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Guler Y, Keskin A, Eskara H, Karslıoglu B, İmren Y, Semih Dedeoglu S. Lateral extrarticular tenodesis enhances outcomes in primary anterior cruciate ligament repair with knotless anchor: 24-Month minimum follow up. Knee 2024; 50:77-87. [PMID: 39128173 DOI: 10.1016/j.knee.2024.07.005] [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] [Revised: 03/30/2024] [Accepted: 07/02/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Previous studies have shown that primary repair of proximal ligament avulsion from the femoral condyle may have reasonable recovery and stability rates after repair. As a result, selecting patients more narrowly and more specifically has been recognized to improve short- and medium-term outcomes. PURPOSE This study aimed to assess the potential benefits of primary repair for acute anterior cruciate ligament (ACL) tears with a proximal tear and to evaluate the effect of performing lateral extraarticular tenodesis (LET) in addition to primary repair on patient outcomes. STUDY DESIGN Retrospective cohort study. METHODS This study was a retrospective cohort study. Thirty-eight patients between the ages of 21 and 40 years who underwent ACL repair surgery within the first 3 weeks after injury due to Sherman type 1 proximal ACL tears were evaluated. Group 1 (n = 18) underwent only primary ACL repair with knotless anchor, while Group 2 (n = 20) had LET with iliotibial band autograft in addition to primary repair. Patients were evaluated using various tests and scoring systems at 6, 12, and 24 months postoperatively. RESULTS There was no statistically significant difference between the groups in preoperative and postoperative 6- and 12-month visual analog scale (VAS) scores (P >0.05). However, the 24-month VAS score of Group 1 was statistically significantly higher than that of Group 2 (P <0.05). The preoperative International Knee Documentation Committee (IKDC) score of Group 1 was statistically significantly higher than that of Group 2 (p: 0.004; P <0.05). Group 1 had statistically significantly lower IKDC scores at postoperative 6, 12, and 24 months than Group 2. Similarly, Group 1 had statistically significantly lower Single Assessment Numeric Evaluation (SANE) and Tegner-Lysholm scores at postoperative 6, 12, and 24 months than Group 2 (P <0.05). The occurrence rate of Lachman positivity in the preoperative period was 28.6% in Group 1 and 33.3% in Group 2. CONCLUSION Our study suggests that performing LET with iliotibial band autograft in addition to primary ACL repair may lead to better outcomes in terms of pain relief, knee function, and stability compared with primary ACL repair alone.
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Affiliation(s)
- Yasin Guler
- University of Health Sciences Baltalimanı Bone Diseases Training and Researh Hospital, Turkey.
| | - Ahmet Keskin
- University of Health Sciences Kartal Dr.Lutfi Kırdar City Hospital, Turkey
| | - Hakan Eskara
- University of Health Sciences Sancaktepe Sehit Prof. Dr. İlhan Varank Training and Research Hospital, Turkey
| | - Bulent Karslıoglu
- University of Health Sciences Prof. Dr. Cemil Tascıoglu City Hospital, Turkey
| | - Yunus İmren
- University of Health Sciences Baltalimanı Bone Diseases Training and Researh Hospital, Turkey
| | - Suleyman Semih Dedeoglu
- University of Health Sciences Baltalimanı Bone Diseases Training and Researh Hospital, Turkey
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Lutz C, Casin C, Pioger C, Jacquot X, Jaeger JH, Van Hille W. Combined ACLR and lateral extra-articular tenodesis with a continuous iliotibial band autograft is a viable option in a population of athletes who participate in pivoting sports. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38922782 DOI: 10.1002/ksa.12324] [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: 11/14/2023] [Revised: 05/31/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The aim of this study was to evaluate the clinical results, return to sport and complications after anterior cruciate ligament reconstruction (ACLR) associated with lateral extra-articular tenodesis using continuous plasty with an iliotibial band. METHODS This was a prospective multicentre study involving 186 patients who had surgery for anterior cruciate ligament (ACL) rupture. Patients with multiligament ruptures and revision surgery were excluded from the study. All patients included were involved in pivoting sports and wished to resume their activity after surgery. Patients were assessed at a minimum 2-year follow-up using functional and psychological questionnaires (subjective International Knee Documentation Committee [IKDC], Tegner, Lysholm and ACL-RSI scores), ligament assessment including instrumented laxity measurement (Rolimeter), Lachman test and pivot shift and isokinetic testing. Return to sport was assessed using a questionnaire, and complications and repeat surgeries were recorded. RESULTS At a mean follow-up of 43.1 months, the subjective IKDC, Lysholm, ACL-RSI and objective IKDC scores were significantly improved (59.8 vs. 94.5 p < 0.0001, 75 vs. 99 p < 0.0001, 60 vs. 93 p < 0.0001, IKDC A 0% vs. 72%, B 12% vs. 27%, C 60% vs. 1% D 28% vs. 0% p < 0.0001). The Tegner activity level was 9 (3-10) before the accident and 9 (3-10) at the last review. Seventy-six percent of the patients had returned to sports at the same level. The differential laxity was 6.6 mm (±1.7) preoperatively and 1.1 mm (±1.4) postoperatively. Additionally, 97% were equal in pivot shift at the last follow-up. At the 6-month isokinetic assessment, the muscle strength recovery for the quadriceps and hamstring was over 85% compared with the healthy side for 79% and 70% of the patients, respectively. Ten patients had graft rupture (5.6%). Four (2.4%) patients had a contralateral ACL rupture, and seven (4%) underwent a reoperation with meniscectomy. CONCLUSION Anterior ligament reconstruction with lateral extra-articular tenodesis using a continuous strip of iliotibial band enables 76% of patients in a population with a high demand for sports to resume their activities at the same level. The clinical results and complication rates, particularly reruptures (5.6%), were similar to those of other techniques involving lateral extra-articular tenodesis. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Christian Lutz
- Institut de Chirurgie Orthopédique et Sportive à Strasbourg, Strasbourg, France
| | | | - Charles Pioger
- Department of Orthopedic Surgery, Ambroise Paré Hospital, AP-HP 9, Boulogne-Billancourt, France
| | - Xavier Jacquot
- Institut de Chirurgie Orthopédique et Sportive à Strasbourg, Strasbourg, France
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Nakanishi Y, Hegarty P, Vivacqua T, Firth A, Milner JS, Pritchett S, Willits K, Litchfield R, Bryant D, Getgood AMJ. Quantitative MRI Analysis of Patellofemoral Joint Cartilage Health 2 Years After Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis. Am J Sports Med 2024; 52:1773-1783. [PMID: 38794906 DOI: 10.1177/03635465241248642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND The addition of an iliotibial band-based lateral extra-articular tenodesis (LET) to anterior cruciate ligament (ACL) reconstruction (ACLR) has been shown to reduce failure rates. However, there are concerns as to the potential overconstraint of tibiofemoral kinematics that may increase the risk of cartilage degradation. To date, no clinical study has investigated the effect of LET on patellofemoral joint articular cartilage health. HYPOTHESIS It was hypothesized that at 2 years postoperatively, (1) the addition of LET at the time of ACLR would have no effect on cartilage health on magnetic resonance imaging (MRI), and (2) higher cartilage relaxation values would be associated with worse patient-reported and functional outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A subset of patients from the STABILITY 1 randomized controlled trial were included. All patients underwent primary ACLR with a hamstring autograft. Patients were randomized to either LET augmentation or not. Cartilage status in the patellofemoral joint between the ACLR group and ACLR+LET group was compared using 2-year postoperative quantitative MRI and the ACL osteoarthritis scores of both the surgical and the contralateral nonsurgical knees. Objective functional outcomes and patient-reported outcome measures (PROMs) were attained. RESULTS A total of 92 patients (43 patients in the ACLR group; mean age, 18.9 ± 3.2 years; 60.5% female; and 49 patients in the ACLR+LET group; mean age, 18.7 ± 3.2 years, 63.3% female) were included. No significant differences were seen in the mean values (ms) for adjusted T1ρ/T2 relaxation times in the medial patella (47.8/42.2 vs 47.3/43.2), central patella (45.5/42.5 vs 44.1/42.7), lateral patella (48.2/43.5 vs 47.3/43.0), medial trochlea (54.7/50.9 vs 56.4/50.9), central trochlea (53.3/51.1 vs 53.1/52.0), and lateral trochlea (54.9/52.1 vs 53.9/52.6) between the ACLR and ACLR+LET groups. No difference in overall ACL osteoarthritis scores was observed (P = .99). An increase in medial patellar T2 relaxation times was associated with a decreasing International Knee Documentation Committee score (P = .046), Knee injury and Osteoarthritis Outcome Score (KOOS) Symptoms subscale score (P = .01), and total KOOS (P = .01). CONCLUSION There was no statistical difference in patellofemoral cartilage health between knees 2 years after primary ACLR with hamstring tendon autograft with or without LET. Statistically significant correlations were found between quantitative MRI relaxation times, functional outcome scores, and PROMs; however, the correlations were weak and the clinical significance is unknown. REGISTRATION NCT02018354 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Yuta Nakanishi
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Paul Hegarty
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Thiago Vivacqua
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Andrew Firth
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Jaques S Milner
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Stephany Pritchett
- Department of Medical Imaging, Musculoskeletal Division, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Kevin Willits
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Robert Litchfield
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Dianne Bryant
- School of Physical Therapy, Western University, London, Ontario, Canada
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alan M J Getgood
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
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Risvas K, Stanev D, Moustakas K. Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis. PLoS One 2024; 19:e0293161. [PMID: 38412190 PMCID: PMC10898738 DOI: 10.1371/journal.pone.0293161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/21/2024] [Indexed: 02/29/2024] Open
Abstract
One of the most common knee injuries is the Anterior Cruciate Ligament (ACL) rupture with severe implications on knee stability. The usual treatment is the ACL Reconstruction (ACLR) surgery where the surgeon replaces the torn ligament with a graft in an effort to restore knee kinematics. In case of excessive rotatory instability, Lateral Extra-Articular Tenodesis (LET) can be performed in combination with ACLR. Additionally, LET appears to reduce ACLR graft forces minimizing graft failure chances. However, there are concerns about overconstraining physiological rotation. To gain insight in this controversial topic, we developed an automatic, open-source tool to create a series of Finite Element (FE) models attempting to investigate the interactions of ACLR and LET through simulation. We started by creating a validated model of the healthy knee joint that served as reference for subsequent FE simulations. Then, we created FE models of standalone ACLR and combined ACLR-LET. Each model was assessed by applying a loading profile that resembles the reduction phase of the Pivot-Shift clinical exam. We measured the External Tibia Rotation (ETR), the Posterior Tibia Translation (PTT) of the lateral tibial compartment, and the ACLR graft stress developed around the femoral tunnel insertion site. We observed the following: a) LET reduces ETR and PTT compared to isolated ACLR, b) combined ACLR-LET is more sensitive to LET graft pretension with lower values showcasing performance closer to the healthy joint, c) LET reduces ACLR graft forces for the same pretension values, d) LET exhibits significant overconstraint for higher pretension values. In general, these findings are in agreement with relevant clinical studies and accentuate the potential of the developed framework as a tool that can assist orthopaedists during surgery planning. We provide open access for the FE models of this study to enhance research transparency, reproducibility and extensibility.
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Affiliation(s)
- Konstantinos Risvas
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Dimitar Stanev
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
- École Polytechnique Fédérale de Lausanne, Institute of Bioengineering, Lausanne, Switzerland
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Jones EN, Post HK, Stovall BA, Ierulli VK, Vopat BG, Mulcahey MK. Lateral Extra-articular Tenodesis Augmentation of Anterior Cruciate Ligament Reconstruction Is Most Commonly Indicated for Pivot Shift of Grade 2 or Greater and for Revision Anterior Cruciate Ligament Reconstruction. Arthroscopy 2024:S0749-8063(24)00085-9. [PMID: 38331370 DOI: 10.1016/j.arthro.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/14/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To determine the most common indications for lateral extra-articular tenodesis (LET) augmentation of anterior cruciate ligament reconstruction (ACLR). METHODS A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Embase, Web of Science, and Cochrane Database of Systematic Reviews from 2000 to the present (June 2022). Studies that met the following criteria were included: patients of any age who underwent LET in addition to ACLR, studies reporting at least 1 indication for LET, and observational/randomized controlled trial study designs including prevalence of indications. Publications had to be reported in English and peer reviewed and to have originated in the United States or countries offering identical protocols and procedures. RESULTS A total of 463 studies were identified from the initial search, 23 of which met inclusion criteria and were included in the review. Eight of the 23 studies (34.8%) used a modified Lemaire technique, seven (30.4%) used a MacIntosh modified by Arnold-Coker, and eight (34.8%) used other techniques to perform LET. A total of 2,125 patients (53% female, 47% male [3 studies did not report sex]) underwent ACLR augmented with LET. The indications along with prevalence were as follows: positive pivot shift test (grade ≥2) (19 of 23, 82.6%), revision ACLR (12 of 23, 52.2%), ligamentous laxity (11 of 23, 47.8%), general sports participation (11 of 23, 47.8%), age less than 25 years (8 of 23, 34.8%), high risk of graft failure (5 of 23, 21.7%), and positive Lachman test (4 of 23, 17.4%). CONCLUSIONS Pivot shift grade ≥2 was the most common reason orthopaedic surgeons chose to add LET to ACLR, with revision ACLR, patient age <25, and general sports participation following closely behind. LEVEL OF EVIDENCE Level I to IV, systematic review of studies.
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Affiliation(s)
- Emily N Jones
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Hunter K Post
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
| | - Bailey A Stovall
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Victoria K Ierulli
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Bryan G Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, U.S.A..
