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Kantrowitz DE, Darden CN, Haunschild ED, Gladstone JN, Anthony SG. Modified Bridge-Enhanced Anterior Cruciate Ligament Repair. Arthrosc Tech 2024; 13:103034. [PMID: 39308585 PMCID: PMC11411291 DOI: 10.1016/j.eats.2024.103034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/01/2024] [Indexed: 09/25/2024] Open
Abstract
Historically, the treatment of anterior cruciate ligament (ACL) injuries shifted from primary repair to reconstruction because the native, intrasynovial location of the ACL precluded the formation of a fibrin-rich clot needed for ligament healing. However, increasing attention has been paid to augmenting the biological environment surrounding the ACL to facilitate its healing after arthroscopic repair. The bridge-enhanced ACL restoration implant uses resorbable collagen mixed with autologous blood to provide a biological scaffold for tissue healing. The short-term results of this procedure are promising, showing noninferiority to traditional ACL reconstruction at 2 years postoperatively and a higher rate of return to sport at 6 months. Our technique for performing the bridge-enhanced ACL repair is efficient, is easy to learn, and achieves excellent fixation of the ACL stump augmented with an internal brace.
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Affiliation(s)
- David E. Kantrowitz
- Department of Orthopedic Surgery, Mount Sinai Health System, New York, New York, U.S.A
| | - Christon N. Darden
- Department of Orthopedic Surgery, Mount Sinai Health System, New York, New York, U.S.A
| | - Eric D. Haunschild
- Department of Orthopedic Surgery, Mount Sinai Health System, New York, New York, U.S.A
| | - James N. Gladstone
- Department of Orthopedic Surgery, Mount Sinai Health System, New York, New York, U.S.A
| | - Shawn G. Anthony
- Department of Orthopedic Surgery, Mount Sinai Health System, New York, New York, U.S.A
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Fleming BC, Baranker B, Badger GJ, Kiapour AM, Ecklund K, Micheli LJ, Murray MM. Bridge-Enhanced Anterior Cruciate Ligament Restoration: 6-Year Results From the First-in-Human Cohort Study. Orthop J Sports Med 2024; 12:23259671241260632. [PMID: 39143986 PMCID: PMC11322937 DOI: 10.1177/23259671241260632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/02/2024] [Indexed: 08/16/2024] Open
Abstract
Background Bridge-enhanced anterior cruciate ligament restoration (BEAR) combines suture repair of the anterior cruciate ligament (ACL) with an extracellular matrix implant plus autologous blood to facilitate native ACL healing. Purpose/Hypothesis The purpose of this study was to compare the 6-year follow-up outcomes of patients who underwent the BEAR procedure with those of a nonrandomized concurrent control group receiving autograft ACL reconstruction (ACLR) in the first-in-human safety study of the BEAR implant (BEAR I trial). Based on the 2-year results, it was hypothesized that isometric hamstring strength after the BEAR procedure would be greater than that after ACLR and that there would be no other differences in outcomes at 6 years. Study Design Cohort study, Level of evidence, 2. Methods Ten patients underwent BEAR and 10 received ACLR with a 4-stranded hamstring autograft. Outcomes assessed included the record of subsequent surgeries, the International Knee Documentation Committee (IKDC) Subjective Knee Score, IKDC physical examination grade, the Knee injury and Osteoarthritis Outcome Score, instrumented knee laxity, functional outcomes (ie, muscle strength assessments and hop testing), and qualitative magnetic resonance imaging assessment. Comparisons between treatments were based on computations of the mean differences and the associated 95% CIs. Results One patient in the BEAR group and 3 patients in the ACLR group were lost to follow-up. In the period between 2 and 6 years, 1 patient in each group underwent revision surgery. There were no differences between groups at the 6-year follow-up in any of the outcome measures except for isometric hamstring strength, which was approximately equal to that of the contralateral knee in the BEAR group and <44% of that in the contralateral knee in the ACLR group (P < .01). Conclusion This preliminary study suggests that the outcomes of BEAR and ACLR with a hamstring tendon graft may be similar at the 6-year follow-up and warrants investigation of the BEAR procedure in a larger cohort of patients.
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Affiliation(s)
- Braden C. Fleming
- Department of Orthopaedics, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ben Baranker
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Ata M. Kiapour
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kirsten Ecklund
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lyle J. Micheli
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Sritharan P, Milantoni V, Abdel Khalik H, Kay J, Slawaska-Eng D, Johnson J, de Sa D. Evaluating the quality of systematic reviews of comparative studies in autograft-based anterior cruciate ligament reconstruction using the AMSTAR-2 tool: A systematic umbrella review. Knee Surg Sports Traumatol Arthrosc 2024; 32:583-598. [PMID: 38372015 DOI: 10.1002/ksa.12062] [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: 10/09/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE There remains a lack of consensus around autograft selection in anterior cruciate ligament reconstruction (ACLR), though there is a large body of overlapping systematic reviews and meta-analyses. Systematic reviews and their methodological quality were aimed to be further assessed, using a validated tool known as assessing the methodological quality of systematic reviews (AMSTAR-2). METHODS MEDLINE, Embase and CENTRAL were searched from inception to 23 April 2023 for systematic reviews (with/without meta-analysis) comparing primary ACLR autografts. A final quality rating from AMSTAR-2 was provided for each study ('critically low', 'low', 'moderate' or 'high' quality). Correlational analyses were conducted for ratings in relation to study characteristics. RESULTS Two thousand five hundred and ninety-eight studies were screened, and 50 studies were ultimately included. Twenty-four studies (48%) were rated as 'critically low', 17 (34%) as 'low', seven (14%) as 'moderate' and two (4%) as 'high' quality. The least followed domains were reporting on sources of funding (1/50 studies), the impact of risk of bias on results of meta-analyses (11/36 studies) and publication bias (17/36 studies). There was a significant increase in the frequency of studies graded as 'moderate' compared to 'low' or 'critically low' quality over time (p = 0.020). CONCLUSION The methodological quality of systematic reviews comparing autografts in ACLR is low, with many studies being rated lower due to commonly absent aspects of systematic review methodology such as investigating sources of funding and publication bias. More recent studies were generally more likely to be of higher quality. Authors are advised to consult AMSTAR-2 prior to conducting systematic reviews in ACLR. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Praveen Sritharan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Vincent Milantoni
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hassaan Abdel Khalik
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jansen Johnson
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
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Laboute E, James-Belin E, Ucay O, Caubere A, Verhaeghe E. Prospective study of functional outcomes and return to sports after anterior cruciate ligament reconstruction in the knee. INTERNATIONAL ORTHOPAEDICS 2024; 48:455-463. [PMID: 37700201 PMCID: PMC10799780 DOI: 10.1007/s00264-023-05973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Individual factors of low rates of return to sport after anterior cruciate ligament (ACL) reconstruction were unclear. We evaluated the impact of various individual factors after ACL reconstruction for return to sport in athletes. METHODS A prospective study was performed in 1274 athletes, who had undergone ACL autograft reconstruction. Individual factors survey about return to sport was performed during the second year after surgery. Athlete responses were analyzed with a multivariate logistic model adjusted for baseline patient characteristics and an adjusted Cox model. RESULTS Younger age and involvement in higher-level sporting activities were associated with a significantly higher frequency and a significantly shorter time to return to sport (running, training, competition; p = 0.001 to 0.028). Men returned to sport more rapidly than women, for both training (p = 0.007) and competition (p = 0.042). Although there was no difference to return to sport between hamstring (HT) and patellar tendon (PT) autograft. We note that MacFL surgery (Mac Intosh modified with intra- and extra-articular autografts used the tensor fasciae latae muscle) was associated with a higher frequency (p = 0.03) and rapidity (p = 0.025) of return to training than HT. Sports people practicing no weight-bearing sports returned to training (p < 0.001) and competition (p < 0.001) more rapidly than other sports people. By contrast, the practicing pivoting sports with contact started running again sooner (p < 0.001). CONCLUSION Younger age, male sex, higher level of sports, sportspeople practicing no weight-bearing sports, and MacFL surgery reduce time to return to sport after ACL reconstruction.
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Affiliation(s)
- E Laboute
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France.
| | - E James-Belin
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France
| | - O Ucay
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France
| | - A Caubere
- Service de Chirurgie Orthopédique Et Traumatologie, Hôpital d'Instruction Des Armées Sainte-Anne, 2, Bd Sainte Anne, BP 600, 83800, Cedex 9, Toulon, France
| | - E Verhaeghe
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France
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Renshaw A, Few WE, Desai B, Godshaw B, Jones D. Patellar Tendon Reconstruction Using Tibialis Posterior Allograft for Treatment of Patellar Tendon Rupture After Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction. Ochsner J 2024; 24:151-156. [PMID: 38912180 PMCID: PMC11192220 DOI: 10.31486/toj.23.0104] [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] [Indexed: 06/25/2024] Open
Abstract
Background: Bone-patellar tendon-bone (BPTB) autografts are often used to treat anterior cruciate ligament (ACL) tears in young, highly active patients. These grafts are robust and provide adequate stability, allowing for return to sport and optimal functional outcomes in athletes. Patellar tendon rupture following BPTB ACL reconstruction is rare and can be difficult to treat. Case Report: A 19-year-old collegiate wrestler injured his left knee during a match. On evaluation 7 days after the injury, he was found to have increased anterior translation of the tibia on Lachman testing and an abnormal pivot shift. Magnetic resonance imaging demonstrated a complete tear of the ACL, and he successfully underwent a BPTB ACL reconstruction without complication. He progressed appropriately in the acute postoperative period. Six weeks after his index surgery, the patient reinjured his left knee and was diagnosed with a patellar tendon rupture. The previously reconstructed ACL was intact. A posterior tibialis tendon graft was used to repair the patellar tendon via a transosseous tunnel in the tibial tuberosity. The patient's recovery was complicated by a superficial wound that resolved with treatment. He achieved full range of motion and was able to return to sport. Conclusion: No technique for treating patellar tendon rupture following BPTB ACL reconstruction has been widely accepted. The treatment of this injury is left to the preference of the surgeon. This case demonstrates that tibialis posterior allografts are a viable option for the treatment of such injuries.
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Affiliation(s)
- Andrew Renshaw
- Department of Orthopedic Surgery, Ochsner Clinic Foundation, New Orleans, LA
| | - W. Evans Few
- Department of Orthopedic Surgery, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
| | - Bhumit Desai
- Department of Orthopedic Surgery, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
| | - Brian Godshaw
- Department of Orthopedic Surgery, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
| | - Deryk Jones
- Department of Orthopedic Surgery, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
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Noailles T, Toanen C, Geffroy L, Lopes R, Hardy A. Preserving the hamstring tendon insertion during ACL reconstruction with an autograft: Systematic literature review. Orthop Traumatol Surg Res 2023; 109:103556. [PMID: 36682410 DOI: 10.1016/j.otsr.2023.103556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The hamstring tendons (gracilis and semitendinosus) are often used as an autograft for anterior cruciate ligament (ACL) reconstruction. Healing of this graft involves a slow biological process called ligamentization. To encourage this process, some authors have proposed preserving the insertion of the hamstring tendons. HYPOTHESIS Leaving the tibial insertion of the hamstring tendons intact will provide better early biological incorporation and superior tibial mechanical fixation resulting in various clinical advantages. MATERIALS AND METHODS In January 2022, a systematic literature review was carried out independently by two authors of the Medline, PubMed and Embase databases. The keywords used were "pedicular" or "pedicled" or "preservation of tibial attachment" or "hamstring tibial insertion" AND "ACL reconstruction". Each author's data was analyzed separately. RESULTS Sixteen articles were analyzed. Preserving the hamstring tibial insertion during ACL reconstruction improves the graft's biological incorporation during the initial postoperative phase according to clinical studies with MRI analysis and provides a mechanical advantage at the graft's tibial attachment according to biomechanical studies (construct up to 65% stiffer). There was no difference in the clinical and functional scores when compared to the conventional technique in which the hamstring tendons are detached from their tibial insertion. DISCUSSION The main conclusion of this systematic literature review was that preserving the hamstring tibial insertion during ACL reconstruction appears to improve the graft's ligamentization with biological and mechanical advantages relative to detaching the hamstring tendons. The clinical and functional results were comparable to other techniques. Prospective studies with large cohorts are still needed to confirm these findings. LEVEL OF EVIDENCE IV; Systematic review of literature.
