shida T, Osaki M. Double-bundle anterior cruciate ligament reconstruction improves tibial rotational instability: analysis of squatting motion using a 2D/3D registration technique. J Orthop Surg Res 2018; 13:111. [PMID: 29769139 PMCID: PMC5956752 DOI: 10.1186/s13018-018-0825-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/02/2018] [Indexed: 01/07/2023] Open
Abstract
Background The anterior cruciate ligament-deficient (ACLD) knee requires appropriate treatment for the patient to return to sports. The purpose of this study was to clarify the kinematics of the anterior cruciate ligament-deficient knee in squatting motion before and after double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using a 2D/3D registration technique. Methods The subjects of this study were 10 men with confirmed unilateral ACL rupture who underwent DB-ACLR. Computed tomography (CT) of the knee joints was performed before DB-ACLR. Fluoroscopic imaging of the knee motion in squatting before and after DB-ACLR was also performed. The 2D/3D registration technique is a method of calculating positional relationships by projecting the 3D bone model created from the CT data onto the image extracted from the fluoroscopic images. The tibial anteroposterior (AP) and rotational positions were analyzed with reference to the femur. Results The tibial AP position of the ACLD knees was significantly anterior to the contralateral knees (p = 0.015). The tibial rotational position of the ACLD knees was significantly internally rotated compared to the contralateral knees (p < 0.001). Both tibial AP and rotational positions improved after DB-ACLR (p < 0.001), with no significant differences compared to the contralateral knees. Conclusion DB-ACLR improved not only tibial AP instability but also tibial rotational instability at knee flexion with weight-bearing. DB-ACLR appears to be a useful technique for normalizing the knee joint kinematics of ACLD knees.
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Affiliation(s)
- Kenichi Kidera
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Akihiko Yonekura
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takeshi Miyaji
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yusuke Nakazoe
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kazuyoshi Gamada
- Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Hiroshima, Japan
| | - Kei Yoneta
- Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Hiroshima, Japan
| | - Futoshi Ikuta
- Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Hiroshima, Japan
| | - Masato Tomita
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takashi Miyamoto
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shiro Kajiyama
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Akira Hozumi
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Ko Chiba
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Narihiro Okazaki
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takayuki Shida
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Jiang C, Chen G, Chen P, Li W, Zhang H, Zhang W. Double-bundle revision anterior cruciate ligament reconstruction is effective in rescuing failed primary reconstruction and re-introducing patients to physical exercise. Exp Ther Med 2018; 15:2074-2080. [PMID: 29434808 DOI: 10.3892/etm.2017.5647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 07/14/2017] [Indexed: 01/12/2023] Open
Abstract
The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee and is critical for knee stability, as it limits anterior tibial translation on the femur, restrains rotation and resists varus and valgus joint forces. The present study aimed to assess the effect of double-bundle revision anterior cruciate ligament (ACL) reconstruction in improving the subjective and objective functions and re-introducing patients to physical activity after primary ACL reconstruction had failed. A total of 34 patients who underwent double-bundle ACL revision surgeries were included in the present retrospective study. Lysholm, Tegner and IKDC scores as well as KT-2000 arthrometry measures were obtained pre- and post-operatively. The follow-up time was at least 2 years. The results indicated that the IKDC, Lysholm and Tegner scores as well as KT-2000 flexion scores were significantly improved after revision ACL reconstruction. All patients resumed to performing physical exercise activities after revision surgeries, 65% of whom reached pre-injury levels. In conclusion, these results demonstrated that double-bundle revision ACL reconstruction was consistently effective in rescuing failed primary ACL reconstruction and re-introducing patients to physical exercise.
