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Sherman SL, Raji Y, Calcei JG, Sherman MF. Anterior Cruciate Ligament Repair-Here to Stay or History Repeating Itself? Clin Sports Med 2024; 43:433-448. [PMID: 38811120 DOI: 10.1016/j.csm.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Anterior cruciate ligament (ACL) injuries continue to be a prevalent concern among athletes and individuals with an active lifestyle. Traditionally, the standard of care for ACL tears has involved surgical reconstruction using autograft or allograft. This article aims to provide an overview of the evolving landscape of primary ACL repair, examining the current evidence, surgical techniques, patient selection criteria, outcomes, and potential future directions in this field.
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Affiliation(s)
- Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, MC 6342, Pavilion C, Redwood City, CA 94063, USA.
| | - Yazdan Raji
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, MC 6342, Pavilion C, Redwood City, CA 94063, USA
| | - Jacob G Calcei
- University Hospitals Drusinsky Sports Medicine Institute, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Hanna House 6th Floor, Cleveland, OH 44106, USA
| | - Mark F Sherman
- Richmond University Medical Center, 2052 Richmond Road, Staten Island, NY 10306, USA
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2
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Annibaldi A, Monaco E, Carrozzo A, Caiolo V, Criseo N, Cantagalli MR, Ferretti A, Maffulli N. Return to Soccer After Acute Anterior Cruciate Ligament Primary Repair: A 2-Year Minimum Follow-up Study of 50 Amateur Players. Am J Sports Med 2024:3635465241256099. [PMID: 38868946 DOI: 10.1177/03635465241256099] [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] [Indexed: 06/14/2024]
Abstract
BACKGROUND Return to sport (RTS) after treatment of an anterior cruciate ligament (ACL) tear is a critical parameter to assess the outcome of a surgical procedure. However, few studies have investigated RTS after ACL repair. PURPOSE To evaluate RTS of a group of amateur soccer players at a minimum follow-up of 2 years after ACL repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review of all patients treated with acute ACL repair was conducted. A total of 50 amateur soccer players were included in the study. Patients were examined clinically or contacted to complete postoperative patient-reported outcome measures, namely the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee questionnaire, the ACL-Return to Sport After Injury scale, and the Forgotten Joint Score-12. RESULTS The patients' mean age was 25.8 ± 7.7 years (range, 14-47 years), and the mean follow-up was 34.3 ± 10.7 months (range, 24-51.3 months). The median Tegner Activity Scale score was 9. The ACL repair failure rate was 16% (8/50). The mean time from repair to failure was 23.1 ± 12.7 months (range, 6-44 months), and the mean age of patients who sustained ACL repair failure was 19.9 ± 3.3 years (range, 14-24 years), significantly lower compared with patients who did not experience ACL repair failure (26.9 ± 7.9 years; range, 16-47 years; P = .017). Multivariate analysis showed that age ≤21 years was the only significant risk factor for ACL repair failure (odds ratio, 5.45; confidence interval, 1.24-27.91; P = .041). Excluding the 8 patients who experienced repair failure, 31 of 42 patients (73.8%) returned to soccer after ACL repair, with 29 of the 31 (93.5%) returning at their preinjury level of play. Moreover, patients who played competitive soccer and returned to their preinjury level of play were significantly younger than those who did not return to their preinjury level of play (mean, 21.1 ± 3.4 vs 29.2 ± 9.5 years, respectively; P = .002) and had significantly better ACL-Return to Sport After Injury scores (mean, 96.6 ± 4 vs 87.8 ± 11, respectively; P = .044). CONCLUSION In this study, 73.8% (n = 31) of patients returned to playing soccer, of whom 93.5% (n = 29) returned to their preinjury level after ACL repair. The failure rate was 16% (n = 8) and mainly involved patients ≤21 years old.
