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Henkelman E, Ayres JM, Prô SL. MRI Accurately Predicts Quadrupled Semitendinosus Autograft Size Using Posterior Hamstring Harvest for ACL Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100844. [PMID: 38706973 PMCID: PMC11065659 DOI: 10.1016/j.asmr.2023.100844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/07/2023] [Indexed: 05/07/2024] Open
Abstract
Purpose To determine the effectiveness of preoperative magnetic resonance imaging (MRI) measurements of the cross-sectional area (CSA) of the semitendinosus tendon in predicting the intraoperative quadrupled semitendinosus graft diameter of a posteriorly harvested hamstring autograft for anterior cruciate ligament (ACL) reconstruction. Methods A retrospective review of patients who underwent ACL reconstruction with autograft using a posterior hamstring harvest was performed. Patient demographics and operative reports were reviewed, and measurements of the CSA of the semitendinosus on MRI were performed. Multiple linear regression was used to analyze the predictors for graft diameter. A P value < .05 was considered statistically significant. Interrater and intrarater reliability were calculated. Results 280 patients were included. Patient height (P < .0001), and CSA of the semitendinosus (P < .0001) were significant predictors. Patients shorter than 63 inches had an average graft diameter of 7.89 mm compared to 8.69 mm for patients above 63 in (P < .001). The formula for the model is as follows: Graft diameter (mm2) = 2.74 + .067·Height (in) + .00009 · Weight (lbs) + .0018 · Age (years) +.12·Gender (1 if M, 0 if F) + 8.56 · CSA (cm2). The R2 for the model (0.5620), was greater than models using only height (R2 = .4092) or only CSA Semitendinosus (R2 = .3932). None of the interaction terms between covariates (e.g., height, weight, age, gender) were significant. Age (P =.6400), weight (P = .9970), and gender (P = .6700) were not significant predictors. Both intraclass (ICC = 0.864, 95% CI=[0.791, 0.912]) and interclass correlation (ICC=0.827, 95% CI=[0.715, 0.894]) showed good reliability. Conclusion CSA semitendinosus tendon and patient height independently perform similarly as predictors of graft diameter. When used together, CSA and height accurately predict the graft diameter. In particular, for patients under 63 in tall who demonstrated an average graft diameter below the minimum 8 mm, as suggested by the literature, this may be a useful tool for preoperative planning of patients intending to undergo ACL reconstruction with posterior hamstring harvest. Level of Evidence Level III, diagnostic: retrospective cohort study.
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Affiliation(s)
- Erik Henkelman
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Jack M. Ayres
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
- Prisma Health/University of South Carolina School of Medicine, Columbia, South Carolina, U.S.A
| | - Stephan L. Prô
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
- OrthoKansas, Lawrence Memorial Hospital, Lawrence, Kansas, U.S.A
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Akhtar M, Razick D, Baig O, Aamer S, Asad S, Bernal C, Dhaliwal A, Shelton T. No Difference in Most Reported Outcome Measures for Allograft Versus Autograft for Hip Labral Reconstruction: A Systematic Review of Comparative Studies. Arthroscopy 2024:S0749-8063(24)00097-5. [PMID: 38336107 DOI: 10.1016/j.arthro.2024.01.041] [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: 08/11/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To systematically review studies comparing outcomes of allograft versus autograft for hip labral reconstruction. METHODS A systematic review following guidelines established by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) was performed in 3 databases using the terms "labrum," "hip," "acetabulum," "reconstruction," "augmentation," "allograft," and "autograft." Data on study characteristics, patient demographic characteristics, follow-up time, patient-reported outcomes (PROs), rates of revision surgery, and rates of conversion to total hip arthroplasty (THA) were collected. RESULTS Three studies were included, with Methodological Index for Non-randomized Studies (MINORS) scores ranging from 17 to 23. Among 92 patients receiving allografts, the mean ages ranged from 30.6 to 34.8 years; mean follow-up times, from 34.6 to 66.1 months; revision rates, from 0% to 23.6%; and conversion-to-THA rates, from 0% to 20%. Among 185 patients receiving autografts, the mean ages ranged from 34.6 to 35.9 years; mean follow-up times, from 32.7 to 80.8 months; revision rates, from 0% to 7.3%; and conversion-to-THA rates, from 0% to 6.7%. One study reported significantly higher revision rates in the allograft group. All studies reported no statistically significant differences in postoperative PROs, and all postoperative PROs significantly improved compared with preoperative PROs. Rates of achievement of the minimal clinically important difference and patient acceptable symptomatic state, reported by 1 study, were statistically similar between the 2 groups and ranged from 55.6% to 100% for the allograft group and from 53.8% to 84.6% for the autograft group. CONCLUSIONS There were no significant differences between allograft and autograft patients in terms of postoperative PROs; however, all PRO measures were slightly higher in allograft patients. Both revision and conversion-to-THA rates were higher in allograft patients in 2 studies, with the level of significance being reached in terms of revision in 1 study. The third study reported zero revisions and conversions to THA in allograft and autograft patients. LEVEL OF EVIDENCE Level III, systematic review of Level II and III studies.
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Affiliation(s)
- Muzammil Akhtar
- California Northstate University College of Medicine, Elk Grove, California, U.S.A..
| | - Daniel Razick
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Osamah Baig
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, U.S.A
| | - Sonia Aamer
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Shaheryar Asad
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Carter Bernal
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Anand Dhaliwal
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Trevor Shelton
- Utah Valley Orthopedics and Sports Medicine, Intermountain Health, Provo, Utah, U.S.A
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Lin CH, Chih WH, Chiang CH. Effect of graft types for outcomes in revision anterior cruciate ligament reconstruction: A meta-analysis. Orthop Traumatol Surg Res 2024; 110:103696. [PMID: 37783425 DOI: 10.1016/j.otsr.2023.103696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE This meta-analysis was performed to compare outcomes among different types of graft for revision anterior cruciate ligament reconstruction (ACLR). METHODS A comprehensive search from Embase, PubMed, and Cochrane Library was performed to identify relevant articles. Studies that conducted a comparative analysis on outcomes among different types of grafts were included. A meta-analysis was performed using Review Manager 5.4 software. RESULTS In total, 7 non-randomized studies with a minimum 1-year follow-up were included in analysis, and all studies compared outcomes between autograft and allograft. International Knee Documentation Committee subjective knee (IKDC) scores and side-to-side anterior laxity were not significantly different between autograft and allograft. Revision ACLR with allograft had a higher risk of failure than autograft at the final follow-up (OR=2.22, 95% CI=1.55-3.18). The rates of return to pre-injury type of sport and return to same and higher level of pre-injury sport were not significantly different between autograft and allograft. CONCLUSION The outcomes of IKDC score, side-to-side anterior laxity, and rates of return to sport were not significantly different between autograft and allograft. Autografts provide a significantly lower risk of failure than allografts in revision ACLR. LEVEL OF EVIDENCE IV; meta-analysis.
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Affiliation(s)
- Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No.539, Zhongxiao Rd., East Dist., 60002 Chiayi City, Taiwan
| | - Wei-Hsing Chih
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No.539, Zhongxiao Rd., East Dist., 60002 Chiayi City, Taiwan
| | - Chen-Hao Chiang
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No.539, Zhongxiao Rd., East Dist., 60002 Chiayi City, Taiwan.
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Yu C, Feng S, Li Y, Chen J. Application of Nondegradable Synthetic Materials for Tendon and Ligament Injury. Macromol Biosci 2023; 23:e2300259. [PMID: 37440424 DOI: 10.1002/mabi.202300259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
Tendon and ligament injuries, prevalent requiring surgical intervention, significantly impact joint stability and function. Owing to excellent mechanical properties and biochemical stability, Nondegradable synthetic materials, including polyethylene terephthalate (PET) and polytetrafluoroethylene (PTFE), have demonstrated significant potential in the treatment of tendon and ligament injuries. These above materials offer substantial mechanical support, joint mobility, and tissue healing promotion of the shoulder, knee, and ankle joint. This review conclude the latest development and application of nondegradable materials such as artificial patches and ligaments in tendon and ligament injuries including rotator cuff tears (RCTs), anterior cruciate ligament (ACL) injuries, and Achilles tendon ruptures.
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Affiliation(s)
- Chengxuan Yu
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
| | - Sijia Feng
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
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Huyke-Hernández FA, Doxey SA, Only AJ, Sibley A, Mikhael N, Kweon CY, Cunningham BP. Autograft patellar bone-tendon-bone use does not increase operative time in anterior cruciate ligament reconstruction. J Orthop 2023; 45:6-12. [PMID: 37809348 PMCID: PMC10551805 DOI: 10.1016/j.jor.2023.09.009] [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: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) is a common procedure that has been shown to have relatively good outcomes amongst various graft types. Operative time in ACLR has been found to influence outcomes and cost. The purpose of this study was to evaluate the association of operative time in primary arthroscopically performed anterior cruciate ligament reconstruction (ACLR) and graft type while controlling for confounders that influence time. Methods All patients who received ACLR between 2018 and 2022 were included in this retrospective cohort study. Exclusion criteria consisted of age (≤16 years), revisions, concomitant ligament reconstruction or tendon repairs, or other simultaneously performed procedures that could potentially add substantial variation in operative time. The primary outcome was operative time. Graft types included allograft, bone-tendon-bone (BTB) autograft, hamstring tendon (HS) autograft and quadriceps tendon (QT) autograft. Results A total of 1813 primary ACLRs were included. The average operative time was 98.9 ± 33.0 min. Graft utilization varies considerably among surgeons. The most used graft type was BTB autograft (42.6%) followed by HS autograft (32.3%) and allograft (21.4%). Only 68 cases (3.8%) used a QT autograft. Seven of the 15 included surgeons primarily used BTB autograft. One surgeon predominately used QT autograft. No difference in operative time was observed among the autograft types (p = 0.342). Allograft ACLR was significantly faster by 27-33 min compared to using BTB autograft, HS autograft, or QT autograft (p < 0.001). Conclusion Operative time did not vary by type of autograft selected. Allograft ACLR was performed approximately 30 min faster than autograft ACLR. Further studies examining the effect on patient outcomes of reduced operative time and minimizing graft harvest morbidity in ACLR is important to more accurately determine the cost-effectiveness of allograft ACLR.
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Affiliation(s)
- Fernando A. Huyke-Hernández
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
| | - Stephen A. Doxey
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
| | - Arthur J. Only
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Sibley
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Nizar Mikhael
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Brian P. Cunningham
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA
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Noailles T, Toanen C, Geffroy L, Lopes R, Hardy A. Preserving the hamstring tendon insertion during ACL reconstruction with an autograft: Systematic literature review. Orthop Traumatol Surg Res 2023; 109:103556. [PMID: 36682410 DOI: 10.1016/j.otsr.2023.103556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The hamstring tendons (gracilis and semitendinosus) are often used as an autograft for anterior cruciate ligament (ACL) reconstruction. Healing of this graft involves a slow biological process called ligamentization. To encourage this process, some authors have proposed preserving the insertion of the hamstring tendons. HYPOTHESIS Leaving the tibial insertion of the hamstring tendons intact will provide better early biological incorporation and superior tibial mechanical fixation resulting in various clinical advantages. MATERIALS AND METHODS In January 2022, a systematic literature review was carried out independently by two authors of the Medline, PubMed and Embase databases. The keywords used were "pedicular" or "pedicled" or "preservation of tibial attachment" or "hamstring tibial insertion" AND "ACL reconstruction". Each author's data was analyzed separately. RESULTS Sixteen articles were analyzed. Preserving the hamstring tibial insertion during ACL reconstruction improves the graft's biological incorporation during the initial postoperative phase according to clinical studies with MRI analysis and provides a mechanical advantage at the graft's tibial attachment according to biomechanical studies (construct up to 65% stiffer). There was no difference in the clinical and functional scores when compared to the conventional technique in which the hamstring tendons are detached from their tibial insertion. DISCUSSION The main conclusion of this systematic literature review was that preserving the hamstring tibial insertion during ACL reconstruction appears to improve the graft's ligamentization with biological and mechanical advantages relative to detaching the hamstring tendons. The clinical and functional results were comparable to other techniques. Prospective studies with large cohorts are still needed to confirm these findings. LEVEL OF EVIDENCE IV; Systematic review of literature.
