1
|
Malesa K, Tramś E, Kuliński K, Kamiński R. The effectiveness of quadrupled semitendinosus graft technique in anterior cruciate ligament reconstruction: A network meta-analysis assessing various graft preparation techniques. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39126286 DOI: 10.1002/ksa.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE This study aims to perform a network meta-analysis of hamstring graft preparation techniques to enhance anterior cruciate ligament (ACL) reconstruction guidelines and inform clinical decision-making in patients with primary ACL rupture. METHODS A review of the literature, from 1 January 1990, to 31 August 2023, was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, focusing on the clinical outcomes of various hamstring graft preparation techniques. Forty-six studies (over 4800 knees) were analysed. Eight graft compositions: doubled hamstring (ST/G)-1978 grafts, doubled hamstring with augmentation (ST/G+A)-586 grafts, tripled semitendinosus (3ST)-124 grafts, quadrupled semitendinosus (4ST)-1273 grafts, five-strand tripled semitendinosus + doubled gracilis (3ST/2GR-839 grafts, six-strand tripled semitendinosus + tripled gracilis (3ST/3GR)-335 grafts, seven-strand quadrupled semitendinosus + tripled gracilis (4ST/3GR)-11 grafts and ≥eight strands-24 grafts were compared, considering graft sizes, laxity, muscle strength, range-of-motion, patient-reported outcome measures (PROMs), return to sport (RTS) and adverse events. RESULTS The 4ST grafts fared better than the ST/G grafts in the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) Sport, KOOS Q and RTS (mean difference [MD], -1.69; p = 0.0159; MD, -1.55; p = 0.0325; MD, -1.93; p = 0.001; odds ratio: 3.13; p < 0.0001). The IKDC differed significantly between the 4ST and ST/G+A groups (MD, 1.88; p = 0.046). The ST/G+A resulted in the lowest knee laxity, surpassing the ST/G, 3ST and 4ST. The ST/G had the smallest diameter (ST/G vs. ST/G+A: MD, 1.26; 95% confidence interval [CI]: 0.67-1.86, p < 0.0001). Reduced failure rates were noted with the 3ST/2GR (3ST/2GR vs. ST/G: MD, 6.93; p = 0.009) and 3ST/3GR (3ST/3GR vs. ST/G: MD, 53.64; p = 0.006). CONCLUSION The ideal hamstring graft for ACLR should be individualized. A 4ST graft is likely to yield good PROMs. For high stability and rapid RTS, adding augmentation to the graft is advisable. The ST/G is the thinnest graft possible. LEVEL OF EVIDENCE Network meta-analysis of level I-III studies.
Collapse
Affiliation(s)
- Kamila Malesa
- Department of Musculoskeletal Trauma and Orthopaedics, Gruca Orthopaedic and Trauma Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Ewa Tramś
- Department of Musculoskeletal Trauma and Orthopaedics, Gruca Orthopaedic and Trauma Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Krzysztof Kuliński
- Department of Musculoskeletal Trauma and Orthopaedics, Gruca Orthopaedic and Trauma Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Rafał Kamiński
- Department of Musculoskeletal Trauma and Orthopaedics, Gruca Orthopaedic and Trauma Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| |
Collapse
|
2
|
Sengoku T, Nakase J, Mizuno Y, Ishida Y, Yanatori Y, Takemoto N, Demura S. Knee flexor strength at 6 months after anterior cruciate ligament reconstruction using hamstring tendon can be predicted from that at 3 months. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39015061 DOI: 10.1002/ksa.12370] [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: 01/16/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE This study aimed to identify factors influencing persistent muscle weakness in knee flexor strength after anterior cruciate ligament (ACL) reconstruction using the hamstring tendon and establish a clear cut-off value at 3 months postoperatively for the limb symmetry index (LSI) to exceed 90% at 6 months postoperatively. METHODS One hundred forty-eight patients undergoing ACL reconstruction were included and categorised into two groups based on knee flexor strength at 6 months postoperatively: patients with LSI of 90% or greater (achieved group: n = 114) and patients with LSI less than 85% (nonachieved group: n = 34). Items with significant differences between the two groups (preoperative waiting period, LSI to body weight ratio of knee flexor and extensor