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Cheng R, Yao G, Dimitriou D, Jiang Z, Yang Y, Tsai TY. The 45° and 60° of sagittal femoral tunnel placement in anterior cruciate ligament reconstruction provide similar knee stability. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38973630 DOI: 10.1002/ksa.12341] [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: 11/06/2023] [Revised: 06/03/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE The aim of the present study was to compare 45° and 60° of sagittal femoral tunnel angles in terms of anterior tibial translation (ATT), valgus angle and graft in situ force following anterior cruciate ligament reconstruction (ACLR). METHODS Ten porcine knees were subjected to the following loading conditions: (1) 89 N anterior tibial load at 35° (full extension), 60° and 90° of knee flexion and (2) 5 N m valgus tibial moment at 35° and 45° of knee flexion. ATT and graft in situ force of the intact anterior cruciate ligament (ACL) and ACLR were collected using a robotic universal force/moment sensor (UFS) testing system for (1) ACL intact, (2) ACL-deficient (ACLD) and (3) two different ACLR using different sagittal femoral tunnel angles (coronal 45°/sagittal 45° and coronal 45°/sagittal 60°). RESULTS During the anterior tibial load, the femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° and 60° had significantly higher ATT than that of the ACL-intact knees at 60° of knee flexion (p < 0.05). The femoral tunnel angle of ACLR knees at coronal 45°/sagittal 60° had significantly lower graft in situ force than that of the ACL-intact knees at 60° and 90° of knee flexion (p < 0.05). During the valgus tibial moment, the femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° and 60° had significantly lower graft in situ force than that of the ACL-intact knees at all knee flexions (p < 0.05). CONCLUSIONS The femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° provided similar ATT, valgus angle and graft in situ force to that of ACLR knees at coronal 45°/sagittal 60°. Therefore, both femoral tunnel angles could be used in ACLR, as the sagittal femoral tunnel angle does not appear to be relevant in post-operative knee stability. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Gai Yao
- The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Dimitris Dimitriou
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Ziang Jiang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Yangyang Yang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
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Hong IS, Ifarraguerri AM, Berk AN, Trofa DP, Piasecki DP, Saltzman BM. Clinical Outcomes of a Novel Hybrid Transtibial Technique for Femoral Tunnel Drilling in Anterior Cruciate Ligament Reconstruction: A Large Single-Center Case Series With a Minimum 2-Year Follow-up. Orthop J Sports Med 2024; 12:23259671241242778. [PMID: 39131489 PMCID: PMC11310593 DOI: 10.1177/23259671241242778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 08/13/2024] Open
Abstract
Background A novel hybrid transtibial (HTT) approach to femoral tunnel drilling in anterior cruciate ligament reconstruction (ACLR) has been developed that circumvents the need for knee hyperflexion and orients the graft in the most anatomic position without sacrificing the tunnel length or aperture. Hypothesis Patients who underwent ACLR utilizing the HTT technique would achieve excellent patient-reported outcome scores and experience low rates of graft failure and reoperations. Study Design Case series; Level of evidence, 4. Methods Patients who underwent primary ACLR at a single institution between 2005 and 2020 were retrospectively reviewed. Patients treated with the HTT, anteromedial portal (AMP), and transtibial (TT) approaches were matched based on age, sex, and body mass index ±3 kg/m2. Demographic and surgical data as well as femoral tunnel angle measurements on anteroposterior and lateral radiographs were collected for the 3 groups. However, clinical outcomes were only reported for the HTT group because of concerns of graft heterogeneity. Results A total of 170 patients (median age, 26.5 years [interquartile range (IQR), 18.0-35.0 years]) who underwent ACLR using the HTT approach were included. The median coronal- and sagittal-plane femoral tunnel angles were 47° (IQR, 42°-53°) and 40° (IQR, 34°-46°), respectively. The sagittal-plane femoral tunnel angles in the HTT group were significantly more horizontal compared with those in the TT group (P < .0001), whereas the coronal-plane femoral tunnel angles in the HTT group were found to be significantly more vertical compared with those in the AMP group (P = .001) and more horizontal compared with those in the TT group (P < .0001). The graft failure and reoperation rates in the HTT group at a minimum 2-year follow-up were 1.8% (3/170) and 4.7% (8/170), respectively. The complication rate was 6.5% (11/170), with the most common complication being subjective stiffness in 7 patients. The median Lysholm score was 89.5 (IQR, 79.0-98.0); the median International Knee Documentation Committee score was 83.9 (IQR, 65.5-90.8); and the median Veterans RAND 12-Item Health Survey physical and mental component summary scores were 55.0 (IQR, 52.6-55.9) and 56.2 (IQR, 49.1-59.3), respectively. Conclusion ACLR using the HTT technique was associated with low graft retear and revision surgery rates and good patient-reported outcome scores at medium-term follow-up and demonstrated femoral tunnel obliquity on postoperative radiographs that correlated with optimal parameters previously reported in cadaveric and biomechanical studies.
