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Qiao Y, Zhang X, Zhao Y, Wu C, Xu C, Chen J, Zhao J, Zhao S. Comparing Ultrasound and MRI Evaluations of the Hamstring Tendon for Predicting Autograft Size in Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2024; 12:23259671241248187. [PMID: 39176268 PMCID: PMC11339936 DOI: 10.1177/23259671241248187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/13/2023] [Indexed: 08/24/2024] Open
Abstract
Background Adequate graft size and length are crucial factors in anterior cruciate ligament (ACL) reconstruction. Accurate identification of patients who may be at risk for an insufficient length or size of the hamstring tendon (HT) can aid surgeons in preoperative planning. Purpose To evaluate whether magnetic resonance imaging (MRI) or ultrasound could more accurately predict the size of the semitendinosus tendon (ST) and gracilis tendon (GT) and to investigate the correlation between anthropometry, graft size, and imaging measurements to find a predictive formula. Study Design Cross-sectional study; Level of evidence, 3. Methods Included in the study were 36 patients who underwent ACL reconstruction with HT autograft at our institution between July 2021 and May 2022. Anthropometric data and MRI and ultrasound measurements were collected preoperatively. The length and diameter of the HT were recorded intraoperatively. Correlations between anthropometry, graft size, and imaging measurements were analyzed. Linear regression analysis was performed to construct a prediction formula. Results The intraoperative graft diameters of the ST and GT were weakly to moderately associated with their cross-sectional areas as measured by MRI and ultrasound. MRI and ultrasound interpreted 11.9% to 15.7% and 18.4% to 41.7% of the variation in the graft diameter of the HT, with an accuracy of 50.0% to 55.6% and 69.4% to 86.1%, respectively. The intraoperative lengths of the ST and GT were both associated with patient height and tendon lengths as measured by ultrasound. Additionally, intraoperative GT length was associated with patient weight. Four formulas combining relevant anthropometric parameters and imaging measurements were calculated from multilinear regression analysis, explaining up to 46.3% of the variance in the size of HT. Conclusion Ultrasound and MRI alone showed limited ability to predict the graft diameter of the ST and GT, while ultrasound could more accurately predict the graft size than MRI. Among the different anthropometric variables, height was the most influential in predicting tendon length.
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Affiliation(s)
- Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Yu Zhao
- Department of Orthopaedics, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Chen
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Mirza K, Menezes RJ, Acharya PU, Austine J, d'Almeida VR, Kamath A. Donor-site morbidity following arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04046-x. [PMID: 39039170 DOI: 10.1007/s00590-024-04046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Peroneus longus has proved to be a promising graft for ACL reconstruction due to its high tensile strength, and ease of harvesting. While multiple studies have assessed the functional outcomes of the knee after ACL reconstruction using peroneus longus autograft, we aimed to evaluated donor site morbidity among the Indian population. MATREIALS AND METHODS This was a prospective, longitudinal, descriptive study conducted at a tertiary care hospital. Preoperative AOFAS and Karlsson-Peterson scores were obtained, and patients were followed up after surgery for a period of 6-months using the same scoring systems and strength testing with a hand-held Chatillon MSE-100-M dynamometer. Pedobarographs were done using Diers Pedoscan Plantar Pressure Measurement System on a subset of seven patients. RESULTS 20 patients participated in the study. Mean AOFAS and Karlsson-Peterson scores pre-operatively were 99.7 ± 1.34 and 98.5 ± 4.62 respectively. On completing 6- months of follow-up these scores were found to be 95.6 ± 9.43 and 88.75 ± 18.42 respectively. Deterioration of mean evertor strength was noted at all follow-ups compared to the opposite side. Static pedobarographs showed significant decreased in total surface area of contact and pressure over the posterior aspect of the operated side by 3-months which improved later at 6-months. Dynamic pedobarographs showed decreased mean average plantar pressure while walking on the operated side and significant increase in mean surface area of contact of the operated side (191.886±22.678 cm2) at 6-months of follow-up compared to the opposite side (184.471 ± 22.218 cm2). Five patients showed deviation of the point of maximum pressure while walking on the operated foot making it lateral to the COP with increased lateral plantar/ medial plantar pressure ratio. CONCLUSION While the use of peroneus longus tendon autografts in arthroscopic ACL reconstruction does not seem problematic on short-term subjective assessment, there is objective evidence in keeping with evertor weakness, weakness of first ray plantar flexion and possible ankle instability. LEVEL OF EVIDENCE Level lll.
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Affiliation(s)
- Kiyana Mirza
- Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.
| | - Ronald Joseph Menezes
- Department of Orthopaedic Surgery, Father Muller Medical College, Mangalore, 575002, India
| | | | - Jose Austine
- Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK
| | | | - Ashwin Kamath
- Department of Orthopaedic Surgery, Father Muller Medical College, Mangalore, 575002, India
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Park JY, Fernandes A, Park SY, Lim H, Sayudo IF, Leibovitch L, Machinski E, Ha J. Comparative effectiveness of peroneus longus tendon (PLT) autografts versus hamstring tendon (HT) autografts in anterior cruciate ligament reconstruction: a comprehensive systematic review and meta analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2691-2699. [PMID: 38755499 PMCID: PMC11291530 DOI: 10.1007/s00590-024-03984-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
The hamstring tendon (HT) autograft is currently the most widely utilised autograft option for anterior cruciate ligament (ACL) reconstruction. However, recent studies endorse the peroneus longus tendon (PLT) autograft as a viable alternative. To evaluate this, we systematically reviewed randomised controlled trials (RCTs) to compare the efficacy of PLT against HT autografts. Our search encompassed Cochrane, Embase, OVID, PubMed, and Scopus databases for RCTs comparing outcomes of PLT and HT autografts in ACL reconstruction. Primary outcomes included Lysholm and International Knee Documentation Committee (IKDC) scores, while secondary outcomes involved American Orthopaedic Foot and Ankle Society (AOFAS) scores, graft diameters and donor-site complications. Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration) and heterogeneity was assessed with I2 statistics. 683 patients from 6 RCTs were included, with 338 (49.5%) patients treated with PLT autografts. Follow-up ranged from 12 to 30 months. Despite lower preoperative Lysholm scores in the PLT group, no significant differences were observed at 6 and 12 months. Although preoperative and 6-month IKDC scores were lower in the PLT group, no significant differences were found at 12 and 24 months. AOFAS scores showed no significant preoperative difference, but slightly lower scores were noted in the PLT group at 12 or 24 months. There was no significant difference in graft diameter, while donor-site complications were fewer in the PLT group. In summary, the PLT autograft is a promising and non-inferior alternative to the HT autograft, demonstrating equivalent outcomes in patient-reported knee and ankle metrics, comparable graft diameters and fewer donor-site complications.
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Affiliation(s)
- Jae Yong Park
- Department of Medicine, Imperial College London, Ayrton Rd, South Kensington, London, SW7 5NH, UK.
| | - André Fernandes
- Department of Trauma and Orthopaedics, York and Scarborough NHS Trust, London, UK
| | - Shin Young Park
- Department of Medicine, Manchester University, Manchester, UK
| | - Hayeon Lim
- Department of Medicine, Imperial College London, Ayrton Rd, South Kensington, London, SW7 5NH, UK
| | | | | | - Elcio Machinski
- Department of Medicine, State University of Ponta Grossa, Ponta Grossa, Brazil
| | - Joon Ha
- St Michael's Hospital, University of Toronto, Toronto, Canada
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Punnoose DJ, Varghese J, Theruvil B, Thomas AB. Peroneus Longus Tendon Autografts have Better Graft Diameter, Less Morbidity, and Enhanced Muscle Recuperation than Hamstring Tendon in ACL Reconstruction. Indian J Orthop 2024; 58:979-986. [PMID: 38948366 PMCID: PMC11208339 DOI: 10.1007/s43465-024-01185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/12/2024] [Indexed: 07/02/2024]
Abstract
Background Recently the peroneus longus tendon (PLT) gained popularity in anterior cruciate ligament (ACL) reconstruction and has been utilized with satisfactory outcomes. However, there are concerns regarding donor site morbidity. This study aims to compare the functional outcome of ACL reconstruction using hamstring (HT) and PLT autografts and evaluate the donor site morbidity. Methods Patients who underwent ACL reconstruction were allocated to two groups (HT and PLT). Graft diameter was measured intraoperatively. Knee functional outcome was evaluated with IKDC and Tegner-Lysholm scores preoperatively, and postoperatively after 3 months, 6 months, and 1 year. Donor site morbidities were assessed with thigh circumference measurements, subjective evaluation of sensory disturbances, and ankle scoring with AOFAS and FADI scores. Results At 1-year follow-up, the PLT group showed comparable IKDC (p = 0.925) and Tegner-Lysholm (p = 0.600) scores with those of the HT group. The mean graft diameter in the PLT group (7.93 ± 0.52 mm) was larger compared with the HT group (7.43 ± 0.50 mm) (p < 0.001). The incidence of thigh atrophy (HT-16.7%, PLT-10%) and sensory disturbances (HT-73.3%, PLT-10%) was greater in the HT group. There was no significant ankle donor site morbidity in the PLT group (AOFAS-98.67 ± 3.45, FADI-99.23 ± 1.69). Conclusion ACL reconstruction with PLT had comparable functional outcome with that of HT at 1 year. However, PLT demonstrated larger graft diameter, less donor site morbidity, and enhanced muscle recovery without significantly affecting the ankle function. PLT can be safely used as an acceptable alternative graft choice harvested from outside the knee for ACL reconstruction.
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Affiliation(s)
| | - Jacob Varghese
- Department of Orthopaedics, VPS Lakeshore Hospital, Kochi, 682040 Kerala India
| | - Bipin Theruvil
- Department of Orthopaedics, VPS Lakeshore Hospital, Kochi, 682040 Kerala India
| | - Appu Benny Thomas
- Department of Orthopaedics, VPS Lakeshore Hospital, Kochi, 682040 Kerala India
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Quinn M, Byrne RA, Albright JA, Testa E, Ahn B, Lemme N, Petit L, Blankenhorn B, Owens BD. Peroneus Longus Tendon Autograft May Present a Viable Alternative for Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2024; 40:1366-1376.e1. [PMID: 37898307 DOI: 10.1016/j.arthro.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE To examine the available literature to better understand the objective and patient-reported outcomes using peroneus longus tendon (PLT) autograft compared with more commonly used autografts, such as the quadrupled hamstring tendons (HT), in patients undergoing primary for anterior cruciate ligament reconstruction (ACLR). METHODS A comprehensive search of published literature in PubMed, Web of Science, Cochrane Library, Ovid, and EMBASE databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included patients undergoing ACLR with PLT autograft, inclusion of patient-recorded outcome measures, and availability in English language. Publications that included only biomechanical analysis or ACLR with use of allograft or combination grafts were excluded. RESULTS A total of 16 studies (Level of Evidence range: I-IV) met inclusion criteria, with follow-up ranging from 3 months to 5 years. In the available case series, patient-reported outcomes ranged from Lysholm = 80.7 to 95.1, International Knee Documentation Committee 78.1 to 95.7. In prospective cohorts and randomized controlled trials, PLT performance was comparable with HT autografts (PLT/HT: Lysholm = 88.3-95.1/86.5-94.9, International Knee Documentation Committee = 78.2-92.5/87.4-93.4). The majority of PLT grafts diameters were equal or greater than HT counterparts with a mean of >8 mm (PLT/HT: 7.0-9.0 mm/7.65-8.5 mm). There was minimal donor-site morbidity associated with PLT harvest. CONCLUSIONS Although limitations exist within the available literature, existing evidence suggests that PLT autograft routinely produces adequately sized grafts with comparable early outcomes to HT autograft and low risk of donor-site morbidity. However, the PLT autograft is yet to demonstrate superiority to any of the more-traditional autograft selections. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Matthew Quinn
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A..
| | - Rory A Byrne
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - J Alex Albright
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Edward Testa
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Benjamin Ahn
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Nicholas Lemme
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Logan Petit
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Brad Blankenhorn
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Brett D Owens
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
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Viswanathan VK, Iyengar KP, Jain VK. The role of peroneus longus (PL) autograft in the reconstruction of anterior cruciate ligament (ACL): A comprehensive narrative review. J Clin Orthop Trauma 2024; 49:102352. [PMID: 38356688 PMCID: PMC10862405 DOI: 10.1016/j.jcot.2024.102352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Background Peroneus longus tendon (PLT) is a known graft utilised in the ligamentous reconstructions of knee. The current review was performed to analyze the available evidence regarding PLT in the arthroscopic anterior cruciate ligament (ACL) reconstruction. Methods A comprehensive search of literature was performed on March 1, 2023 using 5 databases (for manuscripts published between 2010 and 2023). All studies reporting ACL reconstruction with PL graft in adults ≥18 years were considered; and final studies were shortlisted based on specific exclusion criteria. Results The search identified 684 articles, among which 26 manuscripts were finally selected. PLT has been used in primary ACL reconstruction (ACLR), revision ACLR, ACLR in multiligamentous injuries and those at risk for anterior knee pain. The full-thickness PLT graft is variable in its dimensions with the mean size ranging between 7 and 8.8 mm (half-PLT grafts ≤8.1 mm). The ultimate strength of doubled PLT graft is significantly higher than native ACL and comparable to the quadrupled hamstring.There was statistically insignificant difference in the laxity and functional outcome of knee following ACLR with PLT, as compared with other autografts (p > 0.05). PLT harvest is associated with satisfactory clinical foot and ankle outcomes, as well as excellent regenerative ability. Overall, studies have demonstrated lower complications with PLT (p < 0.05). Conclusion The dimensions of harvested PLT graft are more consistent than HT. It has similar functional outcome and survival, as compared to other autografts. It also has lower risk for donor-site morbidity and lower complications than HT. PLT is a promising, alternative autograft choice in patients undergoing ACLR.
