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Nishimura T, Takahashi T, Takeshita K. Comparison of Electrothermal Ablation and Electrolyte Plasmalization Devices Based on the Mechanical Properties of Anterior Cruciate Ligament Femoral Attachment Following Partial Debridement: A Biomechanical Study Using a Porcine Model. Cureus 2023; 15:e47911. [PMID: 38034242 PMCID: PMC10683839 DOI: 10.7759/cureus.47911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose This study aimed to clarify whether differences in ablation devices used in the knee joint during partial debridement of the proximal end of the femoral attachment of the anterior cruciate ligament (ACL) affect the mechanical properties of the femur-ACL-tibia complex. Methods Electrothermal ablation was generated from Vulcan for the left knees, and radiofrequency ablation was generated from Werewolf Flow 50 Wand for the right knees. The probes were set to the default setting of 120 W and 150 W for Vulcan and Werewolf Flow 50 Wand, respectively. To mimic partial debridement in remnant tissue-preserving (RTP) ACL reconstruction, the bipolar ablation mode and serpentine movements were employed while in contact with the femoral fan-like extension fibers of the ACL. To simulate the arthroscopic environment, the model was immersed in a saline solution. The probes were applied for 60 s, and their biomechanical properties were evaluated. Results A significant difference was observed in the upper yield load between the two groups (Vulcan group, 107.1 ± 93.4 N; Werewolf group, 177.9 ± 108.8 N; P = 0.045). However, no significant differences were noted in linear stiffness (Vulcan group, 47.6 ± 30.9 N/mm; Werewolf group, 50.1 ± 30.5 N/mm; P = 0.85), maximum load (Vulcan group, 276.2 ± 171.8 N; Werewolf group, 397.7 ± 150.8 N; P = 0.26), or elongation at failure (Vulcan group, 6.1 ± 0.9 mm; Werewolf group, 11.6 ± 10.4 mm; P = 0.20) between the two groups. Conclusion The mechanical properties of the ACL after partial ACL femoral attachment debridement for RTP-ACL reconstruction were better when an electrolyte plasmalization device was used. When performing RTP-ACL reconstruction, surgeons must consider that the device used for partial femoral ACL stump debridement may affect the mechanical properties of the ACL remnant tissue. Clinical relevance When performing RTP-ACL reconstruction, surgeons must consider that the device used for partial femoral ACL stump debridement may affect the mechanical properties of the ACL remnant tissue.
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Affiliation(s)
| | - Tsuneari Takahashi
- Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimotsuke, JPN
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Park SY, Cho JH, Ho JPY, Tu NT, Kim YB, Lee YS. Graft impingement increases anterior cruciate ligament graft signal more than acute graft bending angle: magnetic resonance imaging-based study in outside-in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:4379-4389. [PMID: 37351630 DOI: 10.1007/s00167-023-07491-z] [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: 02/21/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE In this study, the relationship between patient-specific geometric factors and tunnel placement in graft impingement was identified by using magnetic resonance imaging (MRI) signal intensity of anterior cruciate ligament (ACL) grafts. METHODS Ninety-two patients, who were treated between 2014 and 2020, were included retrospectively. These patients underwent primary remnant-preserving outside-in ACL reconstruction (ACLR) and were followed up with postoperative MRI at least one year after surgery. Plain radiographs and computed tomography (CT) were used to analyze tibial and femoral tunnel positions. Postoperative MRI was performed, at 32.8 ± 17.5 months after surgery, to evaluate the graft signal intensity, the ACL/posterior cruciate ligament (PCL) ratio (APR), ACL/muscle ratio (AMR), tunnel positions, and graft impingement. Clinical and stability outcomes were analyzed using the International Knee Documentation Committee (IKDC) subjective and objective scores, Lysholm scores, and side-to-side differences (SS-D). RESULTS The mean APR and AMR of the proximal third of the grafts were significantly lower than those of the middle third of the grafts (p = 0.017 and p = 0.045, respectively). Multivariate regression analysis showed that there was a negative association between the mean APR and AMR of entire intra-articular ACL graft and the distance from the anterior end of the intercondylar roof to the center of the tibial tunnel in the sagittal plane (p < 0.001 and p < 0.001, respectively) and the notch width index (p < 0.001 and p = 0.002, respectively). No significant correlations were found between tunneling and geometric factors, and clinical scores or SS-D. CONCLUSIONS Graft impingement on the anterior tibial tunnel relative to the end of the intercondylar roof and narrow notch was a more significant contributing factor on increased signal intensities of the ACL graft, compared with the acute femoral bending angle in remnant-preserving outside-in ACLR. Therefore, surgeons should focus on intercondylar notch anatomy during tibial tunnel placement to avoid roof impingement. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Joon Hee Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Jade Pei Yuik Ho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Nguyen Thanh Tu
