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Sritharan P, Milantoni V, Abdel Khalik H, Kay J, Slawaska-Eng D, Johnson J, de Sa D. Evaluating the quality of systematic reviews of comparative studies in autograft-based anterior cruciate ligament reconstruction using the AMSTAR-2 tool: A systematic umbrella review. Knee Surg Sports Traumatol Arthrosc 2024; 32:583-598. [PMID: 38372015 DOI: 10.1002/ksa.12062] [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: 10/09/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE There remains a lack of consensus around autograft selection in anterior cruciate ligament reconstruction (ACLR), though there is a large body of overlapping systematic reviews and meta-analyses. Systematic reviews and their methodological quality were aimed to be further assessed, using a validated tool known as assessing the methodological quality of systematic reviews (AMSTAR-2). METHODS MEDLINE, Embase and CENTRAL were searched from inception to 23 April 2023 for systematic reviews (with/without meta-analysis) comparing primary ACLR autografts. A final quality rating from AMSTAR-2 was provided for each study ('critically low', 'low', 'moderate' or 'high' quality). Correlational analyses were conducted for ratings in relation to study characteristics. RESULTS Two thousand five hundred and ninety-eight studies were screened, and 50 studies were ultimately included. Twenty-four studies (48%) were rated as 'critically low', 17 (34%) as 'low', seven (14%) as 'moderate' and two (4%) as 'high' quality. The least followed domains were reporting on sources of funding (1/50 studies), the impact of risk of bias on results of meta-analyses (11/36 studies) and publication bias (17/36 studies). There was a significant increase in the frequency of studies graded as 'moderate' compared to 'low' or 'critically low' quality over time (p = 0.020). CONCLUSION The methodological quality of systematic reviews comparing autografts in ACLR is low, with many studies being rated lower due to commonly absent aspects of systematic review methodology such as investigating sources of funding and publication bias. More recent studies were generally more likely to be of higher quality. Authors are advised to consult AMSTAR-2 prior to conducting systematic reviews in ACLR. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Praveen Sritharan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Vincent Milantoni
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hassaan Abdel Khalik
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jansen Johnson
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
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Vermeijden HD, Holuba K, Yang XA, O’Brien R, van der List JP, DiFelice GS. Prospective Comparison of Postoperative Pain and Opioid Consumption Between Primary Repair and Reconstruction of the Anterior Cruciate Ligament. Orthop J Sports Med 2023; 11:23259671231187442. [PMID: 37786478 PMCID: PMC10541769 DOI: 10.1177/23259671231187442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 10/04/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction (ACLR) is associated with postoperative pain and necessitates using perioperative nerve blocks and multimodal analgesic plans. Purpose To assess postoperative pain and daily opioid use after ACL repair versus ACLR and to assess whether ACL repair could be performed successfully without using long-acting nerve blocks. Study Design Cohort study; Level of evidence, 2. Methods All eligible patients who underwent ACL surgery between 2019 and 2022 were prospectively enrolled. Patients were treated with primary repair if proximal tears with sufficient tissue quality were present; otherwise, they underwent single-bundle ACLR with either hamstring tendon or quadriceps tendon autograft. The patients were divided into 3 groups: ACLR with adductor canal nerve block (up to 20 mL of 0.25% bupivacaine with 2 mg dexamethasone), primary repair with nerve block, and primary repair without nerve block. Pain visual analog scale and number of opioids used were recorded during the first 14 postoperative days (PODs). Furthermore, patients completed the Quality of Recovery-15 (QoR-15) survey, and range of motion was assessed. Group differences were compared using Mann-Whitney U test and chi-square test. Results Seventy-eight patients were included: 30 (39%) underwent ACLR, 19 (24%) ACL repair with nerve block, and 29 (37%) ACL repair without nerve block. Overall, the ACL repair group used significantly fewer opioids than the ACLR group on POD 1 (1 vs 3, P = .027) and POD 2 (1 vs 3, P = .014) while also using fewer opioids in total (3 vs 8, P = .038). This difference was even more marked when only analyzing those patients who received postoperative nerve blocks (1 vs 8, P = .029). Repair patients had significantly higher QoR-15 scores throughout the first postoperative week, and they had greater range of motion (all P < .05). There were no significant differences in pain scores, opioid usage, or QoR-15 scores between patients who underwent repair with versus without nerve block. Conclusion The ACL repair group experienced less postoperative pain during the first 2 weeks after surgery and used significantly fewer opioids than the ACLR group. Furthermore, they had improved knee function and higher recovery quality than patients who underwent ACLR during the initial postoperative period. Postoperative nerve blocks may not be necessary after ACL repair.
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Affiliation(s)
- Harmen D. Vermeijden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, the Netherlands
| | - Kurt Holuba
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, the Netherlands
| | - Xiuyi A. Yang
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, the Netherlands
| | - Robert O’Brien
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, the Netherlands
| | - Jelle P. van der List
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, the Netherlands
| | - Gregory S. DiFelice
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Fayard JM, Foissey C, Pacoret V, Abid H, Vieira TD, Gabr A, Thaunat M. Return to Sports After ACL Augmentation With Anterolateral Reconstruction (ALR) Harvesting Gracilis Only Compared With ACL Reconstruction With ALR Harvesting Both Hamstring Tendons. Am J Sports Med 2023; 51:2918-2927. [PMID: 37548031 DOI: 10.1177/03635465231187038] [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] [Indexed: 08/08/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) repair (ACL-Rp) is known to be a valuable alternative to ACL reconstruction (ACL-Rc) in selected indications. The majority of the ACL-Rp techniques recommend the use of a synthetic brace. The use of the gracilis allows both a biological internal brace and anterolateral ligament reconstruction (ALR). PURPOSE The primary objective was to compare the early ability to return to sports between patients who underwent ACL-Rp using a gracilis autograft as an internal brace augmentation with ALR and patients who underwent the conventional ACL-Rc with ALR technique sacrificing both the gracilis and the semitendinosus. The secondary objective was to compare the failure rate, clinical scores, and return to sports at a minimum follow-up of 2 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was undertaken. A total of 49 patients who underwent ACL-Rp with ALR between December 2018 and May 2019 were propensity matched at a 1:1 ratio to those who underwent ACL-Rc with ALR during the same period. The decision to perform ACL-Rp with ALR was based on preoperative selection and intraoperative arthroscopic findings: proximal avulsion tear, partial ACL tear, low- to midlevel sports participation, and good tissue quality. The ability to return to sports was assessed using isokinetic tests and the Knee Santy Athletic Return to Sport test functional test at 6 months postoperatively. At the final follow-up, knee laxity parameters, return to sports, and clinical outcome (Lysholm score, Tegner Activity Scale score, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Anterior Cruciate Ligament-Return to Sport after Injury score) were recorded. RESULTS The ACL-Rp group had significantly less hamstring strength deficit when compared with their counterparts who underwent ACL-Rc (0.2% vs 10.2% in concentric, P < .001; 2.5% vs 14% in eccentric, P < .001). The mean Knee Santy Athletic Return to Sport test score was significantly higher in the ACL-Rc group (69.7% ± 16.6% [range, 19%-100%] vs 61% ± 16.8% [range, 19%-100%]; P = .001). In the ACL-Rp group, 61% (30/49) of the patients were authorized to return to pivot sports versus 41% (20/49) in the ACL-Rc group (P = .04). At a mean final follow-up of 31.4 ± 3.5 months, no significant differences were demonstrated between groups with respect to clinical scores and knee laxity parameters. There was a trend for a higher failure rate in the ACL-Rp group without any significance (ACL-Rp: 6.1% [3/49] vs ACL-Rc: 0%; P = .08). CONCLUSION At 6 months after operation, harvesting only the gracilis with this ACL-Rp and augmentation with ALR technique was linked to a better early ability to return to sports compared with the ACL-Rc with ALR technique harvesting both the gracilis and semitendinosus. This technique had a limited effect on early flexion strength and provided a satisfactory rerupture rate.
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Affiliation(s)
- Jean-Marie Fayard
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Constant Foissey
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Victor Pacoret
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Hichem Abid
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Ayman Gabr
- University College London Hospital, London, United Kingdom
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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Takahashi T, Watanabe S, Hino M, Takeda H, Ito T. Excellent short-term results of dome-shaped high tibial osteotomy combined with all-inside anterior cruciate ligament reconstruction. J Exp Orthop 2023; 10:69. [PMID: 37428298 DOI: 10.1186/s40634-023-00632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023] Open
Abstract
PURPOSE This study aimed to evaluate short-term outcomes at least 2 years after dome-shaped high tibial osteotomy (HTO) combined with all-inside anterior cruciate ligament reconstruction (ACL) in patients with persistent ACL insufficiency accompanied by pain due to varus deformity. METHODS The study enrolled 19 knees of 18 patients. The mean age was 58.4 ± 13.4 years and the mean postoperative follow-up period was 31.4 ± 6.6 months (24-49 months). JOA(Japanese Orthopaedic Association)-OA(osteoarthritis) score, Lysholm score, radiographic outcomes such as femoro-tibia angle (FTA) in a standing position, side-to-side difference in KT-1000 measurements were evaluated at pre op. and post operative final follow up. And arthroscopic evaluation was evaluated at the time of the HTO plate-removal procedure. RESULTS Before surgery, the mean JOA-OA score was 65.0 ± 13.5, the mean Lysholm score was 47.2 ± 16.2, the mean femoro-tibia angle (FTA) in a standing position was 183.8 ± 3.4° (range;180-190°), and the mean side-to-side difference in KT-1000 measurements was 4.1 ± 1.3 mm. After surgery, the mean JOA-OA score, Lysholm score, and side-to-side difference in KT-1000 measurements improved to 93.1 ± 6.0 (P < 0.00001), 94.2 ± 5.9 (P < 0.00001), and -0.2 ± 0.8 mm (P < 0.00001), respectively. The mean FTA decreased to 168.0 ± 3.3 (P < 0.00001), and the mean posterior tibial slope angle decreased to 5.0 ± 3.6° from 6.9 ± 2.6° preoperatively (P = 0.024). Arthroscopic evaluation during the HTO plate-removal procedure of 17 knees were performed at a mean of 16 months after the surgery. The reconstructed ACL graft in 13 knees were successful, a cyclops lesion in one knee, and looseness of the graft in three knees. CONCLUSIONS Dome-shaped HTO allows for a relatively high degree of varus correction and decreases the steep posterior tibial slope that causes excessive load on the ACL. Therefore, its use in combination with ACL reconstruction seems to be effective.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Sports and Health Science, Faculty of Collaborating Regional Innovation, Ehime University, 3 Bunkyo-Cho, Matsuyama, Ehime, 790-8577, Japan.