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Affiliation(s)
- Ian S. Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Anna M. Ifarraguerri
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Alexander N. Berk
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - David P. Trofa
- Department of Orthopedics, New York–Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Dana P. Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
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Mao Y, Zhang K, Li J, Fu W. Transtibial Versus Anteromedial Portal Technique for Femoral Tunnel Drilling in Primary Single-Bundle Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Level 1 and 2 Evidence of Clinical, Revision, and Radiological Outcomes. Am J Sports Med 2023; 51:250-262. [PMID: 34652233 DOI: 10.1177/03635465211044476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although numerous clinical studies have compared transtibial (TT) and anteromedial portal (AMP) drilling of femoral tunnels during anterior cruciate ligament reconstruction (ACLR), there is no high-quality, evidence-based consensus regarding which technique affords the best outcome. HYPOTHESIS There would be no difference between the TT and AMP techniques in terms of knee stability, patient-reported outcomes, incidence of revision, and radiological results. STUDY DESIGN Meta-analysis; Level of evidence, 2. METHODS The PubMed and EMBASE databases were searched from inception to February 1, 2021. Level 1 and 2 clinical trials that compared TT and AM techniques were included. Data were meta-analyzed for the outcome measures of knee stability, patient-reported functional outcomes, incidence of revision, and radiological results. Dichotomous variables were presented as odds ratios (ORs), and continuous variables were presented as mean differences (MDs) and standard mean differences (SMDs). RESULTS The meta-analysis included 18 clinical studies, level of evidence 1 or 2, that involved 53,888 patients. Pooled data showed that the AMP group had a lower side-to-side difference (SMD, 0.22; 95% CI, 0.06 to 0.39; P = .009), a lower incidence of pivot-shift phenomenon (OR, 3.69; 95% CI, 1.26 to 10.79; P = .02), and a higher postoperative Lysholm score (SMD, -0.26; 95% CI, -0.44 to -0.08; P = .005) than the TT group. However, no statistically significant differences were seen in other outcomes, including subjective International Knee Documentation Committee scores (SMD, -0.11; 95% CI, -0.30 to 0.09; P = .30) or grades (OR, 0.93; 95% CI, 0.35 to 2.49; P = .89), postoperative activity level (MD, -0.14; 95% CI, -0.42 to 0.15; P = .35), and incidence of revision ACLR (OR, 1.04; 95% CI, 0.93 to 1.16; P = .45). The TT technique was more likely to create longer (SMD, 1.05; 95% CI, 0.05 to 2.06; P = .04) and more oblique (SMD, 0.81; 95% CI, 0.51 to 1.11; P < .001) femoral tunnels than the AMP technique, and a higher height ratio of the aperture position was detected with the TT technique (SMD, -3.51; 95% CI, -5.54 to -1.49; P < .001). CONCLUSION The AMP technique for ACLR may be more likely to produce better knee stability and improved clinical outcomes than the TT technique, but no difference was found in the incidence of revision between the 2 groups.
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Affiliation(s)
- Yunhe Mao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Kaibo Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Cinque ME, Kunze KN, Williams BT, Moatshe G, LaPrade RF, Chahla J. Higher Incidence of Radiographic Posttraumatic Osteoarthritis With Transtibial Femoral Tunnel Positioning Compared With Anteromedial Femoral Tunnel Positioning During Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:255-263. [PMID: 33769902 DOI: 10.1177/0363546521993818] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anteromedial (AM) femoral tunnel positioning in anterior cruciate ligament reconstruction (ACLR) has been reported by some authors to yield superior clinical and functional outcomes compared with the transtibial (TT) approach; however, differences in the subsequent rates of posttraumatic osteoarthritis (PTOA) are not clear. PURPOSE To perform a systematic review and meta-analysis of the literature to evaluate the influence of femoral tunnel positioning during primary ACLR on the development of radiographic PTOA. STUDY DESIGN Systematic review and Meta-analysis. METHODS The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2019), and MEDLINE (1980-2019) were queried for all studies describing the development of PTOA after TT or AM ACLR. Data pertaining to patient demographics, ACLR technique, and radiographic PTOA were extracted. A meta-analysis utilizing the DerSimonian-Laird method for random effects was used to compare the weighted proportion of PTOA after ACLR between the TT and AM approaches. RESULTS There were 16 studies identified for inclusion with a total of 1546 patients. The mean follow-up across all studies was 10.9 years (range, 5.4-17.8 years). The mean follow-up in the AM and TT groups was 10.8 years (range, 5.4-17 years) and 11.4 years (range, 6-17.8 years), respectively. A total of 783 (50.6%) patients underwent TT ACLR. Of these patients, 401 (weighted mean, 49.3%) developed radiographic PTOA. A total of 763 (49.4%) patients underwent AM ACLR. Of these patients, 166 (mean, 21.8%) went on to develop radiographic PTOA. The meta-analysis demonstrated a significantly greater rate of PTOA after ACLR using a TT technique compared with an AM technique overall (49.3% vs 25.4%, respectively; P < .001) and when studies were stratified by 5- to 10-year (53.7% vs 14.2%, respectively; P < .001) and greater than 10-year (45.6% vs 31.2%, respectively; P < .0001) follow-up. CONCLUSION TT ACLR was associated with higher overall rates of radiographic PTOA compared with the AM ACLR approach. The rates of radiographic PTOA after ACLR with a TT approach were also significantly higher than using an AM approach when stratified by length of follow-up (5- to 10-year and >10-year follow-up).