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Affiliation(s)
- Thibaut Noailles
- Département de Chirurgie Orthopédique, Polyclinique de Bordeaux Nord, 15/35, rue Claude Boucher, 33000 Bordeaux, France.
| | - Cécile Toanen
- Service de Chirurgie Orthopédique, CHD Vendée, Boulevard Stéphane Moreau, 85925 La Roche-sur-Yon, France
| | - Loïc Geffroy
- Département de Chirurgie Orthopédique, Polyclinique de l'Atlantique, avenue Claude Bernard, 44819 Saint Herblain Cedex, France
| | - Ronny Lopes
- Département de Chirurgie Orthopédique, Polyclinique de l'Atlantique, avenue Claude Bernard, 44819 Saint Herblain Cedex, France
| | - Alexandre Hardy
- Clinique du sport Paris V, 36, boulevard Saint Marcel, 75005 Paris, France
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Weinert K, Holzhausen HJ, Bartels T, Spahn G, Hofmann GO. Histopathological Analysis of the Degree of Tendinosis in Failed Anterior Cruciate Ligament Grafts. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:500-510. [PMID: 35196738 DOI: 10.1055/a-1717-2889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION After reconstruction of the anterior cruciate ligament, the modification processes in the transplanted tendon tissue directly influence the biomechanical properties of the knee. The histopathological alterations in failed grafts have hardly been studied. OBJECTIVE Our study focused on examining the presence and extent of tendinosis (low or high grade) in the tendon tissue of failed anterior cruciate ligament reconstructions. We considered its relationship to the type of transplant, the symptoms, the arthroscopic appearance, the mode of trauma, and the timing of the failure. MATERIALS AND METHODS The tendon tissue of failed anterior cruciate ligament reconstructions in 30 patients was gathered during revision surgery and its histopathology was analysed for the occurrence of structural alterations. The classification of the tendinosis as low or high grade was semiquantitative based on five qualities. We used a standardised questionnaire to collect patient data and we used the Marburg Arthroscopy Score for the intraoperative evaluation of the graft. RESULTS We found histological vitality and, except for two samples, structural alterations consistent with tendinosis, predominantly high grade, in all failed anterior cruciate ligament grafts. No direct link could be proved between the degree of tendinosis and the type of graft used, the symptoms (except for instability) or the timing of the graft failure, the mode of trauma, or the arthroscopic appearance of the failed plasty. However, the accumulation of high-grade tendinosis in patients with hamstring tendons, subjective instability, and graft failure between 1 to 5 years postoperatively was noteworthy. CONCLUSION Structural alterations consistent with tendinosis could be detected, with different expressions, in the vital tendon tissue of anterior cruciate ligament reconstructions. This indicates that the graft is subject to repetitive microtrauma. However, it is still unclear how tendinosis influences the failure of anterior cruciate ligament reconstructions.
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Affiliation(s)
- Katja Weinert
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle, Halle, Deutschland
| | - Hans-Jürgen Holzhausen
- Amedes MVZ für Pathologie, Zytodiagnostik und Humangenetik in Halle GmbH, Halle, Deutschland
| | - Thomas Bartels
- MVZ Sportklinik Halle: Zentrum für Gelenkchirurgie, Halle, Deutschland
| | - Gunter Spahn
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
- Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach, Deutschland
| | - Gunter O Hofmann
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Halle, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
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Chang MJ, Choi YS, Shin JH, Yoon TH, Kim TW, Chang CB, Kang SB. Comparison of failure rates and functional outcomes between hamstring autografts and hybrid grafts in anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2023; 109:103499. [PMID: 36462633 DOI: 10.1016/j.otsr.2022.103499] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The viability of augmenting small-diameter hamstring autografts with allografts remains unclear. Recent studies have reported different clinical results after allograft augmentation. Hence, we sought to determine whether hamstring autografts and hybrid grafts differed in terms of failure rates and functional outcomes after anterior cruciate ligament (ACL) reconstruction. We also evaluated whether the results of the comparisons differed based on allograft sterilization methods. PATIENTS AND METHODS This systematic review and meta-analysis were performed by searching the PubMed, Cochrane Library, and EMBASE databases to identify prospective or retrospective studies (evidence levels 1, 2, or 3) that compared the failure rates and functional outcomes of ACL reconstruction using autografts and hybrid grafts. RESULTS We identified 15 relevant studies, including 1,521 patients, with 798 and 723 treated using autografts and hybrid grafts, respectively. Fourteen studies were retrospective comparative studies, and one was a prospective randomized controlled trial. Of these, three studies used non-irradiated allografts. In the analysis of all participants, no significant differences in failure rates and subjective International Knee Documentation Committee (IKDC) scores were observed between the autograft and hybrid graft groups. Comparing the autograft and hybrid graft groups that used non-irradiated allografts, no differences in the failure rates and subjective IKDC scores were also noted. Meanwhile, in the groups that used irradiated allograft, the autograft group demonstrated higher Lysholm knee scores and reduced anterior laxity than the hybrid graft group. DISCUSSION Overall, ACL reconstruction using hybrid grafts may not reduce failure rates compared to reconstructions using hamstring autografts, although hybrid grafts with irradiation may decrease functional outcomes. LEVEL OF EVIDENCE III; systematic review of level II and III studies.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | | | - Tae Hyuck Yoon
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnamsi, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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Zhao D, Pan JK, Lin FZ, Luo MH, Liang GH, Zeng LF, Huang HT, Han YH, Xu NJ, Yang WY, Liu J. Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3053-3075. [PMID: 36189967 DOI: 10.1177/03635465221119787] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The rerupture or need for revision after anterior cruciate ligament reconstruction (ACLR) is a serious complication. Preventive strategies that target the early identification of risk factors are important to reduce the incidence of additional surgery. PURPOSE To perform a systematic review and meta-analysis to investigate risk factors for revision or rerupture after ACLR. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Literature searches were performed in PubMed, Embase, and Web of Science from database inception to November 2021 and updated in January 2022. Quantitative, original studies reporting potential adjusted risk factors were included. Odds ratios (ORs) were calculated for potential risk factors. RESULTS A total of 71 studies across 13 countries with a total sample size of 629,120 met the inclusion criteria. Fifteen factors were associated with an increase in the risk of revision or rerupture after ACLR: male sex (OR, 1.27; 95% CI, 1.14-1.41), younger age (OR, 1.07; 95% CI, 1.05-1.08), lower body mass index (BMI) (OR, 1.03; 95% CI, 1.00-1.06), family history (OR, 2.47; 95% CI, 1.50-4.08), White race (OR, 1.32; 95% CI, 1.08-1.60), higher posterolateral tibial slope (OR, 1.15; 95% CI, 1.05-1.26), preoperative high-grade anterior knee laxity (OR, 2.30; 95% CI, 1.46-3.64), higher baseline Marx activity level (OR, 1.07; 95% CI, 1.02-1.13), return to a high activity level/sport (OR, 2.03; 95% CI, 1.15-3.57), an ACLR within less than a year after injury (OR, 2.05; 95% CI, 1.81-2.32), a concomitant medial collateral ligament (MCL) injury (OR, 1.62; 95% CI, 1.31-2.00), an anteromedial portal or transportal technique (OR, 1.36; 95% CI, 1.22-1.51), hamstring tendon (HT) autografts (vs bone-patellar tendon-bone [BPTB] autografts) (OR, 1.60; 95% CI, 1.40-1.82), allografts (OR, 2.63; 95% CI, 1.65-4.19), and smaller graft diameter (OR, 1.21; 95% CI, 1.05-1.38). The other factors failed to show an association with an increased risk of revision or rerupture after ACLR. CONCLUSION Male sex, younger age, lower BMI, family history, White race, higher posterolateral tibial slope, preoperative high-grade anterior knee laxity, higher baseline Marx activity level, return to a high activity level/sport, an ACLR within less than a year from injury, a concomitant MCL injury, an anteromedial portal or transportal technique, HT autografts (vs BPTB autografts), allografts, and smaller graft diameter may increase the risk of revision or rerupture after ACLR. Raising awareness and implementing effective preventions/interventions for risk factors are priorities for clinical practitioners to reduce the incidence of revision or rerupture after ACLR.
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Affiliation(s)
- Di Zhao
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jian-Ke Pan
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang-Zheng Lin
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-Hui Luo
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gui-Hong Liang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ling-Feng Zeng
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - He-Tao Huang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Hong Han
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nan-Jun Xu
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Yi Yang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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Abstract
Anterior cruciate ligament (ACL) reconstruction failure can be defined as abnormal knee function due to graft insufficiency with abnormal laxity or failure to recreate a functional knee according to the expected outcome. Traumatic ruptures have been reported as the most common reason for failure. They are followed by technical errors, missed concomitant knee injuries, and biological failures. An in-depth preoperative examination that includes a medical history, clinical examinations, advanced imaging, and other appropriate methods is of utmost importance. There is still no consensus as to the ideal graft, but autografts are the favorite choice even in ACL revision. Concomitant meniscal treatment, ligamentous reconstruction, and osteotomies can be performed in the same surgical session to remove anatomical or biomechanical risk factors for the failure. Patient expectations should be managed since outcomes after ACL revision are not as good as those following primary ACL reconstruction.
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Affiliation(s)
- Juan Carlos Monllau
- Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- ICATKnee, Institut Catalá de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain
| | - Simone Perelli
- Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- ICATKnee, Institut Catalá de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain
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Ruelos VCB, Masood R, Puzzitiello RN, Moverman MA, Pagani NR, Menendez ME, Salzler MJ. The reverse fragility index: RCTs reporting non-significant differences in failure rates between hamstring and bone-patellar tendon-bone autografts have fragile results. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07420-0. [PMID: 37093236 DOI: 10.1007/s00167-023-07420-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The reverse fragility index (RFI) is a novel metric to appraise the results of studies reporting statistically non-significant results. The purpose of this study was to determine the statistical robustness of randomized controlled trials (RCTs) reporting non-significant differences in anterior cruciate ligament reconstruction (ACLR) graft failure rates, defined as re-rupture/revision ACLR rate, between hamstring tendon (HT) and bone-patellar tendon-bone (BTB) autografts by calculating RFIs. METHODS A systematic review was performed to identify RCTs that compared HT to BTB grafts for ACLR through January 2022. Studies reporting non-significant differences in graft re-rupture and revision ACLR rate (n.s.) were included. The RFI, defined as the fewest number of event reversals needed to change the non-significant graft re-rupture/revision outcome to statistically significant (P < 0.05), was recorded for each study. In addition, the number of studies in which the loss to follow-up exceeded the RFI was recorded. RESULTS Among the 16 included RCTs, the median (interquartile range [IQR]) sample size was 71 (64-114), and the median (IQR) total number of graft re-rupture/revision ACLR events was 4 (4-6). The median (IQR) graft re-rupture/revision ACLR rate was 4.3% (3.0-6.4) overall, 4.1% (2.6-6.7) in the BTB group, and 5.4% (3.0-6.3) in the HT group. The median (IQR) RFI was 3 (3-4), signifying that a reversal of the outcome in 3 patients in one arm was needed to flip the studies' result from non-significant to statistically significant (P < 0.05). The median (IQR) number of participants lost to follow-up was 11 (3-13), and 13 (81.3%) of the included studies had a loss to follow-up greater than the studies' RFI. CONCLUSION The results of RCTs reporting statistically non-significant re-rupture/revision ACLR rates between HT and BTB autografts would become significant if the outcome were reversed in a small number of patients-a number that was less than the loss to follow-up in the majority of studies. Thus, the neutrality of these studies is fragile, and a true statistically significant difference in re-rupture/revision rates may have been undetected. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | - Raisa Masood
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Mariano E Menendez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA.
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Shiraishi R, Ueda S. Relationship between the change in infrapatellar fat pad thickness assessed using ultrasonography and anterior knee pain on squatting after anterior cruciate ligament reconstruction. J Med Ultrason (2001) 2023; 50:237-243. [PMID: 36961646 PMCID: PMC11018648 DOI: 10.1007/s10396-023-01300-3] [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] [Received: 05/22/2022] [Accepted: 02/11/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Anterior knee pain (AKP) may occur after anterior cruciate ligament (ACL) reconstruction. The present study investigated the relationship between the change in infrapatellar fat pad (IFP) thickness assessed using ultrasonography (US) and AKP on squatting in patients after ACL reconstruction. METHODS Patients were enrolled 3 months after ACL reconstruction using the bone-tendon-bone (BTB) technique. Subjects were divided into the AKP group (numerical rating scale [NRS] score ≥ 1) and control group (NRS score < 1) using a NRS of pain on squatting, and intergroup comparisons were performed. On US evaluation, measurement angles of the knee joint were 0° and 30° in the supine position. The IFP between the femoral intercondylar notch and patellar tendon was measured on short-axis images. The changes in IFP thickness were calculated from values measured at different angles of the knee joint. RESULTS Twenty-one patients (mean age 24.9 ± 9.3 years) were included in the present study: 12 in the AKP group (9 males, 3 females) and nine in the control group (5 males, 4 females). A significant difference in the change in IFP thickness at 3 months was observed between the AKP and control groups (0.67 ± 0.44 mm vs. 1.84 ± 0.34 mm, p < 0.001). There was a negative correlation between the change in IFP thickness and the NRS score (r = - 0.720, p < 0.001) in reconstructed knees. CONCLUSION A smaller change in IFP thickness assessed using US after ACL reconstruction was identified as a factor contributing to AKP on squatting.