| | - Seiji Watanabe
- Department of Orthopaedic Surgery, Watanabe Hospital, Matsuyama, Ehime, 791-0054, Japan
| | - Masanori Hino
- Department of Orthopaedic Surgery, Saijo Central Hospital, Saijo, Ehime, 793-0027, Japan
| | - Haruhiko Takeda
- Department of Orthopaedic Surgery, Saijo Central Hospital, Saijo, Ehime, 793-0027, Japan
| | - Toshio Ito
- Department of Orthopaedic Surgery, Murakami Memorial Hospital, Saijo, Ehime, 793-0030, Japan
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Ruelos VCB, Masood R, Puzzitiello RN, Moverman MA, Pagani NR, Menendez ME, Salzler MJ. The reverse fragility index: RCTs reporting non-significant differences in failure rates between hamstring and bone-patellar tendon-bone autografts have fragile results. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07420-0. [PMID: 37093236 DOI: 10.1007/s00167-023-07420-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The reverse fragility index (RFI) is a novel metric to appraise the results of studies reporting statistically non-significant results. The purpose of this study was to determine the statistical robustness of randomized controlled trials (RCTs) reporting non-significant differences in anterior cruciate ligament reconstruction (ACLR) graft failure rates, defined as re-rupture/revision ACLR rate, between hamstring tendon (HT) and bone-patellar tendon-bone (BTB) autografts by calculating RFIs. METHODS A systematic review was performed to identify RCTs that compared HT to BTB grafts for ACLR through January 2022. Studies reporting non-significant differences in graft re-rupture and revision ACLR rate (n.s.) were included. The RFI, defined as the fewest number of event reversals needed to change the non-significant graft re-rupture/revision outcome to statistically significant (P < 0.05), was recorded for each study. In addition, the number of studies in which the loss to follow-up exceeded the RFI was recorded. RESULTS Among the 16 included RCTs, the median (interquartile range [IQR]) sample size was 71 (64-114), and the median (IQR) total number of graft re-rupture/revision ACLR events was 4 (4-6). The median (IQR) graft re-rupture/revision ACLR rate was 4.3% (3.0-6.4) overall, 4.1% (2.6-6.7) in the BTB group, and 5.4% (3.0-6.3) in the HT group. The median (IQR) RFI was 3 (3-4), signifying that a reversal of the outcome in 3 patients in one arm was needed to flip the studies' result from non-significant to statistically significant (P < 0.05). The median (IQR) number of participants lost to follow-up was 11 (3-13), and 13 (81.3%) of the included studies had a loss to follow-up greater than the studies' RFI. CONCLUSION The results of RCTs reporting statistically non-significant re-rupture/revision ACLR rates between HT and BTB autografts would become significant if the outcome were reversed in a small number of patients-a number that was less than the loss to follow-up in the majority of studies. Thus, the neutrality of these studies is fragile, and a true statistically significant difference in re-rupture/revision rates may have been undetected. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | - Raisa Masood
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Mariano E Menendez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA.
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Vermeijden HD, Yang XA, Rademakers MV, Kerkhoffs GMMJ, van der List JP, DiFelice GS. Early and Delayed Surgery for Isolated ACL and Multiligamentous Knee Injuries Have Equivalent Results: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:1106-1116. [PMID: 35099334 DOI: 10.1177/03635465211069356] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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 Early surgery for acute ligamentous injuries has recently shown good clinical and functional outcomes. PURPOSE To assess the advantages of early vs delayed surgery in patients undergoing isolated anterior cruciate ligament (ACL) or multiligament-injured knee (MLIK) surgery. STUDY DESIGN Meta-analyses of Level 1, 2, and 3 studies; Level of evidence, 4. METHODS A systematic search was performed via PubMed, EMBASE, and Cochrane for studies reporting outcomes of timing of surgery after isolated ACL injury or in the MLIK setting using accelerated rehabilitation protocols. Two analyses were conducted to differentiate early and delayed treatment (3- and 6-week cutoffs). Collected outcomes included meniscal or chondral lesions, failure and reoperation rates, range of motion (ROM) deficits, other complications, muscle strength, instrumented laxity, and functional outcomes. Outcomes were reported in risk ratios (RR) or mean differences with 95% CIs. RESULTS For timing of isolated ACL surgery, 16 studies were included with 2093 patients. High-grade evidence indicated that there were no differences in meniscal or chondral lesions, failure and reoperation rates, stiffness, ROM deficits, complications, muscle strength, instrumented laxity, and functional outcomes between patients treated early and late (all P > .05). When including only studies that set no preoperative criteria for early surgery, the findings were similar. Regarding MLIK surgery, 14 studies were included with 1172 patients. Low evidence was noted for the following: patients treated early had significantly fewer meniscal injuries (RR, 0.7; P = .04) and chondral injuries (RR, 0.5; P < .001), while no differences were found in reoperation rates, complications, stiffness, ROM deficits, muscle strength, instrumented laxity, and functional outcomes between the groups. Other than higher Lysholm scores in the early group for the 3-week analysis (mean difference, 6.8; P = .01), there were no differences between cutoff analyses. CONCLUSION This systematic review with meta-analysis found no differences in clinical and functional outcomes between early and delayed surgery for isolated ACL injuries. For MLIK injuries, there were also no differences in surgical outcomes between early and delayed surgery.
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Affiliation(s)
- Harmen D Vermeijden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands
- Amsterdam Movement Science, Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Xiuyi A Yang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Maarten V Rademakers
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam Movement Science, Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam IOC Research Center, Amsterdam, the Netherlands
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands
- Amsterdam Movement Science, Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gregory S DiFelice
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Brand JC, Rossi MJ, Lubowitz JH. Arthroscopy Honors Award-Winning Articles and Authors: Our Annual Research Awards. Arthroscopy 2023; 39:1-6. [PMID: 36543414 DOI: 10.1016/j.arthro.2022.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
With genuine gratitude to the AANA Education Foundation for their unstinting support, it is our honor to announce Arthroscopy's Annual Awards for the best Clinical Research, Basic Science Research, Resident/Fellow Research, and Systematic Reviews published in 2022, as well as the Most Downloaded and Most Cited papers published 5 years ago. And as is customary in January, our editors update their disclosures of potential conflicts of interest, as we require of authors, and we update our masthead to introduce new members of our Editorial Board and Social Media Board.
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Age and Bone Bruise Patterns Predict Tear Location in the Anterior Cruciate Ligament. Arthrosc Sports Med Rehabil 2022; 5:e41-e50. [PMID: 36866318 PMCID: PMC9971897 DOI: 10.1016/j.asmr.2022.10.006] [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: 05/02/2022] [Accepted: 10/03/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose To assess the influence of demographic risk factors, anatomic risk factors, and injury mechanisms on anterior cruciate ligament (ACL) tear patterns. Methods All patients undergoing knee magnetic resonance imaging at our institution for acute ACL tears (within 1 month of injury) in 2019 were retrospectively analyzed. Patients with partial ACL tears and full-thickness posterior cruciate ligament injuries were excluded. On sagittal magnetic resonance images, the proximal and distal remnant lengths were measured, and the tear location was calculated as the distal remnant length divided by the total remnant length. Previously reported demographic and anatomic risk factors associated with ACL injury were then reviewed, including the notch width index, notch angle, intercondylar notch stenosis, alpha angle, posterior tibial slope, meniscal slope, and lateral femoral condyle index. In addition, the presence and severity of bone bruises were recorded. Finally, risk factors associated with ACL tear location were further analyzed using multivariate logistic regression. Results A total of 254 patients (44% male patients; mean age, 34 years; age range, 9-74 years) were included, of whom 60 (24%) had a proximal ACL tear (tear at the proximal quarter). Multivariate enter logistic regression analysis showed that older age (P = .008) was predictive of a more proximal tear location whereas open physes (P = .025), bone bruises in both compartments (P = .005), and posterolateral corner injury (P = .017) decreased the likelihood of a proximal tear (R 2 = 0.121, P < .001). Conclusions No anatomic risk factors were identified to play a role in tear location. Although most patients have midsubstance tears, proximal ACL tears were more commonly found in older patients. Bone contusions involving the medial compartment are associated with midsubstance tears; these findings may indicate that different injury mechanisms play a role in the location at which the ACL tears. Level of Evidence Level III, prognostic, retrospective cohort study.