strength at 3 months postoperatively and peak torque angle of knee flexor muscle) were included in the multiple logistic regression analysis. Additionally, a receiver operating characteristic curve was used to calculate the cut-off value of the LSI at 3 months postoperatively, which was required to achieve the LSI criteria for knee flexor strength 6 months postoperatively. RESULTS Multiple logistic regression analysis extracted the preoperative waiting period and LSI for knee flexor strength at 3 months postoperatively. The cut-off value at 3 months postoperatively was 76.9% (area under the curve value, 0.82; sensitivity, 0.76; and specificity, 0.81) of the LSI. CONCLUSION The LSI of at least 76.9% for knee flexor strength at 3 months after ACL reconstruction was an indicator for achieving the 6 months postoperatively. This is a criterion to aim for, considering the stress on the graft and the regeneration process of the semitendinosus tendon. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Takuya Sengoku
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yushin Mizuno
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yoshihiro Ishida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yusuke Yanatori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Naoki Takemoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
3
|
Bouché PA, Lefevre N, Bohu Y, Gerometta A, Meyer A, Grimaud O, Hardy A. Comparison of the retear rate 2years after ACL reconstruction with the Tape Locking Screw short graft system and the STG technique: A case control study with propensity score matching. Orthop Traumatol Surg Res 2024; 110:103848. [PMID: 38408559 DOI: 10.1016/j.otsr.2024.103848] [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: 09/08/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Theoretically, short semitendinosus grafts result in less pain and morbidity while providing greater knee flexion strength and sparing the gracilis tendon. They often require the use of blind bone tunnels as well as fixation at both ends of the graft with suspensory cortical buttons. The "Tape Locking Screw" (TLS) system is another option. There are few studies comparing ACL reconstruction with a short graft using the 4-strand semitendinosus graft (ST4-TLS) technique with that of the semitendinosus-gracilis (STG) procedure. This study was designed: (1) to compare the retear rate following these two technics after 2years of follow-up, (2) to compare the clinical scores, complications and return to sport times between the two procedures Q1, Q2. HYPOTHESIS Our hypothesis was that there would be no differences in retear rates between the two techniques. METHODS This single center case control study included 290 patients who underwent STG reconstruction that were paired by propensity score matching to 299 patients who underwent ST4-TLS reconstruction. The main evaluation criterion was the retear rate 2years after surgery. Secondary criteria were the two-year postoperative complication rate, the time to return to sport, to pivot sports and to running, as well as the complication rates and clinical scores 6months, 1year and 2years after surgery. RESULTS At the final follow-up, the overall retear rate in our series of ACL ligament reconstruction was 6.0% (36/596). There was no difference in retear rates between the groups 2years after ligament reconstruction [ST4-TLS: 6.7% (20/299) vs. STG: 5.4% (16/297); p=0.47]. The postoperative KOOS symptom score and the Tegner score were found to be better in the STG group at 1year (81 vs. 78, p=0.008) and 2years (5.64 vs. 5.10, p=0.016), respectively, representing the minimally clinically important difference (MCID) for the latter. No difference was found in the other clinical scores 6months, 1year or 2years after surgery. There was no significant difference in the return to sport [TLS: 93.0% (164/299) vs. STG: 93.0% (158/297) p=0.99] or the complication rate [TLS: 8.7% (26/299) vs. STG: 7.4% (22/297) p=0.89] between the groups. DISCUSSION The ST4-TLS ACL ligament reconstruction technique was found to be as reliable as the standard STG procedure 2years after surgery for the retear rate and the return to sport, although the results of certain postoperative clinical scores seem to be lower. LEVEL OF EVIDENCE III; case control study.