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Affiliation(s)
- Ryo Shiraishi
- Rokuto Orthopedic Surgery Az, 46 Onoyama-cho, Naha City, Okinawa, 900-0026, Japan
- Department of Clinical Research and Quality Management, Graduate School of Medicine, University of The Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
- Department of Rehabilitation Therapy, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan
| | - Shinichiro Ueda
- Department of Clinical Research and Quality Management, Graduate School of Medicine, University of The Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan.
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Huntington L, Griffith A, Spiers L, Pile R, Batty L, Tulloch S, Tran P. Suture-tape augmentation of anterior cruciate ligament reconstruction: a prospective, randomised controlled trial (STACLR). Trials 2023; 24:224. [PMID: 36964584 PMCID: PMC10037835 DOI: 10.1186/s13063-023-07127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/30/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction aims to restore anteroposterior and rotatory stability to the knee following ACL injury. This requires the graft to withstand the forces applied during the process of ligamentisation and the rehabilitative period. We hypothesise that the use of suture tape augmentation of single bundle ACL reconstruction (ACLR) will reduce residual knee laxity and improve patient-reported outcomes at 2-year follow-up. We will conduct a 1:1 parallel arm single-centre randomised controlled trial comparing suture tape augmented ACLR to standard ACLR technique. METHODS The study design will be a parallel arm 1:1 allocation ratio randomised controlled trial. Sixty-six patients aged 18 and over waitlisted for primary ACLR will be randomised. Patients requiring osteotomy and extra-articular tenodesis and who have had previous contralateral ACL rupture or repair of meniscal or cartilage pathology that modifies the post-operative rehabilitation will be excluded. The primary outcome measure will be the side-to-side difference in anterior tibial translation (measured on the GNRB arthrometer) at 24 months post-surgery. GNRB arthrometer measures will also be taken preoperatively, at 3 months and 12 months post-surgery. Secondary outcomes will include patient-reported outcome measures (PROMs) collected online, including quality of life, activity and readiness to return to sport, complication rates (return to theatre, graft failure and rates of sterile effusion), examination findings and return to sport outcomes. Participants will be seen preoperatively, at 6 weeks, 3 months, 12 months and 24 months post-surgery. Participants and those taking arthrometer measures will be blinded to allocation. DISCUSSION This will be the first randomised trial to investigate the effect of suture-tape augmentation of ACLR on either objective or subjective outcome measures. The use of suture-tape augmentation in ACLR has been associated with promising biomechanical and animal-level studies, exhibiting equivalent complication profiles to the standard technique, with initial non-comparative clinical studies establishing possible areas of advantage for the technique. The successful completion of this trial will allow for an improved understanding of the in situ validity of tape augmentation whilst potentially providing a further platform for surgical stabilisation of the ACL graft. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12621001162808. Universal Trial Number (UTN): U1111-1268-1487. Registered prospectively on 27 August 2021.
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Affiliation(s)
- Lachlan Huntington
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia.
| | - Andrew Griffith
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Libby Spiers
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Rebecca Pile
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Lachlan Batty
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Scott Tulloch
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
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14
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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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Dai W, Leng X, Wang J, Cheng J, Hu X, Ao Y. Quadriceps Tendon Autograft Versus Bone-Patellar Tendon-Bone and Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:3425-3439. [PMID: 34494906 DOI: 10.1177/03635465211030259] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The best type of autograft for anterior cruciate ligament (ACL) reconstruction remains debatable. HYPOTHESIS Compared with bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts, the quadriceps tendon (QT) autograft has comparable graft survival as well as clinical function and pain outcomes. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library to July 2020. Randomized controlled trials (RCTs) and observational studies reporting comparisons of QT versus BPTB or HT autografts for ACL reconstruction were included. All analyses were stratified according to study design: RCTs or observational studies. RESULTS A total of 24 studies were included: 7 RCTs and 17 observational studies. The 7 RCTs included 388 patients, and the 17 observational studies included 19,196 patients. No significant differences in graft failure (P = .36), the International Knee Documentation Committee (IKDC) subjective score (P = .39), or the side-to-side difference in stability (P = .60) were noted between QT and BPTB autografts. However, a significant reduction in donor site morbidity was noted in the QT group compared with the BPTB group (risk ratio [RR], 0.17 [95% CI, 0.09-0.33]; P < .001). No significant differences in graft failure (P = .57), the IKDC subjective score (P = .25), or the side-to-side stability difference (P = .98) were noted between QT and HT autografts. However, the QT autograft was associated with a significantly lower rate of donor site morbidity than the HT autograft (RR, 0.60 [95% CI, 0.39-0.93]; P = .02). A similar graft failure rate between the QT and control groups was observed after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. However, a significantly lower rate of donor site morbidity was observed in the QT group compared with the control group after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. No difference in effect estimates was seen between RCTs and observational studies. CONCLUSION The QT autograft had comparable graft survival, functional outcomes, and stability outcomes compared with BPTB and HT autografts. However, donor site morbidity was significantly lower with the QT autograft than with BPTB and HT autografts.
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Affiliation(s)
- Wenli Dai
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xi Leng
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian Wang
- Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jin Cheng
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
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16
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Huang Z, Cui J, Zhong M, Deng Z, Chen K, Zhu W. Risk factors of cartilage lesion after anterior cruciate ligament reconstruction. Front Cell Dev Biol 2022; 10:935795. [PMID: 36158222 PMCID: PMC9498578 DOI: 10.3389/fcell.2022.935795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Anterior cruciate ligament injury is the most common sports injury in orthopaedics, which can adversely affect knee joint function and exercise of patients. Using arthroscopy to reconstruct the anterior cruciate ligament has become the first choice for treating anterior cruciate ligament rupture. However, different degrees of articular cartilage injury of the knee can be observed in patients after anterior cruciate ligament reconstruction. More importantly, the articular cartilage injury after anterior cruciate ligament reconstruction indicates that it will develop into osteoarthritis in the long term. It is of great significance to fully understand the factors that lead to the occurrence and development of cartilage injury. This article reviews the effects of surgical methods, meniscus status, different grafts, time from injury to surgical intervention, postoperative knee joint stability, postoperative rehabilitation, knee joint anatomical factors, and demographic characteristics of patients on articular cartilage degeneration after anterior cruciate ligament reconstruction. The present review provides insights into the anterior cruciate ligament reconstruction, which can be used to investigate new treatment strategies to delay and prevent the progress of osteoarthritis. At the same time, it provides a holistic understanding of the influence of multiple factors on cartilage lesions after anterior cruciate ligament reconstruction.
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Affiliation(s)
- Zirong Huang
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jiaming Cui
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Jiaming Cui, ; Weimin Zhu,
| | - Mingjin Zhong
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Zhenhan Deng
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Kang Chen
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Weimin Zhu
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Jiaming Cui, ; Weimin Zhu,
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Kilkenny CJ, Hurley ET, Hogan RE, Moore TK, Withers D, King E, Jackson M, Moran R. Return to play in paediatric & adolescent patients following anterior cruciate ligament reconstruction. Knee 2022; 37:87-94. [PMID: 35728392 DOI: 10.1016/j.knee.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/18/2022] [Accepted: 05/31/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is an increased risk of anterior cruciate ligament (ACL) rupture and subsequent ACL reconstruction in patients <18 years old due to their high levels of sporting participation. PURPOSE The purpose of this study was to assess the rate and timing of return to play (RTP) in paediatric and adolescent patients following ACL reconstruction, and to compare the outcomes between those undergoing ACL reconstruction with bone patella tendon bone autograft (BTB) and hamstring tendon (HT) autograft. STUDY DESIGN Level of Evidence: Level III; Retrospective Comparative Cohort Study. METHODS The institutional ACL registry was screened for patients <18 that had undergone a primary ACL reconstruction. Outcomes were analysed for patients undergoing either a BTB or HT autograft for rate and timing of return to play, functional outcomes and subsequent knee injuries. Statistical analysis was performed using SPSS. RESULTS 358 (BTB; 253, HT; 105) patients were followed up for 24-months (95% follow up). 86 athletes (27 BTB; 59 HT) were aged 13-15 years old with no significant difference in RTP rate or timing between graft types, however, there was a difference in ipsilateral re-ruptures (10.2% HT vs 0% BTB p = 0.03). 272 athletes (226 BTB; 46 HT) were aged 16-18 years old with no significant difference in RTP rate or timing between graft types, or ipsilateral re-ruptures (8.7% HT vs 2.7% BTB p = 0.07). Concurrent ligament, meniscal or chondral injuries found at the time was treated as necessary. CONCLUSION Paediatric and adolescent patients undergoing ACL reconstruction with either BTB or HT had high rates of return to play. This was seen in both subgroups with 13-15-year-olds mostly receiving a HT graft repair and 16-18-year-olds mainly receiving a BTB repair. A moderate re-rupture rate was seen at 24-months. However longer follow up is needed to truly see the long-term impact of such an injury at such a young age.
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Affiliation(s)
| | | | | | | | | | - Enda King
- Sports Surgery Clinic, Santry, Dublin, Ireland
| | | | - Ray Moran
- Sports Surgery Clinic, Santry, Dublin, Ireland
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18
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Can Increased Locomotor Task Difficulty Differentiate Knee Muscle Forces After Anterior Cruciate Ligament Reconstruction? J Appl Biomech 2022; 38:84-94. [PMID: 35287111 DOI: 10.1123/jab.2021-0215] [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: 07/04/2021] [Revised: 12/10/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022]
Abstract
Changes in knee mechanics following anterior cruciate ligament (ACL) reconstruction are known to be magnified during more difficult locomotor tasks, such as when descending stairs. However, it is unclear if increased task difficulty could distinguish differences in forces generated by the muscles surrounding the knee. This study examined how knee muscle forces differ between individuals with ACL reconstruction with different graft types (hamstring tendon and patellar tendon autograft) and "healthy" controls when performing tasks with increasing difficulty. Dynamic simulations were used to identify knee muscle forces in 15 participants when walking overground and descending stairs. The analysis was restricted to the stance phase (foot contact through toe-off), yielding 162 separate simulations of locomotion in increasing difficulty: overground walking, step-to-floor stair descent, and step-to-step stair descent. Results indicated that knee muscle forces were significantly reduced after ACL reconstruction, and stair descent tasks better discriminated changes in the quadriceps and gastrocnemii muscle forces in the reconstructed knees. Changes in quadriceps forces after a patellar tendon graft and changes in gastrocnemii forces after a hamstring tendon graft were only revealed during stair descent. These results emphasize the importance of incorporating sufficiently difficult tasks to detect residual deficits in muscle forces after ACL reconstruction.
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Etzel CM, Nadeem M, Gao B, Boduch AN, Owens BD. Graft Choice for Anterior Cruciate Ligament Reconstruction in Women Aged 25 Years and Younger: A Systematic Review. Sports Health 2022; 14:829-841. [PMID: 35343326 PMCID: PMC9631041 DOI: 10.1177/19417381221079632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT Although anterior cruciate ligament (ACL) tears are relatively common in athletic populations, few studies have systematically reviewed graft choice in young women. OBJECTIVE To quantitatively and qualitatively examine reported outcomes for graft choice in women aged 25 years and younger undergoing primary ACL reconstruction. DATA SOURCE A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search in the PubMed (includes MEDLINE) and EMBASE databases was completed using a combination of key terms. STUDY SELECTION Studies were included if they reported graft choice outcomes in women aged 25 years and younger. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION The following information was extracted: title, author, year of publication, number of female patients and age, graft type, follow-up, and patient-reported outcome measures. The following outcome scores were identified as being reported or not reported by each study: graft failure, contralateral ACL (CACL) rupture, IKDC (International Knee Documentation Committee), graft survival (Kaplan-Meier), Lysholm, Tegner, KT-1000, kneeling pain, return to sport, and Lachman. RESULTS Of 1170 identified articles, 16 met inclusion criteria, reporting on 1385 female patients aged 25 years and younger. Comparison of 655 bone-patellar tendon-bone (BPTB) versus 525 hamstring tendon (HT) autografts showed significant differences in mean failure rate between BPTB autografts (6.13% ± 2.58%) and HT autografts (17.35% ± 8.19%), P = 0.001. No statistically significant differences in CACL failure rates were found between BPTB autografts and HT autografts (P = 0.25). Pooled results for IKDC were possible in 3 of the HT autograft studies, showing a mean score of 88.31 (95% CI 83.53-93.08). Pooled Lysholm score results were possible in 2 of the HT autograft studies, showing a mean score of 93.46 (95% CI 91.90-95.01). CONCLUSION In female patients aged 25 years and younger, BPTB autografts showed significantly less graft failure compared with HT autografts. However, BPTB autografts had comparable patient-reported outcomes compared with HT autografts with the available data. The overall state of evidence for graft choice in female patients aged 25 years and younger is low. Future studies should report statistics by age and sex to allow for further analysis of graft choice for this specific population that is known to be more vulnerable to ACL injury.