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Affiliation(s)
- Mark E Cinque
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Brady T Williams
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Jorge Chahla
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Wang S, Zheng NN, Piasecki DP, Fleischli JE. Influence of graft type on sagittal plane knee biomechanics during stair ambulation following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2021; 81:105233. [PMID: 33221051 DOI: 10.1016/j.clinbiomech.2020.105233] [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: 04/12/2020] [Revised: 09/04/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Both graft type and surgical technique for anterior cruciate ligament reconstruction can affect knee biomechanics. Several studies reported the influence of graft type, but few have controlled the surgical technique and fully investigated stair ambulation. This study aimed to compare knee biomechanics during stair ambulation between patients treated with hamstring tendon graft and those treated with patellar tendon graft when anterior medial portal technique was used to drill femoral tunnel. METHODS Two groups of patients (patellar tendon, n = 18; hamstring tendon, n = 18) at average 12 months after reconstruction surgery were recruited to ascend and descend a customized staircase in a gait lab. Joint kinematics and kinetics were calculated for both operated and contralateral intact limbs based on kinematic analysis and inverse dynamics. The influence of graft type on knee flexion angle and moment was identified using one-way mixed (graft type and limb side) analysis of variance with post-hoc paired t-test. FINDINGS Significant interaction between graft and limb was found for knee flexion and range of motion. Only the hamstring tendon group had significant kinematic deficits on the operated limb than the contralateral limb during stair ascent and descent. No significant interaction was found for knee flexion moment. Both graft groups had significant deficits in peak knee flexion moment on the operated side during stair ascent and descent. INTERPRETATION While the choice of graft type does not affect the restoration of knee dynamic loading, patellar tendon graft better restores knee flexion-extension kinematics during stair ambulation.
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Affiliation(s)
- Shangcheng Wang
- Department of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, NC, United States of America; Center for Biomedical Engineering and Science at University of North Carolina at Charlotte, NC, United States of America
| | - Naiquan Nigel Zheng
- Department of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, NC, United States of America; Center for Biomedical Engineering and Science at University of North Carolina at Charlotte, NC, United States of America.
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Marom N, Ouanezar H, Jahandar H, Zayyad ZA, Fraychineaud T, Hurwit D, Imhauser CW, Wickiewicz TL, Pearle AD, Nawabi DH. Lateral Extra-articular Tenodesis Reduces Anterior Cruciate Ligament Graft Force and Anterior Tibial Translation in Response to Applied Pivoting and Anterior Drawer Loads. Am J Sports Med 2020; 48:3183-3193. [PMID: 33017168 DOI: 10.1177/0363546520959322] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The biomechanical effect of lateral extra-articular tenodesis (LET) performed in conjunction with anterior cruciate ligament (ACL) reconstruction (ACLR) on load sharing between the ACL graft and the LET and on knee kinematics is not clear. PURPOSE/HYPOTHESIS The purpose was to quantify the effect of LET on (1) forces carried by both the ACL graft and the LET and (2) tibiofemoral kinematics in response to simulated pivot shift and anterior laxity tests. We hypothesized that LET would decrease forces carried by the ACL graft and anterior tibial translation (ATT) in response to simulated pivoting maneuvers and during simulated tests of anterior laxity. STUDY DESIGN Controlled laboratory study. METHODS Seven cadaveric knees (mean age, 39 ± 12 years [range, 28-54 years]; 4 male) were mounted to a robotic manipulator. The robot simulated clinical pivoting maneuvers and tests of anterior laxity: namely, the Lachman and anterior drawer tests. Each knee was assessed in the following states: ACL intact, ACL sectioned, ACL reconstructed (using a bone-patellar tendon-bone autograft), and after performing LET (the modified Lemaire technique after sectioning of the anterolateral ligament and Kaplan fibers). Resultant forces carried by the ACL graft and LET at the peak applied loads were determined via superposition. ATT was determined in response to the applied loads. RESULTS With the applied pivoting loads, performing LET decreased ACL graft force up to 80% (44 ± 12 N; P < .001) and decreased ATT of the lateral compartment compared with that of the intact knee up to 7.6 ± 2.9 mm (P < .001). The LET carried up to 91% of the force generated in the ACL graft during isolated ACLR (without LET). For simulated tests of anterior laxity, performing LET decreased ACL graft force by 70% (40 ± 20 N; P = .001) for the anterior drawer test with no significant difference detected for the Lachman test. No differences in ATT were deteced between ACLR with LET and the intact knee on both the Lachman and the anterior drawer tests (P = .409). LET reduced ATT compared with isolated ACLR on the simulated anterior drawer test by 2.4 ± 1.8 mm (P = .032) but not on the simulated Lachman test. CONCLUSION In a cadaveric model, LET in combination with ACLR transferred loads from the ACL graft to the LET and reduced ATT with applied pivoting loads and during the simulated anterior drawer test. The effect of LET on ACL graft force and ATT was less pronounced on the simulated Lachman test. CLINICAL RELEVANCE LET in addition to ACLR may be a suitable option to offload the ACL graft and to reduce ATT in the lateral compartment to magnitudes less than that of the intact knee with clinical pivoting maneuvers. In contrast, LET did not offload the ACL graft or add to the anterior restraint provided by the ACL graft during the Lachman test.