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9
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Lodhia P, Nazari G, Bryant D, Getgood A, McCormack R, Getgood AM, Bryant DM, Litchfield R, Willits K, Birmingham T, Hewison C, Firth AD, Wanlin S, Pinto R, Martindale A, O’Neill L, Jennings M, Daniluk M, McCormack RG, Boyer D, Zomar M, Moon K, Moon R, Fan B, Mohan B, Payne K, Heard M, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, MacDonald PB, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Rezansoff A, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Peterson D, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Bardana D, Howells F, Tough M, Spalding T, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Milan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Verdonk PC, Declerq G, Vuylsteke K, Van Haver M. Performance of 5-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction in the STABILITY Study: A Subgroup Analysis. Am J Sports Med 2022; 50:3502-3509. [PMID: 36260487 PMCID: PMC9630854 DOI: 10.1177/03635465221128581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstructions (ACLRs) with graft diameters <8mm have been shown to have higher revision rates. The 5-strand (5S) hamstring autograft configuration is a proposed option to increase graft diameter. PURPOSE To investigate the differences in clinical outcomes between 4-strand (4S) and 5S hamstring autografts for ACLR in patients who underwent ACLR alone or concomitantly with a lateral extra-articular tenodesis (LET) procedure. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Data from the STABILITY study were analyzed to compare a subgroup of patients undergoing ACLR alone or with a concomitant LET procedure (ACLR + LET) with a minimum graft diameter of 8mm that had either a 4S or 5S hamstring autograft configuration. The primary outcome was clinical failure, a composite of rotatory laxity and/or graft failure. The secondary outcome measures consisted of 2 patient-reported outcome scores (PROs)-namely, the ACL Quality of Life Questionnaire (ACL-QoL) and the International Knee Documentation Committee (IKDC) score at 24 months postoperatively. RESULTS Of the 618 patients randomized in the STABILITY study, 399 (228 male; 57%) fit the inclusion criteria for this study. Of these, 191 and 208 patients underwent 4S and 5S configurations of hamstring ACLR, respectively, with a minimum graft diameter of 8mm. Both groups had similar characteristics other than differences in anthropometric factors-namely, sex, height, and weight, and Beighton scores. The primary outcomes revealed no difference between the 2 groups in rotatory stability (odds ratio [OR], 1.19; 95% CI, 0.77-1.84; P = .42) or graft failure (OR, 1.13; 95% CI, 0.51-2.50; P = .76). There was no significant difference between the groups in Lachman (P = .46) and pivot-shift (P = .53) test results at 24 months postoperatively. The secondary outcomes revealed no differences in the ACL-QoL (P = .67) and IKDC (P = .83) scores between the 2 subgroups. CONCLUSION At the 24-month follow-up, there were no significant differences in clinical failure rates and PROs in an analysis of patients with 4S and 5S hamstring autografts of ≥8mm diameter for ACLR or ACLR + LET. The 5S hamstring graft configuration is a viable option to produce larger-diameter ACL grafts.
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Affiliation(s)
- Parth Lodhia
- Parth Lodhia, MD, University of British Columbia, 403-233
Nelson’s Crescent, New Westminster, V3L 0E4, Canada (
)
| | - Goris Nazari
- Canadian Institutes of Health Research, Ottawa,
Ontario, Canada
| | - Dianne Bryant
- The University of Western Ontario, London,
Ontario, Canada
| | - Alan Getgood
- Western Ontario University, London, Ontario,
Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michal Daniluk
- London Health Sciences Centre, Western
University, Fowler Kennedy Sport Medicine Clinic, London, Canada
| | | | | | | | | | | | | | | | - Kyrsten Payne
- Fraser Orthopaedic Institute, New Westminster,
Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle Mayer
- Sport Medicine Centre, University of Calgary,
Calgary, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mieke Van Haver
- Antwerp Orthopaedic Center, Ghent,
Belgium,Investigation performed at University of
British Columbia, Vancouver, BC, Canada
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10
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Primary Repair versus Reconstruction in Patients with Bilateral Anterior Cruciate Ligament Injuries: What Do Patients Prefer? Adv Orthop 2022; 2022:3558311. [PMID: 36147211 PMCID: PMC9489369 DOI: 10.1155/2022/3558311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose. The purpose is to evaluate knee preference and functional outcomes of patients with primary anterior cruciate ligament (ACL) repair in one knee and ACL reconstruction in the contralateral side. Methods. All patients who underwent both procedures were retrospectively reviewed at minimum two-year follow-up. Patients were asked to complete questionnaires regarding their operated knees’ preferences during rehabilitation, daily activities, sports activities, and overall function. Furthermore, the Subjective International Knee Documentation Committee, Forgotten Joint Score-12, and Anterior Cruciate Ligament-Return to Sport after Injury were completed. Results. Twenty-one patients were included. All patients underwent ACL reconstruction first, which was displayed at younger age at surgery (24 vs. 33 years,
) and longer follow-up (10.2 vs. 2.3 years,
), respectively. Thirty-three percent preferred the repaired knee, 11% the reconstructed knee, and 56% had no preference; however, 78% indicated that their repaired knee was less painful during rehabilitation and 83% reported earlier range of motion (ROM) return following repair, which was similar for both knees in 17%. Eighty-three percent of patients indicated better function and progression during rehabilitation with their repaired knee and 11% with their reconstructed knees. No statistical differences were found in patient-reported outcomes between both procedures (all
). Objective laxity assessment showed mean side-to-side difference of 0.6 mm between both sides in favor of the reconstructed knee. Conclusion. This study showed that ACL repair and ACL reconstruction lead to similar functional outcomes. However, patients undergoing both procedures may have less pain, earlier ROM return, and faster rehabilitation progression following primary repair.
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11
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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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12
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Haybäck G, Raas C, Rosenberger R. Failure rates of common grafts used in ACL reconstructions: a systematic review of studies published in the last decade. Arch Orthop Trauma Surg 2022; 142:3293-3299. [PMID: 34536121 PMCID: PMC9522752 DOI: 10.1007/s00402-021-04147-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/23/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION In this review paper, graft failure rates of different graft types (hamstring tendon autografts, bone-patellar tendon-bone autografts, quadriceps tendon autografts and diverse allografts) that are used for surgical reconstruction of the anterior cruciate ligament are compared and statistically analysed. METHODS Literature search was conducted in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria. A total of 194 studies, which reported graft failure rates of at least one of the anterior cruciate ligament reconstruction methods mentioned above, were included in this systematic review. To be able to compare studies with different follow-up periods, a yearly graft failure rate for each reconstruction group was calculated and then investigated for significant differences by using the Kruskal-Wallis test. RESULTS Overall, a total of 152,548 patients treated with an anterior cruciate ligament reconstruction were included in the calculations. Comparison of graft types showed that hamstring tendon autografts had a yearly graft failure rate of 1.70%, whereas the bone-patellar tendon-bone autograft group had 1.16%, the quadriceps tendon autograft group 0.72%, and the allografts 1.76%. CONCLUSION The findings of this meta-data study indicate that reconstructing the anterior cruciate ligament using quadriceps tendon autografts, hamstring tendon autografts, patellar tendon autografts or allografts does not show significant differences in terms of graft failure rates.
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Affiliation(s)
- Gerwin Haybäck
- grid.21604.310000 0004 0523 5263Universitätsklinik für Orthopädie und Traumatologie, Landeskrankenhaus Salzburg, Paracelsus Medizinische Privatuniversität, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Christoph Raas
- PRIVATKLINIK HOCHRUM, Sanatorium der Kreuzschwestern, Lärchenstraße 41, 6063 Rum, Austria
| | - Ralf Rosenberger
- PRIVATKLINIK HOCHRUM, Sanatorium der Kreuzschwestern, Lärchenstraße 41, 6063 Rum, Austria
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13
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Arnold MP, Calcei JG, Vogel N, Magnussen RA, Clatworthy M, Spalding T, Campbell JD, Bergfeld JA, Sherman SL. ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades. Knee Surg Sports Traumatol Arthrosc 2021; 29:3871-3876. [PMID: 33486558 DOI: 10.1007/s00167-021-06443-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/11/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Anterior cruciate ligament reconstruction (ACLR) aims to restore knee function and stability, allowing patients to return to the activities they enjoy and minimize further injury to the meniscus and cartilage and their ultimate progression to osteoarthritis. This study aims to present the evolution of graft choice over the last three decades according to members of the ACL Study Group (SG). METHODS Prior to the January 2020 ACL SG biannual meeting, a survey was administered consisting of 87 questions and 16 categories, including ACLR graft choice. A similar questionnaire has been administered prior to each meeting and survey results from the past 14 meetings (1992 through 2020, excluding 1994) are included in this work. Survey responses are reported as frequencies in percentages to quantify changes in practice over the surgery period. RESULTS In 1992, the most frequent graft choice for primary ACLR was bone-patellar tendon-bone (BTB) autograft, at nearly 90%. Hamstring tendon (HT) autografts have increased in popularity, currently over 50%, followed by just under 40% BTB autograft. Recently, quadriceps tendon (QT) autograft has increased in popularity since 2014. CONCLUSION Autograft (HT, BTB, QT) is an overwhelming favorite for primary ACLR over allograft. The preference for HT autograft increased over the study period relative to BTB autograft, with QT autograft gaining in popularity in recent years. Graft selection should be individualized for each patient and understanding the global trends in graft choice can help orthopaedic surgeons discuss graft options with their patients and determine the appropriate graft for each case. LEVEL OF EVIDENCE Level V, Expert Opinion.