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Affiliation(s)
- Christine M Etzel
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Maheen Nadeem
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Burke Gao
- Department of Orthopedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Abigail N Boduch
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Brett D Owens
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Assi C, Bonnel F, Mansour J, Daher J, Gerges B, Khoury A, Yammine K. The gracilis and semitendinosus muscles: a morphometric study on 18 specimens with clinical implications. Surg Radiol Anat 2022; 44:813-820. [PMID: 35314874 DOI: 10.1007/s00276-022-02925-8] [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: 11/18/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The pes anserinus consists of the sartorius, semitendinosus, and gracilis muscles. They coalesce together with the leg fascia to form the anserine plate. The semitendinosus and gracilis both form the deep layer of this plate and are clinically relevant for ligament reconstruction. The aim of the study is to report a detailed morphometric evaluation of the semitendinosus and gracilis muscles and assess their clinical implications. METHODS Using a rigorous dissection process on 18 cadaveric hips, measurements of both the semitendinosus and gracilis muscles with bone parameters were conducted. We measured the following: (a) total femur, femoral shaft, and neck lengths, (b) total muscle lengths, and (c) intra-muscular and extra-muscular (free) tendon lengths. Correlation values between bone variables, muscle variables, and in-between muscle variables were computed. RESULTS The total muscle and the distal intra-muscular tendon length of the St and Gr are correlated with the total femur length. When compared to gracilis, the total muscle and distal intra-muscular tendon lengths of the ST are much better correlated with the total femur length. The free distal tendon length for both muscles did not show a significant correlation with any of the femoral bone lengths. CONCLUSION The variability of tendon length of the ST/Gr poses a significant challenge to surgeons. This study reports a detailed morphometric evaluation of the ST/Gr hamstring muscle and tendons. It revealed a positive correlation between the femoral length and the ST/Gr graft lengths. This could help orthopedic surgeons in predicting the graft lengths pre-operatively and develop better planning for reconstructive surgeries.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon.,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
| | - Francois Bonnel
- Anatomy Laboratory, School of Medicine, BD. Henri IV, 34000, Montpellier, France.,Department of Orthopedic Surgery, Clinique Beau Soleil, 119 Avenue de Lodeve, 34070, Montpellier, France
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon.,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
| | - Jimmy Daher
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon.,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
| | - Bassam Gerges
- Department of Anesthesia, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon
| | - Alfred Khoury
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon. .,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon.
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21
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Arida C, Mastrokalos DS, Panagopoulos A, Vlamis J, Triantafyllopoulos IK. A Systematic Approach for Stronger Documentation of Anterior Cruciate Ligament Graft Choice. Cureus 2021; 13:e19017. [PMID: 34824933 PMCID: PMC8611317 DOI: 10.7759/cureus.19017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/05/2022] Open
Abstract
Numerous studies have focused on determining the optimal choice between the two most used anterior cruciate ligament (ACL) reconstruction autografts. In order to address this matter, we performed a systematic review of every meta-analysis published on the PubMed platform between 2001 and 2020, comparing the functional outcomes, the static stability parameters, as well as the postoperative and long-term complications of the patellar tendon (BPTB) autograft and hamstrings (HT). We retrieved a total of 26 meta-analyses that met our criteria, and the characteristics and outcomes of every meta-analysis, as well as subgroup analysis regarding the type of the study design, number of strands of HT autograft, and fixation method, were extensively recorded. The majority of the meta-analyses showed that there were no significant differences between BPTB and HT in terms of functional outcomes and static stability parameters while HT autografts seem to be superior to BPTB regarding kneeling pain and anterior knee pain. Other outcomes seem to be affected by the number of strands of the HT autograft, the fixation technique, and the type of study design, indicating superiority of the four-strand HT autograft with the use of an extra-cortical button fixation. Overall, there is no clear superiority of BPTB over HT autografts for ACL reconstruction, as both types present similar outcomes in the majority of postoperative parameters. Autograft selection should be individualized according to each patient's needs and more RCTs are warranted in order to reach safer results on the appropriate autograft type.
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Affiliation(s)
- Christina Arida
- 3rd Orthopaedic Department, KAT Hospital, National and Kapodistrian University of Athens Medical School, Athens, GRC
| | - Dimitrios S Mastrokalos
- 1st Orthopaedic Department, Attikon Hospital, National and Kapodistrian University of Athens Medical School, Athens, GRC
| | | | - John Vlamis
- 3rd Orthopaedic Department, KAT Hospital, National and Kapodistrian University of Athens Medical School, Athens, GRC
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22
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Soni A, Gupta RK, Raghav M, Masih GD, Bansal P. Comparison of Bone-Patellar Tendon-Bone Graft, Semitendinosus-Gracilis Graft and Semitendinosus-Gracilis with Preserved Tibial Insertion Graft in Anterior Cruciate Ligament Reconstruction in Sports Persons. Malays Orthop J 2021; 15:12-17. [PMID: 34429817 PMCID: PMC8381676 DOI: 10.5704/moj.2107.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/04/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Bone-patellar tendon-bone (BPTB) and semitendinosus-gracilis (STG) are the commonest grafts used for ACL reconstruction. However even after having been debated for years, there is no consensus about the ideal graft. Moreover, the literature is deficient about STG graft with preserved tibial insertion (STGPI) which preserves the proprioception. Our aim is to compare the outcome of BPTB, free STG and STGPI grafts after ACL reconstruction in professional sports persons. We compared the outcome in terms of mechanical stability, functional outcome, return to sports activity and degenerative changes. Material and Methods Professional sports persons aged between 16-50 years operated for ACL tear using BPTB, free STG and STGPI grafts with minimum follow-up of two years were identified from hospital records. Patients with associated knee injuries were excluded. Patients, divided in three groups according to graft used, were compared in terms of mechanical stability (arthrometric examination KT-1000 score), functional outcome (Lysholm Score), return to sports activity (Tegner score and difference in thigh circumference) and degenerative changes (KL grading). Results BPTB graft group was found to be better than free STG and STGPI graft groups in terms of KT-1000 score. There was no statistically significant difference among the groups in terms of Lysholm score, Tegner score, difference in thigh circumference and KL grading. Conclusion BPTB graft is better than free STG and STGPI grafts in terms of knee stability. When compared for patient reported outcome, return to sports activity, osteoarthritic changes and graft failure there is no significant difference among the three types of grafts.
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Affiliation(s)
- A Soni
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - R K Gupta
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - M Raghav
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - G D Masih
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - P Bansal
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
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23
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Senftl M, Petek D, Jacobi M, Schallberger A, Spycher J, Stock A, Hess R, Tannast M. Occurrence of inadequate ACL healing after Dynamic Intraligamentary Stabilization and functional outcome-a multicentre case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1265-1274. [PMID: 34430988 PMCID: PMC9433353 DOI: 10.1007/s00590-021-03096-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022]
Abstract
Introduction Dynamic Intraligamentary Stabilization (DIS) is a technique for preservation, anatomical repair and stabilization of a freshly injured anterior cruciate ligament (ACL). The main purpose of this study was to evaluate the short-term re-operation rate when compared to traditional autograft reconstruction. Methods Four, from the developer independent, centres enrolled patients that underwent ACL repair by DIS, according to the specific indications given by MRI imaging at a minimum follow-up of 12 months. The re-operation rate was recorded as primary outcome. Secondary outcome measures were the postoperative antero-posterior knee laxity (using a portable Rolimeter®), as well as the Tegner, Lysholm and IKDC Scores. Results A total of 105 patients were investigated with a median follow-up of 21 months. Thirteen patients were lost to follow-up. Of the remaining 92 patients 15 (16.3%) had insufficient functional stability and required subsequent ACL reconstruction. These patients were excluded from further analysis, leaving 77 consecutive patients for a 12 months follow-up. The median age at time of surgery was 30 years for that group. At time of follow-up a median antero-posterior translation difference of 2 mm was measured. None of these patients reported subjective insufficiency (giving way), but in 14 patients (18.2%), the difference of antero-posterior translation was more than 3 mm. We found a median Tegner Score of 5.5, a median Lysholm Score of 95.0 and a median IKDC Score of 89.4. Conclusion The main finding of this multicentre study is a relevant re-operation rate of 16.3%. Another 18.2% showed objective antero-posterior laxity (≥ 3 mm) during testing raising the suspicion of postoperative non-healing. The failure rate of DIS in this study is higher than for reconstruction with an autologous tendon graft. However, our successfully treated patients had a good clinical and functional outcome based on antero-posterior knee laxity and clinical scores, comparable to patients treated by autograft reconstruction.
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Affiliation(s)
- Monika Senftl
- Department of Orthopaedic Surgery, Fribourg Hospital, Villars-sur-Glâne, Switzerland
| | - Daniel Petek
- Department of Orthopaedic Surgery, Fribourg Hospital, Villars-sur-Glâne, Switzerland. .,University of Fribourg (UNIFR), HFR Cantonal Hospital, Ch. des Pensionnats 2-6, 1700, Fribourg, Switzerland.
| | | | - Alex Schallberger
- Department of Orthopaedic Surgery, Interlaken Hospital, Unterseen, Switzerland
| | - Jonathan Spycher
- Department of Orthopaedic Surgery, Interlaken Hospital, Unterseen, Switzerland
| | - Anna Stock
- Department of Orthopaedic Surgery, Thun Hospital, Thun, Switzerland
| | - Rolf Hess
- Department of Orthopaedic Surgery, Thun Hospital, Thun, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Fribourg Hospital, Villars-sur-Glâne, Switzerland.,University of Fribourg (UNIFR), HFR Cantonal Hospital, Ch. des Pensionnats 2-6, 1700, Fribourg, Switzerland
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24
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Hunt ER, Jacobs CA, Conley CEW, Ireland ML, Johnson DL, Lattermann C. Anterior cruciate ligament reconstruction reinitiates an inflammatory and chondrodegenerative process in the knee joint. J Orthop Res 2021; 39:1281-1288. [PMID: 32558951 DOI: 10.1002/jor.24783] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/04/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) injury leads to a sustained increase in synovial fluid concentrations of inflammatory cytokines and biomarkers of cartilage breakdown. While this has been documented post-injury, it remains unclear whether ACL reconstruction surgery contributes to the inflammatory process and/or cartilage breakdown. This study is a secondary analysis of 14 patients (nine males/five females, mean age = 9, mean BMI = 28) enrolled in an IRB-approved randomized clinical trial. Arthrocentesis was performed at initial presentation (mean = 6 days post-injury), immediately prior to surgery (mean = 23 days post-injury), 1-week post-surgery, and 1-month post-surgery. Enzyme-linked immunosorbant assay kits were used to determine concentrations of carboxy-terminal telopeptides of type II collagen (CTXII), interleukin-6 (IL-6), and IL-1β in the synovial fluid. The log-transformed IL-1β was not normally distributed; therefore, changes between time points were evaluated using a non-parametric Kruskal-Wallis one-way ANOVA. IL-1β concentrations significantly increased from the day of surgery to the first postoperative time point (P ≤ .001) and significantly decreased at the 4-week postoperative visit (P = .03). IL-1β concentrations at the 4-week postoperative visit remained significantly greater than both preoperative time points (P > .05). IL-6 concentrations at 1-week post-surgery were significantly higher than at initial presentation (P = .013), the day of surgery (P < .001), and 4 weeks after surgery (P = .002). CTX-II concentrations did not differ between the first three-time points (P > .99) but significantly increased at 4 weeks post-surgery (P < .01). ACL reconstruction appears to reinitiate an inflammatory response followed by an increase in markers for cartilage degradation. ACL reconstruction appears to initiate a second "inflammatory hit" resulting in increased chondral breakdown suggesting that post-operative chondroprotection may be needed.