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Affiliation(s)
- Alessandro Annibaldi
- Institute of Sports Medicine and Science, Italian National Olympic Committee CONI, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Edoardo Monaco
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Alessandro Carrozzo
- Institute of Sports Medicine and Science, Italian National Olympic Committee CONI, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Vito Caiolo
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Natale Criseo
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Matteo Romano Cantagalli
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Andrea Ferretti
- Institute of Sports Medicine and Science, Italian National Olympic Committee CONI, Rome, Italy
| | - Nicola Maffulli
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
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Hwang NM, Samuel JT, Thompson AA, Mayfield CK, Abu-Zahra MS, Kotlier JL, Petrigliano FA, Liu JN. Reporting Bias in the Form of Positive Spin Is Highly Prevalent in Abstracts of Systematic Reviews on Primary Repair of the Anterior Cruciate Ligament. Arthroscopy 2024:S0749-8063(23)01022-8. [PMID: 38171422 DOI: 10.1016/j.arthro.2023.12.018] [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] [Received: 08/08/2023] [Revised: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To analyze reporting bias in the form of spin present in systematic reviews and meta-analyses on the topic of primary anterior cruciate ligament (ACL) repair. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed throughout this study. Peer-reviewed systematic reviews were collected from 3 databases (PubMed, Scopus, and SPORTDiscus), and their abstracts were assessed for the 15 most common types of spin. Articles were excluded if they were not published in English, had no evidence, were retracted, were published without an abstract, did not have full text available, or included cadaveric or nonhuman subjects. Full text quality was assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews Version 2). Fisher exact tests were used to examine associations between the different types of spin and other study characteristics such as AMSTAR 2 confidence rating, study design, and level of evidence. RESULTS Spin was present in the abstracts of 13 of 15 articles (86.7%). There were significant associations between PRISMA adherence and lower incidences of spin types 3, 6, and 8 (P = .029 for each). A critically low AMSTAR 2 confidence rating was significantly associated with an increased incidence of spin type 9 (P = .01), and a higher AMSTAR 2 score was significantly associated with decreased spin type 4 and type 5 (P = .039 and P = .048, respectively). A more recent year of publication was correlated with a lower incidence of spin type 14 (P = .044). CONCLUSIONS Spin is present in most systematic reviews and meta-analyses regarding primary repair of the ACL, with two-thirds of abstracts spinning evidence in favor of ACL repair. Standardized guidelines including the PRISMA guidelines and the AMSTAR 2 assessment tool were negatively correlated with spin. More recently published articles were found to contain significantly less spin, as were articles published in journals with higher Clarivate Impact Factors and Scopus CiteScores. LEVEL OF EVIDENCE Level V, systematic review of Level III through V studies.
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Affiliation(s)
- N Mina Hwang
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Justin T Samuel
- City University of New York School of Medicine, New York, New York, U.S.A
| | - Ashley A Thompson
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Cory K Mayfield
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Maya S Abu-Zahra
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Jacob L Kotlier
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Frank A Petrigliano
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A..
| | - Joseph N Liu
- University of Southern California Epstein Family Center for Sports Medicine at Keck Medicine of University of Southern California, Los Angeles, California, U.S.A
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Migliorini F, Vecchio G, Eschweiler J, Schneider SM, Hildebrand F, Maffulli N. Reduced knee laxity and failure rate following anterior cruciate ligament reconstruction compared with repair for acute tears: a meta-analysis. J Orthop Traumatol 2023; 24:8. [PMID: 36805839 PMCID: PMC9941413 DOI: 10.1186/s10195-023-00688-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/04/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Following anterior cruciate ligament (ACL) tears, both repair and reconstruction may be performed to restore joint biomechanics and proprioception. The present study compared joint laxity, patient-reported outcome measures (PROMs), and rate of failure following primary repair versus reconstruction for ACL ruptures. METHODS This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, Google scholar, Embase, and Web of Science were accessed in September 2022. All the clinical investigations comparing repair versus reconstruction for primary ACL tears were accessed. Studies reporting data on multiple ligament injuries settings were not eligible. RESULTS Data from eight articles (708 procedures) were collected. The mean length of the follow-up was 67.3 ± 119.4 months. The mean age of the patients was 27.1 ± 5.7 years. Thirty-six percent (255 of 708 patients) were women. The mean body mass index (BMI) was 24.3 ± 1.1 kg/m2. The mean time span from injury to surgery was 36.2 ± 32.3 months. There was comparability at baseline with regards to instrumental laxity, Lachman test, International Knee Document Committee (IKDC), and Tegner Scale (P > 0.1). Similarity between ACL reconstruction and repair was found in IKDC (P = 0.2) and visual analog scale (VAS) satisfaction (P = 0.7). The repair group demonstrated greater mean laxity (P = 0.0005) and greater rate of failure (P = 0.004). CONCLUSION ACL reconstruction may yield greater joint stability and lower rate of failure compared with surgical repair. Similarity was found in PROMs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 31, 52074, Aachen, Germany. .,Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany.