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Affiliation(s)
- Markus P Arnold
- Practice LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Switzerland
| | - Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Nicole Vogel
- Practice LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Switzerland
| | - Robert A Magnussen
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| | - Mark Clatworthy
- Department of Orthopaedics, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Tim Spalding
- Department of Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - John D Campbell
- Bridger Orthopedics and Sports Medicine, PC, Montana State University, Bozeman, MT, USA
| | - John A Bergfeld
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
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14
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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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15
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Anterior Cruciate Ligament Reconstruction Graft Preference Most Dependent on Patient Age: A Survey of United States Surgeons. Arthroscopy 2021; 37:1559-1566. [PMID: 33539983 DOI: 10.1016/j.arthro.2021.01.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to define the anterior cruciate ligament (ACL) reconstruction (ACLR) graft preference of surgeons and to explore factors associated with their predilection. METHODS A 15-question survey regarding ACLR graft preference in various situations was completed by 514 American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America surgeons. Surgeon and practice demographics, along with various patient factors, were evaluated with bivariate and multivariable models for association with surgeon preference. Surgeons were also queried about their preference for their own ACLR. For surgeons who personally sustained an ACL, an additional 6 questions inquired about their experience. RESULTS Surgeons reported the 5 most important factors in patient graft choice, in order: patient age, graft failure in literature and practice, pivot sport, and patient preference. Autograft patellar and quadriceps tendon were strongly preferred for younger, pivoting athletes (P < .001), among those with fellowship training (47% vs 33%, P = .006), in academic practices (52% vs 44%, P = .003), and in more sports medicine-specific practices, with a higher number of ACLRs performed per year (P < .001). Northeast, Southeast, Midwest, and Southwest surgeons had lower hamstring autograft preference (P < .001). Non-fellowship-trained surgeons preferred hamstring autograft (P = .010). Allograft was preferred for older patients (P < .001). Nonsignificant predictors included highest level of athlete for whom an ACLR had been performed, level of athlete serving as team physician, and years in practice. No factors were associated with surgeon preference for their own ACLR despite deeming these factors important for patients. ACL tears were reported by 13% of respondents, with 86% stating it influenced their decision to enter orthopaedics. CONCLUSIONS Patient age was the most important factor in graft choice, with patellar and quadriceps tendon autograft the preferred graft for ACLR for younger, pivoting athletes. Fellowship training and practice demographics were also correlated with graft choice for patients. CLINICAL RELEVANCE Graft preference for ACLR varies among surgeons and is associated with surgeon experience and patient characteristics, including patient age, type of sport, and patient preference.
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16
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Vermeijden HD, Yang XA, van der List JP, DiFelice GS. Role of Age on Success of Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears. Arthroscopy 2021; 37:1194-1201. [PMID: 33220465 DOI: 10.1016/j.arthro.2020.11.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/11/2020] [Accepted: 11/11/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess failure rates and patient-reported outcomes measures following arthroscopic primary anterior cruciate ligament (ACL) repair of proximal tears in different age groups. METHODS Between 2008 and 2017, the first 113 consecutive patients treated with repair were retrospectively reviewed at minimum of 2 years. Patients were stratified into 3 age groups: ≤21, 22-35, and >35 years. Primary outcomes were ipsilateral reinjury or reoperation, and contralateral injury rates, and secondary outcomes consisted of Lysholm, modified Cincinnati, Single Assessment Numeric Evaluation, International Knee Documentation Committee subjective, pain, and satisfaction scores. Group differences were compared using χ2 tests and Mann-Whitney U tests. RESULTS Follow-up was obtained in 113 patients (100%). Median age was 35 years (interquartile range [IQR] 23-43) and median follow-up was 2.2 years (IQR 2.0-2.8). Overall, ACL reinjury occurred in 13 patients (11.5%), reoperation in 7 patients (6.2%), complications in 2 patients (1.8%) and contralateral ACL injury in 4 patients (3.5%). Overall, median Lysholm was 95 (IQR 89-100) and International Knee Documentation Committee subjective 92 (IQR 84-99). Treatment failure was significantly greater in the youngest age group (37.0%) as compared with the middle and older groups (4.2% and 3.2%, both P < .005). No significant differences were seen in reoperation, complication, or contralateral injury rates between groups (all P > .2), nor in patient-reported outcomes measures between the groups (all P > .1). CONCLUSIONS The failure rate of primary repair of proximal ACL tears is high in patients aged 21 or younger (37.0%), and this should be taken into account when discussing repair in this patient group. In patients older than 21, repair may be an excellent treatment with low failure (3.5%) and complication rates (1.2%) and good subjective scores. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Harmen D Vermeijden
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A
| | - Xiuyi A Yang
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A
| | - Jelle P van der List
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A.; Amsterdam UMC, University of Amsterdam Department of Orthopaedic Surgery, Amsterdam, The Netherlands
| | - Gregory S DiFelice
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A..
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17
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Vermeijden HD, van der List JP, DiFelice GS. Acute and delayed anterior cruciate ligament repair results in similar short to mid-term outcomes. Knee 2021; 29:142-149. [PMID: 33626438 DOI: 10.1016/j.knee.2021.01.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND To assess whether primary repair of proximal ACL tears in the delayed setting leads to similar clinical and functional outcomes as compared to ACL repair in the acute setting. METHODS All patients with proximal tears with good tissue quality treated in the acute (≤3 weeks post-injury) and delayed setting (>3 months post-injury) were retrospectively reviewed at minimum 2-year follow-up. Ipsilateral reinjury or reoperation and contralateral injury rates were recorded. Functional outcomes were evaluated using the Lysholm, modified Cincinnati, Single Assessment Numeric Evaluation, International Knee Documentation Committee subjective, Forgotten Joint Score-12, Anterior Cruciate Ligament-Return to Sport after Injury scale, and satisfaction scores. Finally, time to return to work, time to discontinue brace-usage, time to running, and time to return to sports were reviewed. Group differences were compared using chi-square tests and Mann-Whitney U tests. RESULTS Sixty-nine patients were included, of which 34 (49%) were treated acutely and 35 (51%) in the delayed setting. Besides time from injury to surgery, patient demographics were similar between groups (all p > 0.1). There were three reinjuries (9%) in the acute group and four in the delayed (11%; p > 0.999). Reoperation, complication, and contralateral injury rates were similar between groups (all p > 0.1), while functional outcomes were also comparable (all p > 0.05). CONCLUSION This study found that acute and delayed primary ACL repair results in similar clinical and functional outcomes at short to mid-term follow-up. Therefore, the most important factors for repair surgery success seem to be tissue quality and tissue length, rather than acuity of the surgery. LEVEL OF EVIDENCE Level III, retrospective comparative cohort study.
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Affiliation(s)
- Harmen D Vermeijden
- Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, United States; Spaarne Gasthuis Hospital, Department of Orthopaedic Surgery, Hoofddorp, the Netherlands; Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - Jelle P van der List
- Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, United States; Spaarne Gasthuis Hospital, Department of Orthopaedic Surgery, Hoofddorp, the Netherlands; Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - Gregory S DiFelice
- Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, United States.
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18
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DeFazio MW, Curry EJ, Gustin MJ, Sing DC, Abdul-Rassoul H, Ma R, Fu F, Li X. Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120964919. [PMID: 33403206 PMCID: PMC7745570 DOI: 10.1177/2325967120964919] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow patients to return to prior levels of athletic performance. While existing literature suggests that patient-reported outcomes are similar between bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts, there is less information comparing return-to-sport (RTS) rates between the 2 graft types. Purpose To compare RTS rates among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft. Study Design Systematic review; Level of evidence, 4. Methods The MEDLINE, Embase, and Cochrane Library databases were searched, and studies that reported on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Studies that utilized ACL repair techniques, quadriceps tendon autografts, graft augmentation, double-bundle autografts, allografts, or revision ACL reconstruction were excluded. RTS information was extracted and analyzed from all included studies. Results Included in the review were 20 articles investigating a total of 2348 athletes. The overall RTS rate in our cohort was 73.2%, with 48.9% returning to preinjury levels of performance and a rerupture rate of 2.4%. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 81.0%, with 50.0% of athletes returning to preinjury levels of performance and a rerupture rate of 2.2%. Patients after primary ACL reconstruction with an HT autograft had an overall RTS rate of 70.6%, with 48.5% of athletes returning to preinjury levels of performance and a rerupture rate of 2.5%. Conclusion ACL reconstruction using BTB autografts demonstrated higher overall RTS rates when compared with HT autografts. However, BTB and HT autografts had similar rates of return to preinjury levels of performance and rerupture rates. Less than half of the athletes were able to return to preinjury sport levels after ACL reconstruction with either an HT or BTB autograft.