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Affiliation(s)
- Emily R Hunt
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Cale A Jacobs
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Caitlin E-W Conley
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Mary L Ireland
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Darren L Johnson
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
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25
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Marmura H, Getgood AMJ, Spindler KP, Kattan MW, Briskin I, Bryant DM. Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:1777-1785. [PMID: 33945339 DOI: 10.1177/03635465211010798] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstructions (ACLRs) fail at an alarmingly high rate in young active individuals. The Multicenter Orthopaedic Outcomes Network (MOON) knee group has developed an autograft risk calculator that uses patient characteristics and lifestyle to predict the probability of graft rupture if the surgeon uses a hamstring tendon (HT) or a bone-patellar tendon-bone (BPTB) graft to reconstruct the ligament. If validated, this risk calculator can be used during the shared decision-making process to make optimal ACLR autograft choices and reduce rupture rates. The STABILITY 1 randomized clinical trial offers a large, rigorously collected data set of similar young active patients who received HT autograft with or without lateral extra-articular tenodesis (LET) for ACLR. PURPOSE/HYPOTHESIS The purpose was to validate the ACLR graft rupture risk calculator in a large external data set and to investigate the utility of BPTB and LET for ACLR. We hypothesized that the risk calculator would maintain adequate discriminative ability and calibration in the external STABILITY 1 data set when compared with the initial MOON development data set. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 1. METHODS The model predictors for the risk calculator include age, sex, body mass index, sport played at the time of injury, Marx Activity Score, preoperative knee laxity, and graft type. The STABILITY 1 trial data set was used for external validation. Discriminative ability, calibration, and diagnostic test validity of the model were assessed. Finally, predictor strength in the initial and validation samples was compared. RESULTS The model showed acceptable discriminative ability (area under the curve = 0.73), calibration (Brier score = 0.07), and specificity (85.3%) to detect patients who will experience a graft rupture. Age, high-grade preoperative knee laxity, and graft type were significant predictors of graft rupture in young active patients. BPTB and the addition of LET to HT were protective against graft rupture versus HT autograft alone. CONCLUSION The MOON risk calculator is a valid predictor of ACLR graft rupture and is appropriate for clinical practice. This study provides evidence supporting the idea that isolated HT autografts should be avoided for young active patients undergoing ACLR. REGISTRATION NCT00463099 (MOON); NCT02018354 (STABILITY 1) (ClinicalTrials.gov identifiers).
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, Ontario, Canada.,Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada.,Lawson Research, London Health Sciences Centre, London, Ontario, Canada
| | - Alan M J Getgood
- Faculty of Health Sciences, Western University, London, Ontario, Canada.,Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada.,Lawson Research, London Health Sciences Centre, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Isaac Briskin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dianne M Bryant
- Faculty of Health Sciences, Western University, London, Ontario, Canada.,Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada.,Lawson Research, London Health Sciences Centre, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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26
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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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Functional outcome of implant-free bone-patellar tendon autograft versus hamstring autograft in arthroscopic anterior cruciate ligament reconstruction: A prospective study. Ann Med Surg (Lond) 2021; 63:102184. [PMID: 33732450 PMCID: PMC7937666 DOI: 10.1016/j.amsu.2021.102184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction The use of implant in anterior cruciate ligament (ACL) reconstruction has been associated with several drawbacks including graft injury, implant osteolysis, implant migration and soft tissue irritation. Implant-free ACL reconstruction surgery offers additional benefits of cost-effective, improved graft incorporation and ease of revision surgery. Our study aimed to compare the functional outcome of ACL reconstruction by using bone-patellar tendon autograft with press-fit fixation technique and hamstring autografts with implant. Methods A prospective cohort study design was used. Between March 2013 and March 2014, 12 patients underwent patella tendon-bone graft fixated by press-fit fixation technique (implant-free), while 24 patients underwent ACL reconstruction using implant-fixated hamstring tendon graft. Objective functional outcome was measured by using rolimeter, and subjective functional outcome was measured according to the functional score of IKDC, Tegner-Lysholm and KOOS. Results Both techniques have shown no significant difference in terms of functional outcome, whether assessed by rolimeter measurement, IKDC score, Tegner-Lysholm, KOOS score between implant group and implant-free group, preoperatively and postoperatively. Discussion Our study results are in line with several other studies with various follow-up time and systematic review. With the right technique, graft harvesting of patella tendon-tibial tuberosity bone block can be successfully performed, and associated donor site morbidity can be avoided. Conclusion Patients who underwent ACL reconstruction using implant-free technique by press-fit fixation had comparable outcome with ACL reconstruction with implant, objectively and subjectively. This technique should be further revisited and reevaluated.
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28
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Sanada T, Iwaso H, Fukai A, Honda E, Yoshitomi H, Inagawa M. Anatomic Anterior Cruciate Ligament Reconstruction Using Rectangular Bone-Tendon- Bone Autograft Versus Double-Bundle Hamstring Tendon Autograft in Young Female Athletes. Arthrosc Sports Med Rehabil 2021; 3:e47-e55. [PMID: 33615247 PMCID: PMC7879188 DOI: 10.1016/j.asmr.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/22/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose To assess the clinical outcomes comparing rectangular bone–tendon–bone (BTB) grafts and double-bundle hamstring tendon (HM) grafts used for anatomic anterior cruciate ligament (ACL) reconstruction in young female athletes. Methods From January 2014 to November 2017, young female athletes 20 years or younger who underwent primary ACL reconstructions by a single surgeon were identified. Patients with concomitant injuries, not being a regular sports participant, the existence of contralateral ACL reconstruction, and who did not have a minimum of 1-year follow-up were excluded. We searched the rate and time for return-to-play, clinical outcomes including chronological instrumental side-to-side tibial translation difference, and muscle strength. Second ACL injury rates between the 2 groups during follow-up period were evaluated. Results Twenty-seven BTB ACL reconstructions and 29 HM ACL reconstructions were performed. The mean follow-up periods were 35.2 months in the BTB group and 33.8 months in the HM group. The BTB group showed better knee stability in mean side-to-side translational difference via arthrometric testing of 0.6 mm in the BTB versus 1.7 mm in the HM group at 5 months (P = .01) and 1.1 mm and 2.0 mm at 12 months, respectively (P = .02). There was no significant side-by-side difference in quadriceps muscle strength ratio, but the hamstring muscle strength was significantly better in the BTB group. The graft reinjury rate in the BTB group and the HM group was 0% (0/27) and 10.3% (3/29) (P = .09), respectively. In contrast, contralateral ACL injuries occurred in 17.3% (4/27) of the BTB group and 3.5% (1/29) of the HM group (P = .12). Conclusions For young female athletes aged 20 years or younger, the BTB group had better knee instrumental stability than the HM group without range of motion loss or knee extensor muscle strength deficit. Although there was no statistical significance in terms of second ACL injury, we observed fewer graft rerupture and an increasing rate of contralateral ACL injuries in the BTB group. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Takaki Sanada
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Hiroshi Iwaso
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Atsushi Fukai
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Eisaburo Honda
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Hiroki Yoshitomi
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Miyu Inagawa
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
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Yu X, Mengsteab PY, Narayanan G, Nair LS, Laurencin CT. Enhancing the Surface Properties of a Bioengineered Anterior Cruciate Ligament Matrix for Use with Point-of-Care Stem Cell Therapy. ENGINEERING (BEIJING, CHINA) 2021; 7:153-161. [PMID: 34136308 PMCID: PMC8205060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We have previously developed a poly(L-lactic) acid (PLLA) bioengineered anterior cruciate ligament (ACL) matrix that has demonstrated enhanced healing when seeded with primary ACL cells prior to implantation in a rabbit model, as compared with the matrix alone. This suggests that improving cell adhesion on the matrix may beneficially affect the healing response and long-term performance of the bioengineered ACL matrix. One regenerative engineering approach involves enhancing the surface properties of the matrix to support cell adhesion and growth in combination with point-of-care stem cell therapy. Herein, we studied the cell adhesion properties of PLLA braided microfiber matrices enhanced through the physical adsorption of fibronectin and air plasma treatment. We evaluated the kinetics and binding efficiency of fibronectin onto matrices at three time points and three fibronectin concentrations. Incubating the matrix for 120 min in a solution of 25 mg mL-1 fibronectin achieved the greatest binding efficiency to the matrix and cellular adhesion. Exposing the matrices to air plasma treatment for 5 min before fibronectin adsorption significantly enhanced the cell adhesion of rabbit bone marrow-derived mesenchymal stem cells (R-BMMSCs) 24 h post cell seeding. Finally, cellular proliferation was monitored for up to 21 d, the matrices were exposed to air plasma treatment, and fibronectin adsorption was found to result in enhanced cell number. These findings suggest that exposure to air plasma treatment and fibronectin adsorption enhances the cellular adhesion of PLLA braided microfiber matrices and may improve the clinical efficacy of the matrix in combination with point-of-care stem cell therapies.
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Affiliation(s)
- Xiaohua Yu
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT 06030, USA
| | - Paulos Y. Mengsteab
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Ganesh Narayanan
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT 06030, USA
| | - Lakshmi S. Nair
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Cato T. Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Reconstructive Sciences, University of Connecticut Health, Farmington, CT 06030, USA
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30
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Irrgang JJ, Tashman S, Patterson CG, Musahl V, West R, Oostdyk A, Galvin B, Poploski K, Fu FH.. Anatomic single vs. double-bundle ACL reconstruction: a randomized clinical trial-Part 1: clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2021; 29:2665-2675. [PMID: 33970295 PMCID: PMC8298248 DOI: 10.1007/s00167-021-06585-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/15/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Compare clinical outcomes of anatomic single-bundle (SB) to anatomic double-bundle (DB) anterior cruciate ligament reconstruction (ACLR). It was hypothesized that anatomic DB ACLR would result in better International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) scores and reduced anterior and rotatory laxity compared to SB ACLR. METHODS Active individuals between 14 and 50 years of age that presented within 12 months of injury were eligible to participate. Individuals with prior injury or surgery of either knee, greater than a grade 1 concomitant knee ligament injury, or ACL insertion sites less than 14 mm or greater than 18 mm were excluded. Subjects were randomized to undergo SB or DB ACLR with a 10 mm-wide quadriceps tendon autograft harvested with a patellar bone block and were followed for 24 months. The primary outcome measures included the IKDC-SKF and KT-1000 (side to side difference) and pivot shift tests. Other secondary outcomes included measures of sports activity and participation, range of motion (ROM) and re-injury. RESULTS Enrollment in the study was suspended due to patellar fractures related to harvest of the patellar bone plug. At that time, 57 subjects had been randomized (29 DB) and two-year follow-up was attained from 51 (89.5%). At 24-month follow-up there were no between-group differences detected for the primary outcomes. Twenty-one (77.8%) DB's and 20 (83.3%) SB's reported returning to pre-injury sports 2 years after surgery (n.s) Three subjects (2 DB's, 5.3% of total) sustained a graft rupture and 5 individuals (4 SB's, 8.8% of total) had a subsequent meniscus injury. CONCLUSIONS Due to the early termination of the study, there were no detectable differences in clinical outcome between anatomic SB and DB ACLR when performed with a quadriceps tendon autograft with a bone block in individuals with ACL insertion sites that range from 14 to 18 mm. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- James J. Irrgang
- grid.21925.3d0000 0004 1936 9000Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 210, Bridgeside Point 1, 100 Technology Drive, Pittsburgh, PA 15203 USA ,grid.21925.3d0000 0004 1936 9000Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Scott Tashman
- grid.419649.70000 0001 0367 5968Steadman Philippon Research Institute, Vail, CO USA
| | - Charity G. Patterson
- grid.21925.3d0000 0004 1936 9000Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 210, Bridgeside Point 1, 100 Technology Drive, Pittsburgh, PA 15203 USA
| | - Volker Musahl
- grid.21925.3d0000 0004 1936 9000Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA ,grid.412689.00000 0001 0650 7433UPMC Freddie Fu Sports Medicine, Center, Pittsburgh, PA USA
| | | | - Alicia Oostdyk
- grid.412689.00000 0001 0650 7433UPMC Freddie Fu Sports Medicine, Center, Pittsburgh, PA USA
| | - Bryan Galvin
- grid.412689.00000 0001 0650 7433UPMC Freddie Fu Sports Medicine, Center, Pittsburgh, PA USA
| | - Kathleen Poploski
- grid.21925.3d0000 0004 1936 9000Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 210, Bridgeside Point 1, 100 Technology Drive, Pittsburgh, PA 15203 USA
| | - Freddie H . Fu
- grid.21925.3d0000 0004 1936 9000Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA ,grid.412689.00000 0001 0650 7433UPMC Freddie Fu Sports Medicine, Center, Pittsburgh, PA USA
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Similar functional outcomes of arthroscopic reconstruction in patients with isolated Posterior Cruciate Ligament (PCL) and combined Anterior Cruciate Ligament (ACL) and PCL tears. J Clin Orthop Trauma 2020; 16:65-69. [PMID: 33717940 PMCID: PMC7920014 DOI: 10.1016/j.jcot.2020.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Posterior Cruciate Ligament (PCL) injuries seldom occur in isolation and majority occurs in conjugation with other ligament injuries. Posterior Cruciate Ligament (PCL) reconstruction continues to be taken into consideration as a complicated surgical procedure, with heterogeneity in literature regarding clinical and functional outcomes in isolated PCL and combined ACL and PCL injuries. METHODS The retrospective evaluation of patients with isolated PCL reconstruction (group 1) and combined Anterior Cruciate Ligament (ACL) and PCL reconstruction (group 2) was performed. A total of 66 patients with either isolated PCL or combined ACL and PCL reconstruction surgeries that met the inclusion criteria, were included in the study. These patients were assessed for functional outcome scores including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Lysholm score, International Knee Documentation Committee (IKDC) and Tegner activity score at a minimum follow-up of 5 years. RESULTS The mean follow-up of patients was 82.09 ± 12.43 months in group 1 and 79.36 ± 11.24 months in group 2, with a total of 29 patients in group 1 and 21 patients in group 2. Both the groups were found to be comparable in terms of age, gender, duration of injury and pre-injury Tegner activity level. Post-surgical functional outcome scores (WOMAC score, Lysholm score and Tegner score) were found to be comparable between 2 groups at a mean follow-up of 5 years. Further, 22 patients in group 1 and 16 patients in group 2 had normal or near normal objective IKDC outcome scores at a mean follow-up of 5 years. CONCLUSIONS No differences were observed in functional outcome scores (WOMAC score, Lysholm score, Tegner score and IKDC score) between isolated reconstructed PCL and combined ACL and PCL reconstructed patients.