| | - Gianluca Vecchio
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA Italy
| | - Jörg Eschweiler
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 31, 52074 Aachen, Germany
| | - Sarah-Marie Schneider
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 31, 52074 Aachen, Germany
| | - Frank Hildebrand
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 31, 52074 Aachen, Germany
| | - Nicola Maffulli
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA Italy ,grid.9757.c0000 0004 0415 6205School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke On Trent, England ,grid.4868.20000 0001 2171 1133Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG England
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Clinical Research Progress of Internal Brace Ligament Augmentation Technique in Knee Ligament Injury Repair and Reconstruction: A Narrative Review. J Clin Med 2023; 12:jcm12051999. [PMID: 36902785 PMCID: PMC10004357 DOI: 10.3390/jcm12051999] [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: 01/24/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Knee ligament injuries are most common in sports injuries. In general, ligament repair or reconstruction is necessary to restore the stability of the knee joint and prevent secondary injuries. Despite advances in ligament repair and reconstruction techniques, a number of patients still experience re-rupture of the graft and suboptimal recovery of motor function. Since Dr. Mackay's introduction of the internal brace technique, there has been continuous research in recent years using the internal brace ligament augmentation technique for knee ligament repair or reconstruction, particularly in the repair or reconstruction of the anterior cruciate ligament. This technique focuses on increasing the strength of autologous or allograft tendon grafts through the use of braided ultra-high-molecular-weight polyethylene suture tapes to facilitate postoperative rehabilitation and avoid re-rupture or failure. The purpose of this review is to present detailed research progress in the internal brace ligament enhancement technique of knee ligament injury repair as well as the reconstruction from biomechanical and histological research and clinical studies and to comprehensively assess the value of the application of this technique.
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Shen Z, Chen H, Ye M, Gao Z, Li H, Lu H, Xu G, Hu Z, Shen W, Xu S, Ye Q. Early outcomes of primary repair versus reconstruction for acute anterior cruciate ligament injury: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32411. [PMID: 36595828 PMCID: PMC9794338 DOI: 10.1097/md.0000000000032411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Contemporary techniques for repair of acute anterior cruciate ligament (ACL) rupture have been receiving renewed interest recently because of reports of good outcomes. METHODS A literature search of PUBMED, MEDLINE, EMBASE, and the Cochrane Library was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only RCTs published in English and comparing clinical outcomes of ACL repair versus reconstruction were included. Outcomes were evaluated using the International Knee Documentation Committee subjective score, Lysholm score, Tegner activity scale, visual analog scale pain score, anterior laxity, Lachman test, hop tests, knee injury and osteoarthritis outcome score, extension deficit, revision rate, and re-rupture rate. Statistical analysis was performed with Review Manager 5.4 and Stata 14.0. Two-tailed P < .05 was considered statistically significant. RESULTS Four RCTs (with a total of 293 patients) that met the eligibility criteria were included in this review. Over short-term follow-up, none of the studies found significant differences between the repair groups and reconstruction groups with respect to International Knee Documentation Committee, Lysholm, Tegner, visual analog scale, anterior laxity, Lachman test, re-rupture rate, extension deficit, and performance of 3 hop tests (P > .05). In both groups, the hop tests scores were >90%. CONCLUSION ACL repair and ACL reconstruction appear to provide comparable short-term outcomes. The low revision rate after primary repair is encouraging. For patients with ACL injury, current repair techniques such as dynamic intraligamentary stabilization and bridge-enhanced ACL repair may be an effective alternative to reconstruction.