Collapse
Affiliation(s)
- Pierre-Alban Bouché
- Service de chirurgie orthopédique et traumatologique, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - Nicolas Lefevre
- Clinique du Sport Paris V, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - Yoann Bohu
- Clinique du Sport Paris V, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - Antoine Gerometta
- Clinique du Sport Paris V, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - Alain Meyer
- Clinique du Sport Paris V, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - Olivier Grimaud
- Clinique du Sport Paris V, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - Alexandre Hardy
- Clinique du Sport Paris V, 36, boulevard Saint-Marcel, 75005 Paris, France
| |
Collapse
|
4
|
de Geofroy B, Trescos F, Ghabi A, Choufani C, Peras M, Barbier O, de Landevoisin E, Jouvion AX. Anterior Cruciate Ligament Reconstruction in French Army: Return to Prior Level of Running on Selected Military Tests. Mil Med 2024; 189:e995-e1002. [PMID: 37864821 DOI: 10.1093/milmed/usad406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture is frequently encountered in athletes as well as in military personnel. In civilian population, many studies have looked at the return to sport, but return to duty in Army is a topic that requires further research.The purpose of this study was to determine through annual military fitness tests in real conditions, the return to sport in soldiers after ACL reconstruction and factors influencing failure. MATERIALS AND METHODS This was a retrospective comparative study. Patients were all soldiers and had followed up in a Military Hospital. The SUCCESS group was military personnel who obtained a result of the specific aptitude test greater than or equal to this same test carried out before reconstruction of the ACL, the FAILURE group comprised the others. Results of the annual specific aerobic fitness tests were collected before and after ACL reconstruction. Preoperative epidemiological data, intraoperative information, and isokinetic test results were collected. RESULTS One hundred forty four soldiers were included between January 2011 and December 2017 (94.9% of men with a median age of 27.6 years); 40.3% obtained a result greater than or equal to the preoperative fitness test after ACL reconstruction. Among the soldiers who did not regain their performance, 24.3% were declared unfit or discharged. In the FAILURE group, we found patients with a higher body mass index (25.5 vs. 24.4; P = .04), less patients with isokinetic deficit < 30% on the knee flexors and extensors (26.6% vs. 62.9%; P < .01), more long sick leave (39.5% vs. 13.7%; P < .01), and late resumption of military activities (10.5 vs. 8.9 months; P < .01). CONCLUSION Rupture of ACL has a significant impact on the operational capacity of the French army. The proportion of return to the same level in annual specific fitness tests after ACL reconstruction is 40% among soldiers. Several variables are important to consider in the follow-up of these patients to optimize their recovery of sports performance and therefore their operational capacity.
Collapse
Affiliation(s)
- Bernard de Geofroy
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, Marseille, 13013, France
| | - Florent Trescos
- Department of Physical Medicine and Rehabilitation of the Injured, HIA Laveran, Marseille, 13013, France
| | - Ammar Ghabi
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, Marseille, 13013, France
| | - Camille Choufani
- Department of Orthopaedic Surgery and Traumatology, HIA Sainte Anne, Toulon, 83000, France
| | - Mathieu Peras
- Department of Orthopaedic Surgery and Traumatology, HIA Sainte Anne, Toulon, 83000, France
| | - Olivier Barbier
- Department of Orthopaedic Surgery and Traumatology, HIA Sainte Anne, Toulon, 83000, France
| | | | - Arnaud-Xavier Jouvion
- Department of Physical Medicine and Rehabilitation of the Injured, HIA Laveran, Marseille, 13013, France
| |
Collapse
|
5
|
Matteucci A, Högberg J, Piussi R, Wernbom M, Franceschetti E, Longo UG, Samuelsson K, Lövgren J, Hamrin Senorski E. Comparison of knee flexor strength recovery between semitendinosus alone versus semitendinosus with gracilis autograft for ACL reconstruction: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:136. [PMID: 38347523 PMCID: PMC10863077 DOI: 10.1186/s12891-024-07226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Whether there is a difference in harvesting the semitendinosus tendon alone (S) or in combination with the gracilis tendon (SG) for the recovery of knee flexor strength after anterior cruciate ligament (ACL) reconstruction remains inconclusive. Therefore, this study aimed to assess the recovery of knee flexor strength based on the autograft composition, S or SG autograft at 6, 12, and ≥ 24 months after ACL reconstruction. METHODS A systematic review and meta-analysis was conducted following the PRISMA guidelines. A comprehensive search was performed encompassing the Cochrane Library, Embase, Medline, PEDRo and AMED databases from inception to January 2023. Inclusion criteria were human clinical trials published in English, comprised of randomized controlled trials (RCTs), longitudinal cohort-, cross-sectional and case-control studies that compared knee flexor strength recovery between S and SG autografts in patients undergoing primary ACL reconstruction. Isokinetic peak torques were summarized for angular velocities of 60°/s, 180°/s, and across all angular velocities, assessed at 6, 12, and ≥ 24 months after ACL reconstruction. A random-effects model was used with standardized mean differences and 95% confidence intervals. Risk of bias was assessed with the RoBANS for non-randomized studies and the Cochrane RoB 2 tool for RCTs. Certainty of evidence was appraised using the GRADE working group methodology. RESULTS Among the 1,227 patients from the 15 included studies, 604 patients received treatment with S autograft (49%), and 623 received SG autograft (51%). Patients treated with S autograft displayed lesser strength deficits at 6 months across all angular velocities d = -0.25, (95% CI -0.40; -0.10, p = 0.001). Beyond 6 months after ACL reconstruction, no significant difference was observed between autograft compositions. CONCLUSION The harvest of S autograft for ACL reconstruction yields superior knee flexor strength recovery compared to SG autograft 6 months after ACL reconstruction, irrespective of angular velocity at isokinetic testing. However, the clinical significance of the observed difference in knee flexor strength between autograft compositions at 6 months is questionable, given the very low certainty of evidence and small effect size. There was no significant difference in knee flexor strength recovery between autograft compositions beyond 6 months after ACL reconstruction. TRIAL REGISTRATION CRD42022286773.
