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Jung SH, Park JS, Jung M, Chung K, Ha TH, Choi CH, Kim SH. Combined Anterolateral Ligament Reconstruction Results in Better Knee Stability and More Satisfactory Subjective Outcomes in Non-Athlete Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction. J Clin Med 2024; 13:4087. [PMID: 39064127 PMCID: PMC11278468 DOI: 10.3390/jcm13144087] [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: 06/06/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Consensus has not yet been reached regarding combined anterior cruciate ligament reconstruction (ALLR) with revisional anterior cruciate ligament reconstruction (RACLR). We aimed to compare the clinical outcomes between patients who underwent isolated RACLR and those who underwent RACLR combined with ALLR. Methods: Between June 2010 and June 2021, 49 patients who underwent RACLR were retrospectively reviewed over a 24-month follow-up. Patients were categorized into the isolated RACLR (n = 37, group 1) or combined ALLR group (n = 12, group 2). Clinical outcomes were evaluated with several patient-reported outcome measures (PROMs) and minimal clinically important differences (MCIDs) for each PROM. The side-to-side difference (SSD) of the anterior instability was measured. The pivot-shift test was performed. Results: Baseline characteristics showed no differences between the groups. PROMs showed no significant differences between the groups at the 2-year follow-up. Group 2 was superior to group 1 in the MCID achievement rate for Lysholm knee and International Knee Documentation Committee (IKDC) subjective scores at 24 months postoperatively. At the final follow-up, the proportion of IKDC grade A in SSD for anterior laxity was higher in group 2 than in group 1 (58.3% versus [vs.] 18.3%, p = 0.009), and the proportion of pivot-shift grade 0 was also higher in group 2 (66.7% vs. 27.0%, p = 0.013). The "near return to activity" rate was also higher in group 2 than in group 1 (83.3% vs. 45.9%, p = 0.043). Conclusions: Combining ALLR with RACLR in non-athletes results in a higher proportion of patients with less mechanical graft failure and satisfactory clinical outcomes.
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Affiliation(s)
- Se-Han Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Ji-Soo Park
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kwangho Chung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea
| | - Tae-Ho Ha
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Chong Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.-H.J.); (J.-S.P.); (M.J.); (K.C.); (T.-H.H.); (C.H.C.)
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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Nabil A, Abd Halim Hafez K, Rizk A, Abu Taleb A, Emad R. Does lateral extra-articular tenodesis affect knee stability in cases with isolated anterior cruciate ligament reconstruction? J Orthop 2024; 53:7-12. [PMID: 38450063 PMCID: PMC10912222 DOI: 10.1016/j.jor.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
Objective The purpose of this randomised controlled trial was to assess the effect on knee function and stabilising effectiveness of lateral extra-articular tenodesis (LET) in anterior cruciate ligament (ACL) restoration. Methods A prospective randomised clinical study that compared the functional outcomes of two groups-one undergoing anatomic single bundle ACL reconstruction (ASB-ACLR) with ilio-tibial band tenodesis (LET) for 20 patients, and the other undergoing ASB-ACLR-was carried out between February 2020 and August 2022. Results By combining Lateral Extra-articular Tenodesis (LET) with intra-articular Anterior Cruciate Ligament Reconstruction (ACLR), our study observed a significant reduction in the occurrence of high-grade pivot-shift phenomena. Prior to surgery, both Groups A and B exhibited graded (D) pivot-shift test results. However, post-surgery, the pivot-shift test yielded negative results in 60% of patients in Group A and 90% of patients in Group B. The statistical analysis revealed a notable difference between the two groups, as indicated by a P-value of 0.003. Upon conducting a brief follow-up, we evaluated the Lysholm score, and anterior knee stability of ACLR with LET, finding no statistically significant difference compared to those of single ACLR. The Lachman tests also revealed no significant disparity between the two groups (p = 0.106). Analyzing the Lysholm scores in Group A and Group B, we observed an increase to 90.70% and 91.10%, respectively. Conclusion Rotational stability is much improved when lateral extra-articular tenodesis (LET) utilizing the ilio-tibial band as an augmentation is used in ACL restoration. Especially useful for high-grade pivot-shift phenomena is this technique.
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Affiliation(s)
- Ahmed Nabil
- Orthopaedic Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ahmed Rizk
- Orthopaedic Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abu Taleb
- Orthopaedic Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ramy Emad
- Orthopaedic Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Lutz C, Casin C, Pioger C, Jacquot X, Jaeger JH, Van Hille W. Combined ACLR and lateral extra-articular tenodesis with a continuous iliotibial band autograft is a viable option in a population of athletes who participate in pivoting sports. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38922782 DOI: 10.1002/ksa.12324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/31/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The aim of this study was to evaluate the clinical results, return to sport and complications after anterior cruciate ligament reconstruction (ACLR) associated with lateral extra-articular tenodesis using continuous plasty with an iliotibial band. METHODS This was a prospective multicentre study involving 186 patients who had surgery for anterior cruciate ligament (ACL) rupture. Patients with multiligament ruptures and revision surgery were excluded from the study. All patients included were involved in pivoting sports and wished to resume their activity after surgery. Patients were assessed at a minimum 2-year follow-up using functional and psychological questionnaires (subjective International Knee Documentation Committee [IKDC], Tegner, Lysholm and ACL-RSI scores), ligament assessment including instrumented laxity measurement (Rolimeter), Lachman test and pivot shift and isokinetic testing. Return to sport was assessed using a questionnaire, and complications and repeat surgeries were recorded. RESULTS At a mean follow-up of 43.1 months, the subjective IKDC, Lysholm, ACL-RSI and objective IKDC scores were significantly improved (59.8 vs. 94.5 p < 0.0001, 75 vs. 99 p < 0.0001, 60 vs. 93 p < 0.0001, IKDC A 0% vs. 72%, B 12% vs. 27%, C 60% vs. 1% D 28% vs. 0% p < 0.0001). The Tegner activity level was 9 (3-10) before the accident and 9 (3-10) at the last review. Seventy-six percent of the patients had returned to sports at the same level. The differential laxity was 6.6 mm (±1.7) preoperatively and 1.1 mm (±1.4) postoperatively. Additionally, 97% were equal in pivot shift at the last follow-up. At the 6-month isokinetic assessment, the muscle strength recovery for the quadriceps and hamstring was over 85% compared with the healthy side for 79% and 70% of the patients, respectively. Ten patients had graft rupture (5.6%). Four (2.4%) patients had a contralateral ACL rupture, and seven (4%) underwent a reoperation with meniscectomy. CONCLUSION Anterior ligament reconstruction with lateral extra-articular tenodesis using a continuous strip of iliotibial band enables 76% of patients in a population with a high demand for sports to resume their activities at the same level. The clinical results and complication rates, particularly reruptures (5.6%), were similar to those of other techniques involving lateral extra-articular tenodesis. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Christian Lutz
- Institut de Chirurgie Orthopédique et Sportive à Strasbourg, Strasbourg, France
| | | | - Charles Pioger
- Department of Orthopedic Surgery, Ambroise Paré Hospital, AP-HP 9, Boulogne-Billancourt, France
| | - Xavier Jacquot
- Institut de Chirurgie Orthopédique et Sportive à Strasbourg, Strasbourg, France
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Xing Y, He A, Kang Y, Yang Z, Meng F, Wu P. Loop technique for anterior cruciate ligament reconstruction combined with anterolateral structure reinforcement: technical description and clinical results. BMC Surg 2024; 24:182. [PMID: 38877438 PMCID: PMC11177408 DOI: 10.1186/s12893-024-02439-7] [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: 04/29/2023] [Accepted: 05/06/2024] [Indexed: 06/16/2024] Open
Abstract
PURPOSE We describe a surgical technique for ACL reconstruction combined with anterolateral structure reinforcement and report early clinical follow-up results. METHODS The semitendinosus and gracilis tendons are braided into 5 strands and the ACL femoral tunnel and tibial tunnel are created. The graft is passed through the tunnel with the use of a traction suture and the tibial end is fixed with absorbable interference screws at 30° of knee flexion. The ACL graft traction suture is used as an anterolateral reconstruction structure to pass through the proximal exit of the ACL femoral tunnel and then through the depth of the iliotibial bundle to the anterior to Gerdy's tubercle, a bony tunnel is created from the anterior to Gerdy's tubercle to the goose foot, and the traction suture is passed through this bony tunnel to form a Loop structure at 20° of knee flexion. Between March 2021 and May 2022 IKDC score, Lysholm score, and Tegner score were performed preoperatively and 6-12 months postoperatively in 24 consecutive patients who met the indications for this procedure and underwent surgery. The patient's maximum flexion angle, the circumference of the thigh, and the stress X-ray between the operated and healthy knee were measured. RESULTS Patients showed significant improvement in IKDC score, Lysholm score and Tegner score at a mean follow-up of 7 months postoperatively compared to preoperatively. No significant increase in anterior tibial displacement was found between the patient's operated side and the healthy side. CONCLUSION The Loop technique ACLR combined with ALSA can be used in patients with an ACL tear combined with a high degree of positive pivot shift. The patient's subjective perception was significantly improved from the preoperative period and knee stability was restored. LEVEL OF EVIDENCE IV, therapeutic study.
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Affiliation(s)
- Yang Xing
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Aishan He
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Yan Kang
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Zibo Yang
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Fangang Meng
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Peihui Wu
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China.
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Jacob G, Lim YP, Brito CA, Parker DA. Lateral extra-articular tenodesis does not enhance ACL graft healing, however, does reduce graft tunnel widening. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38860740 DOI: 10.1002/ksa.12310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE The study hypothesized that the addition of lateral extra-articular tenodesis (LEAT) in anterior cruciate ligament reconstruction (ACLR) had a significant effect on ACL graft healing. METHODS A total of 80 patients were divided into two cohorts matched for gender, age, body mass index, time from surgery to post-operative MRI and graft diameter. Forty patients underwent ACL reconstruction alone, while 40 underwent ACLR in addition to LEAT. Patients underwent a magnetic resonance imaging scan at 12 months post-surgery; tunnel apertures were measured using multiplanar reformation, graft healing was assessed using signal-to-noise quotient (SNQ) in three regions of interest and finally graft maturity and integration were classified using the Howell and Ge scale, respectively. In addition, clinical evaluation and patient-reported outcome measures were collected. RESULTS The mean femoral tunnel widening at 12 months post-surgery was 39.8 ± 14.0% in the ACLR + LEAT group and 55.2 ± 12.7% in the ACLR alone group (p < 0.05). The mean tibial tunnel widening was 29.3 ± 12.7% in the ACLR + LEAT group and 44.4 ± 12.1% in the ACLR group (p < 0.05). The mean adjusted graft SNQ was 9.0 ± 14.9 in the ACLR + LEAT group and 9.5 ± 11.4 in the ACLR group (n.s.). CONCLUSION At 1 year post-operatively, we noted significantly less femoral and tibial tunnel widening in the ACLR + LEAT group. LEAT did not result in a statistically significant effect on graft healing. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- George Jacob
- Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
| | - Yoong Ping Lim
- Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
- Charles Darwin University, Darwin, Northern Territory, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | | | - David A Parker
- Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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Guerreiro JPF, Rosa LB, Gonçalves EL, Curcio ARR, Bignardi PR, Danieli MV. Outcomes of Anterior Cruciate Ligament Reconstruction in Patients with Associated Anterolateral Ligament Injury. Rev Bras Ortop 2024; 59:e397-e402. [PMID: 38911889 PMCID: PMC11193583 DOI: 10.1055/s-0044-1785516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/06/2023] [Indexed: 06/25/2024] Open
Abstract
Objective To evaluate if there is a significant difference in the outcomes of isolated anterior cruciate ligament (ACL) reconstruction in patients with or without associated anterolateral ligament (ALL) injury. Methods We conducted a retrospective cross-sectional study through the analysis of medical records and the application of the questionnaires of the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) Subjective Knee Form to patients undergoing isolated ACL reconstruction. Results The 52 participants included were divided into two groups: 19 with associated ALL injury and 33 with no associated ALL injury. None of the patients with associated ALL injury suffered an ACL rerupture, and 21.1% presented injuries to other knee structures after surgery. Among the patients with no associated injury, 6.1% suffered ACL rerupture, and 18.2% presented injuries to other structures after surgery ( p = 0.544). Return to activities at the same level as that of the preoperative period occurred in 60% of the patients with associated ALL injury and in 72% of those with no associated injury ( p = 0.309). The mean score on the Lysholm Knee Scoring Scale was of 81.6 points in patients with associated ALL injury, and of 90.1 in those with no associated injury ( p = 0.032). The mean score on the IKDC Subjective Knee Form was of 70.3 points in patients with associated ALL injury and of 76.7 in those with no associated injury ( p = 0.112). Conclusion There was no statistically significant difference regarding graft injuries or new injuries to other structures, satisfaction with the operated knee, or the score on the IKDC Subjective Knee Form. Return to activity was similar in the groups with and without associated ALL injuries. The scores on the Lysholm Knee Scoring Scale were better, with a statistically significant difference in the group with no associated ALL injuries.