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Affiliation(s)
| | | | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
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Zhao Z, Tang L, Chen J, Bai X, Chen Y, Ng L, Zhou Y, Deng Y. The effect of harvesting the anterior half of the peroneus longus tendon on foot morphology and gait. J Orthop Surg Res 2024; 19:69. [PMID: 38225652 PMCID: PMC10790475 DOI: 10.1186/s13018-023-04429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/29/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES In anterior cruciate ligament reconstruction, the strength of the graft was found to be unsatisfactory usually the anterior half of the peroneus longus tendon was taken for supplementation, but the effect on foot and ankle function and gait in the donor area is unclear. This study aims to explore the changes in the ankle and gait after using the harvested anterior half of the peroneus longus tendon as a reconstruction graft for the anterior cruciate ligament. METHODS A total of 20 patients, 6 males and 14 females, aged 18 to 44 years, with unilateral anterior cruciate ligament injuries, underwent reconstruction using the harvested anterior half of the peroneus longus tendon as a graft between June 2021 and December 2021. The part on which the anterior half of the peroneus longus tendon was harvested was considered the experimental group, while the contralateral foot was the control group. At the 6-month follow-up, the Lysholm knee score, AOFAS ankle score, and gait-related data (foot length, arch index, arch volume, arch volume index, and gait cycle parameters: percentage of time in each gait phase, step frequency, step length, foot strike angle, and push-off angle) were assessed using a 3D foot scanner and wearable sensors for both groups. RESULTS All 20 patients completed the six-month follow-up. There were no statistically significant differences between the experimental and control groups regarding knee scores, ankle scores, foot length, arch index, arch volume, arch volume index, step frequency, and step length (P > 0.05). However, there were statistically significant differences between the experimental and control groups in terms of the gait cycle parameters, including the percentage of time in the stance, mid-stance, and push-off phases, as well as foot strike angle and push-off angle (P < 0.05). CONCLUSION Through our study of the surgical experimental group we have shown that harvesting the anterior half of the peroneus longus tendon does not affect foot morphology and gait parameters; however, it does impact the gait cycle.
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Affiliation(s)
- Zhi Zhao
- Department of Sport Medicine, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, 400012, China
| | - Li Tang
- Chongqing Rongzhi Biotechnology Company Limited, Chongqing, 400012, China
| | - Jing Chen
- Chongqing Rongzhi Biotechnology Company Limited, Chongqing, 400012, China
| | - Xinwen Bai
- Department of Sport Medicine, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, 400012, China
| | - Yu Chen
- Department of Sport Medicine, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, 400012, China
| | - Liqi Ng
- Institute of Orthopaedic and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, UK
| | - Yu Zhou
- Postdoctoral Research Workstation, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, 400012, China.
| | - Yu Deng
- Department of Sport Medicine, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, 400012, China.
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Zhang L, Sun X, Jiang L, Zhou X, Shi H, Yang Y, Cai M, Wang G. The morphology of osseous structure in subtalar joint with chronic ankle instability. Foot Ankle Surg 2024; 30:74-78. [PMID: 37748980 DOI: 10.1016/j.fas.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/22/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Osseous structures have been demonstrated as risk factors for chronic ankle instability (CAI). Previously, the researchers only focused on the osseous structures of ankle, but ignored the osseous structures of subtalar joint(STJ). Accordingly, the aim of our study was to investigate the morphological characteristics of STJ osseous structures in CAI. METHODS 52 patients with CAI and 52 sex- and age- matched control subjects were enrolled from The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. The lateral radiographs of ankle in weight-bearing were used to compare the diversity of the two groups. Specifically, The Length of calcaneus, Calcaneal facet height and Absolute foot height, Böhler's angle, Gissane's angle, Calcaneal inclination angle, Talocalcaneal angle, Tibiotalar angle, Tibiocalcaneal angle, Talar-horizontal angle, talar declination angle, facet inclination angle were gauged in the two groups. RESULTS The Böhler's angle, Calcaneal inclination, Talocalcaneal angle, Tibiotalar angle, Talar-horizontal angle, Talar declination angle, Facet inclination angle and Absolute foot height of CAI group were significantly higher than normal control group (P < 0.05). There were no significant differences in Gissane's angle, Tibiocalcaneal angle, Length of calcaneus and Calcaneal facet height between patients with CAI and normal controls (P > 0.05). CONCLUSIONS The osseous structures of STJ in CAI patients are different from normal people in morphology. Therefore, we should pay more attention to the changes of STJ anatomical parameters in the diagnosis and prevention of CAI. LEVEL OF EVIDENCE Ⅲ.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China; Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China
| | - Xinghao Sun
- School of Clinical Medicine, Southwest Medical University, Luzhou 646000, China
| | - Lu Jiang
- School of Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou 646000, China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China; Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China
| | - Houyin Shi
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China; Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China
| | - Yuening Yang
- School of Clinical Medicine, Southwest Medical University, Luzhou 646000, China
| | - Mingyang Cai
- School of Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou 646000, China
| | - Guoyou Wang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China; Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China.
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Saoji A, Arora M, Jain G, Shukla T. There is a Minimal Difference in Ankle Functional Outcomes After Peroneus Longus Harvest: Systematic Review and Meta-analysis. Indian J Orthop 2023; 57:1993-1999. [PMID: 38009168 PMCID: PMC10673779 DOI: 10.1007/s43465-023-00982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 08/18/2023] [Indexed: 11/28/2023]
Abstract
Importance Recently, peroneus longus (PL) autograft as a graft choice for ligament surgeries have attracted interest due to studies showing good clinical outcomes and minimal donor site morbidity. There remain concerns related to these grafts, especially the potential impact on ankle functions. Aims/Objective The purpose of this review and meta-analysis is to summarize the available evidence for ankle functional outcomes after PL harvest. This will provide objective clinical evidence for surgical decision making. Evidence Review Cochrane, Embase, Medline, and Google Scholar were all searched for articles published between January 2001 and May 2021. For the aim of a systematic review, certain inclusion and exclusion criteria were adopted in accordance with PRISMA recommendations. The primary outcome measure was the assessment of ankle functional outcomes using validated instruments (such as AOFAS score, FADI score etc.). Findings A total of twelve studies representing pooled patient populations of 537 patients were included in this review. The average follow-up duration was 17 months (range; 6-32 months) across all studies. All twelve studies assessed AOFAS score and six studies also additionally assessed FADI score. The pooled mean outcomes measured showed a slight decrease in post-operative as compared to pre-operative AOFAS and FADI score (mean difference of AOFAS 1.92, 95% CI 1.021-3.123, p value < 0.05 and mean difference for FADI 1.50, 95% CI 0.561-2.445, p value < 0.05). Though statistically significant the magnitude of variance implies minimal clinical impact. Conclusion and Relevance This review and meta-analysis found that PL autograft harvest leads to statistically significant but minimal impact on ankle functional outcomes. This, in conjunction with various studies on ankle parameters after PL harvest, shows that PL harvest leads to minimal impact on ankle outcomes and function. Level of Evidence Systematic review Level III.
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Affiliation(s)
- A. Saoji
- Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Maharashtra India
| | - M. Arora
- Department of Orthopedics and Sports Medicine Fortis Hospital, Mohali, Punjab India
| | - G. Jain
- Orthopedics, GBH American Hospital, Udaipur, Rajasthan India
| | - T. Shukla
- Fortis Hospital, Mohali, Punjab India
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Cakar A, Kose O, Selcuk H, Egerci OF, Tasatan E, Dogruoz F. Complications of peroneus longus tendon harvesting: a retrospective review of 82 cases. Arch Orthop Trauma Surg 2023; 143:6675-6684. [PMID: 37453933 DOI: 10.1007/s00402-023-04988-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Peroneus longus tendon (PLT) has become a reliable autologous graft option for various ligament reconstructions. But there are potential risks and complications associated with its use as a graft. This retrospective study aimed to examine the complications and donor site morbidity following PLT harvesting. PATIENTS AND METHODS A retrospective review was performed on an institutional digital patient database, and all patients who underwent ligament reconstruction using PLT autograft were identified. Intraoperative, early, and late complications were reviewed using digital patient notes and patients underwent a complete physical examination during their final follow-up. Ankle function was assessed using the AOFAS score, and manual ankle muscle testing was performed on both sides. Sural nerve iatrogenic injury was evaluated with a dermatomal light touch examination. Cosmetic satisfaction due to incision scar and footwear complaints were also assessed. RESULTS 82 patients (74 male, eight female) with a mean age of 31.9 ± 10.4 years (range, 16-66) were included in the final analysis. The mean follow-up time was 46.6 ± 30.3 months (range, 6-109). The mean AOFAS score for the donor side was 98.7 ± 3.3 (range, 87-100), and the contralateral side score was 100, with manual muscle testing graded as 5 in all movements and similar to the contralateral side. Fifteen patients (18.3%) had hypoesthesia over the dorsolateral aspect of the foot distal to the incision scar, two patients (2.4%) had hyperalgesia over the distal incision scar, and one patient (1.2%) had mild ankle instability. There were two cases (2.4%) of compartment syndrome, both of which were treated with fasciotomy and had complete regression of symptoms after 5 days. One patient (1.2%) had a transient peroneal nerve injury and foot drop that resolved in the sixth month. CONCLUSIONS The results of this retrospective study suggest that harvesting the PLT is associated with a high rate of complications and donor site morbidity. The most common complication was hypoesthesia around the lateral side of the foot, although the ankle functions were not affected significantly. Two cases of compartment syndrome and one transient peroneal nerve injury were observed. Care should be taken while harvesting PLT autograft, and it should be kept in mind that peroneal nerve injury might occur. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Albert Cakar
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık Mah., Kazım Karabekir cd., Antalya, 07100, Muratpasa, Turkey.
| | - Huseyin Selcuk
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık Mah., Kazım Karabekir cd., Antalya, 07100, Muratpasa, Turkey
| | - Omer Faruk Egerci
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık Mah., Kazım Karabekir cd., Antalya, 07100, Muratpasa, Turkey
| | - Ersin Tasatan
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Fırat Dogruoz
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık Mah., Kazım Karabekir cd., Antalya, 07100, Muratpasa, Turkey
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11
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Zeng J, Huang J, Liu Z, Xia H. Influence of peroneus longus tendon autograft for ACL reconstruction on donor-side ankle function in obese patients: A retrospective study of 87 patients. Asian J Surg 2023; 46:5305-5307. [PMID: 37541897 DOI: 10.1016/j.asjsur.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/09/2023] [Indexed: 08/06/2023] Open
Affiliation(s)
- Jin Zeng
- The First District of Department of Orthopedics, Xiangtan Central Hospital, Xiangtan, China; Hengyang Medical College, University of South China, Hengyang, China
| | - Jiaqiang Huang
- The First District of Department of Orthopedics, Xiangtan Central Hospital, Xiangtan, China
| | - Zhaoxiang Liu
- Trauma Center of Xiangtan Central Hospital, Xiangtan, China
| | - Hong Xia
- The First District of Department of Orthopedics, Xiangtan Central Hospital, Xiangtan, China.
