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Bombacı H, Başalan B, Öztürk Ö, Aydoğdu O, Karaaslan M, Sarı Z. Proprioceptive and clinical outcomes of anterior cruciate ligament reconstruction with remnant tissue preservation technique: A comparison according to the preserved tissue length. J Orthop Sci 2024:S0949-2658(24)00149-0. [PMID: 39129069 DOI: 10.1016/j.jos.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/27/2024] [Accepted: 07/25/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND No consensus is obtained regarding the effects of remnant-preserving ACL reconstruction on long-term clinical and proprioceptive outcomes. This study aimed to compare proprioceptive and clinical outcomes of the knee joint after ACL reconstruction with two different lengths of preserved remnant tissue. METHODS This study included 61 patients who underwent single-bundle ACL reconstruction with remnant preservation method using hamstring autograft, divided into two groups according to the length of the remnant tissue. Group ≤33% included subjects with equal and less than 1/3 of the remnant preserved (n = 30) and group >33% included subjects with more than 1/3 of the remnant preserved (n = 31). Proprioception was evaluated at 20°, 50°, and 70° knee angles. Clinical outcome measures included Tegner activity scale, Lysholm knee score, single-leg-hop test, and muscle strength of quadriceps femoris and hamstring muscles which was evaluated using Biodex dynamometer. Anterior laxity was determined with a KT2000 arthrometer. A statistical comparison of the assessments was performed. RESULTS The mean follow-up time after surgery were 28.33 and 33.67 months for group ≤33% and >33%, respectively. No significant differences were detected for Lysholm and Tegner scores between the groups (p > 0.05). Additionally, proprioception and muscle strength values displayed similarity between the groups (p > 0.05). The length of the remnant tissue did not affect post-operative knee stability (p > 0.05). CONCLUSION Patients who underwent remnant-preserving ACL reconstruction obtained similar proprioceptive function, muscle strength, anterior stability, and clinical results regardless of the amount of preserved tissue length at short-term assessment.
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Affiliation(s)
- Hasan Bombacı
- Yeditepe University, Department of Orthopedics and Traumatology, Istanbul, Türkiye
| | - Buğra Başalan
- University of Health Sciences, Haydarpaşa Numune Research and Training Hospital, Department of Orthopedics and Traumatology, Istanbul, Türkiye
| | - Özgül Öztürk
- Acıbadem Mehmet Ali Aydınlar University, Department of Physiotherapy and Rehabilitation, Istanbul, Türkiye.
| | - Onur Aydoğdu
- Marmara University, Department of Physiotherapy and Rehabilitation, Istanbul, Türkiye
| | - Muhammet Karaaslan
- Ağrı Research and Training Hospital, Department of Orthopedics and Traumatology, Ağrı, Türkiye
| | - Zübeyir Sarı
- Marmara University, Department of Physiotherapy and Rehabilitation, Istanbul, Türkiye
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Dong Y, Gao Y, Cui P, He Y, Yao G. Comparison of femoral tunnel position and knee function in anterior cruciate ligament reconstruction: a retrospective cohort study using measuring-fluoroscopy method versus bony marker method. BMC Musculoskelet Disord 2024; 25:572. [PMID: 39044221 PMCID: PMC11264435 DOI: 10.1186/s12891-024-07684-8] [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: 04/17/2024] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Previous studies have shown that surgical technique errors especially the wrong bone tunnel position are the primary reason for the failure of anterior cruciate ligament (ACL) reconstruction. In this study, we aimed to compare the femoral tunnel position and impact on knee function during the ACL reconstruction using measuring combined with fluoroscopy method and bony marker method for femoral tunnel localization. METHODS A retrospective cohort study of patients undergoing ACL reconstruction using the bony marker method or measuring combined with fluoroscopy for femoral tunnel localization was conducted between January 2015 and January 2020. A second arthroscopic exploration was performed more than 1 year after surgery. Data regarding patient demographics, the femoral tunnel position, results of the Lysholm score, the International Knee Documentation Committee (IKDC) score, KT-1000 side-to-side difference, pivot shift grade, and Lachman grade of the knee were collected. RESULTS A total of 119 patients were included in the final cohort. Of these, 42 cases were in the traditional method group, and 77 cases were in the measuring method group. The good tunnel position rate was 26.2% in the traditional method group and 81.8% in the measuring method group (p < 0.001). At the final follow-up, the Lysholm and IKDC scores were significantly greater in the measuring method group than the traditional method group (IKDC: 84.9 ± 8.4 vs. 79.6 ± 6.4, p = 0.0005; Lysholm: 88.8 ± 6.4 vs. 81.6 ± 6.4, p < 0.001). Lachman and pivot shift grades were significantly greater in the measuring method group (p = 0.01, p = 0008). The results of KT-1000 side-to-side differences were significantly better in the measuring method group compared with those in the traditional method group (p < 0.001). CONCLUSIONS The combination of the measuring method and intraoperative fluoroscopy resulted in a concentrated tunnel position on the femoral side, a high rate of functional success, improved knee stability, and a low risk of tunnel deviation. This approach is particularly suitable for surgeons new to ACL reconstructive surgery.
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Affiliation(s)
- Yan Dong
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Yang Gao
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Peng Cui
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuanming He
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guke Yao
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Galvão Cardoso R, Caetano E Souza RH, Araújo Rodrigues AA, Abreu Rosa de Sá A, Martins Naves EL. A study regarding the anterior cruciate ligament remnant: Differences in balance and postural control between remnant-preserving and remnant-non-preserving patients. Rehabilitacion (Madr) 2024; 58:100834. [PMID: 38141427 DOI: 10.1016/j.rh.2023.100834] [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: 12/14/2022] [Revised: 10/23/2023] [Accepted: 11/04/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. However, quantitative studies on evaluate the postural control influence resulted from the ACL remnant preservation or not are scarce. The aim of this study is to evaluate the postural control of patients submitted to ACL reconstruction with and without preservation of the injured remnant in pre and postoperative periods. METHODS Eighteen patients underwent ACL reconstruction and separated into 2 groups according to the preservation or not of the remnant: (I) submitted to ACL reconstruction with preservation of the remnant (10 patients); (II) submitted to ACL reconstruction without preservation of the remnant (8 patients). They were assessed using the Lysholm score and force plate, which evaluated the patient's postural stability for remnant and non-remnant preservation in ACL reconstruction surgery. RESULTS Group I showed statistically significant subjective and objective improvements, both at 3 and 6 months. Additionally, improvement of the Lysholm test at 6 months in Group II was also statistically significant. Furthermore, the results of the Friedman test for the VCOP and VY variables of Group I, with support of the injured side in the force plate, showed a statistically significant difference both for pre and postoperative period at 3 months, compared to the 6-month postoperative period. The variables EAC and VX were statistically different for Group II, considering the preoperative period, 3 and 6 months postoperatively. CONCLUSION Preserving the ACL remnant in patients with ACL injuries has a positive impact on postural stability during recovery.
