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Selcuk H, Baz AB, Egerci OF, Kose O. Peroneus longus tendon autograft versus allograft in revision ACLR: A retrospective comparison. Orthop Traumatol Surg Res 2024; 110:103775. [PMID: 38013008 DOI: 10.1016/j.otsr.2023.103775] [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: 03/21/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE The use of peroneus longus tendon (PLT) autografts in primary anterior cruciate ligament reconstruction (ACLR) has increased recently, but there is a lack of research on its use in revision ACLR. This study aimed to compare the clinical outcomes and complications between revision ACLR using allografts and PLT autografts. MATERIALS AND METHODS Fifty-nine patients who underwent arthroscopic revision of ACLR with complete clinical follow-ups between 2012 and 2021 were retrospectively reviewed. Allograft was used in 44 of these patients, and PLT autograft was used in 15 of them. Lysholm knee score, Tegner activity score, Lachman, and anterior drawer tests were performed after a mean follow-up of 60months (range: 19-116). The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to evaluate the donor ankle functions. Clinical outcomes and complications were compared between groups. RESULTS Both groups showed significantly improved functional outcomes compared to their preoperative assessments. However, both groups had similar clinical results at the final follow-up, including Lysholm knee score, Tegner activity scale, knee range of motion, return to sports, time to return to daily activities, and rate of re-rupture. No major complications were seen in any of the patients. The AOFAS score was 99.13±2.64 in the PLT autograft group without loss of ankle muscle strength, deformity, instability, and permanent iatrogenic neurovascular injuries. The cumulative cost of the allograft group was significantly higher than the PLT autograft group. CONCLUSIONS The PLT autograft might be an alternative autograft option to allografts due to similar clinical outcomes, low donor site morbidity, and reduced cost in ACLR revisions, especially if the primary ACLR was performed using grafts harvested around the knee. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Huseyin Selcuk
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey
| | - Ali Bulent Baz
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey.
| | - Omer Faruk Egerci
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey
| | - Ozkan Kose
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey
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Belk JW, Littlefield CP, Smith JRH, McCulloch PC, McCarty EC, Frank RM, Kraeutler MJ. Autograft Demonstrates Superior Outcomes for Revision Anterior Cruciate Ligament Reconstruction When Compared With Allograft: A Systematic Review. Am J Sports Med 2024; 52:859-867. [PMID: 36867049 DOI: 10.1177/03635465231152232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Multiple studies have compared outcomes among patients undergoing revision anterior cruciate ligament reconstruction (ACLR) with autograft versus allograft, but these data are inconsistently reported and long-term outcomes depending on graft type are yet to be determined. PURPOSE To perform a systematic review of clinical outcomes after revision ACLR (rACLR) with autograft versus allograft. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that compared the outcomes of patients undergoing rACLR with autograft versus allograft. The search phrase used was autograft allograft revision anterior cruciate ligament reconstruction. Graft rerupture rates, return-to-sports rates, anteroposterior laxity, and patient-reported outcome scores (subjective International Knee Documentation Committee, Tegner, Lysholm, and Knee injury and Osteoarthritis Outcome Score) were evaluated. RESULTS Eleven studies met inclusion criteria, including 3011 patients undergoing rACLR with autograft (mean age, 28.9 years) and 1238 patients undergoing rACLR with allograft (mean age, 28.0 years). Mean follow-up was 57.3 months. The most common autograft and allograft types were bone-patellar tendon-bone grafts. Overall, 6.2% of patients undergoing rACLR experienced graft retear, including 4.7% in the autograft group and 10.2% in the allograft group (P < .0001). Among studies that reported return-to-sports rates, 66.2% of patients with an autograft returned to sports as opposed to 45.3% of patients with an allograft (P = .01). Two studies found significantly greater postoperative knee laxity in the allograft group as compared with the autograft group (P < .05). Among all patient-reported outcomes, 1 study found 1 significant difference between groups: patients with an autograft had a significantly higher postoperative Lysholm score when compared with patients with an allograft. CONCLUSION Patients undergoing revision ACLR with an autograft can be expected to experience lower rates of graft retear, higher rates of return to sports, and less postoperative anteroposterior knee laxity when compared with patients undergoing revision ACLR with an allograft.
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Affiliation(s)
- John W Belk
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Eric C McCarty
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rachel M Frank
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
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Boksh K, Sheikh N, Chong HH, Ghosh A, Aujla R. The Role of Anterolateral Ligament Reconstruction or Lateral Extra-articular Tenodesis for Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Comparative Clinical Studies. Am J Sports Med 2024; 52:269-285. [PMID: 36960926 DOI: 10.1177/03635465231157377] [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] [Indexed: 03/25/2023]
Abstract
BACKGROUND After its success in restoring rotational stability and reducing failure rates in primary anterior cruciate ligament reconstruction (ACLR), lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALLR) has been endorsed for use in revision ACLR surgery, where failure rates are historically higher. PURPOSE To perform a systematic review and meta-analysis on whether the addition of a LET or ALLR results in superior clinical outcomes and stability compared with isolated revision ACLR (iACLR). STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis of comparative studies using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: ("extra-articular" OR "tenodesis" OR "anterolateral ligament" OR "iliotibial") AND ("anterior cruciate ligament") AND ("revision" OR "re-operation"). Data pertaining to all patient-reported outcome measures (PROMs), rotational stability, and postoperative complications were extracted from each study. RESULTS After abstract and full-text screening, 10 clinical comparative studies were included. There were 793 patients, of whom 390 had an iACLR while 403 had an ACLR augmented with a LET or an ALLR (augmented ACLR [aACLR]). The mean time for assessment of PROMs was 35 months. The aACLR group had superior International Knee Documentation Committee (IKDC) scores (standardized mean difference [SMD], 0.27; 95% CI, 0.01 to 0.54; P = .04), rotational stability (odds ratio [OR], 2.77; 95% CI, 1.91 to 4.01; P < .00001), and lower side-to-side difference (OR, -0.53; 95% CI, -0.81 to -0.24; P = .0003) than those without the augmentation. Furthermore, they were less likely to fail (OR, 0.44; 95% CI, 0.24 to 0.80; P = .007). Subgroup analysis in the higher-grade laxity cohort (grade ≥2) revealed an even greater IKDC score (SMD, 0.51; 95% CI, 0.16 to 0.86; P = .005) and an improved Lysholm score (SMD, 0.45; 95% CI, 0.24 to 0.67; P < .0001) in the aACLR group. CONCLUSION Revision aACLR with a LET or an ALLR can improve subjective IKDC scores, restore rotational stability, and reduce failure rates compared with iACLR. Although controversy remains on the necessity of augmenting all revision ACLRs, the present meta-analysis advocates adding a lateral procedure, particularly in those with a higher-grade pivot shift.
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Affiliation(s)
- Khalis Boksh
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nomaan Sheikh
- Department of Trauma and Orthopaedics, Kettering General Hospital, Kettering, UK
| | - Han Hong Chong
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Arijit Ghosh
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Randeep Aujla
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
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Abou Al Ezz M, Gerometta A, Valentin E, Meyer A, Grimaud O, Lefevre N, Bohu Y, Hardy A. Comparison of Revision ACL Reconstruction Using Iliotibial Band Augmented With Allograft Versus Bone-Patellar Tendon-Bone Autograft With Lateral Extra-articular Tenodesis. Orthop J Sports Med 2023; 11:23259671231214803. [PMID: 38107845 PMCID: PMC10722940 DOI: 10.1177/23259671231214803] [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: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 12/19/2023] Open
Abstract
Background Bone-patellar tendon-bone (BTB) anterior cruciate ligament reconstruction (ACLR) is one of the conventional techniques in the revision setting especially after a primary hamstring tendon graft. The use of the iliotibial band (ITB) augmented with allograft (AG) is an encouraging graft alternative for ACLR in terms of clinical and biomechanical data in the literature. Purpose To compare the clinical outcomes of BTB graft with lateral extra-articular tenodesis, modified Lemaire (BTB-LET), and an ITB graft augmented with hamstring AG (ITB-AG) in the setting of revision ACLR. Study Design Cohort study; Level of evidence, 3. Methods Descriptive data and clinical outcomes were prospectively collected from patients who underwent revision ACLR with either the BTB-LET or ITB-AG technique between 2012 and 2020 and who had a minimum follow-up of 2 years. The clinical outcomes were assessed by the Lysholm, Tegner, Anterior Cruciate Ligament-Return to Sport after Injury, International Knee Documentation Committee subjective knee evaluation form, and Knee injury and Osteoarthritis Outcome Score. Return to sports, complications, and revisions were also analyzed. Results A total of 167 patients were included, with 106 patients in the BTB-LET group and 61 patients in the ITB-AG group. There were no significant group differences in sociodemographic characteristics; however, the mean follow-up was significantly longer in the BTB-LET compared with the ITB-AG group (52.0 vs 38.8 months, respectively; P = .0001). There were no significant differences in postoperative outcome scores; however, patients in the ITB-AG group had a higher rate of return to competitive pivoting sports (32.8% vs 17.9%; P = .0288) and a higher overall rate of return to preinjury sport (63.9% vs 47.2%; P = .0365). Complications, including revisions for meniscal or chondral lesions and retears (8 [8.3%] in the BTB-LET group and 2 [4.0%] in the ITB-AG group), were not significantly different. All retears were due to sports-related accidents. Conclusion In this study, ITB-AG was not different from BTB-LET in terms of functional outcomes scores but allowed better return to sport rate. Performing ITB-AG reconstruction in the setting of revision ACLR appears to be safe, effective, and associated with a satisfying return-to-sports rate.
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Affiliation(s)
| | | | | | - Alain Meyer
- Clinique du Sport, Ramsay Santé, Paris, France
| | | | | | - Yohan Bohu
- Clinique du Sport, Ramsay Santé, Paris, France
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Lim S, Park KH, Park DY, Kim TH, Koh JH, Chung JY. Rotational stability can be enhanced in revision anterior cruciate ligament reconstruction using the over-the-top augmentation technique compared to single bundle technique. BMC Sports Sci Med Rehabil 2023; 15:111. [PMID: 37715268 PMCID: PMC10504798 DOI: 10.1186/s13102-023-00724-1] [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: 03/31/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE Revision anterior cruciate ligament (ACL) reconstruction is technically challenging due to mispositioned tunnels, bone loss, and tunnel enlargement, which may compromise graft fixation and result in failure. To obtain firm graft fixation and strength in one stage, we utilized an over-the-top augmentation technique using an Achilles tendon allograft in revision ACL reconstruction (OA-ACLR). This study compared OA-ACLR with single-bundle ACL reconstruction (SB-ACLR). We hypothesized that OA-ACLR would enhance the postoperative knee joint rotational stability. METHODS We retrospectively analyzed 47 patients who underwent revisional OA-ACLR and 48 who underwent primary SB-ACLR with minimum follow-up of 6 months. Knee instability was evaluated with the anterior drawer, Lachman, and pivot shift tests preoperatively and at the final follow-up. Side-to-side differences were compared with the non-affected side at the final follow-up. Function was evaluated using the IKDC subjective and Lysholm knee scores preoperatively and at the final follow-up. RESULTS The groups did not differ in terms of sex, age, BMI, and etiology. There were no significant differences in concomitant surgical procedures, such as meniscectomy and meniscus repair, between the two groups (p = 0.335, > 0.99). Both groups significantly improved in the anterior drawer, Lachman, pivot shift tests, and IKDC and Lysholm knee scores after surgery (all p < 0.001). The OA-ACLR group showed significantly higher rotational stability in the pivot shift test than the SB-ACLR group (p = 0.017). The postoperative side-to-side difference, the IKDC and Lysholm scores showed no significant differences between the groups (p = 0.34, 0.301, 0.438). CONCLUSIONS OA-ACLR showed enhanced rotational stability with pivot shift test compared to SB-ACLR. It may be considered a useful alternative for revision ACL reconstruction.
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Affiliation(s)
- Sumin Lim
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Ki-Hoon Park
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
- Daprtment of Orthopedic Surgery, Armed Forces Yangju Medical Center, Yangju-si, Korea
| | - Do Young Park
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Tae Hun Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Jeong-Hyun Koh
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea.