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Affiliation(s)
- João Paulo Fernandes Guerreiro
- Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
- Hospital de Ortopedia Uniort.e, Londrina, PR, Brasil
| | - Larissa Baldow Rosa
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
| | | | | | - Paulo Roberto Bignardi
- Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
| | - Marcus Vinicius Danieli
- Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
- Hospital de Ortopedia Uniort.e, Londrina, PR, Brasil
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Pettinari F, Carrozzo A, Saithna A, Ali AA, Alayane A, Barosso M, Vieira TD, Sonnery-Cottet B. Effect of Lateral Extra-Articular Procedures Combined With ACL Reconstruction on the Rate of Graft Rupture in Patients Aged Older Than 30 Years: A Matched-Pair Analysis of 1102 Patients From the SANTI Study Group. Am J Sports Med 2024; 52:1765-1772. [PMID: 38794893 DOI: 10.1177/03635465241247760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament (ACL) reconstruction (ACLR) and lateral extra-articular procedures (LEAPs) over isolated ACLR in terms of reducing graft rupture and reoperation rates. However, most of the published studies have included young patients, and no studies have focused on patients aged >30 years. PURPOSE/HYPOTHESIS The purpose of this study was to compare the outcomes of isolated ACLR versus ACLR + LEAP at midterm follow-up in patients aged >30 years. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients >30 years of age who underwent primary ACLR + LEAP between January 2003 and December 2020 were propensity matched at a 1:1 ratio to patients who underwent isolated ACLR. A retrospective analysis of prospectively collected data was performed to determine graft rupture rates, knee stability, reoperation rates, and complications. Graft survivorship was assessed using the Kaplan-Meier method. Risk factors associated with the occurrence of graft failure were analyzed using a Cox proportional hazards model. RESULTS Two groups of 551 patients each were included in the study, and the mean follow-up was 97.19 ± 47.23 months. The overall mean age was 37.01 ± 6.24 years. The LEAP group consisted of 503 (91.3%) patients who had anterolateral ligament reconstruction and 48 (8.7%) patients who had a Lemaire procedure. Overall, 19 (1.7%) patients had graft failure: 15 (2.7%) in the no-LEAP group and 4 (0.7%) in the LEAP group (P = .0116). The risk of graft failure was significantly associated with the absence of LEAP (31 vs 12; hazard ratio, 3.309; 95% CI, 1.088-10.065; P = .0350) and age between 30 and 35 years (hazard ratio, 4.533; 95% CI, 1.484-13.841; P = .0080). A higher rate of reoperation for secondary meniscectomy was found in the no-LEAP group (5.6% vs 2.2%; P = .0031). CONCLUSION Patients aged >30 years who underwent combined ACLR and LEAP experienced a >3-fold lower risk of ACL graft failure compared with those who underwent isolated ACLR. Furthermore, the group without LEAP experienced a higher rate of secondary meniscectomy.
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Affiliation(s)
- Francesco Pettinari
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Alessandro Carrozzo
- University of Rome La Sapienza, Orthopaedics and Traumatology Rome, Lazio, Italy
| | - Adnan Saithna
- AZBSC Orthopedics, Scottsdale, Arizona, USA
- Orthopaedics Department, Arizona State University, Tempe, Arizona, USA
| | - Ahmad Abed Ali
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Ali Alayane
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Marta Barosso
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
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Lee JH, Lee GB, Chung W, Han SB, Jang KM. Addition of anterolateral ligament reconstruction to primary anterior cruciate ligament reconstruction could benefit recovery of functional outcomes. Sci Rep 2024; 14:11440. [PMID: 38769088 PMCID: PMC11106076 DOI: 10.1038/s41598-024-62444-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/16/2024] [Indexed: 05/22/2024] Open
Abstract
This study aimed to compare functional outcomes sequentially up to 1 year after combined anterior cruciate ligament reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) and isolated ACLR. Fifty patients who underwent ACLR with versus without ALLR were analyzed at four different time points (preoperatively and 3, 6, and 12 months postoperatively). For the functional outcomes, muscle strength and acceleration time (AT) were measured using an isokinetic dynamometer. Proprioception was evaluated using joint position sense and dynamic postural stability. Patient-reported outcomes were measured using the Tampa Scale for Kinesiophobia (TSK-11) scores. Functional performance was assessed using single-leg hop distance (SLHD) and Limb Symmetry Index. In the operated knees, quadriceps (at 6 months postoperatively, p = 0.003) and hamstring (at 6 and 12 months postoperatively, p < 0.001) strength were significantly higher in the combined ACLR and ALLR group than the isolated ACLR group. The TSK-11 (at 6 and 12 months postoperatively, p < 0.001) was significantly lower in the combined ACLR and ALLR group than the isolated ACLR group. SLHD was significantly higher in the combined ACLR and ALLR group than the isolated ACLR group (at 6 months, p = 0.022 and at 12 months, p = 0.024). The addition of ALLR to primary ACLR yielded better muscle performance, fear of movement, and functional performance than isolated ACLR.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Gyu Bin Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - WooYong Chung
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Seung-Beom Han
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Ki-Mo Jang
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea.
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea.
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Garra S, Moore MR, Li ZI, Eskenazi J, Jazrawi T, Bi AS, Campbell KA, Alaia MJ, Strauss EJ. Segond fracture: an indicator for increased risk of lateral meniscus injury in patients with acute anterior cruciate ligament ruptures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1883-1891. [PMID: 38448565 DOI: 10.1007/s00590-024-03857-2] [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: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The purpose of this study was to investigate the incidence and anatomic distribution of meniscus injury in patients who have sustained acute ACL injuries with and without concomitant Segond fracture. We hypothesized that patients who have sustained a torn ACL with a concomitant Segond fracture would have a higher incidence of lateral meniscal injuries than patients with an isolated ACL injury. METHODS Patients who underwent ACL reconstruction from 2012 to 2022 were retrospectively reviewed. Segond fractures were identified on knee radiographs. Inclusion criteria were age 18-40, injury during sports activity, and reconstruction within 90 days of injury. Sports activity, anatomic location of meniscus injury, and meniscus treatment were documented. Multivariable regression was used to identify predictors of meniscus injury/treatment. RESULTS There were 25 of 603 (4.1%) patients who had an ACL tear with concomitant Segond fracture. The incidence of lateral meniscus injury in the Segond group (72%) was significantly higher than in the non-Segond cohort (49%; p = 0.024). A significantly smaller proportion of medial meniscus injuries among patients with Segond fractures were repaired (23.1%) compared to the non-Segond group (54.2%; p = 0.043). Multivariate analysis found patients with Segond fractures to have increased odds of lateral meniscus injury (OR 2.68; [1.09, 6.60], p = 0.032) and were less likely to have medial meniscus injuries repaired (OR 0.35; [0.15, 0.81], p = 0.014). Additionally, males had increased odds of lateral meniscus injury (OR 1.54; [1.08 - 2.91], p = 0.017), which were more likely to require repair (OR 1.48; [1.02, 2.14], p = 0.038). CONCLUSIONS Among acute ACL injuries, the incidence of lateral meniscus injury is greater among patients with Segond fractures. Patients with Segond fracture were less likely to undergo repair of medial meniscal injuries.
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Affiliation(s)
- Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA.
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Tel-Aviv University, Ramat Gan, Israel.
| | - Michael R Moore
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Taylor Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Andrew S Bi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
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10
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Garra S, Li ZI, Eskenazi J, Jazrawi T, Rao N, Campbell KA, Alaia MJ, Strauss EJ, Jazrawi LM. Patients With Segond Fracture Demonstrate Similar Rates of Return to Sport and Psychological Readiness After Anterior Cruciate Ligament Reconstruction: A Matched Cohort Study at Minimum 2-Year Follow-Up. Arthroscopy 2024; 40:1247-1255. [PMID: 37716633 DOI: 10.1016/j.arthro.2023.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To compare clinical outcomes, rate of return to sports, and psychological readiness among patients undergoing anterior cruciate ligament reconstruction (ACLR) with and without concomitant Segond fracture. METHODS We retrospectively identified patients who underwent primary ACLR from January 2012 to December 2020 with minimum 2-year follow-up. Exclusion criteria were additional ligamentous injury, age <16 years, or a concomitant lateral augmentation procedure. Preoperative knee radiographs were reviewed to identify Segond fractures. Identified patients were matched 1:2 to controls by age/sex/body mass index/graft type. Charts were reviewed for pre- and postoperative knee stability. Surveys administered included preinjury sport participation and return status, Lysholm score, Tegner activity scale, and ACL-Return to Sport Index (ACL-RSI), a metric of psychological sport readiness. Multivariable logistic regression was conducted to identify predictors of return to sport. RESULTS There were 120 patients who were included in the final analysis (40 Segond, 80 controls) at a mean follow-up of 5.7 ± 2.4 years. A total of 52.5% of patients received bone-patellar tendon-bone autograft. The overall rate of return to sport was 79.5% in the Segond group compared with an 83.8% rate of return in the control group (P = .569). In total, 48.7% of the Segond group and 56.8% of the control group returned to their preinjury level of sport (P = .415). Lysholm (89.6 ± 10.3 vs 85.4 ± 16.7, P = .296), Tegner (5.7 ± 1.8 vs 6.1 ± 2.2, P = .723), and ACL-RSI (62.2 ± 25.4 vs 56.6 ± 25.4, P = .578) scores were similar between Segond and control groups. There was a single graft failure in the Segond group 5 years' postoperatively. Increasing ACL-RSI score was significantly predictive of return to sport (P < .001). CONCLUSIONS Patients who had an ACL tear and a concomitant Segond fracture who underwent isolated ACLR without lateral augmentation procedures had similar clinical outcomes and rates of return sport compared with a matched isolated ACLR control group at minimum 2-year follow-up. There was no significant difference in psychological readiness between groups as measured by the ACL-RSI. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.; Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Taylor Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Naina Rao
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
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Saint-Etienne A, Benhenneda R, Vieira TD, Fayard JM, Thaunat M. Clinical Outcomes of Different Management Techniques for Medial Meniscal Type 3 Ramp Lesions in Anterior Cruciate Ligament Reconstruction: A Comparative Analysis Between All-inside Repair, Suture Hook Repair, and Lesions Left In Situ. Am J Sports Med 2024; 52:1250-1257. [PMID: 38523481 DOI: 10.1177/03635465241232088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND There is ongoing debate about the best way to manage ramp lesions at the time of anterior cruciate ligament (ACL) reconstruction (ACLR). Type 3 lesions are not visible by the transnotch approach without superior debridement, making the management debate even more problematic. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the rate of secondary surgical interventions according to the management method of a type 3 ramp lesion concomitant with primary ACLR. The hypothesis was that the rate of secondary ACL or meniscal interventions would be higher in patients who underwent all-inside repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis of all patients who underwent primary ACLR with a type 3 ramp lesion between January 2012 and May 2020, regardless of the treatment method, was performed. The main criterion analyzed in this cohort was a secondary surgical intervention, defined as revision ACLR or a reintervention of the repaired meniscus. A survivorship analysis was performed to evaluate secondary surgical interventions in 3 groups: all-inside repair, suture hook repair, and left in situ. The following data were collected preoperatively and at the last follow-up: patient characteristics, time to surgery, side-to-side difference in laxity, pivot shift, Lysholm score, subjective International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, Tegner score, and meniscal repair failure rate. RESULTS A total of 113 patients who underwent type 3 ramp lesion repair concomitant with ACLR were included: 52 (46.0%) in the all-inside repair group, 23 (20.4%) in the suture hook repair group, and 38 (33.6%) in the lesion left in situ group. There were 17 patients (15.0%) who underwent a secondary intervention because of ACL graft failure (n = 6) or meniscal repair failure (n = 15 [4 of whom underwent a concomitant ACL reintervention]). Overall, 62 patients (54.9%) underwent combined ACLR and anterolateral ligament reconstruction, while 51 patients (45.1%) underwent isolated ACLR. In the adjusted Cox model, the type of meniscal repair was not statistically significantly associated with secondary surgical interventions. The only risk factor for secondary surgical interventions in this cohort was isolated ACLR (hazard ratio, 8.077; P = .007). CONCLUSION The rates of secondary surgical interventions after medial meniscal type 3 ramp lesion repair concomitant with ACLR were similar regardless of the management method of the meniscal lesion. Despite not being associated with meniscal treatment, this rate was 8 times higher for patients who underwent isolated ACLR in this cohort; this is probably because of the protection that lateral extra-articular procedures provide to the ACL graft.
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Affiliation(s)
- Adrien Saint-Etienne
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Rayane Benhenneda
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
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12
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Hagino T, Ochiai S, Hagino T, Furuya N, Wako M, Haro H. Impacts of Segond Fractures on Anterior Cruciate Ligament Reconstruction Outcomes. Cureus 2024; 16:e56542. [PMID: 38646235 PMCID: PMC11027792 DOI: 10.7759/cureus.56542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Segond fractures, characterized by avulsion injuries at the lateral tibial condyle's anterolateral structure (ALS) attachment, often coincide with anterior cruciate ligament (ACL) injuries, potentially leading to knee instability. However, the influence of Segond fractures on knee stability after ACL reconstruction remains uncertain. Despite documented ALS reconstructions, there is a lack of consensus regarding the assessment of ALS failure and the criteria for surgical interventions. This study aimed to determine if Segond fracture presence impacts ACL reconstruction outcomes, utilizing patient-reported subjective assessments and healthcare providers' objective evaluations. MATERIALS AND METHODS This retrospective study encompassed 639 patients (328 males, 311 females; mean age 26.9 years) who underwent ACL reconstruction, with a follow-up of at least one year. Subjects were divided into two groups: Segond fractures diagnosed through radiographic findings (Group S+, n = 17) and no Segond fractures (Group S-, n = 622). Clinical evaluation included the 36-item Short Form Survey (SF-36), Lysholm score, visual analog scale (VAS) for knee pain, knee injury and osteoarthritis outcome score (KOOS), and knee instability assessment via Telos SE (Telos Japan, Tokyo, Japan). Statistical comparisons were performed between the two groups. RESULTS At the final follow-up, all SF-36 subscales improved in all eight subscales compared to before surgery, reaching national standard scores; no significant inter-group differences were evident. Lysholm scores were 93.0 ± 12.1 (Group S+) and 91.7 ± 10.9 (Group S-) (P = 0.62), VAS for knee pain was 10.0 ± 18.0 (Group S+) and 11.9 ± 16.9 (Group S-) (P = 0.62), total KOOS was 89.0 ± 17.4 (Group S+) and 90.7 ± 9.9 (Group S-) (P = 0.39), and anterior tibial translation differences were 2.8 ± 3.0 mm (Group S+) and 2.7 ± 2.9 mm (Group S-) (P = 0.73). All these values represent postoperative measurements. No significant discrepancies existed between groups across evaluation methods. CONCLUSIONS This study's results suggest that Segond fractures have minimal impact on clinical ACL reconstruction outcomes, as assessed through both patient-reported subjective evaluations and objective healthcare provider evaluations. Segond fractures' significance in postoperative outcomes questions the necessity of ALS reconstruction.