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Lima LHPD, Gomes JLE. Must a Knee with Anterior Cruciate Ligament Deficiency and High-grade Pivot Shift Test Present an Increase in Internal Rotation? Rev Bras Ortop 2024; 59:e82-e87. [PMID: 38524720 PMCID: PMC10957268 DOI: 10.1055/s-0044-1779316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/29/2023] [Indexed: 03/26/2024] Open
Abstract
Objective: Rupture of the anterior cruciate ligament (ACL) is one of the most common injuries in athletes and is often associated with damage to anterolateral structures. This combination of injuries presents itself clinically as a high-grade pivot shift test. The hypothesis of this study is that patients with ACL deficiency and high-grade pivot shift test should have an increased internal knee rotation. Methods: Twenty-two patients were tested. After effective spinal anesthesia, two tests were performed with the patient in supine position. First, the bilateral pivot shift test was performed manually, and its grade was recorded. Then, with the knee flexed to 90 degrees, the examiner drew the projection of the foot in a neutral position and in maximum internal rotation, and the angle of internal rotation was measured from the axes built between the central point of the heel and the hallux. Results: In the ACL-deficient knee, it was observed that there is a statistically significant average internal rotation (IR) delta of 10.5 degrees between the groups when not adjusted for age, and 10.6 degrees when adjusted for age. Conclusions: Knees with ACL deficiency and with pivot shift test grade I do not show increased internal rotation in relation to knees with intact ACL. Knees with ACL deficiency and with pivot shift test grades II and III show increased internal rotation in comparison to healthy knees.
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Yang HY, Cheon JH, Choi JH, Song EK, Seon JK. Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Decreases Passive Anterior Tibial Subluxation Compared With Isolated Anterior Cruciate Ligament Reconstruction Despite Similar Rotational Stability and Clinical Outcomes. Arthroscopy 2023; 39:2513-2524.e2. [PMID: 37142134 DOI: 10.1016/j.arthro.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To analyze the effect of augmenting a hamstring autograft anterior cruciate ligament reconstruction (ACLR) with an anterolateral ligament reconstruction (ALLR) on a primary outcome of passive anterior tibial subluxation (PATS) and a secondary outcome of the clinical outcomes. METHODS ACL-injured patients who underwent primary ACLR between March 2014 and February 2020 at our center were enrolled. Patients who underwent combined procedures (ACLR + ALLR) were matched in a 1:1 propensity ratio to patients who underwent ACLR only. We evaluated PATS, knee stability (side-to-side laxity difference, pivot-shift test), and patient-reported outcome measures (PROMs) after the procedure and documented complications. RESULTS From an initial cohort of 252 patients with a minimum follow-up period of 2 years (48.4 ± 16.6 months), 35 matched pairs were included, and 17 patients (48.6%) in each group underwent second-look arthroscopy. The combined ACLR + ALLR group showed significantly better improvement of PATS in the lateral compartments than the isolated ACLR group (P = .034). There were no significant differences between the groups regarding knee stability (side-to-side laxity difference, pivot-shift test), PROMs, complications, and second-look arthroscopic findings (all P > .05). Moreover, the proportions of patients who achieved the minimal clinically important difference in PROMs were not different between groups. CONCLUSIONS The combined ACLR + ALLR procedure was associated with a mean improvement in anterior tibial subluxation for the lateral compartment that was 1.2 mm better than an isolated ACLR procedure, despite its lack of clinical significance. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Hong Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea
| | - Jae Hyeok Cheon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea
| | - Ji Hoon Choi
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea
| | - Eun Kyoo Song
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea
| | - Jong Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea.
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Perelli S, Gelber PE, Morales-Avalos R, Ronco S, Torres-Claramunt R, Espregueira-Mendes J, Monllau JC. Isolated lateral extra-articular tenodesis in ACL-deficient knees: in vivo knee kinematics and clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07344-9. [PMID: 36810948 DOI: 10.1007/s00167-023-07344-9] [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: 11/10/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To carry out an in vivo kinematic analysis of isolated modified Lemaire lateral extra-articular tenodesis (LET) to explore its ability to modify the stability of anterior cruciate ligament (ACL) deficient knees. The secondary aim was to look at the clinical outcomes of the isolated LET to analyze whether biomechanical changes have an influence on clinical improvement or not. METHODS A total of 52 patients who underwent an isolated modified Lemaire LET were prospectively studied. Twenty-two were over 55-year-old patients with ACL rupture and subjective instability (group 1). They were followed up for 2 years postoperatively. Thirty were patients underwent a two-stage ACL revision (group 2). They were followed up for 4 months postoperatively (up to the second stage of the ACL revision). Preoperative, intraoperative, and postoperative kinematic analyses were carried out using the KiRA accelerometer and KT1000 arthrometer to look for residual anterolateral rotational instability and residual anteroposterior instability. Functional outcomes were measured with the single-leg vertical jump test (SLVJT) and the single-leg hop test (SLHT). Clinical outcomes were evaluated using the IKDC 2000, Lysholm, and Tegner scores. RESULTS A significant reduction of both rotational and anteroposterior instability was detected. It was present both with the patient under anesthesia (p < 0.001 and p = 0.007 respectively) as well as with the patient awake (p = 0.008 and p = 0.018 respectively). Postoperative analysis of knee laxity did not show any significant variation from the first to the last follow-up. Both the SLVJT and SLHT improved significantly at the last follow-up (p < 0.001 and p = 0.011 respectively). The mean values of both the IKDC and Lysholm and Tegner scores showed an improvement (p = 0.008; p = 0.012; p < 0.001). CONCLUSION The modified Lemaire LET improves the kinematics of ACL-deficient knees. The improvement in the kinematics leads to an improvement in subjective stability as well as in the function of the knee and in the clinical outcomes. At the 2-year follow-up, these improvements were maintained in a cohort of patients over 55 years. Following our findings, to reduce knee instability, an isolated LET in ACL-deficient knees may be used when ACL reconstruction in patients over 55 years is not indicated. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Simone Perelli
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain. .,Knee and Arthroscopy Unit, Department of Orthopedic Surgery, Institut Catalá de Traumatologia I Medicina de L'Esport (I.C.A.T.M.E.), Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Pablo Eduardo Gelber
- Knee and Arthroscopy Unit, Department of Orthopedic Surgery, Institut Catalá de Traumatologia I Medicina de L'Esport (I.C.A.T.M.E.), Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain.,Department of Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Rodolfo Morales-Avalos
- Department of Physiology, School of Medicine, Universidad Autonoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México.,Department of Orthopedic Surgery and Traumatology, Knee UnitSchool of Medicine and University Hospital "DrJosé Eleuterio González", Universidad Autonoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - Sergio Ronco
- Orthopaedic Surgery Department, E. Agnelli Hospital, Pinerolo, (Turin), Italy
| | - Raul Torres-Claramunt
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain.,Knee and Arthroscopy Unit, Department of Orthopedic Surgery, Institut Catalá de Traumatologia I Medicina de L'Esport (I.C.A.T.M.E.), Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - João Espregueira-Mendes
- Clínica Espregueira FIFA Medical Centre of Excellence, Porto, Portugal.,School of Medicine, University of Minho, Braga, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, European Institute of Excellence On Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
| | - Joan Carles Monllau
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain.,Knee and Arthroscopy Unit, Department of Orthopedic Surgery, Institut Catalá de Traumatologia I Medicina de L'Esport (I.C.A.T.M.E.), Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain
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Mogoş Ş, D'Ambrosi R, Antonescu D, Stoica IC. Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Results in Superior Rotational Stability Compared with Isolated Anterior Cruciate Ligament Reconstruction in High Grade Pivoting Sport Patients: A Prospective Randomized Clinical Trial. J Knee Surg 2023; 36:54-61. [PMID: 33932949 DOI: 10.1055/s-0041-1729621] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of the current randomized clinical trial (RCT) was to evaluate the clinical outcomes of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction and to compare them with those of isolated ACL reconstruction. The hypothesis was that combined ACL and ALL reconstruction will result in superior clinical outcomes in terms of the rotational stability of the knee. This prospective RCT included 57 patients (44 men and 13 women, mean age = 31 ± 7.1 years) who underwent ACL reconstruction either isolated (Group I: 25 patients) or combined with ALL reconstruction (Group II: 32 patients). The evaluation of the patients was done preoperatively and postoperatively at 6 weeks, 12 weeks, 6 months, and 12 months including a clinical examination (Lachman's test, Pivot shift's test, and Rolimeter differential anterior laxity), an objective clinical scores (objective: the International Knee Documentation Committee [IKDC] score) and a subjective clinical scores (subjective: IKDC's score, Lysholm's score, and Tegner's activity score). Postoperative complications of all the patients were recorded. There was a significant difference between the study groups at all follow-up intervals when evaluating the postoperative pivot shift test (p < 0.05) with a superior rotational stability in the group of combined ACL and ALL reconstruction. At the final follow-up evaluation, 36% of the patients from Group I and 6.2% in Group II had a grade I positive pivot shift test (p < 0.05). There was a statistically significant difference between the two groups regarding the number of patients with a grade A IKDC objective score (p < 0.05) at the 6- and 12-month follow-up intervals (p = 0.007). There was a significant difference concerning the IKDC subjective score between the two study groups in favor of the combined ACL and ALL reconstruction group at 12 months postoperatively (p = 0.048). Combined ACL and ALL reconstruction technique was demonstrated to be effective in obtaining a superior control of the rotational knee instability and to improve the clinical objective and subjective outcomes when compared with isolated ACL reconstruction in sports patients with high-grade pivoting shifts.
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Affiliation(s)
- Ştefan Mogoş
- Foişor Orthopaedics Hospital, Bucharest, Romania
| | | | - Dinu Antonescu
- University of Medicine and Pharmacy, Carol Davila Bucharest, Romania
| | - Ioan-Cristian Stoica
- Foişor Orthopaedics Hospital, Bucharest, Romania.,University of Medicine and Pharmacy, Carol Davila Bucharest, Romania
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Perelli S, Morales-Avalos R, Formagnana M, Rojas-Castillo G, Serrancolí G, Monllau JC. Lateral extraarticular tenodesis improves stability in non-anatomic ACL reconstructed knees: in vivo kinematic analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:1958-1966. [PMID: 35091787 DOI: 10.1007/s00167-021-06854-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To carry out an in vivo kinematic analysis to determine whether adding a lateral extraarticular tenodesis (LET) for those patients with subjective instability and objective residual laxity after a transtibial (TT) anterior cruciate ligament reconstruction (ACLR) reduces anteroposterior and rotational laxity and to evaluate the 2-year follow-up clinical outcomes to analyze whether biomechanical changes determine clinical improvement or not. METHODS A total of 19 patients with residual knee instability after TT ACLR who underwent a modified Lemaire LET were prospectively evaluated for at least 2-year follow-up. Preoperative, intraoperative, and 6 and 24-month postoperative kinematic analyses were carried out using the KiRA accelerometer and KT1000 arthrometer to look for residual anterolateral rotational instability and residual anteroposterior instability. Functional outcomes were measured with the single-leg vertical jump test and the single-leg hop test. Clinical outcomes were evaluated using the IKDC 2000, Lysholm, and Tegner scores. RESULTS A significant reduction in anterolateral rotational instability was detected with the patient under anesthesia (from 3 ± 1.2 to 1.1 ± 1.1 m/s2; p < 0.05) as well as with the patient awake (from 2.1 ± 0.8 to 0.7 ± 1.4 m/s2; p < 0.05). A significant reduction in anteroposterior instability was only present under anesthesia (from 3.4 ± 1.9 to 2.1 ± 1.1 mm; p < 0.05), while no difference was present without anesthesia (from 2.3 ± 1.1 to 1.6 ± 1 mm; n.s.). Postoperative analysis of knee laxity did not show any significant variation from the first to the last follow-up. Both the single-leg vertical jump test and single-leg hop test improved significantly at the last follow-up (both p < 0.05). The mean values of both the IKDC and Tegner scores showed an improvement (p < 0.05 and p < 0.05, respectively), whereas that was not the case with the Lysholm score (n.s.). CONCLUSIONS The modified Lemaire LET can improve the kinematics of a non-anatomic ACL reconstructed knee with residual subjective and objective instability. These kinematic changes were able to lead to an improvement in subjective stability as well as the function of the knee in a small cohort of recreationally active patients. At 2-year follow-up, the kinematic changes as well as the level of activity of the patients and the IKDC score show their improvement sustained. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Simone Perelli
- Institut Català de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - Rodolfo Morales-Avalos
- Institut Català de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr, José Eleuterio González", Universidad Autonoma de Nuevo León, Monterrey, Mexico. .,Knee Unit, Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr, José Eleuterio González", Universidad Autonoma de Nuevo León (U.A.N.L.), 4th Floor, Central Building of the University Hospital, Av. Francisco I. Madero and Av. Dr. Eduardo Aguirre Pequeño, s/n, Col. Mitras Centro, C.P. 64460, Monterrey, Nuevo León, Mexico.
