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Liu D, Lu W, Vithran DTA, Bi Q, Hong Z, Liu X, Yuan D, Chen C, Xiao W, Li Y. Gradual stabilization and narrowing of bone tunnels following primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39091244 DOI: 10.1002/ksa.12398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/27/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The purpose of this study is to dynamically assess variations in tunnel diameters following anterior cruciate ligament reconstruction (ACLR) and investigate correlations with patient-reported outcomes (PROs) and graft maturity based on signal-to-noise quotient (SNQ). METHODS Tunnel diameter and tunnel position were measured using three-dimensional models derived from computed tomography (CT) data. Postoperative graft maturity and integration were evaluated using magnetic resonance imaging (MRI). Clinical outcomes were assessed through PROs, which included the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Scores and Lysholm scores. The correlation between tunnel enlargement extent, PROs and SNQ values, as well as correlations between confounding factors, tunnel diameter differences and SNQ were analyzed. RESULTS A total of 73 participants underwent primary ACLR and scheduled follow-ups. At the segment of the articular aperture, the femoral tunnel was enlarged by 32.3% to 10.4 ± 1.6 mm (p < 0.05), and the tibial tunnel was widened by 17.2% to 9.6 ± 1.2 mm (p < 0.05) at the 6-month follow-up. At 1 year postoperatively, diameters at the articular aperture were not further increased on the femoral (n.s.) and tibial (n.s.) sides. In early postoperative follow-up, the femoral tunnel was anteriorly and distally shifted, coupled with posterior and lateral deviation involving the tibial side, exhibiting minimal migration at 1-year follow-up. The degree of tunnel widening was not correlated with PROs and SNQ values. Age, gender, body mass index (BMI), time from surgery to follow-up, concomitant injuries and autograft type were not correlated with tunnel diameter differences and SNQ. CONCLUSIONS The femoral and tibial bone tunnels exhibited eccentrical widening and gradually stabilized at 1 year following ACLR. Furthermore, the enlarged bone tunnels were not correlated with unsatisfied PROs and inferior graft maturity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Di Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenhao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Djandan Tadum Arthur Vithran
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Bi
- Department of Sports Medicine, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zheping Hong
- Department of Sports Medicine, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xu Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Dongliang Yuan
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Can Chen
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Xue H, Xiao F, Li R, Wu G, Zhu Z, Zhang C, Li M. Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft for acute rupture of Achilles tendon: clinical evaluation. Sci Rep 2024; 14:17815. [PMID: 39090165 PMCID: PMC11294335 DOI: 10.1038/s41598-024-68582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
Achilles tendon reconstruction is an effective method of repairing Achilles tendon rupture defects. We introduce a new approach for Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft. The study aimed to evaluate the clinical role of this new Achilles tendon reconstruction. We retrospectively enrolled patients who underwent Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft for acute Achilles tendon rupture defects from 2016 to 2021. The clinical and radiological results were assessed at the preoperative and the final postoperative follow-up with Visual Analog Score (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores and Achilles tendon Total Rupture Scores (ATRS). Besides, at the last postoperative follow-up, the difference in ankle range of motion between the two side of the patients and the incidence of postoperative complications were recorded. Results revealed patients had significantly lower VAS and higher AOFAS and ATRS (P < 0.01). Compared to the healthy ankle, the operative ankle showed significant deficits in ankle range of motion (P < 0.01). Additionally, radiological results showed no noticeable signs of tunnel enlargement in the calcaneus and no patient had re-rupture. Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft is an effective treatment option for patients with acute Achilles tendon rupture with large defects and have high postoperative exercise demands.
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Affiliation(s)
- Han Xue
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Fengxu Xiao
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Ruochen Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Guangwei Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Zheyue Zhu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Chen Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Miao Li
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
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Lavender CD, Schaver AL, Taylor S, Peluso R, Berdis G, Singh V, Cipriani K, Jasko J, Hewett TE. Anterior Cruciate Ligament (ACL) Reconstruction Augmentation With Bone Marrow Aspirate, Demineralized Bone Matrix, and Suture Tape Demonstrates No Difference In Outcomes, But Faster Functional Recovery, Versus Non-augmented ACL Reconstruction. Arthroscopy 2024:S0749-8063(24)00492-4. [PMID: 39047990 DOI: 10.1016/j.arthro.2024.06.042] [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: 11/26/2023] [Revised: 06/14/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To compare outcomes after anterior cruciate ligament reconstruction (ACLR) with bone marrow aspirate concentrate (BMAC), demineralized bone matrix (DBM), and suture tape augmentation (STA) vs. ACLR without biologic augmentation or STA. METHODS A prospective randomized controlled trial at a single institution was performed to compare ACLR with BMAC, DBM, and STA (Group A) vs. ACLR without biologic or STA (Group NA). One hundred patients were required. Skeletally mature patients <25 years old received quadriceps tendon autografts, while patients ≥25 years old received allograft ACLR with an all-inside technique. Concomitant meniscal pathologies were included. Primary outcomes compared were range-of-motion (ROM), limb symmetry, and patient-reported outcomes (PROs). Secondary outcomes included radiographic outcomes and surgical complications. Univariate and mixed-model regression analysis were used to compare outcomes. RESULTS Fifty-nine patients were included (Group A: 29 patients, 11 females, 38%; Group NA: 30 patients, 15 females, 50%). Early range-of-motion at 6 weeks (125° vs 109° flexion, p<0.0001) and limb symmetry testing at 12 weeks (80.6 % vs. 36.7% [Delta 43.9%], p<0.001) were significantly improved in Group A. At two years, International Knee Documentation (IKDC) scores were similar (91.1 ± 12.7 vs. 85.3 ± 10.8, p=0.109). Knee Injury and Osteoarthritis and Outcome Score (KOOS) Quality of Life (QOL) scores were significantly enhanced in Group A (85.2 ± 20.9 vs. 72.1 ± 20.4, p=0.042). Twenty-two patients (12 Group A, 10 Group NA) underwent CT scans at 6-months to compare bone tunnel healing. Overall, the mean increase in bone tunnel diameter was significantly smaller in Group A vs. NA. No difference in graft re-ruptures or re-operations was observed. Seven of 59 patients (11.9%) underwent re-operation for stiffness (A: 3 (10%) vs. NA: 4 (13%), p=1.0). CONCLUSION There were no differences in IKDC scores between groups at 2-year follow-up. Functional outcomes including early range-of-motion and limb symmetry were significantly improved in patients who received ACLR with BMAC, DBM, and STA. ACLRACLR.ACLR.
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Affiliation(s)
- Chad D Lavender
- Marshall University, Department of Orthopedic Surgery 1600 Medical Center Dr. Huntington, WV 25701.
| | - Andrew L Schaver
- Marshall University, Department of Orthopedic Surgery 1600 Medical Center Dr. Huntington, WV 25701
| | - Shane Taylor
- Marshall University, Department of Orthopedic Surgery 1600 Medical Center Dr. Huntington, WV 25701
| | - Richard Peluso
- Marshall University, Department of Orthopedic Surgery 1600 Medical Center Dr. Huntington, WV 25701
| | - Galen Berdis
- Marshall University, Department of Orthopedic Surgery 1600 Medical Center Dr. Huntington, WV 25701
| | - Vishapreet Singh
- Marshall University, Department of Orthopedic Surgery 1600 Medical Center Dr. Huntington, WV 25701
| | - Kara Cipriani
- Marshall University, Department of Orthopedic Surgery 1600 Medical Center Dr. Huntington, WV 25701
| | - John Jasko
- Marshall University, Department of Orthopedic Surgery 1600 Medical Center Dr. Huntington, WV 25701
| | - Timothy E Hewett
- Marshall University, Department of Orthopedic Surgery 1600 Medical Center Dr. Huntington, WV 25701
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Li X, Li H, Su J, Ding R. Anterior cruciate ligament femoral side retained stump technique reduces enlargement of the femoral bone tunnel after anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:380. [PMID: 38745214 PMCID: PMC11092199 DOI: 10.1186/s12891-024-07464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Enlargement of the bone tunnel has become an unavoidable early complication after anterior cruciate ligament (ACL) reconstruction, whether it is a single or double-bundle ACL reconstruction. Preservation of the ACL stump in ACL reconstruction reduces enlargement of the bone tunnel. The purpose of this study was to investigate the question of whether single-bundle ACL reconstruction using the ACL femoral side retained stump technique reduces enlargement of the femoral tunnel. METHODS Forty patients who underwent single-bundle reconstruction of the ACL were included in this study. The patients were categorized into a Remnant preservation group (Group R) and the Non-remnant preservation group (Group N). In the Remnant preservation group, a high-flexion femoral side retained stump technique was used intraoperatively for the establishment of the femoral side bone tunnel, and in the Non-remnant preservation group, the conventional femoral positioning method was used (we used a femoral positioning drill for localization and drilling of the femoral bone tunnel), and MRI of the operated knee joints was performed at 6 months postoperatively. We measured the internal diameter of the femoral bone tunnel at 5 mm from the intra-articular outlet of the femoral bone tunnel on an MRI scan image perpendicular to the femoral bone tunnel. The size of the tunnel was compared between the intraoperative drilling of the bone tunnel and the size of the bone tunnel at 6 months postoperatively. Postoperative clinical assessment was Lysholm score. RESULTS After a 6-month follow-up of 40 patients, the diameter of the femoral tunnel at a distance of 5 mm from the inner opening of the femoral tunnel was 10.96 ± 0.67 mm and 10.11 ± 0.62 mm in patients of group N and group R, respectively, and the difference was statistically significant (P < 0.05).The diameter of the femoral tunnel at 6 months postoperatively in group N and group R compared to the intraoperative bone tunnel increased by 2.58 ± 0.24 mm and 1.94 ± 0.31 mm, and the difference was statistically significant (P < 0.05).The femoral tunnel enlargement rates of group N and group R were 30.94 ± 3.00% and 24.02 ± 5.10%, respectively, and the differences were significant (P < 0.05). CONCLUSION ACL femoral side retained stump technique does not sacrifice the ideal location of the femoral tunnel and is able to preserve the possible benefits of the ACL stump: reduced femoral tunnel enlargement.
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Affiliation(s)
- Xiaobo Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hanlin Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- Clinical Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Jixian Su
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- Clinical Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Ran Ding
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China.
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Lin Y, Zhang L, Shen S, Chen Y, Xu L, Ji M, Guo Y, Wei J, Li Y, Wu X, Lu J. No Difference in Bone Tunnel Enlargement and Clinical Outcome between Cortical Suspension and Hybrid Femoral Fixation in Hamstring Anterior Cruciate Ligament Reconstruction. Orthop Surg 2024; 16:902-911. [PMID: 38444378 PMCID: PMC10984824 DOI: 10.1111/os.14024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE The best method for femoral fixation in anterior cruciate ligament reconstruction (ACLR) remains controversial. The study assesses the bone tunnel enlargement and clinical outcome in hamstring ACLR using cortical suspension or hybrid (cortical suspension and compression) femoral fixation. METHODS From January 2010 to December 2021, 102 patients who underwent quadruple hamstring ACLR using cortical suspension (39 patients) or hybrid (63 patients) fixation on the femoral side were retrospectively analyzed. Clinical evaluation was conducted using the international knee documentation committee score, the Lysholm score, the Tegner activity level scale, the knee injury and osteoarthritis outcome score (quality of life score), the Lachman test, and the side-to-side difference by the KT-1000 arthrometer. The complications after the surgery were also evaluated. These data were compared at baseline and last follow-up. The diameters of the femoral tunnel were calculated at three sites: the width of the entrance of the femoral tunnel, 1 cm proximal to the entrance of the femoral tunnel and the largest diameter of the femoral tunnel on magnetic resonance imaging (MRI) coronal images. Bone tunnel widening data were contrasted between MRI images conducted at least 2 years and within 2 weeks after surgery. The morphology of bone tunnel enlargement was also observed and recorded. The categorical parameters were analyzed using the χ2-test and Fisher's exact test. The continuous variables conforming to a normal distribution were analyzed using Student's t-test, and the Mann-Whitney U-test was undertaken between the two groups without normal distribution. RESULTS Both cortical suspension and hybrid femoral fixation in quadruple hamstring ACLR achieved significantly improved patient-reported outcome scores and knee stability compared to preoperative data. However, no significant differences were found between these two methods in clinical evaluations, postoperative complications, and patient-reported outcome scores. Although the mean diameter of the enlarged bone tunnel was lowered by an additional bioabsorbable interference screw fixation near the joint line, a statistically insignificant difference was found between the hybrid and cortical suspension fixation on the femoral side. There was no statistical difference in the distribution of enlarged bone tunnel morphology between groups. CONCLUSIONS No significant difference was found in the bone tunnel enlargement and clinical outcome between cortical suspension and hybrid femoral fixation in ACLR using hamstring autograft.