Collapse
Affiliation(s)
- Angelo Matteucci
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden.
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden.
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Mathias Wernbom
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Edoardo Franceschetti
- Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo 200, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Umile Giuseppe Longo
- Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo 200, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Johan Lövgren
- Active Physio Sports Medicine Clinic, Brogatan 23, 431 30, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
- Swedish Olympic Committee, Stockholm, Sweden
| |
Collapse
|
6
|
de Geofroy B, Chateau L, Barbier O, Demoures T, Coste S, Mathieu L, de L'Escalopier N, Choufani C. Return to Sport and Duty in French Military Personnel after Medial Opening Wedge High Tibial Osteotomy. Mil Med 2024:usae005. [PMID: 38294141 DOI: 10.1093/milmed/usae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/10/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Medial opening wedge high tibial osteotomy (MOWHTO) is a surgical option for medial femorotibial osteoarthritis, which preserves articular cartilage by correcting the extra-articular deformities of the lower limbs that cause osteoarthritis. This is an increasingly popular treatment in a population with high functional demand, such as the French military population. The aim of this study was to evaluate the rate of return to work and military activities at 6 months postsurgery and at last follow-up in this military population following MOWHTO.The hypothesis of this study was that MOWHTO enabled a majority of service members to return to the same level of activity within 6 months of surgery. MATERIALS AND METHODS This was a retrospective, multicenter study including all French military personnel operated on for MOWHTO alone for osteoarthritis of medial compartment between 2008 and 2018 in different Military Teaching Hospitals. We excluded civilian patients. For each patient, a questionnaire was used to collect epidemiological, professional, sports, and functional data. The primary endpoint was the rate of return to work at 6 months postsurgery. We also studied the recovery of sports activities and functional results at a 6.6-year follow-up by standardized questionnaires (Tegner activity scale, Lysholm, IKDC subjective (International Knee Documentation Commitee)). RESULTS Twenty-four MOWHTOs were performed during this period in a cohort of 22 French military personnel. Return to work at 6 months was possible in 20/24 cases (83.3%). Of the four patients who did not return to work at 6 months, two changed their activities, while the other two returned to their jobs after 6 months. The rate of resumption of sporting activities at an equal or higher level was 50% (11/22). There was no difference between pre- and postoperative Tegner Activity Scale scores at the longest follow-up (P = .08). The mean postoperative Lysholm scores were 73.5 (standard deviation 17.8) and IKDC 59 (standard deviation 8.7). No intraoperative complications were found, and one case of postoperative infection was found. CONCLUSIONS A total of 83% of the operated soldiers were able to return to their professional activities in less than 6 months. We observed a functional improvement at the last follow-up. Comparing these results with data from civilian populations, the rate of occupational recovery is comparable. However, the return to sport is much better in the series of nonmilitary patients with approximately 90% return to work and sport in the year following surgery. MOWHTO improves the functional results of the knee, enabling a return to work and sport in most cases in young, active populations such as the French military.
Collapse
Affiliation(s)
- Bernard de Geofroy
- Department of Orthopaedic and Trauma Surgery, Laveran Military Hospital, Marseille 13013, France
- Department of Orthopaedic Surgery and Traumatology Sainte Anne Military Hospital, Toulon Mediterranean Orthopaedic and Trauma, TMOST, Toulon 83000, France
| | - Lucas Chateau
- Department of Orthopaedic surgery and traumatology, Begin Military Hospital, Saint-Mandé 94160, France
| | - Olivier Barbier
- Department of Orthopaedic Surgery and Traumatology Sainte Anne Military Hospital, Toulon Mediterranean Orthopaedic and Trauma, TMOST, Toulon 83000, France
- Department of Orthopaedic Surgery and Traumatology, Edouard Herriot Hospital, Lyon 69003, France
| | - Thomas Demoures
- Department of Orthopaedic surgery and traumatology, Begin Military Hospital, Saint-Mandé 94160, France
| | - Sébastien Coste
- Department of Orthopaedic surgery and traumatology, Begin Military Hospital, Saint-Mandé 94160, France
| | - Laurent Mathieu
- Department of Orthopaedic Surgery and Traumatology, Edouard Herriot Hospital, Lyon 69003, France
| | - Nicolas de L'Escalopier
- Department of Orthopaedic Surgery and Traumatology, Percy Military Hospital, Clamart 92140, France
| | - Camille Choufani
- Department of Orthopaedic Surgery and Traumatology Sainte Anne Military Hospital, Toulon Mediterranean Orthopaedic and Trauma, TMOST, Toulon 83000, France
- Department of Orthopaedic Surgery and Traumatology, Edouard Herriot Hospital, Lyon 69003, France
| |
Collapse
|
7
|
Marquina V, Sánchez C, Mariscal G, Espí F, Crespo D, Hernández L. Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:64-72. [PMID: 37406733 DOI: 10.1016/j.recot.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. RESULTS A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.