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Lee JK, Cho SI, Lee DW, Yang SJ, Kim TW, Kim JG. Additional Anterolateral Ligament Reconstruction Helps Patients Improve Dynamic Postural Stability in Revision Anterior Cruciate Ligament Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1242. [PMID: 37512054 PMCID: PMC10386532 DOI: 10.3390/medicina59071242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The goal in treating anterior cruciate ligament (ACL) injury especially in revision cases is return to sports activity by regaining dynamic postural stability. Among various methods to achieve this goal, additional anterolateral ligament reconstruction (ALLR) is gaining attention. The purpose of this study was to evaluate the effects of additional ALLR in revision ACL reconstruction (RACLR). Materials and Methods: Patients who underwent RACLR between July 2015 and June 2018 were enrolled. The exclusion criteria were less than 1-year follow-up, age older than 45 years, concomitant multiple ligament injuries, contralateral knee injury, subtotal or total meniscectomized state, and articular cartilage lesions worse than Outerbridge grade 3. Thirty-nine patients (20 patients; RACLR only (Group A), 19 patients; RACLR with additional ALLR (Group B)) were included. Clinical scores (Lysholm score, subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale), isokinetic strength test, single-leg-hop for distance test (SLHDT), Y-balance test (YBT) were checked preoperatively and 1-year postoperatively. Results: Limb symmetry index values in YBT showed significantly better result in Group B 1-year postoperatively (Group A: 97.2 ± 4.0, Group B: 100.3 ± 2.9, p = 0.010), although there were no differences preoperatively between groups (Group A: 90.4 ± 6.7, Group B: 89.3 ± 5.5, p = 0.594). Regarding clinical scores, isokinetic strength tests, and SLHDT, there were no differences between groups preoperatively nor 1-year postoperatively. Conclusions: Additional ALLR in RACLR helped patients gain better dynamic postural stability at 1-year postoperative follow-up.
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Affiliation(s)
- Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Seung-Ik Cho
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Dhong-Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Sang-Jin Yang
- Department of Health & Exercise Management, Tongwon University, Gwangju-si 12813, Republic of Korea
| | - Tae-Wook Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Jin-Goo Kim
- Department of Orthopaedic Surgery, Myong-Ji Hospital, Goyang-si 10475, Republic of Korea
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Lin L, Wang HJ, Wang YJ, Wang J, Chen YR, Yu JK. Comparison of the Clinical Outcomes of Revision and Primary ACL Reconstruction: A Matched-Pair Analysis With 3-5 Years of Follow-up. Am J Sports Med 2023; 51:634-641. [PMID: 36734479 DOI: 10.1177/03635465221148746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are limited studies designed by matching related factors to compare clinical outcomes and return to sport (RTS) between patients undergoing revision anterior cruciate ligament reconstruction (R-ACLR) and primary ACLR (P-ACLR). PURPOSE (1) To compare the outcomes between R-ACLR and P-ACLR in a matched-pair analysis with 3- to 5-year follow-up and (2) to evaluate patient-reported factors for not returning to preinjury-level sport. STUDY DESIGN Cohort study; Level of evidence, 4. METHODS Patients who underwent R-ACLR between September 2016 and November 2018 were propensity matched by age, sex, body mass index, passive anterior tibial subluxation, and generalized hypermobility in a 1:1 ratio to patients who underwent P-ACLR during the same period. By combining in person follow-up at 2 years postoperatively and telemedicine interview at the final follow-up (January 2022), knee stability and clinical scores were compared, including International Knee Documentation Committee (IKDC), Lysholm, and Tegner. Status of RTS was requested, specifically whether the patient returned to preinjury level of sport. Patient-reported reasons for not returning were analyzed. RESULTS There were 63 matched pairs in the present study. Knee stability was similar in terms of KT-2000 arthrometer, Lachman test, and pivot-shift test results between the groups at 2 years of follow-up. At the final follow-up, no significant difference was found between groups for postoperative clinical scores (IKDC, Tegner, and Lysholm) (P > .05). There was a significant difference in total RTS: 53 (84.1%) in the P-ACLR cohort and 41 (65.1%) in the R-ACLR cohort (P = .014). No significant difference was shown in terms of RTS at the same level: 35 (55.6%) in P-ACLR and 31 (49.2%) in R-ACLR (P = .476). Significantly more patients showed fear of reinjury: 26 of 32 (81.3%) in the R-ACLR group as compared with 15 of 28 (53.5%) in the P-ACLR group (P < .021). CONCLUSION R-ACLR resulted in similar clinical scores (IKDC, Tegner, and Lysholm) but significantly lower RTS versus P-ACLR at 3 to 5 years of follow-up. Fear of reinjury was the most common factor that caused sport changes in patients with R-ACLR.
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Affiliation(s)
- Lin Lin
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Hai-Jun Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Yong-Jian Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Jian Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - You-Rong Chen
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
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Li X, Yan L, Li D, Fan Z, Liu H, Wang G, Jiu J, Yang Z, Li JJ, Wang B. Failure modes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2023; 47:719-734. [PMID: 36642768 DOI: 10.1007/s00264-023-05687-z] [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: 10/01/2022] [Accepted: 01/01/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE The reason for graft failure after anterior cruciate ligament reconstruction (ACLR) is multifactorial. Controversies remain regarding the predominant factor and incidence of failure aetiology in the literature. This review aimed to provide a meta-analysis of the literature to evaluate the relative proportion of various failure modes among patients with ACLR failure. METHODS The PubMed, Embase, Cochrane Library, Web of Science, and EBSCO databases were searched for literature on ACLR failure or revision from 1975 to 2021. Data related to causes for ACLR surgical failure were extracted, and a random effects model was used to pool the results, which incorporates potential heterogeneity. Failure modes were compared between different populations, research methods, graft types, femoral portal techniques, and fixation methods by subgroup analysis or linear regression. Funnel plots were used to identify publication bias and small-study effects. RESULTS A total of 39 studies were analyzed, including 33 cohort studies and six registry-based studies reporting 6578 failures. The results showed that among patients with ACLR failure or revision, traumatic reinjury was the most common failure mode with a rate of 40% (95% CI: 35-44%), followed by technical error (34%, 95% CI: 28-42%) and biological failure (11%, 95% CI: 7-15%). Femoral tunnel malposition was the most common cause of the technical error (29%, 95% CI: 18-41%), with more than two times higher occurrence than tibial tunnel malposition (11%, 95% CI: 6-16%). Traumatic reinjury was the most common factor for ACLR failure in European populations and in recent studies, while technical errors were more common in Asian populations, earlier studies, and surgery performed using the transtibial (TT) portal technique. Biological factors were more likely to result in ACLR failure in hamstring (HT) autografts compared to bone-patellar tendon-bone (BPTB) autografts. CONCLUSION Trauma is the most important factor leading to surgical failure or revision following ACLR. Technical error is also an important contributing factor, with femoral tunnel malposition being the leading cause of error resulting in failure.
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Affiliation(s)
- Xiaoke Li
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lei Yan
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Dijun Li
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Zijuan Fan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Haifeng Liu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Guishan Wang
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, China
| | - Jingwei Jiu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Ziquan Yang
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China.
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
| | - Bin Wang
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China.
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Wright RW, Huston LJ, Haas AK, Pennings JS, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study. Am J Sports Med 2023; 51:605-614. [PMID: 36734487 PMCID: PMC10338044 DOI: 10.1177/03635465231151389] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction. PURPOSE To determine if meniscal and/or articular cartilage pathology at the time of revision ACL surgery significantly influences a patient's outcome at 6-year follow-up. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients undergoing revision ACL reconstruction were prospectively enrolled between 2006 and 2011. Data collection included baseline demographics, surgical technique, pathology, treatment, and scores from 4 validated patient-reported outcome instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx Activity Rating Scale. Patients were followed up at 6 years and asked to complete the identical set of outcome instruments. Regression analysis assessed the meniscal and articular cartilage pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction. RESULTS An overall 1234 patients were enrolled (716 males, 58%; median age, 26 years). Surgeons reported the pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (43%), lateral femoral condyle (29%), medial tibial plateau (11%), lateral tibial plateau (17%), patella (30%), and trochlea (21%). Six-year follow-up was obtained on 79% of the sample (980/1234). Meniscal pathology and articular cartilage pathology (medial femoral condyle, lateral femoral condyle, lateral tibial plateau, trochlea, and patella) were significant drivers of poorer patient-reported outcomes at 6 years (IKDC, KOOS, WOMAC, and Marx). The most consistent factors driving outcomes were having a medial meniscal excision (either before or at the time of revision surgery) and patellofemoral articular cartilage pathology. Six-year Marx activity levels were negatively affected by having either a repair/excision of the medial meniscus (odds ratio range, 1.45-1.72; P≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; P = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation (P < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores (P < .05). Lower baseline outcome scores, higher body mass index, being a smoker, and incurring subsequent surgery all significantly increased the odds of reporting poorer clinical outcomes at 6 years. CONCLUSION Meniscal and chondral pathology at the time of revision ACL reconstruction has continued significant detrimental effects on patient-reported outcomes at 6 years after revision surgery.
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Affiliation(s)
| | | | - Amanda K Haas
- Washington University in St Louis, St Louis, Missouri, USA
| | | | | | | | | | | | | | | | | | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | | | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | | | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | | | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
| | | | | | | | | | - J Brad Butler
- Orthopedic and Fracture Clinic, Portland, Oregon, USA
| | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
| | | | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | | | - C Benjamin Ma
- University of California, San Francisco, California, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada
| | | | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | | | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | | | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
| | | | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | | | | | | | | | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA
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10
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Brinkman JC, Tummala SV, Moore ML, Economopoulos KJ. All-Soft Tissue Quadriceps Tendon Autograft in Revision Anterior Cruciate Ligament Reconstruction in Athletes: Comparison to Bone-Patellar Tendon-Bone Autograft With at Least a 2-Year Follow-up. Am J Sports Med 2022; 50:3770-3777. [PMID: 36285655 DOI: 10.1177/03635465221126523] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Revision anterior cruciate ligament (ACL) reconstruction is being performed at an increasing rate. Previous literature has suggested that autograft ACL reconstruction is a better option than allograft in revision surgery, although the optimal autograft choice remains unknown. The all-soft tissue quadriceps tendon (ASTQT) autograft has been found to be an effective option for primary ACL reconstruction. However, few studies have evaluated ASTQT autograft in revision ACL reconstruction. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the ASTQT autograft in revision ACL reconstruction in athletes compared with bone-patellar tendon-bone (BTB) autograft. We hypothesized that the ASTQT autograft would lead to similar return to play, time to return to play, retear rate, and patient-reported outcomes compared with BTB autograft. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective study was performed on all athletes undergoing revision ACL reconstruction between August 2013 and December 2019 at a single institution. Patients participating in high school or college athletics undergoing first-time revision with either ASTQT or BTB autograft with ≥2 years of follow-up were included. Demographic variables, complications, return to sports, and outcome scores including the International Knee Documentation Committee (IKDC) and Lysholm were collected and compared between the 2 cohorts. RESULTS A total of 58 revision ACL reconstructions were included, with 32 in the ASTQT cohort and 26 in the BTB cohort. Return to sports at the same level occurred in 62.5% of the ASTQT group and 53.8% of the BTB group. The ASTQT group returned to sports significantly faster than the BTB group (8.9 vs 10.3 months; P = .020). There was no difference in retear rates (3.1%, ASTQT; 7.7%, BTB) or other complications between the 2 groups. The IKDC scores were significantly higher at the 6- and 12-month follow-up for the ASTQT autograft group compared with the BTB group (6 months: ASTQT, 71.3; BTB, 61.7, P = .001; 12 months: ASTQT, 82.7; BTB, 78.6; P = .021). Lysholm scores were also greater in the ASTQT cohort at these time points (6 months: ASTQT, 75.1; BTB, 63.6; P < .001; 12 months: ASTQT, 82.0; BTB, 74.5; P < .001). However, IKDC and Lysholm scores were similar between both groups at final follow-up (IKDC: ASTQT, 82.9; BTB, 81.7; P = .344; Lysholm: ASTQT, 83.0; BTB, 81.0; P = .104) There was no significant clinical difference in the absolute difference in scores or rate of achieving clinical thresholds between the 2 cohorts. CONCLUSION ASTQT autograft for revision ACL in athletes has similar outcomes compared with BTB autograft. However, the ASTQT may possibly afford quicker return to sports and better early improvements in patient-reported outcomes that normalize by 1 year. The soft tissue quadriceps autograft should be considered a viable graft option in revision ACL reconstruction in athletes.