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Affiliation(s)
- Yucheng Lin
- Department of Orthopaedic SurgeryZhongda Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Lu Zhang
- Department of AnesthesiologyWomen's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care HospitalNanjingChina
| | - Sinuo Shen
- Department of Orthopaedic SurgeryZhongda Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Yuzhi Chen
- Department of Orthopaedic SurgeryZhongda Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Li Xu
- Department of Orthopaedic SurgeryZhongda Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Mingliang Ji
- Department of Orthopaedic SurgeryZhongda Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Yudong Guo
- Department of Orthopaedic SurgeryZhongda Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Jinan Wei
- Department of Orthopaedic SurgeryZhongda Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Yonggang Li
- Department of Orthopaedic SurgeryZhongda Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Xiaotao Wu
- Department of Orthopaedic SurgeryZhongda Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Jun Lu
- Department of Orthopaedic SurgeryZhongda Hospital, School of Medicine, Southeast UniversityNanjingChina
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Yoon KH, Park CH, Hwang SH, Baek H, Lee HS. Anatomic femoral tunnel position in medial patellofemoral ligament reconstruction: anterior versus posterior. BMC Musculoskelet Disord 2023; 24:945. [PMID: 38057743 DOI: 10.1186/s12891-023-07069-3] [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: 09/18/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament reconstruction (MPFLR) between anatomic femoral tunnel positions at anterior and posterior footprints. METHODS Fifty-seven patients who underwent MPFLR for patellofemoral instability with anterior or posterior femoral tunnels between 2014 and 2021 with at least 2 years of follow-up were retrospectively analyzed. Based on postoperative images, the femoral tunnel positions anterior to the line connecting the adductor tubercle and medial epicondyle were assigned to the anterior group, group A, and those posterior to the line to the posterior group, group P. Thirty-two patients were included in group A (mean age, 22.4 ± 8.8 years), and another 25 patients were included in group P (mean age, 21.1 ± 6.1 years). The International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity score, Kujala score, and complications were evaluated. Radiologically, the Caton-Deschamps index (CDI), patellar tilt angle, and patellofemoral osteoarthritis (PFOA) using the Kellgren-Lawrence (KL) scale were evaluated. The patellofemoral cartilage status according to the International Cartilage Repair Society (ICRS) grade, bone contusion, femoral tunnel enlargement, and MPFL graft signal intensity were also evaluated. RESULTS All clinical scores significantly improved in both groups (p < 0.01). No differences were noted between the two groups in terms of their preoperative demographic data, postoperative clinical scores (IKDC, Lysholm, Tegner, and Kujala), complications, or radiological findings (CDI, patellar tilt angle, PFOA, bone contusion, femoral tunnel enlargement, and graft signal intensity). The ICRS grade for the medial facet of the patella progressed in group A (30%, p = 0.02) but not in group P (18%, p = n.s.). Additionally, no significant differences were observed in the other compartments of the patellofemoral joint. CONCLUSIONS The clinical outcomes were significantly improved in both groups; however, MPFLR with anterior femoral tunnel position had worse cartilage status on the medial facet of the patella than the posterior femoral tunnel position. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Sung Hyun Hwang
- Department of Orthopaedic Surgery, Pohang St. Mary's Hospital, Pohang-si, Gyeongsangbuk-do, Republic of Korea
| | - Hyunjae Baek
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Hee Sung Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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Lee SS, Lee DH. Serial change of femoral and tibial tunnel width after anterior cruciate ligament reconstruction with allograft. Knee Surg Sports Traumatol Arthrosc 2023; 31:5057-5066. [PMID: 37698665 DOI: 10.1007/s00167-023-07543-4] [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: 12/28/2022] [Accepted: 08/09/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To investigate progressive tunnel widening and its correlation with postoperative outcomes after anterior cruciate ligament (ACL) reconstruction using allografts. METHODS Sixty-five patients who underwent ACL reconstruction using a tibialis anterior allograft between 2015 and 2017 were enrolled. Femoral and tibial tunnel widths were measured on anteroposterior (AP) and lateral radiographs immediately and at 3, 6, 12, and 24 months postoperatively. Average femoral and tibial tunnel widths in AP and lateral views were calculated at three different measurement points. Tunnel widening was calculated as the difference in tunnel width immediately and 2 years postoperatively. The correlation between tunnel widening and the postoperative results was analysed. RESULTS Tunnel width changes between immediate and 2 years postoperatively were as follows, in AP and lateral views, respectively: femur, 3.0 mm ± 1.5 mm and 2.4 mm ± 1.4 mm; and tibia, 2.8 mm ± 1.4 mm and 2.9 mm ± 1.5 mm. Femoral tunnel widths significantly increased until 1 year, but not from 1 to 2 years postoperatively. Tibial tunnel width significantly increased until 2 years postoperatively. In all tunnels, the increments in tunnel widening decreased over time. Increased knee laxity significantly correlated with greater femoral tunnel widening in AP (r = 0.346, P = 0.006) and lateral views (r = 0.261, P = 0.049). CONCLUSION Femoral tunnel widths gradually increased until 1 year postoperatively, and tibial tunnel widths increased until 2 years after ACL reconstruction with allografts. The tunnel widening rate gradually decreased over time. Femoral tunnel widening of 3.7 mm and 3.2 mm on AP and lateral views, respectively, were the cut-off values for postoperative knee laxity. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
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Lee OS, Kim JI, Han SH, Lee JK. Beneficial Effect of Curved Dilator System for Femoral Tunnel Creation in Preventing Femoral Tunnel Widening after Anterior Cruciate Ligament Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1437. [PMID: 37629727 PMCID: PMC10456963 DOI: 10.3390/medicina59081437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Backgrounds and objectives: A prevalent concern in anterior cruciate ligament (ACL) reconstruction is postoperative tunnel widening. We hypothesized that employing a curved dilator system (CDS) for femoral tunnel creation can reduce this widening after ACL reconstruction compared to the use of a conventional rigid reamer. Materials and Methods: A retrospective study was conducted involving 56 patients who underwent primary ACL reconstruction between January 2012 and July 2013. The patients were categorized into two groups: the reamer group (n = 28) and CDS group (n = 28). All participants were followed up for a minimum of 2 years. Clinical assessment included the Lachman test and pivot-shift test, and the Lysholm score and subjective International Knee Documentation Committee scores. Radiographic evaluation covered the tunnel widening rate, represented as the ratio of the tunnel diameter 2 years after surgery to the tunnel diameter immediately after surgery, and the ratio (A/B) of femoral tunnel (A) to tibial tunnel (B) diameters at respective time points. Results: No significant disparities were found between the two groups in terms of clinical outcomes. However, the reamer group exhibited a greater femoral tunnel widening rate compared to the CDS group (reamer group vs. CDS group: 142.7 ± 22.0% vs. 128.0 ± 19.0% on the anteroposterior (AP) radiograph and 140.8 ± 14.2% vs. 122.9 ± 13.4% on the lateral radiograph; all p < 0.05). Two years post-operation, the A/B ratio rose in the reamer group (0.96 ± 0.05→1.00 ± 0.05 on the AP radiograph and 0.94 ± 0.03→1.00 ± 0.0.04 on the lateral radiograph; all p < 0.05), while it decreased in the CDS group (0.99 ± 0.02→0.96 ± 0.05 on the AP radiograph and 0.97 ± 0.03→0.93 ± 0.06 on the lateral radiograph; all p < 0.05). Conclusion: The use of CDS for femoral tunnel creation in primary ACL reconstruction provides a potential advantage by limiting tunnel widening compared to the conventional rigid-reamer approach.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Uijeongbu-si 11759, Republic of Korea;
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul 07741, Republic of Korea;
| | - Seok Hyeon Han
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
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Kurihara S, Yanagisawa S, Takahashi T, Hagiwara K, Hatayama K, Takase R, Kimura M, Chikuda H. Increased Bone Plug Depth From the Joint Increases Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft With Suspensory Femoral Fixation. Arthrosc Sports Med Rehabil 2023; 5:100755. [PMID: 37520501 PMCID: PMC10382878 DOI: 10.1016/j.asmr.2023.100755] [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: 12/17/2022] [Accepted: 05/29/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To determine a safe bone plug depth fixation zone based on early tunnel enlargement rates in anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autograft with suspensory femoral fixation. Methods Patients who had undergone rectangular tunnel ACL reconstruction using BPTB autograft with suspensory femoral fixation were retrospectively identified. Femoral and tibial tunnel aperture areas were measured on computed tomography 2 weeks and 6 months after surgery to calculate rates of femoral and tibial tunnel enlargement (FTE and TTE), respectively. Femoral bone plug depth (FBPD) and tibial bone plug depth (TBPD) were defined as the distance of the tip of the plug from the respective joint lines. Optimal FBPD and TBPD cutoff values were calculated for the following rates of FTE and TTE, respectively: 0%, 15%, 30%, and 50%. Results Sixty-four patients (19 females, 45 males; mean age, 29.5 ± 12.3 years) were included in the study. The femoral and tibial tunnel apertures significantly enlarged over time. FBPD (P < .001; r = 0.607) and TBPD (P = .013; r = 0.308) were positively correlated with FTE and TTE, respectively. The optimal FBPD cutoff value was 2.8 mm for FTE rates of 0% and 15%, 3.6 mm for 30%, and 6.0 mm for 50%. The optimal TBPD cutoff value was 1.48 mm for a 0% TTE rate and 5.1 mm for those higher. The cutoff value specificities were lower for the tibial tunnel than the femoral tunnel for each tunnel enlargement rate. Conclusion Early tunnel enlargement and bone plug depth were significantly correlated in bone the femoral and tibial tunnels. The degree of correlation was higher in the femoral tunnel. To minimize bone tunnel enlargement, the distal end of the femoral bone plug should be placed less than 2.8 mm from the tunnel aperture. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Shingo Kurihara
- Department of Orthopaedic Surgery, Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Shinya Yanagisawa
- Department of Orthopaedic Surgery, Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Tsuneari Takahashi
- Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimokoyama, Japan
| | - Keiichi Hagiwara
- Department of Orthopaedic Surgery, Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Kazuhisa Hatayama
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Gunma Central Hospital, Gunma, Japan
| | - Ryota Takase
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Masashi Kimura
- Department of Orthopaedic Surgery, Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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10
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Kanto R, Yamaguchi M, Yoshiya S, Matsumoto A, Sasaki K, Kambara S, Nakayama H, Tachibana T. Postoperative Tunnel Widening, Elliptical Aperture Shape, and No Preservation of the Remnant Are Related to the Tendon Graft-Bone Tunnel Gap Formation at the Intra-Articular Aperture After Double-Bundle Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2023; 5:e507-e514. [PMID: 37101875 PMCID: PMC10123504 DOI: 10.1016/j.asmr.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/06/2023] [Indexed: 04/28/2023] Open
Abstract
Purpose To examine the bone-tendon healing at the posterolateral (PL) femoral tunnel aperture by second-look arthroscopy after double-bundle anterior cruciate ligament reconstruction (ACLR), and assess the risk factors for impaired healing at the tendon-bone interface. Methods A consecutive series of knees undergoing primary double-bundle ACLR using hamstring tendon autografts were enrolled in the study. The exclusion criteria were as follows: previous knee surgeries, concomitant ligamentous and osseous procedures, and a lack of second-look arthroscopy or postoperative computed tomography data for the analysis. Cases in which a gap was identified between the graft and tunnel aperture during the second-look arthroscopic examination were classified as the gap formation (GF) group. A multivariate logistic regression analysis was performed to assess the relationship between the GF and variables that may determine prognosis. Results A total of 54 knees that met the inclusion/exclusion criteria were included in the study. Second-look arthroscopy revealed the GF at the PL aperture in 22 of the 54 knees (40%). The time period from surgery to arthroscopy averaged 16 months. In the multivariate logistic regression analysis, the percentage tunnel widening at 1 year on computed tomography (odds ratio, 10.4; 95% confidence interval [CI] 1.56-69.2), ellipticity of the tunnel aperture (odds ratio, 3.57; 95% CI, 0.79-16.11), and no ACL remnant preservation (odds ratio, 5.99; 95% CI, 1.23-29.06) were identified as prognostic factors significantly related to graft-bone tunnel GF. Conclusions Second-look arthroscopy revealed GF at the PL graft-bone tunnel interface in 40% of the knees after double-bundle ACLR. Incomplete healing of the interface, as evidenced by a graft-bone gap at the tunnel aperture, was associated with tunnel widening 1-year postsurgery, an elliptical aperture shape, and no preservation of the ACL remnant. Level of Evidence Ⅲ, retrospective case-control study.
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Affiliation(s)
- Ryo Kanto
- Department of Orthopaedic Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
- Address correspondence to Ryo Kanto, M.D., Ph.D., Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan.
| | - Motoi Yamaguchi
- Department of Orthopaedic Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya, Hyogo, Japan
| | - Akio Matsumoto
- Department of Orthopaedic Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan
| | - Ken Sasaki
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe, Hyogo, Japan
| | - Shunichiro Kambara
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
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11
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Lee SS, Kim IS, Shin TS, Lee J, Lee DH. Femoral Tunnel Position Affects Postoperative Femoral Tunnel Widening after Anterior Cruciate Ligament Reconstruction with Tibialis Anterior Allograft. J Clin Med 2023; 12:jcm12051966. [PMID: 36902753 PMCID: PMC10004624 DOI: 10.3390/jcm12051966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
This study aims to identify potential factors for both femoral and tibial tunnel widening (TW) and to investigate the effect of TW on postoperative outcomes after anterior cruciate ligament (ACL) reconstruction with a tibialis anterior allograft. A total 75 patients (75 knees) who underwent ACL reconstruction with tibialis anterior allografts were investigated between February 2015 and October 2017. TW was calculated as the difference in tunnel widths between the immediate and 2-year postoperative measurements. The risk factors for TW, including demographic data, concomitant meniscal injury, hip-knee-ankle angle, tibial slope, femoral and tibial tunnel position (quadrant method), and length of both tunnels, were investigated. The patients were divided twice into two groups depending on whether the femoral or tibial TW was over or less than 3 mm. Pre- and 2-year follow-up outcomes, including the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, and side-to-side difference (STSD) of anterior translation on stress radiographs, were compared between TW ≥ 3 mm and TW < 3 mm. The femoral tunnel position depth (shallow femoral tunnel position) was significantly correlated with femoral TW (adjusted R2 = 0.134). The femoral TW ≥ 3 mm group showed greater STSD of anterior translation than the femoral TW < 3 mm group. The shallow position of the femoral tunnel was correlated with the femoral TW after ACL reconstruction using a tibialis anterior allograft. A femoral TW ≥ 3 mm showed inferior postoperative knee anterior stability.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi 10380, Republic of Korea
| | - Il Su Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Tae Soo Shin
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jeounghun Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Correspondence: ; Tel.: +82-2-3410-3509
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12
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Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020390. [PMID: 36837591 PMCID: PMC9967347 DOI: 10.3390/medicina59020390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Background and Objectives: Tunnel enlargement (TE) is a widely reported phenomenon after anterior cruciate ligament reconstruction (ACLR). Given the paucity of knowledge in the literature, it remains unclear whether screw position in the tunnel affects TE. This retrospective cohort study evaluated differences in postoperative tunnel enlargement rates (TER) and clinical results between anterior and posterior tibial interference screw insertion during single-bundle ACLR using autologous hamstring grafts. Materials and Methods: A group of consecutive patients that underwent primary arthroscopic single-bundle ACLR in our hospital were screened and divided into two groups based on the position of the tibial interference screw (determined by Computer Tomography within 3 days after surgery): anterior screw position group (A) and posterior screw position group (B). The bone tunnel size was measured using magnetic resonance imaging (MRI) performed 1 year after surgery. International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used for clinical results 1 year postoperatively. Results: 87 patients were included. The TER of Group A is higher than that of Group B (43.17% vs. 33.80%, p = 0.024). Group A showed a significant increase (12.1%) in enlargement rates at the joint line level than group B (43.77% vs. 31.67%, p = 0.004). Moreover, KOOS and IKDC scores improved in both groups. There were no significant differences in clinical outcomes between the two groups. Conclusions: One year after ACLR, patients with posterior screw showed significantly lower TE than patients with anterior screw. However, the position of screw did not lead to differences in clinical results over our follow-up period. Posterior screw position in the tibial tunnel maybe a better choice in terms of reducing TE. Whether the different screw positions affect the long-term TE and long-term clinical outcomes needs to be confirmed by further studies.
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13
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Zhang S, Wen A, Li S, Yao W, Liu C, Lin Z, Jin Z, Chen J, Hua Y, Chen S, Li Y. Radial Extracorporeal Shock Wave Therapy Enhances Graft Maturation at 2-Year Follow-up After ACL Reconstruction: A Randomized Controlled Trial. Orthop J Sports Med 2023; 10:23259671221116340. [PMID: 36760537 PMCID: PMC9902647 DOI: 10.1177/23259671221116340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/16/2022] [Indexed: 02/05/2023] Open
Abstract
Background Graft maturation is an important prognostic factor for hamstring autograft anterior cruciate ligament reconstruction (ACLR). It remains unclear whether extracorporeal shock wave therapy (ESWT) can promote graft healing after ACLR. Purpose To evaluate the therapeutic and graft maturation effects of ESWT in hamstring autograft ACLR. Study Design Randomized controlled trial; Level of evidence, 1. Methods Between May 18, 2019, and September 20, 2019, we randomly assigned 30 patients who met study inclusion criteria to 2 groups. Patients in the control group followed a 5-week advanced rehabilitation training program (30 minutes/session, 5 times/week) starting at 3 months postoperatively. In the ESWT group, together with the 5-week advanced rehabilitation training, radial ESWT was applied once a week for 5 weeks. Functional scores (Lysholm, International Knee Documentation Committee, and Tegner scores), KT-1000 arthrometer knee laxity measurement, and magnetic resonance imaging scans were assessed at 3 months (baseline), 6 months, and 24 months postoperatively. To evaluate graft maturation, we assessed the graft signal-to-noise quotients (SNQs) of the tibial, intra-articular, and femoral sides on magnetic resonance imaging scans. Data were compared between the ESWT and control groups. Results In total, 26 patients (13 with ESWT, 13 controls) were assessed. There were no significant between-group differences on any assessment at baseline, and no significant within-group or between-group differences were found in knee laxity at any point. At 24-month follow-up, the ESWT group had significantly higher Lysholm and Tegner scores compared with the controls (P = .012 and .017, respectively). Regarding graft maturation, at 6-month follow-up, the SNQ of the tibial intraosseous graft was significantly lower in the ESWT group versus controls (P = .006), but no differences were detected at the femoral intraosseous graft (P = .321) or the intra-articular graft (P = .314). At 24-month follow-up, the SNQs of the femoral intraosseous graft and intra-articular graft were significantly lower in the ESWT group versus controls (P = .020 and .044, respectively) but no difference was found at the tibial intraosseous graft (P = .579). Conclusion Both enhanced graft maturation and improved functional scores at 24-month follow-up were seen in patients who received radial ESWT during rehabilitation after hamstring autograft ACLR. Registration ChiCTR1900022853 (Chinese Clinical Trial Registry).
