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Hung YC, Chuang CA, Yao SY, Lin KY, Hung SF, Chen YJ, Chiu CH, Ho CS, Yang CP, Chan YS. Correlation between higher lateral tibial slope and inferior long term subjective outcomes following single bundle anterior cruciate ligament reconstruction. J Orthop Surg Res 2024; 19:315. [PMID: 38807173 PMCID: PMC11131331 DOI: 10.1186/s13018-024-04795-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The impact of anatomical factors, such as the lateral tibial slope (LTS), on outcomes following anterior cruciate ligament (ACL) reconstruction is an area of growing interest. This study was led by the observation that patients with a higher LTS may have different recovery trajectories. HYPOTHESIS/PURPOSE The purpose of this study was to investigate the correlation between a higher LTS and long term subjective outcomes following single-bundle ACL reconstruction. STUDY DESIGN This study was designed as a retrospective cohort study. METHODS The study comprised 138 patients who underwent single-bundle ACL reconstruction. The LTS was measured on preoperative radiographs. Patient-reported outcome measures (PROMs) were collected, which included the Lysholm Knee Score, UCLA Activity Score, IKDC Score, and Tegner Activity Score, over a mean follow-up duration of 137 months. RESULTS A significant negative correlation was found between LTS and all measured PROMs (p < 0.001). The established cut-off value of LTS distinguishing between "Good" and "Fair" Lysholm scores was 8.35 degrees. Female patients have statistically significant higher LTS and lower PROMs scores than male. Patients with LTS greater than or equal to 8.35 had significantly lower PROMs, indicative of poorer functional and subjective outcomes. CONCLUSION Our findings suggest that a higher LTS is associated with inferior subjective outcomes following single-bundle ACL reconstruction in long term. The LTS cut-off value of 8.35 degrees could potentially be used as a reference in preoperative planning and patient counseling. CLINICAL RELEVANCE Understanding the relationship between LTS and ACL reconstruction outcomes could inform surgical planning and postoperative management. These findings highlight the need to consider anatomical variances, such as LTS, when assessing patient-specific risks and recovery expectations, contributing to the advancement of personalized care in sports medicine.
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Affiliation(s)
- Yu-Chieh Hung
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan
| | - Chieh-An Chuang
- Comprehensive Sports Medicine Center, Taoyuan Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan
| | - Shang-Yu Yao
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan
| | - Keng-Yi Lin
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan
| | - Shih-Feng Hung
- Department of Orthopedic Surgery, Taoyuan Hospital, Ministry of Health and Welfare, Taoyuan City, 333, Taiwan
| | - Yi-Jou Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan
| | - Chih-Hao Chiu
- Comprehensive Sports Medicine Center, Taoyuan Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan
| | - Chin-Shan Ho
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan City, 333, Taiwan
| | - Cheng-Pang Yang
- Comprehensive Sports Medicine Center, Taoyuan Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung City, 204, Taiwan.
- Comprehensive Sports Medicine Center, Taoyuan Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
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Zhu S, Li R. All-Inside Anterior Cruciate Ligament Reconstruction Had Clinical Outcome Similar to the Transtibial Technique Except for Improved Side-to-Side Difference and Tegner Activity Scale: A Systematic Review and Meta-Analysis. Arthroscopy 2024:S0749-8063(24)00100-2. [PMID: 38354760 DOI: 10.1016/j.arthro.2024.01.044] [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: 10/19/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE To compare clinical outcomes of the all-inside technique with the transtibial technique in anterior cruciate ligament reconstruction based on available literature on this topic. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, we conducted a systematic search for randomized controlled trials and cohort studies. Our comprehensive search encompassed PubMed, Embase, Cochrane Library, and Web of Science. We included randomized controlled trials (RCTs) and cohort studies that compared the 2 techniques with a minimal 1-year follow-up. Two independent authors assessed RCTs using the risk of bias tool developed by the Cochrane Collaboration and evaluated the quality of cohort studies using the Newcastle-Ottawa Scale for Assessing the Quality of Nonrandomized Comparative Trials. The subjective and objective outcomes, complications, and graft failure were obtained. R software was used to perform the analysis. RESULTS The present analysis enrolled 9 RCTs (n = 687) and 11 cohort studies (n = 910). After a minimal 1-year follow-up in RCTs, functional outcomes such as International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity scale, Knee Society Score, and hop test were found to be similar between 2 techniques. The laxity outcomes, including the IKDC objective grade and pivot-shift test, were suggested to be comparable. There was a significant difference favoring the transtibial technique in terms of side-to-side difference (P = .04; 95% confidence interval [CI], 0.08-0.90). The pooled data from cohort studies indicated equivalent results in terms of IKDC subjective score, Lysholm score, side-to-side difference, IKDC objective grade, complications, and graft failure, with the exception of statistical difference in the Tegner activity scale (P = .03; 95% CI, -0.50 to -0.04). CONCLUSIONS Our findings suggest that there is no difference in most outcome scores between the all-inside and transtibial techniques for anterior cruciate ligament reconstruction. There are statistically significant differences in side-to-side difference and Tegner activity scale favoring the all-inside technique. LEVEL OF EVIDENCE Level IV, meta-analysis of Level I to IV studies.
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Affiliation(s)
- Shuang Zhu
- Department of Orthopaedics, Southern Medical University Zhujiang University, Guangzhou, China
| | - Renbin Li
- Department of Orthopaedics, Southern Medical University Zhujiang University, Guangzhou, China.
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Xu Z, Ma L, Li R. Anatomic Double-Bundle and Single-Bundle Reconstructions Yield Similar Outcomes Following Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-analysis. Arthroscopy 2024; 40:481-494. [PMID: 37230187 DOI: 10.1016/j.arthro.2023.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE To evaluate outcomes of arthroscopic single-bundle (SB) versus anatomic double-bundle (ADB) anterior cruciate ligament reconstruction (ACLR) in adults through a synthesis of randomized controlled trials (RCTs). We hypothesized that SB and ADB methods would lead to similar outcomes after reconstruction of ACL rupture. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist guided our reporting. To identify RCTs that compared SB and ADB reconstructions, a thorough literature search was conducted of PubMed, Embase, Cochrane library, and Web of Science. The methodologic quality of each included study was independently assessed by 2 authors using the Cochrane Collaboration's risk of bias tool. The Anatomic ACL Reconstruction Scoring Checklist (AARSC) was used to screen the eligibility of each study's operative approaches. Twelve clinical outcomes were investigated through pooled analyses conducted using Review Manager 5.3. RESULTS This meta-analysis synthesized 13 RCTs comparing postoperative outcomes between ADB and SB reconstructions of ACLs. After a minimum follow-up of 12 months, ADB and SB technique resulted in similar subjective clinical outcomes, including the International Knee Documentation Committee subjective score, Lysholm score, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score sports subscale. Similarly, no statistically significant outcomes were found for objective outcomes such as International Knee Documentation Committee objective grade, pivot-shift test, Lachman test, side-to-side difference, extension deficit, flexion deficit, and osteoarthritis change. However, patients who underwent SB reconstruction had significantly greater complication rates than those that underwent ADB reconstruction. CONCLUSIONS When an ACLR approach meets a minimal total AARSC score of 8, ADB and SB techniques may result in similar subjective and objective outcomes, but the ADB technique may lead to lower complication rates following surgery. We recommend that surgeons favor ADB ACLR, as guided by the AARSC. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis of Level I randomized controlled trials.
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Affiliation(s)
- Zhiteng Xu
- Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Liang Ma
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Renbin Li
- Department of Orthopedics, Southern Medical University Zhujiang Hospital, Guangzhou, Guangdong Province, China.
