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Liu D, Lu W, Vithran DTA, Bi Q, Hong Z, Liu X, Yuan D, Chen C, Xiao W, Li Y. Gradual stabilization and narrowing of bone tunnels following primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39091244 DOI: 10.1002/ksa.12398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/27/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The purpose of this study is to dynamically assess variations in tunnel diameters following anterior cruciate ligament reconstruction (ACLR) and investigate correlations with patient-reported outcomes (PROs) and graft maturity based on signal-to-noise quotient (SNQ). METHODS Tunnel diameter and tunnel position were measured using three-dimensional models derived from computed tomography (CT) data. Postoperative graft maturity and integration were evaluated using magnetic resonance imaging (MRI). Clinical outcomes were assessed through PROs, which included the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Scores and Lysholm scores. The correlation between tunnel enlargement extent, PROs and SNQ values, as well as correlations between confounding factors, tunnel diameter differences and SNQ were analyzed. RESULTS A total of 73 participants underwent primary ACLR and scheduled follow-ups. At the segment of the articular aperture, the femoral tunnel was enlarged by 32.3% to 10.4 ± 1.6 mm (p < 0.05), and the tibial tunnel was widened by 17.2% to 9.6 ± 1.2 mm (p < 0.05) at the 6-month follow-up. At 1 year postoperatively, diameters at the articular aperture were not further increased on the femoral (n.s.) and tibial (n.s.) sides. In early postoperative follow-up, the femoral tunnel was anteriorly and distally shifted, coupled with posterior and lateral deviation involving the tibial side, exhibiting minimal migration at 1-year follow-up. The degree of tunnel widening was not correlated with PROs and SNQ values. Age, gender, body mass index (BMI), time from surgery to follow-up, concomitant injuries and autograft type were not correlated with tunnel diameter differences and SNQ. CONCLUSIONS The femoral and tibial bone tunnels exhibited eccentrical widening and gradually stabilized at 1 year following ACLR. Furthermore, the enlarged bone tunnels were not correlated with unsatisfied PROs and inferior graft maturity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Di Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenhao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Djandan Tadum Arthur Vithran
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Bi
- Department of Sports Medicine, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zheping Hong
- Department of Sports Medicine, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xu Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Dongliang Yuan
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Can Chen
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Kemler B, Coladonato C, Sonnier JH, Campbell MP, Darius D, Erickson BJ, Tjoumakaris FP, Freedman KB. Evaluation of Failed ACL Reconstruction: An Updated Review. Open Access J Sports Med 2024; 15:29-39. [PMID: 38586217 PMCID: PMC10998505 DOI: 10.2147/oajsm.s427332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 03/23/2024] [Indexed: 04/09/2024] Open
Abstract
Failure rates among primary Anterior Cruciate Ligament Reconstruction (ACLR) range from 3.2% to 11.1%. Recently, there has been increased focus on surgical and anatomic considerations which predispose patients to failure, including excessive posterior tibial slope (PTS), unaddressed high-grade pivot shift, and improper tunnel placement. The purpose of this review was to provide a current summary and analysis of the literature regarding patient-related and technical factors surrounding revision ACLR, rehabilitation considerations, overall outcomes and return to sport (RTS) for patients who undergo revision ACLR. There is a convincingly higher re-tear and revision rate in patients who undergo ACLR with allograft than autograft, especially amongst the young, athletic population. Unrecognized Posterior Cruciate Ligament (PLC) injury is a common cause of ACLR failure and current literature suggests concurrent operative management of high-grade PLC injuries. Given the high rates of revision surgery in young active patients who return to pivoting sports, the authors recommend strong consideration of a combined ACLR + Anterolateral Ligament (ALL) or Lateral extra-articular tenodesis (LET) procedure in this population. Excessive PTS has been identified as an independent risk factor for ACL graft failure. Careful consideration of patient-specific factors such as age and activity level may influence the success of ACL reconstruction. Additional technical considerations including graft choice and fixation method, tunnel position, evaluation of concomitant posterolateral corner and high-grade pivot shift injuries, and the role of excessive posterior tibial slope may play a significant role in preventing failure.