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Affiliation(s)
- Tetsuhiro Hagino
- Department of Orthopedic Surgery, National Hospital Organization (NHO) Kofu National Hospital, Kofu, JPN
- Department of Orthopedic Surgery, University of Yamanashi, Chuo, JPN
| | - Satoshi Ochiai
- Department of Orthopedic Surgery, National Hospital Organization (NHO) Kofu National Hospital, Kofu, JPN
| | - Tetsuo Hagino
- Department of Orthopedic Surgery, National Hospital Organization (NHO) Kofu National Hospital, Kofu, JPN
| | - Naoto Furuya
- Department of Orthopedic Surgery, National Hospital Organization (NHO) Kofu National Hospital, Kofu, JPN
| | - Masanori Wako
- Department of Orthopedic Surgery, University of Yamanashi, Chuo, JPN
| | - Hirotaka Haro
- Department of Orthopedic Surgery, University of Yamanashi, Chuo, JPN
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Suh DK, Kang MW, Kim TJ, Kim SY, Wang JH. Incidence of Convergence Between Distally and Anteriorly Oriented ALL Femoral Tunnels and ACL Femoral Tunnels in Combined ACL and ALL Reconstruction: 3-Dimensional Computed Tomography Analysis of 227 Patients. Am J Sports Med 2024; 52:902-908. [PMID: 38353108 DOI: 10.1177/03635465241227223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND Adjusting the direction of the anterolateral ligament (ALL) femoral tunnel is suggested to avoid tunnel convergence during anterior cruciate ligament (ACL) reconstruction. Yet, there has been no in vivo clinical study reporting the effect of changing the direction of the ALL tunnel on the incidence of convergence with the ACL tunnel. PURPOSE To report the incidence of convergence between the ACL femoral tunnel and a distally and anteriorly directed ALL femoral tunnel and to determine a safe distal angle and anterior angle. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 227 patients undergoing concomitant ALL and anatomic single-bundle ACL reconstruction between January 2020 and December 2022 were retrospectively reviewed. The tunnel convergence rate, angular orientation of the tunnels, and distance between tunnels were obtained using postoperative computed tomography. The patients were grouped based on the direction of the ALL tunnel (transverse vs distal anterior) and the presence of tunnel convergence (convergence vs no convergence). RESULTS The overall tunnel convergence rate was 53.3% (121/227 patients). Tunnel convergence was observed less frequently in the distal anterior group (33.7%) than in the transverse group (65.2%) (P < .001). The no convergence group showed an ALL tunnel oriented more distally (20.2°± 11.1°) and anteriorly (19.5°± 10.2°) compared with the convergence group (8.7°± 6.5° and 6.9°± 5.3°, respectively) (P = .005 and P = .008, respectively). There were no cases of tunnel convergence for ALL tunnels >24.3° distally and >25.5° anteriorly. There was no difference in the angle of the ACL femoral tunnel between all groups. CONCLUSION A distally and anteriorly directed ALL femoral tunnel reduced the incidence of convergence with the ACL femoral tunnel. A distal angle >24.3° and an anterior angle >25.5° of an ALL tunnel are suggested to safely avoid convergence with the ACL tunnel.
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Affiliation(s)
- Dae Keun Suh
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Min Wook Kang
- Department of Orthopaedic Surgery, Incheon Himchan General Hospital, Incheon, Republic of Korea
| | - Tae Jin Kim
- Department of Orthopaedic Surgery, Incheon Himchan General Hospital, Incheon, Republic of Korea
| | - Si Yeon Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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14
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Guruprasad A, Sinha U, Kumar S, Kumar A, Ahmad S, Kumar P, Agrawal P. Utility of three-dimensional proton density-weighted sequence MRI in knee for the assessment of Anterolateral complex in Anterior cruciate ligament injury. Br J Radiol 2024; 97:583-593. [PMID: 38276884 PMCID: PMC11027298 DOI: 10.1093/bjr/tqae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/09/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To assess the proportion and pattern of injury of the anterolateral ligament (ALL) and the Kaplan fibre (KF) complex in knees with anterior cruciate ligament (ACL) injuries on MRI using three-dimensional (3D) proton density (PD) sequences. METHODS A total of 88 patients having ACL injury were included in this cross-sectional study. 3D PD sequences were used to assess injury of ALL and the KF complex and were graded on a scale of 0 to 3. MR images were evaluated by two radiologists. Interobserver agreement was determined using Cohen Kappa. RESULTS Femoral, meniscal, and tibial portions of ALL were visualized in 90.9%, 92%, and 94.3% of the study subjects, respectively. Proximal and distal KF were visualized in 92% and 93.2% of patients, respectively. Injury to ALL and KF was seen in 63.6% and 17% of the patients, respectively. Excellent interobserver agreement was noted for the identification and grading of ALL and KF complex injuries. CONCLUSIONS Oblique reformatted 3DPD MRI reliably detect ALC; however, ALL injury is better characterized than KF injury using this sequence. ADVANCES IN KNOWLEDGE Given the potential role of anterolateral complex (ALC) in maintaining the rotational stability of the knee, ALC assessment using the 3D PD sequences and their oblique reformatted images should be incorporated as routine review area of the knee MRI, particularly in the setting of ACL tear.
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Affiliation(s)
- Ankith Guruprasad
- Department of Radiodiagnosis, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Upasna Sinha
- Department of Radiodiagnosis, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Sudeep Kumar
- Department of Orthopedics, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Avinash Kumar
- Department of Orthopedics, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Shamshad Ahmad
- Department of Community and Family Medicine, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Prem Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Prabhat Agrawal
- Department of Orthopedics, All India Institute of Medical Sciences Patna, Bihar, 801507, India
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Kawanishi Y, Kobayashi M, Yasuma S, Fukushima H, Kato J, Murase A, Takenaga T, Yoshida M, Kuroyanagi G, Kawaguchi Y, Murakami H, Nozaki M. Factors Associated With Residual Pivot Shift After ACL Reconstruction: A Quantitative Evaluation of the Pivot-Shift Test Preoperatively and at Minimum 12-Month Follow-up. Orthop J Sports Med 2024; 12:23259671241230967. [PMID: 38414663 PMCID: PMC10898316 DOI: 10.1177/23259671241230967] [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: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 02/29/2024] Open
Abstract
Background Postoperative residual rotatory laxity remains despite improvement in surgical techniques for anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose To evaluate factors associated with residual pivot shift after ACLR by quantitative measurement of the pivot shift before and after surgery. Study Design Case-control study; Level of evidence, 3. Methods A total of 97 patients who underwent primary double-bundle ACLR between June 2016 and March 2021 and underwent surgery to remove staples, with at least 12 months of follow-up evaluation, were enrolled. Quantitative measurements were performed under general anesthesia immediately before ACLR (preoperatively), after temporary fixation of the ACL graft (intraoperatively), and immediately before staple removal (postoperatively). The laxity of pivot shift was assessed using inertial sensors to measure acceleration and external rotational angular velocity (ERAV). Descriptive data were assessed for associations with postoperative acceleration and ERAV in a univariate analysis. A multiple linear regression analysis was performed to identify factors associated with postoperative acceleration and ERAV. Results Anterior tibial translation, acceleration, and ERAV increased from intra- to postoperatively (P < .05). Factors significantly associated with postoperative acceleration were age (β = -0.238; P = .021), lateral posterior tibial slope (PTS) (β = 0.194; P = .048), and preoperative acceleration (β = 0.261; P = .008). Factors significantly affecting postoperative ERAV were age (β = -0.222; P = .029), ramp lesions (β = 0.212; P = .027), and preoperative ERAV (β = 0.323; P = .001). Conclusion Greater preoperative laxity in the pivot shift was the factor having the most significant association with residual pivot shift after ACLR using quantitative measurements under general anesthesia. Younger age, higher lateral PTS, and concomitant ramp lesions were significant predictors of residual pivot shift. These findings can help pre- and intraoperative decision-making regarding whether an anterolateral structure augmentation should be added.
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Affiliation(s)
- Yusuke Kawanishi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Makoto Kobayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Sanshiro Yasuma
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Hiroaki Fukushima
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Jiro Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Atsunori Murase
- Kasugai Joint & Sports Orthopedic, Pain Clinic, Kasugai, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Masahito Yoshida
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Gen Kuroyanagi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
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Lima LHPD, Gomes JLE. Must a Knee with Anterior Cruciate Ligament Deficiency and High-grade Pivot Shift Test Present an Increase in Internal Rotation? Rev Bras Ortop 2024; 59:e82-e87. [PMID: 38524720 PMCID: PMC10957268 DOI: 10.1055/s-0044-1779316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/29/2023] [Indexed: 03/26/2024] Open
Abstract
Objective: Rupture of the anterior cruciate ligament (ACL) is one of the most common injuries in athletes and is often associated with damage to anterolateral structures. This combination of injuries presents itself clinically as a high-grade pivot shift test. The hypothesis of this study is that patients with ACL deficiency and high-grade pivot shift test should have an increased internal knee rotation. Methods: Twenty-two patients were tested. After effective spinal anesthesia, two tests were performed with the patient in supine position. First, the bilateral pivot shift test was performed manually, and its grade was recorded. Then, with the knee flexed to 90 degrees, the examiner drew the projection of the foot in a neutral position and in maximum internal rotation, and the angle of internal rotation was measured from the axes built between the central point of the heel and the hallux. Results: In the ACL-deficient knee, it was observed that there is a statistically significant average internal rotation (IR) delta of 10.5 degrees between the groups when not adjusted for age, and 10.6 degrees when adjusted for age. Conclusions: Knees with ACL deficiency and with pivot shift test grade I do not show increased internal rotation in relation to knees with intact ACL. Knees with ACL deficiency and with pivot shift test grades II and III show increased internal rotation in comparison to healthy knees.
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Kolin DA, Apostolakos J, Fabricant PD, Jivanelli B, Yen YM, Kramer DE, Kocher MS, Pennock AT, Nepple JJ, Willimon SC, Perkins CA, Ellis HB, Wilson PL, McClincy M, Everett Voos J, Spence DD, Heyworth BE. Knee Flexion Angle of Fixation During Anterolateral Ligament Reconstruction or Lateral Extra-articular Tenodesis: A Systematic Review and Meta-analysis of Lateral Extra-articular Reinforcement Techniques Performed in Conjunction With ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241231254. [PMID: 38425364 PMCID: PMC10903213 DOI: 10.1177/23259671241231254] [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: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 03/02/2024] Open
Abstract
Background Anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) is being used more frequently in conjunction with anterior cruciate ligament reconstruction (ACLR). However, the knee flexion angle at which fixation of ALLR or LET is performed during the procedure is quite variable based on existing technique descriptions. Purpose/Hypothesis The purpose of this study was to identify whether flexion angle at the time of ALLR/LET fixation affected postoperative outcomes in a clinical population. It was hypothesized that ALLR/LET fixation at low versus high flexion angles would lead to no statistically significant differences in patient-reported outcome measures and graft failure rates. Study Design Systematic review; Level of evidence, 4. Methods The PubMed, Embase, and Cochrane Library databases were searched according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify published clinical studies of ACLR with ALLR/LET in which the knee flexion angle at the time of ALLR/LET was reported. A priori, low flexion was defined as 0° to 30°, and high flexion was defined as 60° to 90°. Studies were excluded if the flexion angle was between 31° and 59° because these angles constituted neither low nor high flexion angles and including them in an analysis of high versus low flexion angle at fixation would have biased the study results toward the null. The overall risk of bias was assessed using the Newcastle-Ottawa Scale. The pooled results of the studies were analyzed using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores, along with reported graft failure rates. Results A total of 32 clinical studies (5230 patients) met inclusion criteria: 22 studies (1999 patients) in the low-flexion group and 10 studies (3231 patients) in the high-flexion group. The median Newcastle-Ottawa Scale score was 6. Comparisons of patients with a low flexion angle versus a high flexion angle demonstrated no differences in the IKDC (P = .84), Lysholm (P = .67), or Tegner (P = .44) scores or in graft failure (3.4% vs 4.1%, respectively; P = .69). Conclusion The results of this review indicated that ACLR performed in conjunction with ALLR/LET provides good to excellent patient-reported outcomes and low graft failure rates when ALLR/LET fixation is performed in either low or high knee flexion.
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Affiliation(s)
| | | | - Peter D. Fabricant
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | | | | | - Yi-Meng Yen
- Boston Children’s Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | - Michael McClincy
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Bechis M, Rosso F, Blonna D, Rossi R, Bonasia DE. Lateral Extra-Articular Tenodesis with Indirect Femoral Fixation Using an Anterior Cruciate Ligament Reconstruction Suspensory Device. J Clin Med 2024; 13:377. [PMID: 38256513 PMCID: PMC10816928 DOI: 10.3390/jcm13020377] [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: 12/21/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The lateral extra-articular tenodesis (LET) procedure associated with anterior cruciate ligament (ACL) reconstruction can be considered in selected patients to diminish the risk of persistent rotatory instability and achieve a protective effect on the graft. Several techniques have been described in the literature to treat rotatory instability. Usually, a strip of the iliotibial band (ITB) is harvested from its middle while leaving the distal insertion, then passed underneath the lateral collateral ligament and fixed on the lateral aspect of the distal femur with various fixation methods such as staples, screws, anchors or extracortical suspensory devices. Despite their effectiveness, these fixation methods may be associated with complications such as lateral pain, over-constraint and tunnel convergence. METHODS This study presents a detailed surgical description of a new technique to perform an LET during ACL reconstruction with any type of graft fixing the ITB strip with the sutures of the ACL femoral button, comparing its pros and cons in relation to similar techniques found in the literature. CONCLUSIONS This technique represents a reproducible, easy to learn and inexpensive solution to perform a lateral extra-articular tenodesis associated with an ACL reconstruction using the high-resistance sutures of the femoral button.