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Affiliation(s)
- Niv Marom
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Hervé Ouanezar
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Hamidreza Jahandar
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Zaid A Zayyad
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Thomas Fraychineaud
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Daniel Hurwit
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Thomas L Wickiewicz
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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WANG SHANGCHENG, LIU ZHIHONG, FENG JIANMING, DENG LIANFU, ZHENG NAIQUANNIGEL. COMPARING TRANSVERSE PLANE BIOMECHANICS BETWEEN FIXED- AND MOBILE-BEARING TOTAL KNEE ARTHROPLASTY DURING LEVEL WALKING, STAIR NEGOTIATION AND PIVOTING. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Compared with fixed-bearing (FB) total knee arthroplasty (TKA), mobile-bearing (MB) TKA may promote knee rotation and reduce rotational load at bone–implant interface. Unfortunately, this hypothesis has not been examined with neither knee rotation during stance of pivoting nor knee rotational moment during activities other than level walking. This study used 3D motion analysis to obtain the rotation of tibia relative to the femur and knee rotation moment during stance phase of level walking, stair ascent/descent, step and spin turn for 17 FB, 20[Formula: see text]MB and 28 healthy knees. Statistical comparisons revealed that transverse plane biomechanics was similar between MB and FB knees. Compared with healthy knees ([Formula: see text]), both FB ([Formula: see text]) and MB knees ([Formula: see text]) reduced internal rotation during step turn at early stance. During spin turn, FB knees ([Formula: see text] vs. [Formula: see text]) reduced internal rotation at late stance, whereas MB knees ([Formula: see text] versus [Formula: see text]) reduced external rotation at early stance. MB knees (0.064% and 0.126% body weight [Formula: see text] height) had lower peak external rotation moments during early stance phase of both level walking and spin turn than healthy knees (0.108% and 0.238% body weight [Formula: see text] height). Using FB for TKA surgery without bias and step-turn strategy for pivoting were recommended.
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Affiliation(s)
- SHANGCHENG WANG
- Department of Mechanical Engineering and Science, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
| | - ZHIHONG LIU
- Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P. R. China
| | - JIANMING FENG
- Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P. R. China
| | - LIANFU DENG
- Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P. R. China
| | - NAIQUAN NIGEL ZHENG
- Department of Mechanical Engineering and Science, Center of Biomedical Engineering and Science, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
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Tampere T, Devriendt W, Cromheecke M, Luyckx T, Verstraete M, Victor J. Tunnel placement in ACL reconstruction surgery: smaller inter-tunnel angles and higher peak forces at the femoral tunnel using anteromedial portal femoral drilling-a 3D and finite element analysis. Knee Surg Sports Traumatol Arthrosc 2019; 27:2568-2576. [PMID: 30406406 DOI: 10.1007/s00167-018-5272-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/29/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE Recent studies have emphasized the importance of anatomical ACL reconstruction to restore normal knee kinematics and stability. Aim of this study is to evaluate and compare the ability of the anteromedial (AM) and transtibial (TT) techniques for ACL reconstruction to achieve anatomical placement of the femoral and tibial tunnel within the native ACL footprint and to determine forces within the graft during functional motion. As the AM technique is nowadays the technique of choice, the hypothesis is that there are significant differences in tunnel features, reaction forces and/or moments within the graft when compared to the TT technique. METHODS Twenty ACL-deficient patients were allocated to reconstruction surgery with one of both techniques. Postoperatively, all patients underwent a computed tomography scan (CT) allowing 3D reconstruction to analyze tunnel geometry and tunnel placement within the native ACL footprint. A patient-specific finite element analysis (FEA) was conducted to determine reaction forces and moments within the graft during antero-posterior translation and pivot-shift motion. RESULTS With significantly shorter femoral tunnels (p < 0.001) and a smaller inter-tunnel angle (p < 0.001), the AM technique places tunnels with less variance, close to the anatomical centre of the ACL footprints when compared to the TT technique. Using the latter, tibial tunnels were more medialised (p = 0.007) with a higher position of the femoral tunnels (p = 0.02). FEA showed the occurrence of higher, but non-significant, reaction forces in the graft, especially on the femoral side and lower, however, statistically not significant, reaction moments using the AM technique. CONCLUSION This study indicates important, technique-dependent differences in tunnel features with changes in reaction forces and moments within the graft. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Thomas Tampere
- Department of Orthopaedic Surgery, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Wouter Devriendt
- Department of Orthopaedic Surgery, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Michiel Cromheecke
- Department of Orthopaedic Surgery, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Thomas Luyckx
- Department of Orthopaedic Surgery, AZ Delta, Brugsesteenweg 90, 8800, Roeselare, Belgium
| | - Matthias Verstraete
- Department of Orthopaedic Surgery, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Jan Victor