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Affiliation(s)
- Changqing Jiang
- Department of Sport Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Guofei Chen
- Department of Orthopedics, Shenzhen Guangming New People's Hospital, Shenzhen, Guangdong 518106, P.R. China
| | - Peng Chen
- Department of Sport Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Wei Li
- Department of Sport Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Honglei Zhang
- Department of Sport Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Wentao Zhang
- Department of Sport Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
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Ahn JH, Kang HW, Choi KJ. Outcomes After Double-Bundle Anterior Cruciate Ligament Reconstruction. Arthroscopy 2018; 34:220-230. [PMID: 28893426 DOI: 10.1016/j.arthro.2017.07.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the risk factors predicting unsatisfactory postoperative clinical outcomes after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using multivariate logistic regression. METHODS Inclusion criteria were consecutive DB ACL reconstructions from January 2006 to September 2012 with a minimum 3-year follow-up. Exclusion criteria included (1) a delay to surgery from initial injury of more than 4 years (210 weeks); (2) contralateral knee pathology; (3) the lack of postoperative 3-dimensional computed tomography; (4) single-bundle ACL reconstruction; (5) revision ACL reconstruction; (6) meniscus allograft transplantation after total or subtotal meniscectomy; (7) multiple ligament surgeries. According to the overall International Knee Documentation Committee (IKDC) rating at the last follow-up, we sorted all enrolled subjects into superior (IKDC grade A or B) and inferior outcome groups (IKDC grade C or D). Multivariate logistic regression was used to analyze risk factors, including age, gender, body mass index, time from injury to surgery, posterior tibial slope, notch width index, cartilage injury, meniscus injury, and femoral and tibial tunnel positions. RESULTS In comparison between the superior outcome group (n = 240) and inferior outcome group (n = 50), anterior (adjusted odds ratio [OR]: 0.902, 95% confidence interval [CI]: 0.846-0.962) or distal (adjusted OR: 1.025, 95% CI: 1.006-1.060) femoral anteromedial tunnel position was a significant risk factor for the inferior outcomes. Partial meniscectomy of medial (adjusted OR: 49.002, 95% CI: 7.047-340.717) or lateral (adjusted OR: 14.974, 95% CI: 2.181-102.790) meniscus and delayed time from injury to surgery (adjusted OR: 1.062, 95% CI: 1.023-1.102) were also a significant predictor. CONCLUSION Anterior or distal anteromedial femoral tunnel position, partial meniscectomy of medial or lateral meniscus, and prolonged surgical delay of more than 11.5 weeks from injury were significant risk factors for the inferior clinical outcomes after DB ACL reconstruction. LEVEL OF EVIDENCE Level III, retrospective therapeutic case series.
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Affiliation(s)
- Ji Hyun Ahn
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea.
| | - Ho Won Kang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Kug Jin Choi
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
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Short-term complications in intra- and extra-articular anterior cruciate ligament reconstruction. Comparison with the literature on isolated intra-articular reconstruction. A multicenter study by the French Arthroscopy Society. Orthop Traumatol Surg Res 2017; 103:S231-S236. [PMID: 28917520 DOI: 10.1016/j.otsr.2017.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Lateral tenodesis (LT) is performed to limit the risk of iterative tear following anterior cruciate ligament (ACL) reconstruction in at-risk patients. By adding an extra procedure to isolated ACL graft, LT reconstruction increases operating time and may complicate postoperative course. The objective of the present study was to evaluate the rate of early complications. The study hypothesis was that associating ALL reconstruction to ACL reconstruction does not increase the complications rate found with isolated ACL reconstruction. MATERIAL AND METHODS A prospective multicenter study included 392 patients: 70% male; mean age, 29.9 years; treated by associated ACL and LT reconstruction. All adverse events were inventoried. RESULTS Mean hospital stay was 2 days, with 46% day-surgery. Walking was resumed at a mean 27 days, with an advantage for patients treated by the hamstring technique. The early postoperative complications rate was 12%, with 1.7% specifically implicating LT reconstruction: pain, hematoma, stiffness in flexion and extension, and infection. There was a 5% rate of surgical revision during the first year, predominantly comprising arthrolysis for extension deficit. The 1-year recurrence rate was 2.8%. DISCUSSION The complications rate for combined intra- and extra-articular reconstruction was no higher than for isolated intra-articular ACL reconstruction, with no increase in infection or stiffness rates. The rate of complications specific to ALL reconstruction was low, at 1.7%, and mainly involved fixation error causing lateral soft-tissue impingement. LEVEL OF EVIDENCE IV, prospective multicenter study.
