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Siboni R, Pioger C, Mouton C, Seil R. Presentation of an intraosseous suspensory fixation technique for pediatric and adult ACL reconstruction. Orthop Traumatol Surg Res 2024; 110:103633. [PMID: 37121431 DOI: 10.1016/j.otsr.2023.103633] [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: 08/25/2022] [Revised: 01/24/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023]
Abstract
The aim is to present a technique for pediatric and adult ACL reconstruction using an intraosseous suspensory fixation. This technique uses a 4-strands hamstring graft fixed in the femoral tunnel, with a loop locked in a polyetheretherketone (PEEK) cage. The ACLip® device offers an inside-out drilling system and a closer fixation to the joint than an extracortical button fixation. The technique can be easily used both in adults and in skeletally immature patients. The first practical experience shows promising results regarding the safety and the effectiveness of the technique. Level of evidence: IV.
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Affiliation(s)
- Renaud Siboni
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Department of Orthopaedic Surgery, Reims teaching Hospital, hôpital Maison Blanche, 45, rue Cognacq-Jay, 51092 Reims, France
| | - Charles Pioger
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Department of Orthopaedic Surgery, Ambroise-Paré Hospital, Paris Saclay University, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Caroline Mouton
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg; Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg, Luxembourg.
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Vari N, Cavaignac E, Cavaignac M, Bérard É, Marot V. Outcomes of hamstring graft with preserved tibial insertion for ACL reconstruction: systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:67-73. [PMID: 37644333 PMCID: PMC10771374 DOI: 10.1007/s00590-023-03698-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Evaluate the outcomes of ACL (Anterior Cruciate Ligament) reconstruction techniques that use a hamstring graft with a preserved tibial insertion and compare them to standard techniques. METHODS A systematic literature review and meta-analysis was done of the PubMed, MEDLINE, Cochrane and Ovid databases to identify published clinical studies on ACL reconstruction in which a non-detached hamstring tendon (NDHT) was used as a graft and to compare them to studies in which a detached hamstring tendon (DHT) or other techniques were used. The eligible studies were analyzed for the knee laxity, Lachman test, pivot shift test, joint range of motion, anterior drawer, pain, re-tear, revision surgery, Lysholm score, Tegner score, ACL-RSI scale, KOOS, IKDC, SNQ and Howell scale. RESULTS Twelve articles in which NDHT was used for ACL reconstruction were analyzed. There was no significant difference between NDHT and DHT in the Lachman > 1 (p = .07), pivot shift test > 1 (p = .40), re-tears (p = .62), pain (p = .85) and the Tegner score (p = .95). However, the outcomes were somewhat better with the NDHT technique for the Lachman (RR = 0.30; 95% CI 0.08-1.12), pivot shift test (RR = 0.50; 95% CI 0.10-2.49) and re-tears (RR = 0.66; 95% CI 0.13-3.42). The other criteria were not included in the meta-analysis because of lack of data or because specific outcome scores were used in each article. CONCLUSION NDHT techniques provide similar results to DHT for ACL reconstruction and tend to produce better stability and a lower re-tear rate.
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Affiliation(s)
- Nicolas Vari
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France.
| | - Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | | | - Émilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR 1295 CERPOP, University of Toulouse, INSERM, UPS, Toulouse University Hospital (CHU), Toulouse, France
| | - Vincent Marot
- Orthopaedics Unit, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
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Noailles T, Toanen C, Geffroy L, Lopes R, Hardy A. Preserving the hamstring tendon insertion during ACL reconstruction with an autograft: Systematic literature review. Orthop Traumatol Surg Res 2023; 109:103556. [PMID: 36682410 DOI: 10.1016/j.otsr.2023.103556] [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: 01/17/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The hamstring tendons (gracilis and semitendinosus) are often used as an autograft for anterior cruciate ligament (ACL) reconstruction. Healing of this graft involves a slow biological process called ligamentization. To encourage this process, some authors have proposed preserving the insertion of the hamstring tendons. HYPOTHESIS Leaving the tibial insertion of the hamstring tendons intact will provide better early biological incorporation and superior tibial mechanical fixation resulting in various clinical advantages. MATERIALS AND METHODS In January 2022, a systematic literature review was carried out independently by two authors of the Medline, PubMed and Embase databases. The keywords used were "pedicular" or "pedicled" or "preservation of tibial attachment" or "hamstring tibial insertion" AND "ACL reconstruction". Each author's data was analyzed separately. RESULTS Sixteen articles were analyzed. Preserving the hamstring tibial insertion during ACL reconstruction improves the graft's biological incorporation during the initial postoperative phase according to clinical studies with MRI analysis and provides a mechanical advantage at the graft's tibial attachment according to biomechanical studies (construct up to 65% stiffer). There was no difference in the clinical and functional scores when compared to the conventional technique in which the hamstring tendons are detached from their tibial insertion. DISCUSSION The main conclusion of this systematic literature review was that preserving the hamstring tibial insertion during ACL reconstruction appears to improve the graft's ligamentization with biological and mechanical advantages relative to detaching the hamstring tendons. The clinical and functional results were comparable to other techniques. Prospective studies with large cohorts are still needed to confirm these findings. LEVEL OF EVIDENCE IV; Systematic review of literature.