- Department of Orthopaedic Surgery, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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Weber AE, Zuke W, Mayer EN, Forsythe B, Getgood A, Verma NN, Bach BR, Bedi A, Cole BJ. Lateral Augmentation Procedures in Anterior Cruciate Ligament Reconstruction: Anatomic, Biomechanical, Imaging, and Clinical Evidence. Am J Sports Med 2019; 47:740-752. [PMID: 29401410 DOI: 10.1177/0363546517751140] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been an increasing interest in lateral-based soft tissue reconstructive techniques as augments to anterior cruciate ligament reconstruction (ACLR). The objective of these procedures is to minimize anterolateral rotational instability of the knee after surgery. Despite the relatively rapid increase in surgical application of these techniques, many clinical questions remain. PURPOSE To provide a comprehensive update on the current state of these lateral-based augmentation procedures by reviewing the origins of the surgical techniques, the biomechanical data to support their use, and the clinical results to date. STUDY DESIGN Systematic review. METHODS A systematic search of the literature was conducted via the Medline, EMBASE, Scopus, SportDiscus, and CINAHL databases. The search was designed to encompass the literature on lateral extra-articular tenodesis (LET) procedures and the anterolateral ligament (ALL) reconstruction. Titles and abstracts were reviewed for relevance and sorted into the following categories: anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes. RESULTS The search identified 4016 articles. After review for relevance, 31, 53, 27, 35, 45, and 78 articles described the anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes of either LET procedures or the ALL reconstruction, respectively. A multitude of investigations were available, revealing controversy in addition to consensus in several categories. The level of evidence obtained from this search was not adequate for systematic review or meta-analysis; thus, a current concepts review of the anatomy, biomechanics, imaging, surgical techniques, and clinical outcomes was performed. CONCLUSION Histologically, the ALL appears to be a distinct structure that can be identified with advanced imaging techniques. Biomechanical evidence suggests that the anterolateral structures of the knee, including the ALL, contribute to minimizing anterolateral rotational instability. Cadaveric studies of combined ACLR-LET procedures demonstrated overconstraint of the knee; however, these findings have yet to be reproduced in the clinical literature. The current indications for LET augmentation in the setting of ACLR and the effect on knee kinematic and joint preservation should be the subject of future research.
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Affiliation(s)
- Alexander E Weber
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - William Zuke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Erik N Mayer
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan Getgood
- Fowler Kennedy Sports Clinic, Western University, London, Ontario, Canada
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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10
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Eysturoy NH, Nielsen TG, Lind MC. Anteromedial Portal Drilling Yielded Better Survivorship of Anterior Cruciate Ligament Reconstructions When Comparing Recent Versus Early Surgeries With This Technique. Arthroscopy 2019; 35:182-189. [PMID: 30611349 DOI: 10.1016/j.arthro.2018.08.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare anteromedial (AM) and transtibial (TT) femoral drilling hole techniques in primary anterior cruciate ligament reconstruction, using the Danish Knee Ligament Reconstruction Register, comparing revision rates and clinical outcomes from 2 time periods, 2007 to 2010 and 2012 to 2015. METHODS A total of 8,386 primary anterior cruciate ligament reconstructions were registered between January 2007 to December 2010 and 8,818 in the period January 2012 to December 2015. Revision ACL was the primary endpoint. Secondary endpoints were the objective and subjective clinical outcomes. Crude and adjusted relative risks (RRs) with 95% confidence interval (CIs) were calculated. RESULTS The adjusted RR for revision surgery in the AM (2007-10) group compared with the TT (2007-10) group was 1.45 (95% CI, 1.17-1.78; P < .05), but when comparing the AM (2012-15) group with TT (2012-15) group, the RR was 0.99 (95% CI, 0.68-1.45; P = .96). One-year postoperative objective stability testing showed an RR = 1.38 (95% CI, 1.19-1.60; P < .01) for rotational stability and an RR = 1.37 (95% CI, 0.99-1.89; P < .01) for sagittal stability when comparing AM (2007-10) to TT (2007-10). No significant difference in objective stability was found in the more recent period. Lastly, comparing the subjective scores, the AM (2012-15) had a significantly higher Tegner score 1 year postoperatively compared with the TT-group (2012-15). CONCLUSIONS This study found an increased RR of revision anterior cruciate ligament and rotational and sagittal instability 1 year postoperatively for the AM technique in the period from 2007 to 2010. However, there was no significant difference in revision surgery and objective measures between the techniques from 2012 to 2015. Nevertheless, a higher activity level was found in the AM group. The results could indicate that the results found in the period 2007 to 2010 may have been caused by a learning curve when introducing a new and more complex procedure (AM). LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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Affiliation(s)
| | - Torsten G Nielsen
- Division of Sports Trauma, Orthopedic Department, Aarhus University Hospital, Aarhus, Denmark
| | - Martin C Lind
- Division of Sports Trauma, Orthopedic Department, Aarhus University Hospital, Aarhus, Denmark.