| | - Mario Formagnana
- Department of Orthopaedic Surgery and Traumatology, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Gonzalo Rojas-Castillo
- Department of Orthopaedic Surgery and Traumatology, Talca Regional Hospital, Universidad Catolica del Maule, Talca, Chile
| | - Gil Serrancolí
- Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Juan Carlos Monllau
- Institut Català de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
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Viglietta E, Ponzo A, Monaco E, Iorio R, Drogo P, Andreozzi V, Conteduca F, Ferretti A. ACL Reconstruction Combined With the Arnold-Coker Modification of the MacIntosh Lateral Extra-articular Tenodesis: Long-term Clinical and Radiological Outcomes. Am J Sports Med 2022; 50:404-414. [PMID: 34939890 DOI: 10.1177/03635465211062609] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Interest in the role of lateral extra-articular tenodesis (LET) in preventing rotatory instability and the pivot-shift phenomenon after anterior cruciate ligament reconstruction (ACLR) has been recently renewed. Nevertheless, there is still concern about overconstraint of the lateral compartment of the knee and the risk of subsequent osteoarthritis (OA). PURPOSE The purpose of this retrospective study was to compare long-term subjective and objective outcomes and the rate of OA development between patients undergoing isolated ACLR (iACLR) with a hamstring tendon autograft and those with a combined Arnold-Coker modification of the McIntosh extra-articular procedure. Risk factors for long-term OA were evaluated. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The study included 165 consecutive patients treated at a single center by ACLR. A total of 86 patients underwent iACLR (iACLR group) and 79 received combined intra- and extra-articular reconstruction (ACLR+LET). The International Knee Documentation Committee (IKDC), Lysholm, and Tegner activity scores were administered. Knee stability was tested through the Lachman test, the pivot-shift test, and the KT-1000 knee arthrometer test. A positive pivot-shift test (++/+++), laxity on the KT-1000, and referred giving-way episodes or revision ACLR were considered failures. Radiographic results were assessed according to the Fairbank, IKDC, and Kellgren-Lawrence scales. Radiographic evaluation included both the overall tibiofemoral joint and the medial and lateral compartment separately. A univariate and a multivariate logistic regression with penalized maximum likelihood was used to identify risks factors associated with long-term OA. RESULTS The mean follow-up was 15.7 years. There were no statistically significant differences in subjective scores between the 2 groups. A side-to-side difference >5 mm on the KT-1000 arthrometer evaluation was found in 8 patients in the iACLR group and in 1 patient in the ACLR+LET group (P = .01). Nine cases of failure were found in the iACLR group and only 1 case was found in the ACLR+LET group (P = .0093). Patients in the iACLR group had a significantly higher OA grades than those in the ACLR+LET group for the overall tibiofemoral joint and the lateral compartment of the knee. No differences were found in the medial compartment. A higher level of lateral compartment OA was found in patients who received partial lateral meniscectomy in the iACLR group compared with those in the ACLR+LET group. Univariate and multivariate analysis results demonstrated that meniscectomy was the most significant factor for long-term OA development. CONCLUSION A significantly higher risk of long-term OA was found with iACLR than with ACLR combined with the Arnold-Coker modification of the McIntosh extra-articular procedure. Knees with combined ACLR also had a significantly lower OA grade after partial lateral meniscectomy. Additionally, those undergoing combined ACLR had better knee stability and lower graft rupture rates at the long-term follow-up. Partial meniscectomy was the main risk factor negatively associated with OA changes.
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Affiliation(s)
- Edoardo Viglietta
- Orthopaedic & Traumatology Unit of Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Ponzo
- Orthopaedic & Traumatology Unit of Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Edoardo Monaco
- Orthopaedic & Traumatology Unit of Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Raffaele Iorio
- Orthopaedic & Traumatology Unit of Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Piergiorgio Drogo
- Orthopaedic & Traumatology Unit of Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Valerio Andreozzi
- Orthopaedic & Traumatology Unit of Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Fabio Conteduca
- Orthopaedic & Traumatology Unit of Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Andrea Ferretti
- Orthopaedic & Traumatology Unit of Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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12
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Matava MJ, Koscso J, Melara L, Bogunovic L. Suture Tape Augmentation Improves the Biomechanical Performance of Bone-Patellar Tendon-Bone Grafts Used for Anterior Cruciate Ligament Reconstruction. Arthroscopy 2021; 37:3335-3343. [PMID: 33964381 DOI: 10.1016/j.arthro.2021.04.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the time-zero biomechanical properties (stiffness, displacement, and load at failure) of bone-patellar tendon-bone (BTB) grafts used for anterior cruciate ligament (ACL) reconstruction with and without suture tape augmentation as a means to determine the potential clinical benefit of this technique. METHODS Eight juvenile porcine knees underwent ACL reconstruction with a human cadaveric BTB graft (control). These were compared to 8 juvenile porcine knees that underwent ACL reconstruction with a BTB graft augmented with suture tape. All knees underwent biomechanical testing utilizing a dynamic tensile testing machine. Cyclic loading between 50-250N was performed for 500 cycles at 1 Hz to simulate in vivo ACL loads during the early rehabilitation phase. The grafts were displaced during load-at-failure tensile testing at 20 mm/min. Differences in graft displacement, stiffness, and load at failure for the control and suture tape augmented groups were compared with the Student t-test with a significance level of P < .05. RESULTS There was no difference in graft displacement between the 2 groups. A 104% higher postcyclic stiffness was noted in the augmented group compared to the controls (augmentation: 261 ± 76 N/mm versus control 128 ± 28 N/mm, P = .002). The mean ultimate load at failure was 57% higher in the augmented group compared to controls (744 ± 219 N vs postcyclic 473 ± 169 N, respectively [P = .015]). There was no difference in mode of failure between the control knees and those augmented with suture tape, with approximately half failing from pull off of the tendon from the bone plug and half with pull out of the bone plug from the tunnel. CONCLUSION Independent suture tape augmentation of a BTB ACL reconstruction grafts was associated with a 104% increase in graft stiffness and a 57% increase in load at failure compared to nonaugmented BTB grafts. CLINICAL RELEVANCE In vivo suture tape augmentation of a BTB ACL reconstruction increases graft construct strength and stiffness, which may reduce graft failure in the clinical setting.
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Affiliation(s)
- Matthew J Matava
- Washington University Department of Orthopedic Surgery, St. Louis, Missouri.
| | - Jonathan Koscso
- Washington University Department of Orthopedic Surgery, St. Louis, Missouri
| | - Lucia Melara
- Arthrex Department of Orthopedic Research, Naples, Florida, U.S.A
| | - Ljiljana Bogunovic
- Washington University Department of Orthopedic Surgery, St. Louis, Missouri
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Mazza D, Monaco E, Redler A, Wolf MR, Iorio R, Daggett M, Massafra C, Ferretti A. Segond Fractures Involve the Anterolateral Knee Capsule But Not the Iliotibial Band. Arthrosc Sports Med Rehabil 2021; 3:e639-e643. [PMID: 34195626 PMCID: PMC8220572 DOI: 10.1016/j.asmr.2020.10.011] [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: 05/20/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the relationship between the Segond fracture and the anterolateral complex of the knee. Methods Between January 2014 and March 2020, patients who presented with an anterior cruciate ligament (ACL) tear requiring acute surgical reconstruction (within 10 days from trauma) were evaluated for inclusion in this study. Patients were included if they had an acute ACL tear with an associated Segond fracture (or “Segond lesion”) as detected by radiograph or magnetic resonance imaging. The lateral compartment was exposed in all cases using a 5-cm lateral hockey-stick incision, which was carried down to the iliotibial band. The fascia lata was first inspected and then longitudinally divided along its fibers to expose lateral compartment. The posterolateral corner to Gerdy’s tubercle anteriorly was exposed and examined. Once the Segond fracture was identified, it was recorded and photographed. Results Seventeen patients were enrolled in the study. Dissection of the Segond fracture demonstrated attachment to the anterolateral capsule only. No other discernible attachment to the Segond fracture was noted. Surgical exploration of the anterolateral knee did not reveal injury to the iliotibial band. Conclusions Careful dissection of Segond fractures during repair revealed that there is a discernible attachment with the anterolateral capsule to the bone injury in all patients with acute ACL tears undergoing surgical reconstruction and no connections to the iliotibial band. Clinical Relevance The precise pathogenesis of Segond fractures has been the subject of debate, partially due to the complexity of the anatomy of the anterolateral aspect of the knee. Proper understanding of the anatomy of type IV ALL injures with Segond fractures is important to improve treatment of these injuries.
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Affiliation(s)
- Daniele Mazza
- University of Rome “Sapienza,” Sant’ Andrea Hospital Via di Grottarossa, Rome, Italy
- Address correspondence to Daniele Mazza, M.D., University of Rome La Sapienza, Sant’Andrea Hospital, Via di Grottarossa 1039, Rome, Italy.
| | - Edoardo Monaco
- University of Rome “Sapienza,” Sant’ Andrea Hospital Via di Grottarossa, Rome, Italy
| | - Andrea Redler
- University of Rome “Sapienza,” Sant’ Andrea Hospital Via di Grottarossa, Rome, Italy
| | - Megan Rianne Wolf
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, U.S.A
| | - Raffaele Iorio
- University of Rome “Sapienza,” Sant’ Andrea Hospital Via di Grottarossa, Rome, Italy
| | | | - Carlo Massafra
- University of Rome “Sapienza,” Sant’ Andrea Hospital Via di Grottarossa, Rome, Italy
| | - Andrea Ferretti
- University of Rome “Sapienza,” Sant’ Andrea Hospital Via di Grottarossa, Rome, Italy
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14
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van der List JP, Hagemans FJA, Zuiderbaan HA, van Dijke CF, Rademakers MV, van Noort A, Kerkhoffs GMMJ. Age, activity level and meniscus injury, but not tear location, tibial slope or anterolateral ligament injury predict coping with anterior cruciate ligament injury. Knee 2021; 29:222-232. [PMID: 33640621 DOI: 10.1016/j.knee.2021.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Early recognition of potential predictors on the success of conservative treatment of anterior cruciate ligament (ACL) is important, as appropriate treatment can be applied to each individual patient. The goal of this study is to assess the patient demographic and radiological parameters that predict coping with ACL injuries. METHODS All patients presenting with a complete ACL injury between 2014 and 2018 at our clinic were included. The role of patient demographics (age, gender, activity level, meniscus injury and time from injury to clinic), and ACL tear location, bone bruises, tibial slope, and anterolateral ligament (ALL) injury were assessed on the success of conservative treatment using univariate and multivariate analyses. RESULTS Sixty-five patients (32%) were copers and 141 (68%) were non-copers. Univariate analysis showed that copers were significantly older (40 vs. 27 years, P < 0.001), had lower preinjury activity level (Tegner 5.7 vs. 6.5, P < 0.001) and less often lateral meniscus tears (16% vs. 5%, P = 0.019) but not medial meniscus tears (17% vs. 14%, P = 0.609) than non-copers. Multivariate analysis revealed that increasing age (P < 0.001), Tegner level ≤ 6 (P = 0.003) and no meniscus injury (P = 0.045) were independent predictors of coping with ACL deficiency. CONCLUSIONS Older age, participation in lower activity sports levels and absence of meniscus injury were predictive of coping with ACL deficiency, whereas there was no such role for tear location, tibial slope, lateral bone bruise presence, ALL injury or gender. These findings might help to identify potential copers and guide surgeons early in the optimal treatment for patients with ACL injury.
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Affiliation(s)
- Jelle P van der List
- NorthWest Clinics, Department of Orthopaedic Surgery, Alkmaar, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands; Spaarne Gasthuis, Department of Orthopaedic Surgery, Hoofddorp, the Netherlands.
| | - Frans J A Hagemans
- NorthWest Clinics, Department of Orthopaedic Surgery, Alkmaar, the Netherlands
| | - Hendrik A Zuiderbaan
- NorthWest Clinics, Department of Orthopaedic Surgery, Alkmaar, the Netherlands; Medical Clinics Velsen, Department of Orthopaedic Surgery, Velsen, the Netherlands
| | | | | | - Arthur van Noort
- Spaarne Gasthuis, Department of Orthopaedic Surgery, Hoofddorp, the Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam UMC, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), University of Amsterdam and Vrije Universiteit Amsterdam IOC Research Center, Amsterdam, the Netherlands
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15
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Chen J, Wang C, Xu C, Qiu J, Xu J, Tsai TY, Zhao J. Effects of Anterolateral Structure Augmentation on the In Vivo Kinematics of Anterior Cruciate Ligament-Reconstructed Knees. Am J Sports Med 2021; 49:656-666. [PMID: 33464924 DOI: 10.1177/0363546520981743] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Double-bundle anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-known treatment that restores the stability of ACL-deficient knees. However, some isolated ACL-reconstructed knees ultimately show rotatory laxity and develop osteoarthritis. Whether combined ACLR with anterolateral structure (ALS) augmentation (ALSA) can provide better improvement in the in vivo knee rotational kinematics remains unknown. HYPOTHESIS When compared with isolated double-bundle ACLR, combined double-bundle ACLR with ALSA can improve knee in vivo rotational kinematics and provide better restoration of knee kinematics. STUDY DESIGN Controlled laboratory study. METHODS Sixteen patients with unilateral ACL injury were randomly divided into 2 groups to receive either combined double-bundle ACLR and ALSA (ALSA group) or isolated double-bundle ACLR (ACLR group). All patients performed a single-leg lunge using the operative and nonoperative/contralateral legs under dual-fluoroscopic imaging system surveillance during a hospital visit at a minimum 1 year (12-13 months) of follow-up to assess the 6 degrees of freedom knee kinematics. Functional evaluation using the Lysholm and Marx rating scales and clinical examinations were also performed. RESULTS From full extension to approximately 90° of knee flexion at 5° intervals, the mean ± SD internal rotation of the reconstructed knees in the ALSA group (1.5°± 0.9°) was significantly smaller than that of the contralateral knees (8.2°± 1.9°; P = .008). The ALSA group knees also showed significantly (P = .045) more medial translation than the contralateral knees. In the ACLR group, the mean internal rotation of the reconstructed knee (6.0°± 2.1°) was significantly smaller than that of the contralateral knees (8.9°± 0.6°; P < .001). At full extension, the tibia was significantly more externally rotated than that of the contralateral legs (0.5°± 7.4° vs 7.6°± 3.4°, P = .049). CONCLUSION When compared with isolated double-bundle ACLR, double-bundle ACLR augmented with ALS reconstruction resulted in anterolateral rotatory overconstraint during the lunge motion. CLINICAL RELEVANCE Additional ALSA of double-bundle ACL-reconstructed knees overconstrained rotatory stability. Therefore, the use of ALSA for ACL-reconstructed knees should be considered with caution for patients with ACL deficiency and anterolateral rotatory instability. Longer-term follow-up to evaluate long-term outcomes and altered kinematics over time is recommended.