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Imbert P, Lustig S, Steltzlen C, Batailler C, Colombet P, Dalmay F, Bertiaux S, D'ingrado P, Ehkirch FP, Louis ML, Pailhé R, Panisset JC, Schlaterrer B, Sonnery-Cottet B, Sigwalt L, Saragaglia D, Lutz C. Midterm results of combined intra- and extra-articular ACL reconstruction compared to historical ACL reconstruction data. Multicenter study of the French Arthroscopy Society. Orthop Traumatol Surg Res 2017; 103:S215-S221. [PMID: 28917521 DOI: 10.1016/j.otsr.2017.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION During anterior cruciate ligament (ACL) reconstruction procedures, anterolateral reconstruction (ALR) can also be performed to improve the knee's rotational stability. However, the effectiveness of this supplemental technique and its impact on the risk of retears and on the onset of secondary degenerative changesare controversial. HYPOTHESIS ALR improves control over the pivot shift, reduces the retear risk and delays the appearance of secondary degenerative lesions. MATERIAL AND METHODS Clinical examination, knee laxity measurements and X-ray evaluations were done in 478 patients with more than 3years' follow-up after combined ACL and ALR from 11 participating hospitals. The mean patient age at the time of surgery was 28years. Eighty-eight percent of the patients participated in pivot sports and 45% were competitive athletes. The findings of this study were compared to historical isolated ACL reconstruction data. RESULTS The average follow-up was 6.8years. No detectable pivot shift was found in 83% of patients, while 12.8% of patient had a smooth glide. The side-to-side difference in anteroposterior knee laxity with maximum manual force was less than 3mm in 66% of patients and less than 5mm in 95%. The retear rate was 5.4%, with half of these patients undergoing revision ACL surgery. Secondary meniscus damage requiring surgery occurred in 6.3% of patients; the radiological osteoarthritis rate was 17.5%. DISCUSSION When compared to historical ACL reconstruction data, combined intra- and extra-articular reconstruction does not increase the complication rate. At a mean follow-up of 6.8years, it provides better control over the pivot shift along with a low retear rate and low occurrence of secondary meniscus injuries. LEVEL OF EVIDENCE IV, multicenter study.
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Affiliation(s)
- P Imbert
- ICAPS, 87, avenue Archimède, 83700 St-Raphael, France.
| | - S Lustig
- Centre Albert Trillat, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Steltzlen
- Centre hospitalier de Versailles André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - C Batailler
- Centre Albert Trillat, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - P Colombet
- Centre de chirurgie orthopédique et sportive, 2, rue Negrevergne, 33700 Mérignac, France
| | - F Dalmay
- 2UMR Inserm 1094 NET, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
| | - S Bertiaux
- Hôpital privé de l'Estuaire, 505, rue Irène-Joliot-Curie, 76620 le Havre, France
| | - P D'ingrado
- Clinique du parc, 155, boulevard de Stalingrad, 69006 Lyon, France
| | - F P Ehkirch
- Clinique Maussins-Nollet, 67, rue de Romain-Ville, 75019 Paris, France
| | - M L Louis
- Centre ICOS, 463, rue Paradis, 13008 Marseille, France
| | - R Pailhé
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, CHU de Grenoble, hôpital Sud, avenue de Kimberley, 38130 Échirolles, France
| | - J C Panisset
- Centre Ostéo-articulaire des Cèdres, 5, rue des Tropiques, Parc Sud Galaxie, 38130 Échirolles, France
| | | | - B Sonnery-Cottet
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | - L Sigwalt
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, CHU de Grenoble, hôpital Sud, avenue de Kimberley, 38130 Échirolles, France
| | - D Saragaglia
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, CHU de Grenoble, hôpital Sud, avenue de Kimberley, 38130 Échirolles, France
| | - C Lutz
- ICOSS, 50, avenue des Vosges, 67000 Strasbourg, France
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Beyaz S, Güler ÜÖ, Demir Ş, Yüksel S, Çınar BM, Özkoç G, Akpınar S. Tunnel widening after single- versus double-bundle anterior cruciate ligament reconstruction: a randomized 8-year follow-up study. Arch Orthop Trauma Surg 2017; 137:1547-1555. [PMID: 28840325 DOI: 10.1007/s00402-017-2774-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the single-bundle (SB) and double-bundle (DB) surgical techniques for anterior cruciate ligament (ACL) reconstruction with regard to tunnel widening, isokinetic muscle strength, and clinical outcomes over an 8-year follow-up period. METHODS This study included 31 patients with ACL injury who underwent ACL reconstruction via the SB (n = 16) or the DB (n = 15) technique. Isokinetic and concentric strength measurements of the quadriceps and hamstring muscles were conducted at postoperative 6 months and postoperative 8 years, and 3D-CT scans of the knee joints were performed on the 2nd, 3rd and 6th month, and the 8th year postoperatively. Clinical evaluations were performed at 8 years postoperatively with the International Knee Documentation Committee (IKDC), Tegner, and Lysholm knee scoring systems. RESULTS There was marked widening of the parts of the femoral tunnel close to the knee joint in both the SD and the DB groups. There was no difference between the two groups in terms of clinical results and isometric muscle strength at postoperative 8 years; however, there was a significant difference between the preoperative and 6 months postoperative clinical and strength results in both group (P < 0.05). There was no difference between the groups in IKDC score, Lysholm score, Tegner activity scale, and anterior drawer test at postoperative 8 years. On evaluation of the anteromedial bundles alone, the DB group had greater widening than the SB group. CONCLUSION In this study, we have found that the tunnels continue to enlarge after 6 months. However, that has no impact in patients comfort and that did not made any change in our daily routine. On the other hand, we found that the reconstruction of the double-band ligament technique is useless for non-professional athletes.
