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Muench LN. Editorial Commentary: Noninferiority of Anterior Cruciate Ligament Repair With Dynamic Intraligamentary Stabilization at Short- to Mid-Term Follow-Up Does Not Justify Superseding Anterior Cruciate Ligament Reconstruction as the "Gold Standard" for Anterior Cruciate Ligament Surgery. Arthroscopy 2024; 40:2132-2134. [PMID: 38458549 DOI: 10.1016/j.arthro.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
With advances in surgical technology, including the introduction of some kind of mechanical augmentation, there has been a resurgence of interest in primary repair of the anterior cruciate ligament (ACL). If successful, ACL repairs may provide several advantages over reconstruction resulting from the preservation of the native anatomy and proprioception. Recently, augmentation of ACL repair using dynamic intraligamentary stabilization (DIS) has been proposed, to create an optimal biomechanical environment for healing. In the DIS technique, an additional nonresorbable cord is placed along the ACL and attached to a dynamic spring fixed in the proximal tibia, keeping the tibia in a posterior drawer position at every degree of flexion. The analyzed randomized controlled trials comparing ACL repair with DIS to ACL reconstruction found overall similar failure and revision rates, whereas the few observed statistically significant differences in functional scores or knee stability favoring either of the techniques were clearly not clinically relevant. Of course, repair of a torn ACL should be limited to a specific subset of patients presenting with an acute femoral avulsion tear with minimal retraction and good tissue quality. However, the present short- to mid-term results do not justify ACL reconstruction to be superseded by ACL repair with DIS as the "gold standard" for surgical treatment of ACL tears in the future, even in this subset of patients.
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Sherman SL, Raji Y, Calcei JG, Sherman MF. Anterior Cruciate Ligament Repair-Here to Stay or History Repeating Itself? Clin Sports Med 2024; 43:433-448. [PMID: 38811120 DOI: 10.1016/j.csm.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Anterior cruciate ligament (ACL) injuries continue to be a prevalent concern among athletes and individuals with an active lifestyle. Traditionally, the standard of care for ACL tears has involved surgical reconstruction using autograft or allograft. This article aims to provide an overview of the evolving landscape of primary ACL repair, examining the current evidence, surgical techniques, patient selection criteria, outcomes, and potential future directions in this field.
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Affiliation(s)
- Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, MC 6342, Pavilion C, Redwood City, CA 94063, USA.
| | - Yazdan Raji
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, MC 6342, Pavilion C, Redwood City, CA 94063, USA
| | - Jacob G Calcei
- University Hospitals Drusinsky Sports Medicine Institute, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Hanna House 6th Floor, Cleveland, OH 44106, USA
| | - Mark F Sherman
- Richmond University Medical Center, 2052 Richmond Road, Staten Island, NY 10306, USA
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Advanced Graft Development Approaches for ACL Reconstruction or Regeneration. Biomedicines 2023; 11:biomedicines11020507. [PMID: 36831043 PMCID: PMC9953332 DOI: 10.3390/biomedicines11020507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
The Anterior Cruciate Ligament (ACL) is one of the major knee ligaments, one which is greatly exposed to injuries. According to the British National Health Society, ACL tears represent around 40% of all knee injuries. The number of ACL injuries has increased rapidly over the past ten years, especially in people from 26-30 years of age. We present a brief background in currently used ACL treatment strategies with a description of surgical reconstruction techniques. According to the well-established method, the PubMed database was then analyzed to scaffold preparation methods and materials. The number of publications and clinical trials over the last almost 30 years were analyzed to determine trends in ACL graft development. Finally, we described selected ACL scaffold development publications of engineering, medical, and business interest. The systematic PubMed database analysis indicated a high interest in collagen for the purpose of ACL graft development, an increased interest in hybrid grafts, a numerical balance in the development of biodegradable and nonbiodegradable grafts, and a low number of clinical trials. The investigation of selected publications indicated that only a few suggest a real possibility of creating healthy tissue. At the same time, many of them focus on specific details and fundamental science. Grafts exhibit a wide range of mechanical properties, mostly because of polymer types and graft morphology. Moreover, most of the research ends at the in vitro stage, using non-certificated polymers, thus requiring a long time before the medical device can be placed on the market. In addition to scientific concerns, official regulations limit the immediate introduction of artificial grafts onto the market.
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Li Z. Efficacy of repair for ACL injury: a meta‑analysis of randomized controlled trials. Int J Sports Med 2022; 43:1071-1083. [PMID: 35100655 DOI: 10.1055/a-1755-4925] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We aim to compare the curative effect of primary repair for anterior cruciate ligament (ACL) injury with reconstruction and provide the reliable evidence for its clinical application. The literatures were searched in PubMed, EMBASE, Springer, and other medical literature databases published between January 1970 and June 2021. Basic characteristics, surgery technique, clinical outcome scores and physical examination results were recorded and evaluated. Seven randomized controlled trials (RCT) were eligible for inclusion. The results showed that there were no statistically significant differences between arthroscopic ACL repair and ACL reconstruction for Tegner, Lysholm, Lachman, KT-1000, range of motion (ROM), functional outcomes and reoperation rate (P > 0.05), even the result of IKDC scores showed that arthroscopic repair was better than reconstruction (P = 0.04). However, through the subgroup analysis, it was found that the short-term follow-up results of arthroscopic ACL repair were indeed better than those of open ACL repair. Therefore, we can assume that the arthroscopic ACL repair technique is an optional and promising surgical method to treat ACL injury.