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Legallois Y, Baujard A, Lukas S, Leclerc JT, Martinot P, Girard J. Muscular Hernia of the Leg After Anterior Cruciate Ligament Reconstruction with Hamstring Autograft: A Case Report. JBJS Case Connect 2020; 10:e20.00403. [PMID: 33512931 DOI: 10.2106/jbjs.cc.20.00403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 20-year-old woman presented with symptomatic instability secondary to traumatic anterior cruciate ligament (ACL) rupture. Arthroscopic ACL reconstruction was performed using a 4-strand semitendinosus autograft harvested using a posterior approach. At her 2-month follow-up, a painful mass was palpable, and a hernia of the medial gastrocnemius was confirmed by ultrasound. This was treated with fascial closure. The clinical outcome was excellent at final follow-up. CONCLUSION This is the first case reported in the literature of a muscular hernia after an ACL reconstruction using a posterior harvest of the semitendinosus. Surgeons must be aware of this specific complication and how it may be addressed.
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Affiliation(s)
- Yohan Legallois
- Department of Orthopaedic Surgery, Lille University Hospital, Roger Salengro, Lille, France.,Department of Orthopaedic Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Alexandre Baujard
- Department of Orthopaedic Surgery, Lille University Hospital, Roger Salengro, Lille, France
| | - Simon Lukas
- Department of Orthopaedic Surgery, Lille University Hospital, Roger Salengro, Lille, France
| | - Jean-Thomas Leclerc
- Department of Orthopaedic Surgery, Lille University Hospital, Roger Salengro, Lille, France
| | - Pierre Martinot
- Department of Orthopaedic Surgery, Lille University Hospital, Roger Salengro, Lille, France
| | - Julien Girard
- Department of Orthopaedic Surgery, Lille University Hospital, Roger Salengro, Lille, France
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Gupta S, Bartolozzi AR, Miller L, Morgan C, Anyangwe V, Cavinatto L. Preoperative Estimated Width of the Patellar Tendon for Anterior Cruciate Ligament Reconstruction. J Knee Surg 2020; 33:1213-1218. [PMID: 31284320 DOI: 10.1055/s-0039-1693025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aims to compare the actual patellar tendon width with the skin and magnetic resonance imaging (MRI) measurements and to describe a more accurate method to predict the actual patellar tendon width before anterior cruciate ligament reconstruction (ACLR).Thirty-nine patients undergoing primary ACLR were identified. Patients with patellar tendon width of less than 30 mm by skin or MRI measurements were excluded from the study. The actual patellar tendon width was measured as an intraoperative reading taken after surgical exposure. Mean difference between the skin and actual measurement and mean difference between the MRI and actual measurement was calculated. Paired t-test was run to determine any significant differences. A difference was also calculated between the actual measurement and the average sum of skin and MRI measurements for each patient. Skin thickness was compared to Δ (Δ = preincision skin measurement of patellar tendon width minus postincision actual measurement) by Spearman's correlation test. Mean difference between skin and actual measurements was 2.5 mm, with p = 0.001. Mean difference between MRI and actual measurement was -2.7 mm with p = 0.001. However, the mean difference between the actual and the average sum of skin and MRI measurements was 0.13 mm with p = 0.76. The Pearson's correlation coefficient, r s, between average sum of skin and MRI measurements and the actual measurement was 0.6 with p = 0.001. There was no correlation found between the skin thickness and Δ∙. This study indicates that there is a significant difference between the actual patellar tendon width and the measurement of the tendon taken using a ruler on the skin or using MRI image software. However, the average sum of skin and MRI measurements, which is not significantly different from the actual width, can accurately predict the actual patellar tendon width before ACLR. The study reflects level IV evidence.
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Affiliation(s)
- Sunny Gupta
- Division of Orthopedic Surgery, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Arthur R Bartolozzi
- Division of Orthopedic Surgery, Jefferson 3B Orthopedics, Langhorne, Pennsylvania
| | - Lawrence Miller
- Division of Orthopedic Surgery, Cooper Bone and Joint Institute, Camden, New Jersey
| | - Craig Morgan
- Division of Orthopaedic Surgery, Morgan Kellman Clinic, Willmington, Delaware
| | - Victor Anyangwe
- LLC Robinwood Division 24-Orthopedic Surgery, The Centers for Advanced Orthopaedics, Hagerstown, Maryland
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Mattiassich G, Ortmaier R, Kindermann H, Barthofer J, Vasvary I, Kulnik ST, Katzensteiner K, Leister I. Clinical and radiological results after Internal Brace suture versus the all-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery. SPORTVERLETZUNG-SPORTSCHADEN 2020; 35:103-114. [PMID: 33254259 DOI: 10.1055/a-1281-8627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee. METHODS Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained a unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German version of the KOOS (Knee Osteoarthritis Outcome Score), and the German version of themodified Lysholm Score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 Arthrometer (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases. RESULTS Twenty-three subjects (46 %) were men, and the mean age was 34.7 years. The objective IKDC scores were "normal" in 15 and 14 patients, "nearly normal" in 11 and 7 patients, and "abnormal" in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a sideto-side difference of more than 3 mm on maximum manual testing in 11 (44 %) and 6 subjects (28.6 %) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74 %) and 22 subjects (96 %) in the IB and AI groups had an intact ACL. Anterior tibial translation was significantly higher in the IB group compared with the AI group in the manual maximum test. CONCLUSIONS Preservation of the native ACL with the Internal Brace primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot-shift phenomenon were observed during the study period.
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Affiliation(s)
- Georg Mattiassich
- Trauma Center Graz, Teaching Hospital of the Medical University Graz, Graz, Austria.,Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Austria.,Research Unit of Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Hall in Tirol, Austria
| | - Harald Kindermann
- Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, Steyr, Austria
| | - Jürgen Barthofer
- Trauma Center Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Imre Vasvary
- Department of Radiology, Diakonissen Wehrle, Salzburg, Austria.,Department of Radiology, Landeskrankenhaus Salzburg, Paracelsus Medical University
| | - Stefan Tino Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, United Kingdom
| | - Klaus Katzensteiner
- Trauma Center Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Iris Leister
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg(SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
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Vindfeld S, Strand T, Solheim E, Inderhaug E. Failed Meniscal Repairs After Anterior Cruciate Ligament Reconstruction Increases Risk of Revision Surgery. Orthop J Sports Med 2020; 8:2325967120960538. [PMID: 33195722 PMCID: PMC7605002 DOI: 10.1177/2325967120960538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Failed anterior cruciate ligament (ACL) reconstruction (ACLR) can lead to
reduced quality of life because of recurrent episodes of instability,
restrictions in level of activity, and development of osteoarthritis. A
profound knowledge of the causes of a failed surgery can ultimately help
improve graft survival rates. Purpose: To investigate the patient-related risks of inferior outcomes leading to
revision surgery after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: From a prospective cohort of primary ACLRs performed at a single center,
patients who required later revision surgery were matched with a control
group of uneventful primary ACLRs. Patient characteristics, data from the
preoperative examinations, KT-1000 arthrometer laxity testing, Tegner
activity scale, International Knee Documentation Committee subjective score,
Knee injury and Osteoarthritis Outcome Score, and perioperative data from
the initial surgery were included. Results: A total of 100 revision cases and 100 matched controls, with a median
follow-up time of 11 years, were included in the study. Those who had
undergone revision surgery were younger at the time of reconstruction and
had a shorter time from injury to surgery than their matched controls
(P = .006). The control group—of uneventful ACLRs—had a
higher incidence of meniscal repair at reconstruction (P =
.024). Also, the revision group more frequently experienced later failure of
the previous meniscal repair (P = .004). Surgeon experience
was not found to affect the risk of revision ACL surgery. Those who had
undergone ACL revision surgery had more frequently received a hamstring
tendon graft size of <8 mm (P = .018) compared with the
controls. Conclusion: The current study demonstrated that failed meniscal repair and a hamstring
tendon graft size of <8 mm were associated with primary ACLR failure.
Also, younger age at the time of surgery and shorter time from injury to
surgery were found to affect the risk of undergoing revision ACL
surgery.
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Affiliation(s)
| | | | - Eirik Solheim
- Aleris Hospital Nesttun, Nesttun, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eivind Inderhaug
- Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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Marques FDS, Barbosa PHB, Alves PR, Zelada S, Nunes RPDS, de Souza MR, Pedro MDAC, Nunes JF, Alves WM, de Campos GC. Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2020; 8:2325967120961082. [PMID: 33195725 PMCID: PMC7605008 DOI: 10.1177/2325967120961082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/08/2020] [Indexed: 01/13/2023] Open
Abstract
Background Anterior knee pain is a frequent condition after anterior cruciate ligament reconstruction (ACLR), but its origin remains uncertain. Studies have suggested that donor site morbidity in autologous bone-patellar tendon-bone reconstructions may contribute to patellofemoral pain, but this does not explain why hamstring tendon reconstructions may also present with anterior pain. Purpose To evaluate the prevalence of anterior knee pain after ACLR and its predisposing factors. Study Design Case-control study; Level of evidence, 3. Methods We evaluated the records of all patients who underwent ACLR between 2000 and 2016 at a private facility. The prevalence of anterior knee pain after surgery was assessed, and possible risk factors (graft type, patient sex, surgical technique, range of motion) were evaluated. Results The records of 438 patients (mean age, 30 years) who underwent ACLR were analyzed. Anterior knee pain was found in 6.2% of the patients. We found an increased prevalence of anterior knee pain with patellar tendon graft, with an odds ratio of 3.4 (P = .011). Patients who experienced extension deficit in the postoperative period had an odds ratio of 5.3 of having anterior pain (P < .001). Anterior knee pain was not correlated with patient sex or surgical technique. Conclusion The chance of having anterior knee pain after ACLR was higher when patellar tendon autograft was used compared with hamstring tendon graft, as well as in patients who experienced extension deficit in the postoperative period.
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Affiliation(s)
- Fabiano da Silva Marques
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Pedro Henrique Borges Barbosa
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Pedro Rodrigues Alves
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Sandro Zelada
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | | | | | | | | | - Wilson Mello Alves
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Gustavo Constantino de Campos
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,University of Campinas (UNICAMP), Campinas, Brazil
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Mo Z, Li D, Yang B, Tang S. Comparative Efficacy of Graft Options in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Network Meta-Analysis. Arthrosc Sports Med Rehabil 2020; 2:e645-e654. [PMID: 33135006 PMCID: PMC7588648 DOI: 10.1016/j.asmr.2020.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To evaluate the effectiveness of various graft options for anterior cruciate ligament reconstruction using network meta-analysis. Methods A medical literature search was conducted of PubMed, the Cochrane Library, Embase, SCOPUS, and Web of Science from their inception through March 1, 2019. The outcomes, including International Knee Documentation Committee (IKDC) form, Lachman test, Lysholm score, Pivot shift test, and Tegner score, were evaluated among graft options. Data extraction was carried out according to inclusion and exclusion criteria, and a network meta-analysis was performed using STATA 14.0. Results A total of 45 trials with 3992 patients were included. The forest plots revealed no significant differences in IKDC, Lysholm, or Tegner score among the grafts. In Lachman score, a significant difference was found in the comparisons of hamstring tendon allograft (HT-AL) versus patellar tendon autograft (PT-AU) and HT-AL versus hamstring tendon autograft (HT-AU). In pivot shift test, PT-AU was superior to all the other grafts, and quadriceps tendon autograft (QT-AU) was superior to HT-AL and artificial ligament (Art-L) in the number of cases with negative results. According to surface under the cumulative ranking area (SUCRA), PT-AU had the highest probability to be the best intervention in Lachman test and Tegner score; tibialis anterior tendon allograft (TA-AL) in IKDC and Lysholm score; and QT-AU in pivot shift test. Based on the cluster analysis of SUCRA, PT-AU was considered the most appropriate intervention by IKDC and Lachman test. Conclusion This study suggests that PT-AU may be the most appropriate graft for ACL reconstruction according to IKDC and Lachman test results. Level of Evidence Level I, network meta-analysis of randomized controlled trials.