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Affiliation(s)
- R Galvão Cardoso
- Assistive Technology Laboratory, Faculty of Electrical Engineering, Federal University of Uberlandia, Uberlandia, Brazil
| | - R H Caetano E Souza
- Assistive Technology Laboratory, Faculty of Electrical Engineering, Federal University of Uberlandia, Uberlandia, Brazil
| | - A A Araújo Rodrigues
- Assistive Technology Laboratory, Faculty of Electrical Engineering, Federal University of Uberlandia, Uberlandia, Brazil
| | - A Abreu Rosa de Sá
- Assistive Technology Laboratory, Faculty of Electrical Engineering, Federal University of Uberlandia, Uberlandia, Brazil.
| | - E L Martins Naves
- Assistive Technology Laboratory, Faculty of Electrical Engineering, Federal University of Uberlandia, Uberlandia, Brazil
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Kopka M, Heard SM, Buchko GM, Hiemstra LA, Lafave MR, Kerslake S. Remnant-Sparing Anterior Cruciate Ligament Reconstruction Results in Similar Clinical, Functional, and Quality-of-Life Outcomes to Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100898. [PMID: 38405580 PMCID: PMC10883819 DOI: 10.1016/j.asmr.2024.100898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/12/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose To compare a large cohort of patients who underwent remnant-sparing anterior cruciate ligament reconstruction (rACLR) with a matched group of patients who underwent anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) with respect to clinical laxity, patient-reported outcomes, and functional testing. Methods Patients who underwent rACLR between January 2010 and December 2015 were matched according to age, sex, body mass index, and graft type to patients who underwent ACLR. The primary outcome measure was the ACL Quality of Life (ACL-QOL) score at final follow-up of 24 months. Secondary outcomes included functional tests and clinical laxity measurements at 6, 12, and 24 months postoperatively. Concurrent intra-articular pathology at the time of surgery and postoperative complications were also recorded. Statistical analyses included the dependent t test and the Wilcoxon signed rank test. Results A total of 210 rACLR patients were successfully matched to a corresponding cohort of 210 ACLR patients. There were no statistically significant differences in ACL Quality of Life (ACL-QOL) or functional testing results between the groups; however, scores in both groups showed a steady and statistically significant improvement over time. A statistically significant difference was noted with respect to the Lachman test findings, favoring the rACLR cohort (Z = -2.79, P = .005); no between-group difference was seen for the pivot-shift test (Z = -0.36, P = .72). The rACLR group had a significantly lower rate of concurrent meniscal and chondral injury. There was no difference in complications between the groups (Z = -0.49, P = .63). Conclusions There was no difference in patient-reported or functional testing outcomes in patients undergoing remnant-sparing compared with anatomic single-bundle ACLR. There was, however, a significantly lower rate of positive Lachman test findings after rACLR. Furthermore, the rate of concurrent meniscal and chondral pathology was lower in the rACLR group. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Michaela Kopka
- Banff Sport Medicine, Banff, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
| | - S. Mark Heard
- Banff Sport Medicine, Banff, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Gregory M. Buchko
- Banff Sport Medicine, Banff, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Laurie A. Hiemstra
- Banff Sport Medicine, Banff, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Mark R. Lafave
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
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He Y, Fan Y, Zhai L, Zhu W. Comparative efficacy and safety of different surgical approaches for the treatment of anterior cruciate ligament injury: a Bayesian network meta-analysis protocol. BMJ Open 2024; 14:e077242. [PMID: 38553073 PMCID: PMC10982744 DOI: 10.1136/bmjopen-2023-077242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture can be treated surgically or non-surgically, with several surgical interventions available at present. However, the comparatively effective surgical intervention with relatively fewer side effects remains unknown. This study aims to fill in this gap by conducting a Bayesian network meta-analysis (NMA) and provide a theoretical basis for the clinical application. METHOD AND ANALYSIS We will perform a Bayesian NMA and will include randomised controlled trials (RCTs) published in English or Chinese that compare surgical intervention (ie, standard ACL reconstruction, ACL remnant-preserving reconstruction and ACL repair with suture augmentation to conservative therapy or studies that compare one surgical intervention to another for the symptom relief and function recovery of patients with ACL rupture. Primary outcome will be the proportion of patients with symptomatic and functional improvement measured by the Knee Injury and Osteoarthritis Outcome Score before and 6 months after treatment, with scores ranging from 0 (worst) to 100 (best). Secondary outcomes will be knee-specific quality of life (ACL QoL), return to activity and level of sport participation (Tegner or modified Tegner score), health-related QoL (EuroQol Group 5-Dimension 5-Level, EQ-5D-5L), resource use, intervention-related complications and patient satisfaction. We have developed search strategies for PubMed, Embase, the Cochrane Library and Web of Science, retrieving RCTs that meet the inclusion criteria from database inception to 1 December 2023. The methodological quality of the included RCTs will be assessed based on the Cochrane risk of bias table. The relative ranking probability of the best intervention will be estimated using the surface under the cumulative ranking curve. The Bayesian NMA will be conducted by using WinBUGS V.1.4.3. The Grading of Recommendations Assessment, Development and Evaluation approach will be applied to determine our confidence in an overall treatment ranking from the NMA. ETHICS AND DISSEMINATION Ethical approval for this study is not required because no private or confidential patient data will be used in this study. Findings of this study would be disseminated through the publication in a peer-reviewed medical journal. PROSPERO REGISTRATION NUMBER CRD42023437115.
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Affiliation(s)
- Yuchen He
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yishu Fan
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Central South University, Changsha, Hunan, China
| | - Longxiang Zhai
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Weihong Zhu
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Thamrongskulsiri N, Chancharoenchai P, Limskul D, Itthipanichpong T, Tanpowpong T. A Technique for Hamstring Donor-Site Injection With Anesthetic Cocktail in Remnant-Preserving Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2024; 13:102818. [PMID: 38312874 PMCID: PMC10837842 DOI: 10.1016/j.eats.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/27/2023] [Indexed: 02/06/2024] Open
Abstract
Arthroscopic anterior cruciate ligament reconstruction is a common procedure that requires effective postoperative pain management for successful rehabilitation. Opioids are traditionally used for pain relief, but their side effects decrease their widespread use. Local anesthesia techniques have gained interest as an alternative to opioids. This Technical Note discusses the use of an anesthetic cocktail for pain relief at the hamstring's donor site in anterior cruciate ligament reconstruction. This approach may enhance early rehabilitation and patient satisfaction.
