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Horii M, Akagi R, Watanabe S, Enomoto T, Hosokawa H, Ohtori S, Sasho T. Number of intra-operative cyclic knee motion required to achieve stable graft tension in anterior cruciate ligament reconstruction; a prospective clinical study. BMC Musculoskelet Disord 2024; 25:113. [PMID: 38317088 PMCID: PMC10845653 DOI: 10.1186/s12891-024-07239-x] [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: 07/25/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Applying pretension by cyclic knee motion immediately before graft fixation in anterior cruciate ligament (ACL) reconstruction surgery decreases graft elongation during the postoperative course. However, the expected change in graft tension caused by cyclic knee motion remains unclear. We measured graft tension changes caused by cyclic knee motion during double-bundle ACL reconstruction. METHODS We included 39 patients undergoing primary anatomical double-bundle ACL reconstruction with autologous hamstrings as graft sources, at multiple centers between February 2021 and August 2022. After securing the anteromedial (AM) and posterolateral (PL) bundle grafts to the femoral cortex, they were initially tensioned to 40 N per bundle. After 10 cycles of knee extension and flexion motion, ranging from 0 to 90-110°, tension was re-measured and re-tensioned to 40 N if the graft tension had decreased. This was repeated thrice for 10 cycles on each graft. Every 10 cycles, we recorded graft tension changes (ΔGT) and compared the mean ΔGT in the AM and PL bundles. Furthermore, we assessed relationships between total ΔGT in each bundle, age, sex, and graft diameter. RESULTS Twenty-five women and 14 men with a mean age of 27.4 ± 12.4 years were included. The mean ΔGT in AM and PL bundles after every 10 cycles were 6.6 ± 3.7 N, 3.0 ± 2.3 N, 1.4 ± 1.5 N, and 9.9 ± 3.8 N, 4.9 ± 2.6 N, and 2.5 ± 1.9 N, respectively. There were significant differences in ΔGT in both bundles after every 10 cycles (p < 0.01). ΔGT in the AM bundle was significantly lower than in the PM bundle at the same number of cycles (p < 0.01). No correlation was observed between ΔGT in either bundle and age, sex, or graft diameter. CONCLUSIONS The initially applied graft tension decreased by intra-operative cyclic knee movement, and the changes in graft tension decreased after retention and repeated cycles. Three sets of 10 cycles knee motion may avoid initial tension loss of the hamstring autograft in the early phase after double-bundle ACL reconstruction.
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Affiliation(s)
- Manato Horii
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Ryuichiro Akagi
- Oyumino Central Hospital, Knee Surgery and Sports Medicine Center, 6-49-9 Oyumino-Minami, Midori-Ku, Chiba, Chiba, 266-0033, Japan
| | - Shotaro Watanabe
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Takahiro Enomoto
- Oyumino Central Hospital, Knee Surgery and Sports Medicine Center, 6-49-9 Oyumino-Minami, Midori-Ku, Chiba, Chiba, 266-0033, Japan
| | - Hiroaki Hosokawa
- Department of Orthopedics, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Takahisa Sasho
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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Comparative analysis of the results of the anterior cruciate ligament reconstruction using an autograft preparation by known and new methods. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.6.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background. To date, the problem of choosing the optimal graft for anterior cruciate ligament (ACL) reconstruction and the methods for its formation is one of the main trends in the surgical treatment of patients with anterior knee joint instability.The aim. To compare the results of the anterior cruciate ligament reconstruction using the known method and the new proposed method for autograft formation.Materials and methods. The results of treatment of ACL injury in 44 patients were assessed. In the main group (19 patients), an original technique of ACL reconstruction from 1/2 of the width of m. peroneus longus tendon was used. In the control group (25 patients), ACL reconstruction was performed using a graft from the m. semitendinosus tendon prepared by the Lubowitz method.Results. The mean difference in the circumference of the distal third of the hip in the main group was 1.57 ± 1.162 cm and was statistically significantly better than in the control group, where the mean difference in the hip circumference was 4.74 ± 1.7207 cm.The range of motion of the knee joint in the main group 3 months after the surgery was 128.42 ± 9.287°, and in the control group mean flection was 109.6 ± 9.120°.The functional results in the main group were assessed by the Lisholm scale and were statistically significantly better than the results in the control group. The functional results by the AOFAS (American Orthopedic Foot & Ankle Society) scale in the main group were 100 points before the surgery and at all terms after the surgery: this indicates that the use of 1/2 of the width of m. peroneus longus tendon does not cause the its functional impairement.Conclusion. Anterior cruciate ligament plasty with use of 1/2 of the width of m. peroneus longus tendon prepared by the proposed method showed statistically significantly better results compared to the preparation of autograft from semitendinous muscle tendon using known method.