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Affiliation(s)
- Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Michael L Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
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11
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Sasaki E, Kimura Y, Sasaki S, Fujita Y, Yamamoto Y, Tsuda E, Ishibashi Y. Influence of hamstring tendon and bone-patellar tendon-bone autografts on worsened patient reported outcome measurements in revision anterior cruciate ligament reconstruction: Comparing outcomes between primary and revision reconstructions. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 29:1-8. [PMID: 35662999 PMCID: PMC9120044 DOI: 10.1016/j.asmart.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/07/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background This study aimed to compare the clinical outcomes and patient reported outcome measurement scales (PROMs) between hamstring tendon (HT) or bone-patellar tendon-bone (BTB) grafts in each primary and revision anterior cruciate ligament (ACL) reconstruction. Additionally, the clinical outcomes and PROMs between primary and revision surgeries were compared. Methods A total of 150 patients (109 primary and 41 revision ACL reconstructions) were enrolled and followed up for an average of 3.9 years (2 years minimum). Knee injury and osteoarthritis outcome scores (KOOS) were examined as PROMs. Side-to-side differences of anterior knee laxity were assessed using KT-1000 and were recorded at the final follow-up. After categorizing patients into HT and BTB reconstruction groups, regression analysis was performed to determine the relationship between revision surgery and changes in KOOS. Results In patients who underwent primary surgery, there was no significant difference in side-to-side differences of anterior laxity and KOOS between HT and BTB grafts. In those who underwent revision surgery, BTB grafts had a higher KOOS for activities of daily living (ADL) than HT grafts (p = 0.032). Comparing primary and revision surgeries, postoperative side-to-side differences of anterior laxity in the revision group were significantly larger than those in the primary group (p = 0.001). The KOOS for sports after overall revision reconstruction was significantly lower than that after primary reconstruction (p = 0.026). Comparing the KOOS after dividing all patients into HT and BTB reconstruction groups, in the HT reconstruction group, postoperative KOOS results were not different in any subscale from BTB grafts. In contrast, the KOOS for sports (p = 0.008) and QOL (p = 0.039) were significantly lower in revision surgery than in primary surgery. Furthermore, regression analysis including multiple confounders in the HT reconstruction group showed revision surgery using HT graft was correlated with worsened KOOS for symptoms (p = 0.012) and sports (p = 0.010). Revision surgery using BTB graft was not correlated with decreased KOOS. Conclusions There were no differences between the clinical outcome and KOOS in primary and revision surgery, except for ADL scores following revision ACL reconstruction using BTB graft. Side-to-side difference of anterior laxity and KOOS for sports following revision ACL reconstruction were inferior to those following primary ACL reconstruction. Furthermore, revision ACL reconstruction using HT grafts were correlated with low scores in KOOS for symptoms and sports, while there was no difference of anterior laxity between BTB and HT grafts in revision surgery.
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Affiliation(s)
- Eiji Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Fujita
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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12
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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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13
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Figueiredo L, Makhni EC, Dierks M, Ferreira FC, Finkelstein S. Early cost estimating model for new bioabsorbable orthopedic implant candidates: A theoretical study. J Mech Behav Biomed Mater 2021; 124:104731. [PMID: 34500353 DOI: 10.1016/j.jmbbm.2021.104731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 11/24/2022]
Abstract
An early health technology assessment (HTA) study was performed to assess the need for developing a new bioabsorbable implant for the treatment of specific orthopedic injuries. The Anterior Cruciate Ligament Reconstruction (ACLR) procedure was selected based on the need and potential impact of bioabsorbable implants in the treatment of ACL injuries. The economic model considers the possible health events after an ACLR (failures and other complications such as stiffness and pain). A decision tree approach was used, and several sensitivity analyses were performed using a Monte Carlo simulation. A cost estimating model was applied comparatively for currently available metal and bioabsorbable implants against a potential new bioabsorbable implant with improved performance. A reduction in stiffness and pain symptoms were considered as targets for these new implants performance, with reduced inflammation resulting from the use of materials with appropriate biological and mechanical properties. The current study estimates that, under the assumptions made, the introduction of a new bioabsorbable implant in ACLR surgeries may generate yearly cost savings. The model estimates positive cost-benefits of the new implant when it reduces the probability of failure by more than 30%, or reduces at least 14% the probability of complications of an inflammatory nature. The development of a new bioabsorbable orthopedic implant for ACLR is encouraged by this study identifying the need for new bioabsorbable implants with improved biological and mechanical performance. The results of this early HTA have made it possible to anticipate design needs and objectives for the research and development of new orthopedic bioabsorbable implants.
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Affiliation(s)
- Lígia Figueiredo
- Institute of Mechanical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - Eric C Makhni
- Department of Orthopedic Surgery, Henry Ford Health Systems, 2799 W Grand Blvd, Detroit, MI, 48202, United States
| | - Meghan Dierks
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St., Suite 400, Brookline, MA, 02446, United States
| | - Frederico Castelo Ferreira
- Department of Bioengineering and IBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal; Associate Laboratory I4HB-Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisboa, Portugal
| | - Stan Finkelstein
- Institute for Data, Systems and Society, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, United States.
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14
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Andrä K, Kayaalp E, Prill R, Irlenbusch L, Liesaus E, Trommer T, Ullmann P, Becker R. Joint effusion, anteroposterior stability, muscle strength and degree of patellofemoral osteoarthritis significantly impact outcome following revision ACL reconstruction. J Exp Orthop 2021; 8:70. [PMID: 34436684 PMCID: PMC8390615 DOI: 10.1186/s40634-021-00370-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Effusion, impaired muscle function and knee instability are considered as some of the most important factors effecting outcome following anterior cruciate ligament reconstruction (ACL-R) but the impact on revision ACL-R remains unclear. It was hypothesized that these factors will significantly worsen clinical outcome following revision ACL-R. METHODS Seventy knees (13 female and 57 male) were followed retrospectively after revision ACL-R at a mean follow-up of 47.8 ± 20.7 months. Clinical examination was based on the International Knee Documentation Evaluation Form-2000 (IKDC), Tegner activity scale. Instrumented measurement of anterior tibial translation was performed using the Rolimeter® (DJO Global, Freiburg, Germany). Bilateral circumference of the thigh was measured 10 and 20 cm proximal to the medial joint space. Cartilage was assessed according to Outerbridge classification during both primary and revision ACL-R. RESULTS Tegner activity scale decreased significantly from 7.8 ± 1.4 points at primary ACL-R to 7 ± 1.8 points at revision ACL-R, and 5.8 ± 1.7 points at the time of follow up (p < 0.001). Joint effusion (r = - 0.47, p < 0.01) and side to side differences in single leg hop test (r = - 0.48, p < 0.1) significantly correlated with inferior outcome. Cartilage lesions were found in 67% of the patients at the time of revision ACL-R compared to 38% at the time of primary ACL-R. According to the IKDC classification A was graded in three patients (4.3%), B in 35 (50%), C in 29 (41.4%) and D in three (4.3%). Joint effusion was measured in 35% of patients at the time of follow-up. Degeneration at the patellofemoral compartment of > grad 2 was responsible for IKDC grade C and D (p = 0.035). Instrumented anteroposterior site-to-site difference of ≥3 mm showed significant impact on clinical outcome (p < 0.019). CONCLUSION The study has shown that chronic effusion, quadriceps dysfunction, cartilage lesions especially at the patellofemoral compartment and side to side difference in anteroposterior stability significantly influences patient outcome after revision ACL-R. These factors require special attention when predicting patient's outcome. LEVEL OF EVIDENCE Level-IV, case-controlled study.
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Affiliation(s)
- Kathleen Andrä
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.,Sports Clinic Erfurt, Erfurt, Germany
| | - Enes Kayaalp
- Department of Orthopedics and Traumatology, Istanbul Taksim Training and Research Hospital, Siraselviler Cad. 34433 Beyoglu, Istanbul, Turkey
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
| | | | | | | | | | - Roland Becker
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.
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15
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Wright RW, Huston LJ, Haas AK, Pennings JS, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Brad Butler V J, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Association Between Graft Choice and 6-Year Outcomes of Revision Anterior Cruciate Ligament Reconstruction in the MARS Cohort. Am J Sports Med 2021; 49:2589-2598. [PMID: 34260326 PMCID: PMC9236596 DOI: 10.1177/03635465211027170] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although graft choice may be limited in the revision setting based on previously used grafts, most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome. HYPOTHESIS In the ACL revision setting, there would be no difference between autograft and allograft in rerupture rate and patient-reported outcomes (PROs) at 6-year follow-up. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients who had revision surgery were identified and prospectively enrolled in this cohort study by 83 surgeons over 52 sites. Data collected included baseline characteristics, surgical technique and pathology, and a series of validated PRO measures. Patients were followed up at 6 years and asked to complete the identical set of PRO instruments. Incidence of additional surgery and reoperation because of graft failure were also recorded. Multivariable regression models were used to determine the predictors (risk factors) of PROs, graft rerupture, and reoperation at 6 years after revision surgery. RESULTS A total of 1234 patients including 716 (58%) men were enrolled. A total of 325 (26%) underwent revision using a bone-patellar tendon-bone (BTB) autograft; 251 (20%), soft tissue autograft; 289 (23%), BTB allograft; 302 (25%), soft tissue allograft; and 67 (5%), other graft. Questionnaires and telephone follow-up for subsequent surgery information were obtained for 809 (66%) patients, while telephone follow-up was only obtained for an additional 128 patients for the total follow-up on 949 (77%) patients. Graft choice was a significant predictor of 6-year Marx Activity Rating Scale scores (P = .024). Specifically, patients who received a BTB autograft for revision reconstruction had higher activity levels than did patients who received a BTB allograft (odds ratio [OR], 1.92; 95% CI, 1.25-2.94). Graft rerupture was reported in 5.8% (55/949) of patients by their 6-year follow-up: 3.5% (16/455) of patients with autografts and 8.4% (37/441) of patients with allografts. Use of a BTB autograft for revision resulted in patients being 4.2 times less likely to sustain a subsequent graft rupture than if a BTB allograft were utilized (P = .011; 95% CI, 1.56-11.27). No significant differences were found in graft rerupture rates between BTB autograft and soft tissue autografts (P = .87) or between BTB autografts and soft tissue allografts (P = .36). Use of an autograft was found to be a significant predictor of having fewer reoperations within 6 years compared with using an allograft (P = .010; OR, 0.56; 95% CI, 0.36-0.87). CONCLUSION BTB and soft tissue autografts had a decreased risk in graft rerupture compared with BTB allografts. BTB autografts were associated with higher activity level than were BTB allografts at 6 years after revision reconstruction. Surgeons and patients should consider this information when choosing a graft for revision ACL reconstruction.
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Affiliation(s)
- Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda K Haas
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christina R Allen
- Yale University, New Haven, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Cooper
- W.B. Carrell Memorial Clinic, Dallas, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas M DeBerardino
- The San Antonio Orthopaedic Group, San Antonio, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Warren R Dunn
- Texas Orthopedic Hospital, Houston, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brett Brick A Lantz
- Slocum Research and Education Foundation, Eugene, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Stuart
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annunziato Ned Amendola
- Duke University, Durham, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jack T Andrish
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C Annunziata
- Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bernard R Bach
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Champ L Baker
- The Hughston Clinic, Columbus, Georgia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffery R Bechler
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Geoffrey A Bernas
- State University of New York at Buffalo, Buffalo, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen F Brockmeier
- University of Virginia, Charlottesville, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert H Brophy
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles A Bush-Joseph
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Brad Butler V
- Orthopedic and Fracture Clinic, Portland, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan M Cooper
- HealthPartners Specialty Center, Saint Paul, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R Alexander Creighton
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diane L Dahm
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth A Garofoli
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher D Harner
- University of Texas Health Center, Houston, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Norman Lindsay Harris
- Grand River Health, Rifle, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith S Hechtman
- UHZ Sports Medicine Institute, Coral Gables, Florida, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elliott B Hershman
- Lenox Hill Hospital, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rudolf G Hoellrich
- Slocum Research and Education Foundation, Eugene, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy S Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan H Jones
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas E Klootwyk
- Methodist Sports Medicine, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce A Levy
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - C Benjamin Ma
- University of California, San Francisco, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew J Matava
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gregory M Mathien
- Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David R McAllister
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, New Westminster, British Columbia, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel F O'Neill
- Littleton Regional Healthcare, Littleton, New Hampshire, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark L Purnell
- Aspen Orthopedic Associates, Aspen, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arthur C Rettig
- Methodist Sports Medicine, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin G Shea
- Intermountain Orthopaedics, Boise, Idaho, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Orrin H Sherman
- NYU Hospital for Joint Diseases, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James R Slauterbeck
- University of South Alabama, Mobile, Alabama, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew V Smith
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joachim J Tenuta
- Albany Medical Center, Albany, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Darius G Viskontas
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard A White
- Fitzgibbon's Hospital, Marshall, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James S Williams
- Cleveland Clinic, Euclid, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michelle L Wolcott
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasadena, Maryland, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
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16
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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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17
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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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18
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Yan X, Yang XG, Feng JT, Liu B, Hu YC. Does Revision Anterior Cruciate Ligament (ACL) Reconstruction Provide Similar Clinical Outcomes to Primary ACL Reconstruction? A Systematic Review and Meta-Analysis. Orthop Surg 2020; 12:1534-1546. [PMID: 32790162 PMCID: PMC7767695 DOI: 10.1111/os.12638] [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: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 01/14/2023] Open
Abstract
More revisionary reconstruction procedures are required following failing anterior cruciate ligament (ACL) reconstructions, which are often regarded as a technique challenge with very limited goals. This study will be performed to compare the outcomes between groups of primary and revision knee reconstruction. Two observers conducted the literature retrieval from the platforms of PubMed, Embase, and CENTRAL. Studies which compared knee function and stability between primary and revisionary reconstructions were included. The data was synthesized by meta‐analysis with fixed‐ or random‐effects models as appropriate. A total of 10 eligible studies were included with 954 subjects in the primary group and 378 in the revision group. The International Knee Documentation Committee International Knee Documentation Committee (IKDC) subscores, side‐to‐side difference, and Lysholm score were demonstrated to be significantly improved at final follow‐up in both groups, while Tegner score was not. The overall IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scores were significantly inferior in the revision group compared to the primary group. However, knee laxity according to side‐to‐side difference was demonstrated to be similar between the two groups. Revision ACL reconstruction (RACLR) could provide patients with excellent restoration of knee outcomes compared to the status before revision. Also, while knee function in the revision group was inferior to the primary group, knee stability was equivalent between the two groups at the final follow‐up.