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Affiliation(s)
- Thibaut Noailles
- Département de Chirurgie Orthopédique, Polyclinique de Bordeaux Nord, 15/35, rue Claude Boucher, 33000 Bordeaux, France.
| | - Cécile Toanen
- Service de Chirurgie Orthopédique, CHD Vendée, Boulevard Stéphane Moreau, 85925 La Roche-sur-Yon, France
| | - Loïc Geffroy
- Département de Chirurgie Orthopédique, Polyclinique de l'Atlantique, avenue Claude Bernard, 44819 Saint Herblain Cedex, France
| | - Ronny Lopes
- Département de Chirurgie Orthopédique, Polyclinique de l'Atlantique, avenue Claude Bernard, 44819 Saint Herblain Cedex, France
| | - Alexandre Hardy
- Clinique du sport Paris V, 36, boulevard Saint Marcel, 75005 Paris, France
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Vari N, Marot V, Ripoll T, Vieira TD, Martinel V, Bérard E, Cavaignac E. Preserving the Semitendinosus Distal Attachment Is Associated With Improved Graft Remodeling After ACL Reconstruction. Am J Sports Med 2023; 51:2064-2072. [PMID: 37204156 DOI: 10.1177/03635465231169047] [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] [Indexed: 05/20/2023]
Abstract
BACKGROUND The semitendinosus (ST) tendon can be used by itself as a graft for anterior cruciate ligament (ACL) reconstruction. An increasing number of these procedures are being done while preserving the ST's tibial attachment, but there are no data on the remodeling of an attached ST (aST) graft. PURPOSE To compare graft remodeling on magnetic resonance imaging (MRI) scans at 1 year after ACL reconstruction between standard free ST graft and aST graft. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This prospective study enrolled 180 patients who were undergoing ACL reconstruction: 90 with the ST graft and 90 with the aST graft. The analysis was performed 1 year after the surgery. The main endpoint was the signal-to-noise quotient (SNQ) on MRI scans (T1-weighted sequence). The secondary endpoints were tibial tunnel widening (TTW), graft maturation (Howell classification), retear rate, new surgery rate, Simple Knee Value, Lysholm score, International Knee Documentation Committee (IKDC) score, postoperative Tegner score, difference between pre- and postoperative Tegner scores, ACL-Return to Sport after Injury (ACL-RSI), return-to-sports rate, and time to return to sports. RESULTS The mean adjusted SNQ was 1.18 (95% CI, 0.72-1.65) in the aST group and 3.88 (95% CI, 3.42-4.34) in the ST group (P < .001). The new surgery rate was 2.2% in the aST group and 10% in the ST group (P = .029). The median Lysholm score was significantly higher in the aST group (99; interquartile range [IQR], 95-100) than in the ST group (95; IQR, 91-99) (P = .004). The mean time to return to sports was significantly shorter in the aST group (248.73 ± 141.62 days) than the ST group (317.23 ± 144.69 days) (P = .002). No statistically significant difference was found between groups in the TTW (P = .503), Howell graft maturity grade (P = .149), retear rate (P > .999), Simple Knee Value (P = .061), postoperative Tegner score (P = .320), pre- to postoperative difference in Tegner score (P = .317), ACL-RSI (P = .097), IKDC score (P = .621), and return-to-sports rate (P > .999). CONCLUSION At 1 year postoperatively, remodeling of an ST graft assessed using MRI is better when its distal attachment is left intact.