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Affiliation(s)
- Shurong Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China
| | - Aizhen Wen
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China.,Department of Sport Rehabilitation, Shanghai University of Sport,
Shanghai, China
| | - Shengkun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China
| | - Wei Yao
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China
| | - Chang Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China
| | - Zifan Lin
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China
| | - Zhengbiao Jin
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Fudan University,
Shanghai, China.,Yunxia Li, MD, Department of Sports Medicine, Huashan Hospital,
Fudan University, Shanghai, China (
)
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14
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Yang W, Li C, Ji X, Yao M, Hong J, Qu Z, Liu A, Wu H. Synergistic Effect of Reverse Drilling and Bone Dust on Femoral Tendon-Bone Healing After Anterior Cruciate Ligament Reconstruction in a Rabbit Model. Am J Sports Med 2022; 50:3844-3855. [PMID: 36326437 DOI: 10.1177/03635465221129267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries and bone tunnel enlargement (BTE) after ACL reconstruction (ACLR) remain frequent issues. Bone dust (BD) produced by tunnel preparation with osteogenic ability and reverse drilling (RD), an easy compaction technique, make it accessible to enhance tendon-bone healing in the clinic. HYPOTHESIS RD and BD synergistically promote tendon-bone healing by improving peritunnel bone and preventing BTE in femurs. STUDY DESIGN Controlled laboratory study. METHODS In total, 96 New Zealand White rabbits underwent ACLR. The semitendinosus tendon was freed before medial parapatellar arthrotomy. After the native ACL was transected, bone tunnels were prepared through the footprint of the native ACL. All animals were randomly assigned to 1 of 4 groups according to different tunnel preparation methods: group 1 (irrigation after extraction drilling [ED]; control group), group 2 (irrigation after RD), group 3 (no irrigation after ED), and group 4 (no irrigation after RD). BD was harvested by irrigating tunnels and was characterized by morphology and size. The specimens underwent microarchitectural, histological, and biomechanical evaluations at 4, 8, and 12 weeks postoperatively. RESULTS Micro-computed tomography demonstrated more peritunnel bone and less BTE in the femurs of group 4 compared with the other groups. Histologically, BD possessed osteogenic activity in bone tunnels postoperatively. Meanwhile, group 4 regenerated a higher amount of the tendon-bone interface and more peritunnel bone than group 1. Biomechanically, group 4 showed higher failure loads and stiffness than group 1. However, peritunnel bone loss, active osteoclasts, and significant BTE were found in the femurs of group 1 and group 3 at 12 weeks postoperatively, while no strong correlation was found between BTE and inflammatory cytokines. Scanning electron microscopy and particle size analysis suggested that BD produced by ED and RD had no difference in size. CONCLUSION Tendon-bone healing was facilitated by the synergistic effect of RD and BD in femurs. CLINICAL RELEVANCE This study provides a more accessible and effective surgical strategy to promote tendon-bone healing after ACLR by increasing peritunnel bone and preventing BTE in femurs.
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Affiliation(s)
- Weinan Yang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Congsun Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Xiaoxiao Ji
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Minjun Yao
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Jianqiao Hong
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Zihao Qu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - An Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Haobo Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
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15
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Chen N, Wang C, Li D, Jiang Y, Ao Y. Effect of Joint Infection After Arthroscopic Single-Bundle ACL Reconstruction With Autologous Hamstring Tendon: A Retrospective Matched MRI Study. Orthop J Sports Med 2022; 10:23259671221125493. [PMID: 36263310 PMCID: PMC9575462 DOI: 10.1177/23259671221125493] [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: 06/28/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Joint infection after anterior cruciate ligament (ACL) reconstruction is a
rare but serious complication. Purpose: To assess the effect of joint infection on the graft, cartilage, and bone
tunnel using magnetic resonance imaging (MRI) after arthroscopic
single-bundle ACL reconstruction with autologous hamstring tendons. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective matched cohort study included 26 patients who underwent
arthroscopic single-bundle ACL reconstruction with hamstring tendon graft at
the authors’ institute between January 2002 and December 2017 and developed
postoperative joint infection. These patients were matched 1:3 to patients
who did not sustain joint infection after ACL reconstruction (control
group). MRI scans were collected at the time of follow-up. The following
parameters were evaluated: graft signal-to-noise quotient (SNQ); graft
signal intensity at the bone-graft interface and within the knee joint; bone
tunnel enlargement at the tunnel aperture, midsection, and exit of the
tibial and femoral tunnels; and cartilage integrity. Results: The average follow-up time was 47.8 months in the infection group and 48.5
months in the control group. Compared with the control group, the infection
group had a significantly higher SNQ (20.01 ± 12.08 vs 7.61 ± 6.70;
P = .014) as well as a higher signal intensity at the
bone-graft interface (P = .037) and higher Howell grade
(P = .031). The mean enlargement at the femoral tunnel
aperture was 31.20% ± 26.76% in the infection group and 19.22% ± 20.10% in
the control group (P = .037). The articular cartilage of
the patellofemoral and lateral femorotibial joints showed more degenerative
change in the infection group. Conclusion: Study findings indicated that graft ligamentization and incorporation graft
maturity were inferior in patients who experienced a joint infection after
ACL reconstruction compared with patients who did not.
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Affiliation(s)
- Nayun Chen
- Department of Sports Medicine, Peking University Third Hospital,
Beijing, China.,Institute of Sports Medicine of Peking University, Beijing,
China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital,
Beijing, China.,Institute of Sports Medicine of Peking University, Beijing,
China
| | - Dai Li
- Department of Sports Medicine, Peking University Third Hospital,
Beijing, China.,Institute of Sports Medicine of Peking University, Beijing,
China
| | - Yanfang Jiang
- Department of Sports Medicine, Peking University Third Hospital,
Beijing, China.,Institute of Sports Medicine of Peking University, Beijing,
China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital,
Beijing, China.,Institute of Sports Medicine of Peking University, Beijing,
China.,Yingfang Ao, MD, Institute of Sports Medicine of Peking
University, 49 North Garden Road, Haidian District, Beijing 100191, China
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16
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Taketomi S, Inui H, Yamagami R, Nakazato K, Kawaguchi K, Kono K, Sameshima S, Kage T, Tanaka S. Lateral posterior tibial slope does not affect femoral but does affect tibial tunnel widening following anatomic anterior cruciate ligament reconstruction using a Bone-Patellar Tendon-Bone graft. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 30:25-31. [PMID: 36254269 PMCID: PMC9539629 DOI: 10.1016/j.asmart.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/17/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
Background Tunnel widening (TW) after anterior cruciate ligament (ACL) reconstruction has been a research area of interest in ACL reconstruction. In recent years, it has been noted that posterior tibial slope (PTS) affects several types of outcomes after ACL reconstruction including TW. However, the relationships between femoral and tibial TW and between PTS and TW following anatomical ACL reconstruction using a bone–patellar tendon–bone (BTB) graft are often not understood. Therefore, the purpose of this study was to retrospectively clarify the magnitude of femoral and tibial TW and the effect of PTS on TW following anatomical ACL reconstruction using a BTB graft. Methods A total of 111 patients who underwent isolated ACL reconstructions using BTB grafts were included in this study. Femoral and tibial tunnel aperture areas were measured using three-dimensional computed tomography (3D CT) at 1 week and 1 year postoperatively, and femoral and tibial TW (%) was calculated. Lateral and medial PTS was also measured using 3D CT. Results As compared with 1 week postoperatively, the mean tibial tunnel aperture areas increased by 30.6% ± 28.5%, and the mean femoral tunnel aperture areas increased by 28.3% ± 27.9% when measured at 1 year postoperatively. Although no significant difference was observed between femoral and tibial TW, a significant positive correlation was noted between femoral and tibial TW (r = 0.240, p = 0.011). A significant correlation was observed only between lateral PTS and tibial TW (r = 0.354, p < 0.001). There was no significant correlation between medial PTS and tibial TW, lateral PTS and femoral TW, or medial PTS and femoral TW. Conclusion Significant positive correlation was observed between femoral and tibial TW. Steeper lateral PTS correlated with greater tibial TW; on the other hand, medial PTS did not correlate with tibial TW. Although lateral PTS affected tibial TW, it did not affect femoral TW.
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Affiliation(s)
- Shuji Taketomi
- Corresponding author. 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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17
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Liu D, Cai ZJ, Lu WH, Pan LY, Yang YT, Li YS, Xiao WF. Eccentrically widened bone tunnels after all-inside anterior cruciate ligament reconstruction: a computed tomography and three-dimensional model-based analysis. Knee Surg Sports Traumatol Arthrosc 2022; 31:2374-2385. [PMID: 36138208 PMCID: PMC10183415 DOI: 10.1007/s00167-022-07164-3] [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] [Received: 06/11/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the extent of tunnel widening after anterior cruciate ligament reconstruction (ACLR) using the all-inside technique and to establish its correlation with patient-reported clinical outcomes and femoral graft bending angle (GBA). METHODS Tunnel widening was evaluated using computed tomography (CT)-based three-dimensional (3D) models, and the femoral GBA was directly measured on CT images using the Picture Archiving and Communication System (PACS) software. Clinical follow-up was routine procedure, and patient-reported clinical outcomes mainly included International Knee Documentation Committee (IKDC), Lysholm, and Knee Injury and Osteoarthritis Outcome Scores (KOOS) scores, and subjective knee stability assessment. RESULTS Fifty-two patients received standard all-inside ACLR, with a median follow-up of 6 months. Reconstructed anterior cruciate ligaments (ACLs) were scanned during the first 3 days and 6 months after surgery. On both the femoral and tibial sides, bone tunnels were most significantly enlarged at the articular aperture segment; the femoral tunnel was 9.2 ± 1.3 mm postoperatively and was significantly enlarged by 32% to a mean tunnel diameter of 12.1 ± 2.0 mm at 6 months after surgery. Moreover, the extent of tunnel enlargement gradually decreased as the measured levels approached those of the bone cortex. The femoral tunnel center was shifted into the anterior and distal direction, and the tibial tunnel center was shifted into the posterior and lateral direction. Additionally, the mean femoral GBA was 105.9° ± 8.1° at the 6-month follow-up. Tunnel enlargement and GBA were not significantly correlated with patient-reported outcomes. CONCLUSIONS Femoral and tibial tunnels were significantly greater and eccentrically shifted at the 6-month follow-up after all-side ACLR. However, the extent of tunnel widening does not markedly affect the short-term clinical outcomes. Meanwhile, the femoral GBA was not significantly correlated with femoral tunnel widening or patient-reported outcomes. Although the tunnel widening following all-inside ACLR was not associated with clinical outcomes, it potentially caused difficulties in revision ACLR. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Di Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Zi-Jun Cai
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Wen-Hao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Lin-Yuan Pan
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Yun-Tao Yang
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Yu-Sheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Wen-Feng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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18
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[Core techniques and adverse events in anterior cruciate ligament reconstruction using a new generation of artificial ligaments: the consensus of Chinese specialists based on a modified Delphi method (Part 2)]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1047-1055. [PMID: 36111464 PMCID: PMC9626301 DOI: 10.7507/1002-1892.202206026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Anterior cruciate ligament (ACL) reconstruction using a new generation of artificial ligaments (NGAL) gained popularity in China owing to its good effectiveness and early functional recovery, but iatrogenic surgical failures and preconceived misconceptions have seriously affected its standardized clinical application. A specialist consensus is now developed to provide guidance and reference for orthopaedic sports medicine doctors when adopting or considering the NGAL for ACL reconstruction. METHODS The consensus on the core techniques and adverse events in ACL reconstruction using the NGAL was developed by a modified Delphi method, referring exclusively to the NGAL for ACL reconstruction approved by the National Medical Products Administration (NMPA). Consensus specialists were selected from the members of the Chinese Association of Orthopaedic Surgeons (CAOS) and the Chinese Society of Sports Medicine (CSSM). The drafting team summarized the draft consensus terms based on medical evidence and organized rounds of investigation: two rounds of online questionnaire investigation and the final round of face-to-face meeting. After discussion, revision, and voting, a consensus on the draft consensus term was reached when the agreement rate exceeded 85%. The consensus terms were categorized as "strong" (agreement rate: 95.0%-100%), "moderate" (agreement rate: 90.0%-94.9%), and "basic" (agreement rate: 85.0%-89.9%). RESULTS Thirty-one specialists completed the questionnaire investigation. They all practiced in university teaching hospitals (Grade-A tertiary hospitals) from 16 provinces, autonomous regions, and municipalities in China. Among them, 28 were chief physicians and 3 were associate chief physicians; 22 were professors and 7 were associate professors; the average seniority in orthopedic sports medicine was 25.2 years (range, 12-40 years); the average seniority in performing ACL reconstruction procedures was 13.2 years (range, 7-23 years); in terms of the number of ACL reconstruction using the NGAL, 18 completed more than 100 cases, of which 6 had more than 300 cases; in terms of research, 28 had published more than 1 related paper in the past 5 years, of which 13 had published more than 3 related papers. Twenty-six specialists attended the face-to-face meeting and reached a consensus on 9 terms, including 8 strong terms and 1 moderate term. CONCLUSION ACL reconstruction using the NGAL must deploy "isometric" or "near-isometric" reconstruction and should preserve the natural ACL remnants as much as possible. Bone tunnel positioning can be performed using intraoperative radiographic measurements or the lateral femoral intercondylar ridge as reference marks. Incorrect positioning of the bone tunnel is the main reason of surgical failure, and there is a lack of consensus on handling interference screws during revision. Bone tunnel enlargement exists after reconstruction but rarely causes related symptoms. Synovitis and infection are uncommon complications. The aging effect of polyethylene terephthalate fiber on the long-term clinical outcomes is unknown and deserves attention.