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Affiliation(s)
- Marco Bechis
- AO Ordine Mauriziano Hospital, Department of Orthopedics and Traumatology, University of Torino, 10124 Turin, Italy
| | | | | | | | - Davide Edoardo Bonasia
- AO Ordine Mauriziano Hospital, Department of Orthopedics and Traumatology, University of Torino, 10124 Turin, Italy
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Suzuki N, Watanabe A, Ninomiya T, Nakajima H, Horii M, Watanabe S, Shiko Y, Sasho T. Lateral meniscal injury without medial meniscal injury indicates the existence of the Segond fracture in ACL-deficient knees. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:59-64. [PMID: 38236496 PMCID: PMC10792093 DOI: 10.1016/j.asmart.2023.11.004] [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: 07/21/2023] [Revised: 10/13/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024] Open
Abstract
Background/Objective The purpose of this study was to find factors indicating the occurrence of the Segond fracture, a specific type of anterolateral ligament injury. Methods From January 2015 to December 2017, we retrospectively reviewed the medical records of patients diagnosed with acute anterior cruciate ligament (ACL) injury who underwent reconstruction within 90 days of injury. Diagnosis of the Segond fracture was determined either by magnetic resonance imaging or plain radiographs. Factors examined were: age at surgery, sex, body mass index (kg/m2), status of menisci, and activities led to ACL injury. After univariate screening, multivariate logistic regression analyses were performed. Patients were divided into four groups based on the presence of lateral meniscal (LM) and/or medial meniscal (MM) injuries and compared with respect to the occurrence of Segond fractures. Results A total of 375 patients were included (163 males, 212 females), with mean age 25.8 years old. Among them, 22 of 375 (5.9 %) had a Segond fracture. We identified injured lateral menisci (adjusted odds ratio (aOR), 3.029; 95 % Confidence Interval (CI), 1.206-7.609; P = 0.018), intact medial menisci (aOR, 0.229; 95 % CI, 0.065-0.810; P = 0.022), and higher body mass index (aOR, 1.102; 95 % CI, 1.008-1.205; P = 0.034) as factors indicative of the occurrence of Segond fracture. LM injury without MM injury suggested the existence of a Segond fracture. Conclusion LM injury without a MM injury indicated the occurrence of a Segond fracture. Higher body mass index also increased the risk for Segond fracture occurrence.
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Affiliation(s)
- Nobutada Suzuki
- Department of Radiology, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Atsuya Watanabe
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Taishi Ninomiya
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, 1-833 Hasamacho, Funabashi, Chiba, 274-0822, Japan
| | - Hirofumi Nakajima
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, 1-833 Hasamacho, Funabashi, Chiba, 274-0822, Japan
| | - Manato Horii
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Shotaro Watanabe
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-0856, Japan
| | - Takahisa Sasho
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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20
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Guo Z, Liu F. Progress in research on and classification of surgical methods of arthroscopic reconstruction of the ACL and ALL using a shared tendon graft through the femoral tunnel. Front Surg 2023; 10:1292530. [PMID: 38186395 PMCID: PMC10766812 DOI: 10.3389/fsurg.2023.1292530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Anterior cruciate ligament (ACL) tear is a common clinical injury, and ACL reconstruction has reached a very mature stage. However, with the accumulation of cases, scholars have found that isolated ACL reconstruction may not completely solve the problem of knee rotational stability. With the increase in our understanding of knee joint structure, ACL combined with anterolateral ligament (ALL) reconstruction has become accepted by most scholars, and this operation has also achieved good clinical results. At present, there is no unified surgical method for ACL combined with ALL reconstruction. There are differences in bone tunnel location, reconstruction methods, and graft selection. Compared with the independent reconstruction of the ACL and ALL during the operation, shared tendon graft reconstruction of the ACL and ALL has the advantages of preserving tendon and avoiding tunnel convergence. So far, there is no relevant literature summarizing the reconstruction of the ACL and ALL with a shared tendon graft. This paper reviews the anatomic study of the ALL, the study of isometric points, surgical indications, and surgical methods and their classification for shared tendon graft reconstruction of the ACL and ALL.
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Affiliation(s)
- Ziteng Guo
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
- School of Graduate, Hebei Medical University, Shijiazhuang, China
| | - Fei Liu
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
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21
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Yang HY, Cheon JH, Choi JH, Song EK, Seon JK. Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Decreases Passive Anterior Tibial Subluxation Compared With Isolated Anterior Cruciate Ligament Reconstruction Despite Similar Rotational Stability and Clinical Outcomes. Arthroscopy 2023; 39:2513-2524.e2. [PMID: 37142134 DOI: 10.1016/j.arthro.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To analyze the effect of augmenting a hamstring autograft anterior cruciate ligament reconstruction (ACLR) with an anterolateral ligament reconstruction (ALLR) on a primary outcome of passive anterior tibial subluxation (PATS) and a secondary outcome of the clinical outcomes. METHODS ACL-injured patients who underwent primary ACLR between March 2014 and February 2020 at our center were enrolled. Patients who underwent combined procedures (ACLR + ALLR) were matched in a 1:1 propensity ratio to patients who underwent ACLR only. We evaluated PATS, knee stability (side-to-side laxity difference, pivot-shift test), and patient-reported outcome measures (PROMs) after the procedure and documented complications. RESULTS From an initial cohort of 252 patients with a minimum follow-up period of 2 years (48.4 ± 16.6 months), 35 matched pairs were included, and 17 patients (48.6%) in each group underwent second-look arthroscopy. The combined ACLR + ALLR group showed significantly better improvement of PATS in the lateral compartments than the isolated ACLR group (P = .034). There were no significant differences between the groups regarding knee stability (side-to-side laxity difference, pivot-shift test), PROMs, complications, and second-look arthroscopic findings (all P > .05). Moreover, the proportions of patients who achieved the minimal clinically important difference in PROMs were not different between groups. CONCLUSIONS The combined ACLR + ALLR procedure was associated with a mean improvement in anterior tibial subluxation for the lateral compartment that was 1.2 mm better than an isolated ACLR procedure, despite its lack of clinical significance. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Hong Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea
| | - Jae Hyeok Cheon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea
| | - Ji Hoon Choi
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea
| | - Eun Kyoo Song
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea
| | - Jong Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Chonnam, Republic of Korea.
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22
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Sørensen OG, Faunø P, Konradsen L, Nielsen T, Schaarup S, Mygind-Klavsen B, Krogsgaard M, Lind M. Combined anterior cruciate ligament revision with reconstruction of the antero-lateral ligament does not improve outcome at 2-year follow-up compared to isolated acl revision; a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:5077-5086. [PMID: 37733288 PMCID: PMC10598101 DOI: 10.1007/s00167-023-07558-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE It is essential to obtain rotational stability of the knee after anterior cruciate ligament reconstruction (ACL-R) and it is suggested that a supplementary reconstruction of the antero-lateral ligament (ALL-R) may supports this. Theoretically, ALL-R may be particularly advantageous to support revision of failed ACL-Rs. It was hypothesized that ACL revision combined with ALL-R will result in superior outcome compared to isolated ACL revision. METHODS The study was designed as a randomized controlled trial. Patients eligible for first time ACL revision were randomized to either isolated ACL revision (- ALL group) or ACL revision combined with a single-stranded allograft ALL-reconstruction (+ ALL group). Patient reported outcomes and function were evaluated at two-year follow-up by KNEES-ACL, KOOS, and Tegner activity scale. Objective knee laxity was evaluated at one-year follow-up using an instrumented Rolimeter test, the pivot shift test, and a manual Lachman test. RESULTS A total of 103 patients were enrolled with 49 patients randomized to the + ALL group and 54 patients in the - ALL group. There were no differences at baseline between groups regarding age, gender, body mass index, preoperative patient reported outcome scores and concomitant meniscus or cartilage injury. The ACL revision was performed with an allograft in 10 patients (20%) in the + ALL group and 8 patients (15%) in the -ALL group. At follow-up there was no significant difference between the groups in patient reported outcome scores and clinical knee laxity. CONCLUSION Supplementary ALL-R does not improve subjective outcome of first time ACL revision at two-years and clinical knee stability at one-year follow-up compared to isolated ACL revision. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Ole Gade Sørensen
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark.
| | - Peter Faunø
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark
| | - Lars Konradsen
- Section for Sports Traumatology, Bispebjerg, Frederiksberg University Hospital, Copenhagen, Denmark
| | - Torsten Nielsen
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark
| | - Susanne Schaarup
- Section for Sports Traumatology, Bispebjerg, Frederiksberg University Hospital, Copenhagen, Denmark
| | | | - Michael Krogsgaard
- Section for Sports Traumatology, Bispebjerg, Frederiksberg University Hospital, Copenhagen, Denmark
| | - Martin Lind
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark
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23
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Ripoll T, Moreira da Silva AG, Saoudi S, Noguero A, Nicolle R, Maris V, Helito C, Cavaignac E. Comparison Between Continuous and Separate Grafts for ALL Reconstruction When Combined With ACL Reconstruction: A Retrospective Cohort Study From the SANTI Study Group. Am J Sports Med 2023; 51:3163-3170. [PMID: 37700466 DOI: 10.1177/03635465231197353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND While various techniques have been described to augment the anterolateral side of the knee, such as lateral extra-articular tenodesis and anterolateral ligament (ALL) reconstruction (ALLR), it is unclear how they affect clinical outcomes. The aim of this study was to compare the results of 2 ALLR techniques for combined anterior cruciate ligament (ACL)/ALL reconstruction. HYPOTHESIS The graft rupture rate, complications, and patient-reported outcomes are similar between a reconstruction technique using a continuous gracilis graft (CG) and single femoral tunnel for ACL/ALL reconstruction, and one using a separate gracilis graft (SG) and independent femoral tunnels. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis of data collected prospectively at 2 hospitals was conducted: one in which a CG is preferred when performing combined ACL/ALL reconstruction and the other in which an SG is preferred. The medical records at these 2 hospitals were searched to identify ACL-deficient patients who had undergone ACL/ALL reconstruction between 2015 and 2020. Eligible patients were between 18 and 60 years of age, had the reconstruction surgery done within 24 months of the injury, and had ≥2 years of follow-up. The eligible patients were contacted to gather outcomes, or their outcomes were collected in person during their last follow-up visit. Outcomes evaluated included graft rupture rate, complication rate, and Lysholm and International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) scores. Preoperative and intraoperative data were also evaluated. RESULTS A total of 237 patients were available for analysis in the GC group and 178 in the SG group with a mean follow-up of 3 years (CG: SD, 9.6 months; SG: SD, 8.1 months). The authors found a low rate of graft rupture (CG: 3.4%; SG: 2.8%; P = .785) and no difference between techniques. The complication rate was 6% in the CG group, while it was 10% in the SG group (P = .112). The mean value of the IKDC-SKF was similar between techniques (CG: 88.1; SG: 87.9; P = .267), and the mean Lysholm score was excellent in both sets of patients (CG: 90.0; SG: 92.4; P < .001). CONCLUSION This study found little to no difference in the graft rupture rate, complication rate, and functional knee scores when using a CG or SG for ALLR during combined ACL/ALL reconstruction. Both techniques are equivalent and can be used for an anterolateral augmentation procedure in combination with ACL reconstruction.
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Affiliation(s)
- Thomas Ripoll
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio Libanês, São Paulo, Brazil
| | - Samy Saoudi
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Antoine Noguero
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Romain Nicolle
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Victor Maris
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Camillo Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio Libanês, São Paulo, Brazil
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
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24
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Mostowy M, Ruzik K, Ebisz M, LaPrade RF, Malinowski K. Impaction Fractures of the Lateral Femoral Condyle Related to Anterior Cruciate Ligament Injury: A Scoping Review Concerning Diagnosis, Prevalence, Clinical Importance, and Management. Clin Orthop Surg 2023; 15:781-792. [PMID: 37811510 PMCID: PMC10551676 DOI: 10.4055/cios22278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 10/10/2023] Open
Abstract
Background During pivot-shift anterior cruciate ligament (ACL) injury, bone bruises or impaction fractures of the lateral femoral condyle (LFC-IF) may occur due to impaction between the posterior part of the lateral tibial plateau and anterocentral part of the LFC. The purpose of the study was to systematically review the literature concerning the diagnosis, prevalence, clinical importance, and management of LFC-IF occurring during ACL injuries. Methods Included were studies concerning impaction fractures of the anterocentral part of the LFC occurring during ACL injuries. Studies concerning only bone bruises or cartilage lesions, without subchondral bone impaction, were not included. A search was performed in Medline and Scopus databases, with final search in May 2022. A secondary search was conducted within the bibliographies of included articles and using "Cited In" option. Two authors independently extracted data in three domains: study design, LFC-IF characteristics, and LFC-IF importance and management. Results A total of 35 studies were included for review with several studies reporting on multiple domains. Summarily, 31 studies were on the diagnosis and prevalence, 19 studies reported on the clinical importance, and 4 studies reported on the management of LFC-IF. Conclusions A LFC-IF occurs due to the pivot-shift mechanism of ACL injury. Its radiological feature is defined as an impaction of terminal sulcus deeper than 1 mm and is present in up to 52% of patients with a torn ACL. An LFC-IF causes injury to the cartilage, probably leads to its progressive degeneration, and is significantly associated with an increased risk of a lateral meniscus injury. A large LFC-IF might be associated with greater rotational knee instability. Although several techniques of LFC-IF treatment were proposed, none of them has been evaluated on a large cohort of patients to date.
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Affiliation(s)
- Marcin Mostowy
- Orthopedic and Trauma Department, Veteran's Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Michał Ebisz
- Artromedical Orthopaedic Clinic, Belchatow, Poland
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25
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Lucenti L, Testa G, Montemagno M, Sapienza M, Russo A, Di Maria F, de Cristo C, Pavone V. The Anterolateral Ligament of the Knee in Pediatric Patients: What Do We Know? A Scoping Review. J Funct Morphol Kinesiol 2023; 8:126. [PMID: 37754959 PMCID: PMC10531858 DOI: 10.3390/jfmk8030126] [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: 07/12/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
The knowledge on the anatomy, function and biomechanics and the role of surgical procedures on the anterolateral ligament (ALL) of the knee is still controversial. Only a few papers have examined the ALL in children. The aim of this review is to analyze all the available literature about ALL in the pediatric population. Following the PRISMA criteria, the literature was systematically reviewed, examining all the articles about ALL in pediatric patients. Eight articles were involved in this study. Five cadaveric studies, two diagnostic studies, and one cross-sectional study were found. The identification of the ALL is not always possible in diagnostic studies using magnetic resonance (MRI) or in dissecting specimens. A high variability in the presence of the ligament and in its origin and insertion were found among the studies. It is more difficult to identify the ligament in younger patients than in older children, suggesting that its presence may develop at some point during the growth. Further studies are needed for a detailed knowledge of the ALL.
