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Vermorel PH, Testa R, Klasan A, Putnis SE, Philippot R, Sonnery-Cottet B, Neri T. Contribution of the Medial Hamstrings to Valgus Stability of the Knee. Orthop J Sports Med 2023; 11:23259671231202767. [PMID: 37840900 PMCID: PMC10571687 DOI: 10.1177/23259671231202767] [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: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 10/17/2023] Open
Abstract
Background Multiligament knee injuries involving the medial side are common. When performing surgical reconstruction, use of the medial hamstrings (HS) as grafts remains controversial in this setting. Purpose To determine the role of the medial HS in stabilizing the valgus knee for different types of medial-sided knee injury. Study Design Controlled laboratory study. Methods A biomechanical study on 10 cadaveric knees was performed. Valgus load (force moment of 10 N/m) was applied at 0°, 30°, and 60° of flexion, and the resultant rotation was recorded using an optoelectronic motion analysis system. Measurements were repeated for 4 different knee states: intact knee, superficial medial collateral ligament (sMCL) injury, deep medial collateral ligament (dMCL) injury, and posterior oblique ligament (POL) injury. For each state, 4 loading conditions (+ loaded; - unloaded) of the semitendinosus (ST) and gracilis (GRA) tendons were tested: ST+/GRA+, ST+/GRA-, ST-/GRA+, and ST-/GRA-. Results At 0° of flexion, combined unloading of the ST and GRA (ST-/GRA-) increased valgus laxity on the intact knee compared with the ST+/GRA+ condition (P < .05). For all medial-sided injury states (isolated sMCL; combined sMCL and dMCL; and combined sMCL, dMCL, and POL damage), ST-/GRA- increased valgus laxity at 0° and 30° of flexion versus ST+/GRA+ (P < .05 for all). The absolute value of valgus laxity increased with the severity of medial-sided ligament injury. Isolated ST unloading increased valgus laxity for the intact knee and the MCL-injured knee (combined sMCL and dMCL) at 0° of flexion (P < .05 vs ST+/GRA+). Isolated unloading of the GRA had no effect on valgus knee stability. Conclusion The medial HS tendons contributed to the stabilization of the knee in valgus, and this was even more important when the medial side was severely affected (POL damage). This stabilizing effect was greater between 0° and 30°, in which the POL is the main valgus stabilizer. Clinical Relevance When deciding on graft selection for multiligament knee injury reconstruction, the surgeon should be aware of the effect of harvesting the medial HS tendon on valgus laxity.
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Affiliation(s)
- Pierre-Henri Vermorel
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France
| | - Rodolphe Testa
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France
| | - Antonio Klasan
- AUVA UKH Steiermark, Graz, Austria
- Johannes-Kepler University, Linz, Austria
| | - Sven E. Putnis
- Bristol Royal Infirmary, University Hospitals Bristol & Weston NHS Foundation Trust, UK
| | - Rémi Philippot
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France
| | - Bertrand Sonnery-Cottet
- Department of Orthopaedic Surgery and Sports Medicine, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France
- Inter-University Laboratory of Human Movement Science, University Lyon–University Jean-Monnet Saint-Étienne, Saint-Étienne, France
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Morris EJ, Gray K, Gibbons PJ, Grayson J, Sullivan J, Amorim AB, Burns J, McKay MJ. Evaluating the Use of PROMs in Paediatric Orthopaedic Registries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1552. [PMID: 37761513 PMCID: PMC10528097 DOI: 10.3390/children10091552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Patient-reported outcome measures (PROMs) provide structured information on the patient's health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.
