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Furumatsu T, Hiranaka T, Kodama Y, Kamatsuki Y, Okazaki Y, Yamawaki T, Endo H, Ozaki T. Intraarticular lengths of double-bundle grafts can change during knee flexion: Intraoperative measurements in anatomic anterior cruciate ligament reconstructions. Orthop Traumatol Surg Res 2021; 107:102816. [PMID: 33484904 DOI: 10.1016/j.otsr.2021.102816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/11/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The lengths of the anteromedial bundle (AMB) and posterolateral bundle (PLB) change during knee motion in double-bundle anterior cruciate ligament (ACL) reconstruction. However, the actual intraarticular graft length would be affected by the bone tunnel position and tunnel creation angle during ACL reconstruction. The aim of this study was to investigate the intraarticular length change of the AMB and PLB in patients who underwent anatomic double-bundle ACL reconstruction. HYPOTHESIS We hypothesized that the PLB would show a more dynamic length change pattern than the AMB during knee flexion at ACL reconstruction. METHODS Thirty-two patients (16 men and 16 women) who had isolated ACL injuries with intact menisci were investigated. Anatomic double-bundle ACL reconstructions were performed using semitendinosus tendon autografts at a mean age of 30.6 years. The graft and tunnel lengths were measured intraoperatively. Intraarticular graft lengths and length changes were calculated at 0° and 90° of knee flexion during ACL reconstruction. Intraoperative data were collected prospectively, and analyses were performed retrospectively. RESULTS The intraarticular length of the AMB at 0° of knee flexion was 28.1±5.5mm. At 90° of knee flexion, the AMB intraarticular length decreased to 25.6±4.8mm. The intraarticular length of the PLB decreased to 17.7±4.6mm at 90° of knee flexion compared to 22.0±4.2mm at 0° of knee flexion. Changes in the intraarticular graft length during knee flexion were detected more in the PLB (4.1mm) than in the AMB (2.0mm, p=0.01). DISCUSSION This study demonstrated that the intraarticular length change of the PLB during knee motion was larger than that of the AMB in anatomic double-bundle ACL reconstructions with semitendinosus tendon autografts and suspensory femoral fixation devices. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan; Department of Orthopaedic Surgery, Sumitomo Besshi Hospital, 3-1 Oujicho, Niihama, 792-8543 Ehime, Japan; Department of Orthopaedic Surgery, Kousei Hospital, 3-8-35 Kouseicho, Kitaku, 700-0985 Okayama, Japan.
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan; Department of Orthopaedic Surgery, Sumitomo Besshi Hospital, 3-1 Oujicho, Niihama, 792-8543 Ehime, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Tadashi Yamawaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan; Department of Orthopaedic Surgery, Kousei Hospital, 3-8-35 Kouseicho, Kitaku, 700-0985 Okayama, Japan
| | - Hirosuke Endo
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
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Mutsuzaki H, Kinugasa T, Ikeda K, Sakane M. Morphological changes in the femoral and tibial bone tunnels after anatomic single-bundle anterior cruciate ligament reconstruction using a calcium phosphate-hybridized tendon graft in 2years of follow-up. Orthop Traumatol Surg Res 2019; 105:653-660. [PMID: 30853458 DOI: 10.1016/j.otsr.2019.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/21/2018] [Accepted: 01/09/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A calcium phosphate (CaP)-hybridized tendon graft improves tendon-to-bone healing. The purpose of the study was to evaluate the progression of morphological changes in the femoral and tibial bone tunnels after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction using the CaP-hybridized tendon graft versus an untreated tendon graft during 2 years of follow-up. HYPOTHESIS We hypothesized that the CaP-hybridized tendon graft would prevent the progression of bone tunnel enlargement compared with the untreated tendon graft. PATIENTS AND METHODS The CaP group comprised 19 patients, while the conventional group comprised 18. Computed tomography was performed at postoperative 1 week, 1 year, and 2 years. The bone tunnel enlargement and tunnel translation at the aperture of the femoral and tibial tunnels were analyzed. RESULTS In the CaP group, the femoral bone tunnel did not expand during 2 years of follow-up. In the conventional group, the femoral bone tunnel diameters at postoperative 1 year and 2 years were enlarged compared with postoperative 1 week, and the proximal and distal walls of the femoral bone tunnel shifted proximally and distally, respectively. The femoral bone tunnel in the CaP group was smaller than that in the conventional group at 1 year postoperatively. Although the tibial bone tunnels expanded for up to 1 year postoperatively in both groups, the expanded bone tunnel reduced during 2 years of follow-up only in the CaP group. DISCUSSION In anatomic single-bundle ACL reconstruction, the femoral bone tunnel in the CaP group did not expand or progress with time compared with the conventional group, while the tibial bone tunnel in the CaP group expanded for up to 1 year postoperatively and then reduced for up to 2 years postoperatively. The CaP-hybridized tendon can prevent the progression of bone tunnel enlargement. LEVEL OF EVIDENCE Level II, Low-powered prospective randomized trial.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami Ami-machi, 300-0394 Inashiki-gun, Ibaraki, Japan.