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Mayr HO, Rosenstiel N, Prakash KS, Comella LM, Woias P, Schmal H, Seidenstuecker M. Digital measurement of anterolateral knee laxity using strain sensors. Arch Orthop Trauma Surg 2023; 143:6719-6729. [PMID: 37592159 PMCID: PMC10542724 DOI: 10.1007/s00402-023-05024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE The ambition of the research group was to develop a sensor-based system that allowed the transfer of results with strain sensors applied to the knee joint. This system was to be validated in comparison to the current static mechanical measurement system. For this purpose, the internal rotation laxity of the knee joint was measured, as it is relevant for anterolateral knee laxity and anterior cruciate ligament (ACL) injury. METHODS This is a noninvasive measurement method using strain sensors which are applied to the skin in the course of the anterolateral ligament. The subjects were placed in supine position. First the left and then the right leg were clinically examined sequentially and documented by means of an examination form. 11 subjects aged 21 to 45 years, 5 women and 6 men were examined. Internal rotation of the lower leg was performed with a torque of 2 Nm at a knee flexion angle of 30°. RESULTS Comparison of correlation between length change and internal knee rotation angle showed a strong positive correlation (r = 1, p < 0.01). Whereas females showed a significant higher laxity vs. males (p = 0.003). CONCLUSIONS The present study showed that the capacitive strain sensors can be used for reproducible measurement of anterolateral knee laxity. In contrast to the previous static systems, a dynamic measurement will be possible by this method in the future.
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Affiliation(s)
- Hermann O Mayr
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Nikolaus Rosenstiel
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Karthika S Prakash
- Department of Microsystems Engineering IMTEK, Albert-Ludwigs-University of Freiburg, Georges-Koehler-Allee 103, 79110, Freiburg, Germany
| | - Laura M Comella
- Department of Microsystems Engineering IMTEK, Albert-Ludwigs-University of Freiburg, Georges-Koehler-Allee 103, 79110, Freiburg, Germany
| | - Peter Woias
- Department of Microsystems Engineering IMTEK, Albert-Ludwigs-University of Freiburg, Georges-Koehler-Allee 103, 79110, Freiburg, Germany
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Michael Seidenstuecker
- G.E.R.N. Center of Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center-University of Freiburg, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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D’Ambrosi R, Kambhampati SBS, Vishwanathan K, Vaish A, Vaishya R. Trends of Publications on Single- and Double-Bundle ACL Reconstructions over the Last 20 Years: A Bibliometric Analysis of the PubMed Literature. Indian J Orthop 2023; 57:1623-1632. [PMID: 37766958 PMCID: PMC10519918 DOI: 10.1007/s43465-023-00977-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/11/2023] [Indexed: 09/29/2023]
Abstract
Purpose To improve the clinical outcomes of anterior cruciate ligament reconstruction (ACLR), there have been attempts to reproduce anatomic reconstruction by modifying the single-bundle (SB) and double-bundle (DB) techniques. Although DB ACLR restores better rotational control compared to SB ACLR, it is still debatable whether there are higher clinical outcomes in favor of DB ACLR. We aimed to study the trends of publications on SB and DB ACLR techniques over the last 20 years. Methods For this bibliometric study, we performed a PubMed search on 31/05/2022 with a well-defined search strategy. The articles were downloaded into Excel software, and citations were determined from the iCite website for PubMed. The analysis was performed using SPSS software version 28.0.1. Data mining was performed using Orange software, Mac version 3.32.0, from the titles of all articles and each group of SB and DB ACLR. The output is presented as word clouds. Results A total of 10,530 publications were identified, of which 9699 publications (92.1%) pertained to SB-ACLR and 831 publications (7.9%) to DB-ACLR. There was a steady increase in the publications on SB-ACLR until 2012, followed by a steep increase that peaked in 2021. The highest number of publications on DB-ACLR was in 2012 (n = 76; 9.1%). The mean citations per year for SB-ACLR and DB-ACLR were 2.87 ± 4.31 and 2.74 ± 3.17, respectively. The most prolific journals publishing on this topic were Knee Surgery Sports Traumatology Arthroscopy, American Journal of Sports Medicine, and Arthroscopy. The top three articles that received the maximum number of citations were from Japanese authors. Conclusion The number of publications related to SB-ACLR was significantly higher than that related to DB-ACLR in the last 20 years. The publications related to DB-ACLR have decreased in the recent past, after reaching a peak in 2012. The citations per year of SB-ACLR and DB-ACLR were similar.
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Affiliation(s)
- Riccardo D’Ambrosi
- IRCCS Ospedale Galeazzi – Sant’Ambrogio, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Karthik Vishwanathan
- Parul Institute of Medical Sciences and Research, Parul University, Limda, Waghodia, Vadodara, Gujarat India
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Berumen-Nafarrate E, Ramos-Moctezuma IR, Pérez-Fontes AG, Sigala-González LR, Leal-Contreras C. U-Dos Double-Bundle and Single-Bundle Allograft Anterior Cruciate Ligament Reconstruction: A Comparative Study. Orthopedics 2023; 46:13-18. [PMID: 36206510 DOI: 10.3928/01477447-20221003-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are very common among athletes. If these injuries are not repaired, meniscus and cartilage damage will arise, with serious consequences in the joint. Different options for ACL reconstruction have been described, aiming for anteroposterior, lateral, and rotational stability. Using single- or double-bundle grafts has been one of the most discussed topics, aiming for better rotational stability. We performed a prospective randomized study to evaluate the outcomes of ACL reconstruction using double- or single-bundle grafts for 72 patients with acute ACL injuries. Patients were blindly randomized into 2 groups of 36 knees before surgery using a blind envelope that contained the technique to be used: double-bundle U-Dos technique (DB group) or single-bundle technique (SB group). All patients had a preoperative and postoperative evaluation and were followed with the same parameters at 2, 4, 6, 12, and 24 months. Both anteroposterior and rotational stability were evaluated using a KT-1000 arthrometer (MEDmetric) and an experimental Pivot-Shift Meter (ORMEDS) device. Functional outcomes were measured using the Tegner-Lysholm scale. The DB group had fewer ACL re-tears, fewer meniscal injuries, and better Tegner-Lysholm and International Knee Documentation Committee scores. This group also had better KT-1000 and Pivot-Shift Meter values. After 2-year follow-up, the DB group had significantly better results than the SB group. [Orthopedics. 2023;46(1):13-18.].