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Affiliation(s)
- Thibaut Noailles
- Département de Chirurgie Orthopédique, Polyclinique de Bordeaux Nord, 15/35, rue Claude Boucher, 33000 Bordeaux, France.
| | - Cécile Toanen
- Service de Chirurgie Orthopédique, CHD Vendée, Boulevard Stéphane Moreau, 85925 La Roche-sur-Yon, France
| | - Loïc Geffroy
- Département de Chirurgie Orthopédique, Polyclinique de l'Atlantique, avenue Claude Bernard, 44819 Saint Herblain Cedex, France
| | - Ronny Lopes
- Département de Chirurgie Orthopédique, Polyclinique de l'Atlantique, avenue Claude Bernard, 44819 Saint Herblain Cedex, France
| | - Alexandre Hardy
- Clinique du sport Paris V, 36, boulevard Saint Marcel, 75005 Paris, France
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Zhao D, Pan JK, Lin FZ, Luo MH, Liang GH, Zeng LF, Huang HT, Han YH, Xu NJ, Yang WY, Liu J. Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3053-3075. [PMID: 36189967 DOI: 10.1177/03635465221119787] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The rerupture or need for revision after anterior cruciate ligament reconstruction (ACLR) is a serious complication. Preventive strategies that target the early identification of risk factors are important to reduce the incidence of additional surgery. PURPOSE To perform a systematic review and meta-analysis to investigate risk factors for revision or rerupture after ACLR. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Literature searches were performed in PubMed, Embase, and Web of Science from database inception to November 2021 and updated in January 2022. Quantitative, original studies reporting potential adjusted risk factors were included. Odds ratios (ORs) were calculated for potential risk factors. RESULTS A total of 71 studies across 13 countries with a total sample size of 629,120 met the inclusion criteria. Fifteen factors were associated with an increase in the risk of revision or rerupture after ACLR: male sex (OR, 1.27; 95% CI, 1.14-1.41), younger age (OR, 1.07; 95% CI, 1.05-1.08), lower body mass index (BMI) (OR, 1.03; 95% CI, 1.00-1.06), family history (OR, 2.47; 95% CI, 1.50-4.08), White race (OR, 1.32; 95% CI, 1.08-1.60), higher posterolateral tibial slope (OR, 1.15; 95% CI, 1.05-1.26), preoperative high-grade anterior knee laxity (OR, 2.30; 95% CI, 1.46-3.64), higher baseline Marx activity level (OR, 1.07; 95% CI, 1.02-1.13), return to a high activity level/sport (OR, 2.03; 95% CI, 1.15-3.57), an ACLR within less than a year after injury (OR, 2.05; 95% CI, 1.81-2.32), a concomitant medial collateral ligament (MCL) injury (OR, 1.62; 95% CI, 1.31-2.00), an anteromedial portal or transportal technique (OR, 1.36; 95% CI, 1.22-1.51), hamstring tendon (HT) autografts (vs bone-patellar tendon-bone [BPTB] autografts) (OR, 1.60; 95% CI, 1.40-1.82), allografts (OR, 2.63; 95% CI, 1.65-4.19), and smaller graft diameter (OR, 1.21; 95% CI, 1.05-1.38). The other factors failed to show an association with an increased risk of revision or rerupture after ACLR. CONCLUSION Male sex, younger age, lower BMI, family history, White race, higher posterolateral tibial slope, preoperative high-grade anterior knee laxity, higher baseline Marx activity level, return to a high activity level/sport, an ACLR within less than a year from injury, a concomitant MCL injury, an anteromedial portal or transportal technique, HT autografts (vs BPTB autografts), allografts, and smaller graft diameter may increase the risk of revision or rerupture after ACLR. Raising awareness and implementing effective preventions/interventions for risk factors are priorities for clinical practitioners to reduce the incidence of revision or rerupture after ACLR.
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Affiliation(s)
- Di Zhao
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jian-Ke Pan
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang-Zheng Lin
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-Hui Luo
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gui-Hong Liang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ling-Feng Zeng
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - He-Tao Huang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Hong Han
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nan-Jun Xu
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Yi Yang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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Fan D, Ma J, Zhang L. Contralateral grafts have comparable efficacy to ipsilateral grafts in anterior cruciate ligament reconstructions: a systematic review. J Orthop Surg Res 2023; 18:596. [PMID: 37568165 PMCID: PMC10422826 DOI: 10.1186/s13018-023-04082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/06/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE To perform a systematic review of the clinical outcomes of anterior cruciate ligament reconstruction using either contralateral or ipsilateral tendon autografts. METHODS A systematic review of literature published from inception to December 9, 2022, in multiple databases (PubMed, Embase, Scopus, and the Cochrane Library) was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews) guidelines. Two reviewers independently screened the literature, extracted the data, performed the risk of bias assessment and assessed the study quality. At least one of the following outcomes was evaluated for each study: muscle strength (isometric strength of the quadriceps or hamstring muscles, isokinetic peak flexion torque of the hamstring, or isokinetic peak extension torque of the hamstring), knee laxity examination, Lysholm score, pivot shift, International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lachman test result, return to sports time, or incidence of complications. A random effects model was used for all analyses. RESULTS Four hundred scientific manuscripts were recovered in the initial search. After screening, 12 studies (2 randomized controlled trials, 9 cohort studies, and 1 case- control study) met the search criteria for the qualitative analysis. Among them, 9 cohort studies were used for the quantitative analysis. The results showed few statistically significant differences in terms of muscle strength (contralateral group versus ipsilateral group or donor site group versus ipsilateral group or donor site group versus nonoperative group), Lysholm score, and return to sports time. A comparison showed no significant differences in knee laxity, IKDC score, Tegner activity score, Lachman test score, or incidence of complication, or contralateral rupture. CONCLUSIONS In anterior cruciate ligament reconstruction, the contralateral autologous tendon has a similar effect as the ipsilateral autologous tendon.
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Affiliation(s)
- DingYuan Fan
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
- Beijing University of Chinese Medicine, Beijing, China
- University College London, London, UK
| | - Jia Ma
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
| | - Lei Zhang
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China.
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China.
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Li D, Wang G, Li J, Yan L, Liu H, Jiu J, Li X, Li JJ, Wang B. Biomaterials for Tissue-Engineered Treatment of Tendinopathy in Animal Models: A Systematic Review. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:387-413. [PMID: 36792921 DOI: 10.1089/ten.teb.2022.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
To conduct a systematic review of studies reporting the treatment of tendon injury using biomaterials in animal models. A systematic search was conducted to retrieve studies involving animal models of tendon repair using biomaterials, in PubMed (database construction to August 2022) and Ovid-Embase (1946 to August 2022). Data related to tendon repair with biomaterials were extracted by two researchers, respectively. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was performed based on the classification of tendon repair biomaterials included in our study. A total of 8413 articles were retrieved, with 78 studies included in our analysis. For tendon repair in animal models using biomaterials, the most commonly seen characteristics were as follows: naturally derived biomaterials, rabbits and rats as animal models, surgery as the injury model, and the Achilles tendon as the injury site. The histology and biomechanical recovery of tendon injury following repair are affected by different biomaterials. Studies of tendon repair in animal models indicate that biomaterials can significantly improve repair outcomes, including tendon structure and biomechanics. Among effective biomaterial strategies are the use of new composites and incorporation of cells or growth factors into the material, both of which provide obvious benefits for tendon healing. More high-quality preclinical studies are required to encourage the translation of biomaterials into clinical practice for tendon repair.
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Affiliation(s)
- Dijun Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Guishan Wang
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, China
| | - Jiarong Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Lei Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haifeng Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingwei Jiu
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoke Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Bin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
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Zhang L, Hoyos IA, Zubler C, Rieben R, Constantinescu M, Olariu R. Challenges and opportunities in vascularized composite allotransplantation of joints: a systematic literature review. Front Immunol 2023; 14:1179195. [PMID: 37275912 PMCID: PMC10235447 DOI: 10.3389/fimmu.2023.1179195] [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: 03/03/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Background Joint allotransplantation (JA) within the field of vascularized composite allotransplantation (VCA) holds great potential for functional and non-prosthetic reconstruction of severely damaged joints. However, clinical use of JA remains limited due to the immune rejection associated with all forms of allotransplantation. In this study, we aim to provide a comprehensive overview of the current state of JA through a systematic review of clinical, animal, and immunological studies on this topic. Methods We conducted a systematic literature review in accordance with the PRISMA guidelines to identify relevant articles in PubMed, Cochrane Library, and Web of Science databases. The results were analyzed, and potential future prospects were discussed in detail. Results Our review included 14 articles describing relevant developments in JA. Currently, most JA-related research is being performed in small animal models, demonstrating graft survival and functional restoration with short-term immunosuppression. In human patients, only six knee allotransplantations have been performed to date, with all grafts ultimately failing and a maximum graft survival of 56 months. Conclusion Research on joint allotransplantation has been limited over the last 20 years due to the rarity of clinical applications, the complex nature of surgical procedures, and uncertain outcomes stemming from immune rejection. However, the key to overcoming these challenges lies in extending graft survival and minimizing immunosuppressive side effects. With the emergence of new immunosuppressive strategies, the feasibility and clinical potential of vascularized joint allotransplantation warrants further investigation.
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Affiliation(s)
- Lei Zhang
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Plastic and Reconstructive Surgery, Plastic and Reconstructive Surgery Center, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Isabel Arenas Hoyos
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Cédric Zubler
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Robert Rieben
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Mihai Constantinescu
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Radu Olariu
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
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11
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Runer A, Keeling L, Wagala N, Nugraha H, Özbek EA, Hughes JD, Musahl V. Current trends in graft choice for primary anterior cruciate ligament reconstruction - part II: In-vivo kinematics, patient reported outcomes, re-rupture rates, strength recovery, return to sports and complications. J Exp Orthop 2023; 10:40. [PMID: 37014518 PMCID: PMC10073382 DOI: 10.1186/s40634-023-00601-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Postoperative patient satisfaction after anterior cruciate ligament reconstruction (ACL-R) is influenced mainly by the degree of pain, the need for reoperation, and functional performance in daily activities and sports. Graft choice has shown to have an influence on postoperative outcomes after ACL-R. While patient reported outcomes measurements do not differ between graft options, evidence shows that normal knee kinematics is not fully restored after ACL-R with an increase in postoperative anterior tibial translation (ATT). Postoperative graft rupture rates seem to favor bone-patella-tendon-bone (BPTB) and quadriceps tendon (QT) autografts over HT or allografts. While return to sports rates seem comparable between different graft types, postoperative extensor strength is reduced in patients with BPTB and QT whereas flexion strength is weakened in patients with HT. Postoperative donor site morbidity is highest in BPTB but comparable between HT and QT. With all graft options having advantages and drawbacks, graft choice must be individualized and chosen in accordance with the patient.
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Affiliation(s)
- Armin Runer
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.
- Department for Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Laura Keeling
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nyaluma Wagala
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hans Nugraha
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Udayana, / Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Emre Anil Özbek
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Optimization of surgical exposure for harvesting gracilis-semitendinosus tendons. INTERNATIONAL ORTHOPAEDICS 2023; 47:131-140. [PMID: 36239745 DOI: 10.1007/s00264-022-05598-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This study was conducted to provide anatomical data and surface markers for the safe and efficient exposure of surgical incisions for harvesting gracilis tendons (GT) and semitendinosus tendons (STT) while avoiding technical pitfalls and nerve injury during harvest for ligament reconstruction. METHODS Seventy-four Chinese cadaveric lower limbs were dissected to expose the infrapatellar branch of the saphenous nerve (IPBSN) and pes anserinus (PA). Measurements of the borders and accessory bands of the PA tendons were taken. The arrangement of PA tendons and distribution of the IPBSN were assessed. RESULTS The PA was roughly shaped like a quadrangle, with its superior border at the horizontal plane of the tibial tuberosity (TT). The GT and STT bifurcation point was located on the medial border of the PA. From medial side to lateral side, the sartorius tendons (ST), GT, and STT fused gradually and formed the lateral border of the PA at the distal end. The tendon arrangement of the PA was primarily affected by ST, which commonly covered GT and STT completely. Variant tendons were found in 41.9% of specimens. The insertion of the accessory bands was distal but close to the inferior border of the PA. Accessory bands were observed only in STT and ST, and STT accounted for the most. The width of the first accessory band of STT was similar to the width of the STT. Additionally, most of the IPBSNs were proximal to the horizontal plane of the TT. CONCLUSION For clearly exposing the GT and STT, it is crucial to expose the GT and STT bifurcation point on the medial border of the PA, whether directly or indirectly through the incision.The influence of ST insertion and the variability of tendons within the PA must be paid attention to during the operation. To protect IPBSNs highly, the incision should not be higher than the TT level.
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13
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A Prospective, Double-Blind Evaluation of Anterior Cruciate Ligament Reconstruction With Tibialis Tendon Allograft: Donor Age Does Not Alter Outcomes. Arthrosc Sports Med Rehabil 2022; 5:e267-e272. [PMID: 36866298 PMCID: PMC9972004 DOI: 10.1016/j.asmr.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the effect of graft donor age on outcomes of anterior cruciate ligament (ACL) reconstruction with nonirradiated, fresh-frozen tibialis tendon allografts. Methods This prospective, randomized, double-blind, single surgeon, 2-year follow-up study enrolled 40 patients (28 female, 12 male who underwent ACL reconstruction with tibialis tendon allografts. Results were compared with historical outcomes for allografts from donors aged 18 to 70 years. Analysis was determined by Group A (<50 years) and Group B (>50 years). Objective and subjective International Knee Documentation Committee (IKDC) forms, KT-1000 testing, and Lysholm scores were used for the evaluation. Results Follow-up on average of 24 months was completed in 37 patients (92.5%; Group A = 17, Group B = 20). Average patient age at surgery for Group A was 42.1 years (range 27-54) and Group B was 41.7 years (range 24-56). None of the patients required additional surgery during the initial 2-year follow-up. At 2-year follow-up, there were no significant differences in subjective outcomes. IKDC objective ratings for Group A were A-15 and B-2, and Group B were A-19 and B-1 (P = .45). Average IKDC subjective scores for Group A were 86.1 (± 16.2) and Group B were 84.1 (± 15.6) (P = .70). KT-1000 side to side differences for Group A were 0-4, 1-10, and 2-2, and Group B were 0-2, 1-10, 2-6 (P = .28). Average Lysholm scores for Group A were 91.4 (± 16.7) and Group B were 88.1 (± 12.3) (P = .49). Conclusions Donor age was not associated with clinical outcomes after ACL reconstruction using nonirradiated, fresh-frozen tibialis tendon allografts. Level of Evidence II, prospective prognostic trial.