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Affiliation(s)
- Zhenli Shen
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Hang Chen
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
- Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Mengmeng Ye
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
- Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Zetian Gao
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
- Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Hongxiang Li
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
- Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Haoxuan Lu
- Department of Cardiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang, China
| | - Guodong Xu
- Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Zeyang Hu
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
- Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Wei Shen
- Department of Pulmonary and Critical Care Medicine, The Third People’s Hospital of Cixi, Ningbo, Zhejiang, China
| | - Shuguang Xu
- Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Qidong Ye
- Department of Pediatrics, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, China
- * Correspondence: Qidong Ye, Department of Pediatrics, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang 315000, China (e-mail: )
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Petersen W, Häner M, Guenther D, Lutz P, Imhoff A, Herbort M, Stein T, Schoepp C, Akoto R, Höher J, Scheffler S, Stöhr A, Stoffels T, Mehl J, Jung T, Eberle C, Vernacchia C, Ellermann A, Krause M, Mengis N, Müller PE, Best R, Achtnich A. Management after acute injury of the anterior cruciate ligament (ACL), part 2: management of the ACL-injured patient. Knee Surg Sports Traumatol Arthrosc 2022; 31:1675-1689. [PMID: 36471029 DOI: 10.1007/s00167-022-07260-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this consensus project was to create a treatment algorithm for the management of the ACL-injured patient which can serve as an aid in a shared decision-making process. METHODS For this consensus process, a steering and a rating group were formed. In an initial face-to-face meeting, the steering group, together with the expert group, formed various key topic complexes for which various questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS During this consensus process, 15 key questions were identified. The literature search for each key question resulted in 24 final statements. Of these 24 final statements, all achieved consensus. CONCLUSIONS This consensus process has shown that ACL rupture is a complex injury, and the outcome depends to a large extent on the frequently concomitant injuries (meniscus and/or cartilage damage). These additional injuries as well as various patient-specific factors should play a role in the treatment decision. The present treatment algorithm represents a decision aid within the framework of a shared decision-making process for the ACL-injured patient. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Wolf Petersen
- Department of Orthopedics, Sportsclinic Berlin, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, 14193, Berlin-GrunewaldBerlin, Germany
| | - Martin Häner
- Department of Orthopedics, Sportsclinic Berlin, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, 14193, Berlin-GrunewaldBerlin, Germany.
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine Cologne Merheim Medical Center (Witten/Herdecke University), Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Patricia Lutz
- Department of Orthopaedics and Trauma Surgery, State Hospital Feldkirch, Carinagasse 41, 6800, Feldkirch, Austria
| | - Andreas Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Mirco Herbort
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | - Thomas Stein
- SPORTHOLOGICUM® Frankfurt Am Main, Siesmayerstraße 44, 60323, Frankfurt Am Main, Germany
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt Am Main, Germany
| | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum, Duisburg gGmbH, Großenbaumer Allee 250, 47249, Duisburg, Germany
| | - Ralph Akoto
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
- Department of Orthopaedics, Trauma Surgery and Sports Medicine, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - Jürgen Höher
- SPORTSCLINIC COLOGNE, Ostmerheiemer Str. 200, 51109, Cologne, Germany
| | - Sven Scheffler
- Sporthopaedicum Berlin, Bismarckstrasse 45-47, 10627, Berlin, Germany
| | - Amelie Stöhr
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | | | - Julian Mehl
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Christian Eberle
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Cara Vernacchia
- Department of Physical Medicine and Rehabilitation, Shirley Ryan Ability Lab, Chicago, IL, USA
- McGaw/Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andree Ellermann
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Natalie Mengis
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