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Affiliation(s)
- Eleanor J. Morris
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Kelly Gray
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia;
| | - Paul J. Gibbons
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Jane Grayson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Anita B. Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Joshua Burns
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, Paediatric Gait Analysis Service of New South Wales, Sydney 2145, Australia
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
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Surgeon's experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries. Knee Surg Sports Traumatol Arthrosc 2023; 31:475-486. [PMID: 35896755 PMCID: PMC9898417 DOI: 10.1007/s00167-022-07057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the influence of surgeon-related factors and clinic routines on autograft choice in primary anterior cruciate ligament reconstruction (ACLR). METHODS Data from the Swedish National Knee Ligament Registry (SNKLR), 2008-2019, were used to study autograft choice (hamstring; HT, patellar; PT, or quadriceps tendon; QT) in primary ACLR. Patient/injury characteristics (sex, age at surgery, activity at time of injury and associated injuries) and surgeon-/clinic-related factors (operating volume, caseload and graft type use) were analyzed. Surgeon/clinic volume was divided into tertiles (low-, mid- and high-volume categories). Multivariable logistic regression was performed to assess variables influencing autograft choice in 2015-2019, presented as the odds ratio (OR) with a 95% confidence interval (CI). RESULTS 39,964 primary ACLRs performed by 299 knee surgeons in 91 clinics were included. Most patients received HT (93.7%), followed by PT (4.2%) and QT (2.1%) grafts. Patients were mostly operated on by high-volume (> 28 ACLRs/year) surgeons (68.1%), surgeons with a caseload of ≥ 50 ACLRs (85.1%) and surgeons with the ability to use ≥ two autograft types (85.9%) (all p < 0.001). Most patients underwent ACLR at high-volume (> 55 ACLRs/year) clinics (72.2%) and at clinics capable of using ≥ two autograft types (93.1%) (both p < 0.001). Significantly increased odds of receiving PT/QT autografts were found for ACLR by surgeons with a caseload of ≥ 50 ACLRs (OR 1.41, 95% CI 1.11-1.79), but also for injury during handball (OR 1.31, 95% CI 1.02-1.67), various other pivoting sports (basketball, hockey, rugby and American football) (OR 1.59, 95% CI 1.24-2.03) and a concomitant medial collateral ligament (MCL) injury (OR 4.93, 95% CI 4.18-5.80). In contrast, female sex (OR 0.87, 95% CI 0.77-0.97), injury during floorball (OR 0.71, 95% CI 0.55-0.91) and ACLR by mid-volume relative to high-volume surgeons (OR 0.62, 95% CI 0.53-0.73) had significantly reduced odds of receiving PT/QT autografts. CONCLUSION An HT autograft was used in the vast majority of cases, but PT/QT autografts were used more frequently by experienced surgeons. Prior research has demonstrated significant differences in autograft characteristics. For this reason, patients might benefit if surgery is performed by more experienced surgeons. LEVEL OF EVIDENCE Level III.
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Freshman RD, Truong NM, Cevallos N, Lansdown DA, Feeley BT, Ma CB, Zhang AL. Delayed ACL reconstruction increases rates of concomitant procedures and risk of subsequent surgery. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07249-z. [PMID: 36459171 DOI: 10.1007/s00167-022-07249-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To utilise a large cross-sectional database to analyse the effects of time duration between diagnosis of anterior cruciate ligament (ACL) tear and ACL reconstruction (ACLR) on concomitant procedures performed and subsequent surgery within 2 years. METHODS An analysis from 2015 to 2018 was performed using the Mariner PearlDiver Patient Records Database. Current Procedural Terminology (CPT), and International Classification of Diseases (ICD-10) codes identified patients with a diagnosis of ACL tear who underwent subsequent ACLR. Patients were stratified in biweekly and bimonthly increments based on the time duration between initial diagnosis of ACL tear and surgical treatment. Chi-squared analysis was used to compare categorical variables, and trend analysis was performed with Cochran-Armitage independence testing. RESULTS Of 11,867 patients who underwent ACLR, 76.1% underwent surgery within 2 months of injury diagnosis. Patients aged 10-19 were most likely to undergo surgery within 2 months of injury diagnosis (83.5%, P < 0.0001). As duration from injury diagnosis to ACLR increased from < 2 months to > 6 months, rates of concomitant meniscectomy increased from 9.1% to 20.5% (P < 0.0001). The overall 2-year subsequent surgery rate was 5.3%. The incidence of revision ACLR was highest for patients who underwent surgery > 6 months after diagnosis (P < 0.0001), whilst the incidence of ipsilateral lysis of adhesions and manipulation under anaesthesia (MUA) was highest for patients who underwent surgery < 2 months after diagnosis (P < 0.0001). ACLR at 6-8 weeks after diagnosis demonstrated the lowest risk for concomitant procedures as well as 2-year subsequent surgery. CONCLUSION The majority of patients undergo ACL reconstruction within 2 months of initial ACL tear diagnosis. Delayed surgery greater than 6 months after the diagnosis of an ACL rupture leads to increased need for concomitant meniscectomy as well as higher risk for revision ACLR within 2 years, but immediate surgery may increase risk for knee arthrofibrosis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ryan D Freshman
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA.