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Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cong Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiayu Qiu
- 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
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Sheean AJ, Lian J, Tisherman R, Meredith SJ, de Sa D, Lynch A, Lesniak BP, Musahl V. Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis. Am J Sports Med 2020; 48:3495-3502. [PMID: 33176107 DOI: 10.1177/0363546520966624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pivot-shift test is used to assess for rotatory knee laxity in the anterior cruciate ligament (ACL)-deficient knee and ACL-reconstructed knee; however, the pivot shift uses a subjective grading system that is limited by variability between examiners. Consequently, quantified pivot shift (QPS) test software (PIVOT iPad application) has been developed and validated to measure the magnitude of rotatory knee laxity during the positive pivot-shift test. PURPOSE To employ intraoperative QPS (iQPS) to assess for differences in residual rotatory knee laxity after ACL reconstruction (ACLR) versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET), and to employ iQPS to determine if ACLR and/or ACLR + LET result in overconstrained knee kinematics when compared with the contralateral knee. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS iQPS was performed in 20 patients by a single surgeon on both the operative and contralateral knees before ACLR. ACLR was augmented with a LET if the lateral compartment tibial translation measured during QPS was greater than or equal to double the amount of lateral tibial compartment translation measured for the contralateral knee. After each reconstruction (ACLR or ACLR + LET), iQPS measurements were performed. iQPS data were compared with the preoperative QPS measurements of the operative and contralateral knees. Postoperative iQPS data were compared with both the preoperative QPS measurements of the operative and contralateral knees with paired samples t tests. Categorical variables were compared using the Fisher exact test. RESULTS The mean age in the cohort was 17.3 years (range, 15-24 years). There were no significant differences between the groups in terms of the proportion of male patients (ACLR: 5 male, 5 female vs ACLR + LET: 4 male, 6 female) or age (ACLR: 17.7 ± 3.3 years; 95% CI, 15.4-24.0 vs ACLR + LET: 16.8 ± 2.8 years, 95% CI, 14.8-22.0; P = .999). There were no significant differences between the groups with respect to preoperative QPS performed during examination under anesthesia (ACLR: 4.7 ± 2.0 mm; 95% CI, 3.3-6.1 vs ACLR + LET: 3.6 ± 1.8 mm; 95% CI, 2.3-4.9; P = .2). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity when compared with preoperative QPS measurements (ACLR: -3.4 ± 1.7 mm; 95% CI, -4.6 to -2.2; P < .001: ACLR + LET: -2.6 ± 1.9 mm; 95% CI, -3.9 to -1.3; P < .002). Moreover, when compared with isolated ACLR, ACLR + LET did not result in a significantly smaller magnitude of change in iQPS between the pre- and postoperative states (P = .3). CONCLUSION Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity. The augmentation of ACLR with LET did not change the constraint of the knee with respect to lateral compartment translation as measured during iQPS.
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Affiliation(s)
- Andrew J Sheean
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Jayson Lian
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sean J Meredith
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Darren de Sa
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Lynch
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Kumar V D, Sontakke YA, Murugharaj S. Truly Existing or Hyped up? Unravelling the Current Knowledge Regarding the Anatomy, Radiology, Histology and Biomechanics of the Enigmatic Anterolateral Ligament of the Knee Joint. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:332-342. [PMID: 32766390 DOI: 10.22038/abjs.2019.40067.2074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ever since its description, anterolateral ligament (ALL) of the knee joint remains as the hotspot of controversies. Though it has been described under various descriptions, the structure gained its limelight when it was christened as anterolateral ligament by Claes in 2013. The main reason for the controversies around it is the lack of concrete evidences regarding its attachments, morphology, biomechanical aspects and radiological appearance. Similarly the role of ALL in pivot shift phenomenon also remains as a point of debate. The advocates of ALL suggest that because of its ability to modulate internal rotation and attachment to the lateral meniscus, ALL contributes to the pivot shift phenomenon. Similarly, the orientation of ALL stands as the reason for varied documentation with respect to imaging techniques. With the growing body of evidence, it is imperative to fix our stand regarding the structure because, if found to be morphologically persistent, it can be used for concomitant anterolateral stabilization along with anterior cruciate ligament reinforcement surgeries. The present review tries to systematically review the anatomy, variations in classifications, descriptions, histology, radiology and biomechanical features of ALL. At the end of the review, we would like to find the answer for the question: Is ALL a distinct ligamentous structure located at the anterolateral aspect of the knee? What is the contribution of it to the tibial internal rotation stability?
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Affiliation(s)
- Dinesh Kumar V
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Yogesh Ashok Sontakke
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sontakke Murugharaj
- Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India
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18
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Kim W, Araujo D, Kohles SS, Kim SG, Alvarez Sanchez HH. Affordance-Based Surgical Design Methods Considering Biomechanical Artifacts. ECOLOGICAL PSYCHOLOGY 2020; 33:57-71. [PMID: 37123457 PMCID: PMC10134908 DOI: 10.1080/10407413.2020.1792782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Surgical design in personalized medicine is often based on native anatomy, which may not accurately reflect the interaction between native musculoskeletal tissues and biomechanical artifacts. To overcome this problem, researchers have developed alternative methods based on affordance-based design. The design process can be viewed in terms of action possibilities provided by the (biological) environment. Here, we use the affordance-based approach to address possibilities for action offered by biomechanical artifacts. In anterior crucial ligament (ACL) reconstruction, the design goal is to avoid ligament impingement while optimizing the placement of the tibial tunnel. Although in the current rationale for tibial tunnel placement roof impingement is minimized to avoid a negative affordance, we show that tibial tunnel placement can rather aim to constrain the target bounds with respect to a positive affordance. We describe the steps for identifying the measurable invariants and provide a mathematical framework for the surgery affordances within the knee.
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Affiliation(s)
- Wangdo Kim
- Mechanical Engineering, University of Engineering & Technology (Ingeniería Mecánica, Universidad de Ingenieria y Tecnologia – UTEC)
| | - Duarte Araujo
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa
| | - Sean S. Kohles
- Kohles Bioengineering; Biomaterials & Biomechanics, School of Dentistry, and Emergency Medicine, School of Medicine, Oregon Health & Science University
| | | | - Helard Henry Alvarez Sanchez
- Mechanical Engineering, University of Engineering & Technology (Ingeniería Mecánica, Universidad de Ingenieria y Tecnologia – UTEC)
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Ferguson D, Cuthbert R, Tibrewal S. The role of anterolateral augmentation in primary ACL reconstruction. J Clin Orthop Trauma 2020; 11:S389-S395. [PMID: 32523299 PMCID: PMC7275283 DOI: 10.1016/j.jcot.2019.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
The anterolateral soft tissue envelope of the knee has long been recognised as a key stabilising structure. Once the mainstay of operative management of anterior cruciate ligament (ACL) rupture, interest in the area fell away with the advent of intraarticular arthroscopic reconstruction. Renewed interest in these structures together with cadaveric data evidencing the potential for restoration of near normal knee biomechanics following ACL and anterolateral soft tissue reconstruction has driven current concepts and development of operative techniques. Options for current anterolateral augmentation techniques in primary ACL reconstruction plus patient selection considerations are reviewed, together with an outlook at future research key to development of this area.
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Affiliation(s)
- David Ferguson
- Department of Trauma & Orthopaedic Surgery, Barnet General Hospital, Royal Free Hospitals NHS Foundation Trust, EN5 3DJ, London, UK
- Corresponding author.
| | - Rory Cuthbert
- Department of Trauma & Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | - Saket Tibrewal
- Department of Trauma & Orthopaedic Surgery, Lewisham & Greenwich NHS Trust, University Hospital Lewisham, High Street, London, SE13 6LH, UK
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Golan EJ, Tisherman R, Byrne K, Diermeier T, Vaswani R, Musahl V. Anterior Cruciate Ligament Injury and the Anterolateral Complex of the Knee-Importance in Rotatory Knee Instability? Curr Rev Musculoskelet Med 2019; 12:472-478. [PMID: 31773476 PMCID: PMC6942070 DOI: 10.1007/s12178-019-09587-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW In the setting of rotatory knee instability following anterior cruciate ligament (ACL) reconstruction, there has been a resurgence of interest in knee's anterolateral complex (ALC). Reconstruction or augmentation of the ALC with procedures such as a lateral extra-articular tenodesis (LET) has been proposed to reduce rotatory knee instability in conjunction with ACL reconstruction. The current review investigates the recent literature surrounding the role of the ALC in preventing rotatory knee instability. RECENT FINDINGS The knee's anterolateral complex (ALC) is a complex structure composed of the superficial and deep portions of the iliotibial band, the capsulo-osseous layer, and the anterolateral capsule. Distally, these various layers merge to form a single functional unit which imparts stability to the lateral knee. While the iliotibial band and the capsule-osseous layer have been shown to be primary restraints to rotatory motion after ACL injury, the biomechanical role of the anterolateral capsule remains unclear. Biomechanical studies have shown that the anterolateral capsule and the anterolateral thickening of this capsule act as a sheet of fibrous tissue which does not resist motion around the knee as other longitudinally oriented ligaments do. Augmentation of the ALC, with LET, has been performed globally for over 30 years. This procedure can decrease rotatory knee instability, but long-term studies have found little difference in patient-reported outcomes, osteoarthritis, or ACL reconstruction failure with the addition of LET. Further research is needed to clarify indications for the clinical use of ALC-based procedures.
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Affiliation(s)
- Elan J Golan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
| | - Robert Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA USA
| | - Kevin Byrne
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
| | - Theresa Diermeier
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
- Orthopaedic Sport Medicine, Technical University Munich, Munich, Germany
| | - Ravi Vaswani
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Freddie Fu Sports Medicine Building, 3200 South Water Street, Pittsburgh, PA 15203 USA
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA USA
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Goncharov EN, Koval OA, Dubrov VE, Bezuglov EN, Filimonova AM, Goncharov NG. Clinical experience with combined reconstruction of the anterior cruciate and anterolateral ligaments of the knee in sportsmen. INTERNATIONAL ORTHOPAEDICS 2019; 43:2781-2788. [DOI: 10.1007/s00264-019-04409-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022]
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Helito CP, Helito PVP, Assirati LFB, Longo CH, Bordalo-Rodrigues M, Souza FFD. Magnetic Resonance Imaging Evaluation of the Anterolateral Ligament in Acute Anterior Cruciate Ligament Injuries in an Adolescent Population. Arthroscopy 2019; 35:2136-2142. [PMID: 31272633 DOI: 10.1016/j.arthro.2019.02.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the frequency of anterolateral ligament (ALL) injuries in acute anterior cruciate ligament (ACL) injuries in adolescent patients using magnetic resonance imaging (MRI) and characterize other potential intra- and extra-articular knee injuries that are associated with ALL injuries. METHODS Patients between 14 and 17 years of age with acute ACL injuries (trauma for <3 weeks before examination) were retrospectively evaluated with MRI over 24 months (January 2016-December 2017). Among this population, ALL was classified as not visible, normal, or injured. Injuries were separated into strains (partial injuries), complete injuries, or Segond fractures. Possible abnormalities of the menisci, collateral ligaments, popliteal tendon, posterior cruciate ligament (PCL), iliotibial tract (ITT), and bone injuries were evaluated. Associations were calculated between ALL injuries and injuries of these other knee structures, as well as age and gender. RESULTS ALL was visible in 171 of the 184 MRI-evaluated knees (92.9%). ALL was considered normal in 68 (39.8%) and damaged in 103 (60.2%) patients. ALL injuries were considered partial in 56 (54.4%) and total in 44 (42.7%) cases. Only 3 (2.9%) cases were Segond fractures. ALL injuries were associated with ITT (P < .0001), lateral meniscus (P = .04), lateral collateral ligament (P = .01), popliteal tendon (P = .001), and medial collateral ligament (P = .009) injuries, in addition to bone contusions in the lateral compartment of the knee (P < .0001). There was no correlation between ALL injuries and medial meniscus (P = .054) or PCL (P = .16) injuries. CONCLUSIONS MRI evaluation showed ALL injuries are present in 60.2% of acute ACL injuries in adolescent patients. These injuries are associated with the medial and lateral collateral ligaments, ITT, lateral meniscus injuries, and bone contusions, but they are not associated with medial meniscus or PCL injuries. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Camilo Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil; Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Paulo Victor Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil; Grupo de Radiologia Musculo-esquelética, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Marcelo Bordalo-Rodrigues
- Hospital Sírio-Libanês, São Paulo, Brazil; Grupo de Radiologia Musculo-esquelética, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Ueki H, Katagiri H, Otabe K, Nakagawa Y, Ohara T, Shioda M, Kohno Y, Hoshino T, Sekiya I, Koga H. Contribution of Additional Anterolateral Structure Augmentation to Controlling Pivot Shift in Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:2093-2101. [PMID: 31211590 DOI: 10.1177/0363546519854101] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several types of anterolateral structure (ALS) augmentation procedures in anterior cruciate ligament (ACL) reconstruction have been reported. However, information is limited regarding the effect of additional ALS augmentation on rotatory stability in a clinical setting. PURPOSE/HYPOTHESIS This study aimed to investigate the contribution of additional ALS augmentation in ACL reconstruction in cases with a high risk of residual pivot shift. The 2 hypotheses were as follows. First, additional ALS augmentation would improve rotatory stability as compared with solely reconstructing the ACL. Second, graft tension changes would be different between the ACL and ALS during knee range of motion and against anterior or rotatory loads. STUDY DESIGN Controlled laboratory study. METHODS Fifteen patients who met at least 1 of the following criteria were included: (1) revision ACL reconstruction, (2) preoperative high-grade pivot shift, or (3) hyperextended knee. The pivot-shift test was performed preoperatively and during surgery after ACL reconstruction and after additional ALS augmentation with acceleration measurements from a triaxial accelerometer. The tension changes of the ACL and ALS grafts were also measured during knee range of motion and against manual maximum anterior tibial translation, internal rotation, and external rotation. RESULTS After ACL reconstruction, the pivot-shift acceleration was still greater than that of the uninjured knee. However, additional ALS augmentation further reduced acceleration when compared with ACL reconstruction alone in both primary and revision cases (P < .05 vs preoperative, P < .05 vs ACL). During knee flexion-extension, the tension of the ACL increased as the knee was extended, whereas that of the ALS did not change. Graft tension of the ACL and ALS became higher with internal rotation and lower with external rotation as compared with the neutral position. Tension of the ACL was significantly increased against anterior tibial translational loads, whereas that of the ALS was not. CONCLUSION Additional ALS augmentation further improved the rotatory stability during ACL reconstruction in patients with a high risk of residual pivot shift at the time of surgery. Significant differences in graft tension changes were also observed between the ACL and ALS against different loads. Additional ALS augmentation may be considered to eliminate the pivot shift in patients with a high risk of residual pivot shift.