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Affiliation(s)
- Zhuoyang Li
- Orthopedics, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
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Muench LN, Berthold DP, Archambault S, Slater M, Mehl J, Obopilwe E, Cote MP, Arciero RA, Chahla J, Lee Pace J. Anterior cruciate ligament (ACL) repair using cortical or anchor fixation with suture tape augmentation vs ACL reconstruction: A comparative biomechanical analysis. Knee 2022; 34:76-88. [PMID: 34875498 DOI: 10.1016/j.knee.2021.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose was to compare knee kinematics in a cadaveric model of anterior cruciate ligament (ACL) repair using an adjustable-loop femoral cortical suspensory (AL-CSF) or independent bundle suture anchor fixation (IB-SAF) with suture tape augmentation to a bone-patellar tendon-bone (BPTB) ACL reconstruction. METHODS Twenty-seven cadaveric knees were randomly assigned to one of three surgical techniques: (1) ACL repair using the AL-CSF technique with suture tape augmentation, (2) ACL repair using the IB-SAF technique with suture tape augmentation, (3) ACL reconstruction using a BPTB autograft. Each specimen underwent three conditions according to the state of the ACL (native, proximal transection, repair/reconstruction) with each condition tested at four different angles of knee flexion (0°, 30°, 60°, 90°). Anterior tibial translation (ATT) and internal tibial rotation (ITR) were evaluated using 3-dimensional motion tracking software. RESULTS ACL transection resulted in a significant increase in ATT and ITR when compared to the native state (P < 0.001, respectively). ACL repair with the AL-CSF or IB-SAF technique as well as BPTB reconstruction restored native ATT and ITR at all tested angles of knee flexion, while showing significantly less ATT at 0°, 30°, 60°, and 90° as well as significantly less ITR at 30°, 60°, and 90° of knee flexion when compared to the ACL-deficient state. There were no significant differences in ATT and ITR between the three techniques utilized. CONCLUSION ACL repair using the AL-CSF or IB-SAF technique with suture tape augmentation as well as BPTB ACL reconstruction each restored native anteroposterior and rotational laxity, without significant differences in knee kinematics between the three techniques utilized. LEVEL OF EVIDENCE Controlled Laboratory Study.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States; Department of Orthopedic Sports Medicine, Technical University of Munich, Germany
| | - Daniel P Berthold
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States; Department of Orthopedic Sports Medicine, Technical University of Munich, Germany
| | - Simon Archambault
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Maria Slater
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Julian Mehl
- Department of Orthopedic Sports Medicine, Technical University of Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Mark P Cote
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Robert A Arciero
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Jorge Chahla
- Department of Orthopedics, Rush University, Chicago, IL 60612, United States
| | - J Lee Pace
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States; Elite Sports Medicine @ Connecticut Children's Medical Center, Farmington, CT 06032, United States.
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Burton DA, Schaefer EJ, Shu HT, Bodendorfer BM, Argintar EH. Primary Anterior Cruciate Ligament Repair Using Suture Tape Augmentation: A Case Series of 29 Patients With Minimum 2-Year Follow-Up. Arthroscopy 2021; 37:1235-1241. [PMID: 33581301 DOI: 10.1016/j.arthro.2020.11.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate clinical outcomes and patient-reported outcomes of patients who underwent primary anterior cruciate ligament (ACL) repair using suture tape augmentation. METHODS Patients with a proximal tear of the ACL who underwent primary ACL repair with a minimum 2-year follow-up were included. The exclusion criteria included multiligamentous knee injuries, midsubstance tears, tibial avulsion fractures, and distal tears. Demographic characteristics, injury pattern, concomitant injury pattern, and patient-reported outcome measures were recorded. Patients were evaluated at a minimum 2-year follow-up for clinical success, defined as stability not requiring revision ACL reconstruction, and for patient-reported outcome measurements. Failure was defined as the need for revision surgery. RESULTS The mean follow-up period was 2.8 ± 0.9 years. Thirty-five patients met the inclusion criteria, with an average age of 32.2 ± 7.2 years, and 2-year follow-up was obtained for 29 of these patients. Revision surgery was required in 2 of the 29 patients (6.9%); successful treatment was achieved in the remaining 93.1%. The Single Assessment Numeric Evaluation score and Knee Injury and Osteoarthritis Outcome Score for the 27 successfully treated patients were recorded, with 70.4% having Single Assessment Numeric Evaluation scores of 80 or greater. CONCLUSIONS This case series shows that primary surgical repair of proximal ACL tears using suture tape augmentation results in a low rate of revision surgery. LEVEL OF EVIDENCE Level IV, prospective case series.
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Affiliation(s)
- Denver A Burton
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A..
| | | | - Henry T Shu
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Blake M Bodendorfer
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A
| | - Evan H Argintar
- Department of Orthopaedic Surgery, MedStarWashington Hospital Center, Washington, DC, U.S.A
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魏 钰, 运 行, 刘 洋, 魏 民. [Effectiveness of partial anterior cruciate ligament suture repair with wide awake local anesthesia no tourniquet technique]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:337-342. [PMID: 33719243 PMCID: PMC8171753 DOI: 10.7507/1002-1892.202008127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique. METHODS Between July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction. RESULTS The operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant ( P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension. CONCLUSION Using WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient's own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.
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Affiliation(s)
- 钰 魏
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 行 运
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 洋 刘
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 民 魏
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
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ACL Repair: A Game Changer or Will History Repeat Itself? A Critical Appraisal. J Clin Med 2021; 10:jcm10050912. [PMID: 33652689 PMCID: PMC7956607 DOI: 10.3390/jcm10050912] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 01/13/2023] Open
Abstract
Until the past decade the common thought was that the anterior cruciate ligament (ACL) was not able to heal and restore knee stability. In this manuscript a brief review of studies of the developers and the early adaptors of four different modern ACL repair techniques are presented. The present status and considerations for the future of ACL repair and its research are shared. After promising short- to midterm ACL healing results by the developers, the results of the early adaptors show more variety in terms of rerupture and reintervention for other reasons. Risk factors for failure are a young age, high preinjury sports activity level, midsubstance ruptures and impaired integrity of the ACL bundles and the synovial sheath. There is a call for more clinical data and randomized clinical trials. Conclusion: an important finding of the past decade is that the ACL is able to heal and subsequently restabilize the knee. Patient selection is emphasized: the ideal patient is a non-high athlete older than 25 and has an acute proximal one bundle ACL rupture. Further research will have to show if ACL repair could be a game changer or if history will repeat itself.