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12
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Nguyen Hoang Q, Nguyen Manh K. Anatomical and Biomechanical Characteristics of Peroneus Longus Tendon: Applications in Knee Cruciate Ligament Reconstruction Surgery. Adv Orthop 2023; 2023:2018363. [PMID: 37409219 PMCID: PMC10319460 DOI: 10.1155/2023/2018363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction The peroneus longus tendon is used in many orthopedic surgeries to regenerate the external ligaments of the knee. This study aims to evaluate some anatomical, biomechanical, and load-bearing properties of the peroneus longus tendon for use in cruciate ligament reconstruction. Materials and Methods The study design is a cross-sectional description. The study subjects were 20 samples of the peroneus longus tendon from fresh carcasses. The leg is still intact, not crushed, is well preserved, and it has never been used in research. Results The average length of the peroneus longus tendon was 29.25 ± 2.1 cm, and the average distance from the peroneus longus tendon to the deep peroneal nerve was 71.1 ± 8.63 mm. The peroneus longus tendon did not have an accessory ligament, the maximum tension of the peroneus longus tendon was 1170.4 ± 203 N, and the maximum length at break was 14.29 ± 3.88 mm. Conclusion Removing the peroneus longus tendon will not affect the surrounding anatomical components. The maximum breaking force and the diameter of the peroneus longus tendon are similar to other graft materials, such as the hamstring tendon and patellar tendon.
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Affiliation(s)
| | - Khanh Nguyen Manh
- Department of Upper Limb Surgery and Sports Medicine, Viet Duc University Hospital, Hanoi 100000, Vietnam
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13
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Zhang Q, Ying L, Han D, Ye L, Tung TH, Liang J, Liu P, Zhou X. Arthroscopic reconstruction of the medial patellofemoral ligament in skeletally immature patients using the modified sling procedure: a novel technique for MPFL reconstruction. J Orthop Surg Res 2023; 18:334. [PMID: 37147697 PMCID: PMC10163800 DOI: 10.1186/s13018-023-03775-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/02/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Patellar dislocation is common in young people. Although isolated anatomic double-bundle reconstruction of the MPFL is a common and effective surgical treatment for patellofemoral instability, concerns about the risk of injury to the epiphysis remain. METHODS A total of 21 children and adolescents (9 males, 12 females; mean age: 10.7 years; range: 8 to 13 years) with recurrent patella dislocation or symptomatic instability following a primary dislocation were enrolled in the study. In all patients, double-bundle medial patellofemoral ligament (MPFL) reconstruction and femoral sling procedure were performed under arthroscopy, using an anterior half peroneus longus tendon (AHPLT) autograft. Functional outcomes were evaluated preoperatively and during follow-ups based on Kujala and Lysholm scores. Radiological examinations including radiographs, 3D-CT, and MRI were performed pre- and post-operatively. RESULTS Among two-year postoperative follow-up (range: 24-42 months) showed significant improvement in functional scores (p < 0.01). The Lysholm score increased from 68 (44.5) to 100 (0) and the Kujala score increased from 26 (34.5) to 100 (2) The patellar tilt angel improved significantly (p < 0.01) from 24.3° ± 10.4 preoperatively to 11.9° ± 7.0 postoperatively. MRIs performed 6- and 12-months post operation did not show any signs of dysfunction of the reconstructed MPFL or cartilage degeneration. STUDY DESIGN Case Series; Level of evidence, 4. CONCLUSION Arthroscopic reconstruction of the MPFL using the modified sling procedure is an effective procedure for the treatment of patellar instability in skeletally immature patients.
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Affiliation(s)
- Qingguo Zhang
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Liwei Ying
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Dawei Han
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Lingchao Ye
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Public Laboratory, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Junbo Liang
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Peihong Liu
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.
| | - Xiaobo Zhou
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.
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Luo J, Wu S, Rothrauff B, Liao Q, Feng J, Tan L, Cao Y, Liang J, Wang J, He J. Preoperative ultrasound can accurately predict the diameter of double-stranded peroneus longus tendon autografts. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07406-y. [PMID: 37014416 DOI: 10.1007/s00167-023-07406-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE This study aimed to determine the correlation between the intraoperative diameter of double-stranded peroneus longus tendon (2PLT) and length of the PLT autograft and preoperative ultrasound (US) measurements, as well as radiographic and anthropometric measurements. The hypothesis was that US can accurately predict the diameter of 2PLT autografts during operation. METHODS Twenty-six patients underwent ligament reconstruction with 2PLT autografts were included. Preoperative US was used to calculate the in situ PLT cross-sectional area (CSA) at seven levels (0, 1, 2, 3, 4, 5, 10 cm proximal to the harvest start point). Femoral width, notch width, notch height, maximum patellar length, and patellar tendon length were determined on preoperative radiographs. Intraoperative measurements of PLT were made, including all fiber lengths of PLT and diameters of 2PLT using sizing tubes calibrated to 0.5 mm. RESULTS CSA at 1 cm proximal to the harvest site had the highest correlation with the diameter of 2PLT (r = 0.84, P < 0.001). Calf length had the highest correlation with PLT length (r = 0.65, P < 0.001). The diameter of the 2PLT autografts could be predicted by the following formula: 4.6 + 0.2 × [sonographic CSA of PLT at 1 cm level]; the length of PLT could be predicted by the following formula: 5.6 + 0.5 × Calf length. CONCLUSION The diameter of 2PLT and length of PLT autografts can be accurately predicted by preoperative US and calf length measurements, respectively. Accurate preoperative prediction of the diameter and length of autologous grafts can provide the most suitable and individualized graft for patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jiewen Luo
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Song Wu
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Benjamin Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Qin Liao
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jing Feng
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Lingjie Tan
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Yangbo Cao
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jiehui Liang
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jiaoju Wang
- School of Mathematics and Statistics, Central South University, Changsha, 410083, Hunan, China
| | - Jinshen He
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China.
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15
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Goyal T, Paul S, Choudhury AK, Sethy SS. Full-thickness peroneus longus tendon autograft for anterior cruciate reconstruction in multi-ligament injury and revision cases: outcomes and donor site morbidity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:21-27. [PMID: 34698925 DOI: 10.1007/s00590-021-03145-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/03/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Peroneus longus tendon (PLT) autograft has been successfully used for isolated anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction cases. Being a powerful evertor and flexor of great toe, there might be associated ankle morbidity with this autograft option. However, there are only a few studies exploring whether the ankle morbidity is significant or not. This study aims to assess the functional outcomes, donor site morbidity, and ankle strength after harvesting ipsilateral peroneus longus autograft for ACL reconstruction in revision ACL and multi-ligament injury cases. METHODS This was a prospective case series. All of the patients were evaluated by clinical examination for knee for laxity, ankle joint stability, and using visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, and Lysholm score, preoperatively and postoperatively at two-year follow-up. Morbidity of donor ankle was assessed using American Orthopedic Foot and Ankle Society (AOFAS) score, bilateral evertors, and first ray plantarflexion strength measurement using an isometer (Innovative Design Orthopedics) at two-year follow-up. RESULTS Ipsilateral PLT graft was used in ten patients of revision ACL reconstruction and 27 patients of the multi-ligament knee injury. The mean length of PLT harvested (cm) was 26.2 (standard deviation 2.6, range 22-31), and mean diameter of the doubled graft (mm) was 7.9 (standard deviation 0.68, range 7.5-8.5). There was a significant improvement in VAS score for pain, Lysholm, and IKDC scores (p = < 0.001) at two -year follow-up. There were no cases of graft failure, superficial, or deep infection. Ankle dorsiflexion(p = 0.32), ankle plantarflexion (p = 0.19), eversion strength(p = 0.6), first ray plantarflexion strength(p = 0.52), and AOFAS score(p = 0.29) were found to be comparable to the normal side in all patients. CONCLUSIONS Peroneus longus autograft can be considered as a potential autograft option for ACL reconstruction in multi-ligament knee injuries and revision ACL reconstruction. No significant donor site morbidity was noted at follow-up. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopedics, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab, 151001, India.
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Siddharth S Sethy
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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16
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Long J, Pappa N, Stitgen M, Flanigan DC, Fowler B, DiBartola AC, Magnussen RA. Patient-Reported Outcomes Following Medial Patellofemoral Reconstruction With Peroneus Longus Allografts Demonstrate Good Results. Arthrosc Sports Med Rehabil 2022; 5:e201-e206. [PMID: 36866312 PMCID: PMC9971893 DOI: 10.1016/j.asmr.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the recurrent dislocation risk and patient-reported outcomes of peroneus longus allograft tissue for medial patellofemoral ligament (MPFL) reconstruction. Methods Patients who underwent MPFL reconstruction with peroneus longus allograft at an academic center between 2008 and 2016 were identified. Record review and patient contact were used to identify any cases of recurrent patellar dislocation and collect patient-reported outcomes scores (Knee injury and Osteoarthritis Outcome Score [KOOS], Norwich Patellar Instability score, Marx activity scale). Patients with 1-year minimum follow-up were included. Outcomes were quantified and the proportion of patients reaching a previously defined patient acceptable symptom state (PASS) for patellar instability was determined. Results Sixty-one patients (42 female and 19 male) underwent MPFL reconstruction with peroneus longus allograft during the study period. Forty-six patients (76%) with 1-year minimum follow up were contacted at a mean of 3.5 years postoperative. The mean age at time of surgery was 22 ± 7.2 years. Patient-reported outcomes data were available in 34 patients. Mean KOOS subscale scores were as follows: Symptoms 83.2 ± 19.1, Pain 85.2 ± 17.6, Activities of Daily Living 89.9 ± 14.8, Sports 75 ± 26.2, and Quality of Life 72.6 ± 25.7. The mean Norwich Patellar Instability score was 14.9% ± 17.4%. The mean Marx activity score was 6.0 ± 5.2. No recurrent dislocations were noted during the study period. Sixty-three percent of patients who underwent isolated MPFL reconstruction met PASS thresholds in at least 4 of 5 KOOS subscales. Conclusions The use of a peroneus longus allograft in MPFL reconstruction in conjunction with other indicated procedures results in a low re-dislocation risk and a high proportion of patients meeting PASS criteria for patient-reported outcome scores 3 to 4 years postoperatively. Level of Evidence IV, case series.
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Affiliation(s)
| | | | | | | | | | | | - Robert A. Magnussen
- Address correspondence to Robert A. Magnussen, M.D., Sports Medicine Research Institute, 2835 Fred Taylor Dr., Columbus, OH, 43202.
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Qiao Y, Xu J, Ye Z, Chen J, Zhang X, Zhao S, Xu C, Zhao J. Double-Tunnel Technique Was Similar to Single-Tunnel Technique in Clinical, Imaging and Functional Outcomes for Medial Patellofemoral Ligament Reconstruction: A Randomized Clinical Trial. Arthroscopy 2022; 38:3058-3067. [PMID: 35690254 DOI: 10.1016/j.arthro.2022.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to compare the clinical, functional, and imaging outcomes of single-tunnel (ST) and double-tunnel (DT) techniques for medial patellofemoral ligament (MPFL) reconstruction. METHODS Ninety-four patients with recurrent patellar instability were randomly divided into 2 groups, receiving either ST or DT MPFL reconstruction. Lateral reticulum release (LRR) and tibial tuberosity (TT) transfer were performed as combined procedures when necessary. Preoperative and postoperative clinical characteristics (symptoms and episodes of redislocation), functional outcomes (Kujala, Lysholm, Tegner, IKDC, and KOOS score), and radiological measurements (congruence angle, patellar tilt angle, lateral patellar angle, and lateral patellar translation) were analyzed. RESULTS The analysis included data from 90 patients with 48 patients in the ST group and 42 patients in the DT group. Patients were followed up for a mean period of 37.8 (range: 27-50) months in the ST group and 38.6 (range: 25-53) months in the DT group. Forty-three patients in the ST group and 40 patients in the DT group received combined TT transfer, and all patients underwent LRR. At the latest follow-up, 1 patient in ST group experienced redislocation, while no patient in the DT group sustained clinical failure (P = .347). Imaging measurements decreased significantly to the normal range postoperatively. No significant difference was noted between the postoperative radiological results of the 2 groups. All clinical scores significantly improved postoperatively, and no significant difference was observed between the 2 groups except for the higher Lysholm score (P = .031), KOOS symptoms score (P = .021) and KOOS knee-related quality of life score (P = .043) in the DT group. CONCLUSION Both techniques could equally mitigate the patellar lateral translation or redislocation. Our results demonstrate several significant differences in functional outcomes that favored DT MPFL reconstruction but no difference in clinical failure rates and radiological results between ST and DT MPFL reconstruction. LEVEL OF EVIDENCE Level I, randomized clinical trial.