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Affiliation(s)
- Xu Yan
- Department of Orthopedics Emergency, Tianjin Hospital, Tianjin, China
| | - Xiong-Gang Yang
- Department of Orthopedic Oncology, Tianjin Hospital, Tianjin, China
| | - Jiang-Tao Feng
- Department of Orthopedic Oncology, Tianjin Hospital, Tianjin, China
| | - Bin Liu
- Center for Medical Device Evaluation NMPA, Beijing, China
| | - Yong-Cheng Hu
- Department of Orthopedic Oncology, Tianjin Hospital, Tianjin, China
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19
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Rahardja R, Zhu M, Love H, Clatworthy MG, Monk AP, Young SW. Factors associated with revision following anterior cruciate ligament reconstruction: A systematic review of registry data. Knee 2020; 27:287-299. [PMID: 32014408 DOI: 10.1016/j.knee.2019.12.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/28/2019] [Accepted: 12/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To identify the patient and surgical factors associated with revision anterior cruciate ligament (ACL) reconstruction as reported by all national and community ACL registries. METHODS A systematic review was performed on the MEDLINE, Embase and Cochrane Library databases. Eligibility criteria included English studies published by national or community ACL registries reporting on primary ACL reconstruction and risk factors associated with revision ACL reconstruction. RESULTS Thirty-three studies from the Swedish, Norwegian, Danish and Kaiser Permanente registries were included for review. Fourteen studies from all four registries reported younger age as a risk factor for revision ACL reconstruction. In addition, the Swedish registry reported concomitant medial collateral ligament (MCL) injury, undergoing earlier surgery, lower Knee Injury and Osteoarthritis Outcome Score (KOOS), smaller graft diameter and an anteromedial portal drilling technique as risk factors for revision. The risk factors reported by the Norwegian registry included lower body mass index (BMI), lower KOOS, hamstring tendon grafts and suspensory fixation. The Danish registry reported hamstring tendon grafts, anteromedial portal drilling and suspensory fixation as risk factors. The Kaiser Permanente registry reported male sex, lower BMI, ethnicity, hamstring tendon grafts, allografts, smaller graft diameter and an anteromedial portal technique as risk factors for revision. CONCLUSION Multiple patient and surgical factors were associated with increased risk of revision ACL reconstruction in registries. Younger age and the use of hamstring tendon grafts were consistently reported as risk factors for failure.
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Affiliation(s)
| | - Mark Zhu
- University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, Auckland Hospital, Auckland, New Zealand
| | | | - Mark G Clatworthy
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Andrew Paul Monk
- University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, Auckland Hospital, Auckland, New Zealand
| | - Simon W Young
- University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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20
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So SY, Suh DW, Lee SS, Jung EY, Ye DH, Ryu D, Kwon KB, Wang JH. Revision Anterior Cruciate Ligament Reconstruction After Primary Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Case Series of 40 Patients. Arthroscopy 2020; 36:546-555. [PMID: 31901397 DOI: 10.1016/j.arthro.2019.08.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/09/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the surgical methods according to the status of tunnels at the time of revision anterior cruciate ligament reconstruction (ACLR) and to evaluate clinical outcomes of revision ACLR in patients who underwent primary ACLR with the anatomic 4-tunnel double-bundle (DB) technique. METHODS A total of 487 patients who underwent primary anatomic DB ACLR from April 2010 to July 2016 were retrospectively reviewed, and among those knees, the patients who underwent revision ACLR were included in the study. The patients with concomitant posterior cruciate ligament injuries were excluded. Forty patients (40 knees) were identified and enrolled. The surgical methods were reviewed. The range of motion, objective laxity using KT-2000, Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, and Tegner score after revision ACLR were compared with those after primary ACLR in the same patient using paired t-test with Bonferroni correction. RESULTS The timing of reinjury after primary ACLR and mean interval between primary and revision ACLR were 18 months (range 1.5-80 months) and 24 months (range 4-82 months), respectively. Among 40 patients, 38 patients (95%) underwent 1-stage revision with the DB technique using pre-existing tunnels without compromised positioning of the grafts, and the other 2 patients (5%) underwent 2-stage revision. The postrevision range of motion, KT-2000, Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, and Tegner score were 137 ± 7°, 2.4 ± 1.2 mm, 91.4 ± 5.8, 98.9 ± 2.2, 78.6 ± 11.5, and 5.5 ± 1.2, respectively, and did not show any differences from those after primary ACLR. CONCLUSIONS In the revision setting after primary anatomic DB ACLR, most of the cases could be managed with 1-stage revision with DB technique using pre-existing tunnels, and the objective laxity and clinical scores after revision DB ACLR were comparable with those after primary DB ACLR. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Sang-Yeon So
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Dong Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-si, Gyeonggi-do, Korea
| | - Eui Yub Jung
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea
| | - Dong-Hee Ye
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongjin Ryu
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeu-Back Kwon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
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21
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Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci 2020; 25:6-45. [PMID: 31843222 DOI: 10.1016/j.jos.2019.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). METHODS The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature. CONCLUSIONS This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.
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Affiliation(s)
- Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Japan
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22
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Revision ACL reconstruction using quadriceps or hamstring autografts leads to similar results after 4 years: good objective stability but low rate of return to pre-injury sport level. Knee Surg Sports Traumatol Arthrosc 2019; 27:3527-3535. [PMID: 30820606 DOI: 10.1007/s00167-019-05444-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 02/25/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Due to the increased importance of revision ACL reconstruction, this study aims to evaluate the outcome 4 years after the surgery, compare two revision strategies and identify factors that influence the results. METHODS Seventy-nine patients who received a revision ACL reconstruction were retrospectively evaluated. All patients were assessed with an average follow-up of 4.4 years (range 3.3-5.5 years). The results of patients treated with a quadriceps autograft were compared with those treated with a hamstring autograft. RESULTS Ninety-seven percent of patients had a KT-1000 side-to-side difference of ≤ 5 mm (mean 1.7 ± 2.0 mm). Pivot-shift test was absent or minor in 95%. In the SLTH-test, 70% of patients reached 90% of the contralateral side. The mean Lysholm score on follow-up was 83 ± 12 (56% excellent/good). The mean IKDC 2000 subjective evaluation score was 81 ± 14 (58% normal/almost normal). The median Tegner activity score was 6 (range 3-10), a median of 2 levels worse than before the first injury. Return to sport rate was 89% but only 34% of patients reached their pre-injury sport level. Most common cause for this reduction was fear of another injury. Three patients suffered a re-rupture. Patients with a hamstring autograft performed pivoting sports more often, but had worse pivot-shift results compared to those with a quadriceps autograft. No significant influence was seen for other parameters. Young, male patients with a high activity level and no chondral damage had the best results. CONCLUSION Through revision ACL reconstruction, the goal of stabilizing the knee can be achieved in the majority of patients. However, a good function and a high activity level are significantly less common in these patients. The main reason for this is fear of a renewed ACL-injury. Both quadriceps and hamstring autografts were able to achieve a good outcome. Young, male, patients with a normal BMI, a high activity level and without cartilage damage seem to benefit the most from revision ACL surgery. The discrepancy between the good laxity restoration and the lower activity rate should therefore be a main point in clinical counseling when deciding for or against revision ACL-Reconstruction. LEVEL OF EVIDENCE III.
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Condello V, Zdanowicz U, Di Matteo B, Spalding T, Gelber PE, Adravanti P, Heuberer P, Dimmen S, Sonnery-Cottet B, Hulet C, Bonomo M, Kon E. Allograft tendons are a safe and effective option for revision ACL reconstruction: a clinical review. Knee Surg Sports Traumatol Arthrosc 2019; 27:1771-1781. [PMID: 30242455 DOI: 10.1007/s00167-018-5147-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/14/2018] [Indexed: 12/23/2022]
Abstract
Revision anterior cruciate ligament reconstruction remains a challenge, especially optimising outcome for patients with a compromised knee where previous autogenous tissue has been used for reconstruction. Allograft tissue has become a recognized choice of graft for revision surgery but questions remain over the risks and benefits of such an option. Allograft tendons are a safe and effective option for revision ACL reconstruction with no higher risk of infection and equivalent failure rates compared to autografts provided that the tissue is not irradiated, or any irradiation is minimal. Best scenarios for use of allografts include revision surgery where further use of autografts could lead to high donor site morbidity, complex instability situations where additional structures may need reconstruction, and in those with clinical and radiologic signs of autologous tendon degeneration. A surgeon needs to be able to select the best option for the challenging knee facing revision ACL reconstruction, and in the light of current data, allograft tissue can be considered a suitable option to this purpose.Level of evidence IV.
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Affiliation(s)
- V Condello
- Department of Orthopaedics, Clinica Humanitas Castelli, Via Mazzini, 11, Bergamo, Italy
| | - U Zdanowicz
- Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Berardo Di Matteo
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, Rozzano, 20089, Milan, Italy. .,Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
| | - T Spalding
- University Hospitals Coventry and Warwickshire (UHCW), Coventry, UK
| | - P E Gelber
- Orthopaedic Department, ICATME-Institut Universitari Quirón-Dexeus, Universitat Autònoma Barcelona, Barcelona, Spain.,Orthopaedic Department, Hospital de Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - P Adravanti
- U.O. Ortopedia, Clinica "Città di Parma", Parma, Italy
| | | | - S Dimmen
- Lovisenberg Diaconal Hospital, Lovisenberggt. 17, 0456, Oslo, Norway
| | - B Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - C Hulet
- Department of Orthopaedic Surgery and Traumatology, Unit INSERM COMETE, UMR U1075, Caen University Hospital, Caen, France
| | - M Bonomo
- Orthopaedic Department, Sacro Cuore-Don Calabria Hospital, Via Don A. Sempreboni, 5, 37024, Negrar, VR, Italy
| | - E Kon
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, Rozzano, 20089, Milan, Italy.,Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, 20089, Milan, Italy
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The presence of patellar tendinopathy in the bone-patellar tendon-bone autograft may increase the risk of anterior cruciate ligament graft failure. Knee Surg Sports Traumatol Arthrosc 2019; 27:766-772. [PMID: 30141146 DOI: 10.1007/s00167-018-5066-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the influence of patellar tendinopathy on primary anterior cruciate ligament (ACL) reconstruction graft failure when using bone-patellar tendon-bone (BPTB) autograft. METHODS All patients undergoing primary ACL reconstruction using ipsilateral BPTB with preoperative magnetic resonance imaging (MRI) available for review were approached for eligibility. The medical charts of included patients were reviewed to obtain demographic information, anatomical characteristics, injury characteristics, treatment characteristics, length of follow-up, and presence of graft failure. A single, fellowship-trained, knee-specialist and blinded researcher performed preoperative MRI interpretation of patellar tendinopathy. The presence/absence of patellar tendinopathy (none, mild, moderate, or severe changes) was compared between patients with (cases) and without (controls) failure of ACL reconstruction. There were 559 cases with a median (range) clinical follow-up was 8 (4-30) months and an average age of 21.5 years (82% males). RESULTS Of the 559 cases, there were 182 (32.6%) with and 377 (67.4%) without patellar tendinopathy. A total of 32 (5.7%) graft failures occurred. There were a significantly higher failure rate in patients with compared to without patellar tendinopathy (p < 0.001), and in patients with compared to without partial tendon tear (p < 0.001). The odds ratio (95% confidence interval) for graft failure was 5.9 (2.7-13.1), 20.8 (6.8-63.9) and 54.4 (5.5-539.4) in patients with patellar tendinopathy (compared to absence of patellar tendinopathy), moderate or severe patellar tendinopathy (compared to none or mild patellar tendinopathy), or partial tendon tear (compared to absence of tendon tear), respectively. CONCLUSION The presence of patellar tendinopathy increases the risk of BPTB graft failure when used for ACL reconstruction. The use of BPTB autograft is not recommended if patellar tendinopathy is obvious or there are suspicious of partial tendon tear on MRI. In such cases, the surgeon should consider using a different graft. LEVEL OF EVIDENCE Retrospective cohort analysis, Level III.