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Hoogeslag RAG, Brouwer RW, de Vries AJ, Boer BC, Huis In 't Veld R. Efficacy of Nonaugmented, Static Augmented, and Dynamic Augmented Suture Repair of the Ruptured Anterior Cruciate Ligament: A Systematic Review of the Literature. Am J Sports Med 2020; 48:3626-3637. [PMID: 32101692 DOI: 10.1177/0363546520904690] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament suture repair (ACLSR) was abandoned late last century in favor of anterior cruciate ligament (ACL) reconstruction (ACLR) because of overall disappointing results. However, in recent years there has been renewed and increasing interest in ACLSR for treatment of ACL ruptures. Several contemporary ACLSR techniques are being used, but any difference in effectiveness is unclear. HYPOTHESIS Contemporary nonaugmented (NA), static augmented (SA), and dynamic augmented (DA) ACLSR leads to (1) comparable outcomes overall and (2) comparable outcomes between proximal third, middle third, and combined ACL rupture locations (a) within and (b) between ACLSR technique categories. STUDY DESIGN Systematic review. METHODS An electronic search was performed in the MEDLINE and Embase databases for the period between January 1, 2010, and August 7, 2019. All articles describing clinical and patient-reported outcomes for ACLSR were identified and included, and outcomes for NA, SA, and DA ACLSR categories were compared. RESULTS A total of 31 articles and 2422 patients were included. The majority of articles (65%) and patients (89%) reported outcomes of DA ACLSR. Overall, there was high heterogeneity in study characteristics and level as well as quality of evidence (19 level 4; 7 level 3; 3 level 2; and 2 level 1). Most studies indicated excellent patient-reported outcomes. Overall, the variability in (and the maximum of) the reported failure rate was high within all ACLSR categories. The variability in (and the maximum of) the reported rate of all other complications was highest for DA ACLSR. Regarding ACL rupture location, the failure rate was highest in proximal ACL ruptures within the SA and DA ACLSR categories; rates of all other reported complications were highest in combined ACL ruptures within the DA ACLSR category. However, no studies in the NA category and only 1 study in the SA ACLSR category evaluated combined ACL ruptures. The majority of studies comparing ACLSR and ACLR found no differences in outcomes. CONCLUSION The amount of high-quality evidence for contemporary ACLSR is poor. This makes it difficult to interpret differences among ACLSR categories and among ACL rupture locations and, though promising, to establish the role of ACLSR in the treatment of ACL ruptures. More high-quality large randomized clinical trials with longer follow-up comparing ACLSR and ACLR are needed.
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Affiliation(s)
| | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Astrid J de Vries
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Barbara C Boer
- Centre for Orthopaedic Surgery OCON, Hengelo, the Netherlands
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Is Primary Arthroscopic Repair Using the Pulley Technique an Effective Treatment for Partial Proximal ACL Tears? Clin Orthop Relat Res 2020; 478:1031-1045. [PMID: 31876551 PMCID: PMC7170704 DOI: 10.1097/corr.0000000000001118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Attention has recently been paid to primary arthroscopic repair to treat ACL tears because of the disadvantages associated with reconstruction. However, there remain many unanswered questions and concerns about its application in the treatment of ACL tears. QUESTIONS/PURPOSES (1) Does primary arthroscopic repair using the pulley technique result in satisfactory ROM (a functional ROM with a flexion contracture of 30° or less), knee stability, and functional scores in patients with partial proximal ACL tears? (2) What complications are associated with primary arthroscopic repair using the pulley technique in patients with partial proximal ACL tears? METHODS Between January 2014 and March 2016, we treated 23 patients surgically who had partial proximal ACL tears and excellent tissue quality (defined as a remnant with mild interstitial tearing and the ability to hold sutures). All patients meeting those two criteria were treated using primary arthroscopic repair using the pulley technique. During that period, this represented 13% (23 of 183) of the patients we treated surgically for an ACL tear. Patients were excluded if they had other ACL tear types, insufficient tissue quality (defined as a severely torn remnant that was not strong enough to hold sutures), multi-ligamentous injuries, or substantial arthrosis (chondromalacia greater than Outerbridge grade 3, most of which underwent conversion to ACL reconstruction). Clinical outcomes were assessed using ROM, the anterior drawer test, the Lachman test, Lysholm score, Tegner activity score, IKDC subjective score, and radiographs. Twenty-one patients were observed for a mean (range) period of 36 months (25-49), and two were lost to follow-up. RESULTS At the most-recent follow-up examination, all patients achieved full extension and only one patient lacked full flexion, with a flexion contracture of 10°. Twenty patients had no instability on the anterior drawer test and Lachman test findings, and one patient had a 1 + anterior drawer test. The mean Lysholm score improved from a mean ± SD of 71 ± 9 before surgery to 94 ± 6 (mean difference 23 points [95% CI 20 to 25]; p < 0.001) at latest follow-up. The IKDC subjective score improved from 64 ± 10 to 86 ± 11 points (mean difference 22 points; p < 0.001). We found no difference in the Tegner score from before surgery to latest follow-up (6.3 ± 1.2 versus 6.1 ± 1.2; mean difference 0.2; p = 0.056). One patient re-ruptured his ACL 2 months after surgery in military training during an obstacle race. No complications such as infection, thrombosis, stiffness, patellofemoral pain, or implant failure were observed. CONCLUSIONS Primary arthroscopic repair using the pulley technique can achieve short-term clinical success in a carefully selected (the selection process includes first identifying the ACL injury pattern preoperatively with MRI, then confirming the diagnosis under arthroscopy, and deciding whether to perform a repair intraoperatively) subset of patients with partial proximal ACL tears and excellent tissue quality (defined as a remnant with mild interstitial tearing and the ability to hold sutures). Despite the promising clinical outcomes of our study, this technique should not be widely adopted unless it has been compared directly with ACL reconstruction, so future studies should be conducted to compare the clinical outcomes between this technique and ACL reconstruction, and longer-term follow-up is necessary to identify whether there is deterioration in the clinical outcomes over time. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Chahla J, Nelson T, Dallo I, Yalamanchili D, Eberlein S, Limpisvasti O, Mandelbaum B, Metzger MF. Anterior cruciate ligament repair versus reconstruction: A kinematic analysis. Knee 2020; 27:334-340. [PMID: 31813701 DOI: 10.1016/j.knee.2019.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/10/2019] [Accepted: 10/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to compare the biomechanical properties of an anterior cruciate ligament (ACL) anatomic repair of a true femoral avulsion to an anatomic ACL reconstruction. It was hypothesized that the ACL repair and ACL reconstruction would have comparable biomechanical behavior when compared to the native knee. METHODS Ten paired fresh-frozen cadaveric knees (n = 20) were used to investigate knee kinematics when an anterior drawer force, varus, valgus, internal, and external rotational moment were applied at 0, 15, 30, 45, 60, and 90 degrees of flexion. Displacement and rotation were recorded in the following conditions: ACL-intact, ACL-deficient, and ACL-repaired vs reconstructed. RESULTS Sectioning of the ACL significantly increased anterior tibial translation (0°, 15°, 30° and 45°) compared to the intact state. The mean anterior displacement difference from intact was lower in the ACL-repaired knees compared to reconstructed knees at 30° and 90°. There were no significant differences between conditions in varus, valgus, internal, or external rotations. CONCLUSION ACL repair and ACL reconstruction procedures restored knee anterior tibial translation in matched paired specimens. There were no differences in valgus, varus, internal, or external rotation. Although, ACL-repaired knees (avulsion model) demonstrated less anterior tibial translation when compared to ACL-reconstructed knees, this difference was less than one millimeter. Based on the findings of this study, repair and reconstruction procedures both restored anterior tibial translation in matched-pair specimens. This suggests that the initial functionality of both techniques is similar and that further clinical studies are needed to compare the long-term stability.