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Affiliation(s)
- Matthew W DeFazio
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Michael J Gustin
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David C Sing
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Hussein Abdul-Rassoul
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Richard Ma
- Missouri Orthopaedic Institute, Columbia, Missouri, USA
| | - Freddie Fu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
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19
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Eliya Y, Nawar K, Rothrauff BB, Lesniak BP, Musahl V, de SA D. Anatomical anterior cruciate ligament reconstruction (ACLR) results in fewer rates of atraumatic graft rupture, and higher rates of rotatory knee stability: a meta-analysis. J ISAKOS 2020. [DOI: 10.1136/jisakos-2020-000476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Vermeijden HD, Yang XA, van der List JP, DiFelice GS, Rademakers MV, Kerkhoffs GMMJ. Trauma and femoral tunnel position are the most common failure modes of anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020; 28:3666-3675. [PMID: 32691095 DOI: 10.1007/s00167-020-06160-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To improve outcomes of anterior cruciate ligament reconstruction (ACLR), it is important to understand the reasons for failure of this procedure. This systematic review was performed to identify current failure modes of ACLR. METHODS A systematic search was performed using PubMed, EMBASE, Cochrane, and annual registries for ACLR failures. Studies were included when failure modes were reported (I) of ≥ 10 patients and (II) at a minimum of two-year follow-up. Modes of failure were also compared between different graft types and in femoral tunnel positions. RESULTS This review included 24 cohort studies and 4 registry-based studies (1 level I, 1 level II, 10 level III, and 16 level IV studies). Overall, a total of 3657 failures were identified. The most common single failure mode of ACLR was new trauma (38%), followed by technical errors (22%), combined causes (i.e. multiple failure mechanisms; 19%), and biological failures (i.e. failure due to infection or laxity without traumatic or technical considerations; 8%). Technical causes also played a contributing role in 17% of all failures. Femoral tunnel malposition was the most common cause of technical failure (63%). When specifically looking at the bone-patellar tendon-bone (BPTB) or hamstring (HT) autografts, trauma was the most common failure mode in both, whereas biological failure was more pronounced in the HT group (4% vs. 22%, respectively). Technical errors were more common following transtibial as compared to anteromedial portal techniques (49% vs. 26%). CONCLUSION Trauma is the single leading cause of ACLR failure, followed by technical errors, and combined causes. Technical errors seemed to play a major or contributing role in large part of reported failures, with femoral tunnel malposition being the leading cause of failure. Trauma was also the most common failure mode in both BPTB and HT grafts. Technical errors were a more common failure mode following transtibial than anteromedial portal technique. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Harmen D Vermeijden
- Orthopaedic Sports Medicine and Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, USA. .,Amsterdam UMC, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands.
| | - Xiuyi A Yang
- Orthopaedic Sports Medicine and Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, USA
| | - Jelle P van der List
- Orthopaedic Sports Medicine and Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, USA.,Amsterdam UMC, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Gregory S DiFelice
- Orthopaedic Sports Medicine and Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, USA
| | - Maarten V Rademakers
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands.,Amsterdam UMC, Academic Center for Evidence Based Sports Medicine (ACES), University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Amsterdam Collaboration on Health and Safety in Sports (ACHSS), University of Amsterdam and Vrije Universiteit Amsterdam IOC Research Center, Amsterdam, The Netherlands
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21
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Vermeijden HD, Yang XA, van der List JP, DiFelice GS. Large variation in indications, preferred surgical technique and rehabilitation protocol for primary anterior cruciate ligament repair: a survey among ESSKA members. Knee Surg Sports Traumatol Arthrosc 2020; 28:3613-3621. [PMID: 32328697 DOI: 10.1007/s00167-020-06011-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/16/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess current surgical preferences and practice patterns regarding primary anterior cruciate ligament (ACL) repair among European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) members. METHODS A web-based survey was designed, including questions regarding indications for primary repair, outcomes of primary repair, and rehabilitation protocols. An invitation for study participation was sent by email to all ESSKA e-mail contacts. Descriptive statistics were performed. RESULTS A total of 169 surgeons responded to the survey (7% response rate of active members). Lack of supporting scientific evidence is the main reason for not using repair as a surgical treatment (63%). Most important indications were proximal avulsion tears (84%), younger age (49%), and older age (34%). Among those currently utilizing repair as a treatment option, transosseous tunnel fixation repair (34%) and repair with internal brace using transosseous tunnel fixation (32%) were the most preferred techniques. Eleven percent indicated dynamic intraligamentary stabilization as their preferred technique. A similar rate of progression for rehabilitation for repair and reconstruction techniques was noted among respondents. CONCLUSION This practice survey shows that the majority of surgeons indicated the main reason for not incorporating primary repair in their current practices was a lack of supporting scientific evidence. Among those holding favourable attitudes and beliefs, most surgeons indicated patients with proximal tears, younger-aged, and older-aged patients might be eligible for repair. Prospective studies with higher levels of evidence are warranted to establish guidelines for repair, including indications, optimal surgical technique, and rehabilitation protocols. LEVEL OF EVIDENCE V (expert opinion).
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Affiliation(s)
- Harmen D Vermeijden
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA
| | - Xiuyi A Yang
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA
| | - Jelle P van der List
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA.,Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gregory S DiFelice
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA.
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Wilding CPTSR, Cruz CPTCA, Mannino LCDRBJ, Deal CPTJB, Wake CPTJ, Bottoni CR. Bone-Tendon-Autograft Anterior Cruciate Ligament Reconstruction: A New Anterior Cruciate Ligament Graft Option. Arthrosc Tech 2020; 9:e1525-e1530. [PMID: 33134055 PMCID: PMC7587499 DOI: 10.1016/j.eats.2020.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/07/2020] [Indexed: 02/03/2023] Open
Abstract
The bone-tendon-bone (BTB) autograft is widely used for anterior cruciate ligament (ACL) reconstruction. However, the primary disadvantages of this technique include postoperative kneeling pain, the risk of perioperative patellar fracture, and graft-tunnel mismatch. Therefore, a single bone plug technique for ACL reconstructions was developed to mitigate the disadvantages of the BTB technique. To differentiate this graft, we have coined the term BTA, for bone-tendon-autograft. The middle third of the patellar tendon is used with a typical width of 10 to 11 mm. A standard tibial tubercle bone plug is harvested. The length of the patellar tendon and graft construct is then measured. If the tendon is >45 mm and the construct at least 70 mm, then we proceed with the BTA technique. At the inferior pole of the patella, electrocautery is used to harvest the tendon from the patella. The advantages of this technique include faster graft harvest and preparation. Obviating the patellar bone plug harvest should eliminate the risk of perioperative patellar fracture and theoretically will mitigate donor site morbidity and kneeling pain, 2 of the most commonly cited complications of the use of BTB autografts for ACL reconstruction. In conclusion, the BTA technique is a reliable technique for ACL reconstruction.
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Affiliation(s)
| | - CPT. Christian A. Cruz
- Address correspondence to Christian Cruz, M.D., 1 Jarrett White Rd., Honolulu, HI 96859, U.S.A.
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Zhao J. Anatomical Single-Bundle Transtibial Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2020; 9:e1275-e1282. [PMID: 33024667 PMCID: PMC7528436 DOI: 10.1016/j.eats.2020.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/11/2020] [Indexed: 02/03/2023] Open
Abstract
Anatomical anterior cruciate ligament (ACL) reconstruction is a reasonable transition from isometric ACL reconstruction to obtain better clinical outcomes, and most authors believe that it can only be performed through the medial portal technique. However, in our clinical practice, we found that anatomical ACL reconstruction can be performed easily and accurately by creating a tibial tunnel, which is accomplished by setting the tibial tunnel with correct angulation to the sagittal plane and tibial axis. Hence, we introduce this special transtibial anatomical ACL reconstruction technique, in which the most critical step is the creation of a shallow tibial tunnel with a proximal projection to the anatomical location of the femoral tunnel. This technique is indicated for primary ACL reconstructions in skeletally mature patients. We believe this Technical Note will give a special view on anatomical ACL reconstruction.
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Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
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24
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Longitudinal Quadriceps Strength Recovery After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft: Patients Stratified by Preoperative Quadriceps Strength Deficit. J Sport Rehabil 2020; 29:602-607. [PMID: 31094615 DOI: 10.1123/jsr.2018-0236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 02/12/2019] [Accepted: 03/24/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Some studies have discussed postoperative quadriceps strength recovery after anterior cruciate ligament reconstruction (ACLR). However, the effect of preoperative quadriceps strength deficit on longitudinal postoperative quadriceps strength recovery after ACLR with hamstring autograft is unknown. OBJECTIVE To reveal the longitudinal postoperative quadriceps strength recovery after ACLR with hamstring autograft among patient groups stratified by preoperative quadriceps strength deficit. DESIGN Retrospective cohort study. SETTING Single center. PATIENTS In total, 420 patients (222 men and 218 women; age at the time of surgery 23.1 [8.9] y) who underwent ipsilateral ACLR with hamstring autograft and completed knee function tests preoperatively and 3, 6, and 12 months postoperatively were included in this study. INTERVENTION The authors measured quadriceps strength at 60°/s, tested 1-leg hop performance (distance and anxiety), and calculated the quadriceps strength index (QSI) and limb symmetry index for 1-leg hop distance. Patients were divided into the following 4 groups according to their preoperative QSI: >80% (Excellent group), 80% to 60% (Good group), 60% to 40% (Moderate group), and ≤40% (Poor group). MAIN OUTCOME MEASURES Postoperative QSI at 3, 6, and 12 months and 1-leg hop performance at 12 months after the surgery. RESULTS The Excellent group had the highest postoperative QSI at all periods. Based on the 1-leg hop performance, the Poor group had the lowest limb symmetry index and significantly greater anxiety during jump performance in comparison with the Excellent and Good groups. CONCLUSION The present study shows a longitudinal recovery process and the average postoperative quadriceps strength after ACLR with hamstring autograft in patient groups stratified by preoperative QSI. The results indicate that the difference in preoperative QSI affects not only the longitudinal postoperative QSI recovery but also high-level 1-leg hop performance after ACLR using hamstring autograft.