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Affiliation(s)
- Bryson Kemler
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | - Carlo Coladonato
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | | | - Michael P Campbell
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | - Danielle Darius
- Department of Education, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | | | - Kevin B Freedman
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
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Moon HS, Choi CH, Jung M, Yoo JH, Kwon HJ, Hong YT, Kim SH. Small Intercondylar Notch Size Is Not Associated with Poor Surgical Outcomes of Anatomical Single-Bundle Anterior Cruciate Ligament Reconstructions. Clin Orthop Surg 2024; 16:73-85. [PMID: 38304206 PMCID: PMC10825255 DOI: 10.4055/cios23081] [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: 03/20/2023] [Revised: 06/25/2023] [Accepted: 06/25/2023] [Indexed: 02/03/2024] Open
Abstract
Background Although many studies have been conducted on the association between the intercondylar notch size and the risk of anterior cruciate ligament (ACL) injury, few studies have examined its relationship with the condition after surgical treatment. Therefore, this study aimed to investigate the surgical outcomes of anatomical single-bundle ACL reconstruction according to intercondylar notch volumes. Methods Medical records of patients who underwent anatomical single-bundle ACL reconstruction using a tibialis anterior allograft between 2015 and 2019 were retrospectively reviewed. For each sex, eligible patients were classified into two groups based on their percentile of intercondylar notch volumes, which were measured using postoperative three-dimensional computed tomography images (group S, ≤ 50th percentile of included patients; group L, > 50th percentile of included patients). Additional grouping was performed based on the group's percentiles of normalized values of intercondylar notch volumes to body heights. Between-group comparative analyses were performed on the perioperative data and surgical outcomes in both objective and subjective aspects. Results One hundred patients were included in the study. For male patients, there were no differences in the overall surgical outcomes between groups, whereas group L showed a significantly greater knee anteroposterior (AP) laxity than group S at the final follow-up (p = 0.042 for the side-to-side differences [SSD] at the maximum manual force). Similarly, there were no differences in the female patients in the overall surgical results between the groups, whereas group L showed a significantly greater knee AP laxity at the final follow-up (p = 0.020 for the SSD at 134 N; p = 0.011 for the SSD at the maximum manual force). Additional analyses based on the normalized values of the intercondylar notch volume showed consistent results for male patients, and additional grouping for female patients was identical to the existing grouping. Conclusions The surgical outcomes of anatomical single-bundle ACL reconstruction in patients with relatively small intercondylar notch volumes were comparable to those with large notch volumes, but rather showed favorable outcomes in postoperative knee AP laxity.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Je-Hyun Yoo
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyuk-Jun Kwon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Taek Hong
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Chiba D, Yamamoto Y, Kimura Y, Sasaki S, Sasaki E, Yamauchi S, Tsuda E, Ishibashi Y. Concomitant Lateral Meniscus Tear is Associated with Residual Rotatory Knee Instability 1 Year after Anterior Cruciate Ligament Reconstruction: Case-cohort Study. J Knee Surg 2023; 36:1341-1348. [PMID: 36564041 DOI: 10.1055/s-0042-1757594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Lateral meniscus tear (LMT) accompanied by anterior cruciate ligament (ACL) injuries has been reported to provoke rotatory instability of the affected knee joint. Unfortunately, these previous papers did not determine whether LMT-derived rotatory knee instability is residual because only preoperative or time zero data exists. This study aimed to longitudinally investigate how the prevalence of comorbid LMT is associated with residual rotatory knee instability (RKI) 1 year after ACL reconstruction (ACLR). A total of 327 patients who underwent double-bundle ACLR (average age: 23.4 years, body mass index: 23.5 kg/m2, 215 females). The patients were divided into three groups based on arthroscopy: 1) intact lateral meniscus (LM); 2) unrepaired LMT; 3) repaired LMT. At the 1-year follow-up, the pivot-shift test was performed. The prevalence of RKI, determined according to IKDC grades (grade ≥1 denoted RKI), was compared with chi-square or Fisher's exact tests. Thirty-eight patients (11.6%) had RKI; 203 subjects (62.1%) showed LMT, and 124 patients were diagnosed with an intact LM. Out of the 203 patients, 79 (38.9%) underwent LM repair. RKI was more prevalent in the LMT group than in the intact group (13.8% versus 8.1%, p = 0.117; Odds ratio: 1.499 [95%CI: 0.864 - 2.600]). In addition, the prevalence of RKI was significantly higher in the LM-repair group than in the intact-LM group (17.7% versus 8.1%, p = 0.038; Odds Ratio: 2.455 [95%CI: 1.032 - 5.842]). Medial meniscus tear (MMT) was detected in 113 patients (34.6%); RKI prevalence was not statistically different between the intact-MM group and the MMT group (12.2% versus 10.6%, p = 0.681). The current cohort study clarified that LMT comorbid with ACL injury was longitudinally associated with increased RKI prevalence 1 year after ACLR. Therefore, patients who underwent both ACLR and LM repair demonstrated a significantly higher prevalence of residual RKI.