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Fang C, Cheng R, Jiang J, Dimitriou D, Wang H, Jiang Z, Tsai TY, Cheng CK. An Efficient Needleless Grasping Suture Technique for Graft Preparation in Anterior Cruciate Ligament Reconstruction. Front Surg 2022; 9:863823. [PMID: 35647013 PMCID: PMC9133538 DOI: 10.3389/fsurg.2022.863823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveSeveral needleless techniques have been developed to outcome the inherent disadvantages of the traditional needle stitching technique for graft preparation, such as tendon damage through the needle, time consumption, and the potential risk of needlestick injury. The purpose of the present study is to compare the graft preparation time and the biomechanical performance between an efficient needleless technique and the traditional needle stitching technique for graft preparation in anterior cruciate ligament reconstruction (ACLR).MethodsThe time required to perform a complete suture on 20 hamstring tendons during ACLRs was measured. The grafts from one side were prepared using the needle stitching technique. The grafts from the other side used the needleless grasping suture technique. For the second part of the study, 12 fresh-frozen porcine flexor tendons were divided into two groups using two techniques and were mounted in an electric tensile test system. Each group was pretensioned to 100 N to simulate the maximum initial graft tension. The suturing state of sutures and graft (intact and damaged) and the load-elongation curve were recorded for each group. A Student’s t-test was used to compare the means of the two groups.ResultsIn operation, the needleless grasping suture technique group (19.8 ± 4.8, range: 13.5–32.9 s) was significantly faster (p < 0.05) than the needle stitching technique group (52.7 ± 12.7, range: 36.0–87.5 s). The state of sutures in each group was intact. The mean elongation was 11.75 ± 1.38 (range: 9.47–12.99) mm and 10.59 ± 1.02 (range: 9.12–11.76) mm in the needleless stitching technique group and the needle grasping suture technique group, respectively. There was no statistically significant difference in the elongation between the two groups (p > 0.05).ConclusionThe needleless grasping suture technique was a convenient and efficient method for graft preparation in ACLR.
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Affiliation(s)
- Chaohua Fang
- Department of Sports Medicine, Ningbo No. 6 Hospital, Zhejiang, China
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
| | - Rongshan Cheng
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Jiang
- Department of Operating Room, Ningbo No. 6 Hospital, Zhejiang, China
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Huizhi Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziang Jiang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Cheng-Kung Cheng Tsung-Yuan Tsai
| | - Cheng-Kung Cheng
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Cheng-Kung Cheng Tsung-Yuan Tsai
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Yongfei F, Chaoyu L, Wenqiang X, Xiulin M, Jian X, Wei W. Clinical outcomes of Tightrope system in the treatment of purely ligamentous Lisfranc injuries. BMC Surg 2021; 21:395. [PMID: 34743702 PMCID: PMC8573989 DOI: 10.1186/s12893-021-01394-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background Purely ligamentous Lisfranc injuries are mainly caused by low energy damage and often require surgical treatment. There are several operative techniques for rigid fixation to solve this problem clinically. This study evaluated the effect of using the Tightrope system to reconstruct the Lisfranc ligament for elastic fixation. Methods We retrospectively analyzed 11 cases with purely ligamentous Lisfranc injuries treated with the Tightrope system from 2016 to 2019, including 8 male and 3 female. X-ray was performed regularly after operation to measure the distance between the first and second metatarsal joint and the visual analogue scale (VAS) score was used to evaluate pain relief. American orthopedic foot & ankle society (AOFAS) and Maryland foot score were recorded at the last follow-up. Results The average follow-up time was 20.5 months (range, 17–24). There was statistically significant difference in the distance between the first and second metatarsal joint and VAS score at 3 months, 6 months, and the last follow-up when compared with preoperative values (P < 0.05).Mean of postoperative AOFAS mid-foot scale and Maryland foot score were 92.4 ± 4.3, 94.1 ± 3.5, respectively. The Tightrope system was not removed and the foot obtained better biomechanical stability. No complications occurred during the operation. Conclusion Tightrope system in the treatment of purely ligamentous Lisfranc injuries can stabilize the tarsometatarsal joint and achieve satisfactory effect.
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Affiliation(s)
- Fan Yongfei
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Liu Chaoyu
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Xu Wenqiang
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Ma Xiulin
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Xu Jian
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Wang Wei
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China.