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14
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Toppo AJ, Perrone GS, Sylvia SM, Miltenberg BH, Power LH, Richmond JC, Salzler MJ. High Levels of Satisfaction and Adequate Patient-Reported Outcomes After Operative Reconstruction of Multiligament Knee Injury With Allograft Among Patients Aged 40 Years and Older. Arthrosc Sports Med Rehabil 2022; 5:e29-e34. [PMID: 36866310 PMCID: PMC9971898 DOI: 10.1016/j.asmr.2022.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/26/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose To describe injury characteristics and patient-reported outcomes (PROs) among patients aged 40 years and older who underwent allograft reconstruction for multiligament knee injury (MLKI). Methods Records of patients aged 40 years and older who underwent allograft multiligament knee reconstruction at a single institution between 2007 and 2017 with a minimum of 2 years of follow-up were retrospectively reviewed. Demographic information, concomitant injuries, patient satisfaction, and PROs including International Knee Documentation Committee and Marx activity scores were obtained. Results Twelve patients were included with a minimum follow-up time of 2.3 years (mean, 6.1; range, 2.3-10.1 years) and a mean age at surgery of 49.8 years. Seven patients were male, and the most common mechanism of injury was sport-related. The most frequently reconstructed MLKIs were anterior cruciate ligament and medial collateral ligament (4), anterior cruciate ligament and posterolateral corner (2), and posterior cruciate ligament and posterolateral corner (2). The majority of patients reported satisfaction with their treatment (11). Median International Knee Documentation Committee and Marx scores were 73 (interquartile range, 45.5-88.0) and 3 (interquartile range 0-5), respectively. Conclusions Patients aged 40 years and older can expect a high level of satisfaction and adequate PROs at 2-years follow-up after operative reconstruction for a MLKI with allograft. This demonstrates that allograft reconstruction for a MLKI in older patients may have clinical utility. Level of Evidence IV, therapeutic case series.
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Affiliation(s)
- Alexander J. Toppo
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Gabriel S. Perrone
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Stephen M. Sylvia
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | | | - Liam H. Power
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | | | - Matthew J. Salzler
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A.,Address correspondence to Matthew J. Salzler, M.D., Tufts Medical Center Biewend Building, 7th Floor, 800 Washington St., Box 306, Boston, MA 02111.
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15
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Liu Y, Liu X, Liu Y, Yang S. Comparison of clinical outcomes of using the nonirradiated and irradiated allograft for anterior cruciate ligament (ACL) reconstruction: A systematic review update and meta-analysis. Medicine (Baltimore) 2022; 101:e29990. [PMID: 35960065 PMCID: PMC9371517 DOI: 10.1097/md.0000000000029990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This study was a systematic review comparing the clinical outcomes of using the nonirradiated and irradiated allograft for anterior cruciate ligament (ACL) reconstruction. METHODS A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane. All databases were searched from the earliest records through August 2019 using the following Boolean operators: irradiated AND nonirradiated AND ACL AND allograft. All prospective and retrospective controlled trials were retrieved that directly compared physical examination and knee function scores and patient-rated outcomes between the nonirradiated and irradiated allograft for ACL reconstruction. RESULTS Three prospective and 2 retrospective articles were identified by the search, and the findings suggested that the nonirradiated allografts were superior to the irradiated allografts based on improved knee joint functional scores and decreased failure rate, even though there was no significantly difference with respect to overall IKDC, range of motion, vertical jump test, and one-leg hop test. CONCLUSIONS Irradiated allograft should be limited to be used in ACL surgery and further research into new alternative sterilization techniques are needed to avoiding the disease transmission without interference with the biomechanical properties of the grafts.
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Affiliation(s)
- Yan Liu
- Outpatient Department of Hebei Armed Police Corps Hospital, Shijiazhuang, Hebei, P.R. China
| | - Xuegang Liu
- Department of General Surgery, The Fourth People’s Hospital of Hengshui, Hengshui, Hebei, P.R. China
| | - Yancai Liu
- Department of Pathology, The Fourth People’s Hospital of Hengshui, Hengshui, Hebei, P.R. China
| | - Shan Yang
- Department of Pain, the Third Hospital of Hebei Medical University. Shijiazhuang, Hebei, P.R. China
- * Correspondence: Shan Yang, MD, Department of Pain, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei, China (e-mail: )
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Jeon YS, Lee JW, Kim SH, Kim SG, Kim YH, Bae JH. Determining the Substantial Clinical Benefit Values for Patient-Reported Outcome Scores After Primary ACL Reconstruction. Orthop J Sports Med 2022; 10:23259671221091795. [PMID: 35547609 PMCID: PMC9083051 DOI: 10.1177/23259671221091795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Little is known about the threshold of patient-reported outcomes (PROs) at which patients perceive to have attained a substantial clinical benefit (SCB) after anterior cruciate ligament reconstruction (ACLR). Purpose: To determine the SCB value of PROs 1 year after ACLR in the general population and to determine factors that predict SCB attainment. Study Design: Case series; Level of evidence, 4. Methods: The Lysholm, International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), Tegner, and Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scores were examined postoperatively in 88 patients who underwent ACLR. At the 12-month follow-up visit, the patients answered 2 independent anchor questions about daily discomfort and functional recovery. Receiver operating characteristic (ROC) curve analysis was used to differentiate PRO scores between patients who responded as having no difficulty versus some difficulty with daily knee discomfort (anchor question 1) and between patients with substantial recovery versus nonsubstantial recovery of knee function (anchor question 2). The area under the ROC curve (AUC) was calculated to assess reliability, and the differences between the AUC values were compared. Multivariate logistic regression analyses were performed to determine predictors affecting SCB attainment. Results: There were 76 patients enrolled in this study. The 12-month Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores that corresponded to the SCB were 88.0, 85.1, 6.5, and 64.2 for anchor question 1 and 84.5, 77.7, 5.5, and 57.1 for anchor question 2, respectively. The AUC values obtained from the ROC curve analyses showed acceptable to excellent reliability (anchor question 1: Lysholm, 0.90; IKDC-SKF, 0.86; Tegner, 0.71; ACL-RSI, 0.92; anchor question 2: Lysholm, 0.80; IKDC-SKF, 0.90; Tegner, 0.82; ACL-RSI, 0.82) and were all statistically significant ( P < .001 to P = .028). For all PROs, younger age (Odds Ratio (OR), 0.88-0.94; P < .001 to P = .027) and greater muscle strength (OR, 1.03-1.07; P < .001 to P = .023) were predictive factors of SCB attainment. Conclusion: The postoperative Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores showed acceptable to excellent reliability in predicting the SCB after ACLR in the general population. Age at surgery and thigh muscle strength influenced SCB attainment for all PROs.
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Affiliation(s)
- Young-Sik Jeon
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ja-Woon Lee
- Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Soo-Hyun Kim
- Department of Orthopedic Surgery, Naval Maritime Medical Center, Jinju, Republic of Korea
| | - Sang-Gyun Kim
- Department of Orthopedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Young-Ha Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Bae
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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17
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ACL autograft reconstruction revisions with tendon allografts: Possibilities and outcomes. A one-year follow-up of 39 patients. Orthop Traumatol Surg Res 2022; 108:102832. [PMID: 33556590 DOI: 10.1016/j.otsr.2021.102832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/16/2020] [Accepted: 11/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The number of anterior cruciate ligament (ACL) reconstructions is steadily rising in France. Re-tear rates of up to 25% have been reported and graft selection remains a notable challenge. Allografts, although rarely used in France, can be a viable option. The primary objective of this study was to demonstrate the benefits of ACL revision with allografts, by determining subjective scores (IKDC score and KOOS), measuring laxity, and evaluating the rate of return to sports. HYPOTHESIS Tendon allografts are reliable and can be used in France for ACL reconstruction revision. MATERIAL AND METHODS We conducted a retrospective study including 39 patients managed in two centres between 2004 and 2016 and followed up for at least a year. Patients were eligible if they had undergone tendon allograft reconstruction for ACL revision with or without rupture of a peripheral plane. We excluded underage patients and patients with a history of ligament injury in the contralateral knee. Mean age was 32 years. The allografts were extensor mechanisms, anterior or posterior tibial tendons, fascia lata tendons, hamstring tendons, and a short fibular tendon. They were obtained from French and Belgian tissue banks. They were used for the reconstruction of 39 ACLs and 11 collateral ligaments. The IKDC score and KOOS were determined in all patients. Laximetry was performed in 31 patients by an independent examiner. RESULTS Mean follow-up was 3.5 years. Arthroscopic release was required in one patient, and 2 patients experienced re-tears. No deep surgical site infections were recorded. The subjective IKDC score and the KOOS improved significantly, from 53.6 to 80.7 and from 60.4 to 83.2, respectively. Mean postoperative differential laxity was 1.4mm (KT 1000) and 1.6mm (GNRB®). Of the 3 patients who were professional athletes, 2 had returned to sports at the same level one year later, and among the recreational athletes, 54% had resumed their previous sporting activities. CONCLUSION In the setting of complex ligament reconstruction revision, tendon allografts are reliable and can be used in France. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Ma R, Guess T, Echelmeyer D, Stannard JP. Bench to Bedside: A Multidisciplinary Approach toward the Unknowns after ACL Injuries to Drive Individual Success. MISSOURI MEDICINE 2022; 119:136-143. [PMID: 36036042 PMCID: PMC9339398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
ACL injury and surgery are increasing in prevalence. Several challenges exist that can be obstacles to an individual achieving success after ACL surgery. A knowledge of these risk factors alongside a multidisciplinary collaborative team approach can result in a greater likelihood of achieving individual success after ACL surgery.
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Affiliation(s)
- Richard Ma
- Gregory L. And Ann L. Hummel Distinguished Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Missouri - Columbia School of Medicine (DOS UMC SOM) and with the Thompson Laboratory for Regenerative Orthopaedics (TLRO), Columbia, Missouri
| | - Trent Guess
- DOS UMC SOM and the Department of Physical Therapy, UMC SOM, Columbia, Missouri
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Current trends in the anterior cruciate ligament part II: evaluation, surgical technique, prevention, and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2022; 30:34-51. [PMID: 34865182 DOI: 10.1007/s00167-021-06825-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
Clinical evaluation and management of anterior cruciate ligament (ACL) injury is one of the most widely researched topics in orthopedic sports medicine, giving providers ample data on which to base their practices. The ACL is also the most commonly treated knee ligament. This study reports on current topics and research in clinical management of ACL injury, starting with evaluation, operative versus nonoperative management, and considerations in unique populations. Discussion of graft selection and associated procedures follows. Areas of uncertainty, rehabilitation, and prevention are the final topics before a reflection on the current state of ACL research and clinical management of ACL injury. Level of evidence V.
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20
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Different timing in allograft and autograft maturation after primary anterior cruciate ligament reconstruction does not influence the clinical outcome at mid-long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2022; 30:2281-2290. [PMID: 34782927 PMCID: PMC8592808 DOI: 10.1007/s00167-021-06785-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE The use of allografts in primary anterior cruciate ligament reconstruction (ACLR) is increasing although they are still supposed to be associated to greater risk of re-rupture due to a slower and less efficient graft maturation. The aim of this prospective randomized controlled study was to compare the graft maturation after ACLR with allograft and autograft by MRI at 6- and 12-month follow-up and integrate these data with the functional and clinical results observed at 6-, 12- and 60-month follow-up. METHODS Fifty patients with indication to primary ACLR were randomly and equally divided into hamstring autograft or allograft tendon groups. The graft maturation was measured at 6- and 12-month follow-up by the SNQ score and other radiological parameters on MRI scans. Clinical and functional recovery was evaluated by Lysholm score, Visual Analogues Scale, Tegner activity scale and modified Cincinnati knee rating system at 6, 12 and 60 months after surgery to estimate the predictive value of the radiological parameters for clinical outcomes. Return-to-sport (ACL-RSI) was measured 60 months after surgery. RESULTS Three patients had retear of the neo-ligament (two from Auto group and one from Allo group). All the clinical/functional parameters significantly improved over time, with no statistically significant difference between the groups. At 6 months, the SNQ value was significantly higher in the Auto than in the Allo group (12.9 vs 7.9, p = 0.038), but at 12 months they were comparable (9.8 vs 10.4). The 6-month SNQ values did not correlate with the clinical scores, whereas the 12-month SNQ values significantly correlated with the Cincinnati score, Lysholm score and Tegner activity scale collected at 60-month follow-up. CONCLUSION No clinical or functional differences have been found between the two treatment groups, supporting the suitability of using allograft in primary ACLR, when available. The results at MRI scans showed a different graft maturation trend in the two groups, with allografts being more reactive in the first 6 months. MRI together with the subjective evaluation allows to evaluate objectively the status of the neo-ligamentization process and therefore helps the surgeon to dictate the individual time for return-to-sport. LEVEL OF EVIDENCE Level I.