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Affiliation(s)
- Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Shohei Yamauchi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
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Gawish HM, Hashish MH, Elghaish MAE. Anterior Cruciate Ligament Reconstruction Using Fixed Loop All-Inside (FLAI) Technique. Arthrosc Tech 2023; 12:e1843-e1852. [PMID: 37942108 PMCID: PMC10628345 DOI: 10.1016/j.eats.2023.06.017] [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: 04/08/2023] [Accepted: 06/22/2023] [Indexed: 11/10/2023] Open
Abstract
The aim of this surgical technical note is to provide a more secure option to prevent possible graft loosening with all-inside anterior cruciate ligament (ACL) reconstruction. A triple strategy is used. First, a fixed loop cortical device is used on the femoral side. Second, an internal brace augmentation for ACL graft is employed to prevent graft loosening during early postoperative period. Lastly, tying off the sutures of tibial adjustable loop after retensioning to secure its locking mechanism from slippage.
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Affiliation(s)
| | - Mahmoud Hammam Hashish
- Department of Orthopedic Surgery and Traumatology, Ibrahim Obeid Specialized Hospital, Alexandria, Egypt
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Heng CHY, Wong JYS, Tan AHC. Both Adjustable and Fixed Loop Hamstring Tendon Graft Fixation Have Similar Clinical and Patient-Reported Outcomes in Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2023; 5:100775. [PMID: 37583621 PMCID: PMC10424139 DOI: 10.1016/j.asmr.2023.100775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/15/2023] [Indexed: 08/17/2023] Open
Abstract
Purpose This study aims to compare the outcomes of fixed-loop device (FLD) vs adjustable-loop device (ALD) graft fixation with up to 2-year follow-up in patients undergoing primary anterior cruciate ligament reconstruction (ACLR) in a predominantly Asian setting. Methods Prospectively collected outcome measures as well as clinical records of patients who underwent primary ACLR using either FLD or ALD fixation of hamstring tendon autograft performed by a single surgeon were reviewed. The surgeon in this study used a fixed-loop device from 2018 to 2019 and then changed to adjustable loop from 2019 to 2020. Suspensory fixation was performed on the femoral side, and aperture (interference screw) fixation was performed on the tibial side. Outcome measures included knee range of motion, KT-1000 arthrometer testing, Lysholm knee score, and Tegner activity scale. Patients were assessed preoperatively and postoperatively at regular intervals of 6, 12, and 24 months. Results A total of 105 patients were identified. Forty-six were excluded due to incomplete follow-up data, so 59 patients with full 2-year follow-up were included in the final study group. Both groups (FLD vs ALD) were similar in demographics except for age (P = .042). Out of 105, there were 59 patients remaining in the study group with 2-year follow-up data. No significant differences were observed between the 2 groups at all respective testing intervals. Conclusions FLDs and ALDs for suspensory fixation of hamstring tendon autograft in ACLR had similar clinical outcomes with a minimum of 2-year follow up. There is no evidence of graft loosening from loop lengthening. Level of Evidence Level III, retrospective comparative trial.