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Affiliation(s)
- Hiroko Ueki
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Katagiri
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Koji Otabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Nakagawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Toshiyuki Ohara
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Mikio Shioda
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yuji Kohno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takashi Hoshino
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.,Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan
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Oishi K, Sasaki E, Naraoka T, Kimura Y, Tsuda E, Shimoda H, Ishibashi Y. Anatomical relationship between insertion sites, tunnel placement, and lateral meniscus anterior horn injury during single and double bundle anterior cruciate ligament reconstructions: A comparative macroscopic and histopathological evaluation in cadavers. J Orthop Sci 2019; 24:494-500. [PMID: 30446333 DOI: 10.1016/j.jos.2018.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 10/09/2018] [Accepted: 10/22/2018] [Indexed: 02/09/2023]
Abstract
PURPOSE The influence of tunnel extension outside the anatomical anterior cruciate ligament (ACL) insertion in single-bundle (SB) or double-bundle (DB) ACL reconstruction is unclear. This study aimed to investigate the anatomical relationship between ACL insertion and tunnel extension in SB and DB ACL reconstruction, and the impact of tibial tunnel extension to the insertion of anterior horn of lateral meniscus in terms of injury. METHODS Forty-six paired cadaver knees (mean age, 82.7 ± 10.7 years) were used. Right and left knees were used for SB (10 mm) and DB tunnel reaming (6 mm for the anteromedial and posterolateral bundles). Tibial and femoral tunnels were created to aim at the center of the ACL insertion by arthroscopic visualization. The relationship between tunnel extension and ACL insertion was evaluated macroscopically, and there ratio in two groups were compared by chi-square test. Further, the relative risk for meniscus injury based on tunnel placement was estimated. Coronal section of tibia and parallel section to Blumensaat line in femur were prepared to evaluate the relationship among tunnel position, ACL insertion, and anterior horn of the meniscus histologically. RESULTS Tibial tunnel extension out of the ACL insertion was observed macroscopically in 9 (39.1%) knees of the SB group, and 3 (13.0%) of the DB group (p = 0.045). In femoral tunnels, extension out of the ACL insertion was seen in 8 (34.8%) knees of the SB group and 1 (4.3%) of the DB group (p = 0.011). Partial injuries of the lateral meniscus anterior horn (LMAH) were observed in 5 (21.7%) knees of the SB group and 1 (4.3%) knee of the DB group (p = 0.091). The relative risk for LMAH injury was calculated as 5.0 (odds ratio, 6.1). Microscopically, SB tunnels appeared to expand out of ACL insertion, both in the femur and tibia. CONCLUSIONS The incidence of tunnel extension out of the ACL insertion in femur and tibia were higher with SB than with DB reconstruction. Furthermore, injury rate of the LMAH in the DB group was lower.
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Affiliation(s)
- Kazuki Oishi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Takuya Naraoka
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroshi Shimoda
- Department of Anatomical Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Smith PA, Thomas DM, Pomajzl RJ, Bley JA, Pfeiffer FM, Cook JL. A Biomechanical Study of the Role of the Anterolateral Ligament and the Deep Iliotibial Band for Control of a Simulated Pivot Shift With Comparison of Minimally Invasive Extra-articular Anterolateral Tendon Graft Reconstruction Versus Modified Lemaire Reconstruction After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:1473-1483. [PMID: 30926192 DOI: 10.1016/j.arthro.2018.11.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the deep fibers of the iliotibial band (dITB) or the anterolateral ligament (ALL) provides more control of a simulated pivot shift and whether a minimally invasive anterolateral reconstruction (ALR) designed to functionally restore the ALL and dITB is mechanically equivalent to a modified Lemaire reconstruction (MLR). METHODS Six matched pairs of cadaveric knees (N = 12) were subjected to a simulated pivot shift to evaluate anteroposterior translation; internal rotation; and valgus laxity at 0°, 30°, and 90° of flexion. The anterior cruciate ligament (ACL) was sectioned in all specimens, and retesting was performed. Within each pair, sequential sectioning of the ALL and dITB was performed, followed by testing; the contralateral knee was sectioned in reverse order. Knees underwent ACL reconstruction (ACLR) and repeat testing. Then, MLR (n = 6) or ALR (n = 6) was performed on matched pairs for final testing. RESULTS Sectioning of the dITB versus ALL (after ACL sectioning) produced significantly more anterior translation at all flexion angles (P = .004, P = .012, and P = .011 for 0°, 30°, and 90°, respectively). The ACL-plus-dITB sectioned state had significantly more internal rotation at 0° versus ACL plus ALL (P = .03). ACLR plus ALR restored native anterior translation at all flexion angles. ACLR plus MLR restored anterior translation to native values only at 0° (P = .34). We found no statistically significant differences between ACLR plus ALR and ACLR plus MLR at any flexion angle for internal rotation or valgus laxity compared with the native state. CONCLUSIONS ALR of the knee in conjunction with ACLR can return the knee to its native biomechanical state without causing overconstraint. The dITB plays a more critical role in controlling anterior translation and internal rotation at 0° than the ALL. The minimally invasive ALR was functionally equivalent to MLR for restoration of knee kinematics after ACLR. CLINICAL RELEVANCE The dITB is more important than the ALL for control of the pivot shift. A minimally invasive extra-articular tendon allograft reconstruction was biomechanically equivalent to a modified Lemaire procedure for control of a simulated pivot shift.
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Affiliation(s)
- Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Columbia Orthopaedic Group, Columbia, Missouri, U.S.A..
| | - Dimitri M Thomas
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Ryan J Pomajzl
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; SSM Health Medical Group, Bridgeton, Missouri, U.S.A
| | - Jordan A Bley
- Columbia Orthopaedic Group, Columbia, Missouri, U.S.A
| | - Ferris M Pfeiffer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
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Vaudreuil NJ, Rothrauff BB, de Sa D, Musahl V. The Pivot Shift: Current Experimental Methodology and Clinical Utility for Anterior Cruciate Ligament Rupture and Associated Injury. Curr Rev Musculoskelet Med 2019; 12:41-49. [PMID: 30706283 PMCID: PMC6388573 DOI: 10.1007/s12178-019-09529-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The purpose of this manuscript is to (1) examine the history, techniques, and methodology behind quantitative pivot shift investigations to date and (2) review the current status of pivot shift research for its clinical utility for management of anterior cruciate ligament (ACL) rupture with associated injuries including the anterolateral complex (ALC). RECENT FINDINGS The pivot shift is a useful physical exam maneuver for diagnosis of rotatory instability related to ACL tear. Recent evidence suggests that the pivot shift is multifactorial and can be seen in the presence of ACL tear with concomitant injury to secondary stabilizers or with predisposing anatomical factors. The presence of a pivot shift post-operatively is associated with poorer outcomes after ACL reconstruction. Recent clinical and biomechanical investigations can help guide clinicians in utilizing pivot shift in diagnosis and surgical planning. Further research is needed to clarify optimal management of ALC in addition to ACL injury.
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Affiliation(s)
- Nicholas J Vaudreuil
- Department of Orthopaedic Surgery, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S. Water St., Pittsburgh, PA, 15203, USA
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S. Water St., Pittsburgh, PA, 15203, USA
| | - Darren de Sa
- Department of Orthopaedic Surgery, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S. Water St., Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S. Water St., Pittsburgh, PA, 15203, USA.
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Abstract
Anterolateral rotational laxity of the knee is a persistent problem following anterior cruciate ligament reconstruction (ACLR) that can lead to increased rates of graft failure. Renewed interest in the anterolateral complex of the knee has led to a resurgence in the use of adjunctive techniques such as lateral extra-articular tenodesis and anterolateral ligament reconstruction. Use of these techniques can restore normal knee kinematics and potentially thereby reduce the rate of graft failure. Historically, experience with modified ACLR techniques such as the double-bundle ACLR have shown that improved biomechanics is not always reflected in clinical outcome trials. Additional procedures also come with additional costs and further economic analysis needs to be performed to clarify whether these additional costs are offset by improved clinical and societal outcomes in the longer-term.
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Affiliation(s)
- Ryan Wood
- The Fowler Kennedy Sport Medicine Clinic
| | - Jacquelyn Marsh
- Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
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28
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Response to "Editorial Commentary: The Anterolateral Ligament: The Emperor's New Clothes?". Arthroscopy 2018; 34:2262-2266. [PMID: 30077245 DOI: 10.1016/j.arthro.2018.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/21/2018] [Indexed: 02/02/2023]
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Kocher MS, Heyworth BE, Fabricant PD, Tepolt FA, Micheli LJ. Outcomes of Physeal-Sparing ACL Reconstruction with Iliotibial Band Autograft in Skeletally Immature Prepubescent Children. J Bone Joint Surg Am 2018; 100:1087-1094. [PMID: 29975275 DOI: 10.2106/jbjs.17.01327] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are occurring in youth athletes with increasing frequency. Many ACL reconstruction procedures designed to allow for continued growth in patients with open physes have been described, but large series with mid- to long-term outcomes data are lacking. The purpose of the current study was to assess the clinical outcomes of a large cohort of prepubescent children who underwent a physeal-sparing, combined intra- and extra-articular ACL reconstruction with iliotibial (IT) band autograft over a 23-year period. METHODS Included in our analysis were 237 patients (240 knees) who underwent ACL reconstruction using IT band autograft at Tanner stage 1 or 2 (mean age of 11.2 ± 1.7 years). Physical examination data were analyzed for 225 of the 240 knees (mean follow-up, 25.8 months), and 137 (57%) of the knees had corresponding patient-reported clinical outcomes (patient-reported graft rupture and Pediatric International Knee Documentation Committee [Pedi-IKDC], Tegner activity scale, and Lysholm scores; mean follow-up, 6.2 years). Rates of growth arrest, IT band graft-harvest morbidity, and return to sports were analyzed. RESULTS Physical examination revealed that 96.8% of the knees were grade A on the Lachman test and 98.8% were grade A on the pivot-shift test. Graft rupture occurred in 9 (6.6%) of 137 knees, at an average of 33.5 months (range, 8.2 months to 8.0 years) postoperatively. For patients who did not sustain a graft rupture, the mean Pedi-IKDC score was 93.3 ± 11.0, the mean Lysholm score was 93.4 ± 9.9, and the mean score on the Tegner activity scale was 7.8 (mode, 7). While lateral thigh asymmetry at the IT band harvest site was noted by 48% of the subjects, only 1.6% reported associated pain. No cases of limb-length discrepancy or angular deformity were observed. CONCLUSIONS This procedure was associated with excellent functional outcomes, minimal risk of growth disturbance, and a low graft-rupture rate in skeletally immature prepubescent children. These results appear durable at mid- to long-term follow-up, at an average of >6 years postoperatively. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Noyes FR, Huser LE, Levy MS. The Effect of an ACL Reconstruction in Controlling Rotational Knee Stability in Knees with Intact and Physiologic Laxity of Secondary Restraints as Defined by Tibiofemoral Compartment Translations and Graft Forces. J Bone Joint Surg Am 2018; 100:586-597. [PMID: 29613928 DOI: 10.2106/jbjs.16.01412] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effect of an anterior cruciate ligament (ACL) reconstruction on restoring normal knee kinematics in unstable knees with physiologic laxity of secondary ligamentous restraints remains unknown. The purpose of this study was to determine the stabilizing function of an ACL reconstruction and the resulting ACL graft forces in knees with severely abnormal anterior subluxation due to associated laxity of secondary restraints. METHODS A 6-degree-of-freedom robotic simulator was used to test 21 cadaveric knees studied as a whole and in subgroups of lax secondary restraints (Lax-SR) and intact secondary restraints (Intact-SR), based on abnormal translations and tibial rotations. Native, ACL-sectioned, and ACL-reconstructed conditions were tested. An instrumented bone-patellar tendon-bone (BPTB) graft measured ACL graft forces. The loading profile involved the Lachman test (25° of flexion and 100-N anterior load), anterior tibial loading (100-N anterior load across 10° to 90° of flexion), internal rotation (25° of flexion and 5-Nm torque), and 2 pivot-shift simulations (100-N anterior load, 7-Nm valgus, and either 5 Nm of internal rotation [Pivot Shift 1] or 1 Nm of internal rotation [Pivot Shift 2]). Equivalence between conditions was defined as being within 2 mm for compartment translation and within 2° for internal tibial rotation, with p < 0.05. RESULTS ACL sectioning increased center translation in the Lachman test by a mean of 10.9 mm (95% confidence interval [CI], 9.3 to 12.5 mm; p = 0.99), which was equivalent to native values after ACL reconstruction in all knees (mean difference, 0.0 mm [95% CI, -0.4 to 0.4 mm]; p = 0.0013), and in subgroups of Lax-SR (mean difference, 0.2 mm [95% CI, -0.5 to 0.8 mm]; p = 0.03) and Intact-SR (mean difference, -0.2 mm [95% CI, -0.8 to 0.4 mm]; p = 0.002). ACL sectioning in the pivot-shift (5-Nm) test increased lateral compartment translation to non-native-equivalent levels, which were restored to native-equivalent values after ACL reconstruction in all knees (mean difference, 0.9 mm [95% CI, 0.4 to 1.4 mm]; p = 0.055), in the Intact-SR subgroup (mean difference, 1.1 mm [95% CI, 0.5 to 1.8 mm]; p = 0.03), and to nearly native-equivalence in the Lax-SR subgroup (mean difference, 0.6 mm [95% CI, -0.3 to 1.6 mm; p = 0.06). The highest ACL graft force reached a mean of 190.9 N in the pivot-shift (5-Nm) test. CONCLUSIONS The ACL reconstruction restored native kinematics and native rotational stability in all knees, including knees having laxity of secondary ligamentous restraints and clinically equivalent Grade-3 pivot-shift subluxation, and did so at ACL graft forces that were not excessive. CLINICAL RELEVANCE An ACL reconstruction with a BPTB graft restored normal stability parameters regardless of the integrity of secondary ligamentous restraints.