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Affiliation(s)
| | - Phanusorn Chancharoenchai
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Danaithep Limskul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Thun Itthipanichpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Thanathep Tanpowpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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Ma W, Yang Y, Ha X. Two-stage ligament reconstruction with remnant preservation as treatment of knee dislocation. BMC Surg 2023; 23:371. [PMID: 38066516 PMCID: PMC10704695 DOI: 10.1186/s12893-023-02271-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical outcomes of two-stage reconstruction (peripheral reconstruction in phase I and central anterior cruciate ligament (ACL) / posterior cruciate ligament (PCL) reconstruction in phase II) with remnant preservation for patients with knee dislocation. METHODS A total of 70 patients (10 IIIM, 17 IIIL, and 43 IV) with knee dislocation were randomly divided into the remnant-preserved group and the simple reconstruction group. Patients underwent two-stage reconstruction, including the reconstruction of collateral ligament in phase I and the reconstruction of ACL/PCL in phase II (12 weeks after phase I). Grafts were harvested from the semitendinosus and gracilis tendons from both lower limbs. After the surgery, the joint flexion and extension, bone tunnel and ligament healing, and joint stability were evaluated. RESULTS After the surgery, the lateral stability recovered in all patients, and X-ray revealed a good position of bone tunnel. Follow-up was performed at 12 months postoperatively and ranged from 24 to 91 months. At the final follow-up, knee flexion angle, IKDC, Lysholm, and Tegner scores were all higher in both groups compared to the preoperative period. Notably, the remnant-preserved group showed superior results in these parameters compared to the simple reconstruction group. There was statistical significance between the two groups in terms of the Lachman test. CONCLUSION The knee function was well recovered after two-stage ligament reconstruction with remnant preservation.
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Affiliation(s)
- Wenpu Ma
- Department of Orthopaedics, Liaocheng People's Hospital, No. 67, Dongchang west Road, Liaocheng City, 252000, Shandong Province, China
| | - Yiqun Yang
- Department of Orthopaedics, Liaocheng People's Hospital, No. 67, Dongchang west Road, Liaocheng City, 252000, Shandong Province, China
| | - Xin Ha
- Department of Electromyogram, Liaocheng People's Hospital, No. 67, Dongchang west Road, Liaocheng City, 252000, Shandong Province, China.
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Zhang Y, Xiao X, Deng W, Wang J, Gao H, Han J. Is remnant preservation in anterior cruciate ligament reconstruction superior to the standard technique? An overview of systematic reviews. BMC Musculoskelet Disord 2023; 24:910. [PMID: 38001516 PMCID: PMC10668441 DOI: 10.1186/s12891-023-07030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament injury is a common knee joint injury. Anterior cruciate ligament reconstruction is a common surgical treatment to treat anterior cruciate ligament injury. It may have certain advantages to retain the ligament stump during the operation, but the results of systematic evaluation on whether to retain the ligament stump are different. The conclusion is still controversial, and the quality needs to be strictly evaluated. OBJECTIVE To evaluate the methodological quality, risk of bias, reporting quality and evidence quality of the systematic review of remnant preservation in anterior cruciate ligament reconstruction, and to provide reference for clinical work. METHODS We systematically searched the system evaluations in 8 electronic databases, the languages were limited to Chinese and English, and the time limit was from the establishment of the database to June 2023. Two reviewers independently screened literature and extracted data. The methodological quality, risk of bias, reporting quality and quality of evidence were evaluated by AMSTAR-2, ROBIS, PRISMA and GRADE tools. RESULTS A total of 14 systematic reviews were included. The evaluation of results showed that the methodological quality of the included systematic reviews was relatively low, of which 5 were low quality and 9 were critically low quality. A small number of systematic reviews were low risk of bias. The system evaluation reports are relatively complete, but the lack of program registration is a common problem. A total of 111 pieces of clinical evidence were extracted from the included 14 systematic reviews. The quality of evidence was generally low, with only 7 pieces of high-quality evidence, 45 pieces of medium-quality evidence, and the rest were low and very low-quality evidence. Among the reasons for relegation, imprecision is the most common, followed by inconsistency and indirectness. The existing evidence shows that patients after anterior cruciate ligament reconstruction with remnant preservation have certain advantages in knee joint function, joint stability and proprioception recovery, which may be a more effective surgical method. However, it may also increase the incidence of postoperative complications and adverse reactions. CONCLUSION Compared with Standard Technique, Remnant Preservation in Anterior Cruciate Ligament Reconstruction has more advantages in restoring joint function and stability and proprioception. But the potential risks should also be considered by surgeons. At present, the quality of evidence is generally low, and the reliability of the conclusion is insufficient. It still needs to be verified and further in-depth research is needed.
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Affiliation(s)
- Yunsong Zhang
- Changchun University of Traditional Chinese Medicine, 1035 Boshuo Road, Nanguan District, Changchun City, Jilin Province, China
| | - Xiangyu Xiao
- Shandong University of Traditional Chinese Medicine, No.4655, Changqing University Science and Technology Park, Changqing District, Jinan City, Shandong Province, China
| | - Wei Deng
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, No.1478 Gongnong Road, Chaoyang District, Changchun City, Jilin Province, China
| | - Jianyu Wang
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, No.1478 Gongnong Road, Chaoyang District, Changchun City, Jilin Province, China
| | - Hongwei Gao
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, No.1478 Gongnong Road, Chaoyang District, Changchun City, Jilin Province, China
| | - Jicheng Han
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, No.1478 Gongnong Road, Chaoyang District, Changchun City, Jilin Province, China.