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Abstract
BACKGROUND There is considerable literature about revision anterior cruciate ligament (ACL) reconstruction in athletes vut there is little published evidence about the same in the nonathletes. The injury itself may remain underdiagnosed and untreated in nonsports persons. This study highlights the high incidence of ACL injury in the nonathletic patient cohort, revision rates, and the outcomes of revision ACL reconstruction. MATERIALS AND METHODS 856 nonathletic patients who underwent primary ACL reconstruction were included in this retrospective study. Patients were asked on phone whether they had undergone revision surgery and whether they had symptoms severe enough to seek reintervention. Clinical assessment and preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm scoring were used to followup patients who underwent revision intervention. RESULTS Clinically, symptomatic revision rate was 5.9% (51 out of 856 patients), and 33 out of these 856 patients (3.9%) underwent revision ACL reconstruction. The reasons for revision were rupture of the previous graft in 21 and laxity (incompetence) of the graft in 12 patients. The mean preoperative and postoperative IKDC scores were 44.1 and 69.8, respectively, and the improvement was statistically significant (P < 0.001). The IKDC score following revision ACL reconstruction was significantly better in those patients who underwent revision <1 year following the onset of recurrent symptoms (P = 0.015). Meniscal tears were present in 47.6%, and chondral injuries were seen in 33.3% of patients. The tibial tunnel positioning was abnormal in 70% of patients. Femoral tunnel positioning was aberrant in all the patients. CONCLUSIONS The revision rate of primary ACL reconstruction of 5.9% in nonathletes and revision ACL reconstruction rate of 3.9% are similar to the reported revision rates of 2.9%-5.8% in athletic patients. Similar to athletes, suboptimal tunnel placement is the major contributor to failure in nonathletes also.
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Affiliation(s)
- Raghu Nagaraj
- Department of Orthopaedics, HOSMAT Hospital, Bengaluru, Karnataka, India
| | - Malhar N Kumar
- Department of Orthopaedics, HOSMAT Hospital, Bengaluru, Karnataka, India,Address for correspondence: Dr. Malhar N Kumar, HOSMAT Hospital, McGrath Road, Bengaluru - 560 025, Karnataka, India. E-mail:
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Cristiani R, Engström B, Edman G, Forssblad M, Stålman A. Revision anterior cruciate ligament reconstruction restores knee laxity but shows inferior functional knee outcome compared with primary reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:137-145. [PMID: 30014185 PMCID: PMC6510814 DOI: 10.1007/s00167-018-5059-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/11/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate and compare knee laxity and functional knee outcome between primary and revision anterior cruciate ligament (ACL) reconstruction in the same cohort of patients. METHODS Patients who underwent primary and revision ACL reconstruction (ACLR) at Capio Artro Clinic, Stockholm, Sweden, from 2000 to 2015, were identified in our local database. Inclusion criteria were: same patients who underwent primary hamstring tendons (HT) and revision bone-patellar tendon-bone (BPTB) autograft ACLR, no associated ligament injuries and no contralateral ACL injuries/reconstructions. The cause of revision ACLR was graft rupture for all patients. The KT-1000 arthrometer, with an anterior tibial load of 134-N, was used to evaluate knee laxity preoperatively and 6-month postoperatively. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at the 1-year follow-up. RESULTS A total of 118 patients with primary and revision ACLR arthrometric laxity measurements were available (51.0% males; mean age at primary ACLR 21.7 ± 7.1 years and revision ACLR 24.3 ± 7.5 years). The mean preoperative and postoperative anterior side-to-side (STS) difference values were not significantly different between primary and revision ACLR. However, primary ACLR showed a significantly higher frequency of postoperative anterior STS difference > 5 mm compared with revision ACLR (8.4 vs 5.0%; P = 0.02). The KOOS was available for primary and revision ACLR for 73 patients (55.4% males; mean age at primary ACLR 21.6 ± 7 years and revision ACLR 24.7 ± 7.3 years). Preoperatively, revision ACLR showed significantly higher scores in all KOOS subscales, except for the activity of daily living (ADL) subscale. For the primary ACLR, the improvement from preoperatively to the 1-year follow-up was significantly greater in all KOOS subscales and, the postoperative scores were superior for Pain, ADL and Sports subscales compared with revision ACLR. CONCLUSIONS The findings of this study showed that anterior knee laxity is restored with revision BPTB autograft ACLR after failed primary HT autograft ACLR, in the same cohort of patients. However, revision ACLR showed a significantly inferior functional knee outcome compared with primary ACLR. It is important for clinicians to inform and set realistic expectations for patients undergoing revision ACLR. Patients must be aware of the fact that having revision ACLR their knee function will not improve as much as with primary ACLR and the final postoperative functional outcome is inferior. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden. .,Capio Artro Clinic, Sophiahemmet Private Hospital, Valhallavägen 91, 11486, Stockholm, Sweden.
| | - Björn Engström
- 0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,Capio Artro Clinic, Sophiahemmet Private Hospital, Valhallavägen 91, 11486 Stockholm, Sweden
| | - Gunnar Edman
- 0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- 0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Anders Stålman
- 0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,Capio Artro Clinic, Sophiahemmet Private Hospital, Valhallavägen 91, 11486 Stockholm, Sweden
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Magnussen RA, Borchers JR, Pedroza AD, Huston LJ, Haas AK, Spindler KP, Wright RW, Kaeding CC, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BA, Mann B, Stuart MJ, Albright JP, Amendola A, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Risk Factors and Predictors of Significant Chondral Surface Change From Primary to Revision Anterior Cruciate Ligament Reconstruction: A MOON and MARS Cohort Study. Am J Sports Med 2018; 46:557-564. [PMID: 29244532 PMCID: PMC7004295 DOI: 10.1177/0363546517741484] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular cartilage health is an important issue following anterior cruciate ligament (ACL) injury and primary ACL reconstruction. Factors present at the time of primary ACL reconstruction may influence the subsequent progression of articular cartilage damage. HYPOTHESIS Larger meniscus resection at primary ACL reconstruction, increased patient age, and increased body mass index (BMI) are associated with increased odds of worsened articular cartilage damage at the time of revision ACL reconstruction. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Subjects who had primary and revision data in the databases of the Multicenter Orthopaedics Outcomes Network (MOON) and Multicenter ACL Revision Study (MARS) were included. Reviewed data included chondral surface status at the time of primary and revision surgery, meniscus status at the time of primary reconstruction, primary reconstruction graft type, time from primary to revision ACL surgery, as well as demographics and Marx activity score at the time of revision. Significant progression of articular cartilage damage was defined in each compartment according to progression on the modified Outerbridge scale (increase ≥1 grade) or >25% enlargement in any area of damage. Logistic regression identified predictors of significant chondral surface change in each compartment from primary to revision surgery. RESULTS A total of 134 patients were included, with a median age of 19.5 years at revision surgery. Progression of articular cartilage damage was noted in 34 patients (25.4%) in the lateral compartment, 32 (23.9%) in the medial compartment, and 31 (23.1%) in the patellofemoral compartment. For the lateral compartment, patients who had >33% of the lateral meniscus excised at primary reconstruction had 16.9-times greater odds of progression of articular cartilage injury than those with an intact lateral meniscus ( P < .001). For the medial compartment, patients who had <33% of the medial meniscus excised at the time of the primary reconstruction had 4.8-times greater odds of progression of articular cartilage injury than those with an intact medial meniscus ( P = .02). Odds of significant chondral surface change increased by 5% in the lateral compartment and 6% in the medial compartment for each increased year of age ( P ≤ .02). For the patellofemoral compartment, the use of allograft in primary reconstruction was associated with a 15-fold increased odds of progression of articular cartilage damage relative to a patellar tendon autograft ( P < .001). Each 1-unit increase in BMI at the time of revision surgery was associated with a 10% increase in the odds of progression of articular cartilage damage ( P = .046) in the patellofemoral compartment. CONCLUSION Excision of the medial and lateral meniscus at primary ACL reconstruction increases the odds of articular cartilage damage in the corresponding compartment at the time of revision ACL reconstruction. Increased age is a risk factor for deterioration of articular cartilage in both tibiofemoral compartments, while increased BMI and the use of allograft for primary ACL reconstruction are associated with an increased risk of progression in the patellofemoral compartment.
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Affiliation(s)
| | - Robert A. Magnussen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James R. Borchers
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Angela D. Pedroza
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura J. Huston
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amanda K. Haas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kurt P. Spindler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rick W. Wright
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher C. Kaeding
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christina R. Allen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Allen F. Anderson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel E. Cooper
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas M. DeBerardino
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Warren R. Dunn
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brett A. Lantz
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Barton Mann
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael J. Stuart
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John P. Albright
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Annunziato Amendola
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jack T. Andrish
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Robert A. Arciero
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bernard R. Bach
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Champ L. Baker
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arthur R. Bartolozzi
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Keith M. Baumgarten
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffery R. Bechler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffrey H. Berg
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Geoffrey A. Bernas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen F. Brockmeier
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert H. Brophy
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles A. Bush-Joseph
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J. Brad Butler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D. Campbell
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James L. Carey
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James E. Carpenter
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian J. Cole
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jonathan M. Cooper
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles L. Cox
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - R. Alexander Creighton
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Diane L. Dahm
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tal S. David
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David C. Flanigan
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert W. Frederick
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Theodore J. Ganley
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Elizabeth A. Garofoli
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles J. Gatt
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven R. Gecha
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James Robert Giffin
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sharon L. Hame
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jo A. Hannafin
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher D. Harner
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Norman Lindsay Harris
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Keith S. Hechtman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Elliott B. Hershman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rudolf G. Hoellrich
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy M. Hosea
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David C. Johnson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy S. Johnson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Morgan H. Jones
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ganesh V. Kamath
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas E. Klootwyk
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bruce A. Levy
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C. Benjamin Ma
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - G. Peter Maiers
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert G. Marx
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew J. Matava
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gregory M. Mathien
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David R. McAllister
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric C. McCarty
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert G. McCormack
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bruce S. Miller
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Carl W. Nissen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel F. O’Neill
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brett D. Owens
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard D. Parker
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mark L. Purnell
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arun J. Ramappa
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael A. Rauh
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arthur C. Rettig
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jon K. Sekiya
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kevin G. Shea
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Orrin H. Sherman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James R. Slauterbeck
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew V. Smith
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffrey T. Spang
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven J. Svoboda
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy N. Taft
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Joachim J. Tenuta
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Edwin M. Tingstad
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Armando F. Vidal
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Darius G. Viskontas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard A. White
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James S. Williams
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michelle L. Wolcott
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian R. Wolf
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James J. York
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Clinical Outcomes in Revision Anterior Cruciate Ligament Reconstruction: A Meta-analysis. Arthroscopy 2018; 34:289-300. [PMID: 28866344 DOI: 10.1016/j.arthro.2017.06.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/08/2017] [Accepted: 06/20/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this meta-analysis was to determine overall objective graft failure rate, failure rate by graft type (allograft vs autograft reconstruction), instrumented laxity, and patient outcome scores following revision anterior cruciate ligament (ACL) reconstruction. Outcomes of interest were collected for all studies meeting the study inclusion criteria, but lower-level studies (level III/IV) were not pooled for quantitative synthesis due to high levels of heterogeneity in these study populations. METHODS A comprehensive search strategy was performed to identify studies reporting outcomes of revision ACL reconstruction. The primary outcome reported was graft failure. A meta-analysis comparing rate of failure by graft type was conducted using a random effects model. Studies also reported patient clinical outcome scores, including International Knee Documentation Committee (IKDC), Lysholm, and knee injury and osteoarthritis outcome scores (KOOS) and graft laxity. RESULTS Eight studies with 3,021 patients (56% male, 44% female) with an average age of 30 ± 4 years and mean follow-up time of 57 months were included. The overall objective failure rate was 6% (95% confidence interval [CI], 1.8%-12.3%). Mean instrumented laxity as side-to-side difference was 2.5 mm (95% CI, 1.9-3.1 mm). Mean IKDC subjective score was 76.99 (95% CI, 76.64-77.34), mean KOOS symptoms score was 76.73 (95% CI, 75.85-77.61), and mean Lysholm score was 86.18 (95% CI, 79.08-93.28). The proportion of patients with IKDC grade A or B was 85% (95% CI, 77%-91%). When the available data for failure rate were analyzed by graft type, autograft reconstruction had a failure rate of 4.1% (95% CI, 2.0%-6.9%), similar to allograft reconstruction at 3.6% (95% CI, 1.4%-6.7%). CONCLUSIONS In this meta-analysis, revision ACL reconstruction had failure rates similar to autograft or allograft reconstruction. Overall outcome scores for revision reconstruction have improved but appear modest when compared with primary ACL reconstruction surgery. LEVEL OF EVIDENCE Meta-analysis of Level II studies, Level II.