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Affiliation(s)
- Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Marco Montemagno
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Arcangelo Russo
- Orthopaedic and Traumatology Unit, Umberto I Hospital, 94100 Enna, Italy;
| | - Fabrizio Di Maria
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Claudia de Cristo
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
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26
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Fahlbusch H, Behrendt P, Akoto R, Frosch KH, Krause M. ACL reconstruction provides superior stability than ACL repair in patients with Schenck III and IV knee joint dislocations: first results of a 12 month follow-up study. Arch Orthop Trauma Surg 2023; 143:5751-5758. [PMID: 37062000 PMCID: PMC10449953 DOI: 10.1007/s00402-023-04884-0] [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: 01/29/2023] [Accepted: 04/09/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE Acute knee dislocation is a rare but devastating multi-ligamentous knee injury with only limited evidence-based surgical technique recommendations. The aim of this study was a comparison of two different anterior cruciate ligament (ACL) restoration techniques as part of an early total surgical care concept: (1) repair of ACL with additional internal bracing (ACLIB) compared to; (2) ACL reconstruction with autograft (ACLR). METHODS Retrospective, clinical-study of patients with an acute type III or IV knee dislocation (according to Schenck classification), in which the ACL was treated with ACLIB or ACLR within 12 days. The PCL was sutured and internally braced in all cases. Medial and lateral complex injuries were repaired and additionally laterally augmented by an Arciero reconstruction. After a minimum 12 months follow-up different patient-reported outcome measurements (IKDC, Lysholm, VAS, Tegner Score) and instrumental stability assessment by Rolimeter -test and stress radiographs (Telos™) were analyzed. Groups were compared by t test with p < 0.05 considered significant. RESULTS In total, 20 patients (5 IIIM, 5 IIIL and 10 IV) were included in this study with an average follow-up of 13.7 ± 2.6 months. There were significant differences in instrumental stability testing (side-to-side difference (SSD) of anterior tibial translation: ACLIB 2.7 ± 1.5 mm vs. ACLR 1.3 ± 1.3; p = 0.0339) and stress radiography (SSD ACL: ACLIB 3.4 ± 2.2 mm vs. ACLR 0.4 ± 2.7; p = 0.0249) between groups. ACLIB group showed greater ROM in terms of flexion (SSD Flexion: ACLIB 7.8 ± 9.9° vs. ACLR 16 ± 7.0°; p = 0.0466; Total Flexion overall 125.5 ± 11.8°). No clinically relevant differences in patient-reported outcome scores (Lysholm Score: ACLIB 82 ± 16.4 vs. ACLR 85 ± 10.4; IKDC subjective score: ACLIB 70.4 ± 17 vs. ACLR 76.6 ± 8.3) were determined. CONCLUSION ACLR provides superior translational stability than ACLIB in terms of instrumental testing and stress radiography. Both techniques were equivalent with respect to PROMS and led to good and excellent clinical results. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- H Fahlbusch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Behrendt
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Orthopaedics, Asklepios St. Georg, Hamburg, Germany
- Department of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - R Akoto
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - K H Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - M Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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27
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Fayard JM, Foissey C, Pacoret V, Abid H, Vieira TD, Gabr A, Thaunat M. Return to Sports After ACL Augmentation With Anterolateral Reconstruction (ALR) Harvesting Gracilis Only Compared With ACL Reconstruction With ALR Harvesting Both Hamstring Tendons. Am J Sports Med 2023; 51:2918-2927. [PMID: 37548031 DOI: 10.1177/03635465231187038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) repair (ACL-Rp) is known to be a valuable alternative to ACL reconstruction (ACL-Rc) in selected indications. The majority of the ACL-Rp techniques recommend the use of a synthetic brace. The use of the gracilis allows both a biological internal brace and anterolateral ligament reconstruction (ALR). PURPOSE The primary objective was to compare the early ability to return to sports between patients who underwent ACL-Rp using a gracilis autograft as an internal brace augmentation with ALR and patients who underwent the conventional ACL-Rc with ALR technique sacrificing both the gracilis and the semitendinosus. The secondary objective was to compare the failure rate, clinical scores, and return to sports at a minimum follow-up of 2 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was undertaken. A total of 49 patients who underwent ACL-Rp with ALR between December 2018 and May 2019 were propensity matched at a 1:1 ratio to those who underwent ACL-Rc with ALR during the same period. The decision to perform ACL-Rp with ALR was based on preoperative selection and intraoperative arthroscopic findings: proximal avulsion tear, partial ACL tear, low- to midlevel sports participation, and good tissue quality. The ability to return to sports was assessed using isokinetic tests and the Knee Santy Athletic Return to Sport test functional test at 6 months postoperatively. At the final follow-up, knee laxity parameters, return to sports, and clinical outcome (Lysholm score, Tegner Activity Scale score, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Anterior Cruciate Ligament-Return to Sport after Injury score) were recorded. RESULTS The ACL-Rp group had significantly less hamstring strength deficit when compared with their counterparts who underwent ACL-Rc (0.2% vs 10.2% in concentric, P < .001; 2.5% vs 14% in eccentric, P < .001). The mean Knee Santy Athletic Return to Sport test score was significantly higher in the ACL-Rc group (69.7% ± 16.6% [range, 19%-100%] vs 61% ± 16.8% [range, 19%-100%]; P = .001). In the ACL-Rp group, 61% (30/49) of the patients were authorized to return to pivot sports versus 41% (20/49) in the ACL-Rc group (P = .04). At a mean final follow-up of 31.4 ± 3.5 months, no significant differences were demonstrated between groups with respect to clinical scores and knee laxity parameters. There was a trend for a higher failure rate in the ACL-Rp group without any significance (ACL-Rp: 6.1% [3/49] vs ACL-Rc: 0%; P = .08). CONCLUSION At 6 months after operation, harvesting only the gracilis with this ACL-Rp and augmentation with ALR technique was linked to a better early ability to return to sports compared with the ACL-Rc with ALR technique harvesting both the gracilis and semitendinosus. This technique had a limited effect on early flexion strength and provided a satisfactory rerupture rate.
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Affiliation(s)
- Jean-Marie Fayard
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Constant Foissey
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Victor Pacoret
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Hichem Abid
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Ayman Gabr
- University College London Hospital, London, United Kingdom
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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Stranger N, Kaulfersch C, Mattiassich G, Mandl J, Hausbrandt PA, Szolar D, Schöllnast H, Tillich M. Frequency of anterolateral ligament tears and ramp lesions in patients with anterior cruciate ligament tears and associated injuries indicative for these lesions-a retrospective MRI analysis. Eur Radiol 2023; 33:4833-4841. [PMID: 36806565 PMCID: PMC10290041 DOI: 10.1007/s00330-023-09444-z] [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: 06/01/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES To assess the frequency of anterolateral ligament (ALL) tears and ramp lesions (RL) detected with MRI in patients with anterior cruciate ligament (ACL) tears and to describe associated injuries indicative for these lesions. METHODS In this retrospective study, 164 patients with surgically verified ACL tears were included. Preoperative MRI scans were reviewed for ALL tears and different types of RL. All coexisting meniscal tears, tears of the medial (MCL) and lateral collateral band (LCL), and posterior-medial tibial bone marrow edema (BME) were recorded. The frequency of ALL tears and RL was assessed and coexisting injuries were correlated using Pearson's chi-square test. A p < 0.05 was defined as statistically significant. In cases of multiple testing, Bonferroni's correction was applied. RESULTS ALL tears and RL combined were detected in 28 patients (17.1%), ALL tears in 48 patients (29.3%), and RL in 54 patients (32.9%) which were significantly associated to each other. ALL tears were significantly associated with tears of the posterior horn of the lateral meniscus (PHLM), BME, and with tears of the LCL and MCL. RL were significantly associated with tears of the posterior horn of the medial (PHMM) and PHLM, with BME, and with tears of the LCL. CONCLUSIONS ACL tears are associated with RL or ALL tears in about one-third of cases and with both lesions combined in about one-fifth of cases. ALL tears and RL are significantly associated with additional posttraumatic injuries, which can thus be indicative of these lesions. KEY POINTS • ACL tears were associated with ramp lesions or ALL tears in about one-third of the cases. • Ramp lesions and ALL tears were significantly associated with each other, tear in the PHLM, tear in the LCL, and BME. • ALL tears were more frequently associated with instable classified ramp lesion type 4b and type 5.
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Affiliation(s)
- Nikolaus Stranger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Christian Kaulfersch
- Department of Trauma Surgery, Klinik Diakonissen Schladming, Schladming, Austria
| | - Georg Mattiassich
- Department of Trauma Surgery, Klinik Diakonissen Schladming, Schladming, Austria
| | | | | | | | - Helmut Schöllnast
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
- Institute of Radiology, LKH Graz II, Göstinger Strasse 22, 8020, Graz, Austria.
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Herbst E, Costello J, Popchak AJ, Tashman S, Irrgang JJ, Fu FH, Musahl V. Untreated Injuries to the Anterolateral Capsular Structures Do Not Affect Outcomes and Kinematics after Anatomic Anterior Cruciate Ligament Reconstruction. J Clin Med 2023; 12:4408. [PMID: 37445441 DOI: 10.3390/jcm12134408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/11/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Injuries to the anterolateral complex (ALC) may contribute to increased rotatory knee laxity. However, it has not been evaluated whether such injuries affect in vivo kinematics when treated in situ. The purpose of this study was to determine the grade of ALC injury and its effect on kinematic and clinical outcomes of ACL-injured patients 24 months after anatomic ACL reconstruction. It was hypothesized that injury to the ALC would be significantly related to patient-reported outcomes (PROs) and in vivo knee kinematics during downhill running. METHODS Thirty-five subjects (mean age: 22.8 ± 8.5 years) participating in a randomized clinical trial to compare single- and double-bundle ACL reconstruction were included in the study. Subjects were divided into two groups based on the presence or absence of injury to the ALC, as determined on MRI scans performed within 6 weeks of injury. None of the patients underwent treatment for these ALC injuries. At 24 months, PROs, including the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS) and in vivo knee kinematics during downhill running, were obtained. Pivot-shift test results, PROs and in vivo knee kinematics were compared between groups with and without ALC injury using the Pearson's Chi Squared test and Mann-Whitney U test with significance set at p < 0.05. RESULTS The average interval between injury and performing the MRI scans was 9.5 ± 10 days. ALC injury was observed in 17 (49%) study participants. No significant differences were detected in PROs and in vivo kinematics between subjects with and without ALC injury (n.s.). CONCLUSION The findings of this study demonstrate that MRI evidence of an ALC injury does not significantly affect in vivo knee kinematics and PROs even in individuals with a high-grade ALC injury. Injuries to the ALC as observed on MRI might not be a useful indication for an anterolateral procedure.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, 48149 Münster, Germany
| | - Joanna Costello
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Scott Tashman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
- Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
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Goes RA, Pereira R, Oliveira FLD, Castelhanito P, Serra Cruz R, Rocha de Faria JL. Single Femoral Tunnel for Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Graft and Lemaire's Extra-Articular Tenodesis as a Good Alternative for Combined Anterior Cruciate Ligament and Anterolateral Ligament Revision Surgeries. Arthrosc Tech 2023; 12:e903-e914. [PMID: 37424656 PMCID: PMC10323833 DOI: 10.1016/j.eats.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/12/2023] [Indexed: 07/11/2023] Open
Abstract
The literature has shown a significant decrease in failure rates when the anterior cruciate ligament (ACL) reconstruction was associated with an extra-articular reinforcement technique such as the anterolateral ligament (ALL) or the iliotibial band tenodesis (ITBT) using the modified Lemaire technique. As much as there is a progressive decrease in the failure rates of ACL reconstructions when the ALL reconstruction technique is associated, there are still and will be cases that will result in graft rupture. These cases will require more alternatives for revision, which are always challenging for the surgeon, where the lateral approaches represent complicating factors, especially because of the distortion of the lateral anatomy (by the previous approach for ALL reconstruction), previous reconstruction tunnels, and the presence of fixation materials. We present here a safe technique that offers great stability to the fixation of the graft and is easy to perform, using a single tunnel for the passage of the ACL and ITBT grafts, allowing a single fixation for both. In this way, we performed a lower-cost surgery, with a lower risk of lateral condyle fracture and tunnel confluence. This technique is indicated to be used in cases of revision after failure of combined ACL reconstruction with ALL.
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Affiliation(s)
- Rodrigo Araújo Goes
- North Lisbon University Hospital Centre (CHULN) - Santa Maria Hospital, Lisbon, Portugal
- The Division of Traumatology and Ortopedics (DITRO) of National Institute of Traumatology and Orthopedics of Brazil (INTO), Rio de Janeiro, Brazil
- Free Assistant of the Chair of Orthopedics at the Faculty of Medicine of Lisbon - FMUL, Lisbon, Portugal
| | - Rafael Pereira
- North Lisbon University Hospital Centre (CHULN) - Santa Maria Hospital, Lisbon, Portugal
| | | | - Pedro Castelhanito
- North Lisbon University Hospital Centre (CHULN) - Santa Maria Hospital, Lisbon, Portugal
| | - Raphael Serra Cruz
- The Division of Traumatology and Ortopedics (DITRO) of National Institute of Traumatology and Orthopedics of Brazil (INTO), Rio de Janeiro, Brazil
| | - José Leonardo Rocha de Faria
- The Division of Traumatology and Ortopedics (DITRO) of National Institute of Traumatology and Orthopedics of Brazil (INTO), Rio de Janeiro, Brazil
- School of Medicine from University of São Paulo, USP Riberão Preto, SP, Brazil
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Lording TD. Review of Cha et al. (2005) on "Arthroscopic Double Bundle Anterior Cruciate Ligament Reconstruction: An Anatomical Approach". J ISAKOS 2023; 8:140-144. [PMID: 36924827 DOI: 10.1016/j.jisako.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/20/2023] [Accepted: 02/16/2023] [Indexed: 03/17/2023]
Abstract
This classic discusses the original publication 'Arthroscopic double-bundle anterior cruciate ligament reconstruction (ACL): An anatomical approach', the first detailed description of the surgical technique popularised by Dr Freddie Fu. The technique, in which the anteromedial and posterolateral bundles of the ACL are reconstructed individually using two grafts with independent bone tunnels, was designed to more closely recreate the function of the native ACL by more closely reproducing the functional anatomy. This reconstruction was biomechanically superior to single-bundle reconstruction, particularly with regards to rotational control, leading to great interest from ACL surgeons around the world. Clinical superiority was more difficult to demonstrate; however, and the technical difficulty of the procedure has limited its use. Nevertheless, the pursuit of improved patient outcomes through attention to functional anatomical detail continues. 'Recreating the functional anatomy of the intact ACL remains the cornerstone of ACL reconstruction'.