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Affiliation(s)
- Jorge Chahla
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Trevor Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ignacio Dallo
- Unit of Regenerative Therapy and Arthroscopy Surgery, Sanatorio Garay, Santa Fe, Argentina
| | - Dheeraj Yalamanchili
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Sam Eberlein
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Orr Limpisvasti
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Bert Mandelbaum
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Melodie F Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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DiFelice GS, Sonnery-Cottet B, Douoguih WA, van der List JP. Should We Rethink How to Define Success After ACL Surgery? Letter to the Editor. Am J Sports Med 2019; 47:NP58-NP59. [PMID: 31365849 DOI: 10.1177/0363546519855355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Fayard JM, Sonnery-Cottet B, Vrgoc G, O'Loughlin P, de Mont Marin GD, Freychet B, Vieira TD, Thaunat M. Incidence and Risk Factors for a Partial Anterior Cruciate Ligament Tear Progressing to a Complete Tear After Nonoperative Treatment in Patients Younger Than 30 Years. Orthop J Sports Med 2019; 7:2325967119856624. [PMID: 31360732 PMCID: PMC6636223 DOI: 10.1177/2325967119856624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Partial anterior cruciate ligament (ACL) tears are observed in 10% to 27% of isolated ACL tears. There is currently no consensus on diagnosis and treatment protocols, and the outcomes of nonoperative treatment remain undefined. Purpose: To assess the incidence and risk factors for the progression of partial ACL tears to complete ruptures after nonoperative treatment in active patients younger than 30 years. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 41 patients, all younger than 30 years and active in sports, were diagnosed with a partial ACL tear, with no associated meniscal or chondral lesions on magnetic resonance imaging (MRI). All were assigned to a nonoperative treatment program. The Lachman test, ≤4-mm side-to-side difference in laxity by Rolimeter, and MRI were utilized for the diagnosis. Tegner and International Knee Documentation Committee (IKDC) scores were assessed before and after the first lesion, and the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) score was assessed at last follow-up. Postinjury Tegner and IKDC scores were assessed before the second injury for patients progressing to a complete ACL tear and at last follow-up for patients without progression. Results: At a mean of 43 months (range, 24-96 months), the partial ACL injury progressed to a complete ACL tear in 16 (39%) patients. In the remaining 25 patients without progression, the mean Tegner and IKDC scores were 7.0 and 96.0 before the injury and 5.9 and 85.7, respectively, at last follow-up. The mean ACL-RSI score was 69.3. The Tegner and IKDC scores were significantly lower at final follow-up (P = .0002 and P < .0001, respectively). Only 18 (44%) patients returned to their preinjury level of sports activities. A significantly increased risk of progression to a complete ACL tear was seen in patients ≤20 years (odds ratio, 5.19; P = .037) or patients practicing pivoting contact sports (odds ratio, 6.29; P = .026). Meniscal lesions were found in 50% of patients with a partial tear that progressed to a complete ACL tear. Conclusion: A partial ACL injury progressed to a complete ACL tear in 39% of young active patients treated conservatively, with half of the complete tears presenting with a concomitant meniscal lesion at the time of reconstruction. Age ≤20 years and participation in pivoting contact sports were identified as significant risk factors for progression to a complete tear.
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Affiliation(s)
- Jean-Marie Fayard
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Goran Vrgoc
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Department of Orthopaedic Surgery, University Hospital "Sveti Duh," Zagreb, Croatia
| | - Padhraig O'Loughlin
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Mater Private Hospital, Cork, Ireland
| | - Geoffroy Dubois de Mont Marin
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Hôpital Trousseau, CHRU de Tours, Chambray-lès-Tours, France
| | - Benjamin Freychet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais D Vieira
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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14
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Chai F, Wan F, Jiang J, Chen S. Micro-scale assessment of the postoperative effect of anterior cruciate ligament reconstruction preclinical study using a 7.1T micro-magnetic resonance imaging. Exp Ther Med 2019; 17:214-220. [PMID: 30651785 PMCID: PMC6307410 DOI: 10.3892/etm.2018.6080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/01/2018] [Indexed: 11/26/2022] Open
Abstract
High-field micro-magnetic resonance imaging (MRI) scanning may provide additional information for quantitative analysis of graft bone healing processes, thus serving as a promising supplementary method in graft and bone healing evaluation following anterior cruciate ligament reconstruction (ACLR) surgery during preclinical studies. The present study included 12 New Zealand white rabbits that underwent ACLR with polyethylene terephthalate (PET) ligament. At 4, 8, and 16 weeks following surgery, 4 rabbits were euthanized and knee joint samples were harvested for a 7.1T micro-magnetic resonance imaging (MRI) scan. The graft bone tunnel diameter and signal noise ratio (SNR) at the region of interest (ROI) were measured. Hematoxylin-eosin staining was performed at each time point to verify the graft bone healing process in histology. The bone tunnel diameter at the graft tunnel interface decreased over time in both femoral and tibial parts. Notably, the tunnel size was smaller than the diameter of the drilling Kirschner wire that was used to observe the femoral part and proximal site of the tibial part at 16 weeks following surgery. SNR research demonstrated that both the femoral and tibial part PET ligaments selected in the ROI exhibited a marked increase in SNR from the initial 4-week results. The micro-MRI result was consistent with that of histological analysis. Micro-MRI scanning was applied in an animal model that underwent ACL reconstruction surgery with PET ligament, and it was determined that micro-MRI is promising in quantitatively observing graft bone healing processes directly with a focus on graft tunnel distances and SNRs.