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Zhou Y, Li L, Chen R, Gong M. Double-bundle versus single-bundle anterior cruciate ligament reconstruction in preventing the progression of osteoarthritis: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e31101. [PMID: 36626441 PMCID: PMC9750529 DOI: 10.1097/md.0000000000031101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The knee has a high incidence of osteoarthritis (OA) following the anterior cruciate ligament (ACL) injury, which was reduced by ACL reconstruction including double-bundle (DB) techniques and single-bundle (SB) techniques. However, the effectiveness of preventing the progression of OA after the ACL reconstruction using DB and SB techniques is controversial. METHODS This meta-analysis was performed following the preferred reporting items for systematic reviews and meta-analyses guidelines. The databases, including PubMed, Embase, and Cochrane Library, were searched. Randomized controlled trials comparing DB with SB ACL reconstruction and reporting clinical outcomes of radiological OA were included. Quality of the included studies was assessed using the Cochrane Collaboration's risk of bias tool. The outcome was analyzed using the risk ratio (RR) and its corresponding 95% confidence interval (CI). RESULTS Ten Randomized controlled trials studies were included in this meta-analysis (accounting 1062 knees: 475 SB and 587 DB). The rate of radiological OA after the ACL reconstruction was 39% in SB group and 34% in DB group. The results of meta-analysis showed no difference in the occurrence of radiological OA between DB group and in SB group (RR, 1.05; 95% CI, 0.85-1.30, P = .63), including subgroup of radiological scores of OA (subgroup of Minimal OA: RR, 0.95; 95% CI, 0.61-1.48; P = .82; subgroup of Notable OA: RR, 1.16; 95% CI, 0.75-1.78; P = .51), subgroup of follow-up time in 5 years and more than 5 years (RR, 0.98; 95% CI, 0.80-1.20; P = .85), and subgroup of autograft graft for ACL (RR, 0.97; 95% CI, 0.79-1.19; P = .77). However, the DB group had less incidences of knee OA than the SB group in subgroup of less than 5 years (RR, 1.48; 95% CI, 1.13-1.92; P = .004) and subgroup of allograft type (RR, 1.42; 95% CI, 1.06-1.91; P = .02). CONCLUSION Overall, this meta-analysis showed that the DB technique was no more effective in preventing the progression of OA than the SB technique in ACL reconstruction at midterm follow-up.
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Affiliation(s)
- Yun Zhou
- People’s Hospital of Leshan, Leshan, Sichuan, China
| | - Linji Li
- Department of Anesthesiology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Ran Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Min Gong
- Department of Orthopaedic Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- * Correspondence: Min Gong, Department of Orthopaedics, the Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi’er Qiao Rd, Chengdu, Sichuan 610075, China (e-mail: )
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Anterior cruciate ligament reconstruction with all-soft tissue quadriceps tendon versus quadriceps tendon with bone block. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07254-2. [PMID: 36449046 DOI: 10.1007/s00167-022-07254-2] [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: 09/07/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether there was a difference in clinical outcomes between patients who underwent primary ACL reconstruction (ACLR) with all-soft tissue quadriceps tendon (sQT) autograft versus QT with bone block (bQT). METHODS A retrospective cohort study of 708 patients who underwent QT ACLR was conducted. Primary ACLR patients with at least 1 year of follow-up were identified and those who received sQT were compared to those who received bQT. Data collection entailed patient demographics, surgical variables, patient reported outcomes (PROs), knee stability testing, and complications. The primary outcome of interest was International Knee Documentation Committee (IKDC) score, reported as mean score, pre- and postoperative difference, and number who met minimum clinically important difference (MCID). Secondary outcomes included Lachman and pivot shift grade, other patient reported outcomes (PROs), complication rates, and return to sport (RTS). RESULTS A total of 195 patients (147 sQT, 48 bQT) who underwent primary QT ACLR met criteria for analysis, with mean follow-up of 17.0 ± 7.9 months. No difference was detected between cohorts with respect to postoperative IKDC score (sQT: n = 120, 81.0 ± 18.9, bQT: n = 10, 80.9 ± 20.4, n.s.), proportion of patients who met MCID (sQT: 68/78 [87%], bQT: 6/7 [86%], n.s.), or results of stability testing. In the sQT cohort, 86% (106/123) of athletes achieved full RTS, compared to 85% (34/40) in the bQT cohort (n.s.). Time to RTS was less than a year in both cohorts (sQT: 10.5 ± 3.8 months [n = 106], bQT: 11.1 ± 3.9 months [n = 31], n.s.). Graft rupture occurred in 7 (5%) sQT patients and 3 (6%) bQT patients (n.s.), and all clinical failures were due to graft rupture (n.s.). No differences were detected for rates of postoperative complications. CONCLUSION No differences in clinical outcomes were detected between patients who underwent primary ACLR with sQT autograft versus bQT autograft. Currently, the decision to employ sQT or bQT is largely determined by surgeon preference. This study demonstrates excellent outcomes with both preparations and supports the use of either graft type at the discretion of the treating surgeon. LEVEL OF EVIDENCE III.
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Balasingam S, Karikis I, Rostgård-Christensen L, Desai N, Ahldén M, Sernert N, Kartus J. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Is Not Superior to Anatomic Single-Bundle Reconstruction at 10-Year Follow-up: A Randomized Clinical Trial. Am J Sports Med 2022; 50:3477-3486. [PMID: 36269582 DOI: 10.1177/03635465221128566] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anatomic double-bundle (DB) technique is purported to be a superior technique due to its mimicking of the double-stranded anatomic formation of the anterior cruciate ligament (ACL). Previous studies with 2-, 5- and 10-year follow-up are conflicted as to whether this technique is superior to the previous gold standard method of ACL reconstruction, the anatomic single-bundle (SB) reconstruction. PURPOSE/HYPOTHESIS The aim of this prospective randomized study was to compare the outcomes of the anatomic DB technique and anatomic SB technique with independent drilling at 10 years after anterior cruciate ligament (ACL) reconstruction. We hypothesized that DB ACL reconstruction would result in a better outcome in terms of the pivot-shift test. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 105 patients (33 women, 72 men; median age, 27 years [range, 18-52 years]) were randomized and underwent ACL reconstruction (DB group: n = 53; SB group: n = 52). All reconstruction procedures were performed anatomically by identifying the ACL footprint, using the anteromedial portal for femoral tunnel drilling, and utilizing interference screws for tibial and femoral fixation. One blinded observer examined the patients both preoperatively and at follow-up (median, 120 months [range, 112-134 months]). Multiple subjective and objective clinical evaluations were used to assess the outcomes. Radiographic assessments of osteoarthritis were performed using the Ahlbäck, Kellgren-Lawrence, and Fairbank classification systems early postoperatively and at the final follow-up. RESULTS Preoperatively, no differences were found between the study groups. Overall, 70 patients (67%; DB group: n = 39; SB group: n = 31) were available for analysis at 10-year follow-up. No significant difference could be shown between the groups in terms of the pivot-shift grade, knee laxity measurements using the KT-1000 arthrometer, manual Lachman grade, single-leg hop test result, range of motion measurements, Lysholm knee score, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score (KOOS) score. Correspondingly, no differences were found between the groups regarding the presence of radiographic osteoarthritis at follow-up. Both groups improved at follow-up compared with preoperatively in terms of the pivot-shift grade, knee laxity measurements using the KT-1000 arthrometer, manual Lachman grade, Lysholm knee score, and KOOS score (P < .05 [highest P value for any comparison]). CONCLUSION The anatomic DB technique was not superior to the anatomic SB technique with independent drilling at 10-year follow-up in regard to objective and subjective measurements. As such, one could argue that there is no need for the continued use of the anatomic DB technique in an unselected population.