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Affiliation(s)
- Frank R Noyes
- The Noyes Knee Institute, Cincinnati, Ohio.,Cincinnati Sports Medicine and Orthopaedic Center - Mercy Health, Cincinnati, Ohio
| | - Lauren E Huser
- The Noyes Knee Institute, Cincinnati, Ohio.,Cincinnati Sports Medicine and Orthopaedic Center - Mercy Health, Cincinnati, Ohio
| | - Martin S Levy
- University of Cincinnati College of Business, Cincinnati, Ohio
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Fu FH. Anterolateral Structure Reconstruction Unnecessary with Anatomic ACL Reconstruction for Knee Stability: Commentary on an article by Frank R. Noyes, MD, et al.: "The Effect of an ACL Reconstruction in Controlling Rotational Knee Stability in Knees with Intact and Physiologic Laxity of Secondary Restraints as Defined by Tibiofemoral Compartment Translations and Graft Forces". J Bone Joint Surg Am 2018; 100:e47. [PMID: 29613938 DOI: 10.2106/jbjs.17.01311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Freddie H Fu
- Department of Orthopaedic Surgery at the University of Pittsburgh School of Medicine and UPMC, Pittsburgh, Pennsylvania
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Monaco E, Fabbri M, Mazza D, Daggett M, Redler A, Lanzetti RM, De Carli A, Ferretti A. The Effect of Sequential Tearing of the Anterior Cruciate and Anterolateral Ligament on Anterior Translation and the Pivot-Shift Phenomenon: A Cadaveric Study Using Navigation. Arthroscopy 2018; 34:1009-1014. [PMID: 29287952 DOI: 10.1016/j.arthro.2017.09.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of progressive lesions of the anterior cruciate ligament (ACL) and anterolateral ligament (ALL) on anterior tibial translation (ATT) as evaluated through the Lachman test and internal tibial rotation (ITR) during a dynamic pivot-shift test in a cadaveric model. METHODS A total of 7 specimens were tested using a navigation system (2.2 OrthoPilot ACL navigation system). The anterior stability of the knee was measured through the Lachman test and dynamic rotational stability was measured through the pivot-shift test in 3 different conditions: intact knee; ACL-deficient knee; and finally, ACL- and ALL-deficient knee. The resulting measurements from the navigation system recorded the real-time changes in both translation and internal rotation during the Lachman and pivot-shift maneuvers. RESULTS Mean ATT was 7.57 ± 0.53 mm in the intact knee, 14 ± 2.44 mm in the ACL-deficient knee, and 14 ± 2.44 mm in the ACL- and ALL-deficient knee. Mean ITR during the pivot-shift test was 10.14° ± 2.26° in the intact knee, 12.14° ± 2.19° in the ACL-deficient knee, and 18.86° ± 2.73° in the ACL- and ALL-deficient knee. There was a statistically significant difference in static ATT between the intact and ACL-deficient knees (P = .039) but no difference through the addition of an ALL lesion (P = .068). For dynamic rotational control testing, there was no significant difference in ATT between groups but a significant difference in ITR was found (F = 25.17, P = .00034). CONCLUSIONS During the pivot-shift test, a combined lesion of the ACL and ALL has a significant effect on ITR whereas an isolated lesion of the ACL has no effect on either ATT or ITR. During the Lachman test, an isolated lesion of the ACL has a significant effect on ATT but an additional lesion of the ALL does not affect ATT. CLINICAL RELEVANCE Dynamic rotational control as tested by the pivot-shift test is greatly influenced by a combined lesion of the ACL and ALL. In clinical cases of a pivot shift, addressing the anterolateral structures may be considered.
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Affiliation(s)
- Edoardo Monaco
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Mattia Fabbri
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Daniele Mazza
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy.
| | | | - Andrea Redler
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | | | - Angelo De Carli
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Ferretti
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
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Porter MD, Shadbolt B, Pomroy S. The Augmentation of Revision Anterior Cruciate Ligament Reconstruction With Modified Iliotibial Band Tenodesis to Correct the Pivot Shift: A Computer Navigation Study. Am J Sports Med 2018; 46:839-845. [PMID: 29389221 DOI: 10.1177/0363546517750123] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Iliotibial band (ITB) tenodesis improves stability and functional outcomes when added to anterior cruciate ligament (ACL) reconstruction. Its precise indications are unknown. Persistence of the pivot shift after revision ACL reconstruction may be one indication. HYPOTHESIS The addition of ITB tenodesis for a persistent pivot shift after revision ACL reconstruction will improve stability and activity levels. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Adults with recurrent ACL ruptures underwent revision ACL reconstruction, followed by a pivot-shift test before the surgery ended. If the pivot shift was grade 0 or 1, no further surgery was performed (group 1). If it was grade 2 or 3, ITB tenodesis was performed (group 2). The pivot-shift test was performed, graded, and measured using computer navigation before revision ACL reconstruction and after revision ACL reconstruction with and without ITB tenodesis. Tegner activity scores were obtained 2 years after surgery. Groups were compared with regard to anterior translation and internal rotation during the pivot shift as well as Tegner activity scores ( P < .05). RESULTS There were 20 patients in group 1 and 18 in group 2. The mean anterior translation improved in group 1, from 17.7 ± 3.5 mm to 6.6 ± 1.9 mm, and group 2, from 18.5 ± 3.3 mm to 6.1 ± 1.2 mm, after revision ACL reconstruction ( P < .001), with no difference between the groups ( P = .15). After ITB tenodesis, the reduction in anterior translation in group 2 (5.3 ± 1.5 mm) became greater than that in group 1 (6.6 ± 1.9 mm) ( P = .03). In both groups after revision ACL reconstruction, there was a reduction in internal rotation (group 1: 24.2° ± 4.0° to 10.3° ± 1.1°; group 2: 25.4° ± 3.7° to 14.6° ± 2.8°; P < .001), but this change was less in group 2 ( P = .02). After ITB tenodesis, internal rotation in group 2 (8.3° ± 2.6°) became less than that in group 1 (10.3° ± 1.1°) ( P = .02). The mean Tegner activity scores in group 1 were 8.1 ± 1.1 before surgery and 7.4 ± 0.9 after surgery, while in group 2 they were 7.0 ± 1.3 and 7.2 ± 0.4, respectively, and not significantly different ( P = .29). CONCLUSION ITB tenodesis improved laxity, although it did not affect activity levels, when there was a persistent pivot shift after revision ACL reconstruction. CLINICAL RELEVANCE An indication to perform ITB tenodesis is the persistence of a grade ≥2 pivot shift after revision ACL reconstruction.
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Affiliation(s)
- Mark D Porter
- Canberra Orthopaedics and Sports Medicine, Calvary Clinic, Bruce, Australia
| | - Bruce Shadbolt
- Department of Epidemiology, Canberra Hospital, Garran, Australia
| | - Samantha Pomroy
- Canberra Orthopaedics and Sports Medicine, Calvary Clinic, Bruce, Australia
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Role of anterolateral reconstruction in patients undergoing anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2018; 104:S47-S53. [PMID: 29191469 DOI: 10.1016/j.otsr.2017.03.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/27/2017] [Accepted: 03/06/2017] [Indexed: 02/06/2023]
Abstract
There is renewed interest in anterolateral reconstruction (ALR) for patients undergoing anterior cruciate ligament (ACL) reconstruction. This is the result of isolated ACL reconstruction and double-bundle reconstruction providing inadequate control over the pivot shift, and recent anatomical and biomechanical studies on the anterolateral ligament (ALL) and its role in the knee's rotational stability. From a technical point of view, ALR can be performed either as a continuity of the intra-articular ACL reconstruction or an independent procedure. The typical peripheral grafts (gracilis and semitendinosus tendons, iliotibial band) can be used. The femoral tunnel must be posterior and proximal to the lateral epicondyle, and the tibial tunnel on a line joining Gerdy's tubercle with the ALL's tibial insertion. Tensioning and fixation are done with the knee near full extension and the tibia in neutral rotation. The ALR complication rate reported in older studies (pain, hematoma, scar damage) has been reduced. Relative to isolated ACL reconstruction, ALR does not alter the infection or stiffness rate, and it reduces the re-injury rate and secondary meniscal damage rate. Analysis of the literature has not shown an increased rate of osteoarthritis after ALR. The objective and functional outcomes are equal to those after isolated ACL reconstruction. Control over rotation is improved by adding ALR and the return to pivot sports appears to be more successful. While the indications must still be refined, ALR can be proposed to young patients undergoing ACL reconstruction who participate in high-intensity pivot sports, have a high-grade pivot shift or who have a failed ACL reconstruction.
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Sonnery-Cottet B, Barbosa NC, Vieira TD, Saithna A. Clinical outcomes of extra-articular tenodesis/anterolateral reconstruction in the ACL injured knee. Knee Surg Sports Traumatol Arthrosc 2018; 26:596-604. [PMID: 28608009 DOI: 10.1007/s00167-017-4596-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/06/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE The role of concomitant extra-articular procedures in improving the outcome of ACL reconstruction has experienced a recent resurgence in interest. The aim of this article is to highlight the differences in philosophies and outcomes of historical lateral extra-articular tenodesis (LET) and contemporary, anterolateral reconstruction. METHODS A narrative review was performed using PubMed/MEDLINE using the keywords "lateral extra-articular tenodesis" and "anterolateral ligament reconstruction". RESULTS Results of search strategy: Thirty-seven studies [13 reporting clinical outcomes of isolated LET in ACL deficient knees and 24 comparing isolated anterior cruciate ligament reconstruction (ACLR) with ACLR + LET] and 1 study on anterolateral ligament (ALL) reconstruction were identified as relevant and included in the review. Results of literature review: Isolated extra-articular reconstructions are rarely performed in contemporary practice. They are associated with a high rate of persistent anterior instability and early degenerative change. Combined ACL reconstruction and lateral extra-articular tenodeses results in a significant reduction in the prevalence of residual pivot shift, but the majority of the studies do not demonstrate any significant difference with respect to patient-reported outcome measures and return to sport. Although several authors report a trend towards decreased graft rupture rates, significant differences were not demonstrated in most studies. In a single clinical study, combined anatomic ACL and anterolateral ligament reconstruction was reported to be associated with a threefold reduction in graft rupture rates and improved return to sport compared to isolated ACL graft choices. CONCLUSIONS Historically performed, combined ACL reconstruction and lateral extra-articular tenodeses are associated with improved knee kinematics. Although trends towards decreased graft rupture rates are reported by several authors, the majority did not demonstrate a significant difference, likely as a result of small and underpowered studies using post-operative immobilisation and delayed rehabilitation protocols. More recently, combined ACLR and ALL reconstruction has been shown to be associated with significant improvements in graft failure and return to sport rates when compared to isolated ACLR. However, these results are from a single clinical series with only medium-term follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, 24 Av Paul Santy, Groupe Ramsay GDS, hôpital Mermoz, 69008, Lyon, France.
| | - Nuno Camelo Barbosa
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, 24 Av Paul Santy, Groupe Ramsay GDS, hôpital Mermoz, 69008, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, 24 Av Paul Santy, Groupe Ramsay GDS, hôpital Mermoz, 69008, Lyon, France
| | - Adnan Saithna
- Southport and Ormskirk Hospitals NHS Trust, Southport, UK.,Department of Clinical Engineering, The University of Liverpool, West Derby Street, Liverpool, L7 8TX, UK
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Secondary Stabilizers of Tibial Rotation in the Intact and Anterior Cruciate Ligament Deficient Knee. Clin Sports Med 2018; 37:49-59. [DOI: 10.1016/j.csm.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Herbst E, Arilla FV, Guenther D, Yacuzzi C, Rahnemai-Azar AA, Fu FH, Debski RE, Musahl V. Lateral Extra-articular Tenodesis Has No Effect in Knees With Isolated Anterior Cruciate Ligament Injury. Arthroscopy 2018; 34:251-260. [PMID: 29079261 DOI: 10.1016/j.arthro.2017.08.258] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate knee kinematics in response to physical examinations to determine the effect of anterolateral capsular injury and lateral extra-articular tenodesis (LET) in anterior cruciate ligament (ACL)-deficient and -reconstructed knees. METHODS Seven human lower limb cadavers were used in this study (mean age, 60 years; age range, 56-63 years). Physical examinations were performed, including the pivot-shift test, Lachman test, anterior drawer at 90°, and internal and external tibial rotation at 30°, 60°, and 90° of knee flexion. ACL injury and reconstruction and LET, all with and without an injured anterolateral capsule, were investigated. Tibial translation and rotation relative to the femur were measured by an electromagnetic tracking system during the physical examination. RESULTS Anterior translation of the lateral knee compartment and internal tibial rotation during the pivot-shift test were highest in combined ACL-deficient and anterolateral capsule-deficient knees (12.3 ± 7.4 mm and 16.3° ± 8.5°, respectively). With the presence of an anterolateral capsular injury, a combined ACL reconstruction and LET reduced the anterior translation of the lateral knee compartment during the pivot-shift test significantly (P = .042), whereas anatomic ACL reconstruction did not. Internal tibial rotation displayed overconstraint when a LET was performed, especially when the anterolateral capsule was intact. CONCLUSIONS ACL reconstruction in combination with a LET was able to reduce anterior tibial translation and internal tibial rotation in response to different physical examinations. However, combined ACL reconstruction and LET led to overconstraint of internal tibial rotation when the anterolateral capsule was intact. CLINICAL RELEVANCE: On the basis of our results, LET with ACL reconstruction restores stability in a combined ACL-injured and anterolateral capsule-injured knee. However, LET with ACL reconstruction overconstrains the knee in an isolated ACL injury.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany
| | - Fabio V Arilla
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, Hospital Universitário, Canoas, Brazil
| | - Daniel Guenther
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Trauma Department, Hannover Medical School, Hannover, Germany
| | - Carlos Yacuzzi
- Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Ata A Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Richard E Debski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A..