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Affiliation(s)
- Yi Qiao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiuyuan Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Wu S, Rothrauff B, Li J, He J. Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions. Knee Surg Sports Traumatol Arthrosc 2022; 31:2454-2460. [PMID: 36251045 DOI: 10.1007/s00167-022-07202-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/10/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the distances using ultrasound between the superficial peroneal nerve (SPN) and sural nerve along the peroneus longus tendon (PLT) autograft harvest path at different ankle or knee positions in order to minimize risk of iatrogenic nerve injury during PLT autograft harvest. METHODS Twenty-four fresh-frozen human cadaveric lower extremities were used to harvest a full-thickness PLT autograft with a tendon stripper. Four specimens were utilized to validate correct identification of nerves under ultrasound. Sonographically guided perineural injections were performed at the start point and end point of the PLT harvest path using coloured latex, followed by dissection with gross inspection. Using ultrasound, the distance from the peroneus brevis muscle to the sural nerve at different ankle positions (20° dorsiflexion, neutral, and 20° plantarflexion) was measured, and the distance from the end of the tendon stripper to the SPN at different knee positions (full extension and 90° flexion) was also measured. Measurements were performed by two separate observers using ImageJ software. RESULTS Cadaveric dissection showed the presence of latex around nerves in all four specimens. The average distance from the brevis muscle to the sural nerve increased significantly from dorsiflexion to plantarflexion. The shortest distance from the tenodesis site to the sural nerve was 5.8 ± 1.7 mm. There was no significant difference from the end of the tendon stripper to the SPN between full extension or 90° flexion of the knee. CONCLUSION When harvesting the PLT, it is recommended to place the ankle at plantarflexion. The knee at full extension or 90° flexion had no effect. Joint positions at the time of graft harvest should be monitored to reduce risks of iatrogenic nerve injury.
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Affiliation(s)
- Song Wu
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Benjamin Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Jiale Li
- Department of Ultrasound, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jinshen He
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China.
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Muacevic A, Adler JR. A Study of the Functional Outcome of Supplementation of Hamstring Graft With Anterior Half of the Peroneus Longus Tendon in Arthroscopic Anterior Cruciate Ligament Reconstruction. Cureus 2022; 14:e30138. [PMID: 36381718 PMCID: PMC9643030 DOI: 10.7759/cureus.30138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION The present study was done to analyze the functional outcome, donor site morbidities, and associated parameters when using the anterior half of the peroneus longus for augmentation of an inadequate hamstring graft when performing arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS Thirty patients with complete ACL tears were operated on. In all these patients, the thickness or length of the hamstring graft taken was found to be inadequate (less than 8 mm and 7.5 cm, respectively). So, additionally, the anterior half of the peroneus longus tendon (AHPLT) graft was harvested to reach an optimum size of the final graft. Functional outcome was assessed using the International Knee Documentation Committee (IKDC) score at six weeks, three months, and six months. The Foot and Ankle Disability Index (FADI) score at six months was used to assess ankle stability. RESULTS The mean age in our study was 28.8 years with male predominance (73.33%). The mean operative time was 86.4 minutes. The mean hamstring graft thickness in our study was 6.5 mm, which improved to 9.12 mm after augmentation. The mean graft length after AHPLT augmentation was 9.38 cm. The mean IKDC score at six months was 87.35. At the end of six months, FADI scores were found within normal limits (range: 135-136) in all the patients. No complications were noted in any of the patients. CONCLUSION The AHPLT graft was always found to be sufficient enough for augmenting the hamstring graft to reach an acceptable thickness and length. There was no graft site morbidity and the ankle functional levels remained the same as preoperative levels, making it an excellent choice for augmentation of inadequate hamstring grafts.
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Butt UM, Khan ZA, Amin A, Shah IA, Iqbal J, Khan Z. Peroneus Longus Tendon Harvesting for Anterior Cruciate Ligament Reconstruction. JBJS Essent Surg Tech 2022; 12:e20.00053. [PMID: 36741045 PMCID: PMC9889288 DOI: 10.2106/jbjs.st.20.00053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
There remains controversy regarding the ideal graft choice for anterior cruciate ligament (ACL) reconstruction1. Bone-patellar tendon-bone and hamstring autografts have been considered the gold standard for decades. Despite the good clinical outcomes, donor-site morbidity is a concern for both of these grafts2. Peroneus longus tendon autograft has also been considered as a potential graft for many orthopaedic reconstructive procedures3. The biomechanical properties and thickness of such a graft permit its use for ACL reconstruction3,4. The tensile strength of a peroneus longus tendon autograft is the same as that of a hamstring autograft and greater than that of a bone-patellar tendon-bone graft and a quadriceps tendon graft3,5. We aimed to describe the steps to harvest the peroneus longus tendon autograft during single-bundle ACL reconstruction. Description Identification of anatomical landmarks is performed, including the distal aspect of the fibula and the posterior border of the fibula, 2 cm above the tip of the bone. A longitudinal incision is made along the posterior border of the fibular bone, from 2cm above the tip of the fibula. Care is taken to identify the tendon sheath that covers the longus and brevis approximately 2 cm above the superior extensor retinaculum, and the peroneus longus is stitched to the peroneus brevis. The proximal aspect of the peroneus longus tendon is whipstitched, after which the peroneus longus tendon and surrounding soft tissues are incised. The peroneus longus tendon is then released with use of a closed stripper, and the graft is prepared. Alternatives Alternative nonoperative treatment options include physical therapy, nonsteroidal anti-inflammatory drugs, rest, and limitation of sporting activities. Alternative surgical treatment options include arthroscopic debridement, ACL repair or reconstruction with bone-patellar tendon-bone or hamstring-tendon autograft, and ACL reconstruction with allograft. Rationale Recent studies have shown that ACL reconstruction with use of a peroneus longus tendon autograft is safe and effective, with less donor-site morbidity compared with other tendon autografts4,6,7. Expected Outcomes The peroneus longus graft has been accepted for ligament reconstruction because of its strength, safety, and less donor-site morbidity7. The peroneus longus graft allows surgeons to harvest the autograft via a relatively small incision, resulting in fewer donor-site complications4. According to Rhatomy et al., the use of a peroneus longus graft provides good functional outcomes that are comparable with those of a hamstring autograft, but it has a larger graft diameter and its harvest results in less thigh hypotrophy8. Additionally, a case series of 10 patients who underwent ACL reconstruction with use of a peroneus longus autograft showed satisfactory Lysholm scores and low disability according to the Foot and Ankle Disability Index9. Important Tips Examination under anesthesia and arthroscopic confirmation of the ACL tear are recommended prior to harvesting the peroneus longus tendon.Take care to identify the anatomical landmarks of the peroneus longus and brevis.Tenodesis of the peroneus longus to the brevis is performed first, followed by whipstitching of the peroneus longus proximal to the site of the tenodesis.Once the peroneus longus tendon is passed through the closed stripper, gently maintain traction on the sutures while pushing the stripper proximally until the tendon is freed.Care should be taken not to damage the superior peroneal retinaculum, which provides the primary restraint to tendon subluxation.Identification of the peroneus longus and brevis is important. The peroneus longus tendon is free of muscle attachment and more rounded in shape, while the peroneus brevis contains muscle fibers. Acronyms & Abbreviations PL = peroneus longusCI = confidence intervalIKDC = International Knee Documentation Committee.
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Affiliation(s)
- Umer M. Butt
- AO Hospital, Karachi, Pakistan,Email for corresponding author:
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Ye Z, Xu J, Chen J, Cho E, Cai J, Wu C, Wu X, Li Z, Xie G, Zhao J, Dong S. Effect of Anterolateral Structure Augmentation on Graft Maturity After Anterior Cruciate Ligament Reconstruction: A Clinical and MRI Follow-up of 2 Years. Am J Sports Med 2022; 50:1805-1814. [PMID: 35593743 DOI: 10.1177/03635465221092768] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterolateral structure augmentation (ALSA) has been applied to prevent residual rotatory instability and lower clinical failure rates after anterior cruciate ligament (ACL) reconstruction (ACLR); however, the effect of combined ALSA on the maturity of ACL grafts remains unknown. PURPOSE To evaluate the graft maturity and patient-reported outcomes in patients who underwent double-bundle ACLR with or without ALSA. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 92 patients who underwent double-bundle ACLR between January 2016 and July 2019 were included in the present study-44 patients with isolated ACLR (ACLR group) and 48 patients with combined ACLR and ALSA (ALSA group). Demographic characteristics, intraoperative findings, and patient-reported outcomes were prospectively collected. On postoperative magnetic resonance imaging at the 2-year follow-up, the signal-to-noise quotient (SNQ) values were separately calculated for 6 sections of the ACL graft, including the femoral intratunnel graft (FTG), intra-articular graft (IAG), and tibial intratunnel graft (TTG) of the anteromedial bundle (AMB) and the posterolateral bundle (PLB). Superior graft maturity was usually indicated by lower SNQ values. RESULTS The rates of return to preinjury sports were 47.9% and 27.3% in the ALSA and ACLR groups, respectively (difference, 20.6% [95% CI, 1.3%-40%]; P = .042). The AMB demonstrated significantly lower SNQ values in the ALSA group than in the ACLR group (FTG, 7.04 ± 3.65 vs 9.44 ± 4.51 [P = .006]; IAG, 6.62 ± 4.19 vs 8.77 ± 5.92 [P = .046]; TTG, 6.93 ± 3.82 vs 8.75 ± 4.55 [P = .040]). The SNQ values were significantly lower in the ALSA group for 2 of the 3 sections of the PLB (IAG, 7.73 ± 4.61 vs 9.88 ± 5.61 [P = .047]; TTG, 5.88 ± 3.10 vs 8.57 ± 4.32 [P = .001]). Partial lateral meniscectomy was correlated with higher SNQ values of the TTG in the AMB (β = 0.27; P = .009) and the PLB (β = 0.25; P = .008), with both groups pooled. Higher body mass index, smaller ACL graft-Blumensaat line angles, larger AMB graft diameters, and lower postoperative Tegner scores were also associated with inferior maturity in specific regions of the ACL graft. CONCLUSION A combination of ACLR and ALSA is a desirable option to improve the maturity of ACL grafts for patients who are young or expected to return to pivoting sports. Meanwhile, further investigations with higher levels of evidence and longer periods of follow-up are warranted.
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Affiliation(s)
- Zipeng Ye
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Eunshinae Cho
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiangyu Cai
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiulin Wu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ziyun Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Gunadham U, Woratanarat P. A retrospective cohort study of anterior half peroneus longus tendon vs hamstring tendon for anterior cruciate ligament reconstruction: A minimum 3-years follow-up. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221085722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The anterior half of the peroneus longus tendon (AHPLT) has recently gained popularity to become the alternate graft choice for anterior cruciate ligament reconstruction due to its acceptable biomechanical properties, easy and safe to harvest. Methods: A retrospective study was conducted to compare the results of anterior cruciate ligament (ACL) reconstruction with AHPLT and hamstring graft at the minimum of 3 years follow-up. Knee stability, International Knee Documentation Committee (IKDC) subjective score and Tegner activity level were collected. Results: There was no clinical significance regarding physical examination. Postoperative IKDC score was higher in the hamstring group compared with AHPLT group. Multiple regression analysis was done. The parsimonious model revealed graft types and gender were the most optimal variables explained postoperative IKDC score. Conclusion: AHPLT graft can be an alternative choice to conventional graft for single anatomic ACL reconstruction with less donor site morbidity, however there must be concern for smaller graft in short and thin female patients.