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Affiliation(s)
- S Beyaz
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Training Centre, Başkent University, Adana, Turkey.
| | - Ü Ö Güler
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Training Centre, Başkent University, Adana, Turkey
| | - Ş Demir
- Department of Radiology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Training Centre, Başkent University, Adana, Turkey
| | - S Yüksel
- Department of Statistics, Yıldırım Beyazıt University, Ankara, Turkey
| | - B M Çınar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Training Centre, Başkent University, Adana, Turkey
| | - G Özkoç
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Training Centre, Başkent University, Adana, Turkey
| | - S Akpınar
- Department of Orthopaedics and Traumatology, Medline Hospital, Adana, Turkey
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Järvelä S, Kiekara T, Suomalainen P, Järvelä T. Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study With 10-Year Results. Am J Sports Med 2017; 45:2578-2585. [PMID: 28661696 DOI: 10.1177/0363546517712231] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A long-term follow-up comparing double-bundle and single-bundle techniques for anterior cruciate ligament (ACL) reconstruction has not been reported before. HYPOTHESIS Double-bundle ACL reconstruction may have fewer graft ruptures, lower rates of osteoarthritis (OA), and better stability than single-bundle reconstruction. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Ninety patients were randomized for double-bundle ACL reconstruction with bioabsorbable screw fixation (DB group; n = 30), single-bundle ACL reconstruction with bioabsorbable screw fixation (SBB group; n = 30), and single-bundle ACL reconstruction with metallic screw fixation (SBM group; n = 30). Evaluation methods consisted of a clinical examination, KT-1000 arthrometer measurements, International Knee Documentation Committee (IKDC) and Lysholm knee scores, and a radiographic examination of both the operated and contralateral knees. RESULTS Eighty-one patients (90%) were available at the 10-year follow-up. Eleven patients (1 in the DB group, 7 in the SBB group, and 3 in the SBM group) had a graft failure during the follow-up and went on to undergo revision ACL surgery ( P = .043). In the remaining 70 patients at 10 years, no significant group differences were found in the pivot-shift test findings, KT-1000 arthrometer measurements, or knee scores. The most OA findings were found in the medial compartment of the knee, with 38% of the patients in the operated knee and 28% of the patients in the contralateral nonoperated knee. However, no significant group difference was found. The most severe OA changes were in the patients who had the longest delay from the primary injury to ACL reconstruction ( P = .047) and in the patients who underwent partial meniscal resection at the time of ACL reconstruction ( P = .024). CONCLUSION Double-bundle ACL reconstruction resulted in significantly fewer graft failures than single-bundle ACL reconstruction during the follow-up. Knee stability and OA rates were similar at 10 years. The most severe OA changes were found in the patients who had the longest delay from the primary injury to ACL reconstruction and in the patients who underwent partial meniscal resection at the time of ACL reconstruction.