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19
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Putnis SE, Klasan A, Oshima T, Grasso S, Neri T, Coolican MRJ, Fritsch BA, Parker DA. Magnetic Resonance Imaging Assessment of Hamstring Graft Healing and Integration 1 and Minimum 2 Years after ACL Reconstruction. Am J Sports Med 2022; 50:2102-2110. [PMID: 35612835 DOI: 10.1177/03635465221096672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An increase has been seen in the number of studies of anterior cruciate ligament reconstruction (ACLR) that use magnetic resonance imaging (MRI) as an outcome measure and proxy for healing and integration of the reconstruction graft. Despite this, the MRI appearance of a steady-state graft and how long it takes to achieve such an appearance have not yet been established. PURPOSE To establish whether a hamstring tendon autograft for ACLR changes in appearance on MRI scans between 1 and 2 years and whether this change affects a patient's ability to return to sports. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients with hamstring tendon autograft ACLR underwent MRI and clinical outcome measures at 1 year and at a final follow-up of at least 2 years. MRI graft signal was measured at multiple regions of interest using oblique reconstructions both parallel and perpendicular to the graft, with lower signal indicative of better healing and expressed as the signal intensity ratio (SIR). Changes in tunnel aperture areas were also measured. Clinical outcomes were side-to-side anterior laxity and patient-reported outcome measures (PROMs). RESULTS A total of 42 patients were included. At 1 year, the mean SIR for the graft was 2.7 ± 1.2. Graft SIR of the femoral aperture was significantly higher than that of the tibial aperture (3.4 ± 1.3 vs 2.6 ± 1.8, respectively; P = .022). Overall, no significant change was seen on MRI scans after 2 years; a proximal graft SIR of 1.9 provided a sensitivity of 96% to remain unchanged. However, in the 6 patients with the highest proximal graft SIR (>4) at 1 year, a significant reduction in signal was seen at final follow-up (P = .026), alongside an improvement in sporting level. A significant reduction in aperture area was also seen between 1 and 2 years (tibial, -6.3 mm2, P < .001; femoral, -13.3 mm2, P < .001), which was more marked in the group with proximal graft SIR >4 at 1 year and correlated with a reduction in graft signal. The patients had a high sporting level; the median Tegner activity score was 6 (range, 5-10), and a third of patients scored either 9 or 10. Overall, PROMs and knee laxity were not associated with MRI appearance. CONCLUSION In the majority of patients, graft SIR on MRI did not change significantly after 1 year, and a proximal graft SIR <2 was a sensitive indicator for a stable graft signal, implying healing. Monitoring is proposed for patients who have a high signal at 1 year (proximal graft SIR >4), because a significant reduction in signal was seen in the second year, indicative of ongoing healing, alongside an improvement in sporting level. A reduction in tunnel aperture area correlated with a reduction in graft SIR, suggesting this could also be a useful measure of graft integration.
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Affiliation(s)
- Sven E Putnis
- Avon Orthopaedic Centre, Bristol, UK.,University Hospitals Bristol & Weston NHS Foundation Trust, UK
| | | | - Takeshi Oshima
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.,Asanogawa General Hospital, Kanazawa, Japan
| | - Samuel Grasso
- University of Sydney, Sydney, Australia.,Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Thomas Neri
- Laboratory of Human Movement Science, University of Lyon - University Jean Monnet, Saint Etienne, France.,Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, France
| | | | | | - David A Parker
- University of Sydney, Sydney, Australia.,Sydney Orthopaedic Research Institute, Sydney, Australia
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20
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DeFroda SF, Owens BD, Wright RW, Huston LJ, Pennings JS, Haas AK, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting. Am J Sports Med 2022; 50:2397-2409. [PMID: 35833922 DOI: 10.1177/03635465221104470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described. PURPOSE To describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics. RESULTS A total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (P≤ .001). Patients who required 2-stage grafting had more previous ACLRs (P < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure (P≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft (P≤ .008) and less likely to receive a soft tissue autograft (P≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (P≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group. CONCLUSION Tunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.
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Affiliation(s)
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- Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven F DeFroda
- University of Missouri, Columbia, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brett D Owens
- Brown Alpert Medical School, Providence, Rhode Island, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jacquelyn S Pennings
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Amanda K Haas
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christina R Allen
- Yale University, New Haven, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel E Cooper
- W.B. Carrell Memorial Clinic, Dallas, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Thomas M DeBerardino
- The San Antonio Orthopaedic Group, San Antonio, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Warren R Dunn
- Texas Orthopedic Hospital, Houston, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brett Brick A Lantz
- Slocum Research & Education Foundation, Eugene, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michael J Stuart
- Mayo Clinic, Rochester, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Annunziato Ned Amendola
- Duke University, Durham, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher C Annunziata
- Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bernard R Bach
- Rush University Medical Center, Chicago, Illinois, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Champ L Baker
- The Hughston Clinic, Columbus, Georgia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffery R Bechler
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Geoffrey A Bernas
- State University of New York at Buffalo, Buffalo, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Stephen F Brockmeier
- University of Virginia, Charlottesville, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert H Brophy
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles A Bush-Joseph
- Rush University Medical Center, Chicago, Illinois, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - J Brad Butler
- Orthopedic and Fracture Clinic, Portland, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brian J Cole
- Rush University Medical Center, Chicago, IL USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jonathan M Cooper
- HealthPartners Specialty Center, St Paul, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - R Alexander Creighton
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert W Frederick
- Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Elizabeth A Garofoli
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher D Harner
- University of Texas Health Center, Houston, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Norman Lindsay Harris
- Grand River Health-Rifle, Rifle, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Keith S Hechtman
- UHZ Sports Medicine Institute, Coral Gables, Florida, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Elliott B Hershman
- Lenox Hill Hospital, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Rudolf G Hoellrich
- Slocum Research & Education Foundation, Eugene, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David C Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Timothy S Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Morgan H Jones
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Thomas E Klootwyk
- Methodist Sports Medicine, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bruce A Levy
- Mayo Clinic Rochester, Rochester, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - C Benjamin Ma
- University of California, San Francisco, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Matthew J Matava
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Gregory M Mathien
- Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David R McAllister
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel F O'Neill
- Littleton Regional Healthcare, Littleton, New Hampshire, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Mark L Purnell
- Aspen Orthopedic Associates, Aspen, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arthur C Rettig
- Methodist Sports Medicine, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Kevin G Shea
- Intermountain Orthopaedics, Boise, Idaho, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Orrin H Sherman
- NYU Hospital for Joint Diseases, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James R Slauterbeck
- University of South Alabama, Mobile, Alabama, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Matthew V Smith
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Joachim J Tenuta
- Albany Medical Center, Albany, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Darius G Viskontas
- Royal Columbian Hospital, New Westminster, British Columbia, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Richard A White
- Fitzgibbon's Hospital, Marshall, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James S Williams
- Cleveland Clinic, Euclid, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michelle L Wolcott
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
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21
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Heuck A, Woertler K. Posttreatment Imaging of the Knee: Cruciate Ligaments and Menisci. Semin Musculoskelet Radiol 2022; 26:230-241. [PMID: 35654092 DOI: 10.1055/s-0041-1741516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cruciate ligament reconstruction and meniscal surgery are frequently performed for restoration of knee joint stability and function after cruciate ligament and meniscus injuries, and they contribute to the prevention of secondary osteoarthritis. In cruciate ligaments, the most common procedure is anterior cruciate ligament (ACL) reconstruction. Meniscal surgery most frequently consists of partial meniscectomy and suture repair, rarely of a meniscus transplant. In patients with symptoms following surgery, imaging reevaluation for a suspected intra-articular source of symptoms is indicated and mainly consists of radiography and magnetic resonance imaging. For proper imaging assessment of cruciate ligament grafts and the postoperative meniscus, it is crucial to understand the surgical techniques applied, to be familiar with normal posttreatment imaging findings, and to be aware of patterns and specific findings of recurrent lesions and typical complications. This article presents an updated review of the techniques and the imaging of cruciate ligament reconstruction and meniscus surgery, recurrent lesions, treatment failure, and potential complications.
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Affiliation(s)
- Andreas Heuck
- Radiologische Klinik und Poliklinik, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Klaus Woertler
- Institut für Diagnostische und Interventionelle Radiologie, Technical University of Munich, Munich, Germany
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22
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Veizi E, Alkan H, Çay N, Şahin A, Çepni Ş, Tecimel O, Fırat A. Clinical and radiological comparison of bioactive glass and poly-L-lactic acid/hydroxyapatite bioabsorbable interference screws for tibial graft fixation in anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2022; 108:103247. [PMID: 35167963 DOI: 10.1016/j.otsr.2022.103247] [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: 08/23/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ligament reconstruction is still the main treatment modality for patients with a complete ligament rupture. The semitendinosus tendon, alone quadrupled or double folded and combined with the gracilis tendon, is still the most frequently used autologous graft for a reconstructive procedure. Absorbable interference screw usage has gained popularity in the past decade because they create less artifacts during MR imaging and tend to osteointegrate over the years, arguably leading to a more anatomic fixation. The purpose of this study was to compare the 5-year radiological and clinical results of two different tibial graft fixation screws. HYPOTHESIS We hypothesized that bioabsorbable interference screws made of bioactive glass would lead to higher rates of osteointegration, better overall clinical results, less foreign body reaction rates and less tibial tunnel widening when compared to the poly-L-lactic acid/hydroxyapatite (PLLA-HA) screws. PATIENTS AND METHODS Fifty-one patients treated with an anatomic single bundle ACL reconstruction between June 2015 and July 2016 at our institution were included in the study. The tibial graft was fixed with a bioactive glass screw in 24, and with a PLLA-HA in 27 patients. Tibial tunnel widening, foreign body reaction, osteointegration and resorption rates were evaluated and compared on a magnetic resonance scan at a minimum of 5 year postoperatively. Overall clinical results and side-to-side difference on KT-1000 were also analyzed in-between groups. RESULTS Tibial tunnel widening was similar for both groups. Foreign body reaction, while not statistically significant, was less aggressive when bioactive glass screws were used. Osteointegration and resorption rates of the bioactive glass screws were significantly higher than the PLLA-HA group (p=0.000). While all patients showed an overall improvement on postoperative scores (p=0.000), patients with a bioactive glass interference screw had statistically higher translational stability with KT-1000, compared to the poly-L-lactic acid/hydroxyapatite group (p=0.001). DISCUSSION At a minimum of 5 years, compared to conventional PLLA-HA interference screws, 45S5 bioactive glass screw provide higher resorption rates, are more highly biodegradable and provide overall good clinical results. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Enejd Veizi
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey.
| | - Hilmi Alkan
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Nurdan Çay
- Department of Radiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Ali Şahin
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Şahin Çepni
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Osman Tecimel
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Fırat
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
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23
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Kimura M, Nakase J, Asai K, Yoshimizu R, Kanayama T, Tsuchiya H. Tibial graft fixation methods and bone tunnel enlargement: A comparison between the TensionLoc implant system and the double-spike plate. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 28:31-37. [PMID: 35465464 PMCID: PMC9019697 DOI: 10.1016/j.asmart.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/17/2022] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
Background/objective TensionLoc (Arthrex, Naples, Florida, USA), a tibial graft fixation system for anterior cruciate ligament (ACL) reconstruction, is expected to apply the preoperatively determined level of graft tension and allow setting of lower initial tension. Considering its mechanism, we hypothesised that TensionLoc would prevent postoperative bone tunnel enlargement (TE) through fixation with lower initial tension. Therefore, the present study aimed to compare TE between ACL reconstructions using the double-spike plate (DSP; Smith and Nephew, Andover, Massachusetts) and TensionLoc implant system. Methods A total of 40 patients who underwent anatomical single-bundle ACL reconstruction with a hamstring tendon graft were retrospectively analysed. In the group in which DSP and screw were used, the initial graft tension was set to 40 N at 20° of knee flexion (group D). In the other group in which TensionLoc was used, the initial graft tension was set to 30 N at 20° of knee flexion (group T). Both groups included 20 patients each. Tunnel areas were measured using computed tomography images at one week and three months after surgery, and the TE ratio was calculated according to the following equation: TE ratio (%) = (tunnel area at three months after surgery - tunnel area at one week after surgery)/tunnel area at one week after surgery × 100. Results The femoral TE ratios were significantly higher in group T (80.5% ± 28.8%) than in group D (45.5% ± 34.6%) (p = 0.001). However, the tibial TE ratios did not significantly differ between the two groups. Conclusion Compared with ACL reconstruction using DSP and screw, ACL reconstruction using TensionLoc fixed the graft with lower initial tension but showed greater femoral TE and restricted knee extension in the early postoperative period.
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Affiliation(s)
- Mitsuhiro Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuki Asai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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24
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Andrä K, Prill R, Kayaalp E, Irlenbusch L, Liesaus E, Trommer T, Ullmann P, Becker R. Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up. J Orthop Traumatol 2021; 22:54. [PMID: 34914026 PMCID: PMC8677851 DOI: 10.1186/s10195-021-00618-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/08/2021] [Indexed: 01/20/2023] Open
Abstract
Purpose Degeneration of the cartilage after anterior cruciate ligament reconstruction (ACL-R) is known, and further deterioration can be expected in patients with tunnel malplacement or partial meniscal resection. It was hypothesized that there is a significant increase in cartilage degeneration after failed ACL-R. Material and methods Isolated ACL revision surgery was performed in 154 patients at an interval of 46 ± 33 months (5–175 months) between primary and revision surgery. Cartilage status at the medial, lateral femorotibial, and patellofemoral compartments were assessed arthroscopically during primary and revision ACL-R in accordance with the Outerbridge classification. Tunnel placement, roof angle, and tibial slope was measured using anteroposterior and lateral radiographic views. Results Cartilage degeneration increased significantly in the medial femorotibial compartment, followed by the lateral and patellofemoral compartments. There was a correlation between both cartilage degeneration in the patellofemoral compartment (PFC) (rs = 0.28, p = 0.0012) and medial tibial plateau (Rs = 0.24, p = 0.003) in relation to the position of tibial tunnel in the frontal plane. Worsening of the cartilage status in the medial femorotibial compartment, either femoral or tibial, was correlated with the tibial aperture site in the lateral view (Rs = 0.28, p < 0.001). Cartilage degeneration in the lateral compartment of the knee, on both femoral or tibial side, was inversely correlated with the femoral roof angle (Rs = −0.1985, p = 0.02). Meniscal tears, either at the medial or lateral site or at both, were found in 93 patients (60%) during primary ACL-R and increased to 132 patients (86%) during revision ACL-R. Discussion Accelerated cartilage degeneration and high prevalence of meniscal lesions are seen in failed ACL-R. Tunnel placement showed significant impact on cartilage degeneration and may partially explain the increased risk of an inferior outcome when revision surgery is required after failed primary ACL-R. Level of evidence: Level IV—retrospective cohort study.
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Affiliation(s)
- Kathleen Andrä
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.,SportsClinic Erfurt, Erfurt, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
| | - Enes Kayaalp
- Department of Orthopedics and Traumatology, Istanbul Taksim Training and Research Hospital, Siraselviler Cad, Beyoglu, Istanbul, 34433, Turkey
| | | | | | | | | | - Roland Becker
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.
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25
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Cheng R, Wang H, Jiang Z, Dimitriou D, Cheng CK, Tsai TY. The Femoral Tunnel Drilling Angle at 45° Coronal and 45° Sagittal Provided the Lowest Peak Stress and Strain on the Bone Tunnels and Anterior Cruciate Ligament Graft. Front Bioeng Biotechnol 2021; 9:797389. [PMID: 34900975 PMCID: PMC8661475 DOI: 10.3389/fbioe.2021.797389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: The aims of this study were to 1) investigate the effects of femoral drilling angle in coronal and sagittal planes on the stress and strain distribution around the femoral and tibial tunnel entrance and the stress distribution on the graft, following anterior cruciate ligament reconstruction (ACLR), 2) identify the optimal femoral drilling angle to reduce the risk of the tunnel enlargement and graft failure. Methods: A validated three-dimensional (3D) finite element model of a healthy right cadaveric knee was used to simulate an anatomic ACLR with the anteromedial (AM) portal technique. Combined loading of 103.0 N anterior tibial load, 7.5 Nm internal rotation moment, and 6.9 Nm valgus moment during normal human walking at joint flexion of 20° was applied to the ACLR knee models using different tunnel angles (30°/45°/60° and 45°/60° in the coronal and sagittal planes, respectively). The distribution of von Mises stress and strain around the tunnel entrances and the graft was calculated and compared among the different finite element ACLR models with varying femoral drilling angles. Results: With an increasing coronal obliquity drilling angle (30° to 60°), the peak stress and maximum strain on the femoral and tibial tunnel decreased from 30° to 45° and increased from 45° to 60°, respectively. With an increasing sagittal obliquity drilling angle (45° to 60°), the peak stress and the maximum strain on the bone tunnels increased. The lowest peak stress and maximum strain at the ACL tunnels were observed at 45° coronal/45° sagittal drilling angle (7.5 MPa and 7,568.3 μ-strain at the femoral tunnel entrance, and 4.0 MPa and 4,128.7 μ-strain at the tibial tunnel entrance). The lowest peak stress on the ACL graft occurred at 45° coronal/45° sagittal (27.8 MPa) drilling angle. Conclusions: The femoral tunnel drilling angle could affect both the stress and strain distribution on the femoral tunnel, tibial tunnel, and graft. A femoral tunnel drilling angle of 45° coronal/ 45° sagittal demonstrated the lowest peak stress, maximum strain on the femoral and tibial tunnel entrance, and the lowest peak stress on the ACL graft.