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Smith PA, Cook CS, Bley JA. All-Inside Quadrupled Semitendinosus Autograft Shows Stability Equivalent to Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction: Randomized Controlled Trial in Athletes 24 Years or Younger. Arthroscopy 2020; 36:1629-1646. [PMID: 32059954 DOI: 10.1016/j.arthro.2020.01.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 12/20/2019] [Accepted: 01/18/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical outcomes of knee anterior cruciate ligament (ACL) autograft reconstruction using all-inside quadrupled semitendinosus (AIST) versus bone-patellar tendon-bone (BPTB) in a high-risk athletic population 24 years or younger. METHODS Skeletally mature candidates younger than 24 years old with an ACL tear were randomized into either the AIST (n = 32) or BPTB (n = 32) group and were followed for 2 years. Magnetic resonance imaging scans were obtained at 1-year follow-up, and radiographs were obtained at 2-year follow-up. All surgeries were performed by a single surgeon using an anteromedial portal to establish the femoral tunnel. The primary outcome measure was KT-1000 stability testing. Secondary outcome measures included International Knee Documentation Committee (IKDC) Knee Evaluation Form, IKDC Subjective Form, Knee Injury and Osteoarthritis Outcome Score, Marx Activity Scale, visual analog pain scale, and SF-12 (Mental and Physical). RESULTS At 2-year follow-up, no statistical difference existed with KT-1000-measured side-to-side laxity between AIST (0.3 ± 0.7 mm, 95% confidence interval 0.0-1.0 mm) and BPTB (0.0 ± 0.8 mm, confidence interval CI -0.3 to 1.1 mm) (P = .197). In addition, no statistical differences between the groups were found for IKDC Subjective Form, Knee Injury and Osteoarthritis Outcome Score, Marx, SF-12 Mental, SF-12 Physical, or with regards to imaging findings. Patients with BPTB reported significantly greater postoperative pain scores at days 2 (P = .049), 3 (P = .004), and 7 (P = .015) and had significantly greater kneeling pain at 2 years (P < .019). A return to sport questionnaire at 2 years revealed no significant difference between the groups for returning to preoperative level of sport activity (83% AIST, 74% BPTB; P = .415). Two graft retears (7%; P = .222) occurred in the AIST group. Three patients in the BPTB group experienced ACL tears in the contralateral knee (9%; P = .239). CONCLUSIONS ACL reconstruction with an all-inside quadrupled semitendinosus autograft construct is equivalent to patellar BPTB autograft based on KT-1000 stability testing in athletes 24 years or younger. LEVEL OF EVIDENCE randomized controlled trial with 92% 2-year follow-up, Level I.
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Affiliation(s)
- Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Columbia Orthopaedic Group, Columbia, Missouri, U.S.A..
| | - Corey S Cook
- Columbia Orthopaedic Group, Columbia, Missouri, U.S.A
| | - Jordan A Bley
- Columbia Orthopaedic Group, Columbia, Missouri, U.S.A
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26
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Vermeijden HD, van der List JP, O'Brien R, DiFelice GS. Patients Forget About Their Operated Knee More Following Arthroscopic Primary Repair of the Anterior Cruciate Ligament Than Following Reconstruction. Arthroscopy 2020; 36:797-804. [PMID: 31919026 DOI: 10.1016/j.arthro.2019.09.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/20/2019] [Accepted: 09/26/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the extent to which patients forget their operative knee joint on a daily basis following arthroscopic primary repair as compared with reconstruction of the anterior cruciate ligament (ACL) at short- to mid-term follow-up. METHODS For this retrospective study, all patients undergoing ACL surgery between May 2012 and May 2017 were identified. All patients were treated with the algorithm of undergoing arthroscopic primary repair for proximal tears and reconstruction for nonrepairable tears. Patients were contacted to complete the Forgotten Joint Score-12 questionnaire between 2 and 5 years following surgery. A greater score represents a more favorable outcome indicating the patient's ability to "forget" the joint in everyday life, whereas lower scores indicate a less-favorable outcome. Data were analyzed using independent t-tests and χ2 tests, and multiple linear regression analysis was performed to correct for potential confounders. RESULTS Eighty-three patients completed the questionnaire (57%). Patients who underwent primary repair thought about their operated knee less when compared with those patients who underwent reconstruction (85.3 ± 14.2 vs 74.3 ± 23.3, P = .022). These differences were significantly greater in patients older than 30 years (85.3 ± 12.9 vs 62.6 ± 24.9, P = .007), male patients (85.0 ± 13.6 vs 72.5 ± 24.7, P = .037), and patients with a body mass index greater than 25 (85.9 ± 14.5 vs 64.7 ± 25.6, P = .009). After we corrected for potential confounders, the overall difference remained significant (P = .045). CONCLUSIONS Based on the data in this study, patients undergoing arthroscopic primary ACL repair can expect to have less daily awareness of their operated knee at short- to mid-term follow-up as compared with patients undergoing ACL reconstruction. LEVEL OF EVIDENCE Retrospective comparative study, level III.
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Affiliation(s)
- Harmen D Vermeijden
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A
| | - Jelle P van der List
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A.; Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Robert O'Brien
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A
| | - Gregory S DiFelice
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A..
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27
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Van Zyl R, Van Schoor AN, Du Toit PJ, Suleman FE, Velleman MD, Glatt V, Tetsworth K, Hohmann E. The Association Between Anterior Cruciate Ligament Length and Femoral Epicondylar Width Measured on Preoperative Magnetic Resonance Imaging or Radiograph. Arthrosc Sports Med Rehabil 2019; 2:e23-e31. [PMID: 32266355 PMCID: PMC7120849 DOI: 10.1016/j.asmr.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To determine whether femoral epicondylar width (FECW) obtained from either magnetic resonance imaging (MRI) or plain radiographs could be used to predict anterior cruciate ligament (ACL) length. A secondary purpose was to develop a formula to use maximum FECW on either MRI or plain radiographs to estimate ACL length preoperatively. Methods The MRIs and radiographs of 40 patients (mean age 41.0 years), with no apparent knee pathology, surgery, or trauma were included. The ACL length was measured on MRI followed by FECW on both MRI and radiograph of the same patient. This allowed the development of equations able to predict ACL length according to the FECW measured on either an MRI or radiograph. Results The mean ACL length was 40.6 ± 3.6 mm. FECW measured on both MRIs and radiographs was sufficient to predict ACL length. Pearson’s correlations revealed a high positive relationship between ACL length and FECW on MRI (r = 0.89, P < .0001) and ACL length and FECW on radiograph (r = 0.83, P < .0001). The coefficient of determination (R2) was calculated to be MRI: R2 = 0.78 and radiograph: R2 = 0.68 and confirmed that FECW measured on both MRI and radiograph were sufficient to predict ACL length. Based on these models, ACL length can be predicted by FECW using the following formulas: MRI: ACL length = 0.47 (FECW) + 1.93 and radiograph: ACL length = 0.31 (FECW) + 11.33. Conclusions This study demonstrated that FECW measured on either MRI or anteroposterior radiograph could reliably estimate ACL length on a sagittal MRI. There was a high positive relationship between ACL length and FECW on both MRI and radiographs, although MRIs do predict ACL length more reliably. Clinical Relevance Preoperative ACL length assessment, using FECW on MRI or radiograph, is useful in graft selection and in preventing inadequate graft harvesting for ACL reconstruction, especially if an individualized anatomical approach is pursued.
