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Helito CP, Silva AGMD, Giglio PN, Pádua VBCD, Pécora JR, Gobbi RG. Risk Factors for Symptomatic Cyclops Lesion Formation after Anterior Cruciate Ligament Reconstruction. Rev Bras Ortop 2023; 58:e760-e765. [PMID: 37908522 PMCID: PMC10615601 DOI: 10.1055/s-0043-1776138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/23/2022] [Indexed: 11/02/2023] Open
Abstract
Objective To evaluate the incidence of symptomatic cyclops lesions requiring surgical treatment after anterior cruciate ligament (ACL) reconstruction and to establish possible intraoperative risk factors related to it. Methods Three hundred and eighty-nine patients aged between 18 and 50 years who underwent primary ACL reconstruction were retrospectively evaluated. Patients were divided into groups according to the presence or absence of symptomatic cyclops lesions, and their characteristics were compared. Patients with associated lesions that required additional surgical procedures (except anterolateral extra-articular procedures) were not included. The rate of symptomatic cyclops lesions was recorded and the following parameters were evaluated: age, gender, time from injury to surgery, graft type and diameter, femoral tunnel perforation technique, fixation type, presence of knee hyperextension, preservation of the ACL remnant, associated anterolateral extra-articular procedure, associated meniscal injury and participation in sports. Results 389 patients were evaluated and 26 (6.7%) patients developed cyclops. The patients with and without cyclops lesions did not differ in age, time from injury to surgery, graft type or diameter, surgical technique, femoral fixation method, presence of knee hyperextension, remnant preservation and associated meniscal injury. The group with cyclops lesion had a higher proportion of females (10 (38.4%) vs 68 (18.7%); OR = 2.7; p = 0.015), higher proportion of extra-articular reconstruction (18 (11.8%) vs 8 (3.4%); OR = 3.8; p = 0.001) and higher proportion of sports practice (23 (8.6%) vs 3 (2.5%); OR = 3.6; p = 0.026). Conclusion In our series, 6.7% of the patients required arthroscopic removal of cyclops lesions. Female gender, associated extra-articular reconstruction and sports practice were factors related to this lesion. Remnant preservation had no relationship with cyclops lesion formation.
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Affiliation(s)
- Camilo Partezani Helito
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Pedro Nogueira Giglio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - José Ricardo Pécora
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Riccardo Gomes Gobbi
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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2
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Sato D, Inoue M, Kasahara Y, Hamano H, Suzuki R, Kondo E, Iwasaki N. Effects of Preserving Anatomically Positioned and Adequate Remnant ACL Tissue in Double-Bundle ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231162389. [PMID: 37113140 PMCID: PMC10126626 DOI: 10.1177/23259671231162389] [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: 12/30/2022] [Accepted: 01/24/2023] [Indexed: 04/29/2023] Open
Abstract
Background The advantages of remnant tissue preservation in anterior cruciate ligament (ACL) reconstruction (ACLR) remain controversial. Hypothesis It was hypothesized that a large amount of remnant tissue, especially if anatomically positioned, would improve patient-reported outcomes and second-look graft appearance after preserved double-bundle ACLR (DB-ACLR). Study Design Cohort study; Level of evidence, 3. Methods This retrospective study included 89 consecutive patients who underwent unilateral remnant-preserving DB-ACLR using 2 hamstring tendon autografts. The authors categorized the arthroscopic findings into 3 groups according to the location and volume of the ACL remnant tissue in the femoral notch: (1) anatomical attachment (group AA; n = 34); (2) nonanatomical attachment (group NA; n = 33); and (3) no remnant (group NR; n = 22). Based on second-look arthroscopy, the reconstructed graft was graded as excellent, fair, or poor. Patient-reported outcomes were evaluated at 2 years after surgery using the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Japanese Anterior Cruciate Ligament Questionnaire-25 (JACL-25). Results The AA and NA groups had a significantly shorter time from injury to surgery compared with the NR group (P = .0165). Considering the second-look arthroscopic findings, the authors found a significant difference in synovial coverage of the grafts between the 3 groups (P = .0018). There were no significant differences in the overall KOOS and JACL-25 score among the 3 groups; however, the KOOS-Sport and Recreation and KOOS-Quality of Life subscale scores were significantly higher in the AA group compared with the NA and NR groups (P = .0014 and .0039, respectively). The JACL-25 score for middle- to high-speed flexion and extension was significantly better in the AA group versus the NR group (P = .0261). Conclusion This study showed that preserving anatomically positioned and adequate remnant tissue during DB-ACLR improved second-look graft appearance and KOOS-Sport and Recreation and KOOS-Quality of Life scores.
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Affiliation(s)
- Dai Sato
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Masayuki Inoue
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
- Masayuki Inoue, MD, PhD,
Department of Orthopaedic Surgery, NTT East Japan Sapporo Hospital, Minami-1,
Nishi-15, Sapporo, Hokkaido, 060-0061, Japan (
)
| | - Yasuhiko Kasahara
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Hiroki Hamano
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Ryota Suzuki
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido
University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery,
Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo,
Japan
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Hopper GP, Philippe C, El Helou A, Campos JP, Vieira TD, Döbele S, Sonnery-Cottet B. Single AnteroMedial Bundle Biological Augmentation: SAMBBA Plus Technique for Combined ACL Repair and Reconstruction. Arthrosc Tech 2023; 12:e135-e139. [PMID: 36814981 PMCID: PMC9939844 DOI: 10.1016/j.eats.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
This technical note presents the single-anteromedial bundle biological augmentation (SAMBBA)-plus technique, which is a combined anterior cruciate ligament (ACL) repair and ACL reconstruction. Preservation of the native ACL fibers improves vascularity by encircling the ACL graft with synovium that is abundant in vascular-derived stem cells. Retaining the proprioceptive fibers of the native ACL can improve the recovery of joint positioning.
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Affiliation(s)
- Graeme P. Hopper
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Corentin Philippe
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Abdo El Helou
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Joao Pedro Campos
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France,Address correspondence to Thais Dutra Vieira, M.D., Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France.
| | - Stefan Döbele
- Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
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4
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Cronström A, Tengman E, Häger CK. Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction. Sports Med 2023; 53:91-110. [PMID: 36001289 PMCID: PMC9807539 DOI: 10.1007/s40279-022-01747-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified. OBJECTIVE The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR. METHODS A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality. RESULTS Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69-9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26-3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32-3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58-2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21-2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34-2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39-0.59), female sex (OR 0.88, 95% CI 0.79-0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69-0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62-0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture. CONCLUSION Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.