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Affiliation(s)
- Ukris Gunadham
- Department of Orthopedics, Trang Regional Hospital, Trang, Thailand
| | - Patarawan Woratanarat
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Malige A, Baghdadi S, Hast MW, Schmidt EC, Shea KG, Ganley TJ. Biomechanical properties of common graft choices for anterior cruciate ligament reconstruction: A systematic review. Clin Biomech (Bristol, Avon) 2022; 95:105636. [PMID: 35428007 DOI: 10.1016/j.clinbiomech.2022.105636] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND This systematic review explores the differences in the intrinsic biomechanical properties of different graft sources used in anterior cruciate ligament (ACL) reconstruction as tested in a laboratory setting. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two authors conducted a systematic review exploring the biomechanical properties of ACL graft sources (querying PubMed, Cochrane, and Embase databases). Using the keywords "anterior cruciate ligament graft," "biomechanics," and "biomechanical testing," relevant articles of any level of evidence were identified as eligible and included if they reported on the biomechanical properties of skeletally immature or mature ACL grafts solely and if the grafts were studied in vitro, in isolation, and under similar testing conditions. Studies were excluded if performed on both skeletally immature and mature or non-human grafts, or if the grafts were tested after fixation in a cadaveric knee. For each graft, failure load, stiffness, Young's modulus, maximum stress, and maximum strain were recorded. FINDINGS Twenty-six articles were included. Most studies reported equal or increased biomechanical failure load and stiffness of their tested bone-patellar tendon-bone, hamstring, quadriceps, peroneus longus, tibialis anterior and posterior, Achilles, tensor fascia lata, and iliotibial band grafts compared to the native ACL. All recorded biomechanical properties had similar values between graft types. INTERPRETATION Most grafts used for ACL reconstruction are biomechanically superior to the native ACL. Utilizing a proper graft, combined with a standard surgical technique and a rigorous rehabilitation before and after surgery, will improve outcomes of ACL reconstruction.
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Affiliation(s)
- Ajith Malige
- St. Luke's University Health Network, Department of Orthopaedic Surgery, 801 Ostrum Street, Bethlehem, PA 18015, USA.
| | - Soroush Baghdadi
- Children's Hospital of Philadelphia Department of Orthopaedic Surgery 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Michael W Hast
- Biedermann Laboratory for Orthopaedic Research, University of Pennsylvania Department of Orthopaedic Surgery, 3737 Market Street 10th Floor, Suite 1050, Philadelphia, PA 19104, USA
| | - Elaine C Schmidt
- Biedermann Laboratory for Orthopaedic Research, University of Pennsylvania Department of Orthopaedic Surgery, 3737 Market Street 10th Floor, Suite 1050, Philadelphia, PA 19104, USA
| | - Kevin G Shea
- Stanford University Department of Orthopaedic Surgery 450 Broadway, Redwood City, CA 94063, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia Department of Orthopaedic Surgery 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Vijay C, Santosh M, Avinash C, Adarsh T. Is Peroneus longus autograft a better alternative to the Hamstring autograft for anterior cruciate ligament reconstruction? – A randomised control study. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221088335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose The anterior cruciate ligament in the knee is commonly prone to injuries. Reconstruction of this ligament with hamstring tendon has been time-tested but peroneus longus autograft is also gaining popularity. However, very limited literature is available comparing the two grafts. This study aims to compare the functional outcome and donor site morbidity between hamstrings and peroneus longus autograft in anterior cruciate ligament reconstruction. Methods A prospective randomised study was conducted on 45 patients, who underwent anterior cruciate ligament reconstruction. Patients were assigned into Hamstring group and the Peroneus longus group. Functional outcome was assessed using Lysholm score and Modified Cincinnati scores for the knee joint and American Orthopedics Foot and Ankle Scoring for ankle joint. Donor site morbidity was assessed by measuring flexion and extension strength of the knee and plantar flexion and eversion strength of the ankle by handheld dynamometer preoperatively and postoperatively at 6 months and 1 year follow up. Results Functional outcome of the knee showed significant improvement in peroneus longus group (p-value 0.002) compared to hamstring group. Even though there was minimal reduction in functional outcome of the ankle at 6 months follow-up in peroneus longus group, it improved at one year follow-up. While assessing the donor site morbidity at the knee joint, knee flexion strength showed improvement in the group (p-value 0.02) but reduced in the hamstring group where the hamstring tendon was harvested. Knee extension strength in the hamstring group scored marginally better than the peroneus longus group, which was not statistically significant (p-value 0.5). Conclusion Autologous peroneus longus tendon can be used as a graft of choice in anterior cruciate ligament reconstruction which showed promising results without compromising on the ankle function. Its usage as an alternative source of the graft may be more useful in multi-ligament injuries of the knee joint.
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Affiliation(s)
- C. Vijay
- Department of Orthopaedics, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - M.S. Santosh
- Department of Orthopaedics, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Chandra Avinash
- Department of Orthopaedics, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - T. Adarsh
- Department of Orthopaedics, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Augmentation of Anterolateral Structures of the Knee Causes Undesirable Tibiofemoral Cartilage Contact in Double-Bundle Anterior Cruciate Ligament Reconstruction-A Randomized In-Vivo Biomechanics Study. Arthroscopy 2022; 38:1224-1236. [PMID: 34509591 DOI: 10.1016/j.arthro.2021.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the in vivo tibiofemoral cartilage contact patterns in knees undergoing double-bundle anterior cruciate ligament reconstruction(DB-ACLR) with or without anterolateral structure augmentation (ALSA). METHODS Twenty patients with an ACL-ruptured knee and a healthy contralateral side were included. Nine patients received an isolated DB-ACLR (DB-ACLR group), and 11 patients had a DB-ACLR with ALSA (DB+ALSA group). At 1-year follow-up, a combined computed tomography, magnetic resonance imaging, and dual fluoroscopy imaging system analysis was used to capture a single-legged lunge of both the operated and healthy contralateral side. Tibiofemoral contact points (CPs) of the medial and lateral compartments were compared. CP locations were expressed as anteroposterior (AP, +/-) and medial-lateral (ML, -/+) values according to the tibia. RESULTS In the DB-ACLR knees, no significant differences were found in CPs when compared with the healthy contralateral knees (P ≥ .31). However, in the DB+ALSA knees, the CPs in the lateral compartment had a significantly more anterior (mean AP: operative, -2.8 mm, 95% confidence interval [CI] -5.0 to-0.7 vs healthy, -5.0 mm, 95% CI -6.7 to -3.2; P = .006) and lateral (mean ML: operative, 23.2 mm, 95% CI 21.9-24.5 vs healthy, 21.8 mm, 95% CI 20.2-23.3; P = .013) location. The CPs in the medial compartment were located significantly more posterior (mean AP: operative, -3.4, 95% CI -5.0 to -1.9 vs healthy, -1.3, 95% CI -2.6 to -0.1; P = .006) and lateral (mean ML: operative, -21.3, 95% CI -22.6 to -20.0 vs healthy, -22.6, 95% CI -24.2 to -21.0; P = .021). CONCLUSIONS DB-ACLR restored the tibiofemoral cartilage contact mechanics to near-normal values at 1-year follow-up. Adding the ALSA to the DB-ACLR resulted in significantly altered tibiofemoral cartilage contact locations in both the medial and lateral compartments. CLINICAL RELEVANCE In DB-ACLR knees, the addition of an ALSA may be unfavorable as it caused significantly changed arthrokinematics.
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26
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Kim SJ, Park YU, Ahn JT, Kim HN. Reconstruction of chronic tibialis anterior tendon ruptures using a free anterior half of a peroneus longus tendon autograft: A technical note. J Orthop Surg (Hong Kong) 2022; 30:10225536221083044. [PMID: 35282738 DOI: 10.1177/10225536221083044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Chronic rupture of the tibialis anterior (TA) tendon is rare. Several reconstruction techniques have been introduced. However, to the best of our knowledge, the use of a free anterior half of a peroneus longus tendon (AHPLT) autograft has not been reported for reconstruction of TA tendon rupture. This study aimed to describe the surgical technique and present the clinical outcomes of reconstruction of the chronic TA tendon ruptures using an AHPLT autograft. Methods: Between September 2013 and April 2019, five patients with chronic TA tendon rupture were surgically treated by reconstruction using an AHPLT autograft. The AHPLT could be easily harvested percutaneously with a tendon stripper from the ipsilateral lower leg around the reconstruction site. The study included four men and one woman, with a mean age of 43.8 (range: 23-65) years. Results: At a mean follow-up period of 42.8 (range; 12-70) months, the mean Foot Function Index value significantly improved from 53.6 ± 19.8 preoperatively to 25.8 ± 20.8 postoperatively (p = .04). None of the patients had morbidities (such as nerve injury, delayed tendon ruptures, or tenosynovitis) around the AHPLT donor site. Three patients were very satisfied, two patients were satisfied, and one patient was fair with the results. Conclusions: Reconstruction of chronic TA tendon ruptures using a free AHPLT autograft could be successfully performed with satisfactory clinical outcomes and minimal donor site morbidities. Future studies with a larger population size and a comparative group are warranted to confirm these findings.
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Affiliation(s)
- Sung Jae Kim
- Department of Orthopaedic Surgery, Dongtan Sacred Hospital, 366256Hallym University, Hwaseong, South Korea
| | - Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, 65783Ajou University School of Medicine, Suwon, Republic of Korea
| | - Joong Taek Ahn
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, 65521Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, 65521Hallym University College of Medicine, Seoul, Republic of Korea
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He J, Byrne K, Ueki H, Kanto R, Linde MA, Smolinski P, Wu S, Fu F. Low to moderate risk of nerve damage during peroneus longus tendon autograft harvest. Knee Surg Sports Traumatol Arthrosc 2022; 30:109-115. [PMID: 34498132 DOI: 10.1007/s00167-021-06698-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to evaluate the proximity of the tendon stripper to both the peroneal and sural nerves during peroneus longus tendon (PLT) autograft harvesting. METHODS Ten fresh-frozen human cadaveric lower extremities were used to harvest a full-thickness PLT autograft using a standard closed blunt-ended tendon stripper. The distance to the sural nerve from the PLT (at 0, 1, 2 and 3 cm proximal to lateral malleolus (LM), and the distance to the peroneal nerve and its branches from the end of the tendon stripper were measured by two separate observers using ImageJ software. RESULTS The average distance from the PLT to the sural nerve increased significantly from 0 to 2 cm proximal to LM. The average distance to the sural nerve at the LM was 4.9 ± 1.5 mm and increased to 10.8 ± 2.4 mm (2 cm proximal to LM). The average distance from the tendon stripper to the deep peroneal nerve was 52.9 ± 11.4 mm. The average distance to the PLT branch of peroneal nerve was 29.3 ± 4.2 mm. The superficial peroneal nerve, which coursed parallel and deep to the tendon stripper, was on average 5.2 ± 0.7 mm from the end of the stripper. No transection injuries of the nerves were observed in any of the ten legs after harvesting. CONCLUSION This cadaver study found during a full-thickness PLT harvest, the distances between the tendon stripper and the nerves were greater than 5 mm with an initial incision at 2 cm proximal to LM which is recommended.
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Affiliation(s)
- Jinshen He
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.,Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Kevin Byrne
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Hiroko Ueki
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Ryo Kanto
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Monica A Linde
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.,Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Song Wu
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Freddie Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA. .,Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
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Simultaneous Anterior Cruciate Ligament, Posterior Cruciate Ligament, Posteromedial Corner, and Posterolateral Corner Reconstruction of the Knee. Arthrosc Tech 2021; 10:e2723-e2731. [PMID: 35004154 PMCID: PMC8719229 DOI: 10.1016/j.eats.2021.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/12/2021] [Indexed: 02/03/2023] Open
Abstract
Concomitant injuries of the 4 groups of ligaments of the knee are a serious condition and challenge the orthopaedic surgeon when reconstruction of all ligaments is needed. Staged reconstruction can be chosen owing to the complexity of the combined procedures; however, simultaneous reconstruction is favored to facilitate recovery. We describe a simultaneous anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), posteromedial corner (PMC), and posterolateral corner (PLC) reconstruction technique, in which autografts are used and both cruciate ligaments are reconstructed in a single-bundle manner. We believe the introduction of this technique will familiarize surgeons with the principle of simultaneous 4-ligament reconstruction of the knee and the method of cruciate ligament balancing during bicruciate ligament reconstruction.
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Tang J, Zhao J. Wide Patellar Insertion Medial Patellofemoral Ligament Reconstruction with Internal Bracing. Arthrosc Tech 2021; 10:e2487-e2493. [PMID: 34868852 PMCID: PMC8626702 DOI: 10.1016/j.eats.2021.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023] Open
Abstract
Medial patellofemoral ligament (MPFL) reconstruction is a common procedure to address MPFL deficiency. Various techniques have been reported, with the best method still being pursued. Previous studies have revealed the advantage of internal bracing and possible advantage of wide patellar insertion in MPFL reconstruction. Thus, we would like to introduce a technique that combines the internal bracing and wide patellar insertion in MPFL reconstruction, in which the critical points are proper location of the patellar and femoral tunnels and proper tensioning of the augmenting sutures and the whole graft complex. Our clinical experience indicates that the proper application of this technique can lead to satisfactory clinical outcome. We consider the introduction of this technique will provide more insight to MPFL reconstruction.