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Affiliation(s)
- Timothy D Lording
- Melbourne Orthopaedic Group, Windsor, 3181, Australia; Monash University, Melbourne, 3800, Australia.
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32
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Baker HP, Bowen E, Sheean A, Bedi A. New Considerations in ACL Surgery: When Is Anatomic Reconstruction Not Enough? J Bone Joint Surg Am 2023; Publish Ahead of Print:00004623-990000000-00808. [PMID: 37205735 DOI: 10.2106/jbjs.22.01079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
➤ Clinicians should be careful to assess for associated injuries including anterolateral complex and medial meniscal ramp lesions or lateral meniscal posterior root tears.➤ Consideration of lateral extra-articular augmentation should be given for patients with >12° of posterior tibial slope.➤ Patients with preoperative knee hyperextension (>5°) or other nonmodifiable risk factors, including high-risk osseous geometry, may benefit from a concomitant anterolateral augmentation procedure to improve rotational stability.➤ Meniscal lesions should be addressed at the time of anterior cruciate ligament reconstruction with meniscal root or ramp repair.
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Affiliation(s)
- Hayden P Baker
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
| | | | - Andrew Sheean
- San Antonio Military Medical Center, San Antonio, Texas
| | - Asheesh Bedi
- Northshore University Health System, Skokie, Illinois
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Pontoh LA, Dilogo IH, Kamal AF, Widodo W, Kholinne E, Rhatomy S, Fiolin J. Double-bundle ACL reconstruction versus anatomic single-bundle ACL reconstruction combined with anterolateral ligament reconstruction: a comparative study of clinical outcome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:489-495. [PMID: 36474084 DOI: 10.1007/s00590-022-03432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Recent studies showed increasing evidences of anterolateral ligament (ALL) reconstruction in conjunction with anterior cruciate ligament (ACL) reconstruction that proves to be more superior to the previous double-bundle (DB) ACLR technique especially in improving knee stability in biomechanic studies. However to date, there have been no studies evaluating the functional outcome of DB-ACLR vs single-bundle (SB) with ALL in ACLR. METHODS A total of 138 patients with ACL deficient knee were enrolled to the study. Double-bundle ACL reconstruction (DB-ACLR) was performed in 75 patients and single-bundle ACL reconstruction with anterolateral ligament reconstruction (SB + ALL) ACLR was performed in 63 patients. Surgical outcomes were compared with The International Knee Documentation Committee Subjective Knee Form (IKDC) and the Kujala score at the 3rd, 6th and 9th month post-operative. RESULTS The IKDC score in the 3rd and 6th month was superior in the SB + ALL group compared to the DB group. However, this difference was not statistically significant. In the meantime, there were no statistically significant difference between the Kujala Score at the 3rd, 6th, and 9th months consecutively. There were no statistically significant differences in the functional outcomes of DB-ACLR and SB + ALL groups at the 3rd, 6th, and 9th months post-operative period. CONCLUSION The functional outcome comparison showed non-superiority of SB + ALL group compared to the DB-ACLR group. The patellar pain was less found in DB-ACLR group at 6- and 9-months post-operative period.
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Affiliation(s)
- Ludwig Andre Pontoh
- Department of Orthopedic and Traumatology, Fatmawati General Hospital - Faculty of Medicine, Universitas Indonesiam, Jl. RS Fatmawati No. 4, South Jakarta, 12430, Indonesia.
| | - Ismail Hadisoebroto Dilogo
- Orthopaedic and Traumatology Department, Faculty of Medicine, RS DR Cipto Mangunkusumo, Jl. Diponegoro No 71, Jakarta, Indonesia
| | - Achmad Fauzi Kamal
- Orthopaedic and Traumatology Department, Faculty of Medicine, RS DR Cipto Mangunkusumo, Jl. Diponegoro No 71, Jakarta, Indonesia
| | - Wahyu Widodo
- Orthopaedic and Traumatology Department, Faculty of Medicine, RS DR Cipto Mangunkusumo, Jl. Diponegoro No 71, Jakarta, Indonesia
| | - Erica Kholinne
- Department of Surgery, St. Carolus Hospital, Jl. Salemba Raya No. 41, Central Jakarta, 10430, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopedic and Traumatology, Soeradji Tirtonegoro Hospital, Klaten, Indonesia
- Faculty of Medicine, Public Health of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jessica Fiolin
- Orthopaedic Surgeon of Jakarta Knee, Shoulder and Orthopedic Sport Clinic, Pondok Indah General Hospital, Jl. Metro Duta Kav UE, South Jakarta, 12310, Indonesia
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Taylan O, Slane J, van Beek N, Dandois F, Scheys L, Claes S. Characterizing the viscoelastic properties of the anterolateral ligament and grafts commonly used in its reconstruction. Clin Biomech (Bristol, Avon) 2023; 104:105949. [PMID: 37018954 DOI: 10.1016/j.clinbiomech.2023.105949] [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: 10/11/2022] [Revised: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Current anatomic anterolateral ligament reconstruction is typically performed using either a gracilis tendon or an iliotibial band graft based on their quasi-static behavior. However, there is limited knowledge about their viscoelastic behaviors. This study aimed to characterize the viscoelastic properties of the anterolateral ligament, distal iliotibial band, distal gracilis tendon and proximal gracilis tendon for graft material choice in anterolateral ligament reconstruction. METHODS All the tissues were harvested from thirteen fresh-frozen cadaveric knees and subjected to preconditioning (3-6 MPa), sinusoidal cycle (1.2-12 MPa), dwell at constant load (12 MPa), and load to failure (3%/s). The quasi-static and viscoelastic properties of the soft tissues were computed and compared using a linear mixed model (p < 0.05). FINDINGS The hysteresis of anterolateral ligament (mean:0.4 Nm) was comparable with gracilis halves (p > 0.85) but iliotibial band (6 Nm) was significantly higher (p < 0.001,ES = 6.5). In contrast, the dynamic creep of anterolateral ligament (0.5 mm) was similar to iliotibial band (0.7 mm, p > 0.82) whereas both gracilis halves were significantly lower (p < 0.007,ES > 1.4). The elastic modulus of anterolateral ligament (181.4 MPa, p < 0.001,ES > 2.1) was the lowest compared to the grafts materials (distal gracilis tendon:835 MPa, distal gracilis tendon:726 MPa, iliotibial band:910 MPa). Additionally, the failure load of the anterolateral ligament (124.5 N, p < 0.001,ES > 2.9) was also the lowest. INTERPRETATION The mechanical properties of the gracilis halves and iliotibial band were significantly different from anterolateral ligament, except for hysteresis and dynamic creep, respectively. Our findings showed that the gracilis halves may be a more appropriate graft choice for anterolateral ligament reconstruction due to its low energy dissipation and permanent deformation under dynamic loads.
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Affiliation(s)
- Orçun Taylan
- Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium; FIBEr, KU Leuven Core Facility for Biomechanical Experimentation, KU Leuven, Leuven, Belgium.
| | - Josh Slane
- Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium
| | - Nathalie van Beek
- Department of Orthopaedic Surgery, AZ St Elisabeth, Herentals, Belgium
| | - Félix Dandois
- Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium; FIBEr, KU Leuven Core Facility for Biomechanical Experimentation, KU Leuven, Leuven, Belgium; Division of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Steven Claes
- Department of Orthopaedic Surgery, AZ St Elisabeth, Herentals, Belgium
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Farshidfar SS, Cadman J, Neri T, Parker D, Appleyard R, Dabirrahmani D. Towards a validated musculoskeletal knee model to estimate tibiofemoral kinematics and ligament strains: comparison of different anterolateral augmentation procedures combined with isolated ACL reconstructions. Biomed Eng Online 2023; 22:31. [PMID: 36973768 PMCID: PMC10044816 DOI: 10.1186/s12938-023-01094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Isolated ACL reconstructions (ACLR) demonstrate limitations in restoring native knee kinematics. This study investigates the knee mechanics of ACLR plus various anterolateral augmentations using a patient-specific musculoskeletal knee model. MATERIALS AND METHODS A patient-specific knee model was developed in OpenSim using contact surfaces and ligament details derived from MRI and CT data. The contact geometry and ligament parameters were varied until the predicted knee angles for intact and ACL-sectioned models were validated against cadaveric test data for that same specimen. Musculoskeletal models of the ACLR combined with various anterolateral augmentations were then simulated. Knee angles were compared between these reconstruction models to determine which technique best matched the intact kinematics. Also, ligament strains calculated by the validated knee model were compared to those of the OpenSim model driven by experimental data. The accuracy of the results was assessed by calculating the normalised RMS error (NRMSE); an NRMSE < 30% was considered acceptable. RESULTS All rotations and translations predicted by the knee model were acceptable when compared to the cadaveric data (NRMSE < 30%), except for the anterior/posterior translation (NRMSE > 60%). Similar errors were observed between ACL strain results (NRMSE > 60%). Other ligament comparisons were acceptable. All ACLR plus anterolateral augmentation models restored kinematics toward the intact state, with ACLR plus anterolateral ligament reconstruction (ACLR + ALLR) achieving the best match and the greatest strain reduction in ACL, PCL, MCL, and DMCL. CONCLUSION The intact and ACL-sectioned models were validated against cadaveric experimental results for all rotations. It is acknowledged that the validation criteria are very lenient; further refinement is required for improved validation. The results indicate that anterolateral augmentation moves the kinematics closer to the intact knee state; combined ACLR and ALLR provide the best outcome for this specimen.
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Affiliation(s)
- Sara Sadat Farshidfar
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Joseph Cadman
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Thomas Neri
- Sydney Orthopaedic Research Institute, Sydney, Australia
- Department of Orthopaedic Surgery, University Hospital of Saint Etienne, Saint Etienne, France
- EA 7424-Inter-University Laboratory of Human Movement Science, University Lyon-University Jean Monnet Saint Etienne, Saint Etienne, France
| | - David Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Richard Appleyard
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Danè Dabirrahmani
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Anterolateral ligament of the knee-Cadaver study in a Caucasian population. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T134-T138. [PMID: 36528296 DOI: 10.1016/j.recot.2022.12.006] [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: 02/20/2022] [Accepted: 06/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships. MATERIALS AND METHODS The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured. RESULTS The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from the tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament. CONCLUSIONS The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.
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Vijayan S, Kyalakond H, Kulkarni MS, Aroor MN, Shetty S, Bhat V, Rao SK. Clinical outcome of anterior cruciate ligament reconstruction with modified transtibial and anteromedial portal. Musculoskelet Surg 2023; 107:37-45. [PMID: 34389922 PMCID: PMC10020253 DOI: 10.1007/s12306-021-00727-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
Arthroscopic ACL reconstruction is the current standard care of treatment for anterior cruciate ligament (ACL) injuries. Modified transtibial (mTT) and anteromedial portal (AMP) techniques aim at the anatomical placement of femoral tunnel. Controversy existed in the literature with regard to the outcome of these techniques. Hence, we designed a retrospective comparative study to analyse the clinical and functional outcomes of mTT and AMP techniques. We hypothesized that there would be no difference between the clinical and functional outcomes in mTT and AMP techniques. This retrospective observational study was conducted in consecutive patients who underwent arthroscopic ACL reconstruction using semitendinosus-gracilis (STG) quadrupled graft in our tertiary care centre with a minimum follow-up of two years. Out of 69 patients, 37 had undergone ACL reconstruction by mTT technique and remaining by AMP technique. All the patients were assessed clinically by anterior drawer, Lachman's, pivot shift and single-legged hop test. Lysholm Knee Scoring Scale and International Knee Documentation Committee (IKDC) subjective knee evaluation score were used for the functional status. Knee instability was assessed objectively by KT-1000 arthrometer. There was no statistically significant difference in baseline demographic characteristics between mTT and AMP groups. At the end of 2 years, no statistically significant difference was noted in the anterior drawer and Lachman's test. Though not significant, IKDC scores and Lysholm's scores showed a better outcome in the AMP group when compared to the mTT group. AMP group showed significantly better outcome with KT-1000 arthrometer. Based on the results obtained, we presume that overall both mTT and AMP have similar functional outcome. However, as AMP technique offers significantly improved subjective rotational stability on pivot shift test, better hop limb symmetry index and KT 1000 readings compared to mTT, we suggest AMP over mTT.
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Affiliation(s)
- S. Vijayan
- grid.465547.10000 0004 1765 924XDepartment of Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104 India
| | - H. Kyalakond
- grid.496653.b0000 0004 1805 6782Department of Orthopedics, BVVS S Nijalingappa Medical College and HSK Hospital and Research Centre, Navanagar, Bagalkot, Karnataka 587103 India
| | - M. S. Kulkarni
- grid.465547.10000 0004 1765 924XDepartment of Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104 India
| | - M. N. Aroor
- grid.465547.10000 0004 1765 924XDepartment of Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104 India
| | - S. Shetty
- grid.465547.10000 0004 1765 924XDepartment of Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104 India
| | - V. Bhat
- grid.411639.80000 0001 0571 5193Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - S. K. Rao
- grid.465547.10000 0004 1765 924XDepartment of Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104 India
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Wei X, Wang Z, Lu Y, Sun J, Riehl J. Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee. J Knee Surg 2023; 36:397-403. [PMID: 34507364 DOI: 10.1055/s-0041-1735311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The existence and anatomy of the anterolateral ligament (ALL) of the knee are a somewhat controversial topic in orthopaedic surgery. The fixation of the avulsion fracture of the ALL (Segond fracture), associated with periarticular knee fractures, is rarely given much consideration while the major fracture fragments are reconstructed. This study aims to confirm the existence of ALL and evaluate the clinical outcomes of surgical management for avulsion fractures, involving its insertion, when associated with periarticular knee fractures. Twenty-three patients (16 males and 7 females) with avulsion fractures of the ALL associated with periarticular knee fractures were fixed with a spider plate, cannulated screw, or suture anchor. Eight patients were diagnosed with distal femoral fracture, 10 with tibial plateau fracture, and 5 with tibial eminence avulsion fracture. All patients underwent X-rays at follow-up. Clinical and functional outcomes were assessed with the pivot-shift test, objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale. The ALL was found and identified as a distinct ligamentous structure in all patients. Prior to Segond repair, patients had significantly more instability, as determined by pivot-shift test, than seen postoperatively (p < 0.0001). At final follow-up, the mean subjective IKDC score was 83.2 ± 10.3. Fourteen patients were graded A, 6 were graded B, and 3 was graded C on the IKDC objective score. The mean Lysholm score was 85.4 ± 12.2. The mean Tegner score was 7.5 ± 1.2. This study confirmed that the ALL is a distinct structure in the anterolateral portion of the knee. The fixation of the avulsion fracture of the ALL associated with periarticular knee fractures can be an effective procedure without specific complications. Long-term and comparative follow-up studies are necessary to confirm the effects.