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Affiliation(s)
| | - Joel Yat Seng Wong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Dash SK, Mishra D, Sahu H, Moharana AK, Angrish S, Ts D. Functional Outcomes Following Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction Using the Sironix Titanium Button and the Polyetheretherketone (PEEK) Button: A Retrospective Observational Study. Cureus 2023; 15:e46186. [PMID: 37908964 PMCID: PMC10613784 DOI: 10.7759/cureus.46186] [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: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) injury is most common among athletes compared to the general population. ACL reconstruction is a clinical standard for restoring joint mechanical stability and enabling sports return. The purpose of the study is to evaluate the safety and functional outcomes after arthroscopic ACL reconstruction using the Sironix titanium button and the polyetheretherketone (PEEK) button. Methods A total of 31 subjects who have undergone arthroscopic ACL reconstruction using the Sironix titanium button and PEEK button between August 2022 and January 2023 were included in the study. Demographic data, surgery details, and other baseline characteristics of the subjects were collected from the hospital records. The primary objective of the study was to assess the functional outcome using the International Knee Documentation Committee (IKDC) questionnaire. The secondary objectives were to determine the pre- and post-surgery activity levels using the Tegner Activity Score (TAS) and Lysholm score. Quality of life evaluation was done by using the Quality of Life (QoL) subscale from the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Single Assessment Numerical Evaluation (SANE). Device-related adverse effect information was recorded. Results The mean (SD) of the total IKDC score of 31 subjects at baseline and post-surgery was 51.4 (2.84) and 91.8 (2.59) out of 100, respectively. The mean (SD) of TAS pre-injury and post-surgery was 5.3 (1.47) and 5.4 (1.38) out of 10, respectively. The total mean (SD) value of the total Lysholm Score at baseline and post-surgery was 53.9 (3.72) and 91.4 (3.61) out of 100, respectively. The mean (SD) value of the quality of life subscale of the KOOS score was 91.2 (3.91) out of 100. The total mean (SD) value of the SANE score that had affected joint/region of interest today was 97.4 (1.78), while for the opposite side today, it was 99.5 (0.85) out of 100. There were no adverse device effects reported in this study. Conclusion Based on the score assessment, it was observed that the performance of Sironix knee implant devices, Proloop-Titanium adjustable loop button, T-Button A® Closed PEEK button, and Surestitch® All Inside Meniscal Repair Implant (Healthium Medtech Limited, Bengaluru, Karnataka, India) was effective and safe with no adverse effects. Therefore, Sironix knee implants are considered safe and effective in ACL reconstruction and meniscus repair surgery.
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Affiliation(s)
| | | | | | | | - Sachin Angrish
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
| | - Deepak Ts
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
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Bachmaier S, Monaco E, Smith PA, Frank RM, Matzkin EG, Wijdicks CA. Biomechanical Comparison of 3 Adjustable-Loop Suspensory Devices for All-Inside ACL Reconstruction: A Time-Zero Full-Construct Model. Orthop J Sports Med 2023; 11:23259671231201461. [PMID: 37786476 PMCID: PMC10541758 DOI: 10.1177/23259671231201461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/19/2023] [Indexed: 10/04/2023] Open
Abstract
Background Little is known about the stability of adjustable-loop devices (ALDs) for anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose To evaluate the stabilization behavior of 3 different types of ALDs for all-inside ACLR in a full-construct surgical technique-based manner. Study Design Controlled laboratory study. Methods The femoral and tibial devices of Ultrabutton (Smith & Nephew), Infinity (Conmed), and TightRope II (Arthrex) were applied to quadrupled bovine tendon grafts (n = 8 each) with tibial-sided traction applied (350 N) for graft tensioning in a simulated fully extended knee. Knotless femoral graft fixation was based on either a suture-locking device (SLD; Ultrabutton), button-locking device (BLD; Infinity), or dual-locking device (DLD; TightRope II). All constructs were progressively loaded (50 