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Affiliation(s)
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
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30
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Tang J, Zhao J. Knee Posterolateral Corner Reconstruction with a Single Tendon. Arthrosc Tech 2021; 10:e2479-e2485. [PMID: 34868851 PMCID: PMC8626666 DOI: 10.1016/j.eats.2021.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023] Open
Abstract
Knee posterolateral corner (PLC) injuries are troublesome conditions and are always involved in complicated knee-ligament injuries. Various surgical techniques have been reported to address these conditions, in either an open or an arthroscopic manner. However, a simple and effective method is still being pursued. We introduce a mini-invasive PLC reconstruction technique in which a single tendon is used to reconstruct the lateral collateral ligament, the popliteofibular ligament and the popliteal tendon simultaneously. The critical points of this technique are proper location and creation of the tibial, fibular and femoral tunnels, proper passing and setting of the tendon graft, as well as protection of the peroneal nerve. Our clinical experience indicates that this technique is easy to perform and effective. We consider that the introduction of this technique will provide more reasonable options when PLC reconstruction is indicated.
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Affiliation(s)
- Jin Tang
- Operating Theater, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China,Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
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31
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Zhao J. Three-in-One Procedure for Revision ACL Reconstruction. Arthrosc Tech 2021; 10:e2471-e2477. [PMID: 34868850 PMCID: PMC8626661 DOI: 10.1016/j.eats.2021.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023] Open
Abstract
Revision anterior cruciate ligament (ACL) reconstruction is a challenge due to the unfavorable condition of the knee and the lack of autogenous graft tissue. Anterolateral structure (ALS) reconstruction of the knee has been proved effective to address the unfavorable condition in revision cases, and lateral extra-articular tenodesis (LET) is a special technique that can enhance anterolateral stability of the knee without graft tissue. We introduce a procedure that combines ACL and ALS reconstruction, as well as LET for failed ACL reconstruction. The critical point of this technique is using the anterior half of the iliotibial band to realize LET and to partially reconstruct the ACL. Our clinical experience indicates this technique is extremely useful in revision ACL reconstruction without enough free graft tissue. This technique will provide a reasonable choice in revision ACL reconstruction.
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Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
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Zhao J. Four-Tunnel Double-Bundle Posterior Cruciate Ligament Reconstruction With Remnant Preservation. Arthrosc Tech 2021; 10:e2343-e2356. [PMID: 34754744 PMCID: PMC8556672 DOI: 10.1016/j.eats.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023] Open
Abstract
The clinical results of posterior cruciate ligament reconstruction (PCL) still leave much room for improvement. To get better knee stability, the double-bundle reconstruction, the use of strong grafts, and the preservation of the remnant have been applied. However, the combination of the 3 measures has seldom been reported. Thus I introduce a 4-tunnel double-bundle PCL reconstruction technique, in which I combine the use of strong grafts and preservation of the remnant. The critical point of this technique is manipulating skillfully across the femoral notch with the preservation, as well as the hindrance to operation of the PCL remnant. My clinical experience indicates this technique is somewhat complicated but most effective. I believe the introduction of this technique will provide an additional choice when PCL reconstruction is to be performed.
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Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
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Zhao J. Single-Bundle Anatomical Posterior Cruciate Ligament Reconstruction With Remnant Preservation. Arthrosc Tech 2021; 10:e2303-e2310. [PMID: 34754738 PMCID: PMC8556646 DOI: 10.1016/j.eats.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023] Open
Abstract
Remnant always exists following injuries of the posterior cruciate ligament (PCL). To improve the clinical outcomes of PCL reconstruction, preservation of the remnant has long been a consideration. However, how to make the remnant-preservation technique simple and more effective is of concern. We describe a single-bundle anatomical PCL reconstruction technique with remnant preservation in which the posteromedial and posterolateral portals are used, the graft is placed at the lateral side of the remnant, and pulleys are used to facilitate graft passage at the 2 killer turns of the grafting routes. We consider introduction of this technique will provide reasonable choices in PCL reconstruction.
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Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
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Peroneus longus tendon autograft has functional outcomes comparable to hamstring tendon autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2869-2879. [PMID: 32984919 DOI: 10.1007/s00167-020-06279-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE This review aimed to assess whether peroneus longus tendon (PLT) autograft would have comparable functional outcomes and graft survival rates when compared to hamstring tendon (HT) autograft for anterior cruciate ligament (ACL) reconstruction. METHODS PubMed, Web of Science, Cochrane Library, Ovid (MEDICINE), and EMBASE databases were queried for original articles from clinical studies including the keywords: ACL reconstruction and PLT autograft. Studies comparing PLT autograft versus HT autograft were included in this analysis and the following data were extracted from studies meeting the inclusion criteria: graft diameter, functional outcomes (Tegner activity scale, Lysholm score, and International Knee Documentation Committee (IKDC) subjective score), knee laxity (Lachman test), and complications (donor site pain or paresthesia, graft failure). Besides, the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Foot and Ankle Disability Index (FADI) pre-operation and at last follow-up were also compared among patients using PLT autograft. Meta-analysis was applied using Review Manager 5.3 and p < 0.05 was considered statistically significant. RESULTS Twenty-three studies including 925 patients with ACL reconstruction met inclusion criteria. Of these, 5 studies included a direct comparison of PLT autograft (164 patients) versus HT autograft (174 patients). No significant difference was observed between PLT and HT autografts for Tegner activity scale, Lachman test, donor site pain, or graft failure. However, PLT groups demonstrated better Lysholm score (mean difference between PLT and HT groups, 1.55; 95% CI 0.20-2.89; p = 0.02) and IKDC subjective score (mean difference between PLT and HT groups, 3.24; 95% CI 0.29-6.19; p = 0.03). No difference of FADI was found (n.s.) but AOFAS was slightly decreased at last post-operative follow-up for patients with PLT autograft compared with pre-operative scores (mean difference of 0.31, 95% CI 0.07-0.54, p = 0.01). CONCLUSION PLT autograft demonstrated comparable functional outcomes and graft survival rates compared with HT autograft for ACL reconstruction. However, a slight decrease in AOFAS score should be considered during surgical planning. Hence, the PLT is a suitable autograft harvested outside the knee for ACL reconstruction to avoid the complication of quadriceps-hamstring imbalance which can occur when harvesting autografts from the knee. LEVEL OF EVIDENCE Level II.
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Chen J, Xu C, Cho E, Huangfu X, Zhao J. Reconstruction for Chronic ACL Tears with or without Anterolateral Structure Augmentation in Patients at High Risk for Clinical Failure: A Randomized Clinical Trial. J Bone Joint Surg Am 2021; 103:1482-1490. [PMID: 34138788 DOI: 10.2106/jbjs.20.01680] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this trial was to determine whether anterior cruciate ligament reconstruction (ACLR) with anterolateral structure augmentation (ALSA) would result in better clinical outcomes in patients with a high risk of clinical failure. METHODS From February 2017 to June 2018, 120 young, active adults with chronic anterior cruciate ligament injury and high risk of clinical failure were randomized. The patients were followed for >2 years, with 5 being lost to follow-up and 1 being withdrawn from the study. Clinical characteristics, operative findings, and postoperative clinical outcomes were analyzed. RESULTS The analysis included data from 114 patients, including 95 men and 19 women with a mean age (and standard deviation) of 30.1 ± 6.7 years in the ACLR group and 30.1 ± 6.4 years in the ALSA group. The rate of clinical failure was 20.4% (11 of 54 patients) and 3.3% (2 of 60 patients) in the ACLR and ALSA groups, respectively (difference, 17.1%; 95% confidence interval [CI], 5.3% to 29.8%; p = 0.007). Significantly higher rates of return to the preinjury level of sports (48.3% versus 27.8%; difference, 20.5%; 95% CI, 2.7% to 36.6%; p = 0.024) and to a competitive level of play (63.3% versus 42.6%; difference, 22.3%; 95% CI, 4.1% to 38.8%; p = 0.027) was found in the ALSA group. CONCLUSIONS Compared with isolated ACLR, combined ACLR and ALSA resulted in a reduction in persistent rotatory laxity and higher rates of return to preinjury and competitive levels of play at 2 years of follow-up in the population studied. Our study suggests that patients with high risk of clinical failure appear to be candidates for the ALSA approach. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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Zhao J. Four-Tunnel Double-Bundle Anatomical Posterior Cruciate Ligament Reconstruction Without Remnant Preservation. Arthrosc Tech 2021; 10:e2087-e2097. [PMID: 34504747 PMCID: PMC8416969 DOI: 10.1016/j.eats.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/14/2021] [Indexed: 02/03/2023] Open
Abstract
Double-bundle posterior cruciate ligament (PCL) reconstruction has long been attempted to obtain better clinical results than single-bundle PCL reconstruction. In most previous reports regarding double-bundle PCL reconstruction, one tibial tunnel and various kinds of grafts were used. We introduce a two-tibial tunnel, double-bundle PCL reconstruction technique with ultra-strong grafts. The critical points of this technique are proper creation of the tibial tunnels and the protection of the posterior neurovascular structures. Our clinical experience indicates this technique can lead to satisfactory stable outcomes. We believe that this technique will provide a reasonable choice for PCL reconstruction without remnant preservation.
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Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
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Anterior Half of the Peroneus Longus Tendon Combined with Semitendinosus and Gracilis Tendons for Anterior Cruciate Ligament Reconstruction: An Athlete Case Report. Case Rep Orthop 2021; 2021:9978383. [PMID: 34258094 PMCID: PMC8249142 DOI: 10.1155/2021/9978383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/12/2021] [Indexed: 11/22/2022] Open
Abstract
In clinical practice, it is observed that the hamstring tendon graft, despite being first choice in knee ligament reconstruction, may not present adequate size. Therefore, it becomes necessary to search for other graft alternatives. In this context, the peroneus longus tendon arises as an option to replace or complement other grafts. The surgeon can opt to use the tendon in its totality or only its anterior half, presenting adequate length, diameter, and biomechanics, without major repercussions for the donor site. In this study, we report a case of an athlete in which the autologous hamstring tendon graft did not present the adequate diameter for anterior cruciate ligament reconstruction. It was, then, necessary to use the anterior half of the peroneus longus tendon.
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Bi M, Zhao C, Zhang Q, Cao L, Chen X, Kong M, Bi Q. All-Inside Anterior Cruciate Ligament Reconstruction Using an Anterior Half of the Peroneus Longus Tendon Autograft. Orthop J Sports Med 2021; 9:2325967121991226. [PMID: 34212065 PMCID: PMC8216365 DOI: 10.1177/2325967121991226] [Citation(s) in RCA: 5] [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] [Received: 09/04/2020] [Accepted: 11/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The peroneus longus tendon (PLT) has been used as a graft in many orthopaedic surgical procedures because of its comparable biomechanical strength with the native anterior cruciate ligament (ACL). Despite its potential, few studies have been performed to investigate the clinical reliability of ACL reconstruction using a PLT autograft. Purpose: To assess the clinical outcomes and donor-site morbidity of ACL reconstruction using an anterior half of the PLT (AHPLT) autograft in patients with an isolated ACL injury. Study Design: Case series; Level of evidence, 4. Methods: Between January 2016 and January 2017, a total of 21 patients with an isolated ACL injury underwent all-inside single-bundle ACL reconstruction using an AHPLT autograft. Knee stability was assessed using the Lachman test, pivot-shift test, and KT-2000 arthrometer (side-to-side difference) with 134-N anterior force and at 30° of knee flexion. Knee function was evaluated using the International Knee Documentation Committee score, Lysholm score, and Tegner score. Donor-site morbidity was assessed using ankle eversion and plantarflexion strength as well as the American Orthopaedic Foot & Ankle Society scoring system and the Foot and Ankle Disability Index. Results: At a mean final follow-up of 40.1 months (range, 36-48 months), the KT-2000 arthrometer side-to-side difference was significantly lower compared with preoperatively (1.1 ± 0.62 vs 7.0 ± 2.18 mm, respectively; P < .001). The mean preoperative International Knee Documentation Committee, Lysholm, and Tegner scores were 52.0 ± 8.27, 50.9 ± 8.50, and 1.8 ± 0.87, respectively, increasing significantly to 94.2 ± 2.61, 95.2 ± 2.64, and 6.8 ± 1.50, respectively, at final follow-up (P < .001 for all). All patients had grade 5 muscle strength in ankle eversion and plantarflexion at the donor site, with mean American Orthopaedic Foot & Ankle Society and Foot and Ankle Disability Index scores of 96.8 and 97.6, respectively. No complications or reoperations occurred. Conclusion: All-inside ACL reconstruction using an AHPLT autograft produced good functional scores and stability without obvious ankle-site morbidity.