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Affiliation(s)
- Fang Chai
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310003, P.R. China.,Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Sports Medicine Center, Fudan University, Shanghai 200040, P.R. China
| | - Fang Wan
- Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Sports Medicine Center, Fudan University, Shanghai 200040, P.R. China
| | - Jia Jiang
- Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Sports Medicine Center, Fudan University, Shanghai 200040, P.R. China
| | - Shiyi Chen
- Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Sports Medicine Center, Fudan University, Shanghai 200040, P.R. China
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15
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Olmos MI, Sonnery-Cottet B, Barth J. How to Succeed in Arthroscopic Anterior Cruciate Ligament Primary Repair? Step-by-Step Technique. Arthrosc Tech 2018; 8:e37-e46. [PMID: 30899649 PMCID: PMC6408695 DOI: 10.1016/j.eats.2018.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 08/19/2018] [Indexed: 02/03/2023] Open
Abstract
Historically, poor results of open primary repair of anterior cruciate ligament (ACL) injuries have been reported. It has recently been recognized that favorable outcomes of primary ACL repair are possible when selectively performed in patients with proximal tears and good tissue quality. Moreover, with arthroscopic technological advances, primary repair can be a valuable treatment option for patients with proximal tears. Preserving the native ACL has several advantages, including maintenance of native proprioceptive function and biology. The procedure is also minimally invasive and reduces the inflammatory reaction often seen in ACL reconstruction. Recently, it has been suggested that additional suture augmentation of the primary repair technique may be beneficial for protecting ligament healing during early range of motion. In this Technical Note, we present the step-by-step surgical technique of arthroscopic primary repair using a femoral suspensory device with suture augmentation.
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Affiliation(s)
- Manuel Ignacio Olmos
- Department of Orthopedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | | | - Johannes Barth
- Department of Orthopedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France,Address correspondence to: Johannes Barth, M.D., Parc Sud Galaxie, 5 Rue des Tropiques, 38130 Echirolles, Grenoble, France
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16
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Delaloye JR, Murar J, Vieira TD, Saithna A, Barth J, Ouanezar H, Sonnery-Cottet B. Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Reconstruction. Arthrosc Tech 2018; 8:e23-e29. [PMID: 30899647 PMCID: PMC6408622 DOI: 10.1016/j.eats.2018.08.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/16/2018] [Indexed: 02/03/2023] Open
Abstract
There has been a renewed interest in anterior cruciate ligament (ACL) repairs over the last decade with some early promising results in the right patient population. Additionally, the anterolateral ligament has been extensively studied and has recently been shown to have a protective effect on standard ACL reconstructions in a clinical trial. Given its protective effect on ACL reconstructions, we believe this phenomenon is also relevant to ACL repairs and can decrease rerupture rates. In this publication, we demonstrate a surgical technique for ACL repair using an internal brace combined with an anterolateral ligament reconstruction using a gracilis autograft.
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Affiliation(s)
- Jean-Romain Delaloye
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, Lyon, France
| | - Jozef Murar
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, Lyon, France
| | - Adnan Saithna
- Ormskirk Hospital, Ormskirk, Lancashire, United Kingdom
| | | | - Herve Ouanezar
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, Lyon, France
- Address correspondence to Bertrand Sonnery-Cottet, M.D., Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, 69008 Lyon, France.
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17
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Meehan WP, Weisskopf MG, Krishnan S, McCracken C, Zafonte R, Taylor HA, Baggish A, Pascual-Leone A, Nadler LM, Speizer FE. Relation of Anterior Cruciate Ligament Tears to Potential Chronic Cardiovascular diseases. Am J Cardiol 2018; 122:1879-1884. [PMID: 30282598 DOI: 10.1016/j.amjcard.2018.08.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 02/04/2023]
Abstract
We have enrolled a cohort of former National Football League players (n = 3,506) who played since 1960 to assess potential long term health consequences associated with participating in the sport. Each participant has completed a self-administered questionnaire including reporting of physician-diagnosed health conditions. One of the early assessments was to evaluate whether anterior cruciate ligament (ACL) tears were associated with later life co-morbidities, including cardiovascular effects. We used Cox proportional hazards to estimate hazard ratios (HR) for joint replacement surgeries, myocardial infarction, sleep apnea, arthritis, dementia, and stroke by history of ACL tear during their professional career. For additional outcomes without date of occurrence reported we used logistic regression to estimate odds ratios adjusted for potential confounding variables in all models. After adjusting for covariates, former National Football League players who tore their ACL had approximately a twofold increase in muscular skeletal co-morbidities, including knee joint replacement and arthritis, compared with those without ACL tears. In addition, those with a history of ACL tears also had more than a 50% increased risk of myocardial infarction (HR 1.52; 95% confidence interval 0.97 to 2.38) and a slight increase in sleep apnea (HR 1.15; 95% confidence interval 0.96 to 1.38). ACL tears sustained by athletes may increase the risk of co-morbidities beyond the musculoskeletal system. As there are more than 100,000 ACL reconstructions annually in the United States, our findings could have widespread public health importance if these findings generalize to a population beyond professional football players. In conclusion, enhanced screening for other risk factors for these conditions in patients who have torn their ACL might identify those who could most benefit from prevention strategies.