| | - Nicole M Truong
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Nicolas Cevallos
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
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Rao R, Bhattacharyya R, Andrews B, Varma R, Chen A. The management of combined ACL and MCL injuries: A systematic review. J Orthop 2022; 34:21-30. [PMID: 35992613 PMCID: PMC9382135 DOI: 10.1016/j.jor.2022.07.024] [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: 04/10/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 10/31/2022] Open
Abstract
Background The management of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries remains contentious. Clinical outcomes of surgical, conservative, and combined approaches have been described in a range of prospective and retrospective studies. The aim of the current systematic review was to evaluate these outcomes and assess the study methodologies. Methods A comprehensive literature search of the following databases was performed: PubMed, OVID, Cochrane Database of Systematic Reviews and Google Scholar. Studies were assessed using the Coleman Methodology Score. Results 52 articles were included (3 randomised controlled trials, 8 prospective comparative studies, 17 retrospective comparative studies and 24 case series). Outcome measures were heterogeneous amongst articles. The most common outcomes assessed were AP laxity, Lysholm score and medial/valgus laxity. Complications at varying follow-up times with differing grades of MCL injury were reported in 25 (48%) studies. Evidence was conflicting, with no consensus from the available published literature regarding the best method of treatment for a combined ACL and MCL injury. Conclusions Heterogeneous outcome measures and limited randomised controlled trials prevent advocacy of a single treatment option. Good outcomes have been reported from repair, reconstruction and conservative management of the MCL together with ACL reconstruction. Further prospective comparative data is required to evaluate MCL management choice and prognostic signs for successful nonsurgical MCL treatment.
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Affiliation(s)
- Raunak Rao
- Orthopaedics and Trauma, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Rahul Bhattacharyya
- Orthopaedics and Trauma, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Barry Andrews
- Orthopaedics and Trauma, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Rajat Varma
- Orthopaedics and Trauma, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Alvin Chen
- Orthopaedics and Trauma, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
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Requicha F, Comley A. Medial soft-tissue complex of the knee: Current concepts, controversies, and future directions of the forgotten unit. Orthop Rev (Pavia) 2021; 13:24463. [PMID: 34745468 DOI: 10.52965/001c.24463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/30/2021] [Indexed: 11/06/2022] Open
Abstract
The medial side of the knee is comprised of ligaments, myotendinous and meniscal structures that work as a unit to stabilize the joint. The superficial medial collateral ligament is its core structure. Still, all elements of the medial side have load-sharing relationships, leading to a cascade of events in the scenario of insufficiency of any of them. Understanding the medial soft tissue structures as part of a unit is of utmost importance because the most common ligaments damaged in knee injuries belong to it. Surprisingly, there is a lack of high-level evidence published around the issue, and most studies focus on the superficial medial collateral ligament, overlooking the complexity of these injuries. Acknowledging the consequences for joint biomechanics and treatment outcomes, interest in this area is growing between researchers. Emerging evidence may become a game-changer in the future management of these injuries. Based on a thorough research of published literature, this review provides a current biomechanical concepts and clinical guidance to treat these injuries.