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Sun Y, Huang Z, Zhang P, Xie H, Wang C, Deng Z, Chen K, Zhu W. Comparative Study of Graft Healing in 2 Years after “Tension Suspension” Remnant-Preserving and Non-Remnant-Preserving Anatomical Reconstruction for Sherman Type II Anterior Cruciate Ligament Injury. J Pers Med 2023; 13:jpm13030477. [PMID: 36983659 PMCID: PMC10059742 DOI: 10.3390/jpm13030477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Purpose: To evaluate the degree of graft healing after “tension suspension” reconstruction of “Sherman II” anterior cruciate ligament injuries versus non-remnant preserving anatomical reconstruction and to compare the clinical outcomes of the two procedures. Method: The clinical data of 64 patients were retrospectively included. There were 31 cases in the “tension suspension” remnant-preserving reconstruction group and 33 cases in the non-remnant-preserving anatomical reconstruction group. The International Knee Documentation Committee (IKDC) score, the Tegner score, and the Lysholm activity score were assessed preoperatively and at 6 months, 1 year, and 2 years postoperatively, respectively. The signal/noise quotient (SNQ) of the grafts was measured at 6 months, 1 year, and 2 years after surgery to quantitatively evaluate the maturity of the grafts after ACL reconstruction; the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the reconstructed ACL region of interest (ROI) were measured using DTI. Result: A total of 64 patients were included in the study. The mean SNQ values of the grafts in the 6 months, 1 year, and 2 years postoperative remnant-preserving reconstruction (RP) groups were lower than those in the non-remnant-preserving (NRP) reconstruction group, with a statistically significant difference (p < 0.05). At each postoperative follow-up, the SNQ values of the tibial and femoral sides of the RP group were lower than those of the NRP group; the SNQ values of the femoral side of the grafts in both groups were higher than those of the tibial side, and the differences were statistically significant (p < 0.05). At 6 months, 1 year, and 2 years postoperatively, the FA and ADC values of the grafts were lower in the RP group than in the NRP group, and the differences were statistically significant (p < 0.05); the IKDC score and Lysholm score of the RP group were higher than the NRP group, which was statistically significant (p < 0.05). Conclusion: For Sherman II ACL injury, the graft healing including ligamentization and revascularization at 2 years after the “tension suspension” remnant-preserving reconstruction was better than that of non-remnant-preserving anatomic reconstruction.
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Affiliation(s)
- Yijia Sun
- Clinical College of the Second Shenzhen Hospital, Anhui Medical University, Shenzhen 518025, China
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Zirong Huang
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou 511436, China
| | - Pingquan Zhang
- Clinical College of the Second Shenzhen Hospital, Anhui Medical University, Shenzhen 518025, China
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Huanyu Xie
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Chen Wang
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Zhenhan Deng
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Kang Chen
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
- Correspondence: (K.C.); (W.Z.)
| | - Weimin Zhu
- Clinical College of the Second Shenzhen Hospital, Anhui Medical University, Shenzhen 518025, China
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
- Correspondence: (K.C.); (W.Z.)
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Bouguennec N, Thaunat M, Barth J, Cavaignac E, Gunepin FX, Letartre R, Netten A, Pujol N, Rousseau T, Sbihi J, Mouton C, Sfa TFAS. Consensus statement on data to be entered in the ACL tear registry: SFA-DataLake. Orthop Traumatol Surg Res 2022; 108:103392. [PMID: 36064107 DOI: 10.1016/j.otsr.2022.103392] [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: 05/26/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction is a frequent procedure, with room for improvement by rehabilitation measures and associated peripheral and meniscal surgeries that are currently under assessment, requiring follow-up. Outside France, there have been ACL registries for 20 years now. The French Arthroscopy Society (SFA) decided to set up an ACL tear registry within its SFA DataLake registry platform. MATERIAL AND METHOD This article presents the methodology underlying the ACL Tear Registry: i.e., identification, definition and coding of essential and relevant data. A test phase comprised an initial assessment to improve data quality and overall coherence, to optimize data-entry time for patients and practitioners, who are the guarantors of the registry's use and efficacy. RESULTS The SFA DataLake ACL Tear Registry was made available to SFA members in December 2021. It aims to enable a review of practices for surgeons, early detection of failure of procedures and implants, with rates of failure and abnormal complications, and identification of prognostic factors for outcome, especially regarding original items that do not figure in previous registries. CONCLUSION SFA DataLake strikes a balance between "indispensable" and "original" items. The choice of contents and data quality is founded on a robust methodology with overall coherence, enabling analysis of large cohorts and comparisons with the literature and other registries. However, it remains to assess rates of data entry and item relevance as the Registry progresses. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Mathieu Thaunat
- Ramsay santé, centre orthopédique Santy, hôpital privé Jean-Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Johannes Barth
- Clinique des Cèdres, 21, avenue Albert-Londres, 38130 Échirolles, France
| | - Etienne Cavaignac
- Clinique universitaire du sport, 1, place du Docteur Joseph-Baylac, 31300 Toulouse, France
| | - François-Xavier Gunepin
- Clinique mutualiste de la porte de l'Orient, 3 rue Robert-de-La-Croix, 56100 Lorient, France
| | - Romain Letartre
- Ramsay santé, hôpital privé la Louvière, 126, rue de la Louvière, 59800 Lille, France
| | | | - Nicolas Pujol
- Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Thomas Rousseau
- Clinique mutualiste catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - Jaafar Sbihi
- Clinique Juge, 116, rue J.-Mermoz, 13008 Marseille, France
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, centre hospitalier Luxembourg, clinique d'Eich, Luxembourg, Luxembourg
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11
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Franciozi CE, Minami FK, Ambra LF, Galvão PHSAF, Schumacher FC, Kubota MS. Remnant preserving ACL reconstruction with a functional remnant is related to improved laxity but not to improved clinical outcomes in comparison to a nonfunctional remnant. Knee Surg Sports Traumatol Arthrosc 2022; 30:1543-1551. [PMID: 33893826 DOI: 10.1007/s00167-021-06572-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The Anterior cruciate ligament (ACL) remnant has been pointed out as a ligamentization enhancer. Nonetheless, the remaining tissue can be functional if it still provides some stability or nonfunctional. This study intends to compare the clinical results and knee stability of functional vs. nonfunctional remnant preservation ACL reconstruction (ACLR). METHODS One hundred and seventy-five patients with ACL injuries were included and underwent remnant preservation ACLR. They were divided into two groups accordingly to remnant tissue functionality: functional (Group F) and nonfunctional (Group NF). Primary outcome was defined as patient reported outcomes measured with Lysholm, IKDC and Tegner continuous scales and improvements. Secondary outcomes comprised of Lachman test, anterior drawer test, pivot shift test, extension and flexion deficit, graft coverage by remnant preserved tissue and failure rate (persistent instability or new ACL lesion). Menisci lesions, cartilage lesions and time to surgery were also recorded for each group. RESULTS One hundred and forty-four patients were available at a mean of 30.2 ± 10.1 months: 69 Functional and 75 Nonfunctional. Lysholm, IKDC and Tegner functional outcomes demonstrated no difference between the groups, Functional compared to Nonfunctional: 88.4 ± 10.5 vs. 92.2 ± 4.9, n.s. and 83.2 ± 11.3 vs. 87 ± 5.3, n.s. and 6 (5-10) vs. 6 (5-9), n.s., respectively. Lysholm and IKDC functional outcomes improvements demonstrated differences between the groups: Functional compared to Nonfunctional (39.3 ± 9.4 vs. 42.3 ± 7.4, p = 0.014 and 37.7 ± 10 vs. 41.0 ± 6.6, p = 0.032); however, they were not clinically significant. Functional group showed more stability on physical examination pre- and post-operatively (p < 0.001, p < 0.001). There was no difference regarding extension deficit (n.s.); however, functional group had more flexion deficit (p = 0.02). Nonfunctional group had better graft coverage (p = 0.001). There was no difference regarding failure rate: 4% vs. 9%, (n.s.). CONCLUSION Both remnant preservation ACLR techniques were able to achieve satisfactory functional outcomes. A functional remnant was not related to improved functional outcomes in comparison to a nonfunctional remnant; however, it was related to less laxity pre and postoperatively and inferior graft coverage. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Carlos Eduardo Franciozi
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil.,Knee Institute - Heart Hospital (Hospital do Coração - Hcor), São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Flávio Kazuo Minami
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil.