- KSA Aarau/Spital Zofingen, Mühlethalstrasse 27, 4800, Zofingen, Schweiz
| | - Peter E Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany
- Department of Sports Medicine and Orthopaedics, University of Tuebingen, Hoppe Seyler Strasse 5, 72074, Tuebingen, Germany
| | - Andrea Achtnich
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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8
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Wilson WT, Hopper GP, Banger MS, Blyth MJG, Riches PE, MacKay GM. Anterior cruciate ligament repair with internal brace augmentation: A systematic review. Knee 2022; 35:192-200. [PMID: 35366618 DOI: 10.1016/j.knee.2022.03.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Primary repair of anterior cruciate ligament (ACL) ruptures has re-emerged as a treatment option for proximal tears, with internal brace augmentation often utilised. The aim of this study is to provide an overview of the current evidence presenting outcomes of ACL repair with internal bracing to assess the safety and efficacy of this technique. METHODS All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears, augmented with internal bracing from 2014-2021 were included. Primary outcome was failure rate and secondary outcomes were subjective patient reported outcome measures (PROMs) and objective assessment of anteroposterior knee laxity. RESULTS Nine studies were included, consisting of 347 patients, mean age 32.5 years, mean minimum follow up 2 years. There were 36 failures (10.4%, CI 7.4% - 14.1%). PROMs reporting was variable across studies. KOOS, Lysholm and IKDC scores were most frequently used with mean scores > 87%. The mean Tegner and Marx scores at follow-up were 6.1 and 7.8 respectively. The mean side to side difference measured for anteroposterior knee laxity was 1.2mm. CONCLUSIONS This systematic review with meta-analysis shows that ACL repair with internal bracing is a safe technique for treatment of proximal ruptures, with a failure rate of 10.4%. Subjective scores and clinical laxity testing also revealed satisfactory results. This suggests that ACL repair with internal bracing should be considered as an alternative to ACL reconstruction for acute proximal tears, with the potential benefits of retained native tissue and proprioception, as well as negating the need for graft harvest.
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Affiliation(s)
- W T Wilson
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK; NHS Greater Glasgow & Clyde, Glasgow, UK.
| | - G P Hopper
- NHS Greater Glasgow & Clyde, Glasgow, UK.
| | - M S Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
| | | | - P E Riches
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
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9
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Wu J, Kator JL, Zarro M, Leong NL. Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair. Sports Health 2021; 14:424-432. [PMID: 34344237 DOI: 10.1177/19417381211032949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Injury to the anterior cruciate ligament (ACL) is among the most common orthopaedic injuries, and reconstruction of a ruptured ACL is a common orthopaedic procedure. In general, surgical intervention is necessary to restore stability to the injured knee, and to prevent meniscal damage. Along with surgery, intense postoperative physical therapy is needed to restore function to the injured extremity. ACL reconstruction (ACLR) has been the standard of care in recent decades, and advances in surgical technology have reintroduced the prospect of augmented primary repair of the native ACL via a variety of methods. EVIDENCE ACQUISITION A search of PubMed database of articles and reviews available in English was performed through 2020. The search terms ACLR, anterior cruciate ligament repair, bridge enhanced acl repair, suture anchor repair, dynamic intraligamentary stabilization, internal bracing, suture ligament augmentation, and internal brace ligament augmentation were used. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS No exact consensus exists on effective rehabilitation protocols after ACL repair techniques, as the variation in published protocols seem even greater than the variation in those for ACLR. For some techniques such as internal bracing and dynamic interligamentary stabilization, it is likely permissible for the patients to progress to full weightbearing and discontinue bracing sooner. However, caution should be applied with regard to earlier return to sport than after ACLR as to minimize risk for retear. CONCLUSION More research is needed to address how physical therapies must adapt to these innovative repair techniques. Until that is accomplished, we recommend that physical therapists understand the differences among the various ACL surgery techniques discussed here and work with the surgeons to develop a rehabilitation protocol for their mutual patients. STRENGTH OF RECOMMENDATION TAXONOMY (SORT) C.