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Affiliation(s)
- Mingguang Bi
- Ningbo Medical Center, Lihuili Hospital, Ningbo University School of Medicine, Ningbo, China
| | - Chen Zhao
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qiong Zhang
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Li Cao
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xinji Chen
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Mingxiang Kong
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qing Bi
- Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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Tang J, Zhao J. Arthroscopic Humeral Bone Tunnel-Based Tendon Grafting and Trapezius Transfer for Irreparable Posterior Superior Rotator Cuff Tear. Arthrosc Tech 2021; 10:e1079-e1087. [PMID: 33981554 PMCID: PMC8085408 DOI: 10.1016/j.eats.2020.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/15/2020] [Indexed: 02/03/2023] Open
Abstract
Irreparable posterior rotator cuff tears pose challenges to orthopaedic surgeons, especially when the medial remaining rotator cuff is not reusable. Trapezius transfer is biomechanically favorable due to the similar vector of the transferred muscle to the native posterior superior rotator cuff. Regarding combined tendon grafting in trapezius transfer, onto-surface tendon attachment to the humerus was reported in most previous reports. For better tendon-humeral head connection, we introduce an humeral bone tunnel-based tendon grafting technique. In this technique, we use the hamstring tendons and the anterior half of the peroneus tendon to make 3 grafts. The most critical steps of this technique are the proper creation of the humeral tunnels and graft implantation. We consider the introduction of this technique will shed light in the field of trapezius transfer for Irreparable posterior rotator cuff tears.
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Affiliation(s)
- Jin Tang
- Operating Theater, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China,Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
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Tang J, Zhao J. Sandwich-Style Anterior Cruciate Ligament Reconstruction: Double-Bundle Anterior Cruciate Ligament Reconstruction With In-Between Remnant Preservation. Arthrosc Tech 2021; 10:e1095-e1102. [PMID: 33981556 PMCID: PMC8085440 DOI: 10.1016/j.eats.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/16/2020] [Indexed: 02/03/2023] Open
Abstract
Various degree of remnant tissues exists following anterior cruciate ligament (ACL) injury. Making use of these tissues may be helpful for the reconstructed ACL from many aspects. There are many methods of remnant preservation and use, as well as many types of combined ACL reconstruction. However, the most effective methods of remnant reuse as well as ACL reconstruction are still being pursued. We introduce an anatomical double-bundle transtibial ACL reconstruction with in-between remnant preservation technique named sandwich-style ACL reconstruction. The indication of this technique is complete ACL tear with a large volume of connectable remnant. The main tricks of this technique are proper ligation of the remnant, proper location of the anteromedial-bundle tibial tunnels, and passing the anteromedial bundle through the shallow side of the remnant. We believe the introduction of this technique will provide more options for remnant preservation and ACL reconstruction.
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Affiliation(s)
- Jin Tang
- Operating Theater, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China,Address correspondence to Shenyang Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
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Joshi S, Shetty UC, Salim MD, Meena N, Kumar RS, Rao VKV. Peroneus Longus Tendon Autograft for Anterior Cruciate Ligament Reconstruction: A Safe and Effective Alternative in Nonathletic Patients. Niger J Surg 2021; 27:42-47. [PMID: 34012241 PMCID: PMC8112358 DOI: 10.4103/njs.njs_22_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/15/2020] [Accepted: 06/21/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction Anterior cruciate ligament (ACL) is a common injury which has been conventionally managed by various graft reconstruction using bone patellar tendon bone, or quadruple hamstring autograft, to name a few. However, all these grafts are associated with many complications. Lately, peroneus longus tendon (PLT) autograft has shown promising results in this field, although there is still a dearth of data on its use. We, therefore, aimed at carrying out a study to evaluate the functional outcome and knee stability results of ACL reconstruction using PLT graft. Patients and Methods Patients with a completely torn ACL were included in the study. The PLT was harvested, and graft length, thickness, and harvesting time were noted intraoperatively. Knee stability and functional scores were evaluated clinically and using Lachman test (primarily) and KT-2000 arthrometer and subjectively with International Knee Documentation Committee (IKDC) score at 6, 12, and 24 months (secondary outcome) postoperatively. Ankle scores were also recorded by making use of American Orthopedic Foot and Ankle Score (AOFAS)-Hindfoot Scale. Results Forty-eight patients met the inclusion criteria. The graft harvest time was 7.4 min (5-9 min). The mean thickness of the graft on doubling was 7.9 mm (7-9 mm). Ninety-six percent of the patients were satisfied with their results of the knee surgery, and 95% of the patients had no complaints of ankle joint. The mean IKDC score postoperatively was 78.16 ± 6.23, and the mean AOFAS score was 98.4 ± 4.1. None of the patients had any neurovascular deficit. Conclusion ACL reconstruction using PLT graft yields a good functional score (IKDC, KT-2000 arthrometer) even at 2-year follow-up. It is a safe and effective autograft option for ACL reconstruction.
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Affiliation(s)
- Sachin Joshi
- Department of Orthopaedics, GMC, Kota, Rajasthan, India
| | | | - M D Salim
- Department of Orthopaedics, GMC, Kota, Rajasthan, India
| | - Naveen Meena
- Department of Orthopaedics, GMC, Kota, Rajasthan, India
| | - R Shiva Kumar
- Department of Orthopaedics, GMC, Kota, Rajasthan, India
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Relation of peroneus longus autograft dimensions with anthropometric parameters in anterior cruciate ligament reconstruction: Importance of the distal leg diameter. Jt Dis Relat Surg 2021; 32:137-143. [PMID: 33463429 PMCID: PMC8073461 DOI: 10.5606/ehc.2021.79580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/24/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives
This study aims to investigate the relationship between various anthropometric parameters and the diameter and length of the peroneus longus tendon (PLT) graft in the anterior cruciate ligament (ACL) reconstruction. Patients and methods
A total of 52 patients (38 males, 14 females; mean age: 29.2±7.7 years; range, 17 to 51 years) who received PLT autograft for ACL reconstruction in our center between July 2018 and June 2020 were retrospectively analyzed. Demographic characteristics of the patients and leg length, and proximal and distal leg diameters were recorded before the operation. The PLT autograft diameter and length were measured during surgery. Results
A statistically significant correlation was found between the graft diameter and length and weight, height, body mass index (BMI), leg length, and proximal and distal leg diameters (p<0.01). There was no statistically significant correlation between the graft diameter and length and age (p>0.05). Distal leg diameter had the highest correlation coefficient for the PLT autograft diameter (r=0.956), while the height had the highest correlation coefficient for the PLT autograft length (r=0.982). Conclusion
Anthropometric parameters of height, weight, BMI, leg length, and proximal and distal leg diameters may be helpful for surgeons to predict the diameter and length of the PLT autograft before surgery. Distal leg diameter is a particularly important parameter in predicting PLT autograft diameter.
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Marín Fermín T, Hovsepian JM, Symeonidis PD, Terzidis I, Papakostas ET. Insufficient evidence to support peroneus longus tendon over other autografts for primary anterior cruciate ligament reconstruction: a systematic review. J ISAKOS 2020; 6:161-169. [PMID: 34006580 DOI: 10.1136/jisakos-2020-000501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/06/2020] [Accepted: 10/24/2020] [Indexed: 11/04/2022]
Abstract
IMPORTANCE Graft choice for anterior cruciate ligament reconstruction (ACLR) remains a subject of interest among orthopaedic surgeons because no ideal graft has yet been found. Peroneus longus tendon (PLT) has emerged as an alternative autograft for reconstruction in kneeling populations and in simultaneous anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries. OBJECTIVE To evaluate the current evidence on the outcome of primary ACLR with PLT autograft in adults and donor ankle morbidity, in addition to determining the average PLT graft dimensions from published studies. EVIDENCE REVIEW Two independent reviewers searched PubMed, CENTRAL, EMBASE, Scopus and Virtual Health Library databases using the terms "anterior cruciate ligament," "peroneus longus" and "fibularis longus" alone and in combination with Boolean operators AND/OR. Studies evaluating clinical and stability outcomes, graft-donor ankle morbidity and graft dimensions of PLT in ACLR were included. Methodological quality was assessed using the Modified Coleman Methodology Score (mCMS). A narrative analysis is presented using frequency-weighted means wherever feasible. Publication bias was assessed using the ROBIS tool. FINDINGS Twelve articles with intermediate-level methodological quality were included. Eight studies assessing the clinical and stability outcomes of reconstruction with PLT showed satisfactory outcomes, similar to those of hamstring tendons (HT). No studies assessed anterior knee pain as an outcome. Six studies evaluated the graft-donor ankle morbidity using general functional foot and ankle scores and non-validated tools, showing favourable outcomes. Nine studies assessed PLT graft diameter, revealing grafts consistently larger than 7 mm among the different preparation techniques, which is comparable with reports of HT grafts. CONCLUSIONS AND RELEVANCE The clinical and stability outcomes of ACLR with different PLT autograft preparation techniques are comparable with those of HT during short-term follow-up; however, there is insufficient evidence to support its use in the populations that motivated its implementation. Thus, stronger evidence obtained with the use of validated tools reporting negligible donor-graft ankle morbidity after PLT harvesting is required prior to recommending its routine use, despite the consistency of its dimensions. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Theodorakys Marín Fermín
- Orthopedics, Hospital Periferico de Coche, Caracas, Capital District, Venezuela, Bolivarian Republic of .,Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Central Macedonia, Greece
| | - Jean Michel Hovsepian
- Department of Orthopaedic Sports Medicine, Chirurgisches Klinikum München Süd, München, Bayern, Germany
| | | | - Ioannis Terzidis
- Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Central Macedonia, Greece.,St. Luke's Hospital, Thessaloniki, Central Macedonia, Greece
| | - Emmanouil Theodorus Papakostas
- Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Central Macedonia, Greece.,Sports Medicine Orthopaedics, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
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Yang Z, Liu F, Cui L, Liu H, Zuo J, Liu L, Li S. Comparison of the effects of reconstruction of the lateral ankle ligaments using peroneus longus and peroneus brevis tendon graft. Medicine (Baltimore) 2020; 99:e22912. [PMID: 33181657 PMCID: PMC7668510 DOI: 10.1097/md.0000000000022912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Peroneus longus and peroneus brevis tendon grafts have been frequently used to reconstruct the lateral ankle ligaments. However, there is no literature comparing the effect of the 2 methods. The purpose of this study was to compare the effects of 2 autologous tendon transplants on ankle joint activity.This retrospective study included 100 adult patients with chronic lateral ankle instability (CLAI) who underwent surgery from January 2014 to December 2017. Group A (50 patients): Reconstruction of the lateral ankle ligaments using the anterior half of peroneus longus tendon graft; Group B (50 patients): Using the anterior half of peroneus brevis tendon graft. Outcomes were assessed by comparing pre- and postoperative AOFAS scores, VAS pain scores, and Karlsson scores, and the radiographic assessment included talar tilt and anterior talar translation. A sensitive dynamometer was used before and after surgery to assess inversion, valgus, plantarflexion, and dorsiflexion strength to evaluate changes in muscle strength in the patients feet.Postoperatively, 88 patients were followed up for 12 to 24 months, including 46 cases in group A and 42 in group B. No severe complications were recorded in the 2 groups. There were significant pre- to post-operative differences between the groups. No significant differences were observed in the postoperative scores and muscle strength changes between the groups. However, the number of patients with decreased valgus strength in group B was statistically significant compared with group A.Both methods can improve the stability of the ankle joint, but the peroneus longus tendon has little effect on the postoperative muscle strength of the foot and should be used as the preferred surgical treatment for the treatment of CLAI.