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Affiliation(s)
- Sally Järvelä
- Department of Accidents and Emergencies, Tampere University Hospital, Tampere, Finland.,Arthroscopic and Sports Medicine Center, Pohjola Hospital, Tampere, Finland
| | - Tommi Kiekara
- Medical Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Piia Suomalainen
- Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Timo Järvelä
- Arthroscopic and Sports Medicine Center, Pohjola Hospital, Helsinki, Finland
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Niu Y, Duan G, Wang F, Tang S, Li Y, Lu J, Yang X. Better 4-year outcomes for anterior cruciate ligament reconstruction with double-layer versus single-layer bone-patellar tendon-bone allografts. Knee Surg Sports Traumatol Arthrosc 2017; 25:1443-1448. [PMID: 26704799 DOI: 10.1007/s00167-015-3936-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the results of anterior cruciate ligament reconstruction using a double-layer bone-patellar tendon-bone (DBPTB) graft. METHODS Between 2010 and 2011, 98 patients underwent anterior cruciate ligament reconstruction with an allograft. Forty-seven of these patients received a DBPTB allograft and 51 received a traditional monolayer BPTB graft. Outcomes were evaluated at the end of a minimum 4-year follow-up in both groups using KT 1000 arthrometer measurements, Lachman and pivot-shift tests, the International Knee Documentation Committee form, and Lysholm scores. RESULTS One patient (1/47, 2 %) in the DBPTB allograft group and six patients (6/51, 12 %) in the traditional monolayer BPTB graft were lost during follow-up because of graft rupture (n.s.). The mean side-to-side differences in the DBPTB and monolayer BPTB graft groups 4 years post-operatively were significantly different at 1.4 ± 1.3 and 1.7 ± 1.6 mm, respectively (p < 0.05). The DBPTB group performed significantly better than the BPTB group on the Lachman test, International Knee Documentation Committee knee score, and Lysholm scores (p < 0.05). CONCLUSIONS The DBPTB allograft group achieved better outcomes than the traditional BPTB allograft group regarding success rate, anterior stability, and knee function. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Guman Duan
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Shiyu Tang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Yao Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Jiangfeng Lu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Xu Yang
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA
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Comparison of outcome after anatomic double-bundle and antero-medial portal non-anatomic single-bundle reconstruction in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 2017; 25:1307-1315. [PMID: 27106922 DOI: 10.1007/s00167-016-4132-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to compare anatomic double-bundle anterior cruciate ligament reconstruction with non-anatomic single-bundle reconstruction. METHODS In a prospective consecutive series, 94 unselected patients [45 anatomic double-bundle (ADB) and 49 non-anatomic single-bundle (SB)] underwent ACL reconstruction involving hamstring tendon autograft, interference screw fixation on both the femoral and tibial side and drilling the femoral tunnel(s) through the antero-medial portal in both groups. In the ADB group, the remnants of the ACL were identified and the grafts were placed anatomically. In the SB group, traditional placement of the graft was performed in a less anatomic manner. Pre-operatively, the groups were comparable in terms of age, gender, time between injury and operation and associated injuries. One independent physiotherapist performed all the pre-operative and post-operative assessments. RESULTS The follow-up period was 26 (22-34) and 24 (23-30) months in the ADB and SB groups, respectively (p = 0.005). At follow-up, 78 % in the ADB group and 74 % in the SB group had a negative pivot-shift test (n.s.). The KT-1000 134N measurements were 2 (-5 to 10.5) and 2 (-4 to 7) mm in the ADB and SB groups, respectively (n.s.). At follow-up, the extension deficit was significantly larger in the ADB group than in the SB group (p = 0.001). The Tegner activity scale was significantly higher in the ADB group both pre-operatively and at follow-up (p = 0.03 and p = 0.004). In overall terms, both groups had improved significantly at the two-year follow-up. CONCLUSION In an unselected group of ACL-injured patients, anatomic double-bundle reconstruction did not result in better rotational or antero-posterior stability measurements than antero-medial portal non-anatomic single-bundle reconstruction at the two-year follow-up. LEVEL OF EVIDENCE III.
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Mei X, Zhang Z, Yang J. Double-layer versus single-layer bone-patellar tendon-bone anterior cruciate ligament reconstruction: a prospective randomized study with 3-year follow-up. Arch Orthop Trauma Surg 2016; 136:1733-1739. [PMID: 27568219 DOI: 10.1007/s00402-016-2548-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the clinical results of a randomized controlled trial of single-layer versus double-layer bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. METHODS Fifty-eight subjects who underwent primary ACL reconstruction with a BPTB allograft were prospectively randomized into two groups: single-layer reconstruction (n = 31) and double-layer reconstruction (n = 27). The following evaluation methods were used: clinical examination, KT-1000 arthrometer measurement, muscle strength, Tegner activity score, Lysholm score, subjective rating scale regarding patient satisfaction and sports performance level, graft retear, contralateral ACL tear, and additional meniscus surgery. RESULTS Forty-eight subjects (24 in single-layer group and 24 in double-layer group) who were followed up for 3 years were evaluated. Preoperatively, there were no differences between the groups. At 3-year follow-up, the Lachman and pivot-shift test results were better in the double-layer group (P = 0.019 and P < 0.0001, respectively). KT measurements were better in the double-layer group (mean 2.9 versus 1.5 mm; P = 0.0025). The Tegner score was also better in the double-layer group (P = 0.024). There were no significant differences in range of motion, muscle strength, Lysholm score, subjective rating scale, graft retear, and secondary meniscal tear. CONCLUSIONS In ACL reconstruction, double-layer BPTB reconstruction was significantly better than single-layer reconstruction regarding anterior and rotational stability at 3-year follow-up. The results of KT measurements and the Lachman and pivot-shift tests were significantly better in the double-layer group, whereas there was no difference in the anterior drawer test results. The Tegner score was also better in the double-layer group; however, there were no differences in the other subjective findings.