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Affiliation(s)
- Nicolas Vari
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Vincent Marot
- Orthopaedics Unit, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Thomas Ripoll
- Musculoskeletal Institute, Hôpital Pasteur 2, CHU Nice, Nice, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Vincent Martinel
- Orthopedic Group Ormeau Pyrénées, Polyclinique de l'Ormeau, Tarbes, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR 1295 CERPOP, University of Toulouse, INSERM, UPS, Toulouse University Hospital (CHU), Toulouse, France
| | - Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
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Noailles T, Toanen C, Geffroy L, Lopes R, Hardy A. Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction With Pedicular Hamstrings Tendon Graft, Single-Strand Gracilis for ALL and Single Blind Femoral Tunnel. Arthrosc Tech 2023; 12:e1145-e1154. [PMID: 37533915 PMCID: PMC10390882 DOI: 10.1016/j.eats.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 08/04/2023] Open
Abstract
Combined anterior cruciate ligament and anterolateral ligament reconstruction (ACL+ALL r) is a common procedure to treat rotational instability and to prevent ACL graft failure. Recent studies have described numerous combined reconstruction techniques to obtain the most anatomical procedure with the least graft donor site morbidity and the best clinical results. Hamstring (HG) grafts are the most popular graft in literature. Leaving pedicle HG can preserve enough blood supply to improve tendon-bone healing with additional mechanical fixation of the graft on the tibial side. A single femoral tunnel reduces bone loss and prevents convergence of 2 femoral tunnels. We describe an original ACL and ALL reconstruction technique that preserves hamstring tibial insertion with a single blind femoral tunnel.
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Affiliation(s)
- Thibaut Noailles
- Département de Chirurgie Orthopédique, Polyclinique de Bordeaux Nord, Bordeaux, France
| | - Cécile Toanen
- Service de Chirurgie Orthopédique, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | | | - Ronny Lopes
- Département de Chirurgie Orthopédique, Polyclinique de l’Atlantique, Saint Herblain Cedex, France
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Vari N, Marot V, Cavaignac M, Vieira TD, Bérard É, Cavaignac E. Factors Affecting Graft Remodeling and Anterior Cruciate Ligament Reconstruction: MRI Study of 180 Knees. Am J Sports Med 2023; 51:2073-2078. [PMID: 37249129 DOI: 10.1177/03635465231171947] [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] [Indexed: 05/31/2023]
Abstract
BACKGROUND Several factors affect the retear rate after anterior cruciate ligament (ACL) reconstruction, but there are few data on which factors affect graft remodeling. PURPOSE To determine which factors are associated with the remodeling of an ACL graft. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A retrospective longitudinal study was conducted to investigate the relationship between various exposure factors and the occurrence of an "event": graft remodeling measured with the signal-to-noise quotient (SNQ). Data were collected prospectively and analyzed retrospectively for this study. The endpoint was the SNQ on magnetic resonance imaging at postoperative 1 year. The effect of the following parameters on SNQ was investigated: sex, smoking habits, age at surgery, body mass index, time to surgery, time to return to sports, type of sport (in-line, pivot, contact), type of graft (free semitendinosus [ST] or attached ST), and addition of lateral tenodesis. RESULTS An overall 180 patients were enrolled (90 with each technique). The following factors were significantly and independently associated with the SNQ: attached ST graft (β = -2.624668; P < .001), age at the time of surgery (β = -0.7948476; P = .012), and time elapsed between the injury event and surgery (β = -0.7137424; P = .046). CONCLUSION Leaving the ST graft attached distally, being older at the time of surgery, and having more time elapse between the injury event and ACL reconstruction surgery were significantly associated with better graft remodeling.