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Affiliation(s)
- William P Meehan
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts; Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc G Weisskopf
- Department of Environmental Health and Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Supriya Krishnan
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Caitlin McCracken
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Herman A Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts; Cardiovascular Research Institute, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Alvaro Pascual-Leone
- Berenson-Allen Center and Division for Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lee M Nadler
- Dana Farber Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Frank E Speizer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Environmental Health and Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts.
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18
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Li Y, Fu SC, Cheuk YC, Song G, Feng H, Yung SH. The non-reconstructive treatment of complete ACL tear with biological enhancement in clinical and preclinical studies: A systematic review. Asia Pac J Sports Med Arthrosc Rehabil Technol 2018; 14:10-16. [PMID: 30302314 PMCID: PMC6170796 DOI: 10.1016/j.asmart.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/28/2018] [Accepted: 04/09/2018] [Indexed: 01/15/2023] Open
Abstract
Introduction There is still controversy regarding the bio-enhanced non-reconstructive ACL treatment. Materials and methods A search for articles in databases was performed in February 2017. The objective and subjective evaluations of clinical studies and biomechanical and histological data of preclinical studies were extracted. Results Eighteen articles were included for analysis. In clinical studies, although subjective scores were significantly improved, the rate of re-operation rate was high. In preclinical studies, bio-enhancing techniques demonstrated promotion of the healing of ACL. Conclusions The efficacy of biological enhancement cannot be validated in clinical studies. Preclinical studies showed improved biomechanical and healing potential.
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Affiliation(s)
- Yue Li
- Sports Medicine Service, Beijing Jishuitan Hospital, China
| | - Sai Cheun Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yau Chuk Cheuk
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Guanyang Song
- Sports Medicine Service, Beijing Jishuitan Hospital, China
| | - Hua Feng
- Sports Medicine Service, Beijing Jishuitan Hospital, China
| | - Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
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19
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Partial Anterior Cruciate Ligament Ruptures: Advantages by Intraligament Autologous Conditioned Plasma Injection and Healing Response Technique-Midterm Outcome Evaluation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3204869. [PMID: 30148163 PMCID: PMC6083554 DOI: 10.1155/2018/3204869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/02/2018] [Indexed: 02/06/2023]
Abstract
The historical treatment options for partial anterior cruciate ligament (ACL) ruptures were conservative therapy or ACL reconstruction by injured bundle or entire ACL replacement. In awareness of the regenerative potential of biologic agents such as mesenchymal stem cells or platelet rich plasma (PRP), the healing response technique was developed to preserve the injured ACL with better outcomes than the conservative therapy. Further improvement of this technique seems to be obtained by the additional application of PRP products. Thus, the aim of this study was to evaluate the midterm outcome after intraligament autologous conditioned plasma (ACP) by a clinical, scoring, and functional performance assessment. 42 patients were evaluated in this study. The failure rate was 9.5%. Outcome evaluation showed good to excellent results. The scores were IKDC subjective 83.2 (SD 14.5), Lysholm 85.5 (SD 15.5), Tegner 4.7 (SD 1.7), and Cincinnati 85.4 (SD 15.5) after a mean follow-up of 33 months. Clinical examination showed stable Lachman test, negative pivot shift phenomenon, and a significant reduction in AP-laxity compared to preoperative status (rolimeter preoperative: 1.9 (SD1.4); postoperative 0.6 (SD1.8), p=0.001) in all patients. Functional performance testing showed no significant differences between the injured and healthy side. Return to sport was achieved after a mean of 5.8 months (SD 3.6) in 71.1% of the included patients. In summary, this new treatment option revealed in midterm follow-up promising results to treat partial ACL lesions with a reduced need for conversion to ACL reconstruction and with a high percentage of return to preinjury sport activity.
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20
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Urbanek O, Kołbuk D, Wróbel M. Articular cartilage: New directions and barriers of scaffolds development – review. INT J POLYM MATER PO 2018. [DOI: 10.1080/00914037.2018.1452224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Olga Urbanek
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
| | - Dorota Kołbuk
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
| | - Mikołaj Wróbel
- Ortopedika – Centre for Specialized Surgery, Warsaw, Poland
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21
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DiFelice GS, van der List JP. Clinical Outcomes of Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears Are Maintained at Mid-term Follow-up. Arthroscopy 2018; 34:1085-1093. [PMID: 29373290 DOI: 10.1016/j.arthro.2017.10.028] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the mid-term clinical outcomes in patients with proximal avulsion anterior cruciate ligament (ACL) tears undergoing arthroscopic primary repair with suture anchors. METHODS The first 11 consecutive patients with proximal avulsion tears treated with arthroscopic primary repair were evaluated at mid-term (minimum 5-year) follow-up. Physical examination was performed; laxity examination consisting of the Lachman, pivot-shift, and anterior drawer tests was performed; and patients were asked to complete the Lysholm, modified Cincinnati, Single Assessment Numeric Evaluation, and International Knee Documentation Committee (IKDC) questionnaires. RESULTS Of the 11 patients, 10 were seen at a mean follow-up of 6.0 ± 1.5 years (range, 4.8-9.2 years). One patient was lost to follow-up, in whom failure had already occurred at short-term follow-up. One additional patient underwent reoperation for a medial meniscus tear and also had a partial ACL tear; this patient was clinically stable at last follow-up. All patients had full range of motion. Nine patients had negative Lachman and negative pivot-shift examination findings (IKDC score of A), and 1 patient had a 1A Lachman result and 1+ pivot-shift result (IKDC score of B). The mean Lysholm score was 96.0 ± 4.5 (range, 88-100); modified Cincinnati score, 95.6 ± 7.4 (range, 80-100); Single Assessment Numeric Evaluation score, 95.4 ± 5.4 (range, 85-100); preinjury Tegner score, 7.2 ± 1.2 (range, 5-9); postoperative Tegner score, 6.6 ± 1.8 (range, 3-9); and IKDC subjective score, 92.3 ± 11.3 (range, 64-100). CONCLUSIONS The clinical outcomes of arthroscopic primary repair of proximal ACL tears with suture anchors are excellent and are maintained at mid-term follow-up in a carefully selected subset of patients with proximal tears and excellent tissue quality. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Gregory S DiFelice
- Orthopaedic Sports Medicine and Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery; NewYork-Presbyterian Hospital; and Weill Medical College of Cornell University, New York, New York, U.S.A
| | - Jelle P van der List
- Orthopaedic Sports Medicine and Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery; NewYork-Presbyterian Hospital; and Weill Medical College of Cornell University, New York, New York, U.S.A..