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Affiliation(s)
- Xuelei Wei
- Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin, China
| | - Zengliang Wang
- Department of Sports Medicine, Tianjin Hospital, Tianjin, China
| | - Yandong Lu
- Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin, China
| | - Jie Sun
- Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin, China
| | - John Riehl
- Department of Orthopaedic Trauma, Pikeville Medical Center, Pikeville, Kentucky
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Lai S, Zhang Z, Li J, Fu WL. Comparison of Anterior Cruciate Ligament Reconstruction With Versus Without Anterolateral Augmentation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop J Sports Med 2023; 11:23259671221149403. [PMID: 37025126 PMCID: PMC10071203 DOI: 10.1177/23259671221149403] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/21/2022] [Indexed: 04/08/2023] Open
Abstract
Background It is clear that the anterolateral ligament has an important role in rotational knee stability. However, whether patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) can benefit from anterolateral augmentation (ALA) is still controversial. Purpose To compare the effects of isolated ACLR versus ACLR combined with ALA (ACLR+ALA) on clinical outcomes and knee stability. Study Design Systematic review; Level of evidence, 1. Methods The methodology followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of the PubMed, Embase, and Cochrane Library Central Register of Controlled Trials databases was undertaken to identify all randomized controlled trials (RCTs) comparing isolated ACLR with ACLR+ALA for the treatment of ACL injuries in the last 15 years. The Cochrane Collaboration risk-of-bias tool and the revised Jadad scale were utilized by 2 independent reviewers to determine the quality of RCTs. Relevant data were extracted and compared between procedures, and heterogeneity across the RCTs was assessed using the I 2 statistic. Results The initial search yielded 849 articles. A total of 14 studies (1850 patients; 941 ACLR and 909 ACLR+ALA) satisfied the eligibility criteria for the meta-analysis. There were no significant differences between the procedures in terms of patient-reported outcomes (International Knee Documentation Committee score, Tegner score, Knee injury and Osteoarthritis Outcome Score) or return-to-sport rates. However, patients who underwent ACLR+ALA had better knee stability based on the pivot-shift test (risk ratio [RR], 1.06 [95% CI, 1.02 to 1.10]; P = .0008), Lachman test (RR, 1.03 [95% CI, 1.00 to 1.07]; P = .04), and side-to-side difference in anterior laxity (standardized mean difference, -0.55 [95% CI, -0.98 to -0.12]; P = .01) as well as a lower incidence of graft failure (RR, 0.30 [95% CI, 0.19 to 0.45]; P < .01) compared with patients who underwent isolated ACLR. Conclusion ALA can be considered as a reinforcement of ACLR to improve anteroposterior and anterolateral rotational stability of the knee and reduce the risk of failure. The patient-reported outcomes of isolated ACLR were similar to those of ACLR+ALA, and both procedures provided improved knee function.
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Affiliation(s)
- Sike Lai
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
| | - Zhong Zhang
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
| | - Jian Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
- Jian Li, MD, or Wei-Li Fu, MD, Department of Orthopedic Surgery,
West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041,
China ( or
, respectively)
| | - Wei-Li Fu
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
- Jian Li, MD, or Wei-Li Fu, MD, Department of Orthopedic Surgery,
West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041,
China ( or
, respectively)
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Fernandes JC, Pinho AR, Pereira PA, Madeira MD, Raposo FA, Sousa AN, Lobo JM. Anterolateral ligament of the knee-Cadaver study in a Caucasian population. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:134-138. [PMID: 35691577 DOI: 10.1016/j.recot.2022.06.001] [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: 02/20/2022] [Revised: 04/18/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships. MATERIALS AND METHODS The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured. RESULTS The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from de tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament. CONCLUSIONS The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.
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Affiliation(s)
- J C Fernandes
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Portugal.
| | - A R Pinho
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - P A Pereira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Portugal
| | - M D Madeira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Portugal
| | - F A Raposo
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A N Sousa
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - J M Lobo
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Suh DK, Cho IY, Noh S, Yoon DJ, Jang KM. Anatomical and Biomechanical Characteristics of the Anterolateral Ligament: A Descriptive Korean Cadaveric Study Using a Triaxial Accelerometer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020419. [PMID: 36837620 PMCID: PMC9964873 DOI: 10.3390/medicina59020419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
Background and Objectives: The anterolateral ligament (ALL) could be the potential anatomical structure responsible for rotational instability after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to investigate the anatomical and biomechanical characteristics of the ALL in Korean cadaveric knee joints. Materials and Methods: Twenty fresh-frozen cadaveric knees were dissected and tested. Femoral and tibial footprints of the ALL were recorded. Pivot shift and Lachman tests were measured with KiRA. Results: The prevalence of ALL was 100%. The average distance of the tibial footprint to the tip of the fibular head was 19.85 ± 3.41 mm; from the tibial footprint to Gerdy's tubercle (GT) was 18.3 ± 4.19 mm; from the femoral footprint to the lateral femoral epicondyle was 10.25 ± 2.97 mm. ALL's footprint distance was the longest at 30° of flexion (47.83 ± 8.05 mm, p < 0.01) in a knee with intact ALL-ACL and neutral rotation. During internal rotation, the footprint distance was the longest at 30° of flexion (50.05 ± 8.88 mm, p < 0.01). Internal rotation produced a significant increase at all three angles after ACL-ALL were transected (p = 0.022), where the footprint distance was the longest at 30° of flexion (52.05 ± 7.60 mm). No significant difference was observed in KiRA measurements between intact ALL-ACL and ALL-transected knees for pivot shift and Lachman tests. However, ACL-ALL-transected knees showed significant differences compared to the intact ALL-ACL and ALL-transected knees (p < 0.01). Conclusions: The ALL was identified as a distinct ligament structure with a 100% prevalence in this cadaveric study. The ALL plays a protective role in internal rotational stability. An isolated ALL transection did not significantly affect the ALL footprint distances or functional stability tests. Therefore, the ALL is thought to act as a secondary supportive stabilizer for rotational stability of the knee joint in conjunction with the ACL.
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Affiliation(s)
- Dae Keun Suh
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Il-Yup Cho
- Joint Center, Seoul Barunsesang Hospital, Seoul 08523, Republic of Korea
| | - Sehyun Noh
- College of Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Dong Joo Yoon
- College of Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
- Correspondence: ; Tel.: +82-920-6406
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Cheng YH, Chiu CH, Chen ACY, Chan YS, Hsu KY. Outcomes of Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction According to GNRB Arthrometer Measurement. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020366. [PMID: 36837568 PMCID: PMC9966521 DOI: 10.3390/medicina59020366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/02/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023]
Abstract
Background and Objectives: To investigate the prognosis of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction, we used a GNRB (Genourob, Laval, France) arthrometer to measure surgical outcomes. Materials and Methods: This retrospective study reviewed patients who underwent combined ACL and ALL reconstruction and had a minimum follow-up of 2 years. Subjective outcomes, namely the International Knee Documentation Committee (IKDC) evaluation form scale scores and Lysholm scores, were evaluated preoperatively and postoperatively. We used a GNRB arthrometer to test the side-to-side laxity under pressures of 134 and 200 N, and we calculated the differential of the slope of the curves. We also recorded complications. Results: Our study examined 18 patients (mean age: 30.56 ± 8.9 years, range: 19-53) with a mean follow-up of 27.37 ± 3.4 months (range: 24-36). Both Lysholm and IKDC scores were significantly improved following the operation. The GNRB arthrometer measured mean anteroposterior laxity side-to-side as 0.76 ± 0.78 mm and 0.82 ± 0.8 mm under pressures of 134 and 200 N, respectively. The mean side-to-side differential slope under 200 N was 3.52 ± 2.17 μm/N. These values indicated that patients displayed no graft tear or low functional knee instability. All patients had a grade 3 pivot shift preoperatively; only two patients had a grade 1 pivot shift postoperatively, with the rest having a negative pivot shift. Conclusions: Our study revealed that combined ACL and ALL reconstruction has an excellent prognosis. GNRB measurement demonstrated excellent stability, and most patients had no residual pivot shift.
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Affiliation(s)
- You-Hung Cheng
- Department of Orthopedic Surgery, New Taipei Municipal Tu-Cheng Hospital, Chang Gung Memorial Hospital, New Taipei City 236, Taiwan
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
| | - Chih-Hao Chiu
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
| | - Alvin Chao-Yu Chen
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
| | - Yi-Sheng Chan
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, New Taipei Municipal Tu-Cheng Hospital, Chang Gung Memorial Hospital, New Taipei City 236, Taiwan
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200 (ext. 2163); Fax: +886-3-327-8113
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Low reoperation rate following lateral meniscus root repair: clinical outcomes at 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 2023; 31:495-502. [PMID: 35908114 DOI: 10.1007/s00167-022-07075-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/13/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to review the outcomes of lateral meniscus posterior root tears repair at the time of ACL reconstruction at a minimum 2-year follow-up. METHODS Between March 2015 and August 2018, 2017 patients underwent primary ACL reconstruction and were considered for study eligibility. Lateral meniscus posterior root tears were identified arthroscopically, and repair was performed with a transtibial pull-out suture technique or a side-to-side suture technique. Clinical outcomes were recorded at the time of physical examination. At the end of the study period, patients were contacted to determine whether they had required reoperation. RESULTS Lateral meniscus posterior root tears were identified in 153 out of the 2,017 primary ACL reconstructions (7.6%). Ninety-nine patients were included for analysis: 23 transtibial pull-out sutures and 76 side-to-side repairs. At a mean follow-up of 42 ± 10 months, one patient (1%) had undergone reoperation for failure of the side-to-side repair. There were 11 reoperations in 10 patients (10.1%), including 6 cyclops syndrome, 1 graft rupture, 1 tibial bone cyst, 1 medial and 1 lateral meniscus repair failure, and 1 arthrolysis. Postoperatively, ninety (90.9%) patients were graded A for the IKDC objective score and 9 (9.1%) patients were graded B, with an IKDC subjective score of 86.9 ± 7.6, a Lysholm score of 90.7 ± 6.7 and a median Tegner Activity Scale of 6 (3-9). All of their objective and subjective evaluations improved after surgery (p < 0.001) except for the Tegner Activity Scale. Ten patients underwent second look arthroscopy (10.1%), lateral meniscus healing was observed in 9 out of 10 patients (90%). CONCLUSION This study demonstrated that lateral meniscus posterior root tear repair is a safe procedure with a very low reoperation rate at a minimum follow-up of 2 years. LEVEL OF EVIDENCE IV.
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Screpis D, Baldini M, Magnanelli S, Amarossi A, Piovan G, Natali S, Zorzi C. Anatomic Combined Anterior Cruciate Ligament and Antero-Lateral Ligament Reconstruction Using Autologous Gracilis and Semitendinosus Graft With Single Tibial and Femoral Tunnel. Arthrosc Tech 2023; 12:e255-e259. [PMID: 36879871 PMCID: PMC9984781 DOI: 10.1016/j.eats.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/31/2022] [Indexed: 01/21/2023] Open
Abstract
Anterior cruciate ligament (ACL) injuries are among the most common lesions in orthopaedics practice, but still today, rates up to 24% of unsatisfactory results are reported. Unaddressed anterolateral complex (ALC) injuries have been claimed to be responsible for residual anterolateral rotatory instability (ALRI) after isolate ACL reconstruction and have demonstrated to increase graft failure. In this article, we present our technique for reconstruction of the ACL and anterolateral (ALL) ligament combining the advantages of the anatomical position and the intraosseous femoral fixation to ensure anteroposterior and anterolateral rotational stability.
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Affiliation(s)
- Daniele Screpis
- IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar di Valpolicella, Italia
| | - Marco Baldini
- Clinica Ortopedica dell’Adulto e Pediatrica, Università Politecnica delle Marche, Ancona, Italia
| | - Stefano Magnanelli
- IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar di Valpolicella, Italia
| | - Andrea Amarossi
- Department of Orthopedics and Trauma Surgery, University of Verona, Verona, Italy
| | - Gianluca Piovan
- IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar di Valpolicella, Italia
| | - Simone Natali
- IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar di Valpolicella, Italia
- Address correspondence to Simone Natali, M.D., IRCCS Ospedale Sacro Cuore - Don Calabria, Viale Luigi Rizzardi 4, Negrar di Valpolicella (VR), Italia.
| | - Claudio Zorzi
- IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar di Valpolicella, Italia
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Kamada K, Matsushita T, Nagai K, Hoshino Y, Araki D, Kanzaki N, Matsumoto T, Niikura T, Kuroda R. Risk factors of residual pivot-shift after anatomic double-bundle anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 2023; 143:977-985. [PMID: 35364734 DOI: 10.1007/s00402-022-04428-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 03/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although anterior cruciate ligament reconstruction (ACLR) is considered a successful procedure, residual pivot-shift after surgery remains to be solved. The purpose of this study was to comprehensively evaluate the risk factors of residual pivot-shift after anatomic double-bundle (DB) ACLR. MATERIALS AND METHODS A total of 164 patients who underwent primary anatomic DB-ACLR between January 2014 and December 2019 and screw removal after the index ACLR in our hospital were included in this retrospective case-control study. The manual pivot-shift test was performed under general anesthesia during screw removal surgery, and patients with grade 1 or higher pivot-shift were classified as the positive pivot-shift group, and those with grade 0 were defined as the negative pivot-shift group. Univariate and logistic regression analyses were performed to identify the factors associated with postoperative residual pivot-shift. Assessment included sex, age, time to surgery, preoperative Tegner activity scale, preoperative pivot-shift grade, preoperative anterior tibial translation by the KT-2000 arthrometer measurement, meniscus injury and its surgical procedure, knee hyperextension, cartilage damage, Segond fracture, medial and lateral posterior tibial slope, lateral-medial slope asymmetry, participation in pivoting sport/activity at the time of injury, and return to sports at postoperative one year line. RESULTS Postoperative positive pivot-shift was observed in 14 (8.5%) of 164 patients. The KT-2000 measurement at 1-year postoperatively was significantly higher in the residual pivot-shift-positive group than in the negative group (P < 0.05). Logistic regression analysis revealed that age of patients < 20 years [P < 0.05, odds ratio (OR): 6.1)], preoperative pivot-shift grade (P < 0.05, OR: 4.4), and hyperextended knee (P < 0.05, OR: 11.8) were risk factors of postoperative pivot-shift. There were no statistically significant differences between other variables. CONCLUSIONS Patients < 20 years of age, with high-grade preoperative pivot-shift, or hyperextended knees had a higher risk of residual postoperative pivot-shift.