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Imbert P, Lustig S, Steltzlen C, Batailler C, Colombet P, Dalmay F, Bertiaux S, D'ingrado P, Ehkirch FP, Louis ML, Pailhé R, Panisset JC, Schlaterrer B, Sonnery-Cottet B, Sigwalt L, Saragaglia D, Lutz C. Midterm results of combined intra- and extra-articular ACL reconstruction compared to historical ACL reconstruction data. Multicenter study of the French Arthroscopy Society. Orthop Traumatol Surg Res 2017; 103:S215-S221. [PMID: 28917521 DOI: 10.1016/j.otsr.2017.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION During anterior cruciate ligament (ACL) reconstruction procedures, anterolateral reconstruction (ALR) can also be performed to improve the knee's rotational stability. However, the effectiveness of this supplemental technique and its impact on the risk of retears and on the onset of secondary degenerative changesare controversial. HYPOTHESIS ALR improves control over the pivot shift, reduces the retear risk and delays the appearance of secondary degenerative lesions. MATERIAL AND METHODS Clinical examination, knee laxity measurements and X-ray evaluations were done in 478 patients with more than 3years' follow-up after combined ACL and ALR from 11 participating hospitals. The mean patient age at the time of surgery was 28years. Eighty-eight percent of the patients participated in pivot sports and 45% were competitive athletes. The findings of this study were compared to historical isolated ACL reconstruction data. RESULTS The average follow-up was 6.8years. No detectable pivot shift was found in 83% of patients, while 12.8% of patient had a smooth glide. The side-to-side difference in anteroposterior knee laxity with maximum manual force was less than 3mm in 66% of patients and less than 5mm in 95%. The retear rate was 5.4%, with half of these patients undergoing revision ACL surgery. Secondary meniscus damage requiring surgery occurred in 6.3% of patients; the radiological osteoarthritis rate was 17.5%. DISCUSSION When compared to historical ACL reconstruction data, combined intra- and extra-articular reconstruction does not increase the complication rate. At a mean follow-up of 6.8years, it provides better control over the pivot shift along with a low retear rate and low occurrence of secondary meniscus injuries. LEVEL OF EVIDENCE IV, multicenter study.
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Affiliation(s)
- P Imbert
- ICAPS, 87, avenue Archimède, 83700 St-Raphael, France.
| | - S Lustig
- Centre Albert Trillat, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Steltzlen
- Centre hospitalier de Versailles André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - C Batailler
- Centre Albert Trillat, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - P Colombet
- Centre de chirurgie orthopédique et sportive, 2, rue Negrevergne, 33700 Mérignac, France
| | - F Dalmay
- 2UMR Inserm 1094 NET, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
| | - S Bertiaux
- Hôpital privé de l'Estuaire, 505, rue Irène-Joliot-Curie, 76620 le Havre, France
| | - P D'ingrado
- Clinique du parc, 155, boulevard de Stalingrad, 69006 Lyon, France
| | - F P Ehkirch
- Clinique Maussins-Nollet, 67, rue de Romain-Ville, 75019 Paris, France
| | - M L Louis
- Centre ICOS, 463, rue Paradis, 13008 Marseille, France
| | - R Pailhé
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, CHU de Grenoble, hôpital Sud, avenue de Kimberley, 38130 Échirolles, France
| | - J C Panisset
- Centre Ostéo-articulaire des Cèdres, 5, rue des Tropiques, Parc Sud Galaxie, 38130 Échirolles, France
| | | | - B Sonnery-Cottet
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | - L Sigwalt
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, CHU de Grenoble, hôpital Sud, avenue de Kimberley, 38130 Échirolles, France
| | - D Saragaglia
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, CHU de Grenoble, hôpital Sud, avenue de Kimberley, 38130 Échirolles, France
| | - C Lutz
- ICOSS, 50, avenue des Vosges, 67000 Strasbourg, France
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"Back to the future": a historical perspective on the role of extra-articular reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:2989-2992. [PMID: 28871384 DOI: 10.1007/s00167-017-4699-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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41
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Miller TK. The Role of an Extra-Articular Tenodesis in Revision of Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2017; 37:101-113. [PMID: 29173550 DOI: 10.1016/j.csm.2017.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Patients who present for anterior cruciate ligament (ACL) revision with a high-grade pivot shift at the time of an index ACL revision procedure and subsequent reconstruction failure or a high-grade pivot shift at revision surgery, patients with generalized joint laxity, and those requiring softs tissue grafts should be considered candidates for lateral tenodesis to supplement intraarticular graft revision. Although there is no consensus regarding the optimal lateral tenodesis technique, due to the tibial positioning associated with tensioning and fixation of extra-articular procedures, a lateral tenodesis should not be used in patients with posterolateral corner injuries or lateral compartment articular disease.
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Affiliation(s)
- Thomas K Miller
- Department of Orthopaedic Surgery, Virginia Tech/Carilion School of Medicine, Institute for Orthopaedics and Neurosciences, 2331 Franklin Road, Roanoke, VA 24018, USA.
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Kosy JD, Schranz PJ, Patel A, Anaspure R, Mandalia VI. The magnetic resonance imaging appearance of the anterolateral ligament of the knee in association with anterior cruciate rupture. Skeletal Radiol 2017; 46:1193-1200. [PMID: 28432395 DOI: 10.1007/s00256-017-2657-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The magnetic resonance imaging (MRI) appearance of the anterolateral ligament (ALL) has been described. However, the appearance of this structure and injury, in the presence of anterior cruciate ligament (ACL) injury, is less well defined. We studied the incidence of injury to the ALL and the pattern of this injury on MRI. MATERIALS AND METHODS Following Institutional Review Board approval, a retrospective study of 375 consecutive MRI studies was performed. Cases were identified from a prospective database of ACL reconstruction patients. Following exclusions, 280 MRIs (277 patients; 197 males: 80 females; mean age 30.2 years, range, 16-54) were evaluated. Injury was defined as full thickness, partial thickness, or an avulsion fracture. Each study was independently assessed by two consultant musculoskeletal radiologists. RESULTS Injury to the ALL was identified (by at least one observer) in only 10.7% of cases (2.50% full thickness, 7.50% partial thickness, and 0.71% avulsion fracture). There was an almost perfect level of interobserver agreement for both the identification of an injury (κ = 0.854) and grading of injury (κ = 0.858). The MRI incidence of ALL injury was significantly greater within 6 weeks of the knee injury (18.5 vs. 8.37%; p < 0.05). CONCLUSIONS ALL injury was identified in only one-tenth of cases of ACL rupture. MRI changes can be reliably identified with strong agreement between observers. ALL injury is found more frequently on MRI within 6 weeks of the knee injury (compared to scans performed after this time period) suggesting that some injuries may resolve or become less visible.
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Affiliation(s)
- Jonathan D Kosy
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK.
| | - Peter J Schranz
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Anish Patel
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Rahul Anaspure
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Vipul I Mandalia
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
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Kodama Y, Furumatsu T, Miyazawa S, Fujii M, Tanaka T, Inoue H, Ozaki T. Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament. J Orthop Res 2017; 35:1625-1633. [PMID: 27673744 DOI: 10.1002/jor.23450] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/23/2016] [Indexed: 02/04/2023]
Abstract
The anterior root of the lateral meniscus provides functional stability to the meniscus. In this study, we evaluated the relationship between the position of the tibial tunnel and extrusion of the lateral meniscus after anterior cruciate ligament reconstruction, where extrusion provides a proxy measure of injury to the anterior root. The relationship between extrusion and tibial tunnel location was retrospectively evaluated from computed tomography and magnetic resonance images of 26 reconstructed knees, contributed by 25 patients aged 17-31 years. A measurement grid was used to localize the position of the tibial tunnel based on anatomical landmarks identified from the three-dimensional reconstruction of axial computed tomography images of the tibial plateaus. The reference point-to-tibial tunnel distance (mm) was defined as the distance from the midpoint of the lateral edge of the grid to the posterolateral aspect of the tunnel aperture. The optimal cutoff of this distance to minimize post-operative extrusion was identified using receiver operating curve analysis. Extrusion of the lateral meniscus was positively correlated to the reference point-to-tibial tunnel distance (r 2 = 0.64; p < 0.001), with a cutoff distance of 5 mm having a sensitivity to extrusion of 83% and specificity of 93%. The mean extrusion for a distance >5 mm was 0.40 ± 0.43 mm, compared to 1.40 ± 0.51 mm for a distance ≤5 mm (p < 0.001). Therefore, a posterolateral location of the tibial tunnel aperture within the footprint of the anterior cruciate ligament decreases the reference point-to-tibial tunnel distance and increases extrusion of the lateral meniscus post-reconstruction. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1625-1633, 2017.
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Affiliation(s)
- Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Masataka Fujii
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takaaki Tanaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Hiroto Inoue
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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Sonnery-Cottet B, Saithna A, Cavalier M, Kajetanek C, Temponi EF, Daggett M, Helito CP, Thaunat M. Anterolateral Ligament Reconstruction Is Associated With Significantly Reduced ACL Graft Rupture Rates at a Minimum Follow-up of 2 Years: A Prospective Comparative Study of 502 Patients From the SANTI Study Group. Am J Sports Med 2017; 45:1547-1557. [PMID: 28151693 DOI: 10.1177/0363546516686057] [Citation(s) in RCA: 319] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Graft failure and low rates of return to sport are major concerns after anterior cruciate ligament (ACL) reconstruction, particularly in a population at risk. PURPOSE To evaluate the association between reconstruction techniques and subsequent graft rupture and return-to-sport rates in patients aged 16 to 30 years participating in pivoting sports. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A prospective study of patients undergoing primary ACL reconstruction with a bone-patellar tendon-bone (B-PT-B) graft, quadrupled hamstring tendon (4HT) graft, or hamstring tendon graft combined with anterolateral ligament reconstruction (HT+ALL) was conducted by the Scientific ACL NeTwork International (SANTI) Study Group. Survivorship data from Kaplan-Meier analysis were analyzed in multivariate Cox regression models to identify the prognosticators of graft ruptures and return to sport. RESULTS Five hundred two patients (mean age, 22.4 ± 4.0 years) with a mean follow-up of 38.4 ± 8.5 months (range, 24-54 months) were included. There were 105 B-PT-B, 176 4HT, and 221 HT+ALL grafts. The mean postoperative scores at latest follow-up were the following: Lysholm: 92.4 ± 8.6, Tegner: 7.4 ± 2.1, and subjective International Knee Documentation Committee (IKDC): 86.8 ± 10.5 for B-PT-B grafts; Lysholm: 91.3 ± 9.9, Tegner: 6.6 ± 1.8, and subjective IKDC: 85.4 ± 10.4 for 4HT grafts; and Lysholm: 91.9 ± 10.2, Tegner: 7.0 ± 2.0, and subjective IKDC: 81.8 ± 13.1 for HT+ALL grafts. The mean side-to-side laxity was 0.6 ± 0.9 mm for B-PT-B grafts, 0.6 ± 1.0 mm for 4HT grafts, and 0.5 ± 0.8 mm for HT+ALL grafts. At a mean follow-up of 38.4 months, the graft rupture rates were 10.77% (range, 6.60%-17.32%) for 4HT grafts, 16.77% (range, 9.99%-27.40%) for B-PT-B grafts, and 4.13% (range, 2.17%-7.80%) for HT+ALL grafts. The rate of graft failure with HT+ALL grafts was 2.5 times less than with B-PT-B grafts (hazard ratio [HR], 0.393; 95% CI, 0.153-0.953) and 3.1 times less than with 4HT grafts (HR, 0.327; 95% CI, 0.130-0.758). There was no significant difference in the graft failure rate between 4HT and B-PT-B grafts (HR, 1.204; 95% CI, 0.555-2.663). Other prognosticators of graft failure included age ≤25 years ( P = .012) and a preoperative side-to-side laxity >7 mm ( P = .018). The HT+ALL graft was associated with higher odds of returning to preinjury levels of sport than the 4HT graft (odds ratio [OR], 1.938; 95% CI, 1.174-3.224) but not compared with the B-PT-B graft (OR, 1.460; 95% CI, 0.813-2.613). CONCLUSION In a high-risk population of young patients participating in pivoting sports, the rate of graft failure with HT+ALL grafts was 2.5 times less than with B-PT-B grafts and 3.1 times less than with 4HT grafts. The HT+ALL graft is also associated with greater odds of returning to preinjury levels of sport when compared with the 4HT graft.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
| | - Adnan Saithna
- Southport and Ormskirk Hospital, Southport, UK.,Department of Clinical Engineering, University of Liverpool, Liverpool, UK
| | - Maxime Cavalier
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
| | - Charles Kajetanek
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - Matt Daggett
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | | | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, France
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45
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Ibrahim SA, Shohdy EM, Marwan Y, Ramadan SA, Almisfer AK, Mohammad MW, Abdulsattar WS, Khirat S. Anatomic Reconstruction of the Anterior Cruciate Ligament of the Knee With or Without Reconstruction of the Anterolateral Ligament: A Randomized Clinical Trial. Am J Sports Med 2017; 45:1558-1566. [PMID: 28293966 DOI: 10.1177/0363546517691517] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotational instability of the knee remains an issue after anterior cruciate ligament (ACL) reconstruction. Hypothesis/Purpose: The purpose was to evaluate the subjective and objective outcomes of combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. The hypothesis was that favorable outcomes can be achieved with this surgical procedure compared with isolated anatomic reconstruction of the ACL. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS One hundred ten patients with a unilateral ACL injury and high-grade pivot shift were randomly assigned to undergo either combined ACL and ALL reconstruction (group A) or isolated ACL reconstruction (group B). Preoperative and postoperative evaluations of the patients were conducted by obtaining history details, recording physical examination findings, measuring knee laxity using the KT-1000 arthrometer, and using validated outcome scores for the knee. P < .05 was considered as the cut-off level of statistical significance. The Fisher exact and Mann-Whitney U tests were used to assess statistical significance. RESULTS At a mean follow-up of 27 months, 53 and 50 patients in groups A and B, respectively, were available for analysis. No statistically different outcomes were found between the 2 groups except for the KT-1000 arthrometer values. The median KT-1000 arthrometer result for combined ACL and ALL reconstruction was 1.3 mm, while the median result for isolated ACL reconstruction was 1.8 mm ( P < .001). None of the patients (n = 0; 0.0%) who underwent combined ACL and ALL reconstruction had anterior translation of greater than 5 mm at maximum pulling strength compared with their normal knees at final follow-up. On the other hand, 3 (6.0%) patients who underwent isolated ACL reconstruction had anterior translation of more than 5 mm. No serious complications were found in both groups. CONCLUSION Combined ACL and ALL reconstruction was found to be effective in improving subjective and objective outcomes. Nevertheless, these findings were not significantly superior to isolated ACL reconstruction except for the instrumented knee laxity testing results. This might indicate that ALL reconstruction should not be performed routinely for patients undergoing ACL reconstruction.