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Affiliation(s)
- Jocelyn Wu
- Department of Orthopaedic Surgery, University of Maryland Baltimore, Baltimore, Maryland
| | - Jamie L Kator
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Zarro
- Department of Physical Therapy, University of Maryland Baltimore, Baltimore, Maryland
| | - Natalie L Leong
- Department of Orthopaedic Surgery, University of Maryland Baltimore, Baltimore, Maryland.,Department of Surgery, Baltimore VA Medical Center, Baltimore, Maryland
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10
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ACL Repair: A Game Changer or Will History Repeat Itself? A Critical Appraisal. J Clin Med 2021; 10:jcm10050912. [PMID: 33652689 PMCID: PMC7956607 DOI: 10.3390/jcm10050912] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 01/13/2023] Open
Abstract
Until the past decade the common thought was that the anterior cruciate ligament (ACL) was not able to heal and restore knee stability. In this manuscript a brief review of studies of the developers and the early adaptors of four different modern ACL repair techniques are presented. The present status and considerations for the future of ACL repair and its research are shared. After promising short- to midterm ACL healing results by the developers, the results of the early adaptors show more variety in terms of rerupture and reintervention for other reasons. Risk factors for failure are a young age, high preinjury sports activity level, midsubstance ruptures and impaired integrity of the ACL bundles and the synovial sheath. There is a call for more clinical data and randomized clinical trials. Conclusion: an important finding of the past decade is that the ACL is able to heal and subsequently restabilize the knee. Patient selection is emphasized: the ideal patient is a non-high athlete older than 25 and has an acute proximal one bundle ACL rupture. Further research will have to show if ACL repair could be a game changer or if history will repeat itself.
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11
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Ji C, Chen Y, Zhu L, Zhang J. Arthroscopic Anterior Cruciate Ligament Injury in Clinical Treatment of Joint Complications and CT Observation. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6667046. [PMID: 33680415 PMCID: PMC7925042 DOI: 10.1155/2021/6667046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/07/2021] [Accepted: 02/15/2021] [Indexed: 01/13/2023]
Abstract
Arthroscopy is the gold standard for diagnosing ACL injuries. It is a dual clinical technique for examination and treatment, which can effectively target the injury site for repair and treatment and can also accurately identify the lesion site and determine the degree of ligament injury through visual and three-dimensional observation of ligament injuries that are difficult to detect on imaging. However, this technique is invasive, so the clinic still needs to improve the related auxiliary imaging examination. In this paper, we performed MPR and VRT on patients with ACL injury and postprocessed the data. The diagnostic compliance rate of dual-source CT was 91.67% (33/36), the true positive rate was 93.33% (28/30), the missed rate was 6.67% (2/30), the true negative rate was 83.33% (5/6), and the misdiagnosis rate was 83.33% (5/6). The rate of true negative was 83.33% (5/6), and the rate of false diagnosis was 16.67% (1/6). Kappa analysis of the consistency between dual-source CT and arthroscopy showed a Kappa value of 0.719, indicating a high degree of consistency between the two examinations. In conclusion, MPR and VRT images are of clinical value for the diagnosis of ACL injury. In addition, dual-source CT can measure the CT value of the ACL and the thickness of each segment by MPR and VRT postprocessing techniques to diagnose the ligament injury in an objective, quantitative, and noninvasive way and can use dual-energy staining techniques to predict the ligament injury in a more intuitive way, which is not available in some arthroscopes.
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Affiliation(s)
- Cheng Ji
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Orthopedics Department, Hangzhou 310006, Zhejiang, China
| | - Yuan Chen
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Anesthesiology Department, Hangzhou 310006, Zhejiang, China
| | - Liulong Zhu
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Orthopedics Department, Hangzhou 310006, Zhejiang, China
| | - Jian Zhang
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Orthopedics Department, Hangzhou 310006, Zhejiang, China
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12
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Affiliation(s)
- Andrea Ferretti
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome La Sapienza, Rome, Italy.