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21
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Leite CBG, Montechi JMN, Camanho GL, Gobbi RG, Angelini FJ. Aseptically Processed Allograft Implantation: A Safe Strategy for Knee Ligament Reconstructions. J Knee Surg 2021; 36:475-482. [PMID: 34610641 DOI: 10.1055/s-0041-1736195] [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] [Indexed: 02/07/2023]
Abstract
Postoperative infections after allograft implantation is a major concern in knee ligament reconstructions considering the theoretical risk of disease transmission and its potential severity. Here, we aimed to evaluate the postoperative infection rate after knee ligament reconstructions using aseptically processed allografts, and provide an overview of the allografts use in an academic tertiary hospital. A retrospective study was performed evaluating patients who underwent knee ligament reconstructions using aseptically processed allografts, including primary and revision surgeries, from 2005 to 2018. Demographic data, including the type of knee injury and trauma energy, and postoperative data were collected focusing on postoperative infections. Regarding these infected cases, further analyses were performed considering the presenting signs and symptoms, the isolated microorganism identified in culture, the time between graft implantation and diagnosis of infection (defined as acute, subacute, and late), and the need for graft removal. A total of 180 cases of ligament reconstructions were included. The mean follow-up was 8.2 (range: 2.1-15.6) years and the mean age at surgery was 34.1 (± 11.1) years. A total of 262 allografts were implanted in those 180 cases, 93 (35.5%) as bone plug allografts and 169 (64.5%) as soft tissue allografts. Common surgical indications included multiligament reconstruction (57.2%) and primary anterior cruciate ligament (ACL) reconstruction (15%). Seven cases (3.9%) presented postoperative infections. Knee pain (100%) and swelling (100%) were the most prevalent symptoms. Two cases (28.6%) presented sinus tract. Allografts were removed in two cases, the same cases that presented draining sinus (p = 0.04). High-energy trauma was the only statistically associated factor for infection (p = 0.04). No significant association between infection and the type of allograft (p > 0.99) or sex (p = 0.35) were observed. Four cases (57.1%) had monomicrobial staphylococcal infections. Based on that, the allograft-related infection rate was 1.7% (the remaining three infected cases). Nonirradiated, aseptically processed allografts have a low postoperative infection rate in knee ligament reconstructions, being a safe alternative for surgeries that require additional source, increased variety, and quantity of grafts.
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Affiliation(s)
- Chilan B G Leite
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP - Hospital das Clinicas, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - João M N Montechi
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP - Hospital das Clinicas, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Gilberto L Camanho
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP - Hospital das Clinicas, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Riccardo G Gobbi
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP - Hospital das Clinicas, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Fabio J Angelini
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP - Hospital das Clinicas, Faculdade de Medicina, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
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22
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Ehlers CB, Curley AJ, Fackler NP, Minhas A, Chang ES. The Statistical Fragility of Hamstring Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies. Am J Sports Med 2021; 49:2827-2833. [PMID: 33211555 DOI: 10.1177/0363546520969973] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Evidence-based medicine utilizes data to inform clinical decision making, despite the ability of a small number of outcome reversals to change statistical significance. P values are common measurements of statistical significance that possess inherent flaws. The inclusion of the fragility index (FI) and fragility quotient (FQ) may provide a clearer conveyance of statistical strength. PURPOSE/HYPOTHESIS The purpose was to examine the statistical stability of studies comparing hamstring tendon and bone-patellar tendon-bone autografts in primary single-bundle anterior cruciate ligament reconstruction with independent tunnel drilling. We hypothesized that the findings of these studies are vulnerable to a small number of outcome event reversals, often fewer than the number of patients lost to follow-up. STUDY DESIGN Systematic review. METHODS Comparative studies and randomized controlled trials (RCTs) published in 10 leading orthopaedic journals between 2000 and 2020 were analyzed. Statistical significance was defined as a P value ≤.05. FI for each outcome was determined by the number of event reversals necessary to alter significance. FQ was calculated by dividing the FI by the respective sample size. RESULTS Of the 1803 studies screened, 643 met initial search criteria, with 18 comparative studies ultimately included for analysis, 8 of which were RCTs. A total of 114 outcomes were examined. Overall, the mean (interquartile range) FI and FQ were 3.77 (2-4) and 0.040 (0.016-0.055), respectively. The FI was less than the number of patients lost to follow-up for 76.3% of outcomes. CONCLUSION Studies examining graft choice for anterior cruciate ligament reconstruction may not be as statistically stable as previously thought. Comparative studies and RCTs are at substantial risk for statistical fragility, with few event reversals required to alter significance. The reversal of <4 outcome events in a treatment group can alter the statistical significance of a given result; this is commonly fewer than the number of patients lost to follow-up. Future comparative study analyses might consider including FI and FQ with P values in their statistical analysis.
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Affiliation(s)
- Cooper B Ehlers
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Andrew J Curley
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Arjun Minhas
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Edward S Chang
- INOVA Orthopaedics and Sports Medicine, Fairfax, Virginia, USA
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23
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Matar HE, Platt SR, Bloch BV, James PJ, Cameron HU. A Systematic Review of Randomized Controlled Trials in Anterior Cruciate Ligament Reconstruction: Standard Techniques Are Comparable (299 Trials With 25,816 Patients). Arthrosc Sports Med Rehabil 2021; 3:e1211-e1226. [PMID: 34430902 PMCID: PMC8365213 DOI: 10.1016/j.asmr.2021.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/24/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To provide an overview of all published randomized controlled trials (RCTs) in anterior cruciate ligament reconstruction (ACLR) summarizing the available evidence. METHODS Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the Cochrane FIGCentral Register of Controlled Trials, Ovid MEDLINE, and Embase for RCTs of ACLR from their inception to August 26, 2020. Outcome measure was whether RCTs reported statistically significant findings. RCTs were then classified according to their intervention groups in a narrative synthesis of the evidence. RESULTS In total, 299 RCTs met the inclusion criteria and were included with a total number of 25,186 patients. Only 30 RCTs (10%) reported significant differences between the intervention and the control groups. These included 101 RCTs on grafts, 20 RCTs on tunnel placements, 48 RCTs on graft fixation, 42 RCTs on single-bundle compared with double-bundle reconstructions, 11 RCTs on additional procedures, 11 RCTs on graft tensioning, 5 RCTs on timing of surgery, 25 RCTs on technical variations from standard techniques, 6 RCTs on ACL repair, 5 RCTs on navigation, 16 RCTs on perioperative management, and 9 RCTs on other aspects of ACLR. Only 14 RCTs (4.7%) reported outcomes beyond 10 years with greater allograft failures compared with autografts, high incidence of osteoarthritic changes in reconstructed knees (22%-100%), with no significant differences in outcomes between bioabsorbable or metal screws for graft fixation, patellar versus hamstrings or single- versus double-bundle reconstructions. CONCLUSIONS The evidence indicates that a standard arthroscopic single- or double-bundle ACLR with hamstrings/patella autografts, transportal technique, and fixation techniques familiar to the surgeon leads to comparable results. This evidence offers surgeons the flexibility to use standard and cost-effective techniques and achieve comparable outcomes. LEVEL OF EVIDENCE Level II; systematic review of Level I-II randomized controlled trials.
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Affiliation(s)
- Hosam E. Matar
- Nottingham Elective Orthopedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Simon R. Platt
- Department of Orthopedic Surgery, Gold Coast University Hospital, Southport, Australia
| | - Benjamin V. Bloch
- Nottingham Elective Orthopedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Peter J. James
- Nottingham Elective Orthopedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Hugh U. Cameron
- Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, Canada
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24
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Loucas M, Loucas R, D'Ambrosi R, Hantes ME. Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211024591. [PMID: 34277881 PMCID: PMC8255613 DOI: 10.1177/23259671211024591] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/28/2021] [Indexed: 01/14/2023] Open
Abstract
Background: The drilling technique used to make a femoral tunnel is critically important for determining outcomes after anterior cruciate ligament (ACL) reconstruction. The 2 most common methods are the transtibial (TT) and anteromedial (AM) techniques. Purpose: To determine whether graft orientation and placement affect clinical outcomes by comparing clinical and radiological outcomes after single-bundle ACL reconstruction with the AM versus TT technique. Study Design: Systematic review; Level of evidence, 3. Methods: Articles in PubMed, EMBASE, the Cochrane Library, ISI Web of Science, Scopus, and MEDLINE were searched from inception until April 25, 2020, using the following Boolean operators: transtibial OR trans-tibial AND (anteromedial OR trans-portal OR independent OR three portal OR accessory portal) AND anterior cruciate ligament. Results: Of 1270 studies retrieved, 39 studies involving 11,207 patients were included. Of these studies, 14 were clinical, 13 were radiological, and 12 were mixed. Results suggested that compared with the TT technique, the AM technique led to significantly improved anteroposterior and rotational knee stability, International Knee Documentation Committee (IKDC) scores, and recovery time from surgery. A higher proportion of negative Lachman (P = .0005) and pivot-shift test (P = .0001) results, lower KT-1000 arthrometer maximum manual displacement (P = .00001), higher Lysholm score (P = .001), a higher incidence of IKDC grade A/B (P = .05), and better visual analog scale score for satisfaction (P = .00001) were observed with the AM technique compared with the TT technique. The AM drilling technique demonstrated a significantly shorter tunnel length (P = .00001). Significant differences were seen between the femoral and tibial graft angles in both techniques. Low overall complication and revision rates were observed for ACL reconstruction with the AM drilling technique, similar to the TT drilling technique. Conclusion: In single-bundle ACL reconstruction, the AM drilling technique was superior to the TT drilling technique based on physical examination, scoring systems, and radiographic results. The AM portal technique provided a more reproducible anatomic graft placement compared with the TT technique.
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Affiliation(s)
- Marios Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Rafael Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Michael Elias Hantes
- Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Shanmugaraj A, Mahendralingam M, Gohal C, Horner N, Simunovic N, Musahl V, Samuelsson K, Ayeni OR. Press-fit fixation in anterior cruciate ligament reconstruction yields low graft failure and revision rates: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:1750-1759. [PMID: 32785757 DOI: 10.1007/s00167-020-06173-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/16/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Press-fit fixation is a hardware-free technique in anterior cruciate ligament reconstruction (ACLR). The purpose of this review was to quantitatively assess the risk profile and outcomes of press-fit fixation and provide an update on its effectiveness compared to more standard fixation techniques of ACLR. METHODS The electronic databases PUBMED, MEDLINE, and EMBASE were searched on March 26, 2020 for therapeutic randomized controlled trials (RCT) addressing press-fit fixation for primary ACLR. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the quality for randomized studies. A meta-analysis with a random-effects model was used to pool applicable outcomes data. RESULTS A total of six eligible RCTs were included in this review. There were 292 patients (72.9% male) with a mean age of 28.8 ± 3.8 years and a mean follow-up of 81.3 ± 88.3 months that underwent press-fit ACLR on the femoral, tibial or both tunnels. Femoral fixation techniques included press-fit fixation (96.6%) and cross-pin fixation (3.4%). Tibial fixation techniques included press-fit (37.0%), staples (28.1%), interference screws (21.2%) and abarticular post-screws (13.7%). Graft options included bone-patellar tend--bone autografts (73.6%) and semitendinosus and gracilis tendon autograft (26.4%). Significant improvements (p < 0.05) from baseline to follow-up were found for clinical outcomes. Significantly less postoperative bone tunnel enlargement (p < 0.05) was found with tibial press-fit fixation when compared to biodegradable screws. The overall complication rate was 13.3%. There were no significant differences in complication rates [odds ratio = 0.84 (95%CI 0.43-1.66); p = n.s.] (I2 = 0%) between patients undergoing femoral press-fit fixation and femoral metal interference screw fixation. CONCLUSION The overall graft failure and revision rates with press-fit ACLR were low. There were no significant differences in complication rates between patients undergoing femoral press-fit and femoral metal interference screw fixation. Included studies found that patients undergoing press-fit fixation for ACLR had significant improvements in functional outcome scores postoperatively and had significantly reduced postoperative bone tunnel enlargement compared to patients undergoing bioabsorbable fixation. Thus, early evidence suggests that press-fit fixation appears to be a good option for patients undergoing ACLR. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Ajaykumar Shanmugaraj
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| | | | - Chetan Gohal
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Nolan Horner
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Nicole Simunovic
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamitlon, ON, Canada.
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26
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Shen X, Qin Y, Zuo J, Liu T, Xiao J. A Systematic Review of Risk Factors for Anterior Cruciate Ligament Reconstruction Failure. Int J Sports Med 2021; 42:682-693. [PMID: 33784786 DOI: 10.1055/a-1393-6282] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Although most studies have introduced risk factors related to anterior cruciate ligament reconstruction failure, studies on combinations of high-risk factors are rare. To provide a systematic review of the risk factors of anterior cruciate ligament reconstruction failure to guide surgeons through the decision-making process, an extensive literature search was performed of the Medline, Embase and Cochrane Library databases. Studies published between January 1, 2009, and September 19, 2019, regarding the existing evidence for risk factors of anterior cruciate ligament reconstruction failure or graft failure were included in this review. Study quality was evaluated with the quality index. Ultimately, 66 articles met our criteria. There were 46 cases classified as technical factors, 21 cases as patient-related risk factors, and 14 cases as status of the knee joint. Quality assessment scores ranged from 14 to 24. This systematic review provides a comprehensive summary of the risk factors for anterior cruciate ligament reconstruction failure, including technical factors, patient-related factors, and the factors associated with the status of the knee joint. Emphasis should be placed on avoiding these high-risk combinations or correcting modifiable risk factors during preoperative planning to reduce the rate of graft rupture and anterior cruciate ligament reconstruction failure.