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Affiliation(s)
- Reinette Van Zyl
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Albert-Neels Van Schoor
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Peet J Du Toit
- Department of Physiology, Faculty of Health Sciences, Associate of the Institute for Food, Nutrition and Well-being, Associate of the Institute for Cellular and Molecular Medicine, Associate of Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa
| | - Farhana E Suleman
- Department of Radiology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Mark D Velleman
- Department of Radiology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Vaida Glatt
- Department of Orthopaedic Surgery, University of Texas Health Science Center, San Antonio, Texas, U.S.A
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Sydney, Australia.,Department of Surgery, School of Medicine, University of Queensland, Queensland, Sydney, Australia.,Orthopaedic Research Institute of Australia, Sydney, Australia
| | - Erik Hohmann
- School of Medicine, University of Pretoria, Pretoria, South Africa.,Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates
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28
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Chen W, Li H, Chen Y, Jiang F, Wu Y, Chen S. Bone-Patellar Tendon-Bone Autografts Versus Hamstring Autografts Using the Same Suspensory Fixations in ACL Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med 2019; 7:2325967119885314. [PMID: 32010729 PMCID: PMC6967236 DOI: 10.1177/2325967119885314] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Bone–patellar tendon–bone (BPB) autografts and hamstring tendon (HT) autografts are 2 popular choices for anterior cruciate ligament reconstruction (ACLR). Although existing meta-analyses have explored the clinical outcomes between BPB and HT autografts, none have based their analysis on studies with just femoral suspensory fixation methods. Purpose: To evaluate and compare clinical outcomes, particularly graft failure and knee stability, of ACLR with BPB or HT autografts with suspensory femoral fixation. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was conducted of studies reporting single-bundle ACLR with BPB autografts and HT autografts with suspensory fixation with a minimum 24-month follow-up. Graft failure rate, knee stability, and clinical outcomes were compared for BPB versus HT autografts. Knee stability was measured with the Lachman test, pivot-shift test, and KT-1000/2000 arthrometer side-to-side difference (SSD). Clinical outcomes were measured with Lysholm scores and the Tegner activity scale, as well as rate of return to preinjury sports. Donor site morbidity among included studies was reviewed. A random-effects model was used for calculations of summary estimates. Subgroup, sensitivity, and trial sequential analyses were conducted. Results: Five studies were included. Graft failure was seen more often in the HT group than the BPB group, and this was statistically significant (P = .03). However, the trial sequential analysis outcome indicated that the included sample size was not large enough to support a solid positive finding. The analysis showed no significant difference in SSD, Lachman test, pivot-shift test, rate of return to sports, Lysholm score, or Tegner score between groups. Subgroup analyses found no significant difference between groups. Conclusion: This meta-analysis demonstrated no significant differences in knee stability and knee functional outcomes between BPB and HT autografts with suspensory fixation. More evidence is needed to prove the lower risk of failure with use of BTB autograft with suspensory fixation.
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Affiliation(s)
- Wenbo Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Yuzhou Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Fangyi Jiang
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Yang Wu
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
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29
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Erickson BJ, Chalmers PN, D'Angelo J, Ma K, Dahm DL, Romeo AA, Ahmad CS. Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in Professional Baseball Players. Orthop J Sports Med 2019; 7:2325967119878431. [PMID: 31696134 PMCID: PMC6822199 DOI: 10.1177/2325967119878431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for ACL tears to allow baseball players to return to sport (RTS). The optimal graft type and femoral tunnel drilling technique are currently unknown. Hypothesis: There is a high rate of RTS in professional baseball players after ACLR, with no significant difference in RTS rates or performance between cases and controls or between graft types or femoral drilling techniques. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent ACLR between 2010 and 2015 were included. Demographic and performance data (pre- and postoperative) for each player were recorded. Performance metrics were then compared between cases and matched controls. Results: A total of 124 players (mean age, 23.7 ± 4.1 years; 83% minor league players) underwent ACLR. Of these, 80% returned to sport (73% to the same or higher level) at a mean 310 ± 109 days overall and 333 ± 126 days at the same or higher level. The most common graft type was an ipsilateral bone–patellar tendon–bone (BTB) autograft (n = 87; 70%). A total of 91 players underwent concomitant meniscal debridement or repair. No significant difference in any of the primary performance metrics existed from before to after ACLR. Compared with matched controls, no significant difference existed in RTS rates or any performance metrics after ACLR. No significant difference existed in RTS rates or primary performance outcome measures between graft types or femoral drilling techniques. Conclusion: The RTS rate for professional baseball players after ACLR was 80%. No significant difference in performance metrics existed between BTB and hamstring autografts or between femoral drilling techniques. Furthermore, no significant difference in performance or RTS rates existed between cases and matched controls. Femoral drilling technique and graft type did not affect performance and RTS rates in professional baseball players after ACLR.
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Affiliation(s)
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - John D'Angelo
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Kevin Ma
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Diane L Dahm
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Christopher S Ahmad
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
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30
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Park YB, Lee HJ, Ro DH, Lee GY, Kim S, Kim SH. Anterolateral ligament injury has a synergic impact on the anterolateral rotatory laxity in acute anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 2019; 27:3334-3344. [PMID: 30631908 DOI: 10.1007/s00167-019-05347-z] [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: 06/04/2018] [Accepted: 01/04/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE To investigate the prevalence of the anterolateral ligament (ALL) injuries and its role in rotatory laxity in acute anterior cruciate ligament (ACL)-injured knees. METHODS Two-hundred and ninety-six consecutive patients with acute ACL injuries were evaluated retrospectively, excluding those with other ligament injury and undetectable path of ALL in MRI. Patients were divided into two groups based on the degree of ACL injury in arthroscopy (complete versus partial group). Logistic regression and discriminant analysis were performed to assess the risk of pivot shift test. RESULTS A total of 169 patients were included (128 with complete and 41 with partial ACL rupture). Overall, 106/169 (62.7%) of ALL injuries were characterized, 87/128 (67.9%) in complete group, and 19/41 (46.3%) in partial group. The incidence of pivot shift was 120/128 (93.8%) and 14/41 (34.1%) in the complete and partial groups, respectively. The odds ratio in the pivot shift of combined ALL injury was found as 3.8 (95% CI 1.8-8.4) with the overall ACL injury, but higher as 17.1 (95% CI 3.1-96.4) with partial group. Higher grade of pivot shift showed a greater incidence of injury of ALL. Degree of ACL injury and ALL injury allowed 87.0% of correct classification of subsequent anterolateral rotatory laxity. CONCLUSION Injury to the ALL could have a synergetic effect on anterolateral rotatory laxity in acute ACL-injured knee, however, its effect might be minor in case of complete tear. Careful assessment about combined ALL injury should be considered, especially in knees with high-grade pivot shift in acute ACL-injured knees. LEVEL OF EVIDENCE Retrospective prognostic study, Level IV.
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Affiliation(s)
- Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Du-Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Geun Young Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea. .,Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France.
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31
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Mutsuzaki H, Kinugasa T, Ikeda K, Sakane M. Morphological changes in the femoral and tibial bone tunnels after anatomic single-bundle anterior cruciate ligament reconstruction using a calcium phosphate-hybridized tendon graft in 2years of follow-up. Orthop Traumatol Surg Res 2019; 105:653-660. [PMID: 30853458 DOI: 10.1016/j.otsr.2019.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/21/2018] [Accepted: 01/09/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A calcium phosphate (CaP)-hybridized tendon graft improves tendon-to-bone healing. The purpose of the study was to evaluate the progression of morphological changes in the femoral and tibial bone tunnels after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction using the CaP-hybridized tendon graft versus an untreated tendon graft during 2 years of follow-up. HYPOTHESIS We hypothesized that the CaP-hybridized tendon graft would prevent the progression of bone tunnel enlargement compared with the untreated tendon graft. PATIENTS AND METHODS The CaP group comprised 19 patients, while the conventional group comprised 18. Computed tomography was performed at postoperative 1 week, 1 year, and 2 years. The bone tunnel enlargement and tunnel translation at the aperture of the femoral and tibial tunnels were analyzed. RESULTS In the CaP group, the femoral bone tunnel did not expand during 2 years of follow-up. In the conventional group, the femoral bone tunnel diameters at postoperative 1 year and 2 years were enlarged compared with postoperative 1 week, and the proximal and distal walls of the femoral bone tunnel shifted proximally and distally, respectively. The femoral bone tunnel in the CaP group was smaller than that in the conventional group at 1 year postoperatively. Although the tibial bone tunnels expanded for up to 1 year postoperatively in both groups, the expanded bone tunnel reduced during 2 years of follow-up only in the CaP group. DISCUSSION In anatomic single-bundle ACL reconstruction, the femoral bone tunnel in the CaP group did not expand or progress with time compared with the conventional group, while the tibial bone tunnel in the CaP group expanded for up to 1 year postoperatively and then reduced for up to 2 years postoperatively. The CaP-hybridized tendon can prevent the progression of bone tunnel enlargement. LEVEL OF EVIDENCE Level II, Low-powered prospective randomized trial.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami Ami-machi, 300-0394 Inashiki-gun, Ibaraki, Japan.