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Affiliation(s)
- Anna Cronström
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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5
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Hishimura R, Kondo E, Suzuki Y, Matsuoka M, Iwasaki K, Onodera T, Momma D, Yagi T, Yasuda K, Iwasaki N. Occurrence Rate of Cyclops Lesion After Anatomic Double-Bundle ACL Reconstruction: Comparison Between Remnant Tissue Preservation and Resection Methods. Orthop J Sports Med 2022; 10:23259671221130688. [PMID: 36324698 PMCID: PMC9620259 DOI: 10.1177/23259671221130688] [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: 07/05/2022] [Accepted: 08/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background The occurrence rate of cyclops lesion after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with remnant tissue preservation remains unclear. Hypothesis The study hypotheses were as follows: (1) the occurrence rate of cyclops lesion will be comparable between the remnant-preserving and remnant-resecting ACL reconstruction methods, and (2) there will be no significant differences in clinical outcomes between the remnant-preserving and remnant-resecting procedures. Methods This retrospective comparative study involved 177 patients who underwent unilateral anatomic double-bundle ACL reconstruction using hamstring tendon autografts from 2014 to 2018 at our hospital. According to the Crain classification of ACL remnant tissue, 98 patients with remnant types I, II, or III underwent the remnant-preserving procedure (group A), and the remaining 79 patients with remnant type IV underwent the remnant-resecting procedure (group B). All patients underwent second-look arthroscopy. Patients were evaluated according to arthroscopic and clinical results at postoperative 15.2 ± 8.4 months (mean ± SD). Statistical comparisons between groups were made using the paired Student t test, chi-square test, and Fisher exact test. Study Design Cohort study; Level of evidence, 3. Results At second-look arthroscopy, the incidence of cyclops lesions was significantly higher in group B than in group A (29.1% vs 13.3%; P = .0139). Cyclops lesions were divided into 4 locations: femoral side (type 1), midsubstance (type 2), tibial side (type 3), and anterior (type 4) of the ACL graft. The ratio of the tibial-side cyclops lesion (type 3) was significantly higher in group B than in group A (P = .0354). There were no significant differences in the clinical evaluation scores between the procedures. Side-to-side anterior laxity was significantly less in group A than in group B (0.7 vs 1.6 mm; P = .0035). Concerning postoperative laceration and synovium coverage of the grafts, group A was significantly better than group B (P < .0001). Conclusion In this cohort of patients undergoing double-bundle ACL reconstruction, resection of the ACL remnant was associated with a significantly higher rate of cyclops lesion formation when compared with preservation of the remnant.
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Affiliation(s)
- Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate
School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo,
Japan.,Eiji Kondo, MD, PhD, Centre for Sports Medicine, Hokkaido
University Hospital, North 14 West 5, Kita-Ku, Sapporo 060-8648, Japan (
)
| | - Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate
School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate
School of Medicine, Hokkaido University, Sapporo, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Hokkaido
University, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate
School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Momma
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo,
Japan
| | - Tomonori Yagi
- Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital,
Sapporo, Japan
| | - Kazunori Yasuda
- Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital,
Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate
School of Medicine, Hokkaido University, Sapporo, Japan
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6
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Yang Y, Jin Z, Luo J, Zhang D, Shen P, Zheng D, Liu D, Bai L. Primary Repair for Treating Acute Proximal Anterior Cruciate Ligament Tears: A Histological Analysis and Prospective Clinical Trial. Front Bioeng Biotechnol 2022; 10:913900. [PMID: 35711630 PMCID: PMC9195517 DOI: 10.3389/fbioe.2022.913900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Reconstruction surgery for acute proximal anterior cruciate ligament (ACL) tears remains controversial. Recently, ACL primary repair has received increasing attention in ACL treatment. This study aimed to explore the histological characteristics of ACL healing in primary repair and compare its therapeutic and prognostic results with the reconstruction of acute proximal ACL tears. Histological experiments using rabbits and a prospective clinical trial were conducted. We established a rabbit model of ACL primary repair, and histological changes were observed using haematoxylin and eosin (HE) and toluidine blue staining. We performed immunohistochemical analysis of CD34 and S-100 and measured the expression of collagen I and II using qRT-PCR, Western blotting, and immunohistochemistry. The prospective clinical trial involved performing ACL primary repair and reconstruction in patients with acute proximal ACL tears to detect proprioception and evaluate the function of joints. We discovered that primary repair promoted cell proliferation in the tendon-bone transition and ligament portions, reduced osteoarthritis-like pathological changes, and maintained blood vessels and proprioceptors within the ACL. In the clinical trial, primary repair achieved similar therapeutic outcomes, including recovery of knee function and proprioception, in the follow-up period as ACL reconstruction. However, the primary repair had a significantly shorter operative time and lower cost than reconstruction. Therefore, doctors should consider the benefit of primary repair in treating acute proximal ACL tears.
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Affiliation(s)
- Yue Yang
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhuangzhuang Jin
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianghua Luo
- Department of Orthopedic Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Delong Zhang
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Shen
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dianbin Zheng
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Donghao Liu
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lunhao Bai
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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7
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Franciozi CE, Minami FK, Ambra LF, Galvão PHSAF, Schumacher FC, Kubota MS. Remnant preserving ACL reconstruction with a functional remnant is related to improved laxity but not to improved clinical outcomes in comparison to a nonfunctional remnant. Knee Surg Sports Traumatol Arthrosc 2022; 30:1543-1551. [PMID: 33893826 DOI: 10.1007/s00167-021-06572-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The Anterior cruciate ligament (ACL) remnant has been pointed out as a ligamentization enhancer. Nonetheless, the remaining tissue can be functional if it still provides some stability or nonfunctional. This study intends to compare the clinical results and knee stability of functional vs. nonfunctional remnant preservation ACL reconstruction (ACLR). METHODS One hundred and seventy-five patients with ACL injuries were included and underwent remnant preservation ACLR. They were divided into two groups accordingly to remnant tissue functionality: functional (Group F) and nonfunctional (Group NF). Primary outcome was defined as patient reported outcomes measured with Lysholm, IKDC and Tegner continuous scales and improvements. Secondary outcomes comprised of Lachman test, anterior drawer test, pivot shift test, extension and flexion deficit, graft coverage by remnant preserved tissue and failure rate (persistent instability or new ACL lesion). Menisci lesions, cartilage lesions and time to surgery were also recorded for each group. RESULTS One hundred and forty-four patients were available at a mean of 30.2 ± 10.1 months: 69 Functional and 75 Nonfunctional. Lysholm, IKDC and Tegner functional outcomes demonstrated no difference between the groups, Functional compared to Nonfunctional: 88.4 ± 10.5 vs. 92.2 ± 4.9, n.s. and 83.2 ± 11.3 vs. 87 ± 5.3, n.s. and 6 (5-10) vs. 6 (5-9), n.s., respectively. Lysholm and IKDC functional outcomes improvements demonstrated differences between the groups: Functional compared to Nonfunctional (39.3 ± 9.4 vs. 42.3 ± 7.4, p = 0.014 and 37.7 ± 10 vs. 41.0 ± 6.6, p = 0.032); however, they were not clinically significant. Functional group showed more stability on physical examination pre- and post-operatively (p < 0.001, p < 0.001). There was no difference regarding extension deficit (n.s.); however, functional group had more flexion deficit (p = 0.02). Nonfunctional group had better graft coverage (p = 0.001). There was no difference regarding failure rate: 4% vs. 9%, (n.s.). CONCLUSION Both remnant preservation ACLR techniques were able to achieve satisfactory functional outcomes. A functional remnant was not related to improved functional outcomes in comparison to a nonfunctional remnant; however, it was related to less laxity pre and postoperatively and inferior graft coverage. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Carlos Eduardo Franciozi
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil.,Knee Institute - Heart Hospital (Hospital do Coração - Hcor), São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Flávio Kazuo Minami
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil.