| | - Tomonori Kinugasa
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Oozone, 300-3295 Tsukuba, Ibaraki, Japan
| | - Kotaro Ikeda
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Oozone, 300-3295 Tsukuba, Ibaraki, Japan
| | - Masataka Sakane
- Department of Orthopaedic Surgery, Tsukuba Gakuen Hospital, 2573-1 Kamiyokoba, 305-0854 Tsukuba, Ibaraki, Japan
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Volpi P, Quaglia A, Carimati G, Galli M, Papalia R, Petrillo S. Double bundle anterior cruciate ligament reconstruction: Failure rate and patients-reported outcomes at 4-11 years of follow up. J Orthop 2019; 16:224-229. [PMID: 30906128 DOI: 10.1016/j.jor.2019.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background Biomechanical studies have demonstrated that single bundle (SB) anterior cruciate ligament (ACL) reconstruction (SB-ACLr), which represents the gold standard for the management of ACL lesions, is not sufficient to completely restore the rotational stability and resistance to valgus stress of the knee. Purpose To evaluate the failure rate and patients reported outcomes at a long-term follow-up of double bundle anterior cruciate ligament reconstruction (DB-ACLr). Study design Retrospective cohort study. Materials and methods The database of arthroscopic DB-ACLr procedures performed from 2006 to 2015 at our Institution was retrospectively reviewed. Patients were screened for eligibility according to the following inclusion criteria: magnetic resonance imaging (MRI) evidence of anterior cruciate ligament (ACL) lesion, positive anterior drawer test and/or Lachman test; age ≤ 45 years at the time of surgery; DB-ACLr with autologous hamstrings, minimum follow up of 24 months. Patients were excluded if they presented associated lesions of the knee preoperatively or at the time of surgery, expect for meniscal lesions, or in case of inability to complete clinical questionnaires. Clinical outcomes were assessed at a mean follow up of 95.4 ± 21.9 months (range 51-129 months; median 98 months) using the Tegner-Lysholm score and the IKDC subjective score. Failures were defined as Tegner-Lysholm score ≤65 points, and were confirmed with MRI. Results 58 (81.7%) male and 13 (18.3%) female patients (mean age 29.7 ± 7.8 years) were included in the study. 2 (2.8%, 95% CI 0.3-9.8%) patients had a failure of DB-ACLr both occurred after a sports trauma. The IKDC subjective score was statically better in patients younger than 30 years. Tegner-Lysholm and IKDC subjective score were statistically better in professional athletes and in patients with isolated medial or lateral meniscus lesion instead of combined medial and lateral meniscus lesion. Conclusion DB-ACLr technique provides excellent clinical results at a long term follow-up. Low failure rate and high percentage of return to sports participation at the same pre-injury level was found in our cohort of patients.
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Affiliation(s)
- Piero Volpi
- Knee Surgery and Sports Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alessandro Quaglia
- Knee Surgery and Sports Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giulia Carimati
- Knee Surgery and Sports Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marco Galli
- Centre of Sports Traumatology and Arthroscopic Surgery, Galeazzi Orthopaedics Institution of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro Del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Stefano Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro Del Portillo, 200, 00128, Trigoria, Rome, Italy
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Chen H, Tie K, Qi Y, Li B, Chen B, Chen L. Anteromedial versus transtibial technique in single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomized controlled trials. J Orthop Surg Res 2017; 12:167. [PMID: 29115973 PMCID: PMC5678560 DOI: 10.1186/s13018-017-0671-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/28/2017] [Indexed: 12/20/2022] Open
Abstract
Background The aim of this study was to compare the clinical outcome and postoperative complication between single-bundle anterior cruciate ligament (ACL) reconstruction with an anteromedial (AM) technique and a transtibial (TT) technique. Methods The study includes clinical randomized controlled trials comparing the clinical outcomes of ACL reconstruction using the autologous hamstring tendon with an AM method and a TT method published up to September 2017 were retrieved from PubMed, Cochrane Library, and Embase databases. Relevant data were extracted and the Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality. Stata/SE 12.0 was used to perform a meta-analysis of the clinical outcome. Results Five RCTs were included, with a total of 479 patients: 239 patients and 240 patients in the AM group and the TT group, respectively. Assessing postoperative stability, better results were found in the AM group for the negative rate of the Lachman test (P < 0.05), the negative rate of the pivot-shift test (P < 0.05) and the side-to-side difference (P < 0.05). Assessing postoperative functional outcome, the AM group yielded superior results in proportion with International Knee Documentation Committee (IKDC) grade A (P < 0.05) and the Lysholm scores (P < 0.05) but had a comparable IKDC score (P > 0.05). In terms of postoperative complication, no significant difference was found between the AM group and the TT group (P > 0.05). Conclusions The outcome of single-bundle ACL reconstruction with the AM technique is better than that with the TT technique in terms of postoperative stability and functional recovery of the knee.
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Affiliation(s)
- Haitao Chen
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Kai Tie
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yongjian Qi
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Bin Li
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Biao Chen
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Liaobin Chen
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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