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Ono Y, Sato Y, Mukai H, Enomoto T, Kimura S, Nakagawa R, Akagi R, Inaba Y, Kawasaki Y, Ohtori S, Sasho T. Randomized comparative study of suspension femoral fixation device in graft position maintenance in anterior cruciate ligament reconstruction: EndoButton CL vs TightRope RT. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 25:42-46. [PMID: 34141595 PMCID: PMC8184406 DOI: 10.1016/j.asmart.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/07/2021] [Accepted: 05/10/2021] [Indexed: 11/06/2022]
Abstract
Background In double-bundle anterior cruciate ligament reconstruction (ACLR), fixed-loop and adjustable-loop cortical suspensory devices are commonly used to fix the soft graft on the femoral side. However, few studies have compared in vivo elongation of the two devices. The purpose of this study was to determine whether EndoButton CL (EB) and TightRope RT (TR), the suspensory fixation devices used in ACLR, maintained their length in vivo from the time of surgery through the postoperative period in a randomized controlled trial. Methods This study prospectively incorporated 30 patients undergoing initial ACLR at a single center. Participants were divided into two groups using a stratified randomization method with age and sex as assignment adjustment factors. EB or TR was used for fixation of the soft graft on the femoral side. The primary endpoint was to compare the elongation distance of the suspensory device. MRIs were taken within seven days after ACLR and 3,6,12 months postoperatively and measured by a radiologist in a blinded fashion. Secondary endpoints included the side-to-side difference in anterior translation, one leg hop test (HOP index), Lachman test, lateral pivot shift test, and Lysholm score one year postoperatively. Results Twenty-eight patients (EB, n = 13; TR, n = 15) were followed for one year. There was no significant difference between EB and TR groups in elongation from the immediate postoperative period to 3, 6, 12 months after surgery. However, the non-inferiority of TR to EB (non-inferiority margin: 1.5 mm) was not proved by the difference in measured elongation between the two groups (TR – EB, lower 95% CI. AM: 1.80 mm; PL: 1.86 mm) at 6 months. There was no significant difference in anterior translation, HOP index, Lachman test, lateral pivot shift test, or Lysholm score. Conclusion EB and TR had similar graft retaining ability in vivo for 12 months, but the non-inferiority of TR against EB was not verified statistically.
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Affiliation(s)
- Yoshimasa Ono
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan.,Musculoskeletal Disease and Pain, Preventive Medical Sciences, Chiba University, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Hiroki Mukai
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University, Japan
| | - Takahiro Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Ryosuke Nakagawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Yosuke Inaba
- Biostatistics Section, Clinical Research Center, Chiba University, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan.,Musculoskeletal Disease and Pain, Preventive Medical Sciences, Chiba University, Japan
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Wichern CR, Skoglund KC, O'Sullivan JG, Burwell AK, Nguyen JT, Herzka A, Brady JM. A biomechanical comparison of all-inside cruciate ligament graft preparation techniques. J Exp Orthop 2018; 5:42. [PMID: 30306283 PMCID: PMC6179971 DOI: 10.1186/s40634-018-0158-0] [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: 06/01/2018] [Accepted: 09/20/2018] [Indexed: 11/17/2022] Open
Abstract
Background The all-inside cruciate ligament graft preparation technique has become popular due to its utility in sparing a growing physis, preserving a tendon in ACL surgery, and/or reduction of pain. However, few studies have compared graft preparation techniques to determine the ideal construct for cruciate ligament reconstruction. We sought to compare biomechanical properties of two quadrupled all-inside cruciate ligament graft preparation techniques and three alternative all-inside graft preparation techniques that may be used when the available tendon is too short to be quadrupled. Methods Fifty porcine extensor tendons were evenly divided into five groups (n = 10) representing all-inside graft preparation techniques, including two quadrupled (Quad-A, Quad-B) and three alternative methods (Tripled, Folded, Two-Doubled). Each graft construct underwent preconditioning (10 loading cycles from 20 to 50 N at 0.1 Hz), cyclic loading (500 loading cycles from 50 to 250 N at 1.0 Hz) and load-to-failure (tension applied at 20 mm/min). Results Quad-A and Quad-B demonstrated no significant differences in cyclic displacement (10.5 ± 0.3 vs 11.7 ± 0.4 mm; p = 0.915), cyclic stiffness (1086.2 ± 487.3 vs 460.4 ± 71.4 N/mm; p = 0.290), pullout stiffness (15.9 ± 4.3 vs 7.4 ± 4.4 N/mm; p = 0.443), ultimate failure load (641.2 ± 84.7 vs 405.9 ± 237.4 N; p = 0.672), or ultimate failure displacement (47.3 ± 6.7 vs 55.5 ± 0.7 mm; p = 0.778). The mean cyclic displacement of the Two-Doubled group was significantly greater than the Quad-A (29.7 ± 2.2 vs 10.5 ± 0.3 mm; p < 0.001), Quad-B (29.7 ± 2.2 vs 11.7 ± 0.4 mm; p < 0.001), Tripled (29.7 ± 2.2 vs 11.3 ± 0.2 mm; p < 0.001), and Folded group (29.7 ± 2.2 vs 13.3 ± 0.2 mm; p < 0.001). There were no other statistically significant differences between the three alternative all-inside graft preparation techniques. Conclusion The current study demonstrates the biomechanical properties of two quadrupled all-inside graft constructs, Quad-A and Quad-B, are not significantly different. When the available tendon is of insufficient length, the Two-Doubled group demonstrated more than twice the cyclic displacement of all other graft preparation techniques, and is therefore not recommended for use in all-inside cruciate ligament reconstruction.
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Affiliation(s)
- Colter R Wichern
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Kathryn C Skoglund
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Joseph G O'Sullivan
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Anora K Burwell
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Joseph T Nguyen
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Andrea Herzka
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Jacqueline M Brady
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA.
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