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Marriott K, Birmingham TB, Pinto R, Primeau C, Bryant D, Degen R, Giffin JR. Gait biomechanics after combined HTO-ACL reconstruction versus HTO alone: A matched cohort study. J Orthop Res 2019; 37:124-130. [PMID: 30303555 DOI: 10.1002/jor.24157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
The purpose of the present study was to compare bilateral external knee moments during gait in patients with concomitant medial compartment knee OA, varus alignment and chronic anterior cruciate ligament (ACL) deficiency who underwent either medial opening-wedge high tibial osteotomy alone (HTO) or simultaneous HTO and ACL reconstruction (HTO-ACLR). Fifty-two patients (26 matched pairs) completed 3D gait analysis preoperatively and at a minimum 5 years postoperatively. Patients were matched for preoperative age, sex, body mass index and magnitude of correction. Primary outcomes selected a priori were the peak knee adduction moment (KAM) and knee flexion (KFM) moment during stance. Moments were compared using mixed model repeated measures analysis of variance (ANOVA). For the peak KAM, there was a significant time by limb interaction. For both groups, there were similar reductions in the peak KAM 5 years postoperatively in the surgical limb only [-1.34 %BW × Ht (-1.71, -0.96) and -1.72 %BW × Ht (-1.99, -1.44) for HTO and HTO-ACLR, respectively]. For the peak KFM, there was a significant time by group by limb interaction. There was a decrease in the peak KFM 5 years postoperatively in the HTO group [-0.88 %BW × Ht (-1.45, -0.31)] but not in the HTO-ACLR group [0.03 %BW × Ht (-0.43, 0.48)]. These results suggest that individuals with medial knee OA, varus alignment and chronic ACL deficiency who undergo simultaneous medial opening-wedge HTO and ACL reconstruction may not experience the same long-term (5 year) changes in sagittal plane knee biomechanics observed in patients undergoing HTO alone. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Kendal Marriott
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Ryan Pinto
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Codie Primeau
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Dianne Bryant
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Ryan Degen
- The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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12
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Tejwani SG, Prentice HA, Wyatt RWB, Maletis GB. Femoral Tunnel Drilling Method: Risk of Reoperation and Revision After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2018; 46:3378-3384. [PMID: 30419174 DOI: 10.1177/0363546518805086] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The femoral tunnel in anterior cruciate ligament reconstruction (ACLR) can be created by the transtibial (TT) or tibial-independent (TI) methods. An anatomically located femoral tunnel can be more consistently achieved by TI methods, which include the anteromedial portal and lateral (outside-in, retrodrill) techniques. Nonanatomic graft placement in ACLR can result in postoperative instability and meniscal or chondral injury. An anatomically located graft is subjected to higher postoperative physiologic forces than one placed nonanatomically. PURPOSE To examine isolated primary ACLR and determine the risk of aseptic revision and reoperation based on femoral tunnel drilling method. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The ACLR registry of an integrated US health care system was used to identify primary isolated unilateral ACLRs from 2009 to 2014. Multivariable Cox proportional hazard regression models were used to evaluate risk for aseptic revision for graft failure and aseptic reoperation for meniscal or chondral injury according to femoral tunnel drilling method: TI versus TT. Models included age, sex, body mass index (BMI), race, graft type, and femoral fixation type as covariates. RESULTS The cohort included 19,059 patients with primary ACLR. The mean age was 28.9 years (SD, 11.5), 6991 patients (36.8%) were younger than 22 years, 11,795 patients (61.9%) were male, 7648 patients (40.1%) had a BMI less than 25 kg/m2, 8913 patients (46.8%) were white, and 7357 patients (38.6%) received an allograft. Median follow-up was 2.30 years (interquartile range, 1.08-3.77). TI techniques were used for 12,342 (64.8%) of the ACLRs, and the TT method was used for 6717 (35.2%). Use of TI techniques increased from 33.6% of all ACLRs in 2009 to 83.4% in 2014. After adjustment for covariates, the TI group had a higher risk for aseptic revision than the TT group (hazard ratio [HR], 1.28; 95% CI, 1.04-1.56), and this risk was 1.41 times higher in patients younger than 22 years specifically. The 5-year cumulative reoperation probability was lower in the TI group (4.50%; 95% CI, 3.78%-5.36%) compared with the TT group (5.06%; 95% CI, 4.31-5.94%). After adjustment for the covariates, no difference in risk for aseptic reoperation was observed (HR, 1.08; 95% CI, 0.85-1.39). CONCLUSION In the largest known study of its type examining femoral tunnel drilling method for primary ACLR, after adjustment for age, sex, BMI, race, graft type, and femoral fixation, TI techniques were found to carry higher risk of aseptic revision compared with the TT method, while no difference was observed in risk for aseptic reoperation.