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22
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Tapasvi SR, Shekhar A, Patil SS. Primary Anterior Cruciate Ligament Repair With Augmentation. Arthrosc Tech 2018; 7:e139-e145. [PMID: 29552480 PMCID: PMC5851946 DOI: 10.1016/j.eats.2017.08.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/10/2017] [Indexed: 02/03/2023] Open
Abstract
Anterior cruciate ligament (ACL) tears are usually managed by reconstruction with autograft or allograft, but primary repair in carefully selected patients is a reasonable option. Proximal avulsions presenting early with excellent tissue quality are amenable to repair and healing. Restoration of native ACL preserves its proprioceptive and kinematic functions. A repair is less invasive and avoids graft-related problems, and faster rehabilitation is possible. Protection for the repair in the early stages will allow better healing. We present our technique of ACL repair using knotless suture anchors with high-strength sutures and protection using high-strength sutures tapes inserted through the same anchors.
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Affiliation(s)
| | | | - Shantanu Sudhakar Patil
- SRM Medical College, SRM University, Kattankulathur, Tamil Nadu, India,Address correspondence to Shantanu Sudhakar Patil, M.B.B.S., M.S.(Ortho.), SRM Medical College, SRM University, Kattankulathur, Tamil Nadu 603202, India.SRM Medical CollegeSRM UniversityKattankulathurTamil Nadu603202India
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23
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Krismer AM, Gousopoulos L, Kohl S, Ateschrang A, Kohlhof H, Ahmad SS. Factors influencing the success of anterior cruciate ligament repair with dynamic intraligamentary stabilisation. Knee Surg Sports Traumatol Arthrosc 2017; 25:3923-3928. [PMID: 28210790 DOI: 10.1007/s00167-017-4445-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Primary repair of the anterior cruciate ligament (ACL) has regained interest of clinicians with recent development of novel repair techniques. Dynamic intraligamentary stabilisation was introduced in an attempt to promote healing by shielding cyclic loads acting upon the ACL during the healing phase. The aim of this study was to identify negative factors likely to influence success of this procedure. METHODS Between 2009 and 2014, 264 patients with an acute ACL rupture undergoing dynamic intraligamentary stabilisation were included in this study. Patients were evaluated for anterior/posterior laxity; range of motion and patient reported outcome measures. Adverse events and re-operations were noted. Failure was defined as AP Translation >3 mm, re-rupture or conversion to ACL reconstruction. Minimum follow-up was 24 months. Univariate and multivariate regression models were utilized to determine predictors of failure. RESULTS An overall complication rate of 15.1% was noted comprising 9.5% (n = 25) re-ruptures, 4.1% (n = 11) persistent instability, and 1.5% (n = 4) > 10° fixed flexion deformity. Two factors were identified as negative predictors of failure: (1) pursuit of competitive sport activities with a Tegner pre-injury score >7 (Odds Ratio (OR) 4.4, CI 1.2-15.9, p = 0.02) and (2) mid-substance ACL rupture location (OR 2.5, 1.1-5.7, p = 0.02). When neither of those risk factors occurred the failure rate was limited to 3.9%. CONCLUSIONS Correct patient selection and narrowing of indications are necessary to maintain high success rates of the procedure. Mid-substance ACL ruptures and a high pre-injury sports activity level are two predictors of inferior outcome. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Anna M Krismer
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland
| | - Lampros Gousopoulos
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland
| | - Sandro Kohl
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
| | - Atesch Ateschrang
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany
| | - Hendrik Kohlhof
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Bonn, Bonn, Germany
| | - Sufian S Ahmad
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland
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24
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Cone SG, Warren PB, Fisher MB. Rise of the Pigs: Utilization of the Porcine Model to Study Musculoskeletal Biomechanics and Tissue Engineering During Skeletal Growth. Tissue Eng Part C Methods 2017; 23:763-780. [PMID: 28726574 PMCID: PMC5689129 DOI: 10.1089/ten.tec.2017.0227] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/14/2017] [Indexed: 12/17/2022] Open
Abstract
Large animal models play an essential role in the study of tissue engineering and regenerative medicine (TERM), as well as biomechanics. The porcine model has been increasingly used to study the musculoskeletal system, including specific joints, such as the knee and temporomandibular joints, and tissues, such as bone, cartilage, and ligaments. In particular, pigs have been utilized to evaluate the role of skeletal growth on the biomechanics and engineered replacements of these joints and tissues. In this review, we explore the publication history of the use of pig models in biomechanics and TERM discuss interspecies comparative studies, highlight studies on the effect of skeletal growth and other biological considerations in the porcine model, and present challenges and emerging opportunities for using this model to study functional TERM.
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Affiliation(s)
- Stephanie G. Cone
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Paul B. Warren
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Matthew B. Fisher
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Waryasz GR, Marcaccio S, Gil JA, Owens BD, Fadale PD. Anterior Cruciate Ligament Repair and Biologic Innovations. JBJS Rev 2017; 5:e2. [DOI: 10.2106/jbjs.rvw.16.00050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Dallo I, Chahla J, Mitchell JJ, Pascual-Garrido C, Feagin JA, LaPrade RF. Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament: A Current Concepts Review. Orthop J Sports Med 2017; 5:2325967116681724. [PMID: 28210653 PMCID: PMC5298533 DOI: 10.1177/2325967116681724] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) has been established as the gold standard for treatment of complete ruptures of the anterior cruciate ligament (ACL) in active, symptomatic individuals. In contrast, treatment of partial tears of the ACL remains controversial. Biologically augmented ACL-repair techniques are expanding in an attempt to regenerate and improve healing and outcomes of both the native ACL and the reconstructed graft tissue. PURPOSE To review the biologic treatment options for partial tears of the ACL. STUDY DESIGN Review. METHODS A literature review was performed that included searches of PubMed, Medline, and Cochrane databases using the following keywords: partial tear of the ACL, ACL repair, bone marrow concentrate, growth factors/healing enhancement, platelet-rich plasma (PRP), stem cell therapy. RESULTS The use of novel biologic ACL repair techniques, including growth factors, PRP, stem cells, and bioscaffolds, have been reported to result in promising preclinical and short-term clinical outcomes. CONCLUSION The potential benefits of these biological augmentation approaches for partial ACL tears are improved healing, better proprioception, and a faster return to sport and activities of daily living when compared with standard reconstruction procedures. However, long-term studies with larger cohorts of patients and with technique validation are necessary to assess the real effect of these approaches.