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Affiliation(s)
- Xianyue Shen
- Department of Orthopedics,The Second Hospital of Jilin University, Changchun, China
| | - Yanguo Qin
- Department of Orthopedics,The Second Hospital of Jilin University, Changchun, China
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tong Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jianlin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
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27
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Takeuchi S, Rothrauff BB, Taguchi M, Kanto R, Onishi K, Fu FH. In situ cross-sectional area of the quadriceps tendon using preoperative magnetic resonance imaging significantly correlates with the intraoperative diameter of the quadriceps tendon autograft. Knee Surg Sports Traumatol Arthrosc 2021; 29:742-749. [PMID: 32333056 DOI: 10.1007/s00167-020-05993-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/07/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Preoperative assessment to determine the sizes of potential autografts is necessary for individualized anterior cruciate ligament reconstruction (ACLR). However, no study has investigated the prediction of the intraoperative diameter of the quadriceps tendon (QT) autograft based upon preoperative imaging. This study investigated the correlation between the intraoperative diameter of a QT autograft and in situ thickness or cross-sectional area (CSA) measured using preoperative MRI. METHODS Thirty-one knees of 31 patients (mean age 20.9 ± 5.0 years) who underwent individualized anatomic ACLR using all soft tissue QT autograft were included retrospectively. At 15 mm proximal to the superior pole of the patella, the maximum QT thickness was assessed in the sagittal plane and the CSA was assessed at the central 10 mm of the QT in the axial plane. The angle between the axial plane and a line perpendicular to the QT longitudinal axis was used to calculate an adjusted CSA using a cosine function. Intraoperatively, each QT autograft was harvested with 10 mm width and the diameter was measured using a graft sizing device. RESULTS Intra- and inter-observer reliabilities of all measurements using preoperative MRI were excellent (intra-class correlation coefficient, 0.833-0.970). Significant correlations were observed between the thickness, CSA, or adjusted CSA, and the intraoperative diameter (R = 0.434, 0.607, and 0.540, respectively; P < 0.05). CONCLUSIONS The CSA correlated most strongly with the QT autograft diameter. For individualized anatomic ACLR, measuring in situ CSA can be useful for preoperative planning of appropriate graft choices prior to surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Satoshi Takeuchi
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA
| | - Masashi Taguchi
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA
| | - Ryo Kanto
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA
| | - Kentaro Onishi
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA.
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28
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Wang HD, Wang TR, Sui Y, Wang J, Chen W, Zhang YZ. An Autograft for Anterior Cruciate Ligament Reconstruction Results in Better Biomechanical Performance and Tendon-Bone Incorporation Than Does a Hybrid Graft in a Rat Model. Am J Sports Med 2020; 48:3515-3524. [PMID: 33141598 DOI: 10.1177/0363546520967668] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The biomechanical and tendon-bone incorporation properties of allograft-augmented hybrid grafts for anterior cruciate ligament (ACL) reconstruction compared with traditional autografts are unknown. HYPOTHESIS Using an autograft for ACL reconstruction yields better results on biomechanical testing, radiographic analysis, and histological evaluation versus using a hybrid graft. STUDY DESIGN Controlled laboratory study. METHODS A total of 66 adult male Sprague Dawley rats underwent unilateral ACL reconstruction with an autograft (AT group; n = 33) or a hybrid graft (HB group; n = 33). The grafts used in both groups were harvested from the peroneus longus tendon and were fixed by suturing to the surrounding periosteum. Samples were harvested for biomechanical testing, micro-computed tomography (CT), and histological evaluation at 4, 8, and 12 weeks postoperatively. Bone tunnels on the femoral and tibial sides were divided into 3 subregions: intra-articular (IA), midtunnel (MT), and extra-articular (EA). A cylinder-like volume of interest in the bone tunnel and a tubular-like volume of interest around the bone tunnel were used to evaluate new bone formation and bone remodeling, respectively, via micro-CT. RESULTS In the AT group, there were significantly higher failure loads and stiffness at 8 weeks (failure load: 3.04 ± 0.40 vs 2.09 ± 0.54 N, respectively; P = .006) (stiffness: 3.43 ± 0.56 vs 1.75 ± 0.52 N/mm, respectively; P < .001) and 12 weeks (failure load: 9.10 ± 1.13 vs 7.14 ± 0.94 N, respectively; P = .008) (stiffness: 4.45 ± 0.75 vs 3.36 ± 0.29 N/mm, respectively; P = .008) than in the HB group. With regard to new bone formation in the bone tunnel, in the AT group, the bone volume/total volume (BV/TV) was significantly higher than in the HB group on the tibial side at 8 weeks (IA: 22.21 ± 4.98 vs 5.16 ± 3.98, respectively; P < .001) (EA: 19.66 ± 7.19 vs 10.85 ± 2.16, respectively; P = .030) and 12 weeks (IA: 30.50 ± 5.04 vs 17.11 ± 7.31, respectively; P = .010) (MT: 21.15 ± 2.58 vs 15.55 ± 4.48, respectively; P = .041) (EA: 20.75 ± 3.87 vs 10.64 ± 3.94, respectively; P = .003). With regard to bone remodeling around the tunnel, the BV/TV was also significantly higher on the tibial side at 8 weeks (MT: 33.17 ± 8.05 vs 15.21 ± 7.60, respectively; P = .007) (EA: 25.19 ± 6.38 vs 13.94 ± 7.10, respectively; P = .030) and 12 weeks (IA: 69.46 ± 4.45 vs 47.80 ± 6.16, respectively; P < .001) (MT: 33.15 ± 3.88 vs 13.76 ± 4.07, respectively; P < .001) in the AT group than in the HB group. Sharpey-like fibers had formed at 8 weeks in the AT group. A large number of fibroblasts withdrew at 12 weeks. In the AT group, the width of the interface was significantly narrower at 4 weeks (85.86 ± 17.49 vs 182.97 ± 14.35 μm, respectively; P < .001), 8 weeks (58.86 ± 10.99 vs 90.15 ± 11.53 μm, respectively; P = .002), and 12 weeks (42.70 ± 7.96 vs 67.29 ± 6.55 μm, respectively; P = .001) than in the HB group. CONCLUSION Using an autograft for ACL reconstruction may result in improved biomechanical properties and tendon-bone incorporation compared with a hybrid graft. CLINICAL RELEVANCE Augmenting small autografts with allograft tissue may result in decreased biomechanical performance and worse tendon-bone incorporation, increasing the risk of graft failure.
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Affiliation(s)
- Hong-De Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Biochemistry and Molecular Biology, Hebei Medical University, Shijiazhuang, China
| | - Tian-Rui Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Biochemistry and Molecular Biology, Hebei Medical University, Shijiazhuang, China.,Department of Orthopaedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yao Sui
- Department of Biochemistry and Molecular Biology, Hebei Medical University, Shijiazhuang, China.,Department of Ophthalmology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Juan Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ying-Ze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, China
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29
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Bistolfi A, Capella M, Guidotti C, Sabatini L, Artiaco S, Massè A, Ferracini R. Functional results of allograft vs. autograft tendons in anterior cruciate ligament (ACL) reconstruction at 10-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:729-735. [PMID: 33174066 DOI: 10.1007/s00590-020-02823-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The anterior cruciate ligament (ACL) tear is one of the most common sports injuries of the knee, and the arthroscopic reconstruction is the gold standard. Nevertheless, controversies about the surgical techniques and the type of graft still exist. Allografts have been considered by many surgeons as valid alternative to autografts. The aim of this study was to assess the effectiveness of allografts compared to autografts at approximately 10 years of follow-up, investigating the level of physical activity currently performed by patients of each group. METHODS Ninety-four patients, divided into two groups (allografts and autografts), have been retrospectively studied. The two groups did not significantly differ in preoperative sport activity level, age (mean 40.70 years for autografts and 41.23 for allografts) and characteristics. Allograft group received a fresh-frozen graft from the musculoskeletal tissues bank. Evaluations were made using the International Knee Documentation Committee (IKDC) and Lysholm score; every patient was interviewed for complications. RESULTS The mean follow-up time was approximately 10 years for both groups, with a minimum of 8 years. There were no statistically significant differences between the two groups. Average IKDC scores were 75.21 (SD 15.36) and 80.69 (SD 13.65) for the allograft and autograft groups, respectively. The mean Lysholm score was 87.57 (SD 9.43) for the allografts and 89.10 (SD 8.33) for the autografts. No major complications linked to the allograft tissue arose. CONCLUSION Both groups achieved almost the same functional outcomes at an average 10 years of follow-up, indicating fresh-frozen allografts as a reasonable alternative for ACL reconstruction. LEVEL OF EVIDENCE IV, Retrospective case-control study.
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Affiliation(s)
- Alessandro Bistolfi
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città Della Salute E Della Scienza, Via Zuretti 29, 10126, Turin, Italy.
| | - Marcello Capella
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città Della Salute E Della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Claudio Guidotti
- Faculty of Medicine and Surgery, University of Turin, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città Della Salute E Della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Stefano Artiaco
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città Della Salute E Della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città Della Salute E Della Scienza, Via Zuretti 29, 10126, Turin, Italy.,Faculty of Medicine and Surgery, University of Turin, Turin, Italy
| | - Riccardo Ferracini
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Largo R. Benzi 10, 16132, Genova, Italy.,Orthopaedics, Koelliker Hospital, Turin, Italy
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30
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de Villiers C, Goetz G, Sadoghi P, Geiger-Gritsch S. Comparative Effectiveness and Safety of Allografts and Autografts in Posterior Cruciate Ligament Reconstruction Surgery: A Systematic Review. Arthrosc Sports Med Rehabil 2020; 2:e893-e907. [PMID: 33377000 PMCID: PMC7754607 DOI: 10.1016/j.asmr.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/30/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the evidence of the effectiveness and safety of allografts compared to autografts in posterior cruciate ligament reconstruction. Methods Four electronic databases were systematically searched for eligible randomized controlled studies. Crucial effectiveness outcomes included patient-reported function, activity level and symptoms, clinical knee stability, health-related quality of life, and patient satisfaction. Safety was evaluated through graft failures, revisions, reruptures and complications. The internal validity of the studies was assessed by the Cochrane risk of bias tool, and the strength of the evidence was judged according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results Two randomized controlled studies were included: 50 patients were analyzed in the allograft group and 58 in the autograft group. No statistically significant postoperative differences were reported between the groups for patient-reported function, activity levels or symptoms. One study reported a statistically significant difference in instrumented postoperative anteroposterior knee laxity favoring stability in autografts. This difference is, however, not relevant in the clinical setting. Insufficient evidence was found to judge safety outcomes and because complications were poorly measured, and none of the studies reported on graft failure, revision or rerupture rates. The studies were judged with unclear to high risk of bias. The strength of the evidence for effectiveness and safety was judged to be low to very low, according to GRADE. Conclusions Allografts may be comparable to autografts for crucial effectiveness outcomes, but insufficient evidence was found to judge crucial safety outcomes due to poor reporting of safety measures and outcomes. Results should be interpreted with caution because there is lack of good-quality evidence to support the superiority of allografts over autografts due to the high risk of bias in the primary studies and overall very low strength of the body of evidence according to GRADE. Level of Evidence Systematic review of Level II studies.
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Affiliation(s)
- Cecilia de Villiers
- HTA Austria - Austrian Institute for Health Technology Assessment GmbH (Former: Ludwig Boltzmann Institute for Health Technology Assessment), Vienna, Austria
| | - Gregor Goetz
- HTA Austria - Austrian Institute for Health Technology Assessment GmbH (Former: Ludwig Boltzmann Institute for Health Technology Assessment), Vienna, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Sabine Geiger-Gritsch
- HTA Austria - Austrian Institute for Health Technology Assessment GmbH (Former: Ludwig Boltzmann Institute for Health Technology Assessment), Vienna, Austria
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Jin JX, Fang PZ, Hu ZW, Chen JL, Wang RR, Wang X. Comparison of the effectiveness of autologous grafts for anterior cruciate ligament reconstruction: A protocol for an overview of systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e22832. [PMID: 33120810 PMCID: PMC7581041 DOI: 10.1097/md.0000000000022832] [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] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament rupture is a common motor system injury, and the most effective treatment is anterior cruciate ligament reconstruction (ACLR). Choosing the right graft is an important factor to ensure the success of the surgery. Current research shows that the clinical effect of autologous ligaments is better than that of allogeneic ligaments and artificial ligaments. However, there are differences between the autogenous ligaments, and how to choose them is still controversial. This study evaluated the published systematic reviews on the efficacy of different autologous ligament grafts in ACLR, and based on this, conducted a network meta-analysis of related randomized controlled trials. METHODS We searched 8 international and Chinese databases including PubMed, Embase, Web of Science, and Cochrane Library. The methodological quality of systematic reviews will be evaluated by Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR2) measurement tool. Cochrane's risk of bias tool will be used to assess the risk of bias of included randomized controlled trials, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to evaluate the evidence quality. Network meta-analysis will be applied to evaluate the therapeutic effect of different autologous grafts. The main outcome measures are IKDC score, clinical failure rate, Lachman test, Lysholm score, and the incidence of complications. Odds ratio and its 95% confidence interval will be used to synthesize the dichotomy results, while the mean difference and 95% confidence interval of continuous variables will be used for continuous variables. RESULTS This study will provide comprehensive evidence for the application of autologous grafts in ACLR. CONCLUSION The results of this study will help clinicians make appropriate decisions. PROTOCOL REGISTRATION NUMBER INPLASY202090061.