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潘 月, 屈 志, 毕 本, 高 飞, 黄 恒, 董 全. [Lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1114-1119. [PMID: 32929903 PMCID: PMC8171732 DOI: 10.7507/1002-1892.202002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/26/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the effectiveness of lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability. METHODS Between September 2014 and November 2018, 32 patients (32 sides) with chronic lateral ankle instability were treated with lateral ankle ligament reconstruction by using autogenous anterior half of the peroneus longus tendon. There were 25 males and 7 females, with an average age of 28.5 years (range, 20-51 years). The disease duration was 6-41 months (mean, 8.9 months). The preoperative Karlsson-Peterson ankle score was 53.7±9.7. The talar tilt angle was (14.9±3.7)°, and the anterior talar translation was (8.2±2.8) mm. Six patients combined with osteochondral lesion of talus and 4 patients combined with bony impingement. RESULTS All incisions healed by first intention postoperatively. All patients were followed up 12-53 months (mean, 22.7 months). At last follow-up, the Karlsson-Peterson ankle score was 85.2±9.6; the talar tilt angle was (4.3±1.4)°; the anterior talar translation was (3.5±1.1) mm. There were significant differences in all indexes between pre- and post-operation ( P<0.05). Seventeen patients were very satisfied with the results, 10 patients were satisfied, 4 patients were normal, and 1 patient was unsatisfied. After operation, the ankle sprain occurred in 7 cases, the tenderness around the compression screws at calcaneus in 5 cases, the anterolateral pain of ankle joint over 6 months in 4 cases. No patient had discomfort around the reciepient sites. At last follow-up, the ultrasonography examination showed that there was no significant difference in the density and diameter between bilateral peroneus longus tendons in 12 cases. CONCLUSION For chronic lateral ankle instability, the lateral ankle ligament reconstruction with the autogenous partial peroneus longus tendon is a safe and effective surgical option.
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Affiliation(s)
- 月海 潘
- 青岛大学附属医院手足外科(山东青岛 266000)Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China
| | - 志刚 屈
- 青岛大学附属医院手足外科(山东青岛 266000)Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China
| | - 本军 毕
- 青岛大学附属医院手足外科(山东青岛 266000)Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China
| | - 飞 高
- 青岛大学附属医院手足外科(山东青岛 266000)Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China
| | - 恒 黄
- 青岛大学附属医院手足外科(山东青岛 266000)Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China
| | - 全宇 董
- 青岛大学附属医院手足外科(山东青岛 266000)Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China
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Tang J, Zhao J. Condyle-Pinching Double-Bundle Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2020; 9:e1109-e1114. [PMID: 32874890 PMCID: PMC7451757 DOI: 10.1016/j.eats.2020.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/10/2020] [Indexed: 02/03/2023] Open
Abstract
The outcomes of anterior cruciate ligament (ACL) reconstruction are still unsatisfactory. Anterolateral ligament (ALL) reconstruction has been applied to augment ACL reconstruction, with better but still nonoptimal results. An anatomical analysis revealed that the route of ALL is quite different from that of ACL on the lateral view of the knee. Thus, we hope to augment ACL reconstruction with the reconstruction of an ACL-mimicking anterolateral structure, in which the route is similar to that of ACL. Thus, we aimed to introduce a combined ACL and ACL-mimicking anterolateral structure reconstruction technique, which we named condyle-pinching double-bundle ACL reconstruction. The main indication of this technique is ACL injury with a high degree of pivot shift or general laxity. The main steps of this technique include preparation of a combined graft, creation of a common femoral tunnel and 2 tibial tunnels, graft placement, and final graft fixation to an adjustable loop. We have been obtaining obvious outcome improvement clinically with this technique and consider that this report will provide special option in ACL reconstruction.
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Affiliation(s)
- Jin Tang
- Operating Theater, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China,Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Rd, Shanghai 200233, China.
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Lee HW, Wang C, Bae TS, Yang I, Liu Y, Park CW, Kim HN. Tendon Regeneration After Partial-Thickness Peroneus Longus Tendon Harvesting: Magnetic Resonance Imaging Evaluation and In Vivo Animal Study. Am J Sports Med 2020; 48:2499-2509. [PMID: 32628507 DOI: 10.1177/0363546520933628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In recent years, the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft source for ligament reconstruction has gained popularity. However, no reports are available regarding tendon regeneration after harvesting of the AHPLT. HYPOTHESIS When half of the tendon is preserved during tendon harvesting, the quality of the regenerated tendon is better than that of the regenerated tendon after full-thickness harvesting. STUDY DESIGN Case series; Level of evidence, 4; controlled laboratory study. METHODS A total of 21 patients who underwent AHPLT harvesting for lower extremity ligament reconstruction participated in the magnetic resonance imaging (MRI) study to evaluate tendon regeneration 1 year after the harvesting. An in vivo animal study was performed to compare the quality of the regenerated tendon after partial-thickness and full-thickness tendon harvesting. A total of 30 adult female Sprague-Dawley rats were allocated to 2 groups-15 rats underwent partial-thickness Achilles tendon harvesting (partial-thickness harvesting [PTH] group), and 15 rats underwent full-thickness Achilles tendon harvesting (full-thickness harvesting [FTH] group). The quality of the regenerated tendons was compared 180 days after tendon harvesting. RESULTS All 21 patients showed regeneration of the peroneus longus tendon (PLT) (homogeneously dark on both T1- and T2-weighted sequences). The cross-sectional area of the regenerated tendon divided by that of the preoperative tendon was 92.6% and 84.5% at 4 cm and 9 cm proximal to the tip of the distal fibula, respectively. In the animal study, the mean histologic score was better for the PTH group compared with the FTH group (9.17 ± 1.35 vs 14.72 ± 0.74; P < .001). The ultimate strength and the stiffness of the regenerated Achilles tendon were significantly higher for the PTH group compared with the FTH group (35.5 ± 8.3 vs 22.4 ± 8.3 N, P = .004; and 31.6 ± 7.7 vs 23.5 ± 4.8 N/mm, P = .016). CONCLUSION The PLT was found to regenerate after partial-thickness harvesting on MRI. In the animal study, the quality of the regenerated tendon when half of the tendon was preserved during tendon harvesting was better than that after full-thickness tendon harvesting.
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Affiliation(s)
- Ho Won Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chenyu Wang
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Tae Soo Bae
- Department of Biomedical Engineering (BME), Jungwon University, Goesan-gun, Chungcheongbuk-do, Republic of Korea
| | - Ik Yang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yuxuan Liu
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chang Won Park
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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Zhao J, Qiu J, Chen J, Xu J. Combined Double-Bundle Anterior Cruciate Ligament Reconstruction and Anterior Cruciate Ligament-Mimicking Anterolateral Structure Reconstruction. Arthrosc Tech 2020; 9:e1141-e1146. [PMID: 32874894 PMCID: PMC7451438 DOI: 10.1016/j.eats.2020.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/21/2020] [Indexed: 02/03/2023] Open
Abstract
The outcomes of double-bundle anterior cruciate ligament (ACL) reconstruction leave room for improvement. We hope to augment double-bundle ACL reconstruction with the reconstruction of an ACL-mimicking anterolateral structure (ALS). Thus, we would like to introduce a combined double-bundle ACL reconstruction and ACL-mimicking ALS reconstruction technique. The main indication for this technique is ACL injury with a high degree of pivot shift test, general laxity, or near critical value of the posterior tibial slope. The main steps in this technique include preparation of an isolated graft for the anteromedial bundle of the ACL and a combined graft for the posterolateral bundle of the ACL and ALS, creation of three tibial tunnels and two femoral tunnels, graft placement, and final graft fixation at an adjustable loop. We have obtained promising clinical outcomes with this technique and consider that this report will provide new options in ACL reconstruction.
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Affiliation(s)
- Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
| | - Jiayu Qiu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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吴 市, 林 文, 徐 伟, 李 洪. [Clinical study on reconstruction of posterior cruciate ligament with platelet rich plasma combined with 3-strand peroneus longus tendons]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:713-719. [PMID: 32538561 PMCID: PMC8171524 DOI: 10.7507/1002-1892.201910115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of the reconstruction of posterior cruciate ligament (PCL) with platelet rich plasma (PRP) and 3-strand peroneal longus tendons under arthroscope. METHODS Between June 2014 and December 2017, 58 patients with PCL rupture were randomly divided into two groups: the trial group (PRP assisted reconstruction of 3-strand peroneal longus tendons) and the control group (4-strand hamstring tendon reconstruction alone), 29 cases in each group. There was no significant difference in gender, age, injury side, Kellgren-Lawrence grade, time from injury to operation, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, International Knee Documentation Committee (IKDC) score, Lysholm score between the two groups ( P>0.05). Before operation, at 3 months and 12 months after operation, the IKDC score and Lysholm score of the two groups were recorded to evaluate the knee joint function, AOFAS ankle-hindfoot score was used to evaluate ankle function; KT-2000 examination (knee flexion of 90°, 30 lbs) was used to evaluate the difference of bilateral knee joint posterior relaxation at 12 months after operation, and MRI was used to evaluate ligament reconstruction; CT was used to evaluate the bone tunnel expansion of femur and tibia at 3 months and 12 months after operation. RESULTS The operation was completed successfully in both groups, there was no complication in the donor tendon area. All the incisions healed by first intention. All the patients were followed up for more than 1 year. The follow-up time of the trial group was 13-17 months, with an average of 15.0 months; that of the control group was 15-20 months, with an average of 15.4 months. At 3 and 12 months after operation, there was no significant difference in AOFAS ankle-hindfoot score when compared with preoperative score and between the two groups ( P>0.05). At 3 and 12 months after operation, the IKDC score and Lysholm score of the two groups were significantly improved, and further improvement was found at 12 months when compared with at 3 months ( P<0.05); the scores in the trial group were significantly better than those of the control group ( P<0.05). At 12 months after operation, the difference of the posterior relaxation of the bilateral knees in the trial group was less than 5 mm in 27 cases, 6-10 mm in 2 cases; in the control group was less than 5 mm in 20 cases, 6-10 mm in 6 cases, and >10 mm in 3 cases; the difference between the two groups was not significant ( Z=0.606, P=0.544). At 12 months after operation, MRI of knee joint showed that all patients had good PCL graft. The MRI score of the trial group was better than that of the control group ( t=2.425, P=0.019). CT examination at 3 and 12 months after operation showed that the bone tunnel expansion of femur and tibia in the trial group were significantly better than those in the control group ( P<0.05). CONCLUSION PRP combined with 3-stand peroneal longus tendons can significantly improve the function and stability of knee joint, effectively promote graft remodeling, and promote tendon bone healing, reduce the expansion of bone tunnel. The effectiveness is satisfactory.
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Affiliation(s)
- 市春 吴
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
| | - 文祥 林
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
| | - 伟华 徐
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
| | - 洪瀚 李
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
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Sakti M, Biakto KT, Usman MA, Tedjajuwana MJ, Pasallo P, Subagio ES. Predicting the peroneus longus tendon autograft size in ACL reconstruction by using anthropometric parameters: A study in South Sulawesi population. J Orthop 2020; 22:1-4. [PMID: 32273665 PMCID: PMC7132115 DOI: 10.1016/j.jor.2020.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/23/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Some literature use peroneus longus tendon (PLT) as the alternative to anterior cruciate ligament (ACL) reconstruction to overcome inadequate autograft size potential risk by using hamstring tendon (HT) autograft. Among the available methods to predict PLT measurements, anthropometric parameters are one of the most accessible and feasible methods. The objective of this prospective study was to predict the PLT autograft sizes in single bundle ACL reconstruction by using preoperative anthropometric measurement. Method Anthropometric parameters, including age, gender, height, weight, body mass index (BMI), true leg length (TLL), shank circumference and shank length of 20 patients with primary ACL reconstruction was measured before surgery. Univariate analysis, independent-sample t-test, Pearson correlation test, and logistic regression to evaluate the influence of these anthropometric variables on the diameter and length of the PLT autograft obtained. Result Pearson correlation test has shown that body weight and height correlates to PLT length and diameter also autograft's length and diameter significantly (p < 0.05). The linear regression analysis showed that height, weight, TLL and shank length were signifcantly related to autograft diameter. While height and TLL were significantly related to autograft length. Conclusion Height, weight, TLL and shank length can use to predict PLT autograft diameter. While height and TLL can use to predict PLT autograft length. It is important to estimate tendon graft size prior to ACL reconstruction surgery. Preoperative anthropometric measurement is a good method to predict PLT autograft size. Height is a good predictor of the PLT autograft diameter and length. Patient less than 153 cm in height, high risk for having in adequate graft size.
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Affiliation(s)
- M Sakti
- Orthopaedy and Traumatology Department, Hasanuddin University School of Medicine, Indonesia
| | - K T Biakto
- Orthopaedy and Traumatology Department, Hasanuddin University School of Medicine, Indonesia
| | - M A Usman
- Orthopaedy and Traumatology Department, Hasanuddin University School of Medicine, Indonesia
| | - M J Tedjajuwana
- Orthopaedy and Traumatology Department, Hasanuddin University School of Medicine, Indonesia
| | - P Pasallo
- Resident of Orthopaedy and Traumatology Department, Hasanuddin University School of Medicine, Indonesia
| | - E S Subagio
- Resident of Orthopaedy and Traumatology Department, Hasanuddin University School of Medicine, Indonesia
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