| | - Luiz Felipe Ambra
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Pedro Henrique Schmidt Alves Ferreira Galvão
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Felipe Conrado Schumacher
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Marcelo Seiji Kubota
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
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12
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van Keulen LZ, Hoogeslag RAG, Brouwer RW, Huis In 't Veld R, Verdonschot N. The importance of continuous remnant preservation in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1818-1827. [PMID: 34596694 DOI: 10.1007/s00167-021-06746-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Selective anteromedial or posterolateral bundle reconstruction is recognized as a treatment modality in partial anterior cruciate ligament (ACL) reconstruction (ACLR) with a biomechanically sufficient ACL remnant. However, there is paucity in literature investigating clinical outcomes of standard ACLR with preservation of residual continuous but biomechanically insufficient ACL tissue. The aim of this study was to investigate the influence of preservation of residual continuous but biomechanical insufficient ACL tissue in standard ACLR on complication and repeat surgery rate, and patient reported and clinical outcome. METHODS The retrospective cohort comprised 134 patients (age 23 ± 7 years; Tegner 6 ± 3) with an isolated acute ACL tear. In 67 patients, residual continuous but biomechanically insufficient ACL tissue was present and preserved based on visual inspection, probing of the ACL tissue and Lachman test under arthroscopic view (standard reconstruction with tissue preservation; SRTP). These patients were matched to 67 patients that underwent ACLR where no residual ACL tissue could be preserved (standard reconstruction; SR) based on gender, age and chondral and/or meniscal status. Clinical failure (recurrent instability, pathological ACL graft laxity and/or ACL graft discontinuity), other complication and repeat-surgery rate within index surgery and 1-year and within index surgery and 2-year follow-up, and patient reported and clinical outcomes at 1-year and at 2-year follow-up were compared. RESULTS A statistically significant lower clinical failure rate within index surgery and 1-year (SRTP, 3%; SR, 13%; P = 0.028) and within index surgery and 2-year follow-up (SRTP, 3%; SR, 23%; P = 0.001), and revision ACL surgery rate within index surgery and 1-year (SRTP, 2%; ST, 10%; P = 0.029) and within index surgery and 2-year follow-up (SRTP, 2%; SR, 18%; P = 0.001) was found in the SRTP group. No statistically significant differences were found for other investigated outcomes in patients that were without clinical failure. CONCLUSION This study shows that in ACLR surgery, preservation of residual continuous but biomechanical insufficient ACL tissue might lead to lower clinical failure rate and ACL revision surgery rate within index surgery and 1-year, and within index surgery and 2-year follow-up compared to standard ACLR where no residual continuous ACL tissue could be preserved. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L Z van Keulen
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Geerdinksweg 141, 7555 DL, Hengelo, The Netherlands
| | - R A G Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Geerdinksweg 141, 7555 DL, Hengelo, The Netherlands.
| | - R W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - R Huis In 't Veld
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Geerdinksweg 141, 7555 DL, Hengelo, The Netherlands.,Strategic Business Development, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - N Verdonschot
- Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Enschede, The Netherlands.,Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen, The Netherlands
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13
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Cho E, Chen J, Xu C, Zhao J. Remnant preservation may improve proprioception after anterior cruciate ligament reconstruction. J Orthop Traumatol 2022; 23:22. [PMID: 35478294 PMCID: PMC9046482 DOI: 10.1186/s10195-022-00641-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 04/10/2022] [Indexed: 01/12/2023] Open
Abstract
Aim Our aim was to evaluate the literature investigating proprioception improvement after anterior cruciate ligament reconstruction (ACLR) and test the hypothesis that ACL tibial remnant-preserving reconstruction (ACLR-R) is more beneficial than standard technique (ACLR-S) in terms of postoperative proprioceptive function with various reported tests, including joint position sense (JPS) and threshold to detect passive motion (TTDPM). Methods An online search was performed in Embase, MEDLINE/PubMed, Cochrane, SPORTDiscus, and Web of Science databases before 5 October 2020, on the basis of the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Key terms [(‘ACLR’ or ‘ACL-R’ or ‘anterior cruciate ligament reconstruction’) AND (‘remnant’ or ‘stump’) AND (‘proprioception’ or ‘proprioceptive’)] were used. The Oxford Centre for Evidence-Based Medicine and The McMaster Critical Review Form for Quantitative Studies were used for quality assessment. In total, four articles comparing proprioceptive functions between ACLR-R and ACLR-S were included, two of which were randomized clinical trials rated as level of evidence II, and two were retrospective cohort studies rated as level of evidence III. The outcomes were then compared. Evaluation of proprioception involved joint position sense (JPS) [reproduction of active positioning (RAP) and reproduction of passive positioning (RPP)] and threshold to detect passive motion (TTDPM) tests. Results Only four studies were included, with a total of 234 patients (119 ACLR-R patients and 115 ACLR-S patients). High heterogeneity in characteristics and outcome measurements was observed among the studies. Three studies performed sparing technique, and one performed tensioning technique. One study tested RAP and reported better results at an average of 7 months follow-up in ACLR-R (P < 0.05). Three studies tested RPP, one of which measured RPP within 12 months after surgery and reported better results in ACLR-R than in ACLR-S (P < 0.05). The other two studies reported similar results; however, the findings of one study were statistically insignificant. TTDPM was tested in one study, with no statistically significant difference found. Conclusion The current literature, although limited, reported proprioception improvement after ACLR-R (compared with ACLR-S) in terms of JPS. However, owing to the heterogeneity of the relevant studies, further research is required to determine remnant preservation effect on knee proprioceptive restoration. Level of evidence Level III, systematic review of Level II and III studies.