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Affiliation(s)
- Nicolas Vari
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Vincent Marot
- Orthopaedics Unit, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | | | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Émilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR 1295 CERPOP, University of Toulouse, INSERM, UPS, Toulouse University Hospital, Toulouse, France
| | - Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
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Fang K, Dai Z, Lin X. The tibial insertion of the hamstring can be considered to be preserved during anterior cruciate ligament reconstruction. Front Surg 2022; 9:996289. [PMID: 36211289 PMCID: PMC9533081 DOI: 10.3389/fsurg.2022.996289] [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: 07/17/2022] [Accepted: 09/01/2022] [Indexed: 11/15/2022] Open
Abstract
Background Hamstring as a graft was very common in anterior cruciate ligament reconstruction surgery. Usually the hamstring muscles needed to be taken out and then woven to be used. Aim In order to investigate whether it was beneficial for patients to preserve the transpedicular insertion of hamstring when using the hamstring as a graft for anterior cruciate ligament reconstruction. Methods This was a retrospective study. Patients with anterior cruciate ligament injury who underwent surgery in a large hospital from January 2015 to May 2021 were included in the study. These patients underwent anterior cruciate ligament reconstruction assisted by arthroscopic. Autologous hamstring muscles were used as grafts. The tibial insertion of the hamstring were preserved during the operation were included in the observation group. The remaining patients were included in the control group. The knee joint function and operation of the two groups were compared. Results A total of 97 patients were included in the study. There was no statistical difference between the two groups in general data including gender, age and surgical side. All the patients’ operations were successfully completed there was no significant difference in the operation time between the two groups. All patients were followed up for at least 1 year. No patients had complications such as wound infection and graft failure at the last follow-up. There was no significant difference between the two groups in Lysholm score and IKDC score before operation. Similarly, there was no significant difference between the two groups in Lysholm score and IKDC score 3 months after operation. However, the Lysholm score and IKDC score of the two groups 1 year after operation were statistically different, and the patients in the observation group had higher Lysholm score and IKDC score. After comparing the MRI images of the knee of the two groups 3 months after operation through the MRI evaluation system, compared with the patients in the control group, the patients in the observation group have higher scores, and the difference was statistically significant. Conclusion In the knee arthroscopic assisted anterior cruciate ligament reconstruction using the hamstring as a graft, the tibial insertion of the hamstring can be preserved, which can make the patient have better function after the operation. This kind of operation leads to the increase of operation time and operation risk.
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Lang E, Hardy A, Tufis O, Grimaud O, Gerometta A, Bohu Y, Lefevre N, Meyer A. Surgical technique of anterior cruciate ligament ligamentoplasty with pedicular hamstrings via an inside-out approach: BIOFAST hamstring tendons graft. Orthop Traumatol Surg Res 2022; 108:103192. [PMID: 34952217 DOI: 10.1016/j.otsr.2021.103192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
This surgical technique of anterior cruciate ligament (ACL) reconstruction uses a 4-stranded hamstring tendons graft (HG), via an inside-out approach with a femoral cortical button and a tibial screw. It offers preservation of the tibial attachment of the hamstrings and enables double tibial fixation: biological and mechanical. This technique, "BIOFAST HG", does not require any calculation of the length of the tunnels, nor the use of different sized, or adjustable, buttons. If the sliding in the femoral tunnel fails, it is possible to easily convert to a so-called "classic technique". The first 60 cases were reviewed with a conversion rate of 3%. This technique allows the benefits of a pedicled graft over the classic HG technique in a simple way, with minimal conversions to the classic technique.
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Affiliation(s)
- Elena Lang
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France.
| | - Alexandre Hardy
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - Olimpia Tufis
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - Olivier Grimaud
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France
| | | | - Yoann Bohu
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - Nicolas Lefevre
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - Alain Meyer
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France
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Ahn JH, Koh IJ, McGarry MH, Patel NA, Lin CC, Lee TQ. Synergistic effect of the anterolateral ligament and capsule injuries on the knee laxity in anterior cruciate ligament injured knees: A cadaveric study. Orthop Traumatol Surg Res 2022; 108:103224. [PMID: 35104628 DOI: 10.1016/j.otsr.2022.103224] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/03/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is much controversy about the practical role of the anterolateral ligament (ALL) and its relation to other anterolateral knee structures including the anterolateral capsule (ALC) and iliotibial band (ITB). The purpose of this cadaveric study was to investigate the effect of the ALL and ALC injuries on knee laxity with the iliotibial band (ITB) preserved in the anterior cruciate ligament (ACL)-injured knee. HYPOTHESIS The ALL and ALC would contribute to knee joint stability during anterior translation and internal rotation of the tibia in an ACL-injured knee. MATERIAL AND METHODS For 10 fresh-frozen cadaveric knees, we measured knee laxity with the following state of knee injuries with ITB preserved: (1) intact knee, (2) ACL-sectioned knee (ACL-), (3) additional sectioning of the ALL (ACL-/ALL-), and (4) additional sectioning of the ALC (ACL-/ALL-/ALC-). We did biomechanical measurements in internal-external rotation, anterior-posterior translation, and varus-valgus angulation for each condition at knee flexion angles of 0°, 30°, 60°, and 90°. RESULTS After we sectioned the ALL (ACL-/ALL-), the mean IR at 0°, 30°, 60°, and 90° of knee flexion were significantly increased, compared to the intact knee (p=<0.001, <0.001, <0.001, and 0.002) and ACL- (p=<0.001, <0.001, <0.001, and 0.002). The additional transection of the ALC (ACL-/ALL-/ALC-) significantly increased IR laxity from the ACL-/ALL- at 30°, 60°, and 90° (p=0.005, 0.003, and 0.047). For anterior laxity, ACL-/ALL- resulted in significantly increased anterior laxity from the ACL- at 30° and 60° (p=0.003 and 0.019), and ACL-/ALL-/ALC- significantly increased anterior laxity even from the ACL-/ALL- at 30° and 60° (p=0.007 and 0.011). For varus laxity, ACL-/ALL- resulted in significantly increased varus laxity from both the intact knee and ACL- at 60° (p=0.004 and 0.007) and 90° (p=<0.001 and<0.001). ACL-/ALL-/ALC- resulted in significantly increased varus from ACL-/ALL- at 60° and 90° (p=<0.001 and 0.003). CONCLUSION The anterolateral ligament and anterolateral capsule injuries in ACL-injured knees even with ITB preserved had a synergistic effect on knee laxity in the aspects of internal rotation, anterior translation, and varus angulation. LEVEL OF EVIDENCE II, Controlled laboratory study.