| | - Luiz Felipe Ambra
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Pedro Henrique Schmidt Alves Ferreira Galvão
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Felipe Conrado Schumacher
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Marcelo Seiji Kubota
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
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8
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Thaunat M, Foissey C, Ingale P, Haidar I, Bauwens PH, Penet A, Kacem S, Fayard JM. Survival and Risk Factor Analysis of Arthroscopic Ramp Lesion Repair During Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2022; 50:637-644. [PMID: 35099318 DOI: 10.1177/03635465211068524] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a lack of research on the management of ramp lesions associated with anterior cruciate ligament (ACL) injuries. Furthermore, there has been no report of the risk factors for failure of ramp lesion sutures, linked to either the technique used (all-inside suture implant vs suture hook through a posteromedial portal) or the type of lesion (location in the red zone or meniscocapsular junction, longitudinal extension, partial- or full-thickness tear). PURPOSE To evaluate the results of arthroscopic repair of ramp lesions and determine the risk factors associated with ramp lesion repair failure, with special focus on their subtype and the suture technique. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS All patients who underwent arthroscopic ramp lesion repair in association with ACL reconstruction between November 2015 and January 2018 were evaluated retrospectively. The following parameters were studied: demographics; clinical history; clinical findings including International Knee Documentation Committee score, complications, time from injury to surgery, side-to-side laxity, and pivot shift; and surgical findings including subtype, surgical management, and type and number of sutures. Failure of the ramp lesion repair was defined at secondary arthroscopy. RESULTS Among the 248 lesions analyzed, 18 (7.3%) failures were documented. The failures occurred in 21.1% of repairs managed with the all-inside device versus 4.3% of sutures managed with the suture hook (P = .003). Among the 6 factors included in the Cox model, the only one identified as a risk factor for failure was the type of repair (P = .003), with a risk for the all-inside device that was >5-fold higher than that for the suture hook repair (corresponding hazard ratio, 5.1 [95% CI, 1.8-14.5]). No other complications involving the surgical technique or device were registered. CONCLUSION An arthroscopic all-inside technique of meniscal repair of ramp lesions appeared to be safe and effective. It provided excellent healing of the repaired meniscus, with an overall failure rate of 7.3%. The type of suture was associated with failure of the ramp lesion repair, with a significantly higher risk with the all-inside device than with suture hook repair sutures.
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Affiliation(s)
- Mathieu Thaunat
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Constant Foissey
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Pramod Ingale
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Ibrahim Haidar
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Paul Henri Bauwens
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Alexandre Penet
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Samih Kacem
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Jean-Marie Fayard
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
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9
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Rodríguez-Merchán EC. Anterior Cruciate Ligament Reconstruction: Is Biological Augmentation Beneficial? Int J Mol Sci 2021; 22:ijms222212566. [PMID: 34830448 PMCID: PMC8625610 DOI: 10.3390/ijms222212566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 12/28/2022] Open
Abstract
Surgical reconstruction in anterior cruciate ligament (ACL) ruptures has proven to be a highly effective technique that usually provides satisfactory results. However, despite the majority of patients recovering their function after this procedure, ACL reconstruction (ACLR) is still imperfect. To improve these results, various biological augmentation (BA) techniques have been employed mostly in animal models. They include: (1) growth factors (bone morphogenetic protein, epidermal growth factor, granulocyte colony-stimulating factor, basic fibroblast growth factor, transforming growth factor-β, hepatocyte growth factor, vascular endothelial growth factor, and platelet concentrates such as platelet-rich plasma, fibrin clot, and autologous conditioned serum), (2) mesenchymal stem cells, (3) autologous tissue, (4) various pharmaceuticals (matrix metalloproteinase-inhibitor alpha-2-macroglobulin bisphosphonates), (5) biophysical/environmental methods (hyperbaric oxygen, low-intensity pulsed ultrasound, extracorporeal shockwave therapy), (6) biomaterials (fixation methods, biological coatings, biosynthetic bone substitutes, osteoconductive materials), and (7) gene therapy. All of them have shown good results in experimental studies; however, the clinical studies on BA published so far are highly heterogeneous and have a low degree of evidence. The most widely used technique to date is platelet-rich plasma. My position is that orthopedic surgeons must be very cautious when considering using PRP or other BA methods in ACLR.
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Affiliation(s)
- Emerito Carlos Rodríguez-Merchán
- Department of Orthopedic Surgery, La Paz University Hospital—IdiPaz, 28046 Madrid, Spain;
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research—IdiPAZ (La Paz University Hospital—Autonomous University of Madrid), 28046 Madrid, Spain
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Criss CR, Melton MS, Ulloa SA, Simon JE, Clark BC, France CR, Grooms DR. Rupture, reconstruction, and rehabilitation: A multi-disciplinary review of mechanisms for central nervous system adaptations following anterior cruciate ligament injury. Knee 2021; 30:78-89. [PMID: 33873089 DOI: 10.1016/j.knee.2021.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/18/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite surgical reconstruction and extensive rehabilitation, persistent quadriceps inhibition, gait asymmetry, and functional impairment remain prevalent in patients after anterior cruciate ligament (ACL) injury. A combination of reports have suggested underlying central nervous system adaptations in those after injury govern long-term neuromuscular impairments. The classic assumption has been to attribute neurophysiologic deficits to components of injury, but other factors across the continuum of care (e.g. surgery, perioperative analgesia, and rehabilitative strategies) have been largely overlooked. OBJECTIVE This review provides a multidisciplinary perspective to 1) provide a narrative review of studies reporting neuroplasticity following ACL injury in order to inform clinicians of the current state of literature and 2) provide a mechanistic framework of neurophysiologic deficits with potential clinical implications across all phases of injury and recovery (injury, surgery, and rehabilitation) RESULTS: Studies using a variety of neurophysiologic modalities have demonstrated peripheral and central nervous system adaptations in those with prior ACL injury. Longitudinal investigations suggest neurophysiologic changes at spinal-reflexive and corticospinal pathways follow a unique timecourse across injury, surgery, and rehabilitation. CONCLUSION Clinicians should consider the unique injury, surgery, anesthesia, and rehabilitation on central nervous system adaptations. Therapeutic strategies across the continuum of care may be beneficial to mitigate maladaptive neuroplasticity in those after ACL injury.