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Affiliation(s)
- Eunshinae Cho
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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14
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Asai K, Nakase J, Yoshimizu R, Kimura M, Tsuchiya H. Does remnant tissue preservation in anterior cruciate ligament reconstruction influence the creation of the rectangular femoral tunnel? J Orthop Surg (Hong Kong) 2022; 29:23094990211061249. [PMID: 34893002 DOI: 10.1177/23094990211061249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE We have previously described anterior cruciate ligament reconstruction with a rounded rectangular femoral tunnel created using a rounded rectangular dilator designed to enable a more anatomical and wider tendon-bone junction. However, the influence of remnant tissue preservation on the creation of the rounded rectangular femoral tunnel is not clear. This study aimed to evaluate the influence of remnant tissue preservation on the creation of the rounded rectangular femoral tunnel. METHODS A total of 198 patients who underwent primary anterior cruciate ligament reconstruction with a rounded rectangular femoral tunnel were evaluated retrospectively. Patients were categorized into a remnant preservation group (group P) and a non-preservation group (group N). Computed tomography images taken 1 week postoperatively were analyzed. The location of the rounded rectangular femoral tunnel evaluated using the quadrant method, its rotation angle, and the graft bending angle were compared between the two groups. The differences and the variance in femoral tunnel assessment were compared using the two-sample t-test and Levene's test. RESULTS Although there was no significant difference in the location of femoral tunnel for the deep/shallow direction along the Blumensaat's line (difference, p = .326; variances, p = .970), the tunnel was significantly lower in group P than in group N, with no variances (difference, p = .001; variances, p = .326). There were no significant differences and no variances in the tunnel rotation angle and the graft bending angle (difference, p = .727 and 0.514, respectively; variances, p = .827 and .445, respectively). Blow out of the posterior wall of the medial aspect of the femoral lateral condyle was an intraoperative complication that occurred in one case in group N. CONCLUSION The remnant preservation approach creates a lower femoral tunnel compared to the non-preservation technique. However, a rounded rectangular femoral tunnel can be created safely and is reproducible with remnant tissue preservation.
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Affiliation(s)
- Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa UniversityKanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa UniversityKanazawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa UniversityKanazawa, Japan
| | - Mitsuhiro Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa UniversityKanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa UniversityKanazawa, Japan
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15
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Suh DW, Yeo WJ, Han SB, So SY, Kyung BS. Remnant preservation with tensioning can improve the clinical outcome after anterior cruciate ligament reconstruction. J Orthop Surg (Hong Kong) 2022; 30:23094990211073378. [PMID: 35007179 DOI: 10.1177/23094990211073378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many studies exist about remnant preservation in anterior cruciate ligament (ACL) reconstruction. However, concern remains for development of a cyclops lesion during remnant preservation. To prevent this, a tensioning method has been suggested. Current study evaluated the clinical and radiologic results of remnant preservation in ACL reconstruction with tensioning compared to classical ACL reconstruction. METHODS From January 2016 to June 2017, ACL reconstruction patients who underwent magnetic resonance imaging (MRI) 2 years postoperatively were enrolled. For comparison, all participants were divided in two groups: remnant preservation with tensioning (group R) and controls (group C). Clinically, Hospital for Special Surgery (HSS), International Knee Documentation Committee (IKDC), Lysholm scores, and incidence of symptomatic cyclops lesions were evaluated. Radiologically, signal-to-noise quotient (SNQ) and size of the synovium on MRI as well as anterior instability in Telos stress radiographs were evaluated. RESULTS A total of 64 patients were enrolled (42 in group R and 22 in group C). The IKDC score in group R (70) was better than that in group C (62; p < 0.05). One patient in group R had a cyclops lesion with clinical symptoms and arthroscopic excision was recommended. Radiologically, the SNQ, synovium area, and anterior instability on Telos radiography showed no difference between the two groups. CONCLUSION Remnant preservation with tensioning is a good option for ACL reconstruction without the development of a cyclops lesion.
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Affiliation(s)
- Dong Won Suh
- Joint Center, 392315Barunsesang Hospital, Seongnam, Korea
| | - Woo Jin Yeo
- Joint Center, 392315Barunsesang Hospital, Seongnam, Korea
| | - Seung Beom Han
- Department of Orthopedic Surgery, 37997Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang-Yeon So
- Joint Center, 392315Barunsesang Hospital, Seongnam, Korea
| | - Bong Soo Kyung
- Joint Center, 392315Barunsesang Hospital, Seongnam, Korea
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16
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Remnants-preserving ACL reconstruction using direct tendinous graft fixation: a new rat model. J Orthop Surg Res 2022; 17:7. [PMID: 34986843 PMCID: PMC8729105 DOI: 10.1186/s13018-021-02890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) repair techniques are new emerging strategies prevailing, in selected cases, over standard reconstruction of the ACL with excision of its remnants. Mid-substance ACL tears represent a challenge for ACL repair techniques, and remnants-preserving ACL reconstruction (rp-ACLR) using an autograft remains the recommended treatment in this situation. However, morbidity associated with the autograft harvesting prompts the need for alternative surgical strategies based on the use of synthetic scaffolds. Relevant small animal models of mid-substance tears with ACL remnants preservation and reconstruction are necessary to establish the preliminary proof of concept of these new strategies. METHODS A rat model of rp-ACLR using a tendinous autograft after complete mid-substance ACL transection was established. Twelve weeks following surgery, clinical outcomes and knee joints were assessed through visual gait analysis, Lachman tests, thigh perimeter measurements, magnetic resonance imaging, micro-computed tomography, and histology, to evaluate the morbidity of the procedure, accuracy of bone tunnel positioning, ACL remnants fate, osteoarthritis, and autograft bony integration. Results were compared with those obtained with isolated ACL transection without reconstruction and to right non-operated knees. RESULTS AND DISCUSSION Most operated animals were weight-bearing the day following surgery, and no adverse inflammatory reaction has been observed for the whole duration of the study. Autograft fixation with cortical screws provided effective graft anchorage until sacrifice. Healing of the transected ACL was not observed in the animals in which no graft reconstruction was performed. rp-ACLR was associated with a reduced degeneration of the ACL remnants (p = 0.004) and cartilages (p = 0.0437). Joint effusion and synovitis were significantly lower in the reconstructed group compared to the transected ACL group (p = 0.004). Most of the bone tunnel apertures were anatomically positioned in the coronal and/or sagittal plane. The most deviated bone tunnel apertures were the tibial ones, located in median less than 1 mm posteriorly to anatomical ACL footprint center. CONCLUSION This study presents a cost-effective, new relevant and objective rat model associated with low morbidity for the preliminary study of bio-implantable materials designed for remnants-preserving ACL surgery after mid-substance ACL tear.