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Zanovello J, Rosso F, Bistolfi A, Rossi R, Castoldi F. Combined Intra- and Extra-Articular Technique in Revision Anterior Cruciate Ligament Reconstruction. JOINTS 2017; 5:156-163. [PMID: 29270546 PMCID: PMC5738484 DOI: 10.1055/s-0037-1605590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose
The aim of the study was to evaluate the “over the top” (OTT) nonanatomical technique for revision of anterior cruciate ligament (ACL) reconstruction.
Methods
Twenty-four patients with a mean age of 31.9 ± 11.2 years underwent revision of ACL reconstruction using OTT technique. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner score, Subjective Patient Outcome for Return to Sport (SPORTS) score, Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, and KT-1000 evaluation were recorded at a mean follow-up of 30.7 ± 18.9 months.
Results
Postoperatively, the IKDC objective total score significantly improved (
p
= 0.0046). The KOOS, Lysholm, and Tegner scores also improved, but the results were not statistically significant (62.4 vs. 72.6, 6.5 vs. 75.8, and 4.1 vs. 6.0, respectively). The subjective IKDC evaluation score improved from an average of 51.1 points to 63.7 points at the last follow-up (
p
= 0.0027). The RTP prevalence was 81.8%, with 44.4% of the patients returning to the same preinjury level. According to the SPORTS score, 16.6% of patients played sport without limitations in activity and performance. The average ACL-RSI score was 52.1 ± 27.0. No major complications were reported. A total of 21.5% of patients underwent surgical removal of staples. The failure prevalence was 14.3% and the cumulative survivorship, calculated using the Kaplan–Meier method, was equal to 70% at 60 months of follow-up.
Conclusion
The OTT technique in the revision ACL reconstruction provided improvement in objective and subjective scores, good RTP prevalence, and acceptable rate of complication and failure. One of the advantages was the possibility to avoid the femoral tunnel.
Level of Evidence
Level IV, therapeutic case series.
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Affiliation(s)
- Jessica Zanovello
- Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, University of Turin, Hospital Città della Salute e della Scienza, Turin, Italy
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, University of Turin, AO Mauriziano "Umberto I" Hospital, Turin, Italy
| | - Alessandro Bistolfi
- Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, Hospital Città della Salute e della Scienza, Turin, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, University of Turin, AO Mauriziano "Umberto I" Hospital, Turin, Italy
| | - Filippo Castoldi
- Department of Orthopaedic Surgery, University of Turin, San Luigi Hospital of Orbassano, Turin, Italy
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Miller TK. The Role of an Extra-Articular Tenodesis in Revision of Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2017; 37:101-113. [PMID: 29173550 DOI: 10.1016/j.csm.2017.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Patients who present for anterior cruciate ligament (ACL) revision with a high-grade pivot shift at the time of an index ACL revision procedure and subsequent reconstruction failure or a high-grade pivot shift at revision surgery, patients with generalized joint laxity, and those requiring softs tissue grafts should be considered candidates for lateral tenodesis to supplement intraarticular graft revision. Although there is no consensus regarding the optimal lateral tenodesis technique, due to the tibial positioning associated with tensioning and fixation of extra-articular procedures, a lateral tenodesis should not be used in patients with posterolateral corner injuries or lateral compartment articular disease.
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Affiliation(s)
- Thomas K Miller
- Department of Orthopaedic Surgery, Virginia Tech/Carilion School of Medicine, Institute for Orthopaedics and Neurosciences, 2331 Franklin Road, Roanoke, VA 24018, USA.
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Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Haas AK, Huston LJ, Lantz B(BA, Mann B, Nwosu SK, Spindler KP, Stuart MJ, Wright RW, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LTCSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45:2586-2594. [PMID: 28696164 PMCID: PMC5675127 DOI: 10.1177/0363546517712952] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes compared with primary ACL reconstruction. HYPOTHESIS Certain factors under the control of the surgeon at the time of revision surgery can both negatively and positively affect outcomes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients undergoing revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique and joint disorders, and a series of validated patient-reported outcome instruments (International Knee Documentation Committee [IKDC] subjective form, Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating scale) completed before surgery. Patients were followed up for 2 years and asked to complete an identical set of outcome instruments. Regression analysis was used to control for age, sex, body mass index (BMI), activity level, baseline outcome scores, revision number, time since last ACL reconstruction, and a variety of previous and current surgical variables to assess the surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. RESULTS A total of 1205 patients (697 male [58%]) met the inclusion criteria and were successfully enrolled. The median age was 26 years, and the median time since their last ACL reconstruction was 3.4 years. Two-year follow-up was obtained on 82% (989/1205). Both previous and current surgical factors were found to be significant contributors toward poorer clinical outcomes at 2 years. Having undergone previous arthrotomy (nonarthroscopic open approach) for ACL reconstruction compared with the 1-incision technique resulted in significantly poorer outcomes for the 2-year IKDC ( P = .037; odds ratio [OR], 2.43; 95% CI, 1.05-5.88) and KOOS pain, sports/recreation, and quality of life (QOL) subscales ( P ≤ .05; OR range, 2.38-4.35; 95% CI, 1.03-10.00). The use of a metal interference screw for current femoral fixation resulted in significantly better outcomes for the 2-year KOOS symptoms, pain, and QOL subscales ( P ≤ .05; OR range, 1.70-1.96; 95% CI, 1.00-3.33) as well as WOMAC stiffness subscale ( P = .041; OR, 1.75; 95% CI, 1.02-3.03). Not performing notchplasty at revision significantly improved 2-year outcomes for the IKDC ( P = .013; OR, 1.47; 95% CI, 1.08-1.99), KOOS activities of daily living (ADL) and QOL subscales ( P ≤ .04; OR range, 1.40-1.41; 95% CI, 1.03-1.93), and WOMAC stiffness and ADL subscales ( P ≤ .04; OR range, 1.41-1.49; 95% CI, 1.03-2.05). Factors before revision ACL reconstruction that increased the risk of poorer clinical outcomes at 2 years included lower baseline outcome scores, a lower Marx activity score at the time of revision, a higher BMI, female sex, and a shorter time since the patient's last ACL reconstruction. Prior femoral fixation, prior femoral tunnel aperture position, and knee flexion angle at the time of revision graft fixation were not found to affect 2-year outcomes in this revision cohort. CONCLUSION There are certain surgical variables that the physician can control at the time of revision ACL reconstruction that can modify clinical outcomes at 2 years. Whenever possible, opting for an anteromedial portal or transtibial surgical exposure, choosing a metal interference screw for femoral fixation, and not performing notchplasty are associated with significantly better 2-year clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tal S. David
- Synergy Specialists Medical Group, San Diego, CA USA
| | | | | | | | | | | | | | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London Ontario, Canada
| | - Sharon L. Hame
- David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | | | | | | | | | | | | | | | | | | | | | | | - Ganesh V. Kamath
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | | | | | | | | | | | | | | | - Eric C. McCarty
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brett D. Owens
- Warren Alpert Medical School, Brown University, Providence, RI USA
| | | | | | | | | | | | | | | | | | | | | | - Jeffrey T. Spang
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Timothy N. Taft
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Edwin M. Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA USA
| | - Armando F. Vidal
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brian R. Wolf
- University of Iowa Hospitals and Clinics, Iowa City, IA USA
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Grassi A, Nitri M, Moulton SG, Marcheggiani Muccioli GM, Bondi A, Romagnoli M, Zaffagnini S. Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? a meta-analysis of 32 studies. Bone Joint J 2017; 99-B:714-723. [PMID: 28566389 DOI: 10.1302/0301-620x.99b6.bjj-2016-0929.r2] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/16/2017] [Indexed: 01/02/2023]
Abstract
AIMS Our aim was to perform a meta-analysis of the outcomes of revision anterior cruciate ligament (ACL) reconstruction, comparing the use of different types of graft. MATERIALS AND METHODS A search was performed of Medline and Pubmed using the terms "Anterior Cruciate Ligament" and "ACL" combined with "revision", "re-operation" and "failure". Only studies that reported the outcome at a minimum follow-up of two years were included. Two authors reviewed the papers, and outcomes were subdivided into autograft and allograft. Autograft was subdivided into hamstring (HS) and bone-patellar tendon-bone (BPTB). Subjective and objective outcome measures were analysed and odds ratios with confidence intervals were calculated. RESULTS A total of 32 studies met the inclusion criteria. Five studies used HS autografts, eight reported using BPTB autografts, two used quadriceps tendon autografts and eight used various types. Seven studies reported using allografts, while the two remaining used both BPTB autografts and allografts. Overall, 1192 patients with a mean age of 28.7 years (22.5 to 39) and a mean follow-up of 5.4 years (2.0 to 9.6) were treated with autografts, while 269 patients with a mean age of 28.4 years (25 to 34.6) and a mean follow-up of 4.0 years (2.3 to 6.0) were treated with allografts. Regarding allografts, irradiation with 2.5 mrad was used in two studies while the graft was not irradiated in the seven remaining studies. Reconstructions following the use of autografts had better outcomes than those using allograft with respect to laxity, measured by KT-1000/2000 (MEDmetric Corporation) and the rates of complications and re-operations. Those following the use of allografts had better mean Lysholm and Tegner activity scores compared with autografts. If irradiated allografts were excluded from the analysis, outcomes no longer differed between the use of autografts and allografts. Comparing the types of autograft, all outcomes were similar except for HS grafts which had better International Knee Documentation Committee scores compared with BPTB grafts. CONCLUSION Autografts had better outcomes than allografts in revision ACL reconstruction, with lower post-operative laxity and rates of complications and re-operations. However, after excluding irradiated allografts, outcomes were similar between autografts and allografts. Overall, the choice of graft at revision ACL reconstruction should be on an individual basis considering, for instance, the preferred technique of the surgeon, whether a combined reconstruction is required, the type of graft that was previously used, whether the tunnels are enlarged and the availability of allograft. Cite this article: Bone Joint J 2017;99-B:714-23.
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Affiliation(s)
- A Grassi
- Orthopedic Institute Rizzoli, 90011 Bologna, Italy
| | - M Nitri
- Orthopedic Institute Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - S G Moulton
- Oregon Health & Science University, 3181 SW, Sam Jackson Park Rd, Portland, Oregon, USA
| | | | - A Bondi
- Orthopedic Institute Rizzoli, 90011 Bologna, Italy
| | - M Romagnoli
- Orthopedic Institute Rizzoli, 90011 Bologna, Italy
| | - S Zaffagnini
- Orthopedic Institute Rizzoli, 90011 Bologna, Italy
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Tomihara T, Hashimoto Y, Taniuchi M, Takigami J, Han C, Shimada N. One-stage revision ACL reconstruction after primary ACL double bundle reconstruction: is bone-patella tendon-bone autograft reliable? Knee Surg Sports Traumatol Arthrosc 2017; 25:1653-1661. [PMID: 28251262 DOI: 10.1007/s00167-017-4483-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/13/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE The purpose of this study is to assess the results of revision anterior cruciate ligament (ACL) reconstruction after the failure of primary ACL double bundle reconstruction (ACL-DBR). METHODS Twenty-two knees in 22 patients (group R) that underwent ACL revision surgery using bone-patellar tendon-bone (BTB) autograft after the failure of primary ACL-DBR were included in this study. Intraoperative findings and postoperative knee laxity and clinical outcomes in group R were assessed. Forty-four knees in 44 patients that were age- and gender- matched with group R and underwent primary ACL reconstruction using BTB autograft were used as a control group (group P). RESULTS The incidence of medial meniscus and cartilage injury in group R was significantly higher than those in group P (p < 0.05). At final follow-up, median Lysholm score was 90.5 (64-100) in group R and 94 (59-100) in group P, respectively. Fourteen patients (63.6%) in group R and 31 patients (70.5%) in group P were able to return to previously-played sports, respectively. There were no significant differences in KT-1000 outcomes (2.0 mm in group R and 1.4 mm in group P) or pivot shift test between the two groups. The rate of subsequent ACL injury was similar in both groups. CONCLUSIONS Revision ACL reconstruction using BTB autograft after failed primary ACL-DBR provided almost compatible postoperative clinical outcomes and knee stability with primary ACL reconstruction using BTB autograft, while the incidence of medial meniscus and cartilage injury at revision surgery was higher. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Tomohiro Tomihara
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan.