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Affiliation(s)
- Xiaoliang Mei
- Orthopedic Department, The Affiliated Taizhou people's Hospital of Nantong University, Taizhou, 225300, Jiangsu, People's Republic of China
| | - Zhenxiang Zhang
- Orthopedic Department, The Affiliated Taizhou people's Hospital of Nantong University, Taizhou, 225300, Jiangsu, People's Republic of China
| | - Jingwen Yang
- Orthopedic Department, The Affiliated Taizhou people's Hospital of Nantong University, Taizhou, 225300, Jiangsu, People's Republic of China.
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Nakamura K, Koga H, Sekiya I, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Muneta T. Dynamic Evaluation of Pivot-Shift Phenomenon in Double-Bundle Anterior Cruciate Ligament Reconstruction Using Triaxial Accelerometer. Arthroscopy 2016; 32:2532-2538. [PMID: 27296869 DOI: 10.1016/j.arthro.2016.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/12/2016] [Accepted: 04/19/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of initial graft tension on rotational stability and to determine the minimum required tension (MRT) based on the pivot-shift phenomenon in isolated anteromedial bundle (AMB), isolated posteromedial bundle (PLB), and double-bundle anterior cruciate ligament (ACL) reconstructions using a triaxial accelerometer during surgery. METHODS Primary double-bundle ACL reconstructions were included. The pivot-shift test and N-test were performed before and during surgery with the acceleration measurements using a triaxial accelerometer. The pivot-shift test was also manually graded. The AMB and PLB were fixed to a graft tensioning system during surgery with the following settings: (1) AMB only (AMB), (2) PLB only (PLB), and (3) AMB and PLB (A+P). The total graft tension was first set at 20 N and then was increased in increments of 10 N until the pivot-shift test became negative, which was defined as the MRT in each setting. RESULTS Twenty-five patients were evaluated. The MRT in the AMB setting averaged 26 N (range, 20 to 40 N); in the PLB setting, 28 N (range, 20 to 40 N); and in the A+P setting, 24 N (range, 20 to 40 N). The MRT in the A+P setting was significantly smaller than that in the PLB setting (P = .008). The acceleration in the A+P setting was significantly smaller than that in the AMB and PLB settings both in the pivot-shift test (vs AMB: P = .007, vs PLB: P = .011) and in the N-test (vs AMB: P < .001, vs PLB: P < .001). CONCLUSIONS Double-bundle ACL reconstruction better controlled rotational stability with smaller MRT than isolated PLB reconstruction at the time of surgery. In double-bundle reconstruction, the MRT based on the pivot-shift phenomenon could be larger than previously reported MRT based on anteroposterior laxity. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Kaori Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Toshifumi Watanabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Tomoyuki Mochizuki
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Masafumi Horie
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Koji Otabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
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Mengsteab PY, Nair LS, Laurencin CT. The past, present and future of ligament regenerative engineering. Regen Med 2016; 11:871-881. [PMID: 27879170 DOI: 10.2217/rme-2016-0125] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Regenerative engineering has been defined as the convergence of Advanced Materials Sciences, Stem Cell Sciences, Physics, Developmental Biology and Clinical Translation for the regeneration of complex tissues and organ systems. Anterior cruciate ligament (ACL) reconstruction necessitates the regeneration of bone, ligament and their interface to achieve superior clinical results. In the past, the ACL has been repaired with the use of autologous and allogeneic grafts, which have their respective drawbacks. Currently, investigations on the use of biodegradable matrices to achieve knee stability and permit tissue regeneration are making promising advancements. In the future, utilizing regenerative biology cues to induce an endogenous regenerative response may aid the enhancement of clinical ACL reconstruction outcomes.