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Lutz PM, Höher LS, Feucht MJ, Neumann J, Junker D, Wörtler K, Imhoff AB, Achtnich A. Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries. J Exp Orthop 2021; 8:76. [PMID: 34524557 PMCID: PMC8443730 DOI: 10.1186/s40634-021-00401-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose
Anterior cruciate ligament (ACL) injuries are often combined with lesions of the medial collateral ligament (MCL). The aim of this study was to evaluate treatment outcome of combined acute ACL and MCL lesions using functional US and clinical examination. Methods Patients aged > 18 years undergoing primary ACL reconstruction with concomitant operative (group 1) or non-operative treatment of the MCL (group 2) between 2014 and 2019 were included after a minimum follow-up of 12 months. Grade II MCL injuries with dislocated tibial or femoral avulsions and grade III MCL ruptures underwent ligament repair whereas grade II injuries without dislocated avulsions were treated non-operatively. Radiological outcome was assessed with functional US examinations. Medial knee joint width was determined in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton) conditions using a fixation device. Clinical examination was performed and patient-reported outcomes were assessed by the use of the subjective knee form (IKDC), Lysholm score, and the Tegner activity scale. Results A total of 40 patients (20 per group) met inclusion criteria. Mean age of group 1 was 40 ± 12 years (60% female) with a mean follow-up of 33 ± 17 months. Group 2 showed a mean age of 33 ± 8 years (20% female) with a mean follow-up of 34 ± 15 months. Side-to-side differences in US examinations were 0.4 ± 1.5 mm (mm) in 0° and 0.4 ± 1.5 mm in 30° knee flexion in group 1, and 0.9 ± 1.1 mm in 0° and 0.5 ± 1.4 mm in 30° knee flexion in group 2, with no statistically significant differences between both groups. MCL repair resulted in lower Lysholm scores (75 ± 19 versus 86 ± 15; p < 0.05). No significant differences could be found for subjective IKDC or Tegner activity scores among the two groups. Conclusion A differentiated treatment concept in combined ACL and MCL injuries based on injury patterns leads to reliable postoperative ligamentous knee stability in US-based and clinical examinations. However, grade II and III MCL lesions with subsequent operative MCL repair (group 1) result in slightly poorer subjective outcome scores. Level of evidence Retrospective cohort study; Level III
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Affiliation(s)
- Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Louisa S Höher
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaningerstrasse 22, 81675, Munich, Germany.,Orthopädische Klinik Paulinenhilfe, Diakonie-Klinikum Stuttgart, Rosenbergstraße 38, 70176, Stuttgart, Germany
| | - Jan Neumann
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Daniela Junker
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Klaus Wörtler
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Andrea Achtnich
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaningerstrasse 22, 81675, Munich, Germany
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Zhou P, Liu JC, Deng XT, Li Z. Hamstring autograft versus patellar tendon autograft for anterior cruciate ligament reconstruction, which graft has a higher contralateral anterior cruciate ligament injury rate?: A meta-analysis of 5561 patients following the PRISMA guidelines. Medicine (Baltimore) 2020; 99:e21540. [PMID: 32756207 PMCID: PMC7402893 DOI: 10.1097/md.0000000000021540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Contralateral anterior cruciate ligament (CACL) injury is one of the devastating complications after anterior cruciate ligament (ACL) reconstruction. Whether the risk of CACL tear is related to graft selection remains controversial due to contradictory results in studies. There are no meta-analyses to compare which graft has a higher CACL injury rate. Hence, this meta-analysis was conducted to compare the incidence of the CACL injury after ACL reconstruction with bone-patellar tendon-bone (BPTB) autografts compared with hamstring (HT) autografts. METHODS A comprehensive search of literature published between 1980 and January 2020 was performed using MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases. RevMan 5.3 software was used for meta-analysis. The overall risk ratio (RR) was calculated using a fixed- or random-effects. The heterogeneity among the included results was analyzed by chi-square test with significance set at P < .10, and the heterogeneity was quantitatively detected by I-square tests. RESULTS Fifteen prospective comparative studies met inclusion criteria. In the BPTB group, the CACL rupture rate ranged from 1.8% to 30%, with a pooled percentage of 8.5%. In the HT group, the CACL rupture rate ranged from 0% to 14.4%, with a pooled percentage of 3.3%. The overall CACL rupture rate was 3.1% and ranged from 1.1% to 27.1%, with a pooled percentage of 4.9%. The pooled results indicate that there was a statistical significant difference in CACL rupture risk rate between BPTB and HT autograft. (RR, 1.53; 95% CL, 1.21-1.91; P = .0004). CONCLUSION This review showed that patients undergoing primary ACL reconstruction with BPTB autograft were more likely to have CACL rupture than patients treated with HT autograft.