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Affiliation(s)
| | - Ioannis Karikis
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden
| | | | - Neel Desai
- Ortho Center Gothenburg, Gothenburg, Sweden
| | | | - Ninni Sernert
- Department of Research & Development, NU Hospital Group, Trollhättan, Sweden
| | - Juri Kartus
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden.,Department of Research & Development, NU Hospital Group, Trollhättan, Sweden
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Mao Z, Wang Z, Xu C, Liu C, Zhang Z, Ren X, Xue A, Li Z, Zhao F, Yao Q, Yu J. Intra-Articular Biomechanical Changes of the Meniscus and Ligaments During Stance Phase of Gait Circle after Different Anterior Cruciate Ligament Reconstruction Surgical Procedures: A Finite Element Analysis. Orthop Surg 2022; 14:3367-3377. [PMID: 36222205 PMCID: PMC9732611 DOI: 10.1111/os.13516] [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: 06/26/2021] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The debate on the superiority of single- or double-bundle for anterior cruciate ligament reconstruction has not ceased. The comparative studies on intra-articular biomechanics after different surgical reconstructions are rare. This study is to evaluate the biomechanical stress distribution intra-knee after single- and double-bundle anterior cruciate ligament reconstruction by three-dimensional finite element analysis, and to observe the change of stress concentration under the condition of vertical gradient loads. METHODS In this study, magnetic resonance imaging data were extracted from patients and healthy controls for biomechanical analysis. Patients included in the three models were matched in age and sex. The strength and distribution of induced stresses were analyzed in two frequently used procedures, anatomical single-bundle anterior cruciate ligament reconstruction and anatomical double-bundle anterior cruciate ligament reconstruction, using femoral-graft-tibial system under different loads, to mimic a post-operation mechanical motion. The three-dimensional finite-element models for normal ligament and two surgical methods were applied. A vertical force simulating daily walking was performed on the models to assess the interfacial stresses and displacements of intra-articular tissues and ligaments. The evaluation results mainly included the stress of each part of ligament and meniscus. The stress values of different parts of three models were extracted and compared. RESULTS The stress of ligament/graft at femoral side of three finite-element models was significantly higher than at tibial side, while the highest level was observed in single-bundle reconstruction finite-element model. With the increase of force, the maximum stress in the medial (7.1-7.1 MPa) and lateral (4.9-7.4 MPa) meniscus of single-bundle reconstruction finite-element model shifted from the anterior horn to the central area (p = 0.0161, 0.0479, respectively). The stress was shown to be at a lower level at femoral side and posterior cruciate ligament of intra-knee in two reconstruction finite-element models than that in normal finite-element models, while presented higher level at the tibial side than normal knee (p = 0.3528). The displacement of the femoral side and intra-knee areas in reconstruction finite-element models was greater than that in normal finite-element model (p = 0.0855). CONCLUSION Compared with the single-bundle technique, the graft of double-bundle anterior cruciate ligament reconstruction has better stress dissipation effect and can prevent postoperative meniscus tear more effectively.
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Affiliation(s)
- Zi‐mu Mao
- Department of Joint SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina,Institute of Sports MedicinePeking UniversityBeijingChina
| | - Zhen‐wei Wang
- Department of Joint SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
| | - Chao Xu
- Xinjiang Key Laboratory Neurological Disorder ResearchKey Laboratory of Autonomous RegionUrumchiChina,The Department of OrthopaedicsThe Second Affiliated Hospital of Xinjiang Medical UniversityUrumchiChina
| | - Chen‐he Liu
- Department of OrthopaedicsFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Zhi‐yu Zhang
- Department of Sports MedicineYan'an Traditional Chinese Medicine HospitalYan'anChina
| | - Xiao‐li Ren
- Shanxi Institute of Sports ScienceTaiyuanTaiyuanChina
| | - An‐qi Xue
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical EngineeringSchool of Biological Science and Medical Engineering, Beihang UniversityBeijingChina,Beijing Institute of Medical Device TestingBeijingChina
| | - Ze‐nan Li
- Fengtai Fourth Outpatient DepartmentBeijing GarrisonBeijingChina
| | - Feng Zhao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical EngineeringSchool of Biological Science and Medical Engineering, Beihang UniversityBeijingChina
| | - Qi Yao
- Department of Joint SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
| | - Jia‐kuo Yu
- Institute of Sports MedicinePeking UniversityBeijingChina
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Alomari MS, Ghaddaf AA, Abdulhamid AS, Alshehri MS, Ashraf M, Alharbi HH. Single Bundle Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Indian J Orthop 2022; 56:1669-1684. [PMID: 36187591 PMCID: PMC9485407 DOI: 10.1007/s43465-022-00718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/31/2022] [Indexed: 02/04/2023]
Abstract
Background Anterior cruciate ligament (ACL) tear is considered as one of the most common sport-related musculoskeletal injuries. Double bundle (DB) and single bundle (SB) surgical techniques has been widely adopted for ACL reconstruction. This systematic review aimed to provide updated evidence by comparing the short-term, mid-term, and long-term knee stability and functional outcomes of DB and SB reconstruction techniques. Methods We searched Medline, Web of Science, and CENTRAL. We have selected randomized controlled trials (RCTs) that compared DB and SB ACL reconstruction techniques for primary isolated ACL tear. We have assessed the following outcomes: pivot shift test, Lachman test, KT-1000/2000 knee ligament arthrometer, Lysholm knee function score, Tegner activity score, and graft failure. We have used the standardized mean difference (SMD) was to summarize the continuous outcomes while risk ratio (RR) was used to summarize the dichotomous outcomes. Results A total of 34 RCTs that enrolled 2,992 participants deemed eligible. Overall, DB showed significantly better outcomes in terms of pivot shift test (RR = 0.61, 95% confidence interval (CI) 0.49-0.75), Lachman test (RR = 0.77, 95% CI 0.62 to 0.95), and KT 1000/2000 arthrometer (SMD = - 0.21, 95% CI - 0.34 to - 0.08). No discernible difference was found between DB and SB techniques in the overall Lysholm score (SMD = 0.12, 95% CI - 0.03 to 0.27), Tegner score (SMD = 0.03, 95% CI - 0.17 to 0.24), or graft failure rate (RR = 0.78, 95% CI 0.33 to 1.85). Conclusions Our review suggests that DB ACL reconstruction technique shows significantly better knee stability and functional outcomes than SB at short-term follow-up. However, both techniques exhibit similar outcomes at mid-term and long-term follow-up. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-022-00718-0.
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Affiliation(s)
- Mohammed S. Alomari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A. Ghaddaf
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed S. Abdulhamid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed S. Alshehri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Surgery/Orthopedic Section, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mujeeb Ashraf
- Department of Surgery/Orthopedic Section, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hatem H. Alharbi
- Department of Surgery/Orthopedic Section, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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12
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Yeo MHX, Seah SJS, Gatot C, Yew A, Lie D. Selective bundle versus complete anterior-cruciate ligament reconstruction: A systematic review and meta-analysis. J Orthop 2022; 33:124-130. [PMID: 35983549 PMCID: PMC9379500 DOI: 10.1016/j.jor.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/10/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Selective bundle reconstruction (SLB) refers to preservation of the intact bundle and reconstruction of the ruptured bundle in a partial tear while complete ACL reconstruction involves the removal of all remnant tissue and reconstruction of one or both bundles. As the evidence for SLB versus complete ACL reconstruction remains unclear, this study aimed to compare the two techniques. This study's hypothesis was that SLB reconstruction allows better function and stability compared to complete ACL reconstruction. Methods A systematic search of PubMed, EMBASE, Scopus and Cochrane Library was conducted, identifying studies that compared SLB ('selective' group) versus complete ('complete' group) ACL reconstruction. Meta-analysis was conducted for post-operative functional scores, stability outcomes and complications as well as pre-operative to post-operative change. Results Eleven studies were included in the meta-analysis, with 1107 patients and a pooled mean follow-up of 29.5 months. Post-operatively, the Selective group had significantly reduced anterior laxity, shown by a lower mean arthrometry side-to-side difference (p<0.01). Analysis of change results showed that the Selective group had a lower mean improvement in arthrometry side-to-side difference as well (p<0.01). No significant difference was shown for all other post-operative outcomes. Conclusion This study provides valuable insight to the management of partial tears. It has demonstrated that the preservation of the intact bundle offers stability and function that is as good as complete reconstruction and that SLB is a potentially viable option in the management of partial tears. Level of evidence Meta-analysis; Level of evidence, 4.