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Affiliation(s)
- Cody R Criss
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.
| | - M Stephen Melton
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Sergio A Ulloa
- OhioHealth Physician Group Heritage College: Orthopedic and Sports Medicine, OhioHealth O'Bleness Memorial Hospital, Athens, OH, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Department of Psychology, College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA; Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
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11
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Pioger C, Saithna A, Rayes J, Haidar IM, Fradin T, Ngbilo C, Vieira TD, Cavaignac E, Sonnery-Cottet B. Influence of Preoperative Tunnel Widening On the Outcomes of a Single Stage-Only Approach to Every Revision Anterior Cruciate Ligament Reconstruction: An Analysis of 409 Consecutive Patients From the SANTI Study Group. Am J Sports Med 2021; 49:1431-1440. [PMID: 33689510 DOI: 10.1177/0363546521996389] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preoperative tunnel widening is a frequently reported indication for performing a 2-stage revision anterior cruciate ligament reconstruction (ACLR) instead of a single-stage procedure. However, the strength of the available evidence to support a 2-stage strategy is low. PURPOSE/HYPOTHESIS The purpose was to evaluate the clinical outcomes of a single stage-only approach to revision ACLR. It was hypothesized that this approach would be associated with significant improvements from baseline in patient-reported outcome measures (PROMs) and knee stability and that there would be no significant differences in any postoperative outcomes between patients with and without preoperative tunnel widening. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was conducted of a large series of consecutive patients undergoing revision ACLR with a minimum follow-up of 2 years. Preoperative tunnel widening was assessed using digital radiographs. All patients underwent single-stage surgery with an outside-in technique, regardless of the degree of tunnel widening. Clinical outcomes were compared according to whether tunnel widening was present (either tunnel ≥12 mm) or not (both tunnels <12 mm). RESULTS The study included 409 patients with a mean ± SD follow-up of 69.6 ± 29.0 months. After revision ACLR, there was a significant reduction in the side-to-side anteroposterior laxity difference, from 7.7 ± 2.2 mm preoperatively to 1.2 ± 1.1 mm at 2 years (P < .001). The mean International Knee Documentation Committee (IKDC) and all subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) exceeded the thresholds for the Patient Acceptable Symptom State defined for primary ACLR. An overall 358 patients had retrievable preoperative radiographs. According to the tunnel diameter measurements, 111 patients were allocated to group A (both tunnels <12 mm) and 247 patients to group B (either/both tunnels ≥12 mm). There were no significant differences between groups with respect to anteroposterior side-to-side laxity difference, graft rupture rates, non-graft rupture related reoperations, or contralateral anterior cruciate ligament injury rates. There was also no significant difference between groups that exceeded minimal detectable change thresholds for any of the PROMs recorded (ACL-RSI [Anterior Cruciate Ligament-Return to Sports After Injury], Lysholm, Tegner, IKDC, KOOS). CONCLUSION A single-stage approach to revision ACLR is associated with excellent clinical results when an outside-in drilling technique is utilized. The presence of preoperative tunnel widening does not significantly influence PROMs, knee stability, graft rupture rates, or non-graft rupture related reoperation rates.
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Affiliation(s)
- Charles Pioger
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Adnan Saithna
- Arizona Brain, Spine and Sports Injuries Center, Scottsdale, Arizona, USA
| | - Johnny Rayes
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Ibrahim M Haidar
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thomas Fradin
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Cedric Ngbilo
- 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
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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12
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Webster KE, Murgier J, Feller JA, Klemm HJ, Devitt BM, Whitehead TS. Preservation of the Tibial Stump During Anterior Cruciate Ligament Reconstruction Surgery Did Not Increase the Rate of Surgery for Symptomatic Cyclops Lesions. Orthop J Sports Med 2021; 9:2325967121992517. [PMID: 33889640 PMCID: PMC8040594 DOI: 10.1177/2325967121992517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/24/2020] [Indexed: 01/12/2023] Open
Abstract
Background Preservation of the tibial stump during anterior cruciate ligament reconstruction (ACLR) is controversial. While proposed benefits include enhanced graft revascularization, improved proprioception, and decreased graft rupture rates, a potential complication is the development of a symptomatic cyclops lesion. It is therefore important to determine whether any benefits outweigh potential complications. Purpose To determine whether greater preservation of the tibial stump remnant would be associated with a decreased graft rupture rate without a concomitant increase in the rate of surgery for symptomatic cyclops lesions at 2 years after ACLR. Study Design Cohort study; Level of evidence, 3. Methods A cohort of 658 patients in whom the amount of tibial stump preserved was classified as no stump (n = 228), <50% (n = 342), or >50% (n = 88) was followed up for 2 years, with graft ruptures and surgical treatment for cyclops lesions recorded. Contingency and Kaplan-Meier survival analyses were used to determine trends among the 3 remnant preservation groups in terms of graft rupture rates and surgery for cyclops lesions. Subgroup analysis was also conducted to examine sex-based differences. Results There was no significant association between graft rupture rates and remnant preservation. There was a significant trend for fewer operations for symptomatic cyclops lesions with greater remnant preservation when the entire cohort was analyzed (P = .04) and also when only female patients were analyzed (P = .04). Conclusion Although preservation of the tibial stump remnant was not associated with a reduced graft rupture rate, it was also not associated with increased rates of surgery for symptomatic cyclops lesions.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Jerome Murgier
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Victoria, Australia.,Aguiléra Private Clinic, Ramsey Générale de Santé, Biarritz, France
| | - Julian A Feller
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,OrthoSport Victoria, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Haydn J Klemm
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Brian M Devitt
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Victoria, Australia
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Rassi GE, Maalouly J, Tawk A, Aouad D. All-Inside Anterior Cruciate Ligament Reconstruction With Augmentation Using the Native Anterior Cruciate Ligament Remnant by Suture Approximation. Arthrosc Tech 2021; 10:e647-e652. [PMID: 33738197 PMCID: PMC7953079 DOI: 10.1016/j.eats.2020.10.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/23/2020] [Indexed: 02/03/2023] Open
Abstract
Anterior cruciate ligament (ACL) rupture remains a debilitating orthopaedic pathology with a substantial economic and psychological burden on patients, especially athletes. The purpose of ACL reconstruction is to attain maximum joint stability and functionality, allowing patients to resume their previous level of activity. Several graft options and techniques are available for ACL reconstruction. The all-inside remnant-preservation technique is a minimally invasive approach aiming for improved proprioception, better graft integration, and increased graft strength via ACL augmentation by suture approximation with an optimal anatomic reconstruction. ACL augmentation is associated with a decreased risk of rerupture. Moreover, enhancement of knee proprioception via the presented technique allows an early return to activity by patients because weight bearing (with a brace) can be initiated as early as day 1 postoperatively. Patients can resume running activities by 2 months postoperatively and return to pivot sports by 3 months postoperatively. Despite this surgical procedure being technically demanding, it is associated with improved clinical outcomes and functional capacities. Patients are also found to better tolerate the postoperative rehabilitation protocol.