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Affiliation(s)
- Paulos Y Mengsteab
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA.,Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Raymond & Beverly Sackler Center for Biomedical, Biological, Physical & Engineering Sciences, University of Connecticut Health, Farmington, CT 06030, USA.,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT 06030, USA
| | - Lakshmi S Nair
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA.,Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Raymond & Beverly Sackler Center for Biomedical, Biological, Physical & Engineering Sciences, University of Connecticut Health, Farmington, CT 06030, USA.,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT 06030, USA.,Department of Materials Science & Engineering, University of Connecticut, Storrs, CT 06269, USA.,Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Cato T Laurencin
- Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA.,Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Raymond & Beverly Sackler Center for Biomedical, Biological, Physical & Engineering Sciences, University of Connecticut Health, Farmington, CT 06030, USA.,Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT 06030, USA.,Department of Materials Science & Engineering, University of Connecticut, Storrs, CT 06269, USA.,Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA.,Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
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Saltzman BM, Cvetanovich GL, Nwachukwu BU, Mall NA, Bush-Joseph CA, Bach BR. Economic Analyses in Anterior Cruciate Ligament Reconstruction: A Qualitative and Systematic Review. Am J Sports Med 2016; 44:1329-35. [PMID: 25930672 DOI: 10.1177/0363546515581470] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND As the health care system in the United States (US) transitions toward value-based care, there is an increased emphasis on understanding the cost drivers and high-value procedures within orthopaedics. To date, there has been no systematic review of the economic literature on anterior cruciate ligament reconstruction (ACLR). PURPOSE To evaluate the overall evidence base for economic studies published on ACLR in the orthopaedic literature. Data available on the economics of ACLR are summarized and cost drivers associated with the procedure are identified. STUDY DESIGN Systematic review. METHODS All economic studies (including US-based and non-US-based) published between inception of the MEDLINE database and October 3, 2014, were identified. Given the heterogeneity of the existing evidence base, a qualitative, descriptive approach was used to assess the collective results from the economic studies on ACLR. When applicable, comparisons were made for the following cost-related variables associated with the procedure for economic implications: outpatient versus inpatient surgery (or outpatient vs overnight hospital stay vs >1-night stay); bone-patellar tendon-bone (BPTB) graft versus hamstring (HS) graft source; autograft versus allograft source; staged unilateral ACLR versus bilateral ACLR in a single setting; single- versus double-bundle technique; ACLR versus nonoperative treatment; and other unique comparisons reported in single studies, including computer-assisted navigation surgery (CANS) versus traditional surgery, early versus delayed ACLR, single- versus double-incision technique, and finally the costs of ACLR without comparison of variables. RESULTS A total of 24 studies were identified and included; of these, 17 included studies were cost identification studies. The remaining 7 studies were cost utility analyses that used economic models to investigate the effect of variables such as the cost of allograft tissue, fixation devices, and physical therapy, the percentage and timing of revision surgery, and the cost of revision surgery. Of the 24 studies, there were 3 studies with level 1 evidence, 8 with level 2 evidence, 6 with level 3 evidence, and 7 with level 4 evidence. The following economic comparisons were demonstrated: (1) ACLR is more cost-effective than nonoperative treatment with rehabilitation only (per 3 cost utility analyses); (2) autograft use had lower total costs than allograft use, with operating room supply costs and allograft costs most significant (per 5 cost identification studies and 1 cost utility analysis); (3) results on hamstring versus BPTB graft source are conflicting (per 2 cost identification studies); (4) there is significant cost reduction with an outpatient versus inpatient setting (per 5 studies using cost identification analyses); (5) bilateral ACLR is more cost efficient than 2 unilateral ACLRs in separate settings (per 2 cost identification studies); (6) there are lower costs with similarly successful outcomes between single- and double-bundle technique (per 3 cost identification studies and 2 cost utility analyses). CONCLUSION Results from this review suggest that early single-bundle, single (endoscopic)-incision outpatient ACLR using either BPTB or HS autograft provides the most value. In the setting of bilateral ACL rupture, single-setting bilateral ACLR is more cost-effective than staged unilateral ACLR. Procedures using CANS technology do not yet yield results that are superior to the results of a standard surgical procedure, and CANS has substantially greater costs.