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17
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Takahashi T, Watanabe S, Ito T. Current and future of anterior cruciate ligament reconstruction techniques. World J Meta-Anal 2021; 9:411-437. [DOI: 10.13105/wjma.v9.i5.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/09/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
In recent years, anterior cruciate ligament (ACL) reconstruction has generally yielded favorable outcomes. However, ACL reconstruction has not provided satisfactory results in terms of the rate of returning to sports and prevention of osteoarthritis (OA) progression. In this paper, we outline current techniques for ACL reconstruction such as graft materials, double-bundle or single-bundle reconstruction, femoral tunnel drilling, all-inside technique, graft fixation, preservation of remnant, anterolateral ligament reconstruction, ACL repair, revision surgery, treatment for ACL injury with OA and problems, and discuss expected future trends. To enable many more orthopedic surgeons to achieve excellent ACL reconstruction outcomes with less invasive surgery, further studies aimed at improving surgical techniques are warranted. Further development of biological augmentation and robotic surgery technologies for ACL reconstruction is also required.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Sports and Health Science, Ehime University, Matsuyama 790-8577, Ehime, Japan
| | - Seiji Watanabe
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan
| | - Toshio Ito
- Department of Orthopaedic Surgery, Murakami Memorial Hospital, Saijo 793-0030, Ehime, Japan
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18
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Yao S, Fu BSC, Yung PSH. Graft healing after anterior cruciate ligament reconstruction (ACLR). ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 25:8-15. [PMID: 34094881 PMCID: PMC8134949 DOI: 10.1016/j.asmart.2021.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/05/2021] [Accepted: 03/21/2021] [Indexed: 01/11/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure in Orthopaedic sports medicine. With advances in surgical techniques providing better positioning and fixation of the graft, subsequent graft failure to certain extent should be accounted by poor graft healing. Although different biological modulations for enhancement of graft healing have been tried in different clinical and animal studies, complete graft incorporation into bone tunnels and the “ligamentization” of the intra-articular part have not been fully achieved yet. Based on the understanding of graft healing process and its failure mechanism, the purpose of this review is to combine both the known basic science & clinical evidence, to provide a much clearer picture of the obstacle encountered in graft healing, so as to facilitate researchers on subsequent work on the enhancement of ACL graft healing.
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Affiliation(s)
- Shiyi Yao
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Bruma Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
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19
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Webster KE, Murgier J, Feller JA, Klemm HJ, Devitt BM, Whitehead TS. Preservation of the Tibial Stump During Anterior Cruciate Ligament Reconstruction Surgery Did Not Increase the Rate of Surgery for Symptomatic Cyclops Lesions. Orthop J Sports Med 2021; 9:2325967121992517. [PMID: 33889640 PMCID: PMC8040594 DOI: 10.1177/2325967121992517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/24/2020] [Indexed: 01/12/2023] Open
Abstract
Background Preservation of the tibial stump during anterior cruciate ligament reconstruction (ACLR) is controversial. While proposed benefits include enhanced graft revascularization, improved proprioception, and decreased graft rupture rates, a potential complication is the development of a symptomatic cyclops lesion. It is therefore important to determine whether any benefits outweigh potential complications. Purpose To determine whether greater preservation of the tibial stump remnant would be associated with a decreased graft rupture rate without a concomitant increase in the rate of surgery for symptomatic cyclops lesions at 2 years after ACLR. Study Design Cohort study; Level of evidence, 3. Methods A cohort of 658 patients in whom the amount of tibial stump preserved was classified as no stump (n = 228), <50% (n = 342), or >50% (n = 88) was followed up for 2 years, with graft ruptures and surgical treatment for cyclops lesions recorded. Contingency and Kaplan-Meier survival analyses were used to determine trends among the 3 remnant preservation groups in terms of graft rupture rates and surgery for cyclops lesions. Subgroup analysis was also conducted to examine sex-based differences. Results There was no significant association between graft rupture rates and remnant preservation. There was a significant trend for fewer operations for symptomatic cyclops lesions with greater remnant preservation when the entire cohort was analyzed (P = .04) and also when only female patients were analyzed (P = .04). Conclusion Although preservation of the tibial stump remnant was not associated with a reduced graft rupture rate, it was also not associated with increased rates of surgery for symptomatic cyclops lesions.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Jerome Murgier
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Victoria, Australia.,Aguiléra Private Clinic, Ramsey Générale de Santé, Biarritz, France
| | - Julian A Feller
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,OrthoSport Victoria, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Haydn J Klemm
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Brian M Devitt
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Victoria, Australia
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Remnant preservation does not affect accuracy of tibial tunnel positioning in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:1157-1163. [PMID: 32602038 DOI: 10.1007/s00167-020-06125-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 06/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Remnant preservation, in anterior cruciate ligament (ACL) reconstruction, has potential biological advantages. However, graft positioning remains vital to functional outcome and the prevention of failure. The aim of this study was to investigate the accuracy and precision of tibial tunnel positioning in remnant preservation single-bundle hamstring reconstruction. METHODS Fifty consecutive adult patients, with isolated ACL rupture, were recruited to a prospective study. Remnant preservation was performed in all cases where > 25% of the native ACL was present. Three-dimensional computer tomography was preformed 3-6 months post-operatively to assess tibial tunnel position (using a grid-based measurement). Accuracy and precision of this technique were assessed against published anatomical data in direct comparison with the group where remnant preservation could not be performed. RESULTS Two patients withdrew following surgery. In the remaining groups (31 remnant preservation; 17 non-remnant preservation), no difference was demonstrated in tunnel position (40.4 ± 6.7% (anterior-to-posterior) and 47.4 ± 1.5% (medial-to-lateral) vs. 38.8 ± 4.9% and 46.7 ± 1.5%, respectively; n.s.), accuracy (6.1% vs. 4.8%; n.s.) or precision (3.9% vs. 2.8%; n.s.). CONCLUSIONS Remnant preservation can be safely performed without compromising tunnel position. Therefore, the potential benefits of this technique can be utilised, in clinical practice, without sacrificing the ability to optimize tibial tunnel positioning. LEVEL OF EVIDENCE III.