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Affiliation(s)
- Ji Hyun Ahn
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, 814 Siksadong, Ilsandonggu, Goyangsi, Gyeonggido, 411-773, South Korea.
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Nilay A Patel
- Department of Orthopaedic Surgery, University of California, Irvine, CA, USA
| | - Charles C Lin
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
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10
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Comparing the Stiffness of Peroneus Longus Tendon Versus Hamstrings in Anterior Cruciate Ligament Reconstruction: A Biomechanical Study. Asian J Sports Med 2021. [DOI: 10.5812/asjsm.110160] [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] [Indexed: 11/16/2022] Open
Abstract
Background: The use of autografts originating from either hamstring tendons or peroneus longus tendons is a surgical option in anterior cruciate ligament (ACL) reconstruction. Objectives: This research aimed to compare the tensile strength between the hamstring tendon and the peroneus longus tendon in ACL reconstruction. The hypothesis of this study was: Peroneus longus grafts have tensile strength equal to hamstring grafts based on living donor patients. Methods: This cross-sectional study was a biomechanical study examining means and standard deviations (SD) by comparing the tensile strength of peroneus longus tendons and hamstring tendons when used as autograft donors in ACL reconstruction. Results: In this study, 51 patients with reconstructive ACL were enrolled. The mean diameter of the hamstring tendon was 7.86 with SD ± 0.69, while the mean diameter of peroneus longus tendon was 7.67 with SD ± 0.63. The mean diameter of the peroneus longus graft was not significantly different. The mean displacement on the hamstring tendon was 2.44 with SD ± 0.42, while the peroneus longus tendon was 2.06 with SD ± 0.14. The peroneus longus tendon had significantly more tensile strength compared to the hamstring tendon. Conclusions: Diameter of the peroneus longus graft was not significantly different from the hamstring graft. However, the peroneus longus graft had more tensile strength than the hamstring graft based on living donor patients.
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Gupta R, Singh S, Kapoor A, Soni A, Kaur R, Kaur N. Graft tunnel integration occurs early in the tibial tunnel compared with the femoral tunnel after anterior cruciate ligament reconstruction with preserved insertion hamstring tendon graft. Knee Surg Relat Res 2021; 33:37. [PMID: 34627401 PMCID: PMC8501577 DOI: 10.1186/s43019-021-00119-x] [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: 05/19/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Preservation of hamstring tendon insertion at the time of anterior cruciate ligament (ACL) reconstruction is a well-known technique; however, its effect on graft integration is not well studied. The present study was conducted to study the graft integration inside the tibial and femoral tunnels, respectively, after ACL reconstruction using hamstring tendon graft with preserved insertion. Methods Twenty-five professional athletes who underwent ACL reconstruction using hamstring tendon graft with preserved tibia insertion were enrolled in the study. Functional outcomes were checked at final follow-up using Lysholm score and Tegner activity scale. Magnetic resonance imaging (MRI) was done at 8 months and 14 months follow-up to study the graft tunnel integration of the ACL graft at both tibial and femoral tunnels. Results The mean Fibrous interzone (FI) score (tibial tunnel) decreased from 2.61 (1–5) at 8 months to 2.04 (1–4) at 14 months follow-up (p = 0.02). The mean FI score (femoral side) decreased from 3.04 (2–5) at 8 months to 2.57 (2–4) at 14 months (p = 0.02). Conclusions Graft integration occurs early in the tibial tunnel as compared with the femur tunnel with preserved insertion hamstring tendon autograft. Trial registration CTRI/2019/07/020320 [registered on 22/07/2019]; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33884&EncHid=&modid=&compid=%27,%2733884det%27
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Affiliation(s)
- Ravi Gupta
- Unit II, Orthopaedics Cum Project Director Sports Injury Centre and Medical Superintendent, Government Medical College Hospital, Chandigarh, India
| | - Sandeep Singh
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Anil Kapoor
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India.