| | - Tomonori Kinugasa
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Oozone, 300-3295 Tsukuba, Ibaraki, Japan
| | - Kotaro Ikeda
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Oozone, 300-3295 Tsukuba, Ibaraki, Japan
| | - Masataka Sakane
- Department of Orthopaedic Surgery, Tsukuba Gakuen Hospital, 2573-1 Kamiyokoba, 305-0854 Tsukuba, Ibaraki, Japan
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Comparison of Modified Transtibial and Outside-In Techniques in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Arthroscopy 2018; 34:2857-2870. [PMID: 30197202 DOI: 10.1016/j.arthro.2018.05.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 05/20/2018] [Accepted: 05/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the bending angle of anterior cruciate ligament (ACL) graft at femoral tunnel, graft maturation, and tunnel positions and the clinical outcomes of the modified transtibial (mTT) and outside-in (OI) techniques. METHODS Patients who met the inclusion criteria were divided into the mTT group (n = 50) and the OI group (n = 50). Using 3-dimensional computed tomography (3-D CT), tunnel placement and femoral tunnel bending angle were analyzed. The 3.0-T magnetic resonance imaging (MRI) was used to assess the graft signal intensity (indicative of maturation) with signal/noise quotient (SNQ). Graft tension and synovialization were evaluated with second-look arthroscopy in all cases. Clinical and functional tests were completed at 36 months of follow-up. RESULTS When tunnel placements were analyzed using the quadrant method, no significant differences were found between the mTT group and the OI group. The femoral graft bending angle was reduced in the mTT group, and the total mean of SNQ values and mean SNQ values at the femoral intraosseous and proximal graft of the mTT group were significantly lower than in the OI group (P < .001), respectively. The femoral graft bending angle on the coronal and axial planes showed moderate-to-strong correlation with the SNQ values at the femoral intraosseous and proximal graft. Second-look arthroscopy revealed better synovialization in the mTT group than in the OI group (P = .040), with no significant difference in graft tension between the 2 groups (P = .328). CONCLUSIONS Anatomic tunnel placements did not vary between the mTT group and the OI group. However, the mTT group had more benefits in femoral graft bending angle and showed higher graft maturity and better synovial coverage than the OI group, although there were no significant differences in clinical outcomes. The acute femoral graft bending angle might negatively affect the maturation of proximal graft. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
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Editorial Commentary: Single-Bundle Versus Double-Bundle Anterior Cruciate Ligament Reconstruction … Are We Barking up the Wrong Tree? Arthroscopy 2018; 34:2654-2655. [PMID: 30173805 DOI: 10.1016/j.arthro.2018.06.016] [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: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023]
Abstract
As techniques in anterior cruciate ligament reconstruction continue to evolve, studies comparing single bundle to double bundle continue to mount in numbers. Although there have been great strides in identifying anatomic tunnel placement, how many tunnels (bundles) are created, and how those tunnels are placed, we still seem to be stuck with grossly similar results with respect to both patient-related and objective outcome measures. It seems to me that we can do a very good job reproducing what we do to a cadaver in a lab. Unfortunately, that cadaver does not get up and walk after our job is done as surgeons. Nearly 20% of our athletes do not return to their prior level of sport, and 30% of our patients develop radiographic signs of osteoarthritis. There must be something we are neglecting.
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Ilahi OA, Staewen RS, Stautberg EF, Qadeer AA. Estimating Lengths of Semitendinosus and Gracilis Tendons by Magnetic Resonance Imaging. Arthroscopy 2018; 34:2457-2462. [PMID: 29859772 DOI: 10.1016/j.arthro.2018.03.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether preoperative magnetic resonance imaging (MRI) can help predict the tendon-only length of the semitendinosus (ST) and the gracilis (G). METHODS The distance from the tibial insertion to the distal-most aspect of the musculotendinous junction (MTJ) of the ST and G was estimated on preoperative MRI scans of patients undergoing primary anterior cruciate ligament (ACL) reconstruction with single-bundle, quadruple-stranded hamstring autograft. This MRI tendon-only length, measured by a musculoskeletal radiologist blinded to surgical findings, was compared to the actual tendon-only length measured upon harvesting each tendon. RESULTS Among the 42 patients comprising the study population, there was very strong correlation between the estimates of tendon-only length made by MRI and surgical measurements for both the ST (Spearman coefficient = 0.83; P < .0001) and the G (Spearman coefficient = 0.82; P < .0001). The difference between MRI and surgical measurements did not exceed 3 cm for any of the 84 harvested hamstring tendons. Bland-Altman plots confirmed agreement between the 2 measurement methods. There was also strong correlation between the surgically measured tendon-only length of the ST and its G counterpart (Spearman coefficient = 0.68; P < .0001). CONCLUSIONS MRI estimates of tendon-only length for both the ST and G very strongly correlate with operative measurements of these lengths; the discrepancy between these 2 measurement methods was found to not exceed 3 cm when the MTJ of these tendons is visible on MRI scans. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Omer A Ilahi
- Texas Arthroscopy and Sports Medicine Institute, Houston, Texas, U.S.A..
| | | | | | - Ali A Qadeer
- Texas Arthroscopy and Sports Medicine Institute, Houston, Texas, U.S.A
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Andia I, Maffulli N. How far have biological therapies come in regenerative sports medicine? Expert Opin Biol Ther 2018; 18:785-793. [PMID: 29939773 DOI: 10.1080/14712598.2018.1492541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Regular engagement in sports produces many health benefits, but also exposes to increased injury risk. The quality of medical care available is crucial not only for sports trauma but also to avoid overuse syndromes and post-traumatic degenerative conditions. AREAS COVERED We provide background information on some clinical needs in sport injuries and describe the main families of biological products used in clinical practice. We also discuss limitations of the current clinical experience. EXPERT OPINION Sport and exercise impairment affects different segments of the population with different needs. The exceptional demands of elite athletes and subsequent media coverage have created hype around regenerative therapies. Statistical evidence, whether weak (cell products) or moderate (PRPs), is not enough to drive medical decisions because of the heterogeneity of the biological products available and their application procedures. Moreover, the specific needs of the different segments of the population along with the available clinical evidence for each musculoskeletal condition should be considered in the decision-making process. There is urgent need to develop regenerative protocols combined with post-intervention rehabilitation, and gather meaningful clinical data on the safety and efficacy of these interventions in the different populations segments.
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Affiliation(s)
- Isabel Andia
- a Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital , Barakaldo , Spain
| | - Nicola Maffulli
- b Department of Musculoskeletal Disorders , University of Salerno School of Medicine and Dentristry , Salerno , Italy.,c Centre for Sport and Exercise Medicine , Queen Mary University of London, Barts and the London School of Medicine and Dentistry , London , England
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Kweon CY, Hagen MS, Gee AO. What's New in Sports Medicine. J Bone Joint Surg Am 2018; 100:712-718. [PMID: 29664859 DOI: 10.2106/jbjs.17.01524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Christopher Y Kweon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Mia S Hagen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Albert O Gee
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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Van Der Bracht H, Tampere T, Beekman P, Schepens A, Devriendt W, Cromheecke M, Verdonk P, Victor J. Peak stresses shift from femoral tunnel aperture to tibial tunnel aperture in lateral tibial tunnel ACL reconstructions: a 3D graft-bending angle measurement and finite-element analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26:508-517. [PMID: 29124289 DOI: 10.1007/s00167-017-4739-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 10/02/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the effect of tibial tunnel orientation on graft-bending angle and stress distribution in the ACL graft. METHODS Eight cadaveric knees were scanned in extension, 45°, 90°, and full flexion. 3D reconstructions with anatomically placed anterior cruciate ligament (ACL) grafts were constructed with Mimics 14.12®. 3D graft-bending angles were measured for classic medial tibial tunnels (MTT) and lateral tibial tunnels (LTT) with different drill-guide angles (DGA) (45°, 55°, 65°, and 75°). A pivot shift was performed on 1 knee in a finite-element analysis. The peak stresses in the graft were calculated for eight different tibial tunnel orientations. RESULTS In a classic anatomical ACL repair, the largest graft-bending angle and peak stresses are seen at the femoral tunnel aperture. The use of a different DGA at the tibial side does not change the graft-bending angle at the femoral side or magnitude of peak stresses significantly. When using LTT, the largest graft-bending angles and peak stresses are seen at the tibial tunnel aperture. CONCLUSION In a classic anatomical ACL repair, peak stresses in the ACL graft are found at the femoral tunnel aperture. When an LTT is used, peak stresses are similar compared to classic ACL repairs, but the location of the peak stress will shift from the femoral tunnel aperture towards the tibial tunnel aperture. CLINICAL RELEVANCE the risk of graft rupture is similar for both MTTs and LTTs, but the location of graft rupture changes from the femoral tunnel aperture towards the tibial tunnel aperture, respectively. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Hans Van Der Bracht
- Department of Orthopaedic Surgery and Traumatology, AZ Sint-Lucas Gent, Groenebriel 1, 9000, Ghent, Belgium
| | - Thomas Tampere
- Department of Orthopaedics and Traumatology, University Hospital Ghent, De pintelaan 185, 9000, Ghent, Belgium
| | - Pieter Beekman
- Department of Orthopaedics and Traumatology, University Hospital Ghent, De pintelaan 185, 9000, Ghent, Belgium.
| | - Alexander Schepens
- Department of Orthopaedic Surgery and Traumatology, AZ Sint-Lucas Gent, Groenebriel 1, 9000, Ghent, Belgium
| | - Wouter Devriendt
- Department of Biofluid, Tissue and Solid Mechanics for Medical Applications, bioMMeda, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Michiel Cromheecke
- Department of Orthopaedics and Traumatology, University Hospital Ghent, De pintelaan 185, 9000, Ghent, Belgium
| | - Peter Verdonk
- Department of Orthopaedics and Traumatology, AZ Monica, Harmoniestraat 68, 2018, Antwerp, Belgium
| | - Jan Victor
- Department of Orthopaedics and Traumatology, University Hospital Ghent, De pintelaan 185, 9000, Ghent, Belgium
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Goradia VK. Editorial Commentary: Three-Dimensional Printing and Stem Cells May Be a Game Changer for Recovery After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2018; 34:180-181. [PMID: 29304962 DOI: 10.1016/j.arthro.2017.08.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 08/08/2017] [Indexed: 02/02/2023]
Abstract
Placing stem cells at the tendon-bone interface of a soft tissue anterior cruciate ligament (ACL) reconstruction in an animal model accelerates graft incorporation at 12 weeks. A 3D-printed scaffold used to deliver the stem cells completely degraded at 12 weeks. Future clinical application of similar technology may improve outcomes after ACL reconstruction.
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Janssen RPA, van Melick N, van Mourik JBA, Reijman M, van Rhijn LW. Similar clinical outcome between patellar tendon and hamstring tendon autograft after anterior cruciate ligament reconstruction with accelerated, brace-free rehabilitation: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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