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Affiliation(s)
- Jia-Xin Jin
- Department of Orthopedics, The Second Hospital of Lanzhou University
| | - Peng-Zhong Fang
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province
| | - Zhi-Wei Hu
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province
| | - Jin-Lei Chen
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province
| | - Rui-Rui Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province
| | - Xin Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
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Cruz AI, Beck JJ, Ellington MD, Mayer SW, Pennock AT, Stinson ZS, VandenBerg CD, Barrow B, Gao B, Ellis HB. Failure Rates of Autograft and Allograft ACL Reconstruction in Patients 19 Years of Age and Younger: A Systematic Review and Meta-Analysis. JB JS Open Access 2020; 5:e20.00106. [PMID: 34322650 PMCID: PMC8312832 DOI: 10.2106/jbjs.oa.20.00106] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Graft choice for pediatric anterior cruciate ligament reconstruction (ACLR) is determined by several factors. There is limited information on the use and outcomes of allograft ACLR in pediatric patients. The purpose of this systematic review and meta-analysis was to quantify reported failure rates of allograft versus autograft ACLR in patients ≤19 years of age with ≥2 years of follow-up. We hypothesized that there would be higher rates of failure for allograft compared with autograft ACLR in this population. METHODS PubMed/MEDLINE and Embase databases were systematically searched for literature regarding allograft and autograft ACLR in pediatric/adolescent patients. Articles were included if they described a cohort of patients with average age of ≤19 years, had a minimum of 2 years of follow-up, described graft failure as an outcome, and had a Level of Evidence grade of I to III. Qualitative review and quantitative meta-analysis were performed to compare graft failure rates. A random-effects model was created to compare failure events in patients receiving allograft versus autograft in a pairwise fashion. Data analysis was completed using RevMan 5.3 software (The Cochrane Collaboration). RESULTS The database search identified 1,604 studies; 203 full-text articles were assessed for eligibility. Fourteen studies met the inclusion criteria for qualitative review; 5 studies were included for quantitative meta-analysis. Bone-patellar tendon-bone (BTB) represented 58.2% (n = 1,012) of the autografts, and hamstring grafts represented 41.8% (n = 727). Hybrid allografts (autograft + supplemental allograft) represented 12.8% (n = 18) of all allograft ACLRs (n = 141). The unweighted, pooled failure rate for each graft type was 8.5% for BTB, 16.6% for hamstring, and 25.5% for allograft. Allografts were significantly more likely than autografts to result in graft failure (odds ratio, 3.87; 95% confidence interval, 2.24 to 6.69). CONCLUSIONS Allograft ACLR in pediatric and adolescent patients should be used judiciously, as existing studies revealed a significantly higher failure rate for allograft compared with autograft ACLR in this patient population. Additional studies are needed to improve the understanding of variables associated with the high ACLR failure rate among pediatric and adolescent patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Aristides I. Cruz
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Hasbro Children’s Hospital, Providence, Rhode Island
| | - Jennifer J. Beck
- Orthopaedic Institute for Children, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Matthew D. Ellington
- Dell Medical School, The University of Texas at Austin, and Central Texas Pediatric Orthopedics, Austin, Texas
| | - Stephanie W. Mayer
- Sports Medicine Center, Department of Orthopaedic Surgery, Children’s Hospital Colorado, University of Colorado, Denver, Colorado
| | - Andrew T. Pennock
- Rady Children’s Hospital, University of California San Diego, San Diego, California
| | - Zachary S. Stinson
- Nemours Children’s Hospital, University of Central Florida, Orlando, Florida
| | - Curtis D. VandenBerg
- Children’s Hospital of Los Angeles, Keck School of Medicine of USC, Los Angeles, California
| | - Brooke Barrow
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Burke Gao
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Henry B. Ellis
- Texas Scottish Rite Hospital for Children, University of Texas Southwestern, Dallas, Texas
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Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. J Orthop Res 2020; 38:1191-1203. [PMID: 31840832 PMCID: PMC7225036 DOI: 10.1002/jor.24562] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/25/2019] [Indexed: 02/04/2023]
Abstract
The underlying theme throughout this series of studies authored by the Multicenter anterior cruciate ligament (ACL) Revision Study consortium has been to determine the modifiable predictors or risk factors of long-term outcomes of revision ACL reconstruction. The observational studies described and summarized in the manuscript are both clinically relevant and of great interest in finding out the long-term consequences of the intervention and its relationship to the original injury. The successful completion of these studies has important implications for both therapy and future clinical trials. The identification of modifiable risk factors will play an important role in secondary prevention, while the identification of nonmodifiable risk factors will aid us in counseling our patients and making surgical decisions. Thus, we expect a profound clinical impact on patients' care. More importantly, this project represents an important step forward in bringing evidence to bear in clinical decision making in orthopedic surgery.
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Tan CW, Hsu WH, Yu PA, Chen CL, Kuo LT, Chi CC, Kim D, Park G. Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120915698. [PMID: 32426406 PMCID: PMC7218932 DOI: 10.1177/2325967120915698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/03/2020] [Indexed: 12/22/2022] Open
Abstract
Background: There is no consensus regarding the best treatment approach for middle-aged patients with anterior cruciate ligament (ACL) injuries. Chronic ACL-deficient knees are often associated with instability as well as secondary meniscal and cartilage lesions. ACL reconstruction (ACLR) has achieved satisfactory outcomes in younger patients; however, the effectiveness and safety of ACLR in middle-aged patients remain uncertain. Purpose: To compare the patient-reported functional scores, arthrometric outcomes, and complications of primary ACLR between older (≥50 years) and younger (<50 years) patients. Study Design: Systematic review; Level of evidence, 3. Methods: We conducted a systematic review of cohort studies that compared the clinical outcomes of ACLR between patients aged ≥50 years and those aged <50 years. The Cochrane Central Register of Controlled Trials, Embase, and MEDLINE databases were searched for relevant studies. The Methodological Index for Non-randomized Studies (MINORS) criteria was used to assess the risk of bias and conducted a random-effects meta-analysis to combine the data, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the overall quality of the body of retrieved evidence. The primary outcome was knee functional outcomes, and secondary outcomes were arthrometric outcomes of ACLR and complications. Results: This study included 4 retrospective cohort studies with a total of 287 participants (129 in the older group and 158 in the younger group). All included studies reported significant improvements in clinical outcomes in both groups after ACLR. No significant differences were noted in the improvement of International Knee Documentation Committee (IKDC) scores (mean difference [MD], 0.20 [95% CI, −2.65 to 3.05]; P = .89) and Lysholm scores (MD, −1.98 [95% CI, −6.93 to 2.98]; P = .43) between the 2 groups. No significant differences were observed in anteroposterior stability or risk of complications between the groups. Conclusion: ACLR may be performed in middle-aged patients (≥50 years) without concern for inferior clinical and arthrometric results compared with younger patients (<50 years).
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Affiliation(s)
- Chong-Wei Tan
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-An Yu
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Chi-Lung Chen
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan
| | - Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Puzi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chi Chi
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Dokyung Kim
- School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Geon Park
- School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
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Grassi A, Compagnoni R, Ferrua P, Pasqualotto S, Zaolino C, Zaffagnini S, Randelli P. Should the patella be everted during primary total knee arthroplasty? A systematic review of overlapping meta-analyses. J Orthop Surg (Hong Kong) 2020; 27:2309499019828550. [PMID: 30776958 DOI: 10.1177/2309499019828550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Patellar eversion during total knee arthroplasty (TKA) is a debated issue. The aim of this study is to perform a review of overlapping meta-analyses analyzing clinical outcomes of patellar eversion compared to noneversion. A search was performed in PubMed\MEDLINE, Scopus, and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials (RCTs) or quasi-RCTs;l comparison between TKAs with or without patellar eversion; and at least one outcome, such as reoperation rate, pain, and functional scores. Meta-analyses were evaluated with the A Measurement Tool to Assess Systematic Review (AMSTAR) score, addressing the most relevant one with the Jadad algorithm. Three meta-analyses were identified and included in this review. No significant differences were found regarding complications, quadriceps strength, functional, and radiological outcomes. The meta-analysis by Zan et al. was selected as the best available one. Patellar eversion group showed a shorter tourniquet time but a longer skin incision. In conclusion, eversion and noneversion techniques did not demonstrate any significant or clinically relevant difference. Level of Evidence: Level II, systematic review of meta-analyses.
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Affiliation(s)
- Alberto Grassi
- 1 II° clinica ortopedica e traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,2 Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Riccardo Compagnoni
- 3 Laboratorio di biomeccanica applicata, dipartimento di scienze biomediche per la salute, Università degli studi di Milano, Milano, Italy.,4 I° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Paolo Ferrua
- 3 Laboratorio di biomeccanica applicata, dipartimento di scienze biomediche per la salute, Università degli studi di Milano, Milano, Italy.,4 I° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Stefano Pasqualotto
- 4 I° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Carlo Zaolino
- 5 U.O. Ortopedia e Traumatologia VII, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Stefano Zaffagnini
- 1 II° clinica ortopedica e traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,2 Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pietro Randelli
- 3 Laboratorio di biomeccanica applicata, dipartimento di scienze biomediche per la salute, Università degli studi di Milano, Milano, Italy.,4 I° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.,6 Dipartimento per le Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
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Sun J, Wei XC, Li L, Cao XM, Li K, Guo L, Lu JG, Duan ZQ, Xiang C, Wei L. Autografts vs Synthetics for Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Orthop Surg 2020; 12:378-387. [PMID: 32180364 PMCID: PMC7189042 DOI: 10.1111/os.12662] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 01/14/2023] Open
Abstract
To describe the outcomes of autografts and synthetics in anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction with respect to instrumented laxity measurements, patient‐reported outcome scores, complications, and graft failure risk. We searched PubMed, Cochrane Library, and EMBASE for published randomized controlled trials (RCT) and case controlled trials (CCTs) to compare the outcomes of the autografts versus synthetics after cruciate ligament reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0. Nine studies were identified from the literature review. Of these studies, three studies compared the results of bone–patellar tendon–bone (BPTB) and ligament augmentation and reconstruction system (LARS), while six studies compared the results of four‐strand hamstring tendon graft (4SHG) and LARS. The comparative study showed no difference in Lysholm score and failure risk between autografts and synthetics. The combined results of the meta‐analysis indicated that there was a significantly lower rate of side‐to‐side difference > 3 mm (Odds Ratio [OR] 2.46, 95% confidence intervals [CI] 1.44–4.22, P = 0.001), overall IKDC (OR 0.40, 95% CI 0.19–0.83, P = 0.01), complications (OR 2.54, 95% CI 1.26–5.14, P = 0.009), and Tegner score (OR −0.31, 95% CI −0.52–0.10, P = 0.004) in the synthetics group than in the autografts group. This systematic review comparing long‐term outcomes after cruciate ligament reconstruction with either autograft or synthetics suggests no significant differences in failure risk. Autografts were inferior to synthetics with respect to restoring knee joint stability and patient‐reported outcome scores, and were also associated with more postoperative complications.