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Affiliation(s)
| | | | | | - Shujie Tang
- Address correspondence to Shujie Tang, M.D., Ph.D., 601 Huangpu Dadao Road, Guangzhou city, Guangdong province, 510632, China.
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Assessment of Flexion Strength Following Single- Versus Double-Hamstring Tendon Harvest for Anterior Cruciate Ligament Reconstruction. Arthroscopy 2020; 36:1409-1416. [PMID: 32001278 DOI: 10.1016/j.arthro.2020.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/04/2020] [Accepted: 01/05/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare isometric hamstring strength deficits, knee laxity, functional outcomes, and patient-reported outcomes between patients who underwent anterior cruciate ligament (ACL) reconstruction with doubled semitendinosus and gracilis tendon autograft (ST/G) versus quadrupled semitendinosus autograft (ST), at a minimum follow-up of 1-year postoperatively. METHODS Patients who underwent ACL reconstruction with ST/G or ST hamstring autografts were retrospectively identified. Isometric hamstring strength was tested with a hand-held dynamometer at 30, 60, and 90° of knee flexion. Anterior knee laxity was assessed using a KT-1000 arthrometer. Functional outcomes were collected using the single-leg hop test and single-leg squat test. Side-to-side differences were determined and compared between the ST/G and ST groups. Patient-reported outcomes were collected on all patients. RESULTS Eighty-four patients who underwent ST/G (n = 34) or ST (n = 50) autograft ACL reconstruction were recruited to participate in this study. There was no difference in knee laxity between the groups. Side-to-side hamstring strength deficits increased with increased flexion angles. At 90° of flexion, the ST/G group had a significantly greater flexion strength deficit compared with the ST group (37.8 ± 15.1% vs 24.7 ± 12.5%, P < .001). Aside from a significant difference in the KOOS pain Score (P .045), no other significant differences in functional or patient reported outcomes between the groups were identified. CONCLUSIONS Patients who underwent ACL reconstruction with ST/G compared with ST autograft have a significantly greater isometric flexion strength deficit at 90° of flexion. Future investigations are required to determine the clinical relevance of this difference and whether specialized therapy protocols can mitigate this deficit. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Ferguson D, Cuthbert R, Tibrewal S. The role of anterolateral augmentation in primary ACL reconstruction. J Clin Orthop Trauma 2020; 11:S389-S395. [PMID: 32523299 PMCID: PMC7275283 DOI: 10.1016/j.jcot.2019.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
The anterolateral soft tissue envelope of the knee has long been recognised as a key stabilising structure. Once the mainstay of operative management of anterior cruciate ligament (ACL) rupture, interest in the area fell away with the advent of intraarticular arthroscopic reconstruction. Renewed interest in these structures together with cadaveric data evidencing the potential for restoration of near normal knee biomechanics following ACL and anterolateral soft tissue reconstruction has driven current concepts and development of operative techniques. Options for current anterolateral augmentation techniques in primary ACL reconstruction plus patient selection considerations are reviewed, together with an outlook at future research key to development of this area.
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Affiliation(s)
- David Ferguson
- Department of Trauma & Orthopaedic Surgery, Barnet General Hospital, Royal Free Hospitals NHS Foundation Trust, EN5 3DJ, London, UK
- Corresponding author.
| | - Rory Cuthbert
- Department of Trauma & Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | - Saket Tibrewal
- Department of Trauma & Orthopaedic Surgery, Lewisham & Greenwich NHS Trust, University Hospital Lewisham, High Street, London, SE13 6LH, UK
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41
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Vermeijden HD, van der List JP, O'Brien R, DiFelice GS. Patients Forget About Their Operated Knee More Following Arthroscopic Primary Repair of the Anterior Cruciate Ligament Than Following Reconstruction. Arthroscopy 2020; 36:797-804. [PMID: 31919026 DOI: 10.1016/j.arthro.2019.09.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/20/2019] [Accepted: 09/26/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the extent to which patients forget their operative knee joint on a daily basis following arthroscopic primary repair as compared with reconstruction of the anterior cruciate ligament (ACL) at short- to mid-term follow-up. METHODS For this retrospective study, all patients undergoing ACL surgery between May 2012 and May 2017 were identified. All patients were treated with the algorithm of undergoing arthroscopic primary repair for proximal tears and reconstruction for nonrepairable tears. Patients were contacted to complete the Forgotten Joint Score-12 questionnaire between 2 and 5 years following surgery. A greater score represents a more favorable outcome indicating the patient's ability to "forget" the joint in everyday life, whereas lower scores indicate a less-favorable outcome. Data were analyzed using independent t-tests and χ2 tests, and multiple linear regression analysis was performed to correct for potential confounders. RESULTS Eighty-three patients completed the questionnaire (57%). Patients who underwent primary repair thought about their operated knee less when compared with those patients who underwent reconstruction (85.3 ± 14.2 vs 74.3 ± 23.3, P = .022). These differences were significantly greater in patients older than 30 years (85.3 ± 12.9 vs 62.6 ± 24.9, P = .007), male patients (85.0 ± 13.6 vs 72.5 ± 24.7, P = .037), and patients with a body mass index greater than 25 (85.9 ± 14.5 vs 64.7 ± 25.6, P = .009). After we corrected for potential confounders, the overall difference remained significant (P = .045). CONCLUSIONS Based on the data in this study, patients undergoing arthroscopic primary ACL repair can expect to have less daily awareness of their operated knee at short- to mid-term follow-up as compared with patients undergoing ACL reconstruction. LEVEL OF EVIDENCE Retrospective comparative study, level III.
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Affiliation(s)
- Harmen D Vermeijden
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A
| | - Jelle P van der List
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A.; Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Robert O'Brien
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A
| | - Gregory S DiFelice
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A..
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Spindler KP, Huston LJ, Zajichek A, Reinke EK, Amendola A, Andrish JT, Brophy RH, Dunn WR, Flanigan DC, Jones MH, Kaeding CC, Marx RG, Matava MJ, McCarty EC, Parker RD, Vidal AF, Wolcott ML, Wolf BR, Wright RW. Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates? Am J Sports Med 2020; 48:298-309. [PMID: 31917613 PMCID: PMC7319140 DOI: 10.1177/0363546519892991] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Physicians' and patients' decision-making process between bone-patellar tendon-bone (BTB) and hamstring tendon autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by a variety of factors in the young, active athlete. PURPOSE To determine the incidence of both ACL graft revisions and contralateral ACL tears resulting in subsequent ACLR in a cohort of high school- and college-aged athletes who initially underwent primary ACLR with either a BTB or a hamstring autograft. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Study inclusion criteria were patients aged 14 to 22 years who were injured in sports, had a contralateral normal knee, and were scheduled to undergo unilateral primary ACLR with either a BTB or a hamstring autograft. All patients were prospectively followed for 6 years to determine whether any subsequent ACLR was performed in either knee after their initial ACLR. Multivariable regression modeling controlled for age, sex, ethnicity/race, body mass index, sport and competition level, baseline activity level, knee laxity, and graft type. The 6-year outcomes were the incidence of subsequent ACLR in either knee. RESULTS A total of 839 patients were eligible, of which 770 (92%) had 6-year follow-up for the primary outcome measure of the incidence of subsequent ACLR. The median age was 17 years, with 48% female, and the distribution of BTB and hamstring grafts was 492 (64%) and 278 (36%), respectively. The incidence of subsequent ACLR at 6 years was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal knee, and 19.7% for either knee. High-grade preoperative knee laxity (odds ratio [OR], 2.4 [95% confidence interval [CI], 1.4-3.9]; P = .001), autograft type (OR, 2.1 [95% CI, 1.3-3.5]; P = .004), and age (OR, 0.8 [95% CI, 0.7-1.0]; P = .009) were the 3 most influential predictors of ACL graft revision in the ipsilateral knee. The odds of ACL graft revision were 2.1 times higher for patients receiving a hamstring autograft than patients receiving a BTB autograft (95% CI, 1.3-3.5; P = .004). No significant differences were found between autograft choices when looking at the incidence of subsequent ACLR in the contralateral knee. CONCLUSION There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft.
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Affiliation(s)
| | - Kurt P. Spindler
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J. Huston
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander Zajichek
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily K. Reinke
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annunziato Amendola
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jack T. Andrish
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert H. Brophy
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Warren R. Dunn
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C. Flanigan
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan H. Jones
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C. Kaeding
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G. Marx
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew J. Matava
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C. McCarty
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard D. Parker
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Armando F. Vidal
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michelle L. Wolcott
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian R. Wolf
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rick W. Wright
- Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
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van der List JP, Vermeijden HD, Sierevelt IN, DiFelice GS, van Noort A, Kerkhoffs GMMJ. Arthroscopic primary repair of proximal anterior cruciate ligament tears seems safe but higher level of evidence is needed: a systematic review and meta-analysis of recent literature. Knee Surg Sports Traumatol Arthrosc 2020; 28:1946-1957. [PMID: 31486914 PMCID: PMC7253375 DOI: 10.1007/s00167-019-05697-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/26/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the outcomes of the various techniques of primary repair of proximal anterior cruciate ligament (ACL) tears in the recent literature using a systematic review with meta-analysis. METHODS PRISMA guidelines were followed. All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears using primary repair, repair with static (suture) augmentation and dynamic augmentation between January 2014 and July 2019 in PubMed, Embase and Cochrane were identified and included. Primary outcomes were failure rates and reoperation rates, and secondary outcomes were patient-reported outcome scores. RESULTS A total of 13 studies and 1,101 patients (mean age 31 years, mean follow-up 2.1 years, 60% male) were included. Nearly all studies were retrospective studies without a control group and only one randomized study was identified. Grade of recommendation for primary repair was weak. There were 9 out of 74 failures following primary repair (10%), 6 out of 69 following repair with static augmentation (7%) and 106 out of 958 following dynamic augmentation (11%). Repair with dynamic augmentation had more reoperations (99; 10%), and more hardware removal (255; 29%) compared to the other procedures. All functional outcome scores were > 85% of maximum scores. CONCLUSIONS This systematic review with meta-analysis found that the different techniques of primary repair are safe with failure rates of 7-11%, no complications and functional outcome scores of > 85% of maximum scores. There was a high risk of bias and follow-up was short with 2.1 years. Prospective studies comparing the outcomes to ACL reconstruction with sufficient follow-up are needed prior to widespread implementation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jelle P. van der List
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands ,Amsterdam UMC, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, The Netherlands ,Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, USA
| | - Harmen D. Vermeijden
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands ,Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, USA
| | - Inger N. Sierevelt
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands ,Amsterdam UMC, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - Gregory S. DiFelice
- Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, USA
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Amsterdam UMC, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, The Netherlands ,Amsterdam UMC, Academic Center for Evidence Based Sports Medicine (ACES), University of Amsterdam, Amsterdam, The Netherlands ,Amsterdam UMC, Amsterdam Collaboration On Health and Safety in Sports (ACHSS), University of Amsterdam, IOC Research Center, Amsterdam, The Netherlands
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Murgier J, Hansom D, Clatworthy M. Current evidence around patellar tendon graft in ACLR for high-risk patients: current concepts. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Risk factors for residual anterolateral rotational instability after double bundle anterior cruciate ligament reconstruction: Evaluation by quantitative assessment of the pivot shift phenomenon using triaxial accelerometer. Knee 2020; 27:95-101. [PMID: 31672497 DOI: 10.1016/j.knee.2019.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/18/2019] [Accepted: 09/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Exact knowledge of risk factors for residual anterolateral rotatinoal instability (ALRI) after anterior cruciate ligament (ACL) reconstruction is limited. The purpose of this study was to analyse possible risk factors for ALRI after ACL reconstruction. METHODS Quantitative assessment of the pivot shift phenomenon by measuring tibial acceleration was performed in 46 patients during primary double-bundle ACL reconstructions. The absolute value of the acceleration of the injured knee after provisional fixation of the ACL grafts ('absolute residual acceleration') and the subtraction of the acceleration of the uninjured knee from absolute residual acceleration ('relative residual acceleration') were defined as indicators for residual ALRI. The associations between these indicators and nine candidate risk factors were analysed using univariate and multiple regression analyses. RESULTS Multiple regression analysis revealed that absolute residual acceleration was positively associated with both preoperative acceleration difference between injured and uninjured knees (β = 0.469, P < 0.001) and tibial acceleration of the uninjured knee (β = 0.597, P < 0.001). Relative residual acceleration was also positively associated with preoperative acceleration difference between injured and uninjured knees (β = 0.446, P< 0.001), but was negatively associated with tibial acceleration of the uninjured knee (β = -0.763, P < 0.001). CONCLUSIONS Patients with larger preoperative side-to-side difference of the pivot shift phenomenon have higher risk for both absolute and relative residual ALRIs after ACL reconstruction, whereas patients with larger pivot shift phenomenon in their uninjured knees are at higher risk for absolute residual ALRI but not for relative residual ALRI.