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Affiliation(s)
| | | | | | - Dany Aouad
- Address correspondence to Dany Aouad, M.D., Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, PO Box 166378, Achrafieh, Lebanon, Beirut, 1100 2807.
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Management of Partial Tears of the Anterior Cruciate Ligament: A Review of the Anatomy, Diagnosis, and Treatment. J Am Acad Orthop Surg 2021; 29:60-70. [PMID: 33394613 DOI: 10.5435/jaaos-d-20-00242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Partial anterior cruciate ligament (ACL) tears comprise an estimated 10% to 27% of isolated ACL injuries. Partial ACL tears may be challenging to clinically diagnose. We reviewed relevant studies focusing on the anatomy, diagnosis, imaging, and treatment of a partial injury with the goal of providing guidance to clinicians. Although a comprehensive patient history, thorough clinical examination, and imaging studies are helpful in arriving at a diagnosis, the benchmark for diagnosis remains visualization and examination of the ACL at the time of knee arthroscopy. Currently, limited data exist about the long-term outcomes of nonsurgical treatment. Some studies demonstrate that younger, active patients have the risk of progressing to a complete ACL rupture with conservative treatment. The decision to proceed with surgery is based on careful history and physical examination findings that suggest either a "functional" or "nonfunctional" ACL. Surgical treatment consists of augmenting the intact bundle with a selective bundle reconstruction versus a traditional ACL reconstruction. Selective bundle reconstruction has limited data available but is an option. The best evidence supports traditional ACL reconstruction for the surgical management of patients with documented nonfunctional partial tears of the ACL.
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McKeon BP, Zaslav KR, Alfred RH, Alley RM, Edelson RH, Gersoff WK, Greenleaf JE, Kaeding CC. Preliminary Results From a US Clinical Trial of a Novel Synthetic Polymer Meniscal Implant. Orthop J Sports Med 2020; 8:2325967120952414. [PMID: 33062765 PMCID: PMC7536377 DOI: 10.1177/2325967120952414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/09/2020] [Indexed: 01/03/2023] Open
Abstract
Background: At least 760,000 outpatient meniscectomies are performed in the United States
each year, making this the most common musculoskeletal procedure. However,
meniscal resection can alter the joint biomechanics and overload the
articular cartilage, which may contribute to degenerative changes and the
need for knee replacement. Avoiding or delaying knee replacement is
particularly important in younger or more active patients. Synthetic
meniscal implants have been developed in an attempt to restore the natural
joint biomechanics, alleviate pain and disability, and potentially minimize
degenerative changes in patients who require meniscectomy. Purpose To evaluate the preliminary results from 2 ongoing trials that are evaluating
the safety and effectiveness of a synthetic polymer meniscal implant
(NUsurface; Active Implants, LLC). Study Design: Cohort study; Level of evidence, 2. Methods: This was a preliminary analysis of the first 100 patients enrolled across 2
studies for 12 months: a single-arm, intervention-only study and a
randomized controlled trial comparing the investigational meniscal implant
with nonsurgical therapy. There were 65 patients in the implant group (30
randomized) and 35 in the control group. Outcomes included Knee injury and
Osteoarthritis Outcome Score (KOOS) and adverse events (AEs) collected at
baseline and follow-up visits of 6 weeks, 6 months, and 12 months. Results: No statistically significant differences were found in baseline
characteristics between the implant and control groups. At 12 months,
follow-up KOOS data were available for 87% of the 100 included patients.
Significantly greater improvements from baseline were observed in the
implant group compared with controls in all KOOS subcomponents, except for
symptoms (119%-177% greater improvement at 12 months). AEs were reported at
similar rates between the 2 groups, with 12 AEs among 11 patients in the
implant group (16.9%) versus 5 AEs among 5 patients (14.3%) in the control
group (P = .99). Conclusion: These preliminary results suggest significant improvements in pain and
function scores with the implant over nonsurgical therapy and a similar
adverse event rate.
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Affiliation(s)
- Brian P McKeon
- Boston Sports & Shoulder Center, Waltham, Massachusetts, USA
| | - Kenneth R Zaslav
- Ortho Virginia, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Richard H Alfred
- The Bone & Joint Center and Albany Medical College, Albany, New York, USA
| | - R Maxwell Alley
- The Bone & Joint Center and Albany Medical College, Albany, New York, USA
| | | | - Wayne K Gersoff
- Advanced Orthopedic and Sports Medicine Specialists, Denver, Colorado, USA
| | | | - Christopher C Kaeding
- Sports Medicine Institute and Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Kambhampati SBS, Gollamudi S, Shanmugasundaram S, Josyula VVS. Cyclops Lesions of the Knee: A Narrative Review of the Literature. Orthop J Sports Med 2020; 8:2325967120945671. [PMID: 32923503 PMCID: PMC7457408 DOI: 10.1177/2325967120945671] [Citation(s) in RCA: 15] [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] [Received: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 11/16/2022] Open
Abstract
Cyclops lesion is a known complication of anterior cruciate ligament
reconstruction (ACLR). Although the incidence of cyclops lesion appears to be
decreasing, it remains an important cause of restriction of extension after
ACLR. We reviewed the available literature regarding the cyclops lesion and
syndrome and cyclops-like lesions to analyze available evidence on cyclops
lesions and variants of cyclops lesions. A keyword search in PubMed, Scopus, Web
of Science, and EMBASE, Ovid Medline, and Ovid journals provided 47 relevant
articles in the English literature, which were used to create this review. We
classified cyclops lesions based on clinical presentation, pathology, and
location. Risk factors, management options, tips to reduce the condition, and
controversies related to the condition have been discussed. Female sex, greater
graft volume, bony avulsion injuries, excessively anterior tibial tunnel,
double-bundle ACLR, and bicruciate-retaining arthroplasty appear to predispose
patients to cyclops lesions. Cyclops syndrome is a cyclops lesion that causes a
loss of terminal extension. Arthroscopic debridement is an effective treatment
for cyclops syndrome, whereas cyclops lesions are usually managed
conservatively. It is important to distinguish between cyclops lesion and
cyclops syndrome, as management differs based on symptoms. Cyclops lesion is
diagnosed using magnetic resonance imaging. The management of choice for
symptomatic lesions is surgical excision. Outcomes after excision are very good,
and recurrence is rare.