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Yong Beom Kim
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital Seoul, 59 Daesagwan-ro, Seoul, Yongsan-gu, South Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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Zhang X, Qian Y, Gao F, He C, Guo S, Gao Q, Zhou J. High anteromedial insertion reduced anteroposterior and rotational knee laxity on mid-term follow-up after anatomic anterior cruciate ligament reconstruction. PeerJ 2023; 11:e15898. [PMID: 37609439 PMCID: PMC10441525 DOI: 10.7717/peerj.15898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background The position of the femoral insertion has a great influence on the laxity of the knee joint after ACLR, especially for rotational laxity. Purpose To compare the effects of different femoral tunnel positions on knee stability after arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods The clinical outcomes of 165 patients after autograft ACLR were analyzed retrospectively. The patients were separated into three groups according to the position of the femoral tunnel, as follows: low center (LC) group, 53 patients; high center (HC) group, 45 patients; and high anteromedial (HAM) group, 67 patients. The side-to-side differences (SSDs) in anteroposterior knee laxity measured using a KT-2000 arthrometer and the pivot shift test (PST) pre- and postoperatively were compared among the three groups and analyzed. Results After 5 years postoperatively, the SSD in the anteroposterior knee laxity in the three groups was significantly decreased postoperatively compared with preoperatively in knees; meanwhile, the negative PST rate was significantly increased in the three groups. The postoperative SSD in anteroposterior knee laxity was significantly increased in the HC group compared with the LC and HAM groups (1.5 ± 1.3 VS 1.0 ± 1.1 VS 1.0 ± 1.0, P<0.05). The negative postoperative PST rate was higher in both the LC and HAM groups than in the HC group (84.9% VS 91.0% VS 71.1%, P<0.05), and there was no significant difference in the negative PST rate between the LC and HAM groups (84.9% VS 91.0%, P>0.05). The negative postoperative PST rate was significantly higher in the HAM group than in the LC and HC groups for patients with a high degree of laxity preoperatively (31.3% VS 3.3% VS 14.4%, P>0.05). Conclusion Patients in HAM group showed better control over anteroposterior laxity, rotational laxity, and subjective knee function compared to other groups post operation. Therefore, the HAM point is the closest to the I.D.E.A.L point concept, and is recommended as the preferred location for the femoral tunnel in ACLR.
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Affiliation(s)
- Xiaohan Zhang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yi Qian
- National Institute of Sports Medicine, Beijing, China
| | - Feng Gao
- National Institute of Sports Medicine, Beijing, China
| | - Chen He
- National Institute of Sports Medicine, Beijing, China
| | - Sen Guo
- National Institute of Sports Medicine, Beijing, China
| | - Qi Gao
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Jingbin Zhou
- National Institute of Sports Medicine, Beijing, China
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Ugawa S, Hiyama S, Takahashi T, Yamaguchi N, Yamanaka T, Matsumura T, Takeshita K. Anterior cruciate ligament reconstruction with retained internal fixation hardware for treating Schatzker type V tibial plateau fracture: Two case reports. Trauma Case Rep 2023; 46:100845. [PMID: 37251437 PMCID: PMC10213086 DOI: 10.1016/j.tcr.2023.100845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
Despite the high incidence of anterior cruciate ligament injury in patients with tibial plateau fractures, we found no reports about anterior cruciate ligament reconstruction with retained internal fixation hardware for these fractures. Herein, we report 2 male patients with Schatzker type V tibial plateau fractures and describe the use of retained hardware for internal fixation in tibia. The patients underwent anterior cruciate ligament reconstruction using outside-in technique for the femoral tunnel. Throughout the follow-up, no radiological symptoms of suspected knee osteoarthritis were observed. Accordingly, surgical intervention can be reduced by creating an independent femoral tunnel.