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Affiliation(s)
- Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & 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
| | - Huizhi Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & 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
| | - Ziang Jiang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & 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
| | - Dimitris Dimitriou
- Department of Orthopedics Balgrist University Hospital, Forchstrasse, Zürich, Switzerland
| | - Cheng-Kung Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & 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
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & 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
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26
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Lateral posterior tibial slope and length of the tendon within the tibial tunnel are independent factors to predict tibial tunnel widening following anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:3818-3824. [PMID: 33459832 DOI: 10.1007/s00167-020-06419-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to conduct a multivariate analysis to identify independent factors that predict tibial tunnel widening (TW) after anatomical anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) grafts. METHODS In total, 103 patients who underwent ACL reconstructions using BPTB grafts were included. Tunnel aperture area was measured using three-dimensional computed tomography 1 week and 1 year postoperatively, and the tibial TW was calculated. The patients were divided into group S comprising 58 patients who had tibial TW < 30% and group L comprising 45 patients who had tibial TW > 30%, retrospectively. Using univariate analyses, age, gender, body mass index, Tegner activity scale, the time between injury and surgery, tibial tunnel location, tibial tunnel angle, medial posterior tibial slope, lateral posterior tibial slope, and length of the tendon in the tibial tunnel were compared between two groups. Multivariate regression analysis was conducted to reveal the independent risk factors for the tibial TW among preoperative demographic factors and radiographic parameters that correlated with the tibial TW in the univariate analyses. RESULTS Compared with those at 1 week postoperatively, mean tibial tunnel aperture areas were increased by 30.3% ± 26.8% when measured at 1 year postoperatively. The lateral posterior tibial slope was significantly larger (p < 0.001), and the length of the tendon within the tibial tunnel was significantly longer in group L than that in group S (p = 0.03) in the univariate analyses. Multivariate regression analysis showed that the increase in lateral posterior tibial slope (p = 0.001) and the length of the tendon within the tibial tunnel (p = 0.03) were predictors of the tibial TW. CONCLUSIONS This study showed that increased lateral posterior tibial slope and a longer tendinous portion within the tibial tunnel were independent factors that predicted the tibial TW following anatomical ACL reconstruction with a BPTB graft. LEVEL OF EVIDENCE III.
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27
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Lee DK, Kim JH, Lee BH, Kim H, Jang MJ, Lee SS, Wang JH. Influence of Graft Bending Angle on Femoral Tunnel Widening After Double-Bundle ACL Reconstruction: Comparison of Transportal and Outside-In Techniques. Orthop J Sports Med 2021; 9:23259671211035780. [PMID: 34708137 PMCID: PMC8543726 DOI: 10.1177/23259671211035780] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Previous studies have suggested that increased mechanical stress due to acute
graft bending angle (GBA) is associated with tunnel widening and graft
failure after anterior cruciate ligament (ACL) reconstruction. Few studies
have compared the GBA between the outside-in (OI) and the transportal (TP)
techniques. Purpose: To evaluate the influence of GBA on clinical outcomes and tunnel widening
after ACL reconstruction with OI versus TP technique. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were 56 patients who underwent double-bundle ACL
reconstruction (n = 28 in the OI group and n = 28 in the TP group). Clinical
outcomes (Lysholm, International Knee Documentation Committee, Tegner score,
and knee laxity) 1 year postoperatively were evaluated. Computed tomography
scans at 5 days and 1 year postoperatively were used for imaging
measurements, and the femoral tunnel was divided into the proximal third,
middle, and aperture sections. The GBA and cross-sectional area (CSA) were
measured using image analysis software and were compared between groups. A
correlation analysis was performed to determine if the GBA affected clinical
outcomes or tunnel widening. Results: No significant difference was observed in clinical outcomes between the
groups. The GBA of both the anteromedial (AM) and posterolateral bundles
were more acute in the OI group compared with the TP group
(P < .05). The CSA at the AM tunnel aperture
increased significantly in the OI group (84.2% ± 64.3%) compared with the TP
group (51.4% ± 36.7%) (P = .04). However, there were no
differences in the other sections. In the Pearson correlation test, GBA was
not correlated with tunnel widening or clinical outcomes. Conclusion: Regardless of technique, the GBA did not have a significant influence on
tunnel widening or clinical outcomes. Considering a wider AM tunnel
aperture, a more proximal and posterior AM tunnel position might be
appropriate with the OI technique.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, South Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, South Korea
| | - Hyeonsoo Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
| | - Min Jae Jang
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
| | - Sung-Sahn Lee
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Science and Technology and Department of Medical Device Management and Research, SAIHST (Samsung Advanced Institute for Health Sciences & Technology), Sungkyunkwan University, Seoul, South Korea
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28
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Kim Y, Kubota M, Muramoto K, Kunii T, Sato T, Inui T, Ohno R, Ishijima M. Clinical and radiographic results after ACL reconstruction using an adjustable-loop device. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 26:32-38. [PMID: 34584849 PMCID: PMC8437790 DOI: 10.1016/j.asmart.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/03/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
Background The femoral cortical suspension device such as fixed loop devices (FLD) and adjustable-loop device (ALD) are used for ACLR technique in recent days. However, there was few studies of clinical and radiographic results for ACLR using ALD. This study was conducted to clarify the clinical and radiographic results, stability and bone tunnel enlargement after ACLR using a ToggleLoc with a zip loop as ALD. Methods 80 patients who had data available from the most recent follow-up at ≥2 years since ACLR were evaluated both clinical and radiographic results. They were divided into single bundle reconstruction group (SBR) and double bundle reconstruction group (DBR). Clinical scores were included subjective scores and objective scores at pre- and postoperatively 2 years. The subjective scores were the Cincinnati knee rating system, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner activity score, Visual Analog Scale (VAS) and ACL-Return to Sport after Injury (RSI) scale. The objective scores were the isokinetic muscle strength, side-to-side difference in anterior instability and single hop test. In radiographical assessment, femoral and tibial tunnel enlargement was evaluated by three-dimensional computed tomography. Results In both SBR and DBR group, the postoperative subjective scores were significantly improved compared to the preoperative values, except for the Tegner activity score. Similarly, the side-to-side differences in muscle strength, anterior instability and single hop test were significantly improved after surgery. The changes in the femoral and tibial tunnel maximum cross section areas of SBR were 104.3 % ± 21.2 % and 89.2 % ± 15.2 %, respectively, at 2 years post-operatively. In DBR, in the femoral bone volume change of the antero medial (AM) and postero lateral (PL) bundle were 107.0 ± 3.5 % and 108.1 ± 3.3, and in the tibial bone volume change of AM and PL bundle were 90.6 ± 3.3 % and 87.0 ± 4.2 %. At the femoral site, the rate of tunnel enlargement increased for the first 12 months and then decreased through 24 months postoperatively. At the tibial site, by contrast, the rate of tunnel enlargement decreased consistently over the two-year postoperative follow-up. Conclusion This is the first study to include clinical data on ACLR using a ToggleLoc with a zip loop device. ACLR using these devices as ALDs resulted in good clinical outcomes and provided good stability of the knee with relatively little bone tunnel enlargement in both SBR and DBR group.
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Affiliation(s)
- Youngji Kim
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan.,Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Mitsuaki Kubota
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Keisuke Muramoto
- Department of Radiology, Koshigaya Municipal Hospital, Saitama, Japan
| | - Takuya Kunii
- Department of Radiology, Koshigaya Municipal Hospital, Saitama, Japan
| | - Taisuke Sato
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan.,Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Tetsuya Inui
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan.,Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Ryuichi Ohno
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan.,Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
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29
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Hexter AT, Karali A, Kao A, Tozzi G, Heidari N, Petrie A, Boyd A, Kalaskar DM, Pendegrass C, Rodeo S, Haddad F, Blunn G. Effect of Demineralized Bone Matrix, Bone Marrow Mesenchymal Stromal Cells, and Platelet-Rich Plasma on Bone Tunnel Healing After Anterior Cruciate Ligament Reconstruction: A Comparative Micro-Computed Tomography Study in a Tendon Allograft Sheep Model. Orthop J Sports Med 2021; 9:23259671211034166. [PMID: 34568508 PMCID: PMC8461134 DOI: 10.1177/23259671211034166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The effect of demineralized bone matrix (DBM), bone marrow–derived mesenchymal stromal cells (BMSCs), and platelet-rich plasma (PRP) on bone tunnel healing in anterior cruciate ligament reconstruction (ACLR) has not been comparatively assessed. Hypothesis: These orthobiologics would reduce tunnel widening, and the effects on tunnel diameter would be correlated with tunnel wall sclerosis. Study Design: Controlled laboratory study. Methods: A total of 20 sheep underwent unilateral ACLR using tendon allograft and outside-in interference screw fixation. The animals were randomized into 4 groups (n = 5 per group): Group 1 received 4mL of DBM paste, group 2 received 10 million BMSCs in fibrin sealant, group 3 received 12 mL of activated leukocyte-poor platelet-rich plasma, and group 4 (control) received no treatment. The sheep were euthanized after 12 weeks, and micro-computed tomography scans were performed. The femoral and tibial tunnels were divided into thirds (aperture, midportion, and exit), and the trabecular bone structure, bone mineral density (BMD), and tunnel diameter were measured. Tunnel sclerosis was defined by a higher bone volume in a 250-µm volume of interest compared with a 4-mm volume of interest surrounding the tunnel. Results: Compared with the controls, the DBM group had a significantly higher bone volume fraction (bone volume/total volume [BV/TV]) (52.7% vs 31.8%; P = .020) and BMD (0.55 vs 0.47 g/cm3; P = .008) at the femoral aperture and significantly higher BV/TV at femoral midportion (44.2% vs 32.9%; P = .038). There were no significant differences between the PRP and BMSC groups versus controls in terms of trabecular bone analysis or BMD. In the controls, widening at the femoral tunnel aperture was significantly greater than at the midportion (46.7 vs 41.7 mm2; P = .034). Sclerosis of the tunnel was common and most often seen at the femoral aperture. In the midportion of the femoral tunnel, BV/TV (r = 0.52; P = .019) and trabecular number (rS = 0.50; P = .024) were positively correlated with tunnel widening. Conclusion: Only DBM led to a significant increase in bone volume, which was seen in the femoral tunnel aperture and midportion. No treatment significantly reduced bone tunnel widening. Tunnel sclerosis in the femoral tunnel midportion was correlated significantly with tunnel widening. Clinical Relevance: DBM might have potential clinical use to enhance healing in the femoral tunnel after ACLR.
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Affiliation(s)
- Adam T Hexter
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Aikaterina Karali
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, UK
| | - Alex Kao
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, UK
| | - Gianluca Tozzi
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, UK
| | - Nima Heidari
- Royal London Hospital and Orthopaedic Specialists (OS), London, UK
| | - Aviva Petrie
- Eastman Dental Institute, University College London, London, UK
| | - Ashleigh Boyd
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Deepak M Kalaskar
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Catherine Pendegrass
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Scott Rodeo
- Hospital of Special Surgery, New York, New York, USA
| | | | - Gordon Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Lee DK, Kim JH, Lee SS, Lee BH, Kim H, Kim J, Wang JH. Femoral Tunnel Widening After Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Autograft Produces a Small Shift of the Tunnel Position in the Anterior and Distal Direction: Computed Tomography-Based Retrospective Cohort Analysis. Arthroscopy 2021; 37:2554-2563.e1. [PMID: 33745939 DOI: 10.1016/j.arthro.2021.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the femoral tunnel position remains in an anatomical footprint after tunnel widening and shifting. METHODS Patients who underwent unilateral double-bundle anterior cruciate ligament reconstruction with hamstring autograft and performed computed tomography scan evaluation at the time of 5 days and 1 year postoperatively were included in this retrospective cohort study. Three-dimensional models of the femur and femoral tunnels were reconstructed from computed tomography scan data. The location of the tunnel center and tunnel margins in the anatomical coordinate system, and the mean shifting distance of tunnel center and margin were measured with image analysis software during the period. The change of tunnel center location in Bernard quadrant was confirmed if the tunnel center remained within the boundaries of anatomical position after tunnel widening. RESULTS A total of 56 patients satisfied the inclusion criteria. The mean shifting distance of AM and PL tunnel centers were 1.7 ± 0.9 mm and 1.6 ± 0.6 mm. The Tunnel margin of the anteromedial (AM) and posteromedial (PL) tunnels were shifted to 2.5 ± 1.3 mm and 2.6 ± 1.4 mm in the anterior direction, and 1.4 ± 0.9 mm and 1.0 ± 0.7 mm in the distal direction, respectively. Among the anatomical located tunnel, 97% (32/33) and 87.1% (27/31) of AM and PL tunnel centers remained in a range of anatomical footprint. The tunnel center was shifted from the anatomical position into a nonanatomical position in 3% (1/33) of the AM tunnel and 12.9% (4/31) of PL tunnel after tunnel widening. The tunnel location which shifted nonanatomically were relatively anterior and distal position. CONCLUSIONS Tunnel widening shifts the tunnel position to the anterior and distal direction, which could change the initial tunnel position. Nevertheless, the majority of tunnel positions remained in the anatomical position after tunnel widening and shifting. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Sung-Sahn Lee
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyeonsoo Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jinwoo Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea; Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
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Yumashev AV, Baltina TV, Babaskin DV. Outcomes after arthroscopic revision surgery for anterior cruciate ligament injuries. Acta Orthop 2021; 92:443-447. [PMID: 33739222 PMCID: PMC8381895 DOI: 10.1080/17453674.2021.1897744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The frequency of primary anterior cruciate ligament (ACL) reconstruction is increasing resulting in more ACL revision surgeries. Therefore, we assessed survival rates of 2 different grafts for ACL revision surgery at 1- and 5-year follow-ups, as well as physical activity levels of patients after revision surgery.Patients and methods - This is a retrospective cohort study involving 218 patients (176 males) who had revision surgery for anterior cruciate ligament injuries between 2008 and 2017 at the Clinic of Traumatology, Orthopedics and Joint Pathology Clinic (I.M. Sechenov First Moscow State Medical University). A comparison group involved 189 patients with only primary surgery. Surgical interventions were performed according to the standard procedure using bone-patellar tendon-bone (BTB) and semitendinosus/gracilis (ST/G) autografts. The results of revision surgery were assessed at 1- and 5-year follow-ups by using the Lysholm and International Knee Documentation Committee scores.Results - Malpositioned bone tunnels were found in 87/218 patients (40%). At 1 and 5 years postoperatively, the revision BTB group had significantly better results in terms of IKDC and Lysholm scores than the revision ST/G group (p = 0.03, Mann-Whitney U-test), and these results were comparable to those in the comparison group. Graft survival after revision was lower than after the primary operation. However, the survival rate of 80% is quite high and is consistent with previous findings. There were no statistically reliable differences in survival between ST/G and BTB autografts.Interpretation - The graft choice for revision ACL surgery should be decided upon before surgery based on, among other things, the state of bone tunnels, in particular their position and degree of bone resorption. Tunnel widening that exceeds 14 mm (osteolysis) would require 2-stage surgery using a BTB autograft with bone plugs because it is larger than the ST/G autograft.