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Affiliation(s)
- Srinivas B S Kambhampati
- Sri Dhaatri Orthopaedic, Maternity & Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh, India
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Rothrauff BB, Kondo E, Siebold R, Wang JH, Yoon KH, Fu FH. Anterior cruciate ligament reconstruction with remnant preservation: current concepts. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Anterior cruciate ligament (ACL) tears are a common knee injury, and anatomic ACL reconstruction (ACLR) is now the standard of care to restore knee stability. Nevertheless, re-tear rates exceeding 5% are commonly reported, with an even higher percentage of patients unable to achieve preinjury knee function. As the torn ACL remnant contains elements (eg, cells, blood vessels and mechanoreceptors) essential to ACL function, it has been hypothesised that ACLR with remnant preservation may improve graft remodelling, in turn more quickly and completely restoring ACL structure and function. In this Current Concepts review, we summarise the present understanding of ACLR with remnant preservation, which includes selective bundle reconstruction of partial (one-bundle) ACL tears and single- and double-bundle ACLR with minimal to partial debridement of the torn ACL stump. Reported benefits of remnant preservation include accelerated graft revascularisation and remodelling, improved proprioception, decreased bone tunnel enlargement, individualised anatomic bone tunnel placement, improved objective knee stability and early mechanical support (with selective bundle reconstruction) to healing tissues. However, clinical studies of ACLR with remnant preservation are heterogeneous in the description of remnant characteristics and surgical technique. Presently, there is insufficient evidence to support the superiority of ACLR with remnant preservation over the standard technique. Future studies should better describe the ACL tear pattern, remnant volume, remnant quality and surgical technique. Progress made in understanding and applying remnant preservation may inform, and be reciprocally guided by, ongoing research on ACL repair. The goal of research on ACLR with remnant preservation is not only to achieve anatomic structural restoration of the ACL but also to facilitate biologic healing and regeneration to ensure a more robust and functional graft.
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Chahla J, Nelson T, Dallo I, Yalamanchili D, Eberlein S, Limpisvasti O, Mandelbaum B, Metzger MF. Anterior cruciate ligament repair versus reconstruction: A kinematic analysis. Knee 2020; 27:334-340. [PMID: 31813701 DOI: 10.1016/j.knee.2019.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/10/2019] [Accepted: 10/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to compare the biomechanical properties of an anterior cruciate ligament (ACL) anatomic repair of a true femoral avulsion to an anatomic ACL reconstruction. It was hypothesized that the ACL repair and ACL reconstruction would have comparable biomechanical behavior when compared to the native knee. METHODS Ten paired fresh-frozen cadaveric knees (n = 20) were used to investigate knee kinematics when an anterior drawer force, varus, valgus, internal, and external rotational moment were applied at 0, 15, 30, 45, 60, and 90 degrees of flexion. Displacement and rotation were recorded in the following conditions: ACL-intact, ACL-deficient, and ACL-repaired vs reconstructed. RESULTS Sectioning of the ACL significantly increased anterior tibial translation (0°, 15°, 30° and 45°) compared to the intact state. The mean anterior displacement difference from intact was lower in the ACL-repaired knees compared to reconstructed knees at 30° and 90°. There were no significant differences between conditions in varus, valgus, internal, or external rotations. CONCLUSION ACL repair and ACL reconstruction procedures restored knee anterior tibial translation in matched paired specimens. There were no differences in valgus, varus, internal, or external rotation. Although, ACL-repaired knees (avulsion model) demonstrated less anterior tibial translation when compared to ACL-reconstructed knees, this difference was less than one millimeter. Based on the findings of this study, repair and reconstruction procedures both restored anterior tibial translation in matched-pair specimens. This suggests that the initial functionality of both techniques is similar and that further clinical studies are needed to compare the long-term stability.
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Affiliation(s)
- Jorge Chahla
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Trevor Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ignacio Dallo
- Unit of Regenerative Therapy and Arthroscopy Surgery, Sanatorio Garay, Santa Fe, Argentina
| | - Dheeraj Yalamanchili
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Sam Eberlein
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Orr Limpisvasti
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Bert Mandelbaum
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, CA, United States of America
| | - Melodie F Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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Delaloye JR, Murar J, Vieira TD, Franck F, Pioger C, Helfer L, Saithna A, Sonnery-Cottet B. Knee Extension Deficit in the Early Postoperative Period Predisposes to Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction: A Risk Factor Analysis in 3633 Patients From the SANTI Study Group Database. Am J Sports Med 2020; 48:565-572. [PMID: 31930921 DOI: 10.1177/0363546519897064] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cyclops syndrome is characterized by a symptomatic extension deficit attributed to impingement of a cyclops lesion within the intercondylar notch. The syndrome is an important cause of reoperation after anterior cruciate ligament reconstruction (ACLR). It has been suggested that remnant-preserving ACLR techniques may predispose to cyclops syndrome, but there is very limited evidence to support this. In general terms, risk factors for cyclops syndrome are not well-understood. PURPOSE To determine the frequency of and risk factors for reoperation for cyclops syndrome in a large series of patients after ACLR. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A retrospective analysis of prospectively collected data was performed, including all patients who underwent primary ACLR between January 2011 to December 2017. Patients undergoing major concomitant procedures were excluded. Demographic data, intraoperative findings (including the size of preserved remnants), and postoperative outcomes were recorded. Those patients who underwent reoperation for cyclops syndrome were identified, and potential risk factors were evaluated in multivariate analysis. RESULTS A total of 3633 patients were included in the study, among whom 65 (1.8%) underwent reoperation for cyclops syndrome. Multivariate analysis demonstrated that preservation of large remnants did not predispose to cyclops lesions (odds ratio [OR], 1.11; 95% CI, 0.63-1.93). The most important risk factor was extension deficit in the early postoperative period. If present at 3 weeks postoperatively, it was associated with a >2-fold increased risk of cyclops syndrome (OR, 2.302; 95% CI, 1.268-4.239; P < .01), which was increased to 8-fold if present 6 weeks after ACLR (OR, 7.959; 95% CI, 4.442-14.405; P < .0001). None of the other potential risk factors evaluated were found to be significantly associated with an increased frequency of cyclops syndrome. CONCLUSION Failure to regain full extension in the early postoperative period was the only significant risk factor for cyclops syndrome after ACLR in a large cohort of patients. Other previously hypothesized risk factors, such as preservation of a large anterior cruciate ligament remnant, did not predispose to the development of this debilitating postoperative complication.