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Affiliation(s)
- Bryan M Saltzman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory L Cvetanovich
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nathan A Mall
- St Louis Center for Cartilage Restoration and Repair Sports Medicine, St Louis, Missouri, USA
| | - Charles A Bush-Joseph
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Karikis I, Desai N, Sernert N, Rostgard-Christensen L, Kartus J. Comparison of Anatomic Double- and Single-Bundle Techniques for Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autografts: A Prospective Randomized Study With 5-Year Clinical and Radiographic Follow-up. Am J Sports Med 2016; 44:1225-36. [PMID: 26948548 DOI: 10.1177/0363546515626543] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this prospective randomized study was to compare the outcomes of the anatomic double-bundle (DB) and anatomic single-bundle (SB) techniques 5 years after anterior cruciate ligament (ACL) reconstruction. Since more effective restoration of rotational laxity is considered the main advantage of the DB technique, the pivot-shift test was the primary outcome variable of the study. HYPOTHESIS Double-bundle ACL reconstruction will result in a better outcome in terms of the pivot-shift test. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 105 patients (33 women, 72 men; median age, 27 years; range, 18-52 years) were randomized and underwent ACL reconstruction (DB group, n = 53; SB group, n = 52). All reconstructions were performed anatomically by identifying the ACL footprints, using the anteromedial portal for the femoral tunnel drilling, and utilizing interference screw for tibial and femoral fixation. A single blinded observer examined the patients preoperatively and at follow-up (median, 64 months; range, 55-75 months). Multiple subjective and objective clinical evaluation tests and radiographic assessments of osteoarthritis (OA) were performed using the Ahlbäck, Kellgren-Lawrence, and Fairbank grading systems at 6 weeks postoperatively and at the final follow-up evaluation. RESULTS Preoperatively, no differences were found between the study groups, apart from the preinjury Tegner activity level, which was lower in the DB group (SB: mean, 7.8 [range, 3-9]; DB: mean, 7.3 [range, 0-9]; P = .02). Eighty-seven patients (83%) were available for examination at the 5-year follow-up. Statistical differences could not be found between the groups in terms of the pivot-shift test, KT-1000 arthrometer laxity measurements, manual Lachman test, single-legged-hop test, square-hop test, range of motion, Lysholm knee scoring scale, Tegner activity scale, or Knee injury and Osteoarthritis Outcome Score. Correspondingly, no differences were found between the groups regarding the presence of OA at follow-up. However, a significant increase of OA was found within the DB group at the 5-year follow-up. Both groups improved at follow-up compared with the preoperative assessment in terms of the laxity tests, hop tests, and scoring scales. CONCLUSION At the 5-year follow-up of an unselected group of patients, anatomic DB reconstruction was not superior to anatomic SB reconstruction in terms of the pivot-shift test.
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Affiliation(s)
- Ioannis Karikis
- Department of Orthopaedics, NU-Hospital Group, Trollhättan/Uddevalla, Sweden Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Neel Desai
- Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Ninni Sernert
- Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Research and Development, NU-Hospital Group, Trollhättan, Sweden
| | | | - Jüri Kartus
- Department of Orthopaedics, NU-Hospital Group, Trollhättan/Uddevalla, Sweden Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Research and Development, NU-Hospital Group, Trollhättan, Sweden
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Abstract
Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using a four-strand semitendinosus tendon was started in our department in July 1994. The motivation for starting the procedure was that the EndoButton with an inside-out procedure instrument became available in Japan. A review article of our DB ACL reconstruction procedure was summarized for the twentieth anniversary of the surgical procedure. Initial tension setting of the two grafts was changed in the first 8 years to achieve better stability during DB ACL reconstruction. A randomized clinical trial (RCT) was started in July 2002 to clarify superiority of the DB procedure to single-bundle (SB) reconstruction under the concept of anatomic reconstruction. Several anatomic studies were performed to describe normal ACL anatomy, which is essential for realizing anatomic reconstruction. A remnant-preserving technique would be an additional option for our DB procedure to improve reconstruction outcomes. Thus, a new remnant-preserving DB procedure was started in 2012. The reproducibility of the new procedure was investigated using three-dimensional computed tomography images. More complex procedures were performed using a transtibial technique and EndoButtons. Initial tension balancing between the two grafts was important for a better outcome. Superiority of knee stability after the DB compared to that after the SB procedure was clarified by the RCT. However, no patient consensus has been reached on any subjective advantage to the DB procedure. Studies of normal ACL anatomy have left questions unresolved regarding where the two tunnels should be created for direct and indirect insertions based on normal anatomy. A new remnant-preserving DB ACL procedure has been practiced. The procedure was more reproducible with respect to creating the femoral tunnel. DB ACL reconstruction using a semitendinosus tendon is an attractive option when pursuing a better outcome for patients.
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Affiliation(s)
- Takeshi Muneta
- Department of Joint Surgery and Sports Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Lubowitz JH, Provencher MT, Brand JC, Rossi MJ. Thirty years brings major change. Arthroscopy 2015; 31:1-5. [PMID: 25554092 DOI: 10.1016/j.arthro.2014.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 02/02/2023]
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