| | - Ashwani Soni
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Ravinder Kaur
- Department of Radio-Diagnosis, Government Medical College Hospital, Chandigarh, India
| | - Narinder Kaur
- Department of Radio-Diagnosis, Government Medical College Hospital, Chandigarh, India
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Meynard P, Pelet H, Angelliaume A, Legallois Y, Lavignac P, De Bartolo R, Fabre T, Costes S. ACL reconstruction with lateral extra-articular tenodesis using a continuous graft: 10-year outcomes of 50 cases. Orthop Traumatol Surg Res 2020; 106:929-935. [PMID: 32534897 DOI: 10.1016/j.otsr.2020.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Persistence of pivot shift is the main problem after isolated intra-articular anterior cruciate ligament (ACL) reconstruction. Adding lateral extra-articular tenodesis (LET) to the ACL procedure increases the knee's stability by controlling rotational laxity. The aim of this study was to evaluate the long-term clinical and radiological outcomes of combined ACL reconstruction with LET using a continuous hamstring graft as a first-line procedure. MATERIAL AND METHODS Fifty patients were reviewed at 10 years postoperative. Subjective outcome scores -IKDC, Lysholm, KOOS and Tegner- were collected. A clinical and radiological assessment was done. The knees' anteroposterior laxity was measured with a rollimeter. RESULTS The mean IKDC subjective score was 85.5, the mean Lysholm score was 90.2 and 80% of patients had a score graded as good or very good. No pivot shift was present in 94% of patients and there was a firm endpoint in the Lachman test in 86% of patients. There was a flexion deficit>5° in 5 patients and an extension deficit of 10° in one patient. Most patients (56%) had resumed their physical activities at the same level as before the surgery. Signs of osteoarthritis were found in 26% of patients (16% were Ahlback stage 1 and 10% were stage 2). There was only one graft failure. These good outcomes are consistent with other published studies on combined ACL-LET. There was neither significant stiffness, nor a higher rate of secondary osteoarthritis relative to ACL reconstruction only, particularly in the lateral tibiofemoral compartment. CONCLUSION Adding primary LET to ACL reconstruction improves control of rotational laxity over time without increasing the complication rate. LEVEL OF EVIDENCE IV, retrospective study without control group.
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Affiliation(s)
- Pierre Meynard
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Hugo Pelet
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Audrey Angelliaume
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Yohan Legallois
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Pierre Lavignac
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Rafael De Bartolo
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Thierry Fabre
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Stéphane Costes
- Département d'orthopédie-traumatologie, hôpital Robert-Boulin, 112, rue de la Marne, 33500 Libourne, France
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Saur M, Clavert P, Bonnomet F, Favreau H, Ehlinger M. Biomechanical effects of stitches on the intra-articular mid-substance of quadruple hamstring-tendon grafts for anterior cruciate ligament reconstruction - a pilot comparative cadaveric study. Knee Surg Relat Res 2020; 32:39. [PMID: 32727593 PMCID: PMC7391568 DOI: 10.1186/s43019-020-00059-y] [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: 03/20/2020] [Accepted: 07/15/2020] [Indexed: 12/02/2022] Open
Abstract
Background There is little data in the literature regarding the preparation methods of the intra-articular portion of quadruple hamstring-tendon grafts for anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare the biomechanical properties of a sutured transplant to that of a non-sutured transplant. The hypothesis was that adding stitches to the intra-articular portion of the graft increased its resistance. Method A comparative cadaveric study was carried out on five pairs of knees. The average age of the cadavers was 68 years. The exclusion criterion was past knee surgery. In the Sutured Group (SG) two stitches were made on the grafts. No stitches were made on the grafts of the Non-sutured Group (NSG). A tensile failure test was carried out using an Instron® loading machine. The maximal load to failure and stiffness were recorded and we observed the mode of failure for each graft. Statistical analysis was performed using the Wilcoxon rank sum test. Level of significance was set at p < 0.05. Results The hypothesis proposed was not