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Affiliation(s)
- Jean-Romain Delaloye
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Jozef Murar
- Twin Cities Orthopedics, Edina, Minnesota, USA
| | - Thais D Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Florent Franck
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Charles Pioger
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Lionel Helfer
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Adnan Saithna
- Sano Orthopedics, Overland Park, Kansas, USA.,Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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20
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Triaxial accelerometer evaluation is correlated with IKDC grade of pivot shift. Knee Surg Sports Traumatol Arthrosc 2020; 28:381-388. [PMID: 31201443 DOI: 10.1007/s00167-019-05563-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the correlation between tibial acceleration parameters measured by the KiRA device and the clinical grade of pivot shift. The secondary objective was to report the risk factors for pre-operative high-grade pivot shift. METHODS Two-hundred and ninety-five ACL deficient patients were examined under anesthesia. The pivot shift tests were performed twice by an expert surgeon. Clinical grading was performed using the International Knee Documentation Committee (IKDC) scale and tibial acceleration data was recorded using a triaxial accelerometer system (KiRA). The difference in the tibial acceleration range between injured and contralateral limbs was used in the analysis. Correlation coefficients were calculated using linear regression. Multivariate logistic regression was used to identify risk factors for high grade pivot shift. RESULTS The clinical grade of pivot shift and the side-to-side difference in delta tibial acceleration determined by KiRA were significantly correlated (r = 0.57; 95% CI 0.513-0.658, p < 0.0001). The only risk factor identified to have a significant association with high grade pivot shift was an antero-posterior side to side laxity difference > 6 mm (OR = 2.070; 95% CI (1.259-3.405), p = 0.0042). CONCLUSION Side-to-side difference in tibial acceleration range, as measured by KiRA, is correlated with the IKDC pivot shift grade in anaesthetized patients. Side-to-side A-P laxity difference greater than 6 mm is reported as a newly defined risk factor for high grade pivot shift in the ACL injured knee. DIAGNOSTIC STUDY Level II.
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21
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Sonnery-Cottet B, Ouanezar H, Vieira TD, Freychet B, Daggett M, Clechet J, Saithna A. High Risk of Tunnel Convergence in Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-articular Tenodesis: Letter to the Editor. Am J Sports Med 2019; 47:NP67-NP68. [PMID: 31567031 DOI: 10.1177/0363546519869244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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22
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Tachibana Y, Shino K, Mae T, Iuchi R, Take Y, Nakagawa S. Anatomical rectangular tunnels identified with the arthroscopic landmarks result in excellent outcomes in ACL reconstruction with a BTB graft. Knee Surg Sports Traumatol Arthrosc 2019; 27:2680-2690. [PMID: 30460396 DOI: 10.1007/s00167-018-5300-0] [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: 04/22/2018] [Accepted: 11/13/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To elucidate tunnel locations and clinical outcomes after anatomic rectangular tunnel (ART) anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BTB) graft. METHODS Sixty-one patients with a primary unilateral ACL injury were included. Tunnels were created inside the ACL attachment areas after carefully removing the ACL remnant and clearly identifying the bony landmarks. Using 3-dimensional computed tomography (3-D CT) images, the proportion of the tunnel apertures to the anatomical attachment areas was evaluated at 3 weeks. The clinical outcomes were evaluated at 2 years postoperatively. RESULTS Geographically, the 3-D CT evaluation showed the entire femoral tunnel aperture; at least 75% of the entire tibial tunnel aperture area was consistently located inside the anatomical attachment areas surrounded by the bony landmarks. In the International Knee Documentation Committee (IKDC) subjective assessment, all patients were classified as 'normal' or 'nearly normal'. The Lachman test and pivot-shift test were negative in 98.4% and 95.1% of patients, respectively. The mean side-to-side difference of the anterior laxity at the maximum manual force with a KT- 1000 Knee Arthrometer was 0.2 ± 0.9 mm, with 95.1% of patients ranging from - 1 to + 2 mm. CONCLUSION By identifying arthroscopic landmarks, the entire femoral tunnel aperture and at least 75% of the entire tibial tunnel aperture area were consistently located inside the anatomical attachment areas. With properly created tunnels inside the anatomical attachment areas, the ART ACLR using a BTB graft could provide satisfactory outcomes both subjectively and objectively in more than 95% of patients. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Yuta Tachibana
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan.
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ryo Iuchi
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Yasuhiro Take
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Shigeto Nakagawa
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
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23
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Fayard JM, Sonnery-Cottet B, Vrgoc G, O'Loughlin P, de Mont Marin GD, Freychet B, Vieira TD, Thaunat M. Incidence and Risk Factors for a Partial Anterior Cruciate Ligament Tear Progressing to a Complete Tear After Nonoperative Treatment in Patients Younger Than 30 Years. Orthop J Sports Med 2019; 7:2325967119856624. [PMID: 31360732 PMCID: PMC6636223 DOI: 10.1177/2325967119856624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Partial anterior cruciate ligament (ACL) tears are observed in 10% to 27% of isolated ACL tears. There is currently no consensus on diagnosis and treatment protocols, and the outcomes of nonoperative treatment remain undefined. Purpose: To assess the incidence and risk factors for the progression of partial ACL tears to complete ruptures after nonoperative treatment in active patients younger than 30 years. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 41 patients, all younger than 30 years and active in sports, were diagnosed with a partial ACL tear, with no associated meniscal or chondral lesions on magnetic resonance imaging (MRI). All were assigned to a nonoperative treatment program. The Lachman test, ≤4-mm side-to-side difference in laxity by Rolimeter, and MRI were utilized for the diagnosis. Tegner and International Knee Documentation Committee (IKDC) scores were assessed before and after the first lesion, and the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) score was assessed at last follow-up. Postinjury Tegner and IKDC scores were assessed before the second injury for patients progressing to a complete ACL tear and at last follow-up for patients without progression. Results: At a mean of 43 months (range, 24-96 months), the partial ACL injury progressed to a complete ACL tear in 16 (39%) patients. In the remaining 25 patients without progression, the mean Tegner and IKDC scores were 7.0 and 96.0 before the injury and 5.9 and 85.7, respectively, at last follow-up. The mean ACL-RSI score was 69.3. The Tegner and IKDC scores were significantly lower at final follow-up (P = .0002 and P < .0001, respectively). Only 18 (44%) patients returned to their preinjury level of sports activities. A significantly increased risk of progression to a complete ACL tear was seen in patients ≤20 years (odds ratio, 5.19; P = .037) or patients practicing pivoting contact sports (odds ratio, 6.29; P = .026). Meniscal lesions were found in 50% of patients with a partial tear that progressed to a complete ACL tear. Conclusion: A partial ACL injury progressed to a complete ACL tear in 39% of young active patients treated conservatively, with half of the complete tears presenting with a concomitant meniscal lesion at the time of reconstruction. Age ≤20 years and participation in pivoting contact sports were identified as significant risk factors for progression to a complete tear.