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Affiliation(s)
- Peng Zhou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province
| | - Jun-Cai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province
| | - Xiang-Tian Deng
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province
- School of Medicine, Nankai University, Tianjin, P.R. China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province
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Favreau H, Eichler D, Bonnomet F, Lustig S, Adam P, Ehlinger M. Revision of anterior cruciate ligament reconstruction with a pedicled quadruple hamstring autograft. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1033-1038. [PMID: 32221680 DOI: 10.1007/s00590-020-02661-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 03/20/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Results of iterative ACL reconstructions are lower than after primary reconstructions. Our aim was to report the results of a retrospective series of revision using pedicled quadruple hamstring autograft. The hypothesis was that the results were satisfactory and comparable to the literature. METHODS The study period was from January 2012 to December 2014. Fourteen patients (average age 26) were included. A fascia lata graft was used 12 times for primary reconstruction. Trauma was the cause of failure 12 times. The time interval between primary reconstruction and revision was 6.2 years. Preoperative scores used were LYSHOLM, TEGNER and IKDC. Sagittal stability was measured using the KT-1000 device. X-rays and MRI were performed to confirm the diagnosis, look for preoperative osteoarthritis and evaluate the position of the bony tunnels (Bernard and Hertel). Bone tunnels were in a proper position 14 times. RESULTS At 45-month follow-up, improvement of objective IKDC score was significant (85.7% A/B, p < 0.0002) as well as subjective IKDC score (85.5, p < 0.0004). A significant improvement was established for the LYSHOLM score (91.8, p = 0.001) using the Wilcoxon test. The average LYSHOLM score was 92% (p > 0.5), and the average TEGNER score was 5.5 (p = 0.003). The Lachman test found a hard stop in all patients. The pivot shift test was negative for 78.5% of the cases. The laxity measurement found 12 cases with less than 3 mm. One persistent distal hypoesthesia at 2-year follow-up was observed. CONCLUSION The hypothesis was confirmed. This series differs by the cause of failure, which was essentially traumatic, and the initial predominance of a fascia lata graft. These results remain to be confirmed. LEVEL OF EVIDENCE Retrospective case series, level IV.
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Affiliation(s)
- Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France.
- Laboratoire INSERM-UNISTRA UMR 1260, 11 rue Humann, 67085, Strasbourg, France.
| | - David Eichler
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
| | - Sébastien Lustig
- Département de Chirurgie Orthopédique, Centre Albert-Trillat, Hôpital de la Croix-Rousse, 103 boulevard de la Croix-Rousse, 69004, Lyon, France
| | - Philippe Adam
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
- Laboratoire ICube, CNRS, UMR 7357, 30 Bd Sébastien Brant, 67400, Illkirch, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
- Laboratoire ICube, CNRS, UMR 7357, 30 Bd Sébastien Brant, 67400, Illkirch, France
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Siegel MG. Editorial Commentary: Variations of National Health Systems: Time From Injury to Surgery Can Affect Anterior Cruciate Ligament-Medial Collateral Ligament Treatment Outcomes. Arthroscopy 2020; 36:212-213. [PMID: 31864578 DOI: 10.1016/j.arthro.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 02/02/2023]
Abstract
A recent investigation using the Swedish National Knee Registry large database showed that "The risk of ACL revision did not differ between HT and PT autografts in patients undergoing ACL reconstruction with a non-surgically treated MCL injury. However, the use of ST-G was associated with poorer two-year patient-reported knee function compared with the ST." However, the Swedish Health care system is so unique that the results may not be universally applicable. Sweden provides universal health care, which is laudable, but there was an average delay of 314 days between injury and surgical intervention. This suggests that the medial collateral ligament (MCL) injury had already become chronic and the anterior cruciate ligament surgery was not effective for or directed toward acute MCL pathology. The timing and MCL treatment algorithm is different from published recommendations. Delay may have negative consequences.
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