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masatoshi Taniuchi
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Changhun Han
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Nagakazu Shimada
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
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Di Benedetto P, Di Benedetto E, Fiocchi A, Beltrame A, Causero A. Causes of Failure of Anterior Cruciate Ligament Reconstruction and Revision Surgical Strategies. Knee Surg Relat Res 2016; 28:319-324. [PMID: 27894180 PMCID: PMC5134790 DOI: 10.5792/ksrr.16.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 01/09/2023] Open
Abstract
Purpose Long-term outcomes of anterior cruciate ligament (ACL) reconstruction are good or excellent; however, 0.7%–20% of patients suffer from recurrent instability due to graft failure. The purpose of this paper was to analyse failure aetiology and the possibilities of revision surgical strategies, with a description of our experience. We obtained optimal and good results in most of our patients. Materials and Methods We retrospectively reviewed 42 patients who underwent revision surgery (43 revisions) due to relapsing instability after ACL reconstruction between 2006 and 2015. We used allografts in 39 cases and autografts in 4 cases. Results The 85.7% of the patients obtained optimal results (normal knee; group A) and the 7.2% obtained good results (nearly normal knee; group B) according to the International Knee Documentation Committee score. The most frequent failure causes were traumatic events, non-anatomic tunnel placement, and lack of graft incorporation. Conclusions A correct revision surgery requires accurate patient evaluation and knee imaging. Preoperative planning starts with the identification of the cause of failure of the primary reconstruction. Then, the most suitable procedure should be determined for each case. It is also important to accurately inform the patient of all the complexity of an ACL revision surgery even if it is a procedure with high rates of excellent and good outcomes.
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Affiliation(s)
| | | | - Andrea Fiocchi
- Clinic of Orthopaedics, Academic Hospital of Udine, Udine, Italy
| | | | - Araldo Causero
- Clinic of Orthopaedics, Academic Hospital of Udine, Udine, Italy
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Anand BS, Feller JA, Richmond AK, Webster KE. Return-to-Sport Outcomes After Revision Anterior Cruciate Ligament Reconstruction Surgery. Am J Sports Med 2016; 44:580-4. [PMID: 26672024 DOI: 10.1177/0363546515618381] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are limited and inconsistent data regarding return-to-sport outcomes after revision anterior cruciate ligament reconstruction (ACLR). HYPOTHESIS Return-to-sport rates will be lower after revision ACLR when compared with primary ACLR. STUDY DESIGN Case series; Level of evidence, 4. METHODS The study cohort consisted of 136 eligible patients who had undergone their first revision ACLR between March 2006 and March 2010. Of these, 109 patients (80%) completed a sports activity survey at a mean 5-year follow-up (range, 3-7 years). Follow-up also included the International Knee Documentation Committee (IKDC) subjective form, Marx Activity Scale, and Knee injury and Osteoarthritis Outcome Score-quality of life (KOOS-QOL) form. Operative details were obtained from the clinical record. RESULTS After revision ACLR, 46% (95% CI, 37%-55%) of patients returned to their preinjury level of sport, compared with 50% (95% CI, 41%-59%) after the primary reconstruction in the same patients. Of the patients who were not able to return to their preinjury level of sport after primary reconstruction, 33% improved to the point that they were able to do so after revision. Younger patients were more likely to have returned to their same level of sport (58% vs 38%, P < .05), while the rate of return was the same between male and female patients. Those who returned to their preinjury level of sport scored higher Marx (P < .01), KOOS-QOL (P < .001), and IKDC scores (P < .01) than those who did not. Patients with <50% thickness articular cartilage lesions at revision surgery were more likely to have returned to their preinjury level (52% vs 31%, P < .05) and had significantly better Marx (P < .01), KOOS-QOL (P < .01), and IKDC scores (P < .01) at follow-up. The status of the menisci at the time of revision surgery was not associated with rates of return to sport, but patients with an intact medial meniscus had significantly higher KOOS-QOL (P < .05) scores at follow-up. CONCLUSION Return-to-sport rates of patients after revision ACLR were similar to those after their primary surgery but were still lower than the reported rates of ACLR patients who did not need revision surgery. Greater chondral pathologic abnormalities at revision surgery were associated with reduced function at follow-up.
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Affiliation(s)
- Bobby S Anand
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia
| | - Julian A Feller
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia
| | | | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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Grassi A, Ardern CL, Marcheggiani Muccioli GM, Neri MP, Marcacci M, Zaffagnini S. Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results. Br J Sports Med 2016; 50:716-24. [PMID: 26809259 DOI: 10.1136/bjsports-2015-094948] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 12/17/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare patient-reported and clinician-reported outcomes, and radiographic results between patients who had had revision ACL reconstruction and those who had had primary ACL reconstruction. DESIGN Systematic review and meta-analysis DATA SOURCES The MEDLINE, CINAHL, EMBASE and SPORTDiscus electronic databases were searched on 6 August 2015, using 3 main concepts: (1) revision ACL reconstruction, (2) primary ACL reconstruction and (3) treatment outcomes. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Articles that compared patient-reported or clinician-reported outcomes or radiographic results between patients who had had revision ACL reconstruction and those who had had primary surgery with a minimum of 2 years follow-up were included. The outcomes evaluated were the Lysholm Knee Scoring Scale, objective International Knee Documentation Committee (IKDC) classification, Tegner Activity Scale, side-to-side difference in anterior tibial translation measured with KT-1000/2000 arthrometer, pivot shift test, tibiofemoral osteoarthritis grading on plain radiographs and subsequent knee surgeries. RESULTS 8 studies (300 revision ACL reconstructions and 413 primary ACL reconstructions) were included in the meta-analysis. Patients who had had revision surgery reported inferior Lysholm Knee Scoring Scale scores (mean difference: 7.8 points), had inferior clinician-reported knee function as assessed with the objective IKDC classification (IKDC category A: 27% vs 57%; IKDC category C or D: 22% vs 8%) and pivot shift test (grade II or III: 7% vs 2%), and more radiographic evidence of tibiofemoral osteoarthritis (50% vs 25%) compared with patients who had had primary surgery. CONCLUSIONS Revision ACL reconstruction restored similar anterior-posterior knee laxity compared with primary ACL reconstruction. Patients who had had revision surgery reported inferior Lysholm Knee Scoring Scale scores, had inferior clinician-reported knee function and more radiographic signs of tibiofemoral osteoarthritis compared with patients with primary ACL reconstruction.
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Affiliation(s)
- Alberto Grassi
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Clare L Ardern
- Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar Division of Physiotherapy, Linköping University, Linköping, Sweden School of Allied Health, La Trobe University, Melbourne, Australia
| | | | - Maria Pia Neri
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurilio Marcacci
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy
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Grassi A, Zaffagnini S, Marcheggiani Muccioli GM, Roberti Di Sarsina T, Urrizola Barrientos F, Marcacci M. Revision anterior cruciate ligament reconstruction does not prevent progression in one out of five patients of osteoarthritis: a meta-analysis of prevalence and progression of osteoarthritis. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Johnson WR, Makani A, Wall AJ, Hosseini A, Hampilos P, Li G, Gill TJ. Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2015; 3:2325967115611660. [PMID: 26779548 PMCID: PMC4714575 DOI: 10.1177/2325967115611660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. Purpose: To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed. Results: Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017). Conclusion: Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction had a statistically significantly, although not clinically significant, higher IKDC score after revision surgery compared with nontraumatic failures. These data may be useful when counseling a patient on whether to pursue revision ACL reconstruction surgery.
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Affiliation(s)
- William R Johnson
- Harvard Medical School, Boston, Massachusetts, USA.; Temple University Health System, Philadelphia, Pennsylvania, USA.; Tufts Medical Center, Boston, Massachusetts, USA
| | | | | | - Ali Hosseini
- Harvard Medical School, Boston, Massachusetts, USA.; Bioengineering Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Guoan Li
- Harvard Medical School, Boston, Massachusetts, USA.; Bioengineering Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas J Gill
- Orthopaedic Surgery, Tufts Medical School, Boston, Massachusetts, USA
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Andriolo L, Filardo G, Kon E, Ricci M, Della Villa F, Della Villa S, Zaffagnini S, Marcacci M. Revision anterior cruciate ligament reconstruction: clinical outcome and evidence for return to sport. Knee Surg Sports Traumatol Arthrosc 2015. [PMID: 26202138 DOI: 10.1007/s00167-015-3702-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE An increasing number of patients undergo revision anterior cruciate ligament (ACL) reconstruction, with the intention of returning to sport being a major indication. The aim of this study is to assess the available evidence for clinical improvement and return to sport, to understand the real potential of this procedure in regaining functional activity, and to facilitate improved counselling of patients regarding the expected outcome after revision ACL reconstruction. METHODS The search was conducted on the PubMed database. Articles reporting clinical results for revision ACL reconstruction were included. A meta-analysis was performed on return to sport, and results were compared to the literature on primary ACL reconstruction. Other specific clinical outcomes (Lysholm, Tegner, IKDC Objective scores) were also included in the meta-analysis. RESULTS Of the 503 identified records, a total of 59 studies involving 5365 patients were included in the qualitative data synthesis. Only 31 articles reported the rate of return to sport. Whereas 73 % of good objective results and satisfactory subjective results were documented, 57 % of patients did not return to the same level of sport activity, significantly inferior to that of a primary procedure. CONCLUSION The real potential of revision ACL reconstruction should not be overestimated due to the low number of patients able to return to their previous activity level, significantly inferior with respect to that reported for primary ACL reconstruction. This finding will help physicians in the clinical practice providing realistic expectations to the patients. Future studies should focus on participation-based outcome measures such as return to sport and in strategies to improve the results in terms of return to previous activities after revision ACL reconstruction. LEVEL OF EVIDENCE Systematic review and meta-analysis including Level IV studies, Level IV.
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Affiliation(s)
- Luca Andriolo
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
| | - Giuseppe Filardo
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Elizaveta Kon
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.,Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Margherita Ricci
- Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | | | | | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Maurilio Marcacci
- II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
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Brophy RH, Haas AK, Huston LJ, Nwosu SK, Wright RW, Wright RW. Association of Meniscal Status, Lower Extremity Alignment, and Body Mass Index With Chondrosis at Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2015; 43:1616-22. [PMID: 25899434 PMCID: PMC4490131 DOI: 10.1177/0363546515578838] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knees undergoing revision anterior cruciate ligament reconstruction (rACLR) have a high prevalence of articular cartilage lesions. HYPOTHESIS The prevalence of chondrosis at the time of rACLR is associated with meniscal status and lower extremity alignment. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Data from the prospective Multicenter ACL Revision Study (MARS) cohort were reviewed to identify patients with preoperative lower extremity alignment films. Lower extremity alignment was defined by the weightbearing line (WBL) as a percentage of the tibial plateau width, while the chondral and meniscal status of each weightbearing compartment was recorded at the time of surgery. Multivariable proportional odds models were constructed and adjusted for relevant factors to examine which risk factors were independently associated with the degree of medial and lateral compartment chondrosis. RESULTS The cohort included 246 patients with lower extremity alignment films at the time of rACLR. Mean (±SD) patient age was 26.9 ± 9.5 years and body mass index (BMI) was 26.4 ± 4.6. The medial compartment had more chondrosis (grade 2/3, 42%; grade 4, 6.5%) than did the lateral compartment (grade 2/3, 26%; grade 4, 6.5%). Disruption of the meniscus was noted in 35% of patients on the medial side and 16% in the lateral side. The mean WBL was 0.43 ± 0.13. Medial compartment chondrosis was associated with BMI (P = .025), alignment (P = .002), and medial meniscal status (P = .001). None of the knees with the WBL lateral to 0.625 had grade 4 chondrosis in the medial compartment. Lateral compartment chondrosis was significantly associated with age (P = .013) and lateral meniscal status (P < .001). Subjects with "intact" menisci were found to decrease their odds of having chondrosis by 64% to 84%. CONCLUSION The status of articular cartilage in the tibiofemoral compartments at the time of rACLR is related to meniscal status. Lower extremity alignment and BMI are associated with medial compartment chondrosis.
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Abstract
Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B.