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Affiliation(s)
- Jean-Marie Fayard
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Goran Vrgoc
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Department of Orthopaedic Surgery, University Hospital "Sveti Duh," Zagreb, Croatia
| | - Padhraig O'Loughlin
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Mater Private Hospital, Cork, Ireland
| | - Geoffroy Dubois de Mont Marin
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Hôpital Trousseau, CHRU de Tours, Chambray-lès-Tours, France
| | - Benjamin Freychet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais D Vieira
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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24
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Ge H, Liu C, Shrestha A, Wu P, Cheng B. Do Nonsteroidal Anti-Inflammatory Drugs Affect Tissue Healing After Arthroscopic Anterior Cruciate Ligament Reconstruction? Med Sci Monit 2018; 24:6038-6043. [PMID: 30160247 PMCID: PMC6128182 DOI: 10.12659/msm.910942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Experimental studies have reported nonsteroidal anti-inflammatory drugs (NSAIDs) could impair tendon healing. The purpose of this study was to investigate whether NSAIDs could affect recovery of knee joint function in patients after anterior cruciate ligament (ACL) reconstruction. Material/Methods We enrolled 40 patients treated with celecoxib and 40 patients treated with tramadol, who underwent ACL reconstruction from January 2011 to December 2017. Visual analogue scale (VAS) and functional outcomes were collected and evaluated. The follow-up period was 12 months. Results In both groups, all patients obtained pain release after surgery, compared with that before surgery. But no significant differences were observed between the 2 groups in VAS scores. We also did not find any differences between the 2 groups at 1 year of follow-up, in terms of anterior drawer test, Lachman test, side-to-side laxity assessed by KT-2000, IKDC score, Lysholm score, and Tegner scale. However, the celecoxib group showed a reduced incidence of nausea compared to the tramadol group (P=0.048). Conclusions The use of NSAIDs after ACL reconstruction is relatively safe and could decrease adverse side effects which were caused by opioid drugs.
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Affiliation(s)
- Heng'an Ge
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Tongji University School of Medicine, Shanghai, China (mainland)
| | - Centao Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Suzhou University School of Medicine, Suzhou, Jiangsu, China (mainland)
| | - Amrit Shrestha
- Shiva Jyoti Hospital and Research Center PVT. Ltd., Kathmandu, Nepal
| | - Peng Wu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Biao Cheng
- Department of Orthopeadics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Boutsiadis A, Panisset JC, Devitt BM, Mauris F, Barthelemy R, Barth J. Anterior Laxity at 2 Years After Anterior Cruciate Ligament Reconstruction Is Comparable When Using Adjustable-Loop Suspensory Fixation and Interference Screw Fixation. Am J Sports Med 2018; 46:2366-2375. [PMID: 30015501 DOI: 10.1177/0363546518784005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adjustable-loop suspensory fixation (ALSF) devices are commonly used in anterior cruciate ligament reconstruction (ACLR). However, concern exists regarding the potential for lengthening under cyclical loads. PURPOSE To compare the residual anterior laxity of 2 methods of femoral fixation, ALSF versus interference screw fixation, in patients undergoing isolated ACLR in the absence of meniscal injuries. To determine the preoperative risk factors associated with residual postoperative anterior laxity. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was performed comparing 2 groups of patients that underwent primary ACLR using ALSF versus bioabsorbable interference screw fixation. Anterior knee laxity was assessed with Telos stress radiography, while functional outcomes were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity level scale at a minimum of 2 years postoperatively. A multivariate analysis was performed to identify factors associated with residual postoperative laxity >3 mm. RESULTS Of the 1136 patients who underwent ACLR during the study period, 363 met the inclusion criteria. A total of 272 patients (75%) (mean age, 31.7 ± 10.7 years) with a mean follow-up of 25.7 ± 4.6 months (range, 24-36 months) consented to participate (screw group: n = 121; ALSF group: n = 151). The 2 groups were statistically comparable in terms of age, sex ratio, time from injury to surgery, graft diameter, preoperative laxity, preoperative objective International Knee Documentation Committee (IKDC) grade, and preoperative Tegner score. The mean postoperative laxity as a continuous variable was significantly different comparing the ALSF and screw groups (1.49 ± 1.98 mm and 2.32 ± 1.97 mm, respectively; P < .001). In the screw group, 76 patients (62.8%) had normal (<3 mm), 40 (33.1%) had nearly normal (3-6 mm), and 5 (4.1%) had abnormal (≥6 mm) postoperative knee laxity according to the IKDC grade, while in the ALSF group, 112 patients (74.2%) had normal, 37 (24.5%) had nearly normal, and 2 (1.3%) had abnormal laxity ( P = .0833). No significant difference was found in KOOS or Tegner scores comparing the 2 femoral fixation methods: KOOS, 90.6 ± 7.5 (ALSF group) and 90.6 ± 7.4 (screw group) ( P = .7631), versus Tegner, 6.5 ± 1.3 (ALSF group) and 6.3 ± 1.4 (screw group) ( P = .2992). A negative correlation was found between postoperative laxity and final Tegner ( rs = -0.303, P < .001) and KOOS scores ( rs = -0.168, P = .005). The initial univariate analysis showed differences between groups of patients with residual knee laxity ≥3 mm and <3 mm on preoperative pivot shift, preoperative laxity, age, fixation type, and preoperative objective IKDC grade. The multivariate analysis on these factors showed that the pivot shift remained the only significant predictor for residual laxity ≥3 mm for pivot shift grade 2 compared with grade 1 (odds ratio, 4.689 [95% CI, 2.465-9.286]) and for pivot shift grade 3 compared with grade 1 (odds ratio, 58.025 [95% CI, 12.757-557.741]) ( P < .001). CONCLUSION For primary ACLR, the use of an ALSF device for femoral fixation is associated with noninferior postoperative anterior knee laxity results compared with interference screw fixation at a minimum 2 years' follow-up. The preoperative pivot shift is the only significant risk factor for postoperative residual anterior knee laxity >3 mm.
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Affiliation(s)
- Achilleas Boutsiadis
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | - Jean-Claude Panisset
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | | | - Frédéric Mauris
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | | | - Johannes Barth
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
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26
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Editorial Commentary: Anterior Cruciate Ligament Augmentation: A Bold, Technically Demanding Surgical Technique… But Don't Forget to Evaluate the Benefit-Risk Ratio! Arthroscopy 2018; 34:723-725. [PMID: 29502692 DOI: 10.1016/j.arthro.2017.10.020] [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: 10/18/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 02/02/2023]
Abstract
Preserving the remnant tissues in anterior cruciate ligament reconstruction, commonly referred to as anterior cruciate ligament augmentation, is an option in the "surgery à la carte" menu that the surgeon may choose from to adapt the surgical technique depending on each patient's specific needs. When possible, preserving this remnant offers definite benefits: improved vascularization, presence of neurosensors, and even mechanical advantages. However, this technique may prove to be tricky, especially when the intercondylar notch is not clearly visible and when the surgeon lacks experience. The benefit-risk ratio must be carefully weighed for each case.
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