confirmed; adding stitches to the intra-articular portion of the four-strand hamstring-tendon graft does not increase its biomechanical properties. The maximal load to failure was 233.5 N ± 40.6 (186.7–274.5 N) for the NSG, 19.6% higher than for the SG which was 195.2 N ± 42.9 (139.0–238.2 N). Nevertheless, the difference observed was not statistically significant (p = 0.188). The stiffness of the grafts for the NSG was 23.5 N/mm ± 5.3 (17.8–29 N/mm) and 19.7 N/mm ± 5.5 (13.2–24.7 N/mm) for the SG grafts. Overall stiffness values for the NSG were 19% higher than those of the SG; however, the results were not statistically significant (p = 0.438). The failure mode was a rupture at the fixation point except for one sample from the SG which failed at an intra-articular stitch. Conclusion Whilst the initial hypothesis was not verified, nevertheless, the maximal loads to failure and stiffness were approximately 20% higher when there were no intra-articular stitches compared to the situation where stitches were added to the intra-articular portion of the graft. This was a cadaveric pilot study and, therefore, whilst we are not able to extend our results to clinical practice, the outcomes would indicate the need for further development of this and related protocols deriving from the question of whether there is weakening the graft when adding stitches to its mid-substance. These results remain to be confirmed by further research.
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Affiliation(s)
- Maurise Saur
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg cedex, France.
| | - Philippe Clavert
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg cedex, France.,Laboratoire iCube-GEBOAS, CNRS UMR 7357, Equipe 12 Matériaux Multi-échelles et Biomécanique, Institut de Mécanique des Fluides et des Solides, 2-4 Rue Boussingault, 67000, Strasbourg, France.,Institut d'Anatomie Normale et Pathologique de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg cedex, France
| | - Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg cedex, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg cedex, France
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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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Santos ADA, Carneiro-Filho M, e Albuquerque RFDM, de Moura JPFM, Franciozi CE, Luzo MVM. Mechanical evaluation of tibial fixation of the hamstring tendon in anterior cruciate ligament double-bundle reconstruction with and without interference screws. Clinics (Sao Paulo) 2020; 75:e1123. [PMID: 32556055 PMCID: PMC7196727 DOI: 10.6061/clinics/2020/e1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/29/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare two postero-lateral bundle (PLB) tibial fixation techniques for the reconstruction of the anterior cruciate ligament with double bundle: a technique without the use of an interference screw, preserving the native tibial insertion of the tendons of the gracilis and semitendineous muscles, and a technique with the use of an interference screw and without preserving the insertion of the tendons. METHODS A comparative study was conducted in cadavers with a universal mechanical test machine. In total, 23 cadaver knees were randomized for tibial fixation of the PLB using the two techniques: Maintaining the tibial insertion of the tendons during reconstruction, without the use of an interference screw (group A, 11 cases); and fixating the graft with an interference screw, without maintaining the insertion of the tendons (group B, 12 cases). A continuous traction was performed (20 mm/min) in the same direction as the produced tunnel, and force (N), elongation (mm), rigidity (N/mm), and tension (N/mm2) were objectively determined in each group. RESULTS Group A exhibited a maximum force (MF) of 315.4±124.7 N; maximum tension of 13.57±3.65 N/mm2; maximum elongation of 19.73±4.76 mm; force at the limit of proportionality (FLP) of 240.6±144.0 N; and an elongation at the limit of proportionality of 14.37±6.58 mm. Group B exhibited a MF of 195.7±71.8 N; maximum tension of 8.8±3.81 N/mm2; maximum elongation of 15.3±10.73 mm; FLP of 150.1±68.7 N; and an elongation at the limit of proportionality of 6.86±2.42 mm. When comparing the two groups, significant differences were observed in the variables of maximum force (p=0.016), maximum tension (p=0.019), maximum elongation (p=0.007), and elongation at the limit of proportionality (p=0.003). CONCLUSION The use of the native insertion of the semitendineous and gracilis tendons, without an additional fixation device, presented mechanical superiority over their fixation with interference screws.