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Affiliation(s)
- Jian Sun
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Xiao-Chun Wei
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Lu Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Xiao-Ming Cao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Kai Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Li Guo
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Jian-Gong Lu
- The Institute of Stem Cell and Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Zhi-Qing Duan
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Chuan Xiang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University; Shanxi Key Lab of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Lei Wei
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
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Mestriner MB, Cury RDPL, Dos Santos Netto A, de Oliveira VM, de Camargo OPA, Belloti JC. Double-bundle posterior cruciate ligament reconstruction: No differences between two types of autografts in isolated or combined lesions. Knee 2020; 27:140-150. [PMID: 31806509 DOI: 10.1016/j.knee.2019.09.015] [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] [Received: 06/02/2019] [Revised: 08/12/2019] [Accepted: 09/20/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To demonstrate and compare results obtained with the transtibial double-bundle posterior cruciate ligament (PCL) reconstruction technique using two types of autografts in isolated and combined PCL lesions. METHODS Fifty-two patients with isolated or combined PCL injuries underwent double-bundle PCL reconstruction and were retrospectively evaluated. Among them, 34 were reconstructed using ipsilateral quadriceps and semitendinosus tendon grafts, and 18 were reconstructed using bilateral hamstring tendon grafts. The criteria for outcome evaluation were: objective International Knee Documentation Committee (IKDC) score, Lysholm score, posterior stability (posterior drawer test and KT-1000TM), and rate of complications, comparing the two types of grafts and comparing isolated PCL and combined lesions. The minimum follow-up was two years. RESULTS Significant improvements were found in all evaluation methods between the pre- and postoperative periods (all P < .05), with no observed differences between the graft type that was used (all P > .05). The whole sample had the following results: objective IKDC score, 96.2% classified as A/B; Lysholm score, 98.1% rated as good or excellent; and KT-1000, 98.1% with a side-to-side difference of up to five millimeters (65.4% with 0 to two millimeters). The complication rate was 9.6%, with no differences between the graft type that was used (P = .585). No significant difference was observed when comparing the results between isolated PCL injuries and combined injuries (all P > .05). CONCLUSIONS The proposed PCL reconstruction technique presented satisfactory results in both isolated and combined PCL lesions, and there were no differences between different types of autografts used. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Marcos Barbieri Mestriner
- Knee Surgery Division, Department of Orthopedics and Traumatology, Santa Casa de Misericórdia de São Paulo (SCMSP) Medical School, São Paulo, SP, Brazil.
| | - Ricardo de Paula Leite Cury
- Knee Surgery Division, Department of Orthopedics and Traumatology, Santa Casa de Misericórdia de São Paulo (SCMSP) Medical School, São Paulo, SP, Brazil
| | - Alfredo Dos Santos Netto
- Knee Surgery Division, Department of Orthopedics and Traumatology, Santa Casa de Misericórdia de São Paulo (SCMSP) Medical School, São Paulo, SP, Brazil
| | - Victor Marques de Oliveira
- Knee Surgery Division, Department of Orthopedics and Traumatology, Santa Casa de Misericórdia de São Paulo (SCMSP) Medical School, São Paulo, SP, Brazil
| | - Osmar Pedro Arbix de Camargo
- Knee Surgery Division, Department of Orthopedics and Traumatology, Santa Casa de Misericórdia de São Paulo (SCMSP) Medical School, São Paulo, SP, Brazil
| | - João Carlos Belloti
- Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (UNIFESP) Medical School, São Paulo, SP, Brazil
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Yang XG, Wang F, He X, Feng JT, Hu YC, Zhang H, Yang L, Hua K. Network meta-analysis of knee outcomes following anterior cruciate ligament reconstruction with various types of tendon grafts. INTERNATIONAL ORTHOPAEDICS 2019; 44:365-380. [PMID: 31858199 DOI: 10.1007/s00264-019-04417-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/13/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Various grafts were selected for restoring knee stability and regaining pre-injury activity levels after anterior cruciate ligament (ACL) rupture. This review aimed to compare the short-term knee outcomes of different tendon grafts for primary ACL reconstruction (ACLR). METHODS Databases of PubMed, Embase, and CENTRAL were retrieved for identifying the published RCT comparing the short-term (≤ 2 years) knee outcomes of different tendon grafts for ACLR. The main outcomes include the International Knee Documentation Committee (IKDC) subjective and objective scores, side-to-side difference on knee laxity, Lachman test, pivot-shift test, Lysholm score, Tegner score, all recorded complications and graft re-ruptures. RESULTS A total of 32 trials involving 2962 patients and 17 grafts were included. Superior IKDC subjective score was found for quadriceps tendon autograft (QTB) when compared with autografts including bone-patellar tendon-bone (BPTB), four-strand hamstring tendon (4S-HT), and double-bundle HT. The 4S-HT autograft was associated with poorer anteroposterior and rotational knee stability than the BPTB autograft. Artificial ligament also was found to provide lower knee stability compared with the autografts including the BPTB, patellar tendon, 4S-HT, 4S-HT with preserved tibial insertion, 6S-HT, and four-strand semitendinosus tendon. Additionally, the BPTB allograft showed a statistically higher knee laxity than 6S-HT allograft, while no difference was found between the genuine autografts and non-irradiated allografts. CONCLUSIONS QTB was recommended to be used even over the BPTB and 4S-HT autografts. BPTB autograft was more effective on restoring the knee stability than 4S-HT autograft. Non-irradiated allografts could be safely used as alternatives to autografts. However, artificial ligaments were not recommended for primary ACLR for significantly increased risk of knee laxity.
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Affiliation(s)
- Xiong-Gang Yang
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, 300070, China
| | - Feng Wang
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, 300070, China
| | - Xin He
- Department of Bone Oncology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, 300211, China
| | - Jiang-Tao Feng
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, 300070, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, 300211, China.
| | - Hao Zhang
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, 300070, China
| | - Li Yang
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, 300070, China
| | - Kunchi Hua
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, 300070, China
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Zheng X, Hu Y, Xie P, Li T, Feng YE, Gu J, Gao S. Clinical outcomes and second-look arthroscopic findings of anterior cruciate ligament reconstruction with autograft, hybrid graft, and allograft. J Orthop Surg Res 2019; 14:380. [PMID: 31752931 PMCID: PMC6868796 DOI: 10.1186/s13018-019-1439-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/30/2019] [Indexed: 01/29/2023] Open
Abstract
Background There is no consensus as to the choice of grafts for primary anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the clinical and second-look arthroscopic outcomes after ACL reconstruction by use of autograft, hybrid graft, and γ-irradiated allograft. Methods Ninety-seven patients who underwent second-look arthroscopy after ACL reconstruction with autografts (28 patients, hamstring autograft), hybrid grafts (32 patients, hamstring autograft augmented with γ-irradiated tibialis anterior tendon allograft), or γ-irradiated allografts (37 patients, tibialis anterior tendons) were included in this study. The clinical outcomes were compared by using Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity score, and the side-to-side differences of KT-1000 measurement. Second-look arthroscopic findings were compared in terms of synovial coverage and graft tension. Results There were no statistical significances among the three groups in Lysholm score, IKDC score, or Tegner activity score (P > 0.05). The KT-1000 examination showed more anterior laxity in the γ-irradiated allograft group than in the autograft or hybrid graft groups (P = 0.006, and P = 0.013, respectively). Two patients in the autograft group, 2 patients in the hybrid graft group and 4 patients in the allograft group were evaluated as graft failure on second-look arthroscopy. The synovial coverage was superior in the autograft group than that in the hybrid graft group or the allograft group (P = 0.013 and P = 0.010, respectively), and was comparable between the hybrid graft group and allograft group (P = 0.876). With regard to graft tension, the autograft group and hybrid group were comparable (P = 0.883) but showed better results than the allograft group (P = 0.011 and P = 0.007, respectively). Conclusion The hamstring autografts and hybrid grafts used for ACL reconstruction produced equal efficacy but provided better knee stability than allografts. In addition, the hamstring autografts showed better synovial coverage than the other two graft types.
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Affiliation(s)
- Xiaozuo Zheng
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China. .,Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Yang Hu
- The Second Department of Intensive Care Unit, Children's Hospital of Hebei Province, No. 133 Jianhua Road, Shijiazhuang, 050030, China
| | - Peng Xie
- Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.,Department of Nuclear medicine, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Tong Li
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.,Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Yu-E Feng
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.,Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Juyuan Gu
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.,Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Shijun Gao
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China. .,Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
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Ligamentäre Allografts in der Gelenkchirurgie. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-00316-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The medial epicondyle of the distal femur is the optimal location for MRI measurement of semitendinosus and gracilis tendon cross-sectional area. Knee Surg Sports Traumatol Arthrosc 2019; 27:3498-3504. [PMID: 30809723 DOI: 10.1007/s00167-019-05421-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Graft diameter ≥ 8 mm reduces the risk of failure after anterior cruciate ligament reconstruction (ALCR) with hamstring tendon autograft. Pre-operative measurement of gracilis (GT) and semitendinosus (ST) cross-sectional area using MRI has been utilized but the optimal location for measurement is unknown. The main purpose of this study was to examine the cross-sectional areas of GT + ST at different locations and develop a model to predict whether a doubled hamstring graft of GT + ST will be of sufficient cross-sectional area for ACLR. METHODS A retrospective review was performed of 154 patients who underwent primary ACLR using doubled hamstring autograft. Cross-sectional area measurements of GT + ST on pre-operative MRI axial images were made at three locations: medial epicondyle (ME), tibiofemoral joint line (TJL), and tibial physeal scar (TPS) and calculated the correlation of intra-operative graft size for each location using the Pearson's correlation coefficient. A receiver operating characteristic (ROC) established a threshold that would predict graft diameter ≥ 8 mm. RESULTS Measurement of GT + ST at the ME had a stronger correlation (r = 0.389) to intra-operative graft diameter than measurements at the TJL (r = 0.256) or TPS (r = 0.240). The ROC indicated good predictive value for hamstring graft diameter ≥ 8 mm based on MRI measurement at the ME with the optimal threshold with the highest sensitivity and specificity as 18 mm2. CONCLUSION Cross-sectional area measurement of GT + ST at the ME correlated most closely to intra-operative diameter of a doubled hamstring autograft compared to measurements at the TJL or the TPS. As graft diameter < 8 mm is correlated with higher failure rates of ACL surgery, the ability to pre-operatively predict graft diameter is clinically useful. LEVEL OF EVIDENCE Level III, prognostic study.
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Lu J, Chamberlain CS, Ji ML, Saether EE, Leiferman EM, Li WJ, Vanderby R. Tendon-to-Bone Healing in a Rat Extra-articular Bone Tunnel Model: A Comparison of Fresh Autologous Bone Marrow and Bone Marrow-Derived Mesenchymal Stem Cells. Am J Sports Med 2019; 47:2729-2736. [PMID: 31339739 DOI: 10.1177/0363546519862284] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite widespread acceptance of fresh autologous bone marrow (BM) for use in clinical practice, limited information exists to analyze if tendon-to-bone healing could be accelerated with local use of fresh autologous BM. PURPOSE To investigate the effect of fresh autologous BM on tendon-to-bone healing with a novel rat model. STUDY DESIGN Controlled laboratory study. METHODS An extra-articular bone tunnel was created and filled with an autologous tendon graft in skeletally mature Sprague-Dawley rats (N = 60). They were then randomly divided into 3 groups: BM group (injection of fresh autologous BM into the tendon-bone interface, n = 20), BM-derived mesenchymal stem cell (BMSC) group (injection of allogenic cultured BMSCs, n = 20), and the control group (tendon-bone interface without injection of BM or BMSCs, n = 20). Biomechanical, histological, and immunohistochemical analyses were performed at 2 and 6 weeks after surgery. RESULTS The BM group showed a relatively well-organized and dense connective tissue interface with better orientation of collagen fibers as compared with the BMSC group. At 2 weeks, the tendon-bone interface tissue thickness of the BMSC group was 140 ± 25 μm (mean ± SEM), which was significantly greater than the BM group (58 ± 15 μm). The BM group showed fewer M1 macrophages at the tendon-bone interface at 2 and 6 weeks (P < .001). In contrast, there were more M2 macrophages at the interface in the BM group 2 and 6 weeks postoperatively when compared with controls and the BMSC group (P < .001). Biomechanical tests revealed significantly higher stiffness in the BM group versus the control and BMSC groups at 2 and 6 weeks after surgery (P < .05). Load to failure showed similar trends to stiffness. CONCLUSION These findings indicate that local delivery of fresh autologous BM enhances tendon-to-bone healing better than the alternative treatments in this study. This effect may be partially due to the observed modulation of inflammatory processes, especially in M2 macrophage polarization. CLINICAL RELEVANCE Fresh autologous BM could be a treatment option for this disorder.
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Affiliation(s)
- Jun Lu
- Department of Orthopaedic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Connie S Chamberlain
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ming-Liang Ji
- Department of Orthopaedic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Erin E Saether
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ellen M Leiferman
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Wan-Ju Li
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ray Vanderby
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Sochacki KR, McCulloch PC, Lintner DM, Harris JD. Hamstring Autograft Versus Hybrid Graft in Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies. Arthroscopy 2019; 35:1905-1913. [PMID: 31053462 DOI: 10.1016/j.arthro.2018.11.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare (1) patient-reported outcomes, (2) objective knee measures of stability, (3) failures, and (4) reoperations after primary anterior cruciate ligament (ACL) reconstruction with semitendinosus-gracilis autograft versus autograft-allograft hybrid grafts. METHODS We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Multiple databases were searched for studies that compared outcomes of ACL reconstruction with semitendinosus-gracilis autograft versus autograft-allograft hybrid grafts in adult human patients with minimum 2-year follow-up. Knee-specific patient-reported outcome scores, objective knee measures of stability, failures, and reoperations were reported for each study and compared between semitendinosus-gracilis autografts and hybrid grafts. Study heterogeneity and levels of evidence precluded meta-analysis. RESULTS We analyzed 6 articles (544 patients; 54.5% male patients; mean age, 30.9 ± 3.9 years; mean follow-up period, 43.6 ± 15.5 months). Of 6 studies, 4 showed no significant differences in International Knee Documentation Committee and Lysholm scores between the semitendinosus-gracilis autograft and hybrid groups. Five of six studies showed no significant differences in KT-1000 measurements between groups. The risk of ACL failure ranged from 3.2% to 8.4% for semitendinosus-gracilis autografts and from 2.4% to 14.3% for hybrid grafts, with no study reporting a significant difference in failure rates between groups. The reoperation rate in the subjects undergoing ACL reconstruction with semitendinosus-gracilis autografts and hybrid grafts ranged from 2.8% to 10.3% and from 2.4% to 48.3%, respectively. In 5 of 6 studies, no significant differences in reoperation rates were found between groups. CONCLUSIONS Most studies reported no significant differences in patient-reported outcome scores, objective knee measures of stability, and reoperation rates between semitendinosus-gracilis autografts and hybrid grafts. No significant difference in ACL failure rates was found between groups in any study. LEVEL OF EVIDENCE Level III, systematic review of Level II and III studies.