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Affiliation(s)
- Alexei V Yumashev
- Department of Prosthetic Dentistry, Sechenov First Moscow State Medical University (Sechenov University), Moscow; ,Correspondence:
| | - Tatyana V Baltina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan;
| | - Dmitrii V Babaskin
- Department of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Luo H, Xiang X, Li R, Li D, Wang W. [Influence of lateral posterior tibial slope on tibial tunnel expansion after anatomical single-bundle anterior cruciate ligament reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:697-703. [PMID: 34142495 DOI: 10.7507/1002-1892.202101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the influence of lateral posterior tibial slope (LPTS) on tibial tunnel expansion after anatomical single-bundle anterior cruciate ligament (ACL) reconstruction and the effect of tibial tunnel expansion on knee joint function. Methods A clinical data of 52 patients with ACL rupture, who underwent arthroscopic anatomical single-bundle reconstruction between November 2018 and December 2019, was retrospectively analyzed. There were 32 males and 20 females with an average age of 34.3 years (range, 14-64 years). There were 22 cases of left knee and 30 cases of right knee. The time from injury to operation ranged from 7 to 30 days, with an average of 15.9 days. The knee function was evaluated by International Knee Documentation Committee (IKDC) score and Lysholm score before operation and at 3 and 6 months after operation. At 3 and 6 months after operation, the LPTS and the width of exit, middle segment, entrance, and 2 cm from the exit of the articular surface of the tibial tunnel were measured based on MRI. The expansion of tibial tunnel was calculated and graded (degrees 0-3). According to LPTS, the patients were divided into group A (<6.0°), group B (6°-12°), and group C (>12°), and the difference in the expansion of tibial tunnel between groups was compared. Results All the 52 patients were followed up 6-12 months (mean, 7.1 months). The IKDC and Lysholm scores at 3 and 6 months after operation were significantly different from those before operation ( P<0.05); and the difference of knee scores between 3 and 6 months after operation was significant ( P<0.05). The tibial tunnel expanded after operation, and the relative expansion at the exit and the middle segment showed significant difference between 3 months and 6 months after operation ( P<0.05). The expansion degree of tibial tunnel was rated as degree 0 in 5 cases, degree 1 in 28 cases, degree 2 in 16 cases, and degree 3 in 3 cases at 3 months after operation, and degree 0 in 5 cases, degree 1 in 20 cases, degree 2 in 25 cases, and degree 3 in 2 cases at 6 months after operation. There was no significant difference in IKDC and Lysholm scores between patients with different expansion degrees of tibial tunnels ( P>0.05). The LPTS of 52 patients ranged from -0.8° to 18.7° (mean, 10.6°); there were 7 cases in group A, 24 cases in group B, and 21 cases in group C. There was no significant difference in age, gender, preoperative IKDC and Lysholm scores, and initial width of tibial tunnel between groups ( P>0.05). There was no significant difference in the relative expansion of tibial tunnel at exit and middle segment between groups at 3 months after operation ( P>0.05), and there was significant difference at 6 months after operation ( P<0.05). Conclusion After anatomical single-bundle reconstruction of ACL, the tibial tunnel would expand to some extent in a short time. LPTS had a significant effect on tibial tunnel expansion, and the larger the angle was, the more obvious the expansion of the proximal tibial tunnel was. However, early knee function is not affected by tibial tunnel expansion.
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Affiliation(s)
- Hao Luo
- Dalian Medical University, Dalian Liaoning, 116027, P.R.China
| | - Xianxiang Xiang
- Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - Ruixin Li
- Department of Sports Medicine, Affiliated Xinhuan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - Danmei Li
- Department of Knee Arthropathy, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P.R.China
| | - Weiming Wang
- Department of Sports Medicine, Affiliated Xinhuan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
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Scrivens B, Kluczynski MA, Fineberg MS, Bisson LJ. Computed Tomography Imaging of BioComposite Interference Screw After ACL Reconstruction With Bone-Patellar Tendon-Bone Graft. Orthop J Sports Med 2021; 9:23259671211006477. [PMID: 33997082 PMCID: PMC8113922 DOI: 10.1177/23259671211006477] [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: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Bioabsorbable interference screws tend to have high resorption rates after
anterior cruciate ligament (ACL) reconstruction; however, no studies have
examined screws composed of 30% biphasic calcium phosphate and 70%
poly-d-lactide (30% BCP/70% PLDLA). Purpose: To evaluate femoral and tibial tunnel widening and resorption of 30% BCP/70%
PLDLA interference screws and replacement with bone at 2 to 5 years after
ACL reconstruction using bone–patellar tendon–bone (BTB) autograft. Study Design: Case series; Level of evidence, 4. Methods: Included were 20 patients who had undergone ACL reconstruction using BTB
autograft and were reevaluated 2 to 5 years after surgery using computed
tomography scans. Tunnel measurements were obtained from computed tomography
scans in the sagittal and coronal planes and were compared with known tunnel
measurements based on operative reports. These images and measurements were
used to assess tunnel widening, resorption of the 30% BCP/70% PLDLA screw,
its replacement with bone, and possible cyst formation. Paired
t tests were used to compare initial and final femoral
and tibial tunnel measurements. Results: The cross-sectional area of the femoral tunnel decreased at the aperture
(P = .03), middle (P = .0002), and
exit (P < .0001) of the tunnel compared with the initial
femoral tunnel size, and the tibial tunnel cross-sectional area decreased at
the aperture (P < .0001) and exit (P =
.01) of the tunnel compared with the initial tibial tunnel size. Bone
formation was observed in 100% of femoral tunnels and 94.7% of tibial
tunnels. Screw resorption was 100% in the femur and 94.7% in the tibia at
the final follow-up. Cysts were noted around the femoral tunnel in 2
patients (5.1%). Conclusion: The 30% BCP/70% PLDLA interference screws used for ACL reconstruction using
BTB autograft had high rates of resorption and replacement with bone, and
there were no increases in tunnel size at 2 to 5 years postoperatively. The
authors observed a low rate of cyst formation and no other adverse events
stemming from the use of this specific biointerference screw, suggesting
that this type of screw is a reasonable option for graft fixation with
minimal unfavorable events and a reliable resorption profile.
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Affiliation(s)
- Brian Scrivens
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Marc S Fineberg
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, The State University of New York at Buffalo, Buffalo, New York, USA
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Tachibana Y, Tanaka Y, Kinugasa K, Mae T, Horibe S. Tunnel Enlargement Correlates With Postoperative Posterior Laxity After Double-Bundle Posterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:2325967120977834. [PMID: 33614798 PMCID: PMC7869171 DOI: 10.1177/2325967120977834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background: There exists little information in the relevant literature regarding tunnel
enlargement after posterior cruciate ligament (PCL) reconstruction
(PCLR). Purpose: To sequentially evaluate tunnel enlargement and radiographic posterior laxity
through double-bundle PCLR using autologous hamstring tendon grafts. Study Design: Case series; Level of evidence, 4. Methods: We prospectively analyzed 13 patients who underwent double-bundle PCLR for an
isolated PCL injury. Three-dimensional computed tomography images were
obtained at 3 weeks, 6 months, and 1 year postoperatively, and the tunnel
enlargement was calculated by sequentially comparing the cross-sectional
areas of the bone tunnels. We also sequentially measured radiographic
posterior laxity. The correlation between the tunnel enlargement ratio and
the postoperative increase in posterior laxity was evaluated. Results: The cross-sectional area at the aperture in each tunnel significantly
increased from 3 weeks to 6 months (P < .003), but it
did not continue doing so thereafter. The 6-month tunnel enlargement ratios
of the femoral anterolateral tunnel, the femoral posteromedial tunnel, the
tibial anterolateral tunnel, and the tibial posteromedial tunnel were 31.6%
± 23.5%, 90.3% ± 54.7%, 30.5% ± 26.8%, and 49.6% ± 37.0%, respectively,
while the corresponding ratios at 1 year were 28.1% ± 19.8%, 83.1% ± 56.9%,
26.8% ± 32.8%, and 47.6% ± 39.0%, respectively. The posterior laxity was 9.0
± 4.0 mm, −1.5 ± 2.3 mm, 3.4 ± 2.0 mm, and 3.9 ± 1.9 mm, preoperatively,
immediately after surgery, 6 months and 1 year postoperatively,
respectively. From the immediate postoperative period, the posterior laxity
significantly increased at 6 months postoperatively (P <
.001), but it did not thereafter. The postoperative increase in posterior
laxity had a significant positive correlation with the anterolateral tunnel
enlargement ratio in both femoral and tibial tunnels at 6 months (ρ =
0.571-0.699; P = .011-.041) and 1 year (ρ = 0.582-0.615;
P = .033-.037). Conclusion: Tunnel enlargement after PCLR mainly occurred within 6 months, with no
progression thereafter. The anterolateral tunnel enlargement positively
correlated with postoperative increase in posterior laxity.
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Affiliation(s)
- Yuta Tachibana
- Department of Sports Orthopaedics, Osaka Rosai Hospital, Sakai, Japan
| | - Yoshinari Tanaka
- Department of Sports Orthopaedics, Osaka Rosai Hospital, Sakai, Japan
| | - Kazutaka Kinugasa
- Department of Sports Orthopaedics, Osaka Rosai Hospital, Sakai, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shuji Horibe
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
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Hexter AT, Sanghani-Kerai A, Heidari N, Kalaskar DM, Boyd A, Pendegrass C, Rodeo SA, Haddad FS, Blunn GW. Mesenchymal stromal cells and platelet-rich plasma promote tendon allograft healing in ovine anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:3678-3688. [PMID: 33331973 PMCID: PMC8514355 DOI: 10.1007/s00167-020-06392-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The effect of bone marrow mesenchymal stromal cells (BMSCs) and platelet-rich plasma (PRP) on tendon allograft maturation in a large animal anterior cruciate ligament (ACL) reconstruction model was reported for the first time. It was hypothesised that compared with non-augmented ACL reconstruction, BMSCs and PRP would enhance graft maturation after 12 weeks and this would be detected using magnetic resonance imaging (MRI). METHODS Fifteen sheep underwent unilateral tendon allograft ACL reconstruction using aperture fixation and were randomised into three groups (n = 5). Group 1 received 10 million allogeneic BMSCs in 2 ml fibrin sealant; Group 2 received 12 ml PRP in a plasma clot injected into the graft and bone tunnels; and Group 3 (control) received no adjunctive treatment. At autopsy at 12 weeks, a graft maturation score was determined by the sum for graft integrity, synovial coverage and vascularisation, graft thickness and apparent tension, and synovial sealing at tunnel apertures. MRI analysis (n = 2 animals per group) of the signal-noise quotient (SNQ) and fibrous interzone (FIZ) was used to evaluate intra-articular graft maturation and tendon-bone healing, respectively. Spearman's rank correlation coefficient (r) of SNQ, autopsy graft maturation score and bone tunnel diameter were analysed. RESULTS The BMSC group (p = 0.01) and PRP group (p = 0.03) had a significantly higher graft maturation score compared with the control group. The BMSC group scored significantly higher for synovial sealing at tunnel apertures (p = 0.03) compared with the control group. The graft maturation score at autopsy significantly correlated with the SNQ (r = - 0.83, p < 0.01). The tunnel diameter of the femoral tunnel at the aperture (r = 0.883, p = 0.03) and mid-portion (r = 0.941, p = 0.02) positively correlated with the SNQ. CONCLUSIONS BMSCs and PRP significantly enhanced graft maturation, which indicates that orthobiologics can accelerate the biologic events in tendon allograft incorporation. Femoral tunnel expansion significantly correlated with inferior maturation of the intra-articular graft. The clinical relevance of this study is that BMSCs and PRP enhance allograft healing in a translational model, and biological modulation of graft healing can be evaluated non-invasively using MRI.
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Affiliation(s)
- Adam T Hexter
- Division of Surgery and Interventional Science, University College London (UCL), London, UK.
- Institute of Orthopaedics and Musculoskeletal Sciences, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, UK.
| | - Anita Sanghani-Kerai
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Nima Heidari
- Royal London Hospital and Orthopaedic Specialists (OS), London, UK
| | - Deepak M Kalaskar
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Ashleigh Boyd
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Catherine Pendegrass
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
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Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A, Yoneyama T, Omae H, Miyamoto R, Chikuda H. A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction. J Orthop Surg (Hong Kong) 2020; 28:2309499019888811. [PMID: 31829103 DOI: 10.1177/2309499019888811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The correlation between the graft bending angle (GBA) of the anteromedial bundle and posterolateral bundle after anterior cruciate ligament reconstruction (ACLR) and postoperative tunnel enlargement was evaluated. METHODS Two hundred fifty-eight patients (137 males, 121 females; mean age 27.3 years) who had undergone double-bundle ACLR were included. Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months postoperatively. The area of the tunnel aperture for femoral anteromedial tunnel (FAMT) and femoral posterolateral tunnel (FPLT) was measured; the area at 2 weeks after ACLR was subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. The femoral tunnel angles were obtained with Cobb angle measurements. The femoral tunnel angle in the coronal plane was measured relative to the tibial plateau (coronal GBA). On the median value, the patients were divided into two groups in each of FAMT and FPLT; those with a coronal GBA of FAMT of ≥27° were classified as group A, while those with a coronal GBA of <27° were classified as group B, those with a coronal GBA of FPLT of ≥23° were classified as group C, while those with a coronal GBA of<23° were classified as group D. RESULTS Group A included 129 knees, while group B included 129 knees. Groups A and B did not significantly differ regarding FAMT enlargement. Group C included 133 knees, while group D included 125 knees. The percentage of FPLT enlargement in group C was significantly smaller than that in group D (p = 0.001). CONCLUSIONS A steep coronal GBA of the FPLT after ACLR results in greater FPLT enlargement. The present findings suggest that surgeons should avoid creating a steep GBA of the FPLT in the outside-in technique.
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Affiliation(s)
- Shinya Yanagisawa
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Masashi Kimura
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Keiichi Hagiwara
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Atsuko Ogoshi
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Tomotaka Yoneyama
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Hiroaki Omae
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Ryosuke Miyamoto
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Van Der Merwe W, Lind M, Faunø P, Van Egmond K, Zaffagnini S, Marcacci M, Cugat R, Verdonk R, Ibañez E, Guillen P, Marcheggiani Muccioli GM. Xenograft for anterior cruciate ligament reconstruction was associated with high graft processing infection. J Exp Orthop 2020; 7:79. [PMID: 33026544 PMCID: PMC7541808 DOI: 10.1186/s40634-020-00292-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose To evaluate clinical ad radiological outcomes of anterior cruciate ligament (ACL) reconstruction with an immunochemically modified porcine patellar tendon xenograft controlled against human Achilles tendon allograft at 24-month minimum follow-up. Methods 66 patients undergoing arthroscopic ACL reconstruction were randomized into 2 groups: 34 allografts and 32 xenografts treated to attenuate the host immune response. Follow-up was 24-month minimum. Anterior knee stability was measured as KT − 1000 side-to-side laxity difference (respect to the contralateral healthy knee). Functional performance was assessed by one-legged hop test. Objective manual pivot-shift test and subjective (IKDC, Tegner and SF-36) outcomes were collected. MRI and standard X-Ray were performed. Results 61 subjects (32 allograft, 29 xenograft) were evaluated at 12 and 24 months. Six of the subjects in xenograft group (20.6%) got an infection attributed to a water-based pathogen graft contamination in processing. Intention-to-treat analysis (using the last observation carried forward imputation method) revealed higher KT − 1000 laxity in xenograft group at 24-month follow-up (P = .042). Also pivot-shift was higher in xenograft group at 12-month (P = .015) and 24-month follow-up (P = .038). Per-protocol analysis (missing/contaminated subjects excluded) did not revealed clinical differences between groups. Tibial tunnel widening in the allograft group was low, whereas xenograft tunnel widening was within the expected range of 20–35% as reported in the literature. No immunological reactivity was associated to xenograft group. Conclusions High infection rate (20.6%) was reported in xenograft group. Both groups of patients achieved comparable clinical outcomes if missing/contaminated subjects are excluded. Improved harvesting/processing treatments in future studies using xenografts for ACL reconstruction are needed to reduce infection rate, otherwise xenograft should not be used in ACL reconstruction. Level of evidence Multicenter and double-blinded Randomized Controlled Clinical Trial, Level I.