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Affiliation(s)
- Anderson de Aquino Santos
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Mario Carneiro-Filho
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Roberto Freire da Mota e Albuquerque
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Carlos Eduardo Franciozi
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Marcus Vinícius Malheiros Luzo
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
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Biomechanical comparison of different tendon suturing techniques for three-stranded all-inside anterior cruciate ligament grafts. Orthop Traumatol Surg Res 2019; 105:1101-1106. [PMID: 31351934 DOI: 10.1016/j.otsr.2019.06.007] [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: 03/19/2019] [Revised: 05/29/2019] [Accepted: 06/05/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In all-inside anterior cruciate ligament (ACL) reconstruction, it is usually difficult to obtain sufficient autologous semitendinosus tendon length for quadruple stranded graft in Asians, females, and those with short stature. The purpose of this study was to compare biomechanical properties of three different types of suture preparations for tripled graft and determine which method could achieve sufficient strength for ACL through in vitro study. The hypothesis of this study was that suturing with a rip-stop (RS) stitch for tripled-strand graft would lead to stronger mechanical properties than suturing with buried-knot four sutures. METHODS Twenty-four bovine digital extensor tendons harvested from forelimbs were prepared for tripled-strand graft in three different ways: (1) buried-knot four sutures, (2) two RS sutures, and (3) four RS sutures. These grafts were directly connected to cylindrical metal rods of a tensile testing machine. All specimens underwent cyclic loading followed by a load-to-failure test. Preparation time, elongation, stiffness, and ultimate failure load were compared. RESULTS For biomechanical comparison, the group with buried-knot four sutures was excluded because six (75%) specimens failed during the cycle load test. The group with four RS sutures showed lower total elongation (two RS sutures: 8.42±5.28mm; four RS sutures: 3.86±0.83mm, p=0.030), higher stiffness (two RS sutures: 247.28±53.39N/mm; four RS sutures: 329.27±55.56N/mm, p<0.001), and higher ultimate failure load (two RS sutures: 567.74±60.50N; four RS sutures: 736.46±32.50N, p=0.009). The most common failure mechanism of triple stranded graft was tendon split across sutures. CONCLUSION The method with four RS sutures showed sufficient strength for triple stranded graft for all-inside ACL reconstruction without increasing preparation time. LEVEL OF EVIDENCE III, controlled laboratory study.
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Bahlau D, Favreau H, Eichler D, Lustig S, Bonnomet F, Ehlinger M. Clinical, functional, and isokinetic study of a prospective series of anterior cruciate ligament ligamentoplasty with pedicular hamstrings. INTERNATIONAL ORTHOPAEDICS 2019; 43:2557-2562. [PMID: 31446455 DOI: 10.1007/s00264-019-04392-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 08/13/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Few studies describe the specific results of anterior cruciate ligament reconstruction with pedicled hamstring graft (HG). Our goal was to report the isokinetic, clinical, and functional outcomes over the post-operative year following pedicled hamstring ligamentoplasty. METHODS Twenty-four patients with ACL rupture (mean age 27.4 years) were included prospectively. The technique used a four-stranded HG transplant pedicled to the tibia. The functional result (Lysholm knee score and subjective IKDC score), clinical result (KT-1000, Lachman test, joint amplitudes, objective IKDC score), and isokinetic complication occurrence were analyzed at six months and 12 months follow-up. The functional results, clinical parameters, and complications were analyzed at 30 months follow-up. The comparison of the variables with the various regressions was carried out by a Wilcoxon sign test. RESULTS Twenty-one patients were reviewed at six, nine, 12, and 30 months. The mean Lysholm knee score was 90/100 at six months, 96/100 at one year, and 95/100 at 30 months. The mean subjective IKDC score was 77/100 and 89/100 at six and 12 months, and 91/100 at 30 months. The mean difference in laxity compared with the healthy knee was 1.4 mm at six months, 1.9 mm at 12 months, and 2 mm at 30 months. The objective IKDC score was A or B for all patients at 12 and 30 months. The average quadriceps strength deficit decreased from 27 to 16% between six and 12 months post-operative (p = 0.0091) and the average flexor deficit from 23 to 12% (p = 0.0084). No complications were identified. CONCLUSION The abovementioned technique allows reaching functional, clinical, and isokinetic results comparable with the standard techniques while preserving the mechanical and biological interest of tibial insertion.
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Affiliation(s)
- David Bahlau
- Service de Chirurgie Orthopédique et de Traumatologie du membre inférieur, CHU Hautepierre 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
| | - Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie du membre inférieur, CHU Hautepierre 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
| | - David Eichler
- Service de Chirurgie Orthopédique et de Traumatologie du membre inférieur, CHU Hautepierre 2, 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
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie du membre inférieur, CHU Hautepierre 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie du membre inférieur, CHU Hautepierre 2, 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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