Collapse
Affiliation(s)
- V Marquina
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - C Sánchez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - G Mariscal
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - F Espí
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - D Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Hernández
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| |
Collapse
|
8
|
Marquina V, Sánchez C, Mariscal G, Espí F, Crespo D, Hernández L. [Translated article] Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T64-T72. [PMID: 37995820 DOI: 10.1016/j.recot.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/29/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analysed using Review Manager 5.4 software. RESULTS A total of seven retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group versus 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.
Collapse
Affiliation(s)
- V Marquina
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - C Sánchez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - G Mariscal
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - F Espí
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - D Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - L Hernández
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| |
Collapse
|
9
|
Chamieh M, Mourad W, Piontek T. Modified Anatomical Anterior Cruciate Ligament Reconstruction with Flat Semitendinosus Graft and C-shaped Tibial Canal. Arthrosc Tech 2024; 13:102835. [PMID: 38312879 PMCID: PMC10838054 DOI: 10.1016/j.eats.2023.09.011] [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: 07/31/2023] [Accepted: 09/07/2023] [Indexed: 02/06/2024] Open
Abstract
Every year, approximately 400,000 patients undergo anterior cruciate ligament (ACL) reconstruction surgery in the United States, accounting for almost 50% of all knee surgeries in the country. Recent studies have demonstrated that the ACL is a ribbon-like structure with a C-shaped tibial insertion and a flat femoral origin. This article introduces a modification of an ACL reconstruction technique. The modification renders the procedure easily reproducible with standard surgical instruments. We will describe a surgical technique modification that goes beyond the standard round bone tunnels and adopts a more anatomical approach using a C-shaped tibial canal and a flat femoral canal using a flat semitendinosus (semi-T) graft. The use of a semi-T graft better reproduces the ribbon-like ACL anatomy. The semi-T graft, a flat femoral canal, and a C-shaped tibial canal provide increased bone-tendon contact surface area and decreased diffusion length, resulting in improved tendon-bone healing. The modification proposed by our team makes the anatomical ribbon-like ACL graft, C-shaped tibial canal, and the flat femoral canal technique feasible in every orthopaedic operating room and mitigates costly specialized instrument.
Collapse
Affiliation(s)
- Marc Chamieh
- Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, Poznań, Poland
| | - Wassim Mourad
- Department of Orthopedic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A
| | - Tomasz Piontek
- Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, Poznań, Poland
- Rehasport Clinic, Poznań, Poland
| |
Collapse
|
10
|
D’Ambrosi R, Ursino N, Di Feo F. Quadrupled Semitendinosus Anterior Cruciate Ligament Reconstruction Without the Use of Tourniquet and Minimal Instrumentation: The "Double D" Technique. Arthrosc Tech 2023; 12:e1589-e1593. [PMID: 37780662 PMCID: PMC10533943 DOI: 10.1016/j.eats.2023.05.008] [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: 03/02/2023] [Accepted: 05/01/2023] [Indexed: 10/03/2023] Open
Abstract
The hamstring tendons are among the most common autografts used for anterior cruciate ligament reconstruction. Typically, the ipsilateral knee's gracilis and semitendinosus tendons are harvested. More recently, studies have described the use of just 1 of the tendons (the semitendinosus [ST]) in a tripled or quadrupled configuration, particularly in all-inside reconstructions. Instead of using a double gracilis and ST, a quadrupled ST tendon allows for a graft with enough diameter to more closely mimic the natural anterior cruciate ligament while lowering the likelihood of graft rupture. The use of tourniquets has been reported to increase the risk of complications, particularly deep vein thrombosis. This Technical Note describes an anterior cruciate ligament reconstruction performed with a quadrupled ST, without the use of a tourniquet, and with only the reamers and a tibial guide as surgical instrumentation.
Collapse
Affiliation(s)
- Riccardo D’Ambrosi
- IRCCS Ospedale Galeazzi-Sant’Ambrogio, Milan, Italy
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milan, Italy
| | | | | |
Collapse
|