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Chen W, Li H, Chen Y, Jiang F, Wu Y, Chen S. Bone-Patellar Tendon-Bone Autografts Versus Hamstring Autografts Using the Same Suspensory Fixations in ACL Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med 2019; 7:2325967119885314. [PMID: 32010729 PMCID: PMC6967236 DOI: 10.1177/2325967119885314] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Bone–patellar tendon–bone (BPB) autografts and hamstring tendon (HT) autografts are 2 popular choices for anterior cruciate ligament reconstruction (ACLR). Although existing meta-analyses have explored the clinical outcomes between BPB and HT autografts, none have based their analysis on studies with just femoral suspensory fixation methods. Purpose: To evaluate and compare clinical outcomes, particularly graft failure and knee stability, of ACLR with BPB or HT autografts with suspensory femoral fixation. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was conducted of studies reporting single-bundle ACLR with BPB autografts and HT autografts with suspensory fixation with a minimum 24-month follow-up. Graft failure rate, knee stability, and clinical outcomes were compared for BPB versus HT autografts. Knee stability was measured with the Lachman test, pivot-shift test, and KT-1000/2000 arthrometer side-to-side difference (SSD). Clinical outcomes were measured with Lysholm scores and the Tegner activity scale, as well as rate of return to preinjury sports. Donor site morbidity among included studies was reviewed. A random-effects model was used for calculations of summary estimates. Subgroup, sensitivity, and trial sequential analyses were conducted. Results: Five studies were included. Graft failure was seen more often in the HT group than the BPB group, and this was statistically significant (P = .03). However, the trial sequential analysis outcome indicated that the included sample size was not large enough to support a solid positive finding. The analysis showed no significant difference in SSD, Lachman test, pivot-shift test, rate of return to sports, Lysholm score, or Tegner score between groups. Subgroup analyses found no significant difference between groups. Conclusion: This meta-analysis demonstrated no significant differences in knee stability and knee functional outcomes between BPB and HT autografts with suspensory fixation. More evidence is needed to prove the lower risk of failure with use of BTB autograft with suspensory fixation.
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Affiliation(s)
- Wenbo Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Yuzhou Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Fangyi Jiang
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Yang Wu
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
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Heusdens CHW, Zazulia K, Roelant E, Dossche L, van Tiggelen D, Roeykens J, Smits E, Vanlauwe J, Van Dyck P. Study protocol: a single-blind, multi-center, randomized controlled trial comparing dynamic intraligamentary stabilization, internal brace ligament augmentation and reconstruction in individuals with an acute anterior cruciate ligament rupture: LIBRƎ study. BMC Musculoskelet Disord 2019; 20:547. [PMID: 31739784 PMCID: PMC6862787 DOI: 10.1186/s12891-019-2926-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/31/2019] [Indexed: 01/15/2023] Open
Abstract
Background The current gold standard for the treatment of an anterior cruciate ligament (ACL) rupture is reconstruction with tendon graft. Recently, two surgical ACL repair techniques have been developed for treating an acute ACL rupture: Dynamic Intraligamentary Stabilization (DIS, Ligamys®) and Internal Brace Ligament Augmentation (IBLA, InternalBrace™). We will conduct a single-blind, multi-center, randomized controlled trial which compares DIS, IBLA and reconstruction for relative clinical efficacy and economic benefit. Methods Subjects, aged 18–50 years, with a proximal, primary and repairable ACL rupture will be included. DIS is preferably performed within 4 weeks post-rupture, IBLA within 12 weeks and reconstruction after 4 weeks post-rupture. Patients are included in study 1 if they present within 0–4 weeks post-rupture and surgery is feasible within 4 weeks post-rupture. Patients of study 1 will be randomized to either DIS or IBLA. Patients are included in study 2 if they present after 4 weeks post-rupture and surgery is feasible between 5 and 12 weeks post-rupture. Patients of study 2 will be randomized to either IBLA or reconstruction. A total of 96 patients will be included, with 48 patients per study and 24 patients per study arm. Patients will be followed-up for 2 years. The primary outcome is change from baseline (pre-rupture) in International Knee Documentation Committee score to 6 months post-operatively. The main secondary outcomes are the EQ-5D-5 L, Tegner score, Lysholm score, Lachman test, isokinetic and proprioceptive measurements, magnetic resonance imaging outcome, return to work and sports, and re-rupture/failure rates. The statistical analysis will be based on the intention-to-treat principle. The economic impact of the surgery techniques will be evaluated by the cost-utility analysis. The LIBRƎ study is to be conducted between 2018 and 2022. Discussion This LIBRƎ study protocol is the first study to compare DIS, IBLA and ACL reconstruction for relative clinical efficacy and economic benefit. The outcomes of this study will provide data which could aid orthopaedic surgeons to choose between the different treatment options for the surgical treatment of an acute ACL rupture. Trial registration This study is registered at ClinicalTrials.gov; NCT03441295. Date registered 13.02.2018.
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Affiliation(s)
- Christiaan H W Heusdens
- Department of Orthopaedics, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - Katja Zazulia
- Department of Orthopaedics, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Lieven Dossche
- Department of Orthopaedics, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Damien van Tiggelen
- Department of Traumatology and Rehabilitation, Queen Astrid Military Hospital, Bruynstraat 1, 1120, Neder-Over-Heembeek, Belgium
| | - Johan Roeykens
- Department of Rehabilitation, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Elke Smits
- Department of Medical management, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Johan Vanlauwe
- Department of Orthopaedics and Traumatology, University Hospital Brussels, Laarbeeklaan 101, 1090, Jette, Belgium
| | - Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
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Park C, Jayakumar P, Fox M. Peroneal Nerve Injury Arising from Harvesting a Contralateral Hamstring Autograft for Cruciate Ligament Reconstruction: A Case Report. JBJS Case Connect 2019; 9:e0350. [PMID: 31365361 DOI: 10.2106/jbjs.cc.18.00350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE A 22-year-old man underwent a posterior cruciate ligament reconstruction following a sporting injury. Postoperatively, he developed a new foot drop on the hamstring harvest side that was contralateral to the ligamentous injury. On surgical exploration, a lesion in the peroneal nerve fascicles of the sciatic nerve, 20 cm from the fibula head, was neurolyzed with improvement in the foot drop. CONCLUSIONS Sciatic nerve injury is a rare complication when harvesting the hamstring. Care of orientation of the tendon stripper blade and direction of harvest is required to avoid injury to the sciatic nerve.
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Affiliation(s)
- Chang Park
- The Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, London, United Kingdom
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Ferguson D, Palmer A, Khan S, Oduoza U, Atkinson H. Early or delayed anterior cruciate ligament reconstruction: Is one superior? A systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1277-1289. [PMID: PMID: 31093753 PMCID: PMC6647395 DOI: 10.1007/s00590-019-02442-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/23/2019] [Indexed: 01/16/2023]
Abstract
Background Anterior cruciate ligament (ACL) reconstruction is a rapidly developing orthopaedic field and an area of notable clinical equipoise. The optimal timing of surgery in an acute (< 3 weeks) or delayed (≥ 3 weeks) time frame remains unresolved with a 2010 meta-analysis concluding no difference between these two groups across multiple outcomes. In an era of evidence-based medicine, surgeons are still basing their decisions on when to operate on little more than anecdotal evidence and personal preference. Clear guidance is required to determine whether the timing of surgery can optimise outcomes in this largely young and active patient cohort. Methods A systematic literature search was performed in January 2018 of Embase, Medline and OpenGrey in accordance with (PRISMA) guidelines. A total of 658 articles were retrieved, with 6 suitable for inclusion, covering 576 ACL reconstructions. Four meta-analyses were performed assessing subjective measures of Tegner activity scale and Lysholm score, and objective measures of arthroscopically identified meniscal and chondral injury. Additional relevant outcome measures underwent narrative review. Study bias was assessed and reported using the Downs and Black checklist. Results A statistically significant difference of 0.39 points was found on the Tegner activity scale in favour of early surgery within 3 weeks (RR 0.39, CI 0.10, 0.67, p = 0.008). No statistically difference was found between groups for the patient-reported Lysholm score (RR − 0.18, CI − 2.40, 2.05, p = 0.17). There was no statistically significant difference between groups for intra-operative findings of meniscal lesions (RR 0.84, CI 0.66, 1.08, p = 0.17). A trend towards significance was observed for the incidence of chondral lesions in the early surgery group (RR 0.56, CI 0.31, 1.02, p = 0.06). All the studies were rated either fair or good on the Downs and Black checklist with no study excluded due to bias. Conclusions Although there was a statistically significant result for the Tegner activity scale in favour of early surgery, the magnitude of the effect is unlikely to translate into any clinically meaningful difference. At present, there remains no clear evidence to determine superiority of acute/early or delayed reconstruction of a ruptured anterior cruciate ligament. Further research through methodologically robust randomised controlled trials or through the UK National Ligament Registry may help to provide clearer guidance.
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Affiliation(s)
- D Ferguson
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | - A Palmer
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - S Khan
- Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - U Oduoza
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - H Atkinson
- Department of Trauma and Orthopaedic Surgery, North Middlesex University Hospital, London, N18 1QX, UK
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50
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Hadi H, Bagherifar A, Tayebi F, Ansaria M, Shahsavaripour A, Qomashi I, Jabalameli M. Anterior Cruciate Ligament Reconstruction with Hamstring Tendons Has no Deleterious Effect on Hip Extension Strength. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:278-283. [PMID: 31312687 PMCID: PMC6578478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/04/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hamstring tendons are secondary hip extensors. Their harvest for graft in anterior cruciate ligament (ACL) reconstruction may create deleterious effect on hip extension strength. This is of particular importance in sports that need powerful hip extension force like climbing and sprinting. Due to scarcity of a comprehensive study in this area, we designed this prospective study to evaluate hip extension strength following ACL reconstruction using different types of grafts. METHODS Fifty eight patients were enrolled in this prospective non-randomized case control study to compare isokinetic hip extension strength following ACL reconstruction with different graft types. Twenty patients in group A (both Semitendinosus and Gracilis tendons autograft (ST-G)), 14 patients in group B (Tibialis Posterior tendon allograft (Allograft)), 12 patients in group C (bone-patellar tendon-bone autograft (BPTB)) and 12 patients in group D (only semitendinosus autograft (ST)) were studied. Hip extension strength was tested post-operatively at three- and six-month periods using a Biodex isokinetic testing machine at a speed of 30 degree per second in operated (cases) and non-operated (controls) limbs. RESULTS There was a significant increase in hip extension force between three and six month intervals in all four groups and in both operated (case) and non-operated (control) limbs (P<0.05, 95% CI). However, there was more increase in case limbs in comparison to control limbs. There was no significant difference in hip extension strength among all four groups (both in case and control limbs) in the third- and the sixth-month post-operative tests. CONCLUSION Graft type had no effect on hip extension strength following ACL reconstruction, and the harvest of one or both hamstrings had no deleterious effect on hip extension force. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hosseinali Hadi
- Arak University of Medical Sciences, Arak, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifar
- Arak University of Medical Sciences, Arak, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fereshte Tayebi
- Arak University of Medical Sciences, Arak, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Ansaria
- Arak University of Medical Sciences, Arak, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Shahsavaripour
- Arak University of Medical Sciences, Arak, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Iman Qomashi
- Arak University of Medical Sciences, Arak, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabalameli
- Arak University of Medical Sciences, Arak, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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