N/500 cycles) from 50 to 300 N for 3000 cycles (0.75 Hz), including complete unloading situations and pull to failure (50 mm/min). Construct elongation, stiffness, and ultimate load were analyzed. Results BLD showed significantly greater initial elongation (-2.69 ± 0.15 mm) than DLD (-3.19 ± 0.21 mm; P < .001) but behaved similarly to SLD (-2.93 ± 0.23 mm). While DLD and SLD had the smallest initial elongation at the same significance level, they behaved opposite to each other with gradually increasing peak loading. At the end of testing, DLD had the lowest (-0.64 ± 0.32 mm) and SLD the highest (3.41 ± 1.01 mm) total elongation (P < .003 for both). SLD displayed significantly higher dynamic elongation (6.34 ± 0.23 mm) than BLD (3.21 ± 0.61 mm) and DLD (2.56 ± 0.31 mm) (P < .001 for both). The failure load of BLD (865.0 ± 183.8 N) was significantly lower (P < .026) compared with SLD and DLD (>1000 N). The predominant failure mode was suture rupture and tibial bone breakage with button subsidence (SLD, n = 4). No significant difference in stiffness between constructs was found. Conclusion While DLD successfully restricted critical construct elongation, BLD partially and SLD completely exceeded the clinical failure threshold (>3 mm) of plastic elongation with loop lengthening during increasing cyclic peak loading with complete unloading. Higher failure loads of SLD and DLD implants (>1000 N) were achieved at similar construct stiffness to BLD. Clinical Relevance A detailed biomechanical understanding of the stabilization potential is pertinent to the continued evolution of ALDs to improve clinical outcomes.
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Affiliation(s)
| | - Edoardo Monaco
- Department of Orthopaedics and Traumatology Sant’Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | | | - Rachel M. Frank
- University of Colorado School of Medicine, Aurora, Colorado, USA
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Vari N, Marot V, Ripoll T, Vieira TD, Martinel V, Bérard E, Cavaignac E. Preserving the Semitendinosus Distal Attachment Is Associated With Improved Graft Remodeling After ACL Reconstruction. Am J Sports Med 2023; 51:2064-2072. [PMID: 37204156 DOI: 10.1177/03635465231169047] [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: 05/20/2023]
Abstract
BACKGROUND The semitendinosus (ST) tendon can be used by itself as a graft for anterior cruciate ligament (ACL) reconstruction. An increasing number of these procedures are being done while preserving the ST's tibial attachment, but there are no data on the remodeling of an attached ST (aST) graft. PURPOSE To compare graft remodeling on magnetic resonance imaging (MRI) scans at 1 year after ACL reconstruction between standard free ST graft and aST graft. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This prospective study enrolled 180 patients who were undergoing ACL reconstruction: 90 with the ST graft and 90 with the aST graft. The analysis was performed 1 year after the surgery. The main endpoint was the signal-to-noise quotient (SNQ) on MRI scans (T1-weighted sequence). The secondary endpoints were tibial tunnel widening (TTW), graft maturation (Howell classification), retear rate, new surgery rate, Simple Knee Value, Lysholm score, International Knee Documentation Committee (IKDC) score, postoperative Tegner score, difference between pre- and postoperative Tegner scores, ACL-Return to Sport after Injury (ACL-RSI), return-to-sports rate, and time to return to sports. RESULTS The mean adjusted SNQ was 1.18 (95% CI, 0.72-1.65) in the aST group and 3.88 (95% CI, 3.42-4.34) in the ST group (P < .001). The new surgery rate was 2.2% in the aST group and 10% in the ST group (P = .029). The median Lysholm score was significantly higher in the aST group (99; interquartile range [IQR], 95-100) than in the ST group (95; IQR, 91-99) (P = .004). The mean time to return to sports was significantly shorter in the aST group (248.73 ± 141.62 days) than the ST group (317.23 ± 144.69 days) (P = .002). No statistically significant difference was found between groups in the TTW (P = .503), Howell graft maturity grade (P = .149), retear rate (P > .999), Simple Knee Value (P = .061), postoperative Tegner score (P = .320), pre- to postoperative difference in Tegner score (P = .317), ACL-RSI (P = .097), IKDC score (P = .621), and return-to-sports rate (P > .999). CONCLUSION At 1 year postoperatively, remodeling of an ST graft assessed using MRI is better when its distal attachment is left intact.