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13
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Kakavas G, Malliaropoulos N, Pruna R, Traster D, Bikos G, Maffulli N. Neuroplasticity and Anterior Cruciate Ligament Injury. Indian J Orthop 2020; 54:275-280. [PMID: 32399146 PMCID: PMC7205971 DOI: 10.1007/s43465-020-00045-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/13/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) tears are common, with a seemingly constant increase in their number, and potentially serious consequences for sports participation and long-term general and musculoskeletal health. AREAS OF AGREEMENT Most players are able to return to cutting sport after ACL reconstruction, but some sustain further knee problems needing different approach to their rehabilitation. GROWING POINTS Neurocognitive tasks, measuring reaction time, processing speed, visual memory and verbal memory, allow indirect assessment of cerebral performance. Situational awareness, arousal, and attentional resources may influence neurocognitive function, affecting the complex integration of vestibular, visual, and somatosensory information needed for neuromuscular control. AREAS OF CONTROVERSY The underlying reasons for uncoordinated, high-velocity movements observed during non-contact injuries of the knee producing an ACL tear are not well understood. Fundamental neuropsychological characteristics are responsible for situational awareness, sensory integration, motor planning, and coordination, all of which control joint stiffness. There is a strong link between acquisition of motor skills and neuronal plasticity at cortical and subcortical levels in the central nervous system; these links may evolve over time and engage different spatially distributed interconnected brain regions. A cascade of neurophysiological alterations occurs after ACL injury. AREAS TIMELY FOR DEVELOPING RESEARCH Training can improve function; hence, rehabilitation programmes which include perturbation training, agility training, vision training and sport-specific skill training are essential after ACL injuries and for injury prevention, and to optimize return to play.
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Affiliation(s)
| | - Nikolaos Malliaropoulos
- Thessaloniki MSK Sports Medicine Clinic, Thessaloniki, Greece ,Queen Mary University of London, Centre for Sports and Exercise Medicine, London, UK
| | - Ricard Pruna
- FC Barcelona, FIFA Medical Center of Excellence, St Joan Despi, Barcelona, Spain
| | - David Traster
- Carrick Institute of Neurology, Cape Canaveral, FL USA
| | - Georgios Bikos
- Euromedica Arogi Rehabilitation Center, Thessaloniki, Greece
| | - Nicola Maffulli
- Queen Mary University of London, Centre for Sports and Exercise Medicine, London, UK ,Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy ,School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB England, UK
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14
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Tranexamic acid is effective in decreasing postoperative intraarticular bleeding in arthroscopic knee surgery. Blood Coagul Fibrinolysis 2020; 31:175-178. [PMID: 31990755 DOI: 10.1097/mbc.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Arthroscopic knee surgery to perform partial meniscectomy and anterior cruciate ligament (ACL) reconstruction is frequent and effective, although a possible complication is postoperative hemarthrosis. When intraarticular bleeding occurs, in addition to the associated pain, the patient usually requires joint aspiration (arthrocentesis) to avoid loss of range of motion (ROM). Sometimes this complication ends up associated with a poor result of surgery due to a loss of ROM. The aim of this narrative review of the literature is to attempt to clarify whether tranexamic acid (TXA) should be utilized in arthroscopic ACL reconstruction and arthroscopic meniscectomy and by what route (intraarticular or intravenous). A number of studies seem to favor the use of intravenous TXA in patients undergoing ACL reconstruction and arthroscopic synovectomy to diminish articular postoperative bleeding and its consequences (pain, swelling, loss of ROM, and the need for arthrocentesis). Regarding the use of intraarticular TXA, one in-vitro study has indicated that TXA in high concentrations is cytotoxic to chondrocytes. Common sense leads me to conclude that until better designed studies can confirm that intraarticular TXA is not cytotoxic to chondrocytes, its use should not be advised. Currently, for patients undergoing arthroscopic ACL reconstruction and arthroscopic meniscectomy, it seems safer to use intravenous TXA.
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