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Affiliation(s)
- Samir Abdulrazik Ibrahim
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Emad Mureed Shohdy
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Yousef Marwan
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Sami Abdulghaffar Ramadan
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Abdulrahman Khalid Almisfer
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Mohammad Wagdy Mohammad
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Wael Shoabe Abdulsattar
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Shiref Khirat
- Division of Sport Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
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Zein A“MN, Ali M, Ali H, Saleh Elsaid AN, Mahmoud AZ, Osman MK, Mohamed Soliman AM. Combined Anatomic Reconstruction of the Anterior Cruciate and Anterolateral Ligaments Using Hamstring Graft Through a Single Femoral Tunnel and With a Single Femoral Fixation. Arthrosc Tech 2017; 6:e567-e577. [PMID: 28706801 PMCID: PMC5495116 DOI: 10.1016/j.eats.2016.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/06/2016] [Indexed: 02/03/2023] Open
Abstract
Patients with complete anterior cruciate ligament (ACL) injury have different degrees of rotational (internal rotation) laxity. A residual pivot shift has been found to be positive in more than 15% of cases after an accurate ACL reconstruction. Improved understanding of the existence, function, and biomechanical role of the anterolateral ligament (ALL) in controlling rotational instability of the knee has redirected and refocused attention on a supplemental extra-articular reconstruction of the ALL in conjunction with the intra-articular ACL reconstruction so as to restore normal kinematics of the knee. This Technical Note describes a technique that allows for a combined ACL and ALL reconstruction using autogenous hamstring graft (semitendinosus and gracilis tendons). One femoral tunnel is used connecting the anatomic femoral attachment of the ALL on the lateral wall of the lateral femoral condyle to the anatomic femoral ACL footprint on the medial wall of the lateral femoral condyle. The remaining part of the graft is fixed to the proximal tibia midway between Gordy's tubercle and the head of the fibula. This Technical Note describes a technique of both ACL and ALL reconstruction with a continuous hamstring graft.
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Affiliation(s)
- Assem “Mohamed Noureldin” Zein
- Address correspondence to Assem “Mohamed Noureldin” Zein, M.D., Orthopedic and Trauma Department, Faculty of Medicine, Minia University, Minia (Kornish el Nile), Egypt.Orthopedic and Trauma DepartmentFaculty of MedicineMinia UniversityMinia (Kornish el Nile)Egypt
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47
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Helito CP, Helito PVP, Leão RV, Demange MK, Bordalo-Rodrigues M. Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2017; 25:1140-1148. [PMID: 28293698 DOI: 10.1007/s00167-017-4498-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/27/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Few studies have used MRI to identify the ALL. As it was shown that it is not possible to precisely characterize this ligament in all examination, it is important to identify concomitant lesions that can help in diagnosing ALL abnormalities. It is important to characterise this injury due to its association with anterolateral knee instability. Thus, the present study was performed to determine the frequency of ALL injuries in patients with acute ACL rupture and to analyse its associated knee lesions. METHODS Patients with acute ACL injuries were evaluated by MRI. Among this population, the ALL was classified as non-visualised, injured or normal. The possible abnormalities of the meniscus, collateral ligaments, popliteus tendon, posterior cruciate ligament, Iliotibial band (ITB), anterolateral capsule and osseus injuries were evaluated. The association of an ALL injury with these other knee structures as well as sex and age was calculated. RESULTS Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury. CONCLUSION ALL injuries are present in approximately 40% of ACL injuries, and a minority of these are Segond fractures. These injuries are associated with peripheral ligament injuries, anterolateral structures lesions and bone contusions, but there is no association with meniscal injuries. Surgeons must be aware of these associations to consider an ALL lesion even if it is not completely clear in imaging evaluation, especially if a high degree of anterolateral instability is present on physical examination. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Camilo Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil. .,Knee Surgery Division, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil.
| | - Paulo Victor Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil.,Musculoskeletal Radiology Department, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | | | - Marco Kawamura Demange
- Knee Surgery Division, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Marcelo Bordalo-Rodrigues
- Hospital Sírio-Libanês, São Paulo, Brazil.,Musculoskeletal Radiology Department, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
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48
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Noyes FR, Huser LE, Jurgensmeier D, Walsh J, Levy MS. Is an Anterolateral Ligament Reconstruction Required in ACL-Reconstructed Knees With Associated Injury to the Anterolateral Structures? A Robotic Analysis of Rotational Knee Stability. Am J Sports Med 2017; 45:1018-1027. [PMID: 28056513 DOI: 10.1177/0363546516682233] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effect of an anterolateral ligament (ALL) reconstruction on rotational knee stability and corresponding anterior cruciate ligament (ACL) graft forces using multiple knee loading conditions including the pivot-shift phenomenon has not been determined. PURPOSE First, to determine the rotational stability and ACL graft forces provided by an anatomic bone-patellar tendon-bone ACL reconstruction in the ACL-deficient knee alone and with an associated ALL/iliotibial band (ITB) injury. Second, to determine the added rotational stabilizing effect and reduction in ACL graft forces provided by an ALL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS A 6 degrees of freedom robotic simulator was used to test 7 fresh-frozen cadaveric specimens during 5 testing conditions: intact, ACL-sectioned, ACL-reconstructed, ALL/ITB-sectioned, and ALL-reconstructed. Lateral and medial tibiofemoral compartment translations and internal tibial rotations were measured under Lachman test conditions, 5-N·m internal rotation, and 2 pivot-shift simulations. Statistical equivalence within 2 mm and 2° was defined as P < .05. RESULTS Single-graft ACL reconstruction restored central tibial translation under Lachman testing and internal rotation under 5-N·m internal rotation torque ( P < .05). A modest increase in internal rotation under 5-N·m internal rotation torque occurred after ALL/ITB sectioning of 5.1° (95% CI, 3.6° to 6.7°) and 6.7° (95% CI, 4.3° to 9.1°) at 60° and 90° of flexion, respectively ( P = .99). Lateral compartment translation increases in the pivot-shift tests were <2 mm. ALL reconstruction restored internal rotation within 0.5° (95% CI, -1.9° to 2.9°) and 0.7° (95% CI, -2.0° to 3.4°) of the ACL-reconstructed state at 60° and 90° of flexion, respectively ( P < .05). The ALL procedure reduced ACL graft forces, at most, 75 N in the pivot-shift tests and 81 N in the internal rotation tests. CONCLUSION Although the ALL reconstruction corrected the small abnormal changes in the internal rotation limit at high flexion angles, the procedure had no effect in limiting tibiofemoral compartment translations in the pivot-shift test and produced only modest decreases in ACL graft forces. Accordingly, the recommendation to perform an ALL reconstruction to correct pivot-shift abnormalities is questioned. CLINICAL RELEVANCE The small changes in rotational stability after ALL/ITB sectioning would not seem to warrant the routine addition of an ALL reconstruction in primary ACL injuries. Clinical exceptions may exist, as in grossly unstable grade 3 pivot-shift knees and revision knees. However, the concern exists of overconstraining normal tibial rotations.
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Affiliation(s)
- Frank R Noyes
- Cincinnati Sports Medicine and Orthopaedic Center-Mercy Health, Cincinnati, Ohio, USA.,The Noyes Knee Institute, Cincinnati, Ohio, USA
| | - Lauren E Huser
- Cincinnati Sports Medicine and Orthopaedic Center-Mercy Health, Cincinnati, Ohio, USA.,The Noyes Knee Institute, Cincinnati, Ohio, USA
| | - Darin Jurgensmeier
- Cincinnati Sports Medicine and Orthopaedic Center-Mercy Health, Cincinnati, Ohio, USA.,The Noyes Knee Institute, Cincinnati, Ohio, USA
| | - James Walsh
- Cincinnati Sports Medicine and Orthopaedic Center-Mercy Health, Cincinnati, Ohio, USA.,The Noyes Knee Institute, Cincinnati, Ohio, USA
| | - Martin S Levy
- Department of Operations and Business Analytics, College of Business, University of Cincinnati, Cincinnati, Ohio, USA
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Kinematics of ACL and anterolateral ligament. Part II: anterolateral and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:1062-1067. [PMID: 28280906 DOI: 10.1007/s00167-017-4496-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/21/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To quantify the influence of Single-Bundle with Lateral Plasty and Double-Bundle reconstruction on static and dynamic laxity in combined ACL- and ALL-deficient knees. METHODS The study included 10 fresh-frozen human knees. The joints were analyzed in the following conditions: ACL + ALL resection, Single-Bundle with Lateral Plasty (SBLP) reconstruction, Double-Bundle (DB) reconstruction. Testing parameters were: anterior displacement at 30° and 90° of flexion (AP30, AP90) applying a manual maximum load; internal rotation at 30° and 90° of flexion (INT30, INT90) applying a 5 Nm torque and acceleration and internal rotation Pivot-Shift (PS) test. Kinematics was acquired by a navigation system. Paired Student's t test was conducted to assess statistical difference (P < 0.05). RESULTS At both 30° and 90° of knee flexion, both SBLP and DB surgical techniques showed a significant reduction (P < 0.01) of anterior-posterior tibial displacement compared to the resection of ACL + ALL. At 30° on knee flexion it is the SBLP that allows the greatest reduction of internal rotational laxity when compared to DB reconstruction. Concerning the PS test, only SBPL procedure had a significant laxity decrease considering the acceleration reached by the joint when compared with the ACL + ALL state (P < 0.01). CONCLUSION Clinical relevance of this study is that the internal rotation and PS test were more efficiently controlled by the SBLP technique than by the DB one at both 30° and 90° of flexion in case of ACL + ALL lesions.
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50
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Yuuki A, Muneta T, Ohara T, Sekiya I, Koga H. Associated lateral/medial knee instability and its relevant factors in anterior cruciate ligament-injured knees. J Orthop Sci 2017; 22:300-305. [PMID: 27876498 DOI: 10.1016/j.jos.2016.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 10/18/2016] [Accepted: 10/22/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Associations of lateral/medial knee instability with anterior cruciate ligament (ACL) injury have not been thoroughly investigated. The purposes of this study were to investigate whether lateral/medial knee instability is associated with ACL injury, and to clarify relevant factors for lateral/medial knee instability in ACL-injured knees. METHODS One hundred and nineteen patients with unilateral ACL-injured knees were included. Lateral/medial knee instability was assessed with varus/valgus stress X-ray examination for both injured and uninjured knees by measuring varus/valgus angle, lateral/medial joint opening, and lateral/medial joint opening index. Manual knee instability tests for ACL were evaluated to investigate associations between lateral/medial knee instability and anterior and/or rotational instabilities. Patients' backgrounds were evaluated to identify relevant factors for lateral/medial knee instability. Damage on the lateral collateral ligament (LCL) on MRI was also evaluated. RESULTS All parameters regarding lateral knee instability in injured knees were significantly greater than in uninjured knees. There were significant correlations between lateral knee instability and the Lachman test as well as the pivot shift test. Patients with LCL damage had significantly greater lateral joint opening than those without LCL damage on MRI. Sensitivity of LCL damage on MRI to lateral joint opening was 100%, while its specificity was 36%. No other relevant factors were identified. In medial knee instability, there were also correlations between medial knee instability and the Lachman test/pivot shift test. However, the correlations were weak and other parameters were not significant. CONCLUSIONS Lateral knee instability was greater in ACL-deficient knees than in uninjured knees. Lateral knee instability was associated with ACL-related instabilities as well as LCL damage on MRI, whereas MRI had low specificity to lateral knee instability. On the other hand, the association of medial knee instability on ACL-related instability was less than that of lateral knee instability. LEVELS OF EVIDENCE Level IV, case series with no comparison group.
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Affiliation(s)
- Arata Yuuki
- Department of Joint Surgery and Sports Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyoku, Tokyo 113-8519, Japan
| | - Takeshi Muneta
- Department of Joint Surgery and Sports Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyoku, Tokyo 113-8519, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Toshiyuki Ohara
- Department of Joint Surgery and Sports Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyoku, Tokyo 113-8519, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyoku, Tokyo 113-8519, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
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