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Affiliation(s)
- Mark HX Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, Singapore
| | - Shawn JS Seah
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, Singapore
| | - Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
| | - Andy Yew
- Division of Musculoskeletal Science, Singapore General Hospital, 1 Outram Road, Singapore
| | - Denny Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
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Evaluation of anterior cruciate ligament surgical reconstruction through finite element analysis. Sci Rep 2022; 12:8044. [PMID: 35577879 PMCID: PMC9110399 DOI: 10.1038/s41598-022-11601-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/21/2022] [Indexed: 11/08/2022] Open
Abstract
Anterior cruciate ligament (ACL) tear is one of the most common knee injuries. The ACL reconstruction surgery aims to restore healthy knee function by replacing the injured ligament with a graft. Proper selection of the optimal surgery parameters is a complex task. To this end, we developed an automated modeling framework that accepts subject-specific geometries and produces finite element knee models incorporating different surgical techniques. Initially, we developed a reference model of the intact knee, validated with data provided by the Open Knee(s) project. This helped us evaluate the effectiveness of estimating ligament stiffness directly from MRI. Next, we performed a plethora of “what-if” simulations, comparing responses with the reference model. We found that (a) increasing graft pretension and radius reduces relative knee displacement, (b) the correlation of graft radius and tension should not be neglected, (c) graft fixation angle of 20\documentclass[12pt]{minimal}
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\begin{document}$$^{\circ }$$\end{document}∘ can reduce knee laxity, and (d) single-versus double-bundle techniques demonstrate comparable performance in restraining knee translation. In most cases, these findings confirm reported values from comparative clinical studies. The numerical models are made publicly available, allowing for experimental reuse and lowering the barriers for meta-studies. The modeling approach proposed here can complement orthopedic surgeons in their decision-making.
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Ehlers CB, Curley AJ, Fackler NP, Minhas A, Rodriguez AN, Pasko K, Chang ES. The Statistical Fragility of Single-Bundle vs Double-Bundle Autografts for ACL Reconstruction: A Systematic Review of Comparative Studies. Orthop J Sports Med 2022; 9:23259671211064626. [PMID: 34988239 PMCID: PMC8721389 DOI: 10.1177/23259671211064626] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The statistical significance of a given study outcome can be liable to small changes in findings. P values are common, but imperfect statistical methods to convey significance, and inclusion of the fragility index (FI) and fragility quotient (FQ) may provide a clearer perception of statistical strength. Purpose/Hypothesis: The purpose was to examine the statistical stability of studies comparing primary single-bundle to double-bundle anterior cruciate ligament reconstruction (ACLR) utilizing autograft and independent tunnel drilling. It was hypothesized that the study findings would be vulnerable to a small number of outcome event reversals, often less than the number of patients lost to follow-up. Study Design: Systematic review; Level of evidence, 2. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors searched PubMed for comparative studies and randomized controlled trials (RCTs) published in select journals, based on impact factor, between 2005 and 2020. Risk-of-bias assessment and methodology scoring were conducted for the included studies. A total of 48 dichotomous outcome measures were examined for possible event reversals. The FI for each outcome was determined by the number of event reversals necessary to alter significance. The FQ was calculated by dividing the FI by the respective sample size. Results: Of the 1794 studies screened, 15 comparative studies were included for analysis; 13 studies were RCTs. Overall, the mean FI and FQ were 3.14 (IQR, 2-4) and 0.050 (IQR, 0.032-0.062), respectively. For 72.9% of outcomes, the FI was less than the number of patients lost to follow-up. Conclusion: Studies comparing single-bundle versus double-bundle ACLR 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 fewer than 4 outcome events in a treatment group can alter the statistical significance of a given result; this is commonly less 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
- Georgetown University School of Medicine, El Segundo, California, USA
| | | | - Nathan P Fackler
- Georgetown University School of Medicine, El Segundo, California, USA
| | - Arjun Minhas
- Georgetown University School of Medicine, El Segundo, California, USA
| | - Ariel N Rodriguez
- Georgetown University School of Medicine, El Segundo, California, USA
| | - Kory Pasko
- Georgetown University School of Medicine, El Segundo, California, USA
| | - Edward S Chang
- Inova Medical Group Orthopedics and Sports Medicine, Fairfax, Virginia, USA
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15
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Double bundle ACL reconstruction leads to better restoration of knee laxity and subjective outcomes than single bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1795-1808. [PMID: 34595573 PMCID: PMC9033716 DOI: 10.1007/s00167-021-06744-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this meta-analysis is to compare arthroscopic single bundle (SB) and double bundle (DB) anterior cruciate ligament (ACL) reconstructions in the light of all available randomised controlled trials (RCTs). A meta-analysis of this well-researched topic was performed and subgroup analyses of the medial portal (MP) technique and the transtibial technique (TT) were added as a new idea. The hypothesis was that the DB technique is superior to the SB technique also in subgroup analyses of the MP and TT techniques. METHODS Instructions of the PRISMA checklist were followed. Systematic literature search from electronic databases, including PubMed, Cochrane library and Scopus was performed to find RCTs that compared the SB and DB techniques. Nine outcomes were used to compare these two techniques. Each study was assessed according to the Cochrane Collaboration's risk of bias tool and three subgroup analyses (minimum 2-years' follow-up, TT technique and MP technique) were performed. RESULTS A total of 40 studies were included in this meta-analysis. When analysing all the included studies, the DB technique was superior to the SB technique in KT-1000/2000 evaluation (p < 0.01), IKDC subjective evaluation (p < 0.05), Lysholm scores (p = 0.02), pivot shift (p < 0.01) and IKDC objective evaluation (p = 0.02). Similar results were also found in the subgroup analyses of minimum 2-years' follow-up and the TT technique. However, there were no differences between the two techniques in a subgroup analysis of the MP technique. CONCLUSION Generally, DB ACL reconstruction leads to better restoration of knee laxity and subjective outcomes than SB ACL reconstruction. The subgroup analysis of the MP technique revealed that surgeons can achieve equally as good results with both techniques when femoral tunnels are drilled through the medial portal. LEVEL OF EVIDENCE II.
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16
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Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture. Arch Orthop Trauma Surg 2022; 142:2839-2847. [PMID: 34870728 PMCID: PMC9474331 DOI: 10.1007/s00402-021-04269-1] [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: 08/02/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of the current study was to objectify the rotational laxity after primary anterior cruciate ligament (ACL) rupture and rerupture after ACL reconstruction by instrumented measurement. It was hypothesized that knees with recurrent instability feature a higher internal rotation laxity as compared to knees with a primary rupture of the native ACL. STUDY DESIGN Cross-sectional study, Level of evidence III. METHODS In a clinical cross-sectional study successive patients with primary ACL rupture and rerupture after ACL reconstruction were evaluated clinically and by instrumented measurement of the rotational and antero-posterior laxity with a validated instrument and the KT1000®, respectively. Clinical examination comprised IKDC 2000 forms, Lysholm Score, and Tegner Activity Scale. Power calculation and statistical analysis were performed (p value < 0.05). RESULTS 24 patients with primary ACL rupture and 23 patients with ACL rerupture were included. There was no significant side-to-side difference in anterior translation. A side-to side difference of internal rotational laxity ≥ 10° was found significantly more frequent in reruptures (53.6%) compared to primary ruptures (19.4%; p < 0.001). A highly significant relationship between the extent of the pivot-shift phenomenon and side-to-side difference of internal rotation laxity could be demonstrated (p < 0.001). IKDC 2000 subjective revealed significantly better scores in patients with primary ACL tear compared to patients with ACL rerupture (56.4 ± 7.8 vs. 50.8 ± 6.2; p = 0.01). Patients with primary ACL tears scored significantly better on the Tegner Activity Scale (p = 0.02). No significant differences were seen in the Lysholm Score (p = 0.78). CONCLUSION Patients with ACL rerupture feature significantly higher internal rotation laxity of the knee compared to primary ACL rupture. The extend of rotational laxity can be quantified by instrumented measurements. This can be valuable data for the indication of an anterolateral ligament reconstruction in ACL revision surgery.