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Affiliation(s)
- Samir G Tejwani
- Department of Orthopaedics, Southern California Permanente Medical Group, Fontana, California, USA
| | - Heather A Prentice
- Surgical Outcomes and Analysis, Southern California Permanente Medical Group, San Diego, California, USA
| | - Ronald W B Wyatt
- Department of Orthopaedics, The Permanente Medical Group, Walnut Creek, California, USA
| | - Gregory B Maletis
- Department of Orthopaedics, Southern California Permanente Medical Group, Baldwin Park, California, USA
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13
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GOETSCHIUS JOHN, HERTEL JAY, SALIBA SUSANA, BROCKMEIER STEPHENF, HART JOSEPHM. Gait Biomechanics in Anterior Cruciate Ligament–reconstructed Knees at Different Time Frames Postsurgery. Med Sci Sports Exerc 2018; 50:2209-2216. [DOI: 10.1249/mss.0000000000001693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Kumar BS, Andrade R, Leal A, Sarmento A, Pereira H, Sevivas N, Espregueira-Mendes J. Surgical Adjustment of the Guide Pin to Perform a Correct Tibial Tunnel in Anatomical Anterior Cruciate Ligament Single-Bundle Reconstruction. Arthrosc Tech 2016; 5:e757-e762. [PMID: 27709033 PMCID: PMC5040105 DOI: 10.1016/j.eats.2016.03.002] [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: 09/22/2015] [Accepted: 03/02/2016] [Indexed: 02/03/2023] Open
Abstract
Anatomical positioning of the graft in anterior cruciate ligament reconstruction is important to restore normal knee kinematics and prevent early joint degeneration. Inadequate position of a first attempt to place the guide pin within the center of the tibial footprint may occur. Therefore, its adjustment is important to achieve the anatomical positioning of the graft within the tibial footprint. When the guide pin exits eccentrically in an inadequate position, it is possible to correct it to the center of the footprint. A small tunnel with a 4.5-mm reamer is made and the guide pin is shifted to the center of the footprint. The center of the tunnel can be corrected until 50% and in all direction in relation to the initial drilled tunnel, without additional associated morbidity. Once the correct position of the center is achieved, the guide pin is fixed in the femoral notch roof to guarantee the accurate correction of the axis, without toggling of the guide pin inside the tunnel and metal dusting. The final tunnel is then drilled with the same size of the graft. With this technique it is possible to adjust an eccentrically misplaced guide pin to the center of the footprint without additional morbidity.
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Affiliation(s)
| | - Renato Andrade
- Faculty of Sports, University of Porto, Porto, Portugal
- Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
| | - Ana Leal
- Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- CMEMS Center for MicroElectroMechanical Systems, Mechanical Engineering Department, University of Minho, Guimarães, Portugal
| | - André Sarmento
- Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal
- Orthopaedic Department, Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Hélder Pereira
- Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal
- 3B's Research Group—Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Nuno Sevivas
- Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- 3B's Research Group—Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopaedics Department, Hospital de Braga, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- 3B's Research Group—Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopaedics Department of Minho University, Minho, Portugal
- Address correspondence to João Espregueira-Mendes, M.D., Ph.D., Via Futebol Clube do Porto—F. C. Porto Stadium, Porto, Portugal.Via Futebol Clube do Porto—F. C. Porto StadiumPortoPortugal
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Song Y, Yu C, Wang C, Ma X, Xu K, Zhong JL, Lv Y, Sung KP, Yang L. Mechano growth factor-C24E, a potential promoting biochemical factor for ligament tissue engineering. Biochem Eng J 2016. [DOI: 10.1016/j.bej.2015.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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16
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Wang H, Koff MF, Potter HG, Warren RF, Rodeo SA, Maher SA. An MRI-compatible loading device to assess knee joint cartilage deformation: Effect of preloading and inter-test repeatability. J Biomech 2015; 48:2934-40. [PMID: 26303166 DOI: 10.1016/j.jbiomech.2015.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 06/30/2015] [Accepted: 08/05/2015] [Indexed: 01/23/2023]
Abstract
It has been suggested that the extent and location of cartilage deformation within a joint under compressive loading may be predictive of predisposition to further degeneration. To explore this relationship in detail requires the quantification of cartilage deformation under controlled loads on a per-patient basis in a longitudinal manner. Our objectives were (1) to design a device capable of applying controllable axial loads while ensuring repeatable within-patient tibiofemoral positioning during magnetic resonance imaging (MRI) scans and (2) to determine the duration for which load should be maintained prior to the image acquisition, for a reproducible measurement of cartilage deformation, within the restraints of a clinical setting. A displacement control loading device was manufactured from MRI-compatible materials and tested on four volunteers for the following five scans: an unloaded scan, two repeat immediate scans which were started immediately after the application of 50% body weight, and two repeat delayed scans started 12 min after load application. Outcome measures included within-patient changes in tibiofemoral position and cartilage deformation between repeat loaded scans. The differences in tibiofemoral position between repeat loaded scans were <1mm in translation and <2° in rotation. Cartilage deformations were more consistent in the delayed scans compared to the immediate scans. We conclude that our loading device can ensure repeatable tibiofemoral positioning to allow for longitudinal studies, and the delayed scan may enable us to obtain more reproducible measurements of cartilage deformation in a clinical setting.