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21
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Tang J, Zhao J. Sandwich-Style Anterior Cruciate Ligament Reconstruction: Double-Bundle Anterior Cruciate Ligament Reconstruction With In-Between Remnant Preservation. Arthrosc Tech 2021; 10:e1095-e1102. [PMID: 33981556 PMCID: PMC8085440 DOI: 10.1016/j.eats.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/16/2020] [Indexed: 02/03/2023] Open
Abstract
Various degree of remnant tissues exists following anterior cruciate ligament (ACL) injury. Making use of these tissues may be helpful for the reconstructed ACL from many aspects. There are many methods of remnant preservation and use, as well as many types of combined ACL reconstruction. However, the most effective methods of remnant reuse as well as ACL reconstruction are still being pursued. We introduce an anatomical double-bundle transtibial ACL reconstruction with in-between remnant preservation technique named sandwich-style ACL reconstruction. The indication of this technique is complete ACL tear with a large volume of connectable remnant. The main tricks of this technique are proper ligation of the remnant, proper location of the anteromedial-bundle tibial tunnels, and passing the anteromedial bundle through the shallow side of the remnant. We believe the introduction of this technique will provide more options for remnant preservation and ACL reconstruction.
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Affiliation(s)
- Jin Tang
- Operating Theater, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China,Address correspondence to Shenyang Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
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Remnant-Preserving Anterior Cruciate Ligament Reconstruction: Remnant Envelope Technique. Arthrosc Tech 2020; 9:e1805-e1812. [PMID: 33294344 PMCID: PMC7695627 DOI: 10.1016/j.eats.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023] Open
Abstract
The awareness of anterior cruciate ligament (ACL) injuries and their treatment is increasing among athletes and within the general population, so patients report early to orthopaedic surgeons. Because we encounter a thick ACL stump during arthroscopic ACL reconstruction, an attempt is made to preserve this stump. Remnant preservation-although promising in terms of graft healing because it enhances cell proliferation, revascularization, and regeneration of the proprioceptive organs in the reconstructed ACL-does not come without complications, such as cyclops lesions, impingement, and extension loss. These problems can be detrimental to an athlete's return to his or her preinjury level after ACL reconstruction. Therefore, we describe a technique in which the ACL is reconstructed using hamstring autograft and suture passes are made through the remnant with an antegrade suture-passing device. After anatomic tunnel drilling, the remnant is tensioned, along with the reconstructed ACL, at the femoral end without the use of an extra implant. Femoral-side fixation is achieved with an adjustable-loop button (Procinch; Stryker) and a bio-composite interference screw (Biosure Regenesorb; Smith & Nephew) on the tibial end. As the sutured remnant is tensioned and knots are made over the button, the remnant envelopes the graft in the orientation of the native ACL, which can be helpful for early and better ligamentization of the graft. The potential advantages of this technique are as follows: orientation of the remnant along the collagen of the ACL graft; no loose ACL stump in the notch, thus preventing cyclops lesions; retention of the proprioceptive organs in the ligament; and no extra implant.
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Synovialization and Revascularization Enhancement in Repaired and Reconstructed ACL: PCL Fat Pad Transfer Technique. Arthrosc Tech 2020; 9:e1559-e1563. [PMID: 33134060 PMCID: PMC7587456 DOI: 10.1016/j.eats.2020.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/11/2020] [Indexed: 02/03/2023] Open
Abstract
The rapid development of anterior cruciate ligament (ACL) reconstruction and repair techniques has significantly improved the outcomes of these procedures. However, there is still some place for how to improve surgical techniques to limit the amount of revision surgeries. Over the past decade, biological solutions and methods of ligament remodeling enhancement have been proposed. The use of the native ACL remnants has been the most thoroughly analyzed technique. However, despite its benefits, this technique may not to be sufficient to improve outcomes and may cause some technical difficulties. On the other hand, the posterior cruciate ligament (PCL) fat pad contains an abundant synovial vascular network and is located in close proximity to the ACL, which makes it a potential biological donor place of cells and tissue that could enhance the ligamentization of the repaired or reconstructed ACL. To optimize the use of this donor site, we propose the technique of ACL synovialization and revascularization enhancement with a PCL fat pad transfer.
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Su C, Kuang SD, Liu WJ, Li YS, Xiong YL, Zhao X, Gao SG. Clinical Outcome of Remnant-Preserving and I.D.E.A.L. Femoral Tunnel Technique for Anterior Cruciate Ligament Reconstruction. Orthop Surg 2020; 12:1693-1702. [PMID: 32975048 PMCID: PMC7767774 DOI: 10.1111/os.12791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/09/2020] [Accepted: 08/02/2020] [Indexed: 12/03/2022] Open
Abstract
Objective To assess the clinical results of the remnant‐preserving and I.D.E.A.L. femoral tunnel technique in the arthroscopic treatment of anterior cruciate ligament (ACL) injuries. Methods This was a retrospective single‐center, single‐surgeon study reviewing data from November 2016 to March 2019. Based on our inclusion/exclusion criteria, a total of 31 patients (18 males, 13 females; mean age, 23.6 years) who underwent arthroscopic ACL reconstruction with the remnant preservation and I.D.E.A.L. femoral tunnel technique were recruited and had a minimum follow‐up of 12 months. Clinical data and status of knee stability were recorded. The International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale were collected both preoperatively and at a minimum of 1‐year follow‐up. Results Statistically significant differences were detected between the preoperative and postoperative values for Lachman test and pivot‐shift test (P < 0.01). The mean postoperative Lysholm score was 89.6 ± 9.4, whereas the mean preoperative Lysholm score was 47.3 ± 12.8 (P < 0.01). The mean Tegner activity score was significantly higher at postoperative evaluation than at preoperative evaluation (6.5 ± 2.1 vs 2.6 ± 1.8; P < 0.01). The mean IKDC score was significantly improved from 49.5 ± 10.6 preoperatively to 88.2 ± 10.7 postoperatively (P < 0.01). No case of infection was reported. No radiograph showed any joint space narrowing or degenerative change at the last postsurgical follow‐up. Conclusion The anatomical remnant‐preserving and I.D.E.A.L. femoral tunnel technique achieves a satisfactory clinical outcome and provides an effective option for the treatment of ACL injuries.
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Affiliation(s)
- Chao Su
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shi-da Kuang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Wei-Jie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yu-Sheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xin Zhao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-Guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.,Hunan Engineering Research Center of Osteoarthritis, Changsha, China.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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