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Affiliation(s)
- Kyle R Sochacki
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | | | - David M Lintner
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A..
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Tisherman R, Wilson K, Horvath A, Byrne K, De Groot J, Musahl V. Allograft for knee ligament surgery: an American perspective. Knee Surg Sports Traumatol Arthrosc 2019; 27:1882-1890. [PMID: 30888445 DOI: 10.1007/s00167-019-05425-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Allografts are frequently use for ligamentous reconstruction at the knee. In the United States, tissue donation and distribution are highly regulated processes with thorough oversight from private and government entities. Allograft is widely available in the United States and allograft procurement is a large industry with varying procurement, sterilization, processing, and distribution procedures. It is important to understand allograft regulation and processing which may affect graft mechanical properties and biological graft integration. METHODS English-language literature, United States government and regulatory agency statues pertaining to allograft procurement, distribution, and usage were reviewed and the findings summarized. RESULTS During the processing of allograft, multiple factors including sterilization procedures, irradiation, storage conditions, and graft type all affect the biomechanical properties of the allograft tissue. Biological incorporation and ligamentization of allograft does occur, but at a slower rate compared with autograft. For ligamentous reconstruction around the knee, allograft offers shorter operative time, no donor-site morbidity, but has shown an increased risk for graft failure compared to autograft. CONCLUSION This article reviews the regulations on graft tissue within the United States, factors affecting the biomechanics of allograft tissue, differences in allograft tissue choices, and the use of allograft for anterior cruciate ligament reconstruction and multiligamentous knee injury reconstruction. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Robert Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA.
| | - Kevin Wilson
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA
| | - Alexandra Horvath
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Kevin Byrne
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA
| | - Joseph De Groot
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA
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Hulet C, Sonnery-Cottet B, Stevenson C, Samuelsson K, Laver L, Zdanowicz U, Stufkens S, Curado J, Verdonk P, Spalding T. The use of allograft tendons in primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:1754-1770. [PMID: 30830297 DOI: 10.1007/s00167-019-05440-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. The use of allograft has risen exponentially in recent years with the attraction of absent donor site morbidity, reduced surgical time and reliable graft size. However, the published evidence examining their clinical effectiveness over autograft tendons has been unclear. The aim of this paper is to provide a current review of the clinical evidence available to help guide surgeons through the decision-making process for the use of allografts in primary ACL reconstruction. METHODS The literature in relation to allograft healing, storage, sterilisation, differences in surgical technique and rehabilitation have been reviewed in addition to recent comparative studies and all clinical systematic reviews and meta-analyses. RESULTS Early reviews have indicated a higher risk of failure with allografts due to association with irradiation for sterilisation and where rehabilitation programs and post-operative loading may ignore the slower incorporation of allografts. More recent analysis indicates a similar low failure rate for allograft and autograft methods of reconstruction when using non-irradiated allografts that have not undergone chemically processing and where rehabilitation has been slower. However, inferior outcomes with allografts have been reported in young (< 25 years) highly active patients, and also when irradiated or chemically processed grafts are used. CONCLUSION When considering use of allografts in primary ACL reconstruction, use of irradiation, chemical processing and rehabilitation programs suited to autograft are important negative factors. Allografts, when used for primary ACL reconstruction, should be fresh frozen and non-irradiated. Quantification of the risk of use of allograft in the young requires further evaluation. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Christophe Hulet
- Department of Orthopedics and Traumatology, Caen University Hospital, Avenue Cote de Nacre, 14000, Caen, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Ciara Stevenson
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - Kristian Samuelsson
- Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lior Laver
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - Urszula Zdanowicz
- Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA, 15219-3110, USA
| | - Sjoerd Stufkens
- Academic Medical Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jonathan Curado
- Department of Orthopedics and Traumatology, Caen University Hospital, Avenue Cote de Nacre, 14000, Caen, France
| | - Peter Verdonk
- Antwerp Orthopedic Center, Monica Hospitals, Antwerp, Belgium
| | - Tim Spalding
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK.
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Mistry H, Metcalfe A, Colquitt J, Loveman E, Smith NA, Royle P, Waugh N. Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective. Knee Surg Sports Traumatol Arthrosc 2019; 27:1782-1790. [PMID: 30874836 PMCID: PMC6541574 DOI: 10.1007/s00167-019-05436-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/20/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE To assess the clinical and cost-effectiveness of allografts versus autografts in the reconstruction of anterior cruciate ligaments. METHODS Systematic review of comparative clinical effectiveness and cost-effectiveness analysis. RESULTS Both autograft and allograft reconstruction are highly effective. Recent studies show little difference in failure rates between autografts and allografts (about 6% and 7%, respectively). In cost-effectiveness analysis, the price differential is the main factor, making autografts the first choice. However, there will be situations, particularly in revision ACL reconstruction, where an allograft may be preferred, or may be the only reasonable option available. CONCLUSION In ACL reconstruction, clinical results with autografts are as good as or slightly better than with allografts. Allografts cost more, indicating that autografts are more cost-effective and should usually be first choice. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Hema Mistry
- Division of Health Sciences, Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL, UK.
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, University of Warwick Medical School, Coventry, CV4 7AL, UK
| | - Jill Colquitt
- Effective Evidence, Waterlooville, Hampshire, PO8 9SE, UK
| | - Emma Loveman
- Effective Evidence, Waterlooville, Hampshire, PO8 9SE, UK
| | - Nick A Smith
- Department of Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, CV2 2DX, UK
| | - Pamela Royle
- Division of Health Sciences, Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL, UK
| | - Norman Waugh
- Division of Health Sciences, Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL, UK
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Murray MM, Kalish LA, Fleming BC, Flutie B, Freiberger C, Henderson RN, Perrone GS, Thurber LG, Proffen BL, Ecklund K, Kramer DE, Yen YM, Micheli LJ. Bridge-Enhanced Anterior Cruciate Ligament Repair: Two-Year Results of a First-in-Human Study. Orthop J Sports Med 2019; 7:2325967118824356. [PMID: 30923725 PMCID: PMC6431773 DOI: 10.1177/2325967118824356] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Bridge-enhanced anterior cruciate ligament repair (BEAR) combines suture repair of the anterior cruciate ligament (ACL) with a specific extracellular matrix scaffold (the BEAR scaffold) that is placed in the gap between the torn ends of the ACL to facilitate ligament healing. Purpose/Hypothesis The purpose of this study was to report the 12- and 24-month outcomes of patients who underwent the BEAR procedure compared with a nonrandomized concurrent control group who underwent ACL reconstruction (ACLR) with an autograft. We hypothesized that the BEAR group would have physical examination findings, patient-reported outcomes, and adverse events that were similar to those of the ACLR group. Study Design Cohort study; Level of evidence, 2. Methods Ten patients underwent BEAR, and 10 underwent ACLR with a 4-stranded hamstring autograft. At 24 months, 9 of the 10 BEAR patients and 7 of the 10 ACLR patients completed a study visit. Outcomes reported included International Knee Documentation Committee (IKDC) subjective and objective results, knee anteroposterior (AP) laxity findings via an arthrometer, and functional outcomes. Results There were no graft or repair failures in the first 24 months after surgery. The IKDC subjective scores in both groups improved significantly from baseline (P < .0001) at 12 and 24 months, to 84.6 ± 17.2 in the ACLR group and to 91.7 ± 11.7 in the BEAR group. An IKDC objective grade of A (normal) was found in 44% of patients in the BEAR group and in 29% of patients in the ACLR group at 24 months; no patients in either group had C (abnormal) or D (severely abnormal) grades. Arthrometer testing demonstrated mean side-to-side differences in AP laxity that were similar in the 2 groups at 24 months (BEAR, 1.94 ± 2.08 mm; ACLR, 3.14 ± 2.66 mm). Functional hop testing results were similar in the 2 groups at 12 and 24 months after surgery. Hamstring strength indices were significantly higher in the BEAR group compared with the ACLR group (P = .0001). Conclusion In this small, first-in-human study, BEAR produced similar outcomes to ACLR with a hamstring autograft. BEAR may result in knee stability and patient-reported outcomes at 2 years sufficient to warrant longer term studies of efficacy in larger groups of patients.
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Affiliation(s)
- Martha M Murray
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Leslie A Kalish
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Braden C Fleming
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Brett Flutie
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christina Freiberger
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachael N Henderson
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gabriel S Perrone
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Laura G Thurber
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Benedikt L Proffen
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kirsten Ecklund
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dennis E Kramer
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
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Sell TC, Hufnagel M, Heebner N, Lephart SM. Reliability, discriminant validity and sex comparisons of dynamic postural stability during a landing task designed to challenge transverse plane knee stability. Sports Biomech 2019; 20:507-519. [PMID: 30882279 DOI: 10.1080/14763141.2019.1569119] [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] [Indexed: 10/27/2022]
Abstract
Internal and external rotational knee stability is essential for sports performance and excessive rotation can lead to injury but is rarely assessed in injury risk analysis. The objectives of this study were to determine the between-session reliability, discriminant validity and potential sex differences of a dynamic postural stability (DPS) assessment that challenges transverse plane knee stability. Thirty-six individuals (21.7 ± 2.6 years) including 19 females (20.8 ± 1.3 years) and 17 males (22.6 ± 3.4 years) participated. We measured DPS during rotational jump tasks (RJT) over 2 test sessions utilising a force plate. Kinematic (motion analysis) and electromyographic measures were compared to a traditional anterior-posterior jump task (APJT) to assess the discriminant validity and comparisons were performed between sexes. The intraclass correlation coefficients were between 0.67 and 0.86. Significant differences in transverse rotation angle at initial contact transverse rotational velocity of the knee were observed between the 2 different RJT and between the RJT and the traditional APJT. No sex differences were observed. The new assessment had good between-session reliability and offers a different challenge than a traditional jump task. This RJT may offer a novel assessment of knee joint rotational stability in conjunction with traditional measures.
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Affiliation(s)
- Timothy C Sell
- Michael W. Kryzewski Human Performance Laboratory, Dukte Sports Sciences Institute, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC, USA
| | | | - Nick Heebner
- Sports Medicine Research Institute, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Scott M Lephart
- Sports Medicine Research Institute, College of Health Sciences, University of Kentucky, Lexington, KY, USA
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Başdelioğlu K, Meriç G, Pündük Z, Akseki D, Atik A, Sargın S. Outcomes of isokinetic tests and functional assessment of anterior cruciate ligament reconstruction: Transtibial versus single anatomic femoral tunnel technique. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:86-91. [PMID: 30745028 PMCID: PMC6510667 DOI: 10.1016/j.aott.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 01/15/2023]
Abstract
Objective The aim of the study was to compare the outcomes of the transtibial and anatomical femoral single tunnel surgical techniques in ACL reconstruction. Methods A total of 30 patients, with 16 patients (15 males and 1 female; mean age: 27.2 ± 7.04) with anatomical femoral single-tunnel technique (AFT) and 14 (12 males and 2 females; mean age: 29.4 ± 8.82) with transtibial technique (TT) were included into the study. All patients were evaluated with isokinetic tests at an angular velocity of 60°/s and 180°/s and the IKDC and Lysholm tests were performed preoperatively and in third, sixth, and 12th months postoperatively. The results were compared between the groups. The mean follow-up time was 17.1 ± 6.48 months. Results Postoperative third month changes in extension parameters of peak torque (AFT: −93.286, TT: −61.500), peak work (AFT: −77.071, TT: −47.500), peak torque ext/kg (AFT: −1.182, TT: −0.773), peak work ext/kg (AFT: −0.982, TT: −0.604), peak work (AFT: −55.143 TT: −33.063) at an angular velocity of 60°/s and postoperative third month change in extension parameter of peak power (AFT: −86.786 TT: −54.875) at an angular velocity of 180°/s were found to be better in the transtibial group (p < 0.05) and postoperative sixth month peak torque (AFT: 1.429, TT: −5.688) value at an angular velocity of 60°/s was found to be less in the anatomical femoral single-tunnel group (p < 0.05). The IKDC (AFT: 94.671, TT: 90.025) (p < 0.05) and Lysholm (AFT: 96.714, TT: 92.375) (p < 0.05) scores of the anatomical femoral single-tunnel group were better than the transtibial group regarding to the postoperative final follow-up. There are positive intermediate correlations between preoperative IKDC and Lysholm scores with preoperative and postoperative some isokinetic test ratio (r = 0.539; p = 0.031), and preoperative peak power extension (r = 0.541; p = 0.030) at the both angular velocity of 60°/s and 180°/s in the transtibial group. There was no significant difference between the two groups with regards to the Lachman, anterior drawer and pivot shift tests (p < 0.05). Conclusion There were differences in terms of isokinetic parameters in early outcomes but there was no statistical difference between isokinetic parameters at the end of 1st year between two groups. There were some correlations between IKDC and Lysholm scores with some isokinetic parameters. Level of Evidence Level III, Therapeutic Study.
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Houck DA, Kraeutler MJ, McCarty EC, Frank RM, Bravman JT. "Doctor, What Happens After My Anterior Cruciate Ligament Reconstruction?". J Bone Joint Surg Am 2019; 101:372-379. [PMID: 30801380 DOI: 10.2106/jbjs.18.00426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Darby A Houck
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
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