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Affiliation(s)
- Satomi Ugawa
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Tokyo Takanawa Hospital, Tokyo, Japan
| | - Shuhei Hiyama
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Naoki Yamaguchi
- Department of Orthopedic Surgery, Nasu Minami Hospital, Karasuyama, Japan
| | - Takuya Yamanaka
- Department of Orthopedic Surgery, Haga Red Cross Hospital, Moka, Japan
| | - Tomohiro Matsumura
- Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Takahashi T, Handa M, Kimura Y, Takeshita K. Intraoperative Laximetry-Based Selective Transtibial Anterior Cruciate Ligament Reconstruction Concomitant With Medial Open Wedge High Tibial Osteotomy for Treating Varus Knee Osteoarthritis With Anterior Cruciate Ligament Deficiency. Arthrosc Tech 2022; 11:e959-e963. [PMID: 35782859 PMCID: PMC9243668 DOI: 10.1016/j.eats.2022.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/17/2022] [Indexed: 02/03/2023] Open
Abstract
High tibial osteotomy (HTO) is used in the treatment of varus knee osteoarthritis (KOA) in young and active patients. At times, a concomitant anterior cruciate ligament (ACL) deficiency is found, and there is no conclusive evidence comparing the osteotomy options for an ACL-deficient knee despite the popularity of medial opening-wedge (MOW) HTO in varus KOA with ACL deficiency. To minimize the incidence of an unnecessary ACL reconstruction with MOW-HTO, we developed an intraoperative laximetry-based selective technique for transtibial ACL reconstruction concomitant with MOW-HTO using a sterilizable metal laximeter. To successfully use the device required for this procedure, surgeons must understand the proper techniques. Hence, this Technical Note aims to give a comprehensive description of the technique.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan,Address correspondence to Tsuneari Takahashi, M.D., Ph.D., Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, 1-15-4 Shimokoyama, 329-0502, Japan.
| | - Mikiko Handa
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Yuya Kimura
- Department of Orthopedic Surgery, Tochigi Medical Center Shimotsuga, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Takahashi T, Handa M, Takeshita K. Compartment syndrome after transtibial anterior cruciate ligament reconstruction: A case report. Trauma Case Rep 2022; 37:100603. [PMID: 35028359 PMCID: PMC8741598 DOI: 10.1016/j.tcr.2021.100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/24/2022] Open
Abstract
Compartment syndrome is a rare complication after anterior cruciate ligament (ACL) reconstruction. This is one of the most devastating complications after surgery of the lower limb, with certain risks of renal failure, shock, and even death. We report a case of compartment syndrome that occurred 12 h after ACL reconstruction. A healthy 67-year-old male who underwent transtibial ACL reconstruction using autogenous hamstring tendon graft complained of progressive intense pain, paresthesia, and paresis. He had a pallid aspect and taut, shiny skin with several blisters around the medial aspect of the lower limb. Computed tomography revealed a hematoma that originated from the tibial bone tunnel. The patient was immediately referred for an urgent decompression fasciotomy. Hematoma debridement, medial fasciotomy, and negative-pressure wound therapy were performed. The patient recovered well and received routine postoperative physiotherapy.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Mikiko Handa
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Takahashi T, Takeshita K. Remnant Tissue Preserved Transtibial Anterior Cruciate Ligament Reconstruction With Femoral Tunnel Created Behind the Resident's Ridge. Arthrosc Tech 2021; 10:e2501-e2506. [PMID: 34868854 PMCID: PMC8626692 DOI: 10.1016/j.eats.2021.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/18/2021] [Indexed: 02/03/2023] Open
Abstract
Although the transtibial (TT) technique for single-bundle (SB) arthroscopic anterior cruciate ligament (ACL) reconstruction has been widely used, surgeons often disadvantageously create the femoral bone tunnel at the arthroscopically noon position, which is alleged the "ACL isometric point," when the femoral bone tunnel could be created behind the resident's ridge with TT-SB ACL reconstruction by paying attention to the location of the tibial tunnel inlet and the angle of tibial tunnel. This alternative approach preserves ACL remnant tissue, which might contribute to better postoperative remodeling and regeneration of proprioceptive mechanoreceptors. This technique reduces surgical invasiveness and can enhance postoperative graft remodeling and proprioceptive recovery. To successfully use the devices required for this procedure, surgeons must understand the proper techniques. Hence, this technical note aims to demonstrate TT-SB ACL reconstruction with remnant tissue preservation.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
- Address correspondence to Tsuneari Takahashi, M.D., Ph.D., Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimotsuke, 1-15-4 Shimokoyama, 329-0502, Japan.
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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