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Affiliation(s)
| | | | | | - Kees Van Egmond
- Dept. of Orthopaedic Surgery, Isala Klinieken, Zwolle, Netherlands
| | - Stefano Zaffagnini
- IRCCS Istituto Ortopedici Rizzoli, University of Bologna, Lab. Biomeccanica - Via di Barbiano, 1/10, 40137, Bologna, Italy
| | - Maurilio Marcacci
- IRCCS Humanitas University, Milano / former Istituto Ortopedici Rizzoli, University of Bologna, II Clinica Ortopedica, Bologna, Italy
| | - Ramon Cugat
- Hospital Quiron, Artoscopia GC, Barcelona, Spain
| | - Rene Verdonk
- Dept. of Orthopaedic Surgery & Traumatology, Gent Univ. Hospital, Ghent, Belgium
| | - Enrique Ibañez
- Clinica Cemtro, Orthopaedic Surgery & Traumatology, Madrid, Spain
| | - Pedro Guillen
- Clinica Cemtro, Orthopaedic Surgery & Traumatology, Madrid, Spain
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Zhang Y, Liu S, Chen Q, Hu Y, Sun Y, Chen J. Maturity Progression of the Entire Anterior Cruciate Ligament Graft of Insertion-Preserved Hamstring Tendons by 5 Years: A Prospective Randomized Controlled Study Based on Magnetic Resonance Imaging Evaluation. Am J Sports Med 2020; 48:2970-2977. [PMID: 32909826 DOI: 10.1177/0363546520951507] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND It has been reported that insertion-preserved hamstring tendon autografts (IP-HT) have better maturity than free hamstring tendon autografts (FHT) at 2 years after anterior cruciate ligament reconstruction (ACLR); however, whether insertion preservation improves the maturity of the entire autograft and clinical outcomes at 5 years after ACLR is still unclear. PURPOSE To investigate the clinical outcomes and maturity of different segments using insertion-preserved and free hamstring tendon autografts up to 5 years after ACLR. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS 45 patients who underwent isolated ACLR with hamstring tendon autografts were enrolled and randomized into 2 groups. The study group had ACLR with IP-HT, whereas the control group had ACLR with FHT. The International Knee Documentation Committee and Tegner scores, Lysholm activity score, and KT-1000 arthrometer measurements were evaluated preoperatively and at 6, 12, 24, and 60 months postoperatively. Three-dimensional-reconstruction MRI examinations were performed at 6, 12, 24, and 60 months to evaluate the signal/noise quotient (SNQ) values of femoral tunnel graft, intra-articular graft, and tibial tunnel graft. RESULTS At 60 months, the SNQ values of the intra-articular and tunnel sections for the grafts in both groups showed no difference; the clinical outcomes were improved compared with before surgery (P < .001) and were similar in both groups. In the early stage, all graft segments in the IP-HT group had lower SNQ values than those of the FHT group. At 6 months, the entire graft in the FHT group and the femoral tunnel section in the IP-HT group had the maximum SNQ values, whereas the femoral tunnel graft had the highest SNQ value compared with intra-articular and tibial tunnel graft in each group. SNQ values of the intra-articular and tibial tunnel graft in the IP-HT group had no significant change within 60 months. CONCLUSION All patients had similar clinical outcomes and graft maturity at 60 months postoperatively. The SNQ values and progressions varied at different graft sites and were highest for the femoral tunnel graft. All significantly changing SNQ values reached the maximum value at 6 months. Compared with FHT autograft, the graft maturity of IP-HT autograft recovered earlier and appeared more stable within the 60-month follow-up; however, no significant association was found between graft maturity and clinical scores.
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Affiliation(s)
- Yuhan Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qingyan Chen
- Department of Biology, Boston University, Boston, Massachusetts, USA
| | - Yiwen Hu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yaying Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Okimura S, Shino K, Nakagawa S, Iuchi R, Take Y, Mae T. Minimal tibial tunnel enlargement after anatomic rectangular tunnel anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. J Orthop Sci 2020; 25:635-639. [PMID: 31331709 DOI: 10.1016/j.jos.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/07/2019] [Accepted: 07/02/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the tibial tunnel enlargement after the anatomical rectangular tunnel (ART) anterior cruciate ligament reconstruction (ACLR) with a bone-patellar tendon-bone (BTB) graft and to elucidate the correlation between the enlargement and length of the tendinous portion inside the tibial tunnel. In addition, we aimed to analyze the correlation between patient characteristics and tibial tunnel enlargement. METHODS This study included 50 patients who underwent ART ACLR. Lateral radiographs at the time of surgery and at 2 years were compared to evaluate the tibial tunnel enlargement. Subsequently, correlations between the tunnel enlargement and (1) length of tendinous portion inside the tibial tunnel or (2) characteristics of the patients, including anterior knee laxity measured by KT-1000 arthrometer, age, sex, height, body weight, and Tegner activity level scale, were analyzed. RESULTS The tibial tunnel was enlarged by 2.6 ± 4.2% 2 years postoperatively. The length of the tendinous portion inside the tibial tunnel was 7.8 ± 4.9 mm. There was no significant correlation between tunnel enlargement and length of tendinous portion inside the tunnel. None of the patient characteristics were detected as a risk factor for tibial tunnel enlargement. CONCLUSIONS (1) The postoperative tibial tunnel enlargement was minimum after ART ACLR with a BTB graft. (2) There was no correlation between tibial tunnel enlargement and length of tendinous portion of BTB graft inside the tunnel. (3) None of the patient characteristics were detected as a risk factor of the tibial tunnel enlargement.
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Affiliation(s)
- Shinichiro Okimura
- Sports Orthopedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan.
| | - Konsei Shino
- Sports Orthopedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Shigeto Nakagawa
- Sports Orthopedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Ryo Iuchi
- Sports Orthopedic Center, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Yasuhiro Take
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Tatsuo Mae
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
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Wang H, Zhang B, Cheng CK. Stiffness and shape of the ACL graft affects tunnel enlargement and graft wear. Knee Surg Sports Traumatol Arthrosc 2020; 28:2184-2193. [PMID: 31690994 DOI: 10.1007/s00167-019-05772-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/22/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Tunnel enlargement and graft rupture are common complications associated with ACL reconstruction (ACLR). This study aims to explore how variations in graft stiffness and shape affect the strain energy density (SED) around bone tunnel entrances and stress on the graft and subsequently influencing the level of tunnel enlargement and graft wear. METHODS Finite element ACLR models were developed using different graft stiffnesses (323 N/mm, 545 N/mm and 776 N/mm) and shapes (circular and elliptical). The models were subjected to a combined loading of 103 N anterior tibial load, 7.5 Nm internal tibial moment, and 6.9 Nm valgus tibial moment at joint flexion of 30°. SED at tunnel entrances and stresses on the graft was recorded and compared among the different models. RESULTS Increasing the graft stiffness resulted in greater stress on the graft (17.2, 24.4 and 31.7 MPa for graft stiffnesses of 323 N/mm, 545 N/mm and 776 N/mm), but had little effect on the SED reduction around the tunnel entrances. Changing the cross section of the graft from circular to elliptical caused an additional reduction in SED (56.8 vs 2.8 kJ/m3) at the posterior zone of the femoral tunnel entrance and increased the stress on the graft (31.7 MPa vs 38.9 MPa). CONCLUSIONS This study recommends using ACL grafts with lower stiffness and a circular cross section to reduce tunnel enlargement and graft wear following ACLR.
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Affiliation(s)
- Huizhi Wang
- School of Biological Science and Medical Engineering, Beihang University, 37 Xueyuan Road, Haidian District, Beijing, 100083, China
| | - Bo Zhang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Cheng-Kung Cheng
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China.
- School of Biological Science and Medical Engineering, Beihang University, 37 Xueyuan Road, Haidian District, Beijing, 100083, China.
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Kim JE, Won S, Jaffar MSA, Lee JI, Kim TW, Lee YS. How does geometric change after open-wedge high tibial osteotomy affect anterior cruciate ligament status? Knee 2020; 27:940-948. [PMID: 32331827 DOI: 10.1016/j.knee.2020.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/26/2020] [Accepted: 04/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Open-wedge high tibial osteotomy (OWHTO) produces three- dimensional (3D) geometric changes. Among them, increased posterior tibial slope (PTS), and altered coronal inclination that induces unintended tibial translation may affect anterior cruciate ligament (ACL) status. The purpose of current study was to evaluate the geometric changes following OWHTO, such as increasing PTS and decreasing tibial subluxation, which may affect the status of ACL. METHODS From April 2014 to December 2015, a total of 72 knees in 64 patients that underwent OWHTO, second-look arthroscopy, and magnetic resonance imaging (MRI) assessment, were enrolled. Preoperative and postoperative coronal and sagittal translation, joint line orientation angle, the distance between medial femoral notch marginal line and medial tibial spine, and PTS were evaluated. ACL status was arthroscopically graded from grade 1 (best) to 4 (worst). The MRI signal of the graft in three portions (proximal, middle, and distal) was graded from grade 1 (best) to 4 (worst). RESULTS High grade (3: partial, and 4: complete rupture) was noted in 28 cases (38.9%) at the second-look arthroscopy compared with 10 cases (13.9%) at index arthroscopy. The MRI signal grade significantly increased at follow up MRI compared with preoperative MRI (P<0.01). An increased signal was commonly noted in the middle and distal portions of the graft. CONCLUSIONS Geometric changes after OWHTO were related to ACL deterioration. The ACL was commonly affected at the middle and distal portions and rarely at the proximal portion. There is a possibility of impingement because of the geometric changes. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ji Eui Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Samuel Won
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | | | - Jae Ik Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
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Yue L, DeFroda SF, Sullivan K, Garcia D, Owens BD. Mechanisms of Bone Tunnel Enlargement Following Anterior Cruciate Ligament Reconstruction. JBJS Rev 2020; 8:e0120. [DOI: 10.2106/jbjs.rvw.19.00120] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zhang S, Liu S, Yang L, Chen S, Chen S, Chen J. Morphological Changes of the Femoral Tunnel and Their Correlation With Hamstring Tendon Autograft Maturation up to 2 Years After Anterior Cruciate Ligament Reconstruction Using Femoral Cortical Suspension. Am J Sports Med 2020; 48:554-564. [PMID: 31967861 DOI: 10.1177/0363546519898136] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Graft healing within the femoral tunnel after anterior cruciate ligament reconstruction (ACLR) using suspensory fixation could be reflected in graft maturation and tunnel morphological changes. However, the correlation between graft maturation and femoral tunnel changes remains unclear. PURPOSE To quantitatively evaluate femoral tunnel morphological changes and graft maturation and to analyze their correlation after ACLR using femoral cortical suspension. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent single-bundle ACLR with a hamstring tendon autograft using femoral cortical suspension were included. Preoperative and postoperative (at 6, 12, and 24 months) knee function were evaluated using KT-1000 arthrometer testing, the Lysholm knee scoring scale, and the International Knee Documentation Committee (IKDC) questionnaire. At 1 day, 6 months, 12 months, and 24 months after ACLR, 3-dimensional magnetic resonance imaging was performed to observe the morphology of the femoral tunnel and to evaluate graft maturation using the graft signal/noise quotient (SNQ). The Pearson product moment correlation coefficients (r) of femoral tunnel radii versus clinical outcomes and graft SNQs at last follow-up were analyzed. RESULTS A total of 22 patients completed full follow-up. KT-1000 arthrometer, Lysholm, and IKDC scores improved over time postoperatively, but no significant improvement was seen after 12 months (P < .05). The radius of the tunnel containing the graft and the SNQs of the femoral intraosseous graft and intra-articular graft were the highest at 6 months, and they decreased by 24 months but remained higher than their 1-day postoperative values (P < .05). Expansion mainly occurred at the anteroinferior wall of the femoral tunnel. The tunnel aperture radius was positively correlated with SNQs of the intraosseous graft (r = 0.591; P < .05) and intra-articular graft (r = 0.359; P < .05) but not with clinical outcomes. CONCLUSION After ACLR using suspensory fixation, morphological changes of the femoral tunnel were mainly observed in the part of the tunnel containing the graft, which expanded at 6 months and reduced by 24 months. Expansion mainly occurred at the anteroinferior wall of the femoral tunnel. Femoral tunnel expansion was correlated with inferior graft maturation but not with clinical outcomes.
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Affiliation(s)
- Shurong Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Sports Medicine Institute, Fudan University, Shanghai, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Sports Medicine Institute, Fudan University, Shanghai, China
| | - Liqin Yang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Sports Medicine Institute, Fudan University, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Sports Medicine Institute, Fudan University, Shanghai, China
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Flanigan DC, Everhart JS, DiBartola AC, Dusane DH, Abouljoud MM, Magnussen RA, Kaeding CC, Stoodley P. Bacterial DNA is associated with tunnel widening in failed ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 2019; 27:3490-3497. [PMID: 30810788 DOI: 10.1007/s00167-019-05405-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/06/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine if tunnel widening, defined as change in maximal tunnel diameter from the time of initial bone tunnel drilling to revision surgery is associated with bacterial deoxyribonucleic acid (DNA) presence and concentration in torn graft tissue from failed anterior cruciate ligament reconstructions (ACLRs). METHODS Thirty-four consecutive revision ACLRs were included (mean age 27.3 years SD 10.9; median time to failure 4.9 years range 105 days-20 years). Graft selection of the failed reconstruction was 68% autograft, 26% allograft, and 6% autograft/allograft hybrid with a mean drilled tunnel diameter of 8.4 mm SD 0.8. Maximal tunnel diameters prior to revision were measured on pre-operative three-dimensional imaging and compared to drilled tunnel diameters at the time of the previous reconstruction. Tissue biopsies of the failed graft were obtained from tibial, femoral, and intraarticular segments. Sterile water left open to air during revision ACLRs and tissue from primary ACLRs were used as negative controls. Clinical cultures were obtained on all revision ACLRs and PCR with universal bacterial primer on all cases and negative controls. Fluorescence microscopy was used to confirm the presence and location of biofilms in two patients with retrieved torn graft tissue and fixation material. Amount of tunnel widening was compared to bacterial DNA presence as well as bacterial DNA concentration via Welch ANOVA. RESULTS Bacterial DNA was present in 29/34 (85%) revision ACLRs, 1/5 (20%) of primary ACLR controls and 0/3 (0%) sterile water controls. Cultures were positive (coagulase negative Staphylococcus sp.) in one case, which also had the greatest degree of tunnel widening. Femoral widening was greater in cases with detectable bacterial DNA (mean widening 2.6 mm SD 3.0) versus without (mean 0.3 mm SD 0.6) (p = 0.003) but was unaffected by bacterial DNA concentration (p = 0.44). Tibial widening was not associated with the presence of bacterial DNA (n.s.); however, higher bacterial DNA concentrations were observed in cases with tibial widening ≥ 3.0 mm (median 2.47 ng bacterial DNA/µg total DNA) versus widening < 3.0 mm (median 0.97 ng bacterial DNA/µg total DNA) (p = 0.046). Tunnel widening was not associated with time to failure, graft selection, or number of prior surgeries (n.s., all comparisons). Fluorescence microscopy confirmed the presence of biofilms on ruptured tendon graft as well as fixation material in 2/2 cases. CONCLUSION Bacterial DNA is commonly encountered on failed ACLR grafts and can form biofilms. Bacterial DNA does not cause clinically apparent infection symptoms but is associated with tunnel widening. Further research is needed to determine whether graft decontamination protocols can reduce graft bacterial colonization rates, ACLR tunnel widening or ACLR failure risk. LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA.