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Affiliation(s)
- Jeffrey Wilde
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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Reverte-Vinaixa MM, Minguell J, Joshi N, Diaz-Ferreiro EW, Duarri G, Carrera L, Castellet E. Revision anterior cruciate ligament reconstruction using tibial or hamstring tendon allografts. J Orthop Surg (Hong Kong) 2014; 22:60-4. [PMID: 24781616 DOI: 10.1177/230949901402200116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To report outcomes of revision anterior cruciate ligament (ACL) reconstruction using tibial or hamstring tendon allografts and to compare with another study using non-irradiated fresh-frozen bone-patellar tendon-bone allografts. METHODS Records of 12 men and 7 women aged 18 to 53 (mean, 33) years who underwent revision ACL reconstructions using tibial tendon (n=17) or hamstring tendon (n=2) allografts were retrospectively reviewed. At the time of primary ACL reconstruction, hamstring autografts (n=8) and bonepatellar tendon-bone allografts (n=11) were used. The mean time interval between surgeries was 93 (range, 11-225) months. The causes of failure were traumatic injury (n=7) and technical or biological reasons (n=12). The physical activity level was high in 2 patients, medium in 10, and low in 7. For clinical assessment, the Lysholm test, International Knee Documentation Committee (IKDC) scale, and visual analogue scale (VAS) for pain were used. Patient satisfaction was also assessed. RESULTS Four of the patients had laxity and were dissatisfied or very dissatisfied with the outcome; the failure rate was 21%. The mean IKDC score was 63% (range, 25-100%), and the mean Lysholm score was 74% (range, 30-100%). Comparing our patients with those in another study using bone-patellar-bone allografts, there was no significant difference in terms of the VAS for pain, IKDC score, and Lysholm score. Comparing our patients with and without chondral and/or meniscal lesions, there was significant difference in terms of the Lysholm score only (86±11 vs. 57±28, p=0.043). Comparing patients who had used hamstring tendon autografts at the primary ACL reconstruction with those who had used bonepatellar tendon-bone autografts, there was significant difference in terms of the VAS for pain only (4.4±3.1 vs. 1.6±1.0, p=0.020). CONCLUSION Revision ACL reconstruction using tibial or hamstring tendon allografts provided acceptable results, similar to those using the bone-patellar tendon-bone allografts.
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Affiliation(s)
- Maria Mercedes Reverte-Vinaixa
- Department of Trauma and Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
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Mahmoud SSS, Odak S, Coogan S, McNicholas MJ. A prospective study to assess the outcomes of revision anterior cruciate ligament reconstruction. INTERNATIONAL ORTHOPAEDICS 2014; 38:1489-94. [PMID: 24687269 DOI: 10.1007/s00264-014-2324-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/10/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Continuously increasing numbers of primary anterior cruciate ligament (ACL) reconstructions invites a parallel increase in graft failures and need for revision ACL reconstruction surgery. High failure rates has previously stigmatised the revision surgery. We performed this study using multiple outcome measures together with clinical examination to offer a full assessment of the outcomes of this procedure. METHODS Twenty patients, with mean age of 29.4 years (17-50 years), were included in this study prior to their revision ACL reconstruction surgery. All patients were followed prospectively collecting the Knee injury and Osteoarthritis Outcome (KOOS), International Knee Documentation Committee (IKDC) and Tegner-Lysholm scores pre- and post-operatively together with clinical assessment of the antero-posterior knee laxity. RESULTS After a mean follow up interval of 30 months (16-60 months) significant post-operative improvement of IKDC, Tegner-Lysholm scores and knee antero-posterior laxity together with the Symptoms, Activities of Daily Living (ADL) and Quality of Life (QOL) components of the KOOS score was noticed (P < 0.05). However, there was no similar improvement in pain and sports components of the KOOS score (P > 0.05). There was no difference in the outcomes of different graft types. CONCLUSION Good outcomes of revision ACL reconstruction surgery are achievable. The use of different graft types did not affect the outcome of the procedure. Most of the patients opted to less aggressive sports participation after the revision procedure.
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Affiliation(s)
- Samer Samir Sayed Mahmoud
- Department of Trauma and Orthopaedics, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, UK, SW17 0QT,
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Lee YS, Lee BK, Moon DH, Park HG, Kim WS, Moon CW. Comparison of tunnel locations of double bundle ACL reconstruction using the conventional transtibial technique with anatomic tunnel locations using a 3D CT model. Arch Orthop Trauma Surg 2013; 133:1121-8. [PMID: 23712710 DOI: 10.1007/s00402-013-1780-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The purposes of this study were: (1) to compare tunnel locations using the conventional transtibial technique with reference data, and (2) to identify factors that make it difficult to position the femoral tunnel correctly or contribute to breakage of the bone bridge between the two tibial tunnels. MATERIALS AND METHODS A prospective study was performed on 28 patients who underwent double bundle ACL reconstruction. Locations of each tunnel were determined using an anatomic coordinate axes method (ACAM). Measurements included: thickness of the bone bridge between tibial two tunnels (BB), height from the union (HU) point to expected joint surface, the ratio between the length of Blumensaat's line and the anterior-posterior length of the lateral femoral condyle (RBL), and the ratio between anterior-posterior and proximal-distal lengths of the medial wall of the lateral femoral condyle (RAPPD). RESULTS The posterior-anterior direction of femoral AM tunnel, the proximal-distal direction of femoral PL tunnel, and the posterior-anterior direction of femoral PL tunnel were statistically significantly different from the reference data. In correlation analyses between BB or HU and other variables, the AM tibial tunnel and RBL showed a moderate negative correlation. The cutoff point for tunnel breakage was an RLB of 1.14, meaning that the possibility of bone bridge breakage would increases for RBL values of >1.14. CONCLUSIONS It seems that conventional transtibial drilling technique used during double bundle ACL reconstruction does not reproduce correct tunnel locations compared with reference data. This problem was found to be related to the bony geometry of the medial wall of the lateral femoral condyle or the bone bridge between the two tibial tunnels. Our results indicate that RBL should be determined by pre-operative CT or plain lateral radiography, and that transtibial single bundle reconstruction or double bundle reconstruction using other methods should be attempted when the RBL exceeds 1.14.
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Affiliation(s)
- Yong Seuk Lee
- Department of Orthopaedic Surgery, Gachon University School of Medicine, Gil Hospital, Incheon, Republic of Korea
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Abstract
Failure after anterior cruciate ligament reconstruction is a potentially devastating event that affects a predominantly young and active population. This review article provides a comprehensive analysis of the potential causes of failure, including graft failure, loss of motion, extensor mechanism dysfunction, osteoarthritis, and infection. The etiology of graft failure is discussed in detail with a particular emphasis on failure after anatomic anterior cruciate ligament reconstruction.
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Abstract
With the rising number of anterior cruciate ligament (ACL) reconstructions performed, revision ACL reconstruction is increasingly common nowadays. A broad variety of primary and revision ACL reconstruction techniques have been described in the literature. Recurrent instability after primary ACL surgery is often due to non-anatomical ACL graft reconstruction and altered biomechanics. Anatomical reconstruction must be the primary goal of this challenging revision procedure. Recently, revision ACL reconstruction has been described using double bundle hamstring graft. Successful revision ACL reconstruction requires an exact understanding of the causes of failure and technical or diagnostic errors. The purpose of this article is to review the causes of failure, preoperative evaluation, graft selection and types of fixation, tunnel placement, various types of surgical techniques and clinical outcome of revision ACL reconstruction.
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Over-the-top double-bundle revision ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20:1404-8. [PMID: 22057386 DOI: 10.1007/s00167-011-1753-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 10/25/2011] [Indexed: 02/07/2023]
Abstract
Revision ACL presents many technical issues that are not seen in the primary ACL reconstruction. A variety of surgical techniques for revising ACL reconstruction have been described in the literature to address these concerns. The purpose of this article is to present a novel technique consisting in a non-anatomic double-bundle ACL revision reconstruction, using a fresh-frozen Achilles tendon allograft with soft tissue fixation. This technique is a valid treatment option when faced with a complex scenario such as ACL revision surgery.
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Brophy RH, Wright RW, David TS, McCormack RG, Sekiya JK, Svoboda SJ, Huston LJ, Haas AK, Steger-May K. Association between previous meniscal surgery and the incidence of chondral lesions at revision anterior cruciate ligament reconstruction. Am J Sports Med 2012; 40:808-14. [PMID: 22374942 PMCID: PMC3650832 DOI: 10.1177/0363546512437722] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knees undergoing revision anterior cruciate ligament (ACL) reconstruction typically have more intra-articular injuries than do knees undergoing primary reconstruction. HYPOTHESIS Previous partial meniscectomy (PM) is associated with a higher rate of chondral lesions at revision ACL reconstruction, whereas previous meniscal repair (MR) is not associated with a higher rate of chondral lesions at revision ACL reconstruction, compared with knees undergoing revision ACL with no previous meniscal surgery. STUDY DESIGN Cohort study (Prevalence); Level of evidence, 2. METHODS Data from a multicenter cohort was reviewed to determine the history of prior meniscal surgery (PM/MR) and the presence of grade II/III/IV chondral lesions at revision ACL reconstruction. The association between previous meniscal surgery and the incidence of chondral lesions was examined. Patient age was included as a covariate to determine if surgery type contributes predictive information independent of patient age. RESULTS The cohort included 725 ACL revision surgeries. Chondrosis was associated with patient age (P < .0001) and previous meniscal surgery (P < .0001). After adjusting for patient age, knees with previous PM were more likely to have chondrosis than knees with previous MR (P = .003) or no previous meniscal surgery (P < .0001). There was no difference between knees without previous meniscal surgery and knees with previous MR (P = .7). Previous partial meniscectomy was associated with a higher rate of chondrosis in the same compartment compared with knees without previous meniscal surgery (P < .0001) and knees with previous MR (P ≤ .03). CONCLUSION The status of articular cartilage at the time of revision ACL reconstruction relates to previous meniscal surgery independent of the effect of patient age. Previous partial meniscectomy is associated with a higher incidence of articular cartilage lesions, whereas previous meniscal repair is not. Although this association may reflect underlying differences in the knee at the time of prior surgery, it does suggest that meniscal repair is preferable when possible at the time of ACL reconstruction.
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Affiliation(s)
- Robert H. Brophy
- Address correspondence to Robert H. Brophy, MD, Washington University Department of Orthopaedic Surgery, Suite 11300, West Pavilion, St. Louis, MO 63110 ()
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Abstract
BACKGROUND We developed the rectangular tunnel ACL reconstruction (RT ACLR) using a 10-mm wide bone-patellar tendon-bone (BTB) graft through rectangular tunnels with a rectangular aperture to reduce tunnel size: the cross-sectional area of the tunnels of 50 mm(2) (5 × 10 mm) in RT ACLR is less than that of 79 mm(2) in a conventional 10-mm round tunnel technique presuming the technique would be more suitable in revision ACLR with previous improperly placed tunnels. DESCRIPTION OF TECHNIQUE Two contiguous 5-mm tunnels inside the anatomic ACL femoral and tibial attachment areas along their long axes, and they are expanded with a 5 × 10-mm dilator into parallelepiped ones. PATIENTS AND METHODS We indicated and intended to perform the RT ACLR procedure in 31 patients requiring revision between 2004 and 2008. Eighteen of the 31 patients treated with the procedure were followed a minimum of 24 months (mean, 38 months; range, 24 to 73 months). We evaluated ROM, obtained IKDC scores, and determined stability with KT-1000. RESULTS The procedure could be applied in 30 of the 31 cases. One of the 18 reruptured the graft at 28 months. Of the remaining 17 patients with followup of 24 months or longer, 15 had full ROM, while the remaining two lost 5° of flexion; 11 were classified as normal and six were nearly normal according to the IKDC evaluation. Stability measured with KT-1000 was 1.0 ± 1.5 mm. CONCLUSION The RT ACLR technique provided acceptable results after one-stage revision ACLR. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Differential cross-linking and radio-protective effects of genipin on mature bovine and human patella tendons. Cell Tissue Bank 2012; 14:21-32. [PMID: 22350064 DOI: 10.1007/s10561-012-9295-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/24/2012] [Indexed: 01/14/2023]
Abstract
Gamma irradiation is a proven sterilization method, but is not widely used on allografts for anterior cruciate ligament reconstruction (e.g., patella tendon) due to radiation-induced decreases in mechanical strength. Addressing this drawback would improve the safety and supply of allografts to meet current and future demand. It was hypothesized that genipin-induced collagen cross-linking would increase the tensile modulus of patella tendon tissue such that 5 MRad gamma irradiation would not reduce the tissue mechanical strength below the original untreated values. Optimized genipin treatment increased the tensile modulus of bovine tendons by ~2.4-fold. After irradiation, genipin treated tissue did not significantly differ from native tissue, proving the hypothesis. Optimized genipin treatment of human tendons increased the tensile modulus by ~1.3-fold. After irradiation, both control and genipin-treated tissues possessed ~50-60% of their native tendon modulus, disproving the hypothesis. These results highlight possible age- and species- dependent effects of genipin cross-linking on tendon tissue. Cross-linking of human allografts may be beneficial only in younger donor tissues. Future research is warranted to better understand the mechanisms and applications of collagen cross-linking for clinical use.
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