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Affiliation(s)
- Hongsheng Wang
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021, United States; Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, NY 10021, United States
| | - Matthew F Koff
- Magnetic Resonance Imaging Laboratory, Hospital for Special Surgery, New York, NY 10021, United States
| | - Hollis G Potter
- Magnetic Resonance Imaging Laboratory, Hospital for Special Surgery, New York, NY 10021, United States
| | - Russell F Warren
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 10021, United States
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 10021, United States
| | - Suzanne A Maher
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021, United States; Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, NY 10021, United States.
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Centeno CJ, Pitts J, Al-Sayegh H, Freeman MD. Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series. J Pain Res 2015; 8:437-47. [PMID: 26261424 PMCID: PMC4527573 DOI: 10.2147/jpr.s86244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction This was a prospective case series designed to investigate treatment for anterior cruciate ligament (ACL) tears using an injection of autologous bone marrow concentrate. Methods Consecutive adult patients presenting to a private outpatient interventional musculoskeletal and pain practice with knee pain, ACL laxity on exam, and magnetic resonance imaging (MRI) evidence of a grade 1, 2, or 3 ACL tears with less than 1 cm retraction were eligible for this study. Eligible patients were treated with an intraligamentous injection of autologous bone marrow concentrate, using fluoroscopic guidance. Pre- and postprocedural sagittal MRI images of the ACLs were analyzed using ImageJ software to objectively quantify changes between pre- and posttreatment scans. Five different types of measurement of ACL pixel intensity were examined as a proxy for ligament integrity. In addition pain visual analog scale (VAS) and Lower Extremity Functional Scale (LEFS) values were recorded at baseline and at 1 month, 3 months, 6 months, and annually postinjection. Objective outcomes measured were pre- to post-MRI measurement changes, as analyzed by the ImageJ software. Subjective outcomes measured were changes in the VAS and LEFS, and a self-rated percentage improvement. Results Seven of ten patients showed improvement in at least four of five objective measures of ACL integrity in their postprocedure MRIs. In the entire study group, the mean gray value, median, raw integrated density, and modal gray value all decreased toward low-signal ACLs (P=0.01, P=0.02, P=0.002, and P=0.08), indications of improved ligament integrity. Seven of ten patients responded to the self-rated metrics follow up. The mean VAS change was a decrease of 1.7 (P=0.25), the mean LEFS change was an increase of 23.3 (P=0.03), and mean reported improvement was 86.7%. Conclusion Based on this small case series, autologous bone marrow concentrate shows promise in the treatment of grade 1, 2, and possibly grade 3 ACL tears without retraction. Further investigation using a controlled study design is warranted.
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Affiliation(s)
- Christopher J Centeno
- Centeno-Schultz Clinic, Broomfield, CO, USA ; Regenerative Sciences, LLC., Broomfield, CO, USA
| | - John Pitts
- Centeno-Schultz Clinic, Broomfield, CO, USA
| | | | - Michael D Freeman
- Public Health Department, Oregon Health and Science University, Portland, OR, USA
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18
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Osti M, Hierzer D, Krawinkel A, Hoffelner T, Benedetto KP. The predictive effect of anatomic femoral and tibial graft tunnel placement in posterior cruciate ligament reconstruction on functional and radiological outcome. INTERNATIONAL ORTHOPAEDICS 2014; 39:1181-6. [PMID: 25324225 DOI: 10.1007/s00264-014-2565-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/01/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Biomechanical reports have advocated anatomic graft tunnel placement for reconstruction of the posterior cruciate ligament (PCL) to restore knee joint stability and facilitate optimal functional outcome. However, in vivo investigations that correlate tunnel position to functional results are lacking so far. This study evaluates the anatomic accuracy of femoral and tibial tunnel apertures on postoperative computed tomography (CT) scans and compares these findings to subjective and objective clinical outcome parameters. METHODS After single-bundle PCL reconstruction, 29 patients were stratified into several subgroups according to the anatomic accuracy of femoral and tibial tunnel apertures measured on postoperative CT scans. A threshold value for the centres of the tunnel apertures was determined using a measurement grid system as a radiographic reference. To evaluate the functional and radiological results, visual analogue scale, International Knee Documentation Committee (IKDC), Tegner, Lysholm, Knee Injury and Osteoarthritis Outcome Score and osteoarthritis scores were obtained. RESULTS Comparison between functional outcome and tunnel position yielded a statistically significant difference for subjective IKDC score and angle segment α and for objective stability and tunnel position P3 but no statistically significant difference with respect to intercondylar depth, intercondylar height and tibial tunnel position P2. No correlation was found between anatomic tunnel position and present or progressive osteoarthritis on follow-up. Of the patients, 72 % classified their result as excellent and good and 90 % would repeat surgical treatment. CONCLUSIONS Despite a small sample size and subject to the threshold values we used, our data indicate a potentially minor effect of anatomic tunnel placement on midterm functional outcome following PCL reconstruction.
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Affiliation(s)
- Michael Osti
- Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Feldkirch, Austria,
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