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Affiliation(s)
| | - Jorge Chahla
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - John A Feagin
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Robert F LaPrade
- The Steadman Philippon Research Institute, Vail, Colorado, USA.; The Steadman Clinic, Vail, CO, USA
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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: 23] [Impact Index Per Article: 2.9] [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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Hao ZC, Wang SZ, Zhang XJ, Lu J. Stem cell therapy: a promising biological strategy for tendon-bone healing after anterior cruciate ligament reconstruction. Cell Prolif 2016; 49:154-62. [PMID: 26929145 DOI: 10.1111/cpr.12242] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022] Open
Abstract
Tendon-bone healing after anterior cruciate ligament (ACL) reconstruction is a complex process, impacting significantly on patients' prognosis. Natural tendon-bone healing usually results in fibrous scar tissue, which is of inferior quality compared to native attachment. In addition, the early formed fibrous attachment after surgery is often not reliable to support functional rehabilitation, which may lead to graft failure or unsatisfied function of the knee joint. Thus, strategies to promote tendon-bone healing are crucial for prompt and satisfactory functional recovery. Recently, a variety of biological approaches, including active substances, gene transfer, tissue engineering and stem cells, have been proposed and applied to enhance tendon-bone healing. Among these, stem cell therapy has been shown to have promising prospects and draws increasing attention. From commonly investigated bone marrow-derived mesenchymal stem cells (bMSCs) to emerging ACL-derived CD34+ stem cells, multiple stem cell types have been proven to be effective in accelerating tendon-bone healing. This review describes the current understanding of tendon-bone healing and summarizes the current status of related stem cell therapy. Future limitations and perspectives are also discussed.
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Affiliation(s)
- Zi-Chen Hao
- Department of Orthopaedics, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China
| | - Shan-Zheng Wang
- Department of Orthopaedics, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China
| | - Xue-Jun Zhang
- Department of Orthopaedics, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China
| | - Jun Lu
- Department of Orthopaedics, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China.,Surgical Research Center, Medical School of Southeast University, Nanjing, 210009, China
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Walter SG, Thomas TS, Tafuro L, Thomas W. Enhanced Bone-Tendon-Bone Approach for Open Anterior Cruciate Ligament Replacement With Conservation of the Joint Capsule. Arthrosc Tech 2015; 4:e609-13. [PMID: 26900562 PMCID: PMC4722702 DOI: 10.1016/j.eats.2015.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/15/2015] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic procedures for ruptured anterior cruciate ligament (ACL) tears are a common standard. However, there are strong alternatives to this standard. The purpose of this study is to present a precise, fast, and minimally invasive but open procedure for reconstruction of the ruptured ACL. The torn ACL is substituted by a widely used bone-patellar tendon-bone (BPTB) autograft. After the BPTB graft has been harvested, the Hoffa body is exposed and mobilized ventrally. The surgeon then has a free view of the remnants of the torn ACL, which are to be removed completely. Through the tibial and femoral footprints of the ACL, a tunnel is drilled under a direct view, thus ensuring optimal anatomic positioning of the BPTB graft. The described approach is simple in handling and advantageous because all steps are performed under a direct view, which improves overall precision and intraoperative functional control.
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Waterman BR, Johnson DH. Synthetic Grafts--Where is the Common Sense? Arthroscopy 2015; 31:1849-50. [PMID: 26433234 DOI: 10.1016/j.arthro.2015.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
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Lubowitz JH. Editorial commentary: tissue engineering in knee arthroscopic and related surgery. Arthroscopy 2015; 31:1022-3. [PMID: 25953231 DOI: 10.1016/j.arthro.2015.02.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 02/06/2023]
Abstract
Stem cells are guided by scaffolds, induced by growth factors, and stimulated by biomechanical forces, with a goal of engineering clinically competent cartilage, meniscus, tendon, or ligament tissue. Translational research, to move us from the preclinical to the clinical phase, is today necessary.
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Abstract
ACL bioactive scaffolds may be used to bioenhance ACL primary repair, and they show preclinical (porcine) promise. We are extremely interested in ongoing clinical development.
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Lubowitz JH. Editorial commentary: ACL tissue bioengineering clinical application is in its infancy. Arthroscopy 2015; 31:980. [PMID: 25953227 DOI: 10.1016/j.arthro.2015.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 02/02/2023]
Abstract
Preclinical ACL tissue engineering studies show promise using a combination of cells, scaffolds, growth factors, and "stimulation," such as ultrasound or shockwave therapy, but clinical application is in its infancy. Bioactive scaffolds may be weak at time zero. A solution could be to add to the combination of cells, scaffolds, growth factors, simulation, and a structural tie.
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Lubowitz JH. Editorial commentary: synthetic ACL grafts are more important than clinical nonbelievers may realize. Arthroscopy 2015; 31:969-70. [PMID: 25953226 DOI: 10.1016/j.arthro.2015.02.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 02/02/2023]
Abstract
Artificial ACL grafts are structural ties, designed to resist tension, but not designed to undergo biologic ligamentization by the host. Strategically, an artificial ACL graft may be used as reinforcement to augment ACL repair, ACL autograft, ACL allograft, or tissue-engineered ACL. Most artificial ACL grafts have had poor reported outcomes. However, the Ligament Augmentation and Reconstruction System (LARS) artificial ACL graft shows positive clinical outcomes.
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