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA.
| | - Joshua S Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Alex C DiBartola
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Devendra H Dusane
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, USA
| | - Moneer M Abouljoud
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA
| | - Christopher C Kaeding
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA
| | - Paul Stoodley
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, USA
- National Centre for Advanced Tribology, Department of Mechanical Engineering, Southampton University, Southampton, UK
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Sun Y, Chen W, Hao Y, Gu X, Liu X, Cai J, Liu S, Chen J, Chen S. Stem Cell-Conditioned Medium Promotes Graft Remodeling of Midsubstance and Intratunnel Incorporation After Anterior Cruciate Ligament Reconstruction in a Rat Model. Am J Sports Med 2019; 47:2327-2337. [PMID: 31306585 DOI: 10.1177/0363546519859324] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Stem cell-conditioned medium (CM) has been increasingly used in regenerative medicine. However, its effect on graft-host integration after anterior cruciate ligament (ACL) reconstruction (ACLR) remains unclear. PURPOSE To examine the effect of human bone marrow stem cell (hBMSC)-CM on graft-bone integration and graft midsubstance ligamentization in a rat model of ACLR. STUDY DESIGN Controlled laboratory study. METHODS CM was obtained from the supernatant of commercially available hBMSCs in serum-free Dulbecco's modified Eagle medium (DMEM). In a rat model of an ACL injury, isometric ACLR was performed. Three groups were established: CM injection group (CM; n = 40), control injection group (CI; n = 40) with serum-free DMEM injections, and no injection group (NI; n = 40). An intra-articular injection was performed weekly. Micro-computed tomography was conducted at 2, 4, and 8 weeks postoperatively. Histological and biomechanical analyses were conducted at 4 and 8 weeks postoperatively. The NIH3T3 fibroblast was utilized as a model in vitro to examine the effect of CM using the cell counting kit-8 (CCK-8) assay and immunofluorescence staining of Ki-67, α-smooth muscle actin (α-SMA), and collagen 1 (Col 1). RESULTS At 4 and 8 weeks, the femoral and tibial bone tunnel areas as well as the interface between the graft and host bone were smaller, while the bone volume/total volume ratio was higher, in the CM group. Sharpey-like fibers formed at 8 weeks in the CM group. At 4 and 8 weeks, more Col 1 was noticed in the CM group than in the NI group (both P < .001) or CI group (both P < .001). Immunohistochemically, the α-SMA-positive area was up-regulated at the graft-bone interface at 4 weeks (P < .001) and declined at 8 weeks (P < .001) in the CM group compared with the other 2 groups. At the midsubstance, α-SMA expression decreased from 4 to 8 weeks in all groups and was significantly lower in the CM group than in the NI group (P < .01) or CI group (P < .05) at 8 weeks. The CCK-8 assay showed that CM increased NIH3T3 viability (P < .001) and the level of Ki-67 (P < .05), α-SMA (P < .001), and Col 1 (P < .001) in CM-educated NIH3T3 cells. CONCLUSION hBMSC-CM accelerates graft-bone incorporation and midsubstance ligamentization and enhances the proliferation, differentiation, and collagen synthesis of fibroblasts. CLINICAL RELEVANCE Graft-host integration is essential after ACLR. The current study identified a novel agent, that is, hBMSC-CM, as a candidate for promoting integration.
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Affiliation(s)
- Yaying Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenbo Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuefeng Hao
- Department of Orthopaedic Surgery, Northern Branch of Suzhou Municipal Hospital, Suzhou, China
| | - Xueping Gu
- Department of Orthopaedic Surgery, Northern Branch of Suzhou Municipal Hospital, Suzhou, China
| | - Xingwang Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiangyu Cai
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Onggo JR, Nambiar M, Pai V. Fixed- Versus Adjustable-Loop Devices for Femoral Fixation in Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2019; 35:2484-2498. [PMID: 31147109 DOI: 10.1016/j.arthro.2019.02.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare biomechanical and clinical outcomes between adjustable-loop devices (ALDs) and fixed-loop devices (FLDs) in the femoral fixation component of anterior cruciate ligament reconstruction (ACLR) using a hamstring autograft or allograft. METHODS A multi-database search was performed on July 18, 2018, according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All articles directly comparing ALDs and FLDs in ACLR using hamstring grafts were included. Non-English-language articles were excluded. RESULTS We included 13 biomechanical, 2 prospective, and 6 retrospective studies in this review. Retensioning of ALDs was performed in 4 of 13 biomechanical studies and in all clinical studies. Biomechanically, 11 studies showed a statistically significantly larger maximum irreversible displacement of the graft in the ALD group. Two studies showed no statistically significant difference with retensioning of the TightRope ALD, whereas all 3 studies that examined knotting of ALDs showed no statistically significant difference between the FLD and ALD groups. Five studies reported statistically significantly higher graft stiffness for FLDs than ALDs. Retensioning or knotting did not produce any significant change in construct stiffness. Nine studies reported a statistically significantly higher ultimate load to failure for FLDs. With knotting of ALDs, this difference was no longer statistically significant in only 1 study. Clinical studies showed no statistically significant differences in clinical, functional, radiologic, and complication outcomes between both groups. CONCLUSIONS Despite the superior biomechanical properties of FLDs, ALDs and FLDs yielded similar clinical outcome scores and graft rerupture rates. Biomechanical outcomes were improved with retensioning of ALDs after tibial fixation, as per manufacturer recommendations. LEVEL OF EVIDENCE Level III, systematic review of Level III and IV studies.
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Neri T, Parker DA, Putnis S, Klasan A, Trombert-Paviot B, Farizon F, Philippot R. Clinical and Radiological Predictors of Functional Outcome After Isolated Medial Patellofemoral Ligament Reconstruction at Midterm Follow-up. Am J Sports Med 2019; 47:1338-1345. [PMID: 30943374 DOI: 10.1177/0363546519831294] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Isolated medial patellofemoral ligament reconstruction (iMPFLR) is increasingly used for the surgical treatment of recurrent patellofemoral instability. PURPOSE The purpose of this study was to identify the clinical and radiological predictors that can significantly influence the functional outcomes after an iMPFLR. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 107 patients (112 ligament reconstructions) who underwent iMPFLR were evaluated with a mean ± SD follow-up of 59 ± 33 months (range, 12-123 months). Functional International Knee Documentation Committee (IKDC) and Kujala scores were assessed preoperatively and every 12 months. Radiological assessment of patellar height and tilt (Laurin angle, Merchant angle, Maldague classification) and computed tomography (CT) scan measurement of patellar tilt (contracted and relaxed quadriceps) and tibial tubercle-trochlear groove distance were performed preoperatively and at 6 months. Femoral tunnel position was assessed following the criteria formulated by Schöttle. The amount of femoral tunnel widening was measured by means of 3-dimensional CT scan at 6 months. Predictors were determined from univariate and multivariate regression analyses integrating clinical and radiological criteria pre- and postoperatively. The dependent variable was defined as the difference between pre- and postoperative scores. RESULTS Between pre- and postoperative measurement at last follow-up, a significant improvement for IKDC and Kujala functional scores was observed (Kujala: 57 ± 11.3 to 87 ± 12.9, P < .001; IKDC: 47.8 ± 13.1 to 79 ± 15.8, P < .001). Demographics (age, body mass index, sex), dislocation characteristics (number of dislocations, time between first dislocation and surgery, age at first dislocation, mechanism of first dislocation, knee side), clinical data (frontal limb alignment, hyperlaxity, recurvatum, pre- and postoperative range of motion), and complications (quadriceps atrophy, complex regional pain syndrome) did not influence functional scores. The predictors of lower improvement in functional scores included small correction of the patellar tilt reported on the CT scan measurement, malpositioning of the femoral tunnel, and a widening of this tunnel near the medial cortex. Malpositioning of the femoral tunnel was correlated with tunnel widening, and patients with anterior and proximal malpositioning experienced stiffness in flexion. CONCLUSION Overall, iMPFLR demonstrated good outcomes. Predictors influencing the functional results were identified. Less improvement in clinical outcome was reported for patients with a high preoperative patellar tilt and only a small correction in tilt and for those who had femoral tunnel malpositioning, which was correlated with tunnel widening.
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Affiliation(s)
- Thomas Neri
- Department of Orthopaedic Surgery, University Hospital of Saint Étienne, Saint Étienne, France
- EA 7424-Interuniversity Laboratory of Human Movement Science, University Lyon-University Jean Monnet, Saint Étienne, France
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | | | - Sven Putnis
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Antonio Klasan
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | | | - Frederic Farizon
- Department of Orthopaedic Surgery, University Hospital of Saint Étienne, Saint Étienne, France
- EA 7424-Interuniversity Laboratory of Human Movement Science, University Lyon-University Jean Monnet, Saint Étienne, France
| | - Remi Philippot
- Department of Orthopaedic Surgery, University Hospital of Saint Étienne, Saint Étienne, France
- EA 7424-Interuniversity Laboratory of Human Movement Science, University Lyon-University Jean Monnet, Saint Étienne, France
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Incidence of graft failure with Achilles tendon allograft combined with RetroScrewTM tibial fixation in primary anterior cruciate ligament reconstruction. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee JH, Park I, Hyun HS, Kim SW, Shin SJ. Comparison of Clinical Outcomes and Computed Tomography Analysis for Tunnel Diameter After Arthroscopic Bankart Repair With the All-Suture Anchor and the Biodegradable Suture Anchor. Arthroscopy 2019; 35:1351-1358. [PMID: 30987905 DOI: 10.1016/j.arthro.2018.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes and radiological findings at the anchor site after arthroscopic Bankart repair with all-suture anchors and biodegradable suture anchors in patients with recurrent anterior shoulder dislocation. METHODS The patients who underwent arthroscopic Bankart repair were divided into 2 groups depending on the type of the suture anchor used in different periods. Power analysis was designed based on the postoperative Rowe score. Clinical outcomes, including the Rowe score, American Shoulder and Elbow Surgeons score, subjective instability, and redislocation rates were evaluated. In all patients enrolled, the tunnel diameter of the anchor was assessed with computed tomography arthrogram at 1 year postoperatively. The Institutional Review Board of Ewha Womans University approved this study (no. EUMC 2017-05-058). RESULTS A total of 67 patients were enrolled: 33 underwent surgery with a 1.3-mm (single-loaded) or 1.8-mm (double-loaded) all-suture anchor (group A), and 34 underwent surgery with a 3.0-mm biodegradable anchor (10.8 mm in length, 30% 1,2,3-trichloropropane/70% poly-lactide-co-glycolic acid) (group B). There were no significant differences in clinical outcomes between groups A and B in the American Shoulder and Elbow Surgeons score (preoperatively, 51.2 ± 13.7 vs 47.7 ± 12.2; 2 years postoperatively, 88.5 ± 12.3 vs 89.7 ± 10.9; P = .667) and Rowe score (preoperatively, 41.4 ± 10.5 vs 41.3 ± 9.4; 2 years postoperatively, 87.9 ± 14.9 vs 88.5 ± 14.6; P = .857). Postoperative redislocation (6.1% vs 5.9%, P = .682) and subjective instability rate (12.2% vs 17.7%, P = .386) of both groups showed no significant difference. Average tunnel diameter increment was significantly greater with the 1.8-mm all-suture anchor (2.8 ± 0.9 mm) than the 1.3-mm all-suture anchor (1.2 ± 0.8 mm) and 3.0-mm biodegradable anchor (0.8 ± 1.2 mm) (P < .001). CONCLUSIONS Arthroscopic Bankart repair with the all-suture anchor showed comparable clinical outcomes and postoperative stability as the conventional biodegradable suture anchor at 2 years after surgery. Tunnel diameter increment of the all-suture anchor was significantly greater than that of the biodegradable suture anchor at the 1-year computed tomography analysis. Although tunnel diameter increment was greater with the all-suture anchor, it did not influence the clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jae-Hoo Lee
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - In Park
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Hwan-Sub Hyun
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Sang-Woo Kim
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, Korea.
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Bhullar R, Habib A, Zhang K, de Sa D, Horner NS, Duong A, Simunovic N, Espregueira-Mendes J, Ayeni OR. Tunnel osteolysis post-ACL reconstruction: a systematic review examining select diagnostic modalities, treatment options and rehabilitation protocols. Knee Surg Sports Traumatol Arthrosc 2019; 27:524-533. [PMID: 30242452 DOI: 10.1007/s00167-018-5142-9] [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] [Received: 05/18/2018] [Accepted: 09/11/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this systematic review was to (1) identify the optimal diagnostic modality for tunnel widening in skeletally mature patients; (2) identify potentially modifiable risk factors for tunnel widening, such as graft type, and (3) determine what elements of a post-operative rehabilitation program exert the most influence on TW. METHODS The electronic databases MEDLINE, EMBASE, PubMed, and Cochrane Library were searched from database inception to January 2018. Studies that discussed tunnel widening following anterior cruciate ligament reconstruction (ACLR) of skeletally mature patients and written in English were included. Descriptive statistics, such as means, ranges, and measures of variance (e.g. standard deviations, 95% confidence intervals (CI)) are presented where applicable. RESULTS 103 studies (6,383 patients) were included. Plain radiographs were the most commonly used diagnostic modality, but radiographs on average required 10 months longer than CT and 2 months longer on average than MRI to diagnose tunnel widening after ACLR. Although CT was the least commonly used modality, it was the shortest time to diagnose tunnel widening at 9.5 months after ACLR. Bone-patellar tendon-bone (BPTB) allograft had the largest average tunnel widening overall. BPTB autograft had the lowest average tunnel widening overall. Double-bundle hamstring graft configuration had a lower average tunnel widening than single-bundle configuration. Rehabilitation protocols after ACLR that used a full weight-bearing prescription in rehabilitation showed a greater average femoral tunnel widening than partial weight-bearing, and partial weight-bearing showed a greater average tibial tunnel widening than full weight-bearing. CONCLUSIONS Based on this systematic review and the descriptive data evaluated, CT demonstrated a time of 9.5 months on average from ACLR to diagnosing tunnel osteolysis post-ACLR. With respect to graft types, double-bundle hamstring autografts reported lower average femoral and tibial TW than single-bundle hamstring autografts. BPTB autografts reported the lowest average TW and BPTB allograft the largest average TW of all the grafts. Furthermore, extension-locked bracing had the lowest TW of all the brace protocols. Lastly, several other surgical technical parameters influencing tunnel osteolysis remain to be determined. No definitive recommendations can be made at this time due to the high heterogeneity of data and the lack of comparative studies analysed in this systematic review. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ramandeep Bhullar
- MacSports Research Program, McMaster University, Hamilton, ON, Canada
| | - Anthony Habib
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Kailai Zhang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Darren de Sa
- UPMC Center for Sports Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Olufemi R Ayeni
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. .,McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
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