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Double-bundle anterior cruciate ligament reconstruction technique has advantages in chondroprotection and knee laxity control compared with single-bundle technique : A long-term follow-up with a minimum of 12 years. Knee Surg Sports Traumatol Arthrosc 2021; 29:3105-3114. [PMID: 33216188 DOI: 10.1007/s00167-020-06350-5] [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] [Received: 06/20/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the long-term clinical outcomes of single-bundle anterior cruciate ligament reconstruction (SBR) and double-bundle anterior cruciate ligament reconstruction (DBR) in patients with isolated anterior cruciate ligament (ACL) rupture, presenting no meniscus injury and no obvious preoperative cartilage degeneration. METHODS One hundred and three patients (38.6 ± 9.5 years) with a median follow-up of 151.6 months (range, 144-189 months) completed the retrospective study (SBR group: n = 51; DBR group: n = 52). Clinical outcomes were evaluated with physical examinations, KT-2000 anterior and posterior stability measurement with the knee in 30º of flexion, International Knee Documentation Committee (IKDC) subjective score, Tegner score, Lysholm score; magnetic resonance imaging (MRI) (3.0 T) was performed, and International Cartilage Repair Society (ICRS) cartilage degeneration grades were determined. Multivariate analysis was performed to identify factors associated with cartilage degeneration. RESULTS There were significant differences in the pre- and postoperative IKDC, Lysholm and Tegner scores between the SBR and DBR groups. The SBR group had over double the rate of positive pressure/rub patellar test results (SBR vs DBR, 43.1% vs. 19.2%, p < 0.011). The KT-2000, pivot-shift and Lachman test results were stratified and analyzed, and significant differences between the SBR and DBR groups were found (p < 0.05, respectively). The distribution of ICRS grades differed significantly between the groups at the last follow-up (p = 0.013). A multivariate analysis found that age and operation procedures were significant predictors of 0 and non-0 ICRS grades (odds ratio, 6.077 [95% CI 2.117-17.447] and 0.210 [95% CI 0.068-0.654], respectively) (p < 0.05). CONCLUSION Both SBR and DBR achieved overall good long-term results. DBR had advantages in objective outcome measures and was superior in preventing the occurrence of cartilage degeneration. Age was identified as a preoperative risk factor for significant postoperative cartilage degeneration. LEVEL OF EVIDENCE III. ClinicalTrials.gov: NCT03984474.
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Subjective assessment reported by patients shows differences between single-bundle and double-bundle anterior cruciate ligament reconstruction, systematic review and meta-analysis. Sci Rep 2021; 11:15385. [PMID: 34321559 PMCID: PMC8319426 DOI: 10.1038/s41598-021-94868-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/15/2021] [Indexed: 01/08/2023] Open
Abstract
To determine the functional recovery, active reincorporation, and anteroposterior and rotational stability of patients undergoing anterior cruciate ligament (ACL) reconstruction using arthroscopy techniques with simple-bundle (SB) or double-bundle (DB). The following databases were searched: PubMed, Embase (Elsevier platform), the Cochrane Central Register of Controlled Trials (Wiley platform), Web of Science, and CINAHL. Level I and II studies involving anterior cruciate ligament arthroscopy were included in the search. Records were screened by title and abstract and assessed the risk of bias of selected studies. Meta-analyses using RevMan 5.3 software were conducted on the following outcomes: knee functionality, objective measurements of knee stability, rotational knee stability and knee anterior stability, sports reincorporation, and subjective assessments. Twenty-four studies of patients undergoing ACL reconstruction were included in the qualitative and quantitative synthesis (1707 patients) for Lysholm score, Subjective International Knee Documentation Committee (IKDC) score, Tegner score, KT-1000/2000, Lachman test, Objective IKDC score, and Pivot-Shift test. A return to pre-injury level showed a significant decrease in the Lysholm score (mean difference, - 0.99; 95% CI - 1.71 to - 0.40; P = 0.007) and Tegner score (mean difference, - 0.07; 95% CI, - 0.13 to - 0.01; P = 0.02) at DB reconstruction, similar to the knee functionality outcome of the subjective IKDC score (mean difference - 1.42; 95% CI - 2.46 to - 0.38; P = 0.007). There is no clear or significant difference in clinical stability and knee function or in sports incorporation with the true difference occurring in the subjective assessment.
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Ahn JH, Koh IJ, McGarry MH, Patel NA, Lin CC, Lee TQ. Double-Bundle Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Tenodesis Is Effective in Restoring Knee Stability in a Chronic, Complex Anterior Cruciate Ligament-Injured Knee Model: A Cadaveric Biomechanical Study. Arthroscopy 2021; 37:2220-2234. [PMID: 33705893 DOI: 10.1016/j.arthro.2021.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare knee stability after intra-articular isolated double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) and single-bundle (SB) and DB ACLR combined with lateral extra-articular tenodesis (LET) in a chronic, complex anterior cruciate ligament (ACL)-injured knee model. METHODS In 10 fresh-frozen cadaveric knees, we measured knee laxity in the following order: (1) intact knee; (2) ACL-sectioned knee; (3) complex ACL-injured knee model with additional sectioning of the anterolateral complex and the posterior horns of the medial and lateral menisci; (4) SB ACLR plus LET; (5) DB ACLR; and (6) DB ACLR plus LET. RESULTS In comparison with the intact knee, significantly increased internal rotation (IR) laxity persisted at 60° and 90° after DB ACLR (P = .002 and P = .003, respectively). SB ACLR plus LET and DB ACLR plus LET resulted in significant reductions in IR laxity at 90° (P = .003 and P = .037, respectively), representing overconstraint in IR. SB ACLR plus LET resulted in persistently increased external rotation (ER) laxity at 30°, 60°, and 90° (P = .001, P < .001, and P < .001, respectively). The DB ACLR condition persistently showed significant increases in anterior tibial translation laxity at 60° and 90° (P = .037 and P = .024, respectively). A greater increase in ER laxity was seen after SB ACLR plus LET versus DB ACLR plus LET at 30°, 60°, and 90° (P < .001, P < .001, and P < .001, respectively). CONCLUSIONS DB ACLR plus LET restored intact knee stability in IR, ER, and anterior tibial translation laxity at 0°, 30°, 60°, and 90° of knee flexion except for overconstraint in IR at 90° in a chronic, complex ACL-injured knee model. CLINICAL RELEVANCE This cadaveric study provides some biomechanical evidence to support performing DB ACLR combined with LET to restore knee stability after a complex, chronic knee injury involving an ACL tear combined with anterolateral complex injury and irreparable tears of the posterior horns of the medial and lateral menisci.