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Affiliation(s)
- Kohei Kamada
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Function and strain of the anterolateral ligament part II: reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:390-398. [PMID: 32712685 DOI: 10.1007/s00167-020-06137-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Anterolateral rotatory instability (ALRI) may result from isolated ruptures of the anterior cruciate ligament (ACL) or combined lesions with the anterolateral ligament (ALL). Biomechanical studies have demonstrated that the ALL contributes to the overall rotational stability of the knee. The purpose of this study was to investigate the biomechanical function of anatomic ALL reconstruction (ALLrec) in the setting of a combined ACL and ALL injury and reconstruction. The hypothesis was that combined ACL reconstruction (ACLrec) and ALLrec (ACL/ALLrec) significantly reduces internal rotation and shows load sharing between both reconstructions compared with isolated ACLrec. METHODS Eight fresh-frozen cadaveric knees were evaluated using a six degrees of freedom knee simulator. Continuous passive motion and external loads were tested. Kinematic differences between ACLrec and combined ACL/ALLrec were compared. Additionally, ACL graft tension and ALL graft strain were measured continuously throughout the testing protocol. RESULTS Combined anatomic ACL/ALLrec significantly improved the internal rotatory stability compared with isolated ACLrec at 30°-90° under an internal rotation moment. During a static pivot-shift test, additional ALLrec showed no significant reduction of ap-translation. ALLrec resulted in an increase in ACL graft tension during continuous passive motion and with additional internal rotation moment. CONCLUSION In the case of a combined ACL and ALL deficiency, concurrent ACLrec and ALLrec significantly improved the rotatory stability of the knee compared with solely reconstructing the ACL at flexion angles ≥ 30°. Nevertheless, additional ALLrec with fixation at 60° and with low tension could not restore extension-near rotatory stability. For that reason, ALLrec with fixation at 60° flexion cannot be recommended in clinical application.
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ACL surgical trends evolve in the last five years for young European surgeons: results of the survey among the U45 ESSKA members. Knee Surg Sports Traumatol Arthrosc 2023; 31:619-625. [PMID: 35699743 DOI: 10.1007/s00167-022-07005-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/10/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Although the outcomes of ACL reconstruction are generally satisfying, there are several patients who do not regain their pre-injury sporting level and suffer persistent symptoms. Orthopaedic practice has evolved significantly over the last five years to address these drawbacks. The aim of the present survey was to analyze the changes in the approach to ACL reconstruction among a population of young ESSKA surgeons dedicated to ACL surgery. METHODS The survey was uploaded on the ESSKA website and was accessible to members under the age of 45. The ESSKA society has 1035 U45 members involved in multiple aspects of Orthopaedic practice. One hundred and forty questionnaires were returned. Several aspects of ACL surgery were investigated at baseline and 5 years prior. They included general details such as the volume of ACL reconstructions per surgeon per year, the graft choice in cases of low and high demanding patients, the technique for femoral tunnel drilling and the preferred device for femoral fixation. The approach to the management of damage to peripheral structures, as well as meniscal ramp and root tears were also investigated. RESULTS Hamstrings and quadrupled semitendinosus were the preferred graft choice in low-demanding patients (92.9%) while quadriceps tendon is gaining popularity in contact sport practitioners (from 4.3 to 10.7%). The percentage of surgeons using femoral screws had decreased from 37.9 to 29.3 while the percentage of those who used buttons increased from 52.9 to 69.3%. Extra-articular procedures (antero-lateral ligament (ALL) or lateral tenodesis have become popular. The percentage of surgeons who perform an additional peripheral reconstruction rose from 28.5 to 71.5%. Of those who perform the meniscal repair more than 50% of patients rose from 14.3 to 27.9%. Similarly, the percentage of surgeons who performed a medial meniscus ramp lesion repair rose from 29.4 to 54.7%. While the percentage of those who choose to perform a transtibial pull-out repair of lateral meniscus root tears significantly rose from 17.9 to 59.3%. CONCLUSIONS The present survey among under 45 years old ESSKA surgeons yields some notable findings. The new evidence on the impact of injuries on peripheral structures and menisci is stimulating surgeons towards a more anatomic approach if identified at the time of ACL reconstruction. This evidence will probably influence future research and decision-making. LEVEL OF EVIDENCE IV.
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Mogoş Ş, D'Ambrosi R, Antonescu D, Stoica IC. Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Results in Superior Rotational Stability Compared with Isolated Anterior Cruciate Ligament Reconstruction in High Grade Pivoting Sport Patients: A Prospective Randomized Clinical Trial. J Knee Surg 2023; 36:54-61. [PMID: 33932949 DOI: 10.1055/s-0041-1729621] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of the current randomized clinical trial (RCT) was to evaluate the clinical outcomes of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction and to compare them with those of isolated ACL reconstruction. The hypothesis was that combined ACL and ALL reconstruction will result in superior clinical outcomes in terms of the rotational stability of the knee. This prospective RCT included 57 patients (44 men and 13 women, mean age = 31 ± 7.1 years) who underwent ACL reconstruction either isolated (Group I: 25 patients) or combined with ALL reconstruction (Group II: 32 patients). The evaluation of the patients was done preoperatively and postoperatively at 6 weeks, 12 weeks, 6 months, and 12 months including a clinical examination (Lachman's test, Pivot shift's test, and Rolimeter differential anterior laxity), an objective clinical scores (objective: the International Knee Documentation Committee [IKDC] score) and a subjective clinical scores (subjective: IKDC's score, Lysholm's score, and Tegner's activity score). Postoperative complications of all the patients were recorded. There was a significant difference between the study groups at all follow-up intervals when evaluating the postoperative pivot shift test (p < 0.05) with a superior rotational stability in the group of combined ACL and ALL reconstruction. At the final follow-up evaluation, 36% of the patients from Group I and 6.2% in Group II had a grade I positive pivot shift test (p < 0.05). There was a statistically significant difference between the two groups regarding the number of patients with a grade A IKDC objective score (p < 0.05) at the 6- and 12-month follow-up intervals (p = 0.007). There was a significant difference concerning the IKDC subjective score between the two study groups in favor of the combined ACL and ALL reconstruction group at 12 months postoperatively (p = 0.048). Combined ACL and ALL reconstruction technique was demonstrated to be effective in obtaining a superior control of the rotational knee instability and to improve the clinical objective and subjective outcomes when compared with isolated ACL reconstruction in sports patients with high-grade pivoting shifts.
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Affiliation(s)
- Ştefan Mogoş
- Foişor Orthopaedics Hospital, Bucharest, Romania
| | | | - Dinu Antonescu
- University of Medicine and Pharmacy, Carol Davila Bucharest, Romania
| | - Ioan-Cristian Stoica
- Foişor Orthopaedics Hospital, Bucharest, Romania.,University of Medicine and Pharmacy, Carol Davila Bucharest, Romania
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Zhou T, Xu Y, Zhang A, Zhou L, Zhang Q, Ji Z, Xu W. Global research status of anterior cruciate ligament reconstruction: a bibliometric analysis. EFORT Open Rev 2022; 7:808-816. [PMID: 36541554 PMCID: PMC9880905 DOI: 10.1530/eor-21-0065] [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] [Indexed: 12/24/2022] Open
Abstract
Purpose The aim of this study is to comprehensively analyze the publications of anterior cruciate ligament reconstruction (ACLR) research and display the current research status in this field. Methods Articles regarding ACLR research published before October 7, 2021, were downloaded from the Web of Science Core Collection. Excel 2016 and Bibliometric website were used to analyze the annual article trends and international cooperation network. CiteSpace V and VOSviewer were used to perform co-occurrence and citation analyses for journals, institutions, authors, cocitation authors and keywords. Burst keyword detection was also performed with CiteSpace V. Results A total of 12 223 ACLR articles were identified. The American Journal of Sports Medicine (1636 publications, 92,310 citations), the Pennsylvania Commonwealth System of Higher Education (624 publications, 25,304 citations) and Freddie H. Fu (321 publications, 15,245 citations) were journals, institutions and authors with the most publications and citations, respectively. Patellar tendon was the keyword with the most occurrences (1618 times) and return to sport was the keyword with the most burst strength (burst strength: 46.99). Conclusion ACLR-related publications showed a rapid increasing trend since 1990. A large number of articles have been published by authors from different institutions and countries, some of which have gained great academic influence. Based on keyword analysis, patellar tendon is identified as the research hotspot and return to sport is identified as the current research frontier.
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Affiliation(s)
- Tianping Zhou
- Department of Joint Surgery and Sports Medicine, Shanghai Changhai Hospital of Navy Medical University, Shanghai, P.R.China
| | - Yihong Xu
- Department of Joint Surgery and Sports Medicine, Shanghai Changhai Hospital of Navy Medical University, Shanghai, P.R.China,Correspondence should be addressed to W Xu;
| | - Aiai Zhang
- Department of Burn Surgery, Shanghai Changhai Hospital of Navy Medical University, Shanghai, P.R.China
| | - Lan Zhou
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Qing Zhang
- Department of Joint Surgery and Sports Medicine, Shanghai Changhai Hospital of Navy Medical University, Shanghai, P.R.China
| | - Zhou Ji
- Department of Joint Surgery and Sports Medicine, Shanghai Changhai Hospital of Navy Medical University, Shanghai, P.R.China
| | - Weidong Xu
- Department of Joint Surgery and Sports Medicine, Shanghai Changhai Hospital of Navy Medical University, Shanghai, P.R.China,Correspondence should be addressed to W Xu;
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50
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Randhawa S, Stavinoha TJ, Trivedi S, Ganley TJ, Tompkins M, Ellis H, Wilson P, Green DW, Fabricant PD, Musahl V, Shea KG. Paediatric reference anatomy for ACL reconstruction and secondary anterolateral ligament or lateral extra-articular tenodesis procedures. J ISAKOS 2022; 7:206-213. [PMID: 35589081 DOI: 10.1016/j.jisako.2022.04.008] [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: 10/27/2021] [Revised: 03/04/2022] [Accepted: 04/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES For iliotibial band (ITB) lateral extra-articular tenodesis or anterolateral ligamentous/capsular reconstruction with anterior cruciate ligament reconstruction, a clear understanding of the referenced anterolateral knee anatomy is critical-especially given the risk of injury to the physis or key anterolateral structures in the paediatric population, which is at high-risk for primary and secondary anterior cruciate ligament injury. The purpose of this study was to quantitatively assess the anatomy of the knee physes, paediatric lateral collateral ligament (LCL) origin, popliteus origin and ITB tibial insertion. METHODS Nine paediatric cadaveric knee specimens with average age 4.2 years (range 2 months-10 years) underwent dissection to identify the LCL's and popliteus' femoral origins and the ITB's tibial insertion. Metallic marking pins demarcated precise anatomic attachment sites, and subsequent computerised tomography scans enabled quantified measurements among them. RESULTS LCL & Popliteus: On the femur, the popliteus origin lay consistently deep to the LCL and inserted both distally and anteriorly to the LCL, a mean distance of 4.6 mm (range 1.9-7.6; standard deviation 2.0). From the joint line, the LCL lay a mean distance of 12.5 mm proximally while the popliteus measured a mean of 8.2 mm. Both were consistently distal to the physis. The LCL was a mean distance of 4.4 mm (range 1.0-9.5) and the popliteus was a mean distance of 8.2 (range 1.7-12.5) from the physis. ITB insertion: The ITB insertion at Gerdy's tubercle had an average footprint measuring 28.2 mm2 (range 10.3-58.4) and the ITB centre lay proximal to the physis in 6 specimens (mean age 4.2 years, median 2.5 years) and distal in 3 specimens (mean age 1.5 years, median 4 months). Mean distance from the footprint centre to the physis was 1.6 mm proximal (range 7.1 proximal - 2.2 distal). CONCLUSION This study describes relative and quantitative positions of the femoral LCL and popliteus origins and tibial ITB attachment and their respective physeal relationships. Knowledge of paediatric anterolateral knee anatomy will help guide essential future research and procedures providing extra-articular anterolateral rotatory stabilisation and may help reduce iatrogenic physeal injury risk. LEVEL OF EVIDENCE N/A (descriptive anatomic study).
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Affiliation(s)
- Sahej Randhawa
- Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road, Palo Alto, CA 94304, USA; UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA 92092, USA
| | - Tyler J Stavinoha
- Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road, Palo Alto, CA 94304, USA
| | - Sunny Trivedi
- Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road, Palo Alto, CA 94304, USA; University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Theodore J Ganley
- The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Marc Tompkins
- University of Minnesota, 2450 Riverside Ave., Minneapolis, MN 55455, USA
| | - Henry Ellis
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Phil Wilson
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Daniel W Green
- Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Peter D Fabricant
- Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Volker Musahl
- University of Pittsburgh, UPMC Freddie Fu Sports Medicine Center, Dept of Orthopedics, 3200 S. Water St, PA 15203, USA
| | - Kevin G Shea
- Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road, Palo Alto, CA 94304, USA.
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