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Affiliation(s)
- Ji Hyun Ahn
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Nilay A Patel
- Department of Orthopaedic Surgery, University of California, Irvine, California, U.S.A
| | - Charles C Lin
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
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Wu B, Liang D, Yang L, Li S, Qiu Z, Qin Q, Liang X, Liu H, Ouyang K, Xiong J, Wang D, Lu W, Zhong M, Li Y, Li H, Feng W, Chen K, Peng L, Zhu W. Interbundle Impingement Pressure in Individualized and Nonindividualized Double-Bundle Anterior Cruciate Ligament Reconstruction: A Cadaveric Study. Orthop J Sports Med 2021; 9:2325967120958487. [PMID: 33614806 PMCID: PMC7869155 DOI: 10.1177/2325967120958487] [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: 12/04/2022] Open
Abstract
Background: Graft impingement is one of the main concerns in double-bundle anterior
cruciate ligament reconstruction (DB-ACLR). Impingement between the
anteromedial (AM) and posterolateral (PL) bundles has been postulated to
cause graft deterioration or rerupture, but this has not been thoroughly
investigated, and the interbundle impingement pressure (IIP) has not been
well researched. Purpose: To determine the IIP between the AM and PL bundles in the native anterior
cruciate ligament (ACL) and in DB-ACLR with individualized and
nonindividualized double-tunnel placement. Study Design: Controlled laboratory study. Methods: A total of 30 fresh-frozen, nonpaired, human cadaveric knees were randomly
divided into 3 groups of 10 knees: native intact ACL (NI group), DB-ACLR
tunnel placement using the preserved remnant procedure (individualized
reconstruction) (PR group), and DB-ACLR tunnel placement using the bony
landmark procedure (nonindividualized reconstruction) (BL group). Pressure
sensors were inserted between the AM and PL bundles. The knee was moved
passively from full extension to full flexion, and the IIP between the 2 ACL
bundles was measured every 15°. Similarly, the impingement pressure was
measured between the ACL and intercondylar roof and between the ACL and
posterior cruciate ligament (PCL). Results: No significant differences were found in the maximum, mean, or minimum
ACL-roof and ACL-PCL impingement pressures among the 3 groups. The IIP
significantly increased when the knee joint was flexed >120° in all 3
groups (P < .001). Compared with the other 2 groups, the
BL group had significantly higher maximum and mean IIP throughout the range
of knee movement (P < .001) and from maximum extension
to 120° of flexion (P < .001). The BL group also had
significantly higher minimum IIP than the other 2 groups when knee flexion
was >120° (P < .001). No significant differences were
seen in maximum, minimum, or mean IIP between the NI and PR groups. Conclusion: The PR procedure (individualized DB-ACLR) was more consistent with the
interbundle biomechanical conditions of the native ACL, whereas the BL
procedure (nonindividualized DB-ACLR) had higher maximum and mean IIP. The
IIP was higher than the ACL–intercondylar roof or ACL-PCL pressures, and it
increased significantly when knee flexion was >120°. Clinical Relevance: These data suggest that surgeons can perform individualized DB-ACLR using
preserved remnants for tunnel placement as impingement-free DB-ACLR.
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Affiliation(s)
- Bing Wu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Daqiang Liang
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Lei Yang
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Sheng Li
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Zhihe Qiu
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Qihuang Qin
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Xinzhi Liang
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Haifeng Liu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Kan Ouyang
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Jianyi Xiong
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Daping Wang
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Wei Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Mingjin Zhong
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China.,Investigation performed at the Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Ying Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China.,Investigation performed at the Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Hao Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China.,Investigation performed at the Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Wenzhe Feng
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China.,Investigation performed at the Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Kang Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China.,Investigation performed at the Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Liangquan Peng
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China.,Investigation performed at the Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Weiming Zhu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China.,Investigation performed at the Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
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21
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Degree of Anterolateral Ligament Injury Impacts Outcomes After Double-Bundle Anterior Cruciate Ligament Reconstruction. Arthroscopy 2021; 37:222-230. [PMID: 32949631 DOI: 10.1016/j.arthro.2020.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of anterolateral ligament (ALL) injury identified on preoperative magnetic resonance imaging (MRI) on postoperative outcomes after double-bundle (DB) anterior cruciate ligament reconstruction (ACLR). METHODS For this retrospective study, the inclusion criteria were patients who were at least 3 years out of DB ACLR. Exclusion criteria included a delay in MRI over 4 weeks, delay in surgery over 6 months, single-bundle ACLR, and revision surgery. Enrolled patients were divided into 2 groups according to the ALL injury grade in preoperative MRI by a musculoskeletal radiologist who was blinded to the perioperative findings (the high-grade group with complete or nearly complete tear: n = 53 and the low-grade group with intact ALL or partial tear: n = 33). Knee laxity, clinical outcomes using the International Knee Documentation Committee (IKDC) examination form, and revision rates were compared at the last follow-up (8.1 ± 2.2 years). An independent t test was applied to compare continuous variables, and χ2 or Fisher exact test was used to compare the nominal variables. RESULTS The anterior translation was 3.2 ± 1.9 mm in the high-grade group and 1.6 ± 1.0 mm in the low-grade group (P < .001). The high-grade group showed 18 cases with a pivot-shift grade of 2 or 3 (40.0%); however, the low-grade group showed only 1 case with a pivot-shift grade 2 or 3 (3.0%) (P = .002). The high-grade group also showed inferior outcomes in the IKDC objective grade (grade A: 49.0%; grade B: 17.0%; grade C: 30.2%; grade D: 3.8% vs grade A: 90.9%; grade B: 6.1%; grade C: 3.0%; grade D: 0%, P = .001) and IKDC subjective score (87.5 ± 9.9 vs 93.9 ± 5.3, P < .001). In addition, the high-grade group showed a greater revision rate (11.3% vs 0%, P = .045). CONCLUSIONS DB ACLR for patients with high-grade ALL injury resulted in increased knee laxity, worse clinical outcomes, and higher revision rate compared to patients with low-grade ALL injury. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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22
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Jensen J, Hansen CF, Brodersen J, Comins JD, Krogsgaard MR. Are PROMs used adequately in sports research? An analysis of 54 randomized controlled trials with PROMs as endpoint. Scand J Med Sci Sports 2020; 31:982-990. [PMID: 33202068 DOI: 10.1111/sms.13880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022]
Abstract
Deviations from adequate use and reporting of PROMs may be problematic and misleading. The aim of this study was to investigate the extent of such problems in randomized clinical trials (RCTs). RCTs involving sports medicine research that used PROMs as primary outcomes were identified in 13 preselected journals. The articles were reviewed for nine potential problems related to how the PROM was used and how the data had been reported. The potential problems were as follows: aggregating subscale scores; combining patient-reported scores with physical, clinical, or para-clinical measures; using a PROM to diagnose or evaluate the individual patient; using a PROM for one leg or arm; selectively excluding domains or items; constructing a PROM for the specific occasion; mixing PROM formats (ie, digital, paper, telephone, e-mail, in person); ambiguous instructions for how the PROM should be completed; and recall bias. As covariates, we registered journal impact factor, year of publication, and existence of a registered protocol. In 29 (53.7%) of 54 identified RCTs, at least one potential problem was identified, the most common being aggregation of domain scores. This was not different with a published protocol or dependent on journal rankings, except for exclusion of domains, which was most common in high-ranking journals. Aggregation of domain scores was significantly less common in recently published articles compared with older articles (P = .03). Potential problematic use of PROMs and reporting of PROM data are common in RCTs, also in high-ranking journals, but less so in more recent articles.
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Affiliation(s)
- Jonas Jensen
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christian Fugl Hansen
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Denmark
| | - Jonathan D Comins
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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23
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Oh JY, Kim KT, Park YJ, Won HC, Yoo JI, Moon DK, Cho SH, Hwang SC. Biomechanical comparison of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a meta-analysis. Knee Surg Relat Res 2020; 32:14. [PMID: 32660562 PMCID: PMC7219200 DOI: 10.1186/s43019-020-00033-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Of the many issues regarding surgical techniques related to anterior cruciate ligament reconstruction (ACLR), single-bundle (SB) or double-bundle (DB) ACLR is one of the most debated topics. However, it is unclear which of the techniques yields better outcomes after ACLR for ACL injury. The purpose of this meta-analysis was to compare the benefits of SB versus DB ACLR in terms of biomechanical outcomes. METHODS The electronic databases MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched for relevant articles comparing the outcomes of SB-ACLR versus DB-ACLR that were published until November 2019. RESULTS Seventeen biomechanical studies were included. The anterior laxity measured using the anterior drawer test showed significantly better results in DB-ACLR when compared with SB-ACLR. In addition, outcomes of the anterior tibial translation test under a simulated pivot shift presented with better results at low flexion and 30° in DB-ACLR, compared with SB-ACLR. However, there were no significant biomechanical differences between the groups in internal rotation. CONCLUSIONS The present study demonstrated that both techniques for ACLR are associated with restoration of normal knee kinematics. DB-ACLR is superior to SB-ACLR in terms of restoration of anteroposterior stability. However, which technique yields better improvement in internal rotation laxity, and internal rotation laxity under a simulated pivot shift at a specific angle, remains unclear. LEVEL OF EVIDENCE This is a level II meta-analysis.
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Affiliation(s)
- Jin-Young Oh
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Kun-Tae Kim
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Young-Jin Park
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Hee-Chan Won
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Dong-Kyu Moon
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Sung-Hee Cho
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751.
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24
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Mayr HO, Prall WC. Editorial Commentary: Revision of Failed Double-Bundle Anterior Cruciate Ligament Reconstruction. Arthroscopy 2020; 36:556-557. [PMID: 32014184 DOI: 10.1016/j.arthro.2019.11.094] [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: 11/09/2019] [Accepted: 11/12/2019] [Indexed: 02/02/2023]
Abstract
Double-bundle (DB) reconstruction of the anterior cruciate ligament was favored for several years. However, recent studies increasingly show that this technique does not provide a clear advantage over the less-invasive single-bundle technique. Unfortunately, the graft fails relatively often after ACL reconstruction. Postoperative communication of the bone tunnels through bone tunnel widening is possible. Since 2 drill channels are created in the DB technique, femoral as well as tibial, it is assumed that this technique may cause problems during revision. So, in part, revision may require a 2-step procedure with bone graft filling of the tunnels as the first step. It is important that surgeons with experience using DB publish their revision strategies and experiences.
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25
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Janko M, Verboket RD, Plawetzki E, Geiger EV, Lustenberger T, Marzi I, Nau C. Vergleichbare Ergebnisse nach arthroskopischem Ersatz des vorderen Kreuzbandes. Chirurg 2019; 91:67-75. [DOI: 10.1007/s00104-019-01050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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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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27
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Murray MM, Kalish LA, Fleming BC, Flutie B, Freiberger C, Henderson RN, Perrone GS, Thurber LG, Proffen BL, Ecklund K, Kramer DE, Yen YM, Micheli LJ. Bridge-Enhanced Anterior Cruciate Ligament Repair: Two-Year Results of a First-in-Human Study. Orthop J Sports Med 2019; 7:2325967118824356. [PMID: 30923725 PMCID: PMC6431773 DOI: 10.1177/2325967118824356] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Bridge-enhanced anterior cruciate ligament repair (BEAR) combines suture repair of the anterior cruciate ligament (ACL) with a specific extracellular matrix scaffold (the BEAR scaffold) that is placed in the gap between the torn ends of the ACL to facilitate ligament healing. Purpose/Hypothesis The purpose of this study was to report the 12- and 24-month outcomes of patients who underwent the BEAR procedure compared with a nonrandomized concurrent control group who underwent ACL reconstruction (ACLR) with an autograft. We hypothesized that the BEAR group would have physical examination findings, patient-reported outcomes, and adverse events that were similar to those of the ACLR group. Study Design Cohort study; Level of evidence, 2. Methods Ten patients underwent BEAR, and 10 underwent ACLR with a 4-stranded hamstring autograft. At 24 months, 9 of the 10 BEAR patients and 7 of the 10 ACLR patients completed a study visit. Outcomes reported included International Knee Documentation Committee (IKDC) subjective and objective results, knee anteroposterior (AP) laxity findings via an arthrometer, and functional outcomes. Results There were no graft or repair failures in the first 24 months after surgery. The IKDC subjective scores in both groups improved significantly from baseline (P < .0001) at 12 and 24 months, to 84.6 ± 17.2 in the ACLR group and to 91.7 ± 11.7 in the BEAR group. An IKDC objective grade of A (normal) was found in 44% of patients in the BEAR group and in 29% of patients in the ACLR group at 24 months; no patients in either group had C (abnormal) or D (severely abnormal) grades. Arthrometer testing demonstrated mean side-to-side differences in AP laxity that were similar in the 2 groups at 24 months (BEAR, 1.94 ± 2.08 mm; ACLR, 3.14 ± 2.66 mm). Functional hop testing results were similar in the 2 groups at 12 and 24 months after surgery. Hamstring strength indices were significantly higher in the BEAR group compared with the ACLR group (P = .0001). Conclusion In this small, first-in-human study, BEAR produced similar outcomes to ACLR with a hamstring autograft. BEAR may result in knee stability and patient-reported outcomes at 2 years sufficient to warrant longer term studies of efficacy in larger groups of patients.
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Affiliation(s)
- Martha M Murray
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Leslie A Kalish
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Braden C Fleming
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Brett Flutie
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christina Freiberger
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachael N Henderson
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gabriel S Perrone
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Laura G Thurber
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Benedikt L Proffen
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kirsten Ecklund
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dennis E Kramer
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
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28
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Mayr HO, Stoehr A. Editorial Commentary: No Difference in Knee Osteoarthritis After Single-Bundle Versus Double-Bundle Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:1004-1005. [PMID: 30827420 DOI: 10.1016/j.arthro.2018.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 02/02/2023]
Abstract
Systematic reviews now play a key role in evidence-based medicine, summarizing empirical findings from evaluated studies on a specific problem and examining the variability of those. These reviews help scientists integrate and evaluate relevant information in their research and support practitioners in decision-making processes. Since the early years of the current century, there has been a debate as to whether double-bundle or single-bundle reconstruction of the anterior cruciate ligament will better protect the knee. An essential aspect in the general indication of ligament reconstruction of the knee joint is the aim to prevent or at least to slow down the development process of osteoarthritis. At present, most clinical measures show no difference in outcome between single-bundle and double-bundle anterior cruciate ligament reconstruction. Systematic review of the literature investigating development of knee osteoarthritis after single-bundle and double-bundle anterior cruciate ligament reconstruction also shows no difference in outcome for this very important measure.
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29
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Servant C. Editorial Commentary: Triple-Bundle Anterior Cruciate Ligament Reconstruction: More Is More or Less Is More? Arthroscopy 2019; 35:906-908. [PMID: 30827442 DOI: 10.1016/j.arthro.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 02/02/2023]
Abstract
We need ambitious pioneers to explore the frontiers of surgical technique, but the surgeons that follow are wise to wait for independent and robust evidence of clinical benefit. Double-bundle anterior cruciate ligament reconstruction has struggled to establish its role, and triple-bundle reconstruction is perhaps even less likely to gain widespread acceptance, given that cadaveric research has shown only a small biomechanical advantage over a double-bundle or even a single-bundle technique and there is no convincing evidence of improved clinical outcomes.
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30
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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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