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Affiliation(s)
- Nicolas Vari
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Vincent Marot
- Orthopaedics Unit, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Thomas Ripoll
- Musculoskeletal Institute, Hôpital Pasteur 2, CHU Nice, Nice, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Vincent Martinel
- Orthopedic Group Ormeau Pyrénées, Polyclinique de l'Ormeau, Tarbes, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR 1295 CERPOP, University of Toulouse, INSERM, UPS, Toulouse University Hospital (CHU), Toulouse, France
| | - Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
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Lai PJ, Wong CC, Chang WP, Liaw CK, Chen CH, Weng PW. Comparison of two different types of hybrid Tibial fixations for anterior cruciate ligament reconstruction: a prospective comparative cohort study. BMC Musculoskelet Disord 2022; 23:1096. [PMCID: PMC9749364 DOI: 10.1186/s12891-022-06057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/05/2022] [Indexed: 12/16/2022] Open
Abstract
Background Previous studies have compared different kinds of fixations for anterior cruciate ligament reconstruction. Nevertheless, there is no optimal method to date. To the best of authors’ knowledge, there is no article discussing the combination of adjustable suspensory device and interference screw for hybrid tibial fixation. Methods In total, 66 patients (n = 34, adjustable suspensory device and interference screw; n = 32, cortical screw and interference screw) were analyzed. Their International Knee Documentation Committee score and Tegner activity level scale were evaluated before and after a 2-year follow-up. The Single Assessment Numeric Evaluation score was evaluated after a 2-year follow-up. Physical exams such as range of motion, anterior knee pain (VAS > = 3) and Lachman test were assessed before and at least 12 months after surgery. To evaluate tunnel widening, anteroposterior and lateral view radiography was conducted 1 day and at least 12 months after surgery. A more than 10% change was considered tibial tunnel widening. Mann–Whitney U test, independent t test, paired t test, Fisher’s exact test and chi-squared test were used to compare the variables. Linear and logistic regression models were applied to adjust for potential confounders. Results No variable except gender (P = 0.006) showed significant difference with regard to demographic data. After adjustment, there was no statistically significant difference between the groups regarding post-operative physical exams. Patients who used adjustable suspensory device and interference screw had lower post-operative Single Assessment Numeric Evaluation score (adjusted β − 8.194; P = 0.017), Tegner activity level scale (adjusted β − 1.295; P = 0.001) and pre-operative degrees of knee flexion (adjusted β − 2.825; P = 0.026). Less percentage of tunnel widening in the lateral view of radiographs was seen in patients in group of adjustable suspensory device and interference screw (adjusted β − 1.733; P = 0.038). No significant difference was observed in the anteroposterior view of radiographs (adjusted β − 0.667; P = 0.26). Conclusion In these 66 patients, we observed less tibial tunnel widening and lower post-operative functional scores in the group of adjustable suspensory device and interference screw. Both groups displayed similar outcomes of physical exams as well as improvement after operation. The proposed method may become an alternative option. Nonetheless, the quality of our study is still limited, and thus further studies are warranted to determine the efficacy and further application. Trial registration Joint Institutional Review Board of Taipei Medical University, Taipei, Taiwan (No: N201805094). Study design Prospective comparative cohort study; Level of evidence, II.
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Affiliation(s)
- Po-Jen Lai
- grid.412896.00000 0000 9337 0481Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 235 Taiwan
| | - Chin-Chean Wong
- grid.412896.00000 0000 9337 0481Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 235 Taiwan ,grid.412896.00000 0000 9337 0481Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 110 Taiwan ,grid.412896.00000 0000 9337 0481Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei City, 110 Taiwan ,grid.412896.00000 0000 9337 0481Research Center of Biomedical Devices, Taipei Medical University, Taipei, 11031 Taiwan ,grid.412896.00000 0000 9337 0481International Ph.D. Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei, 11031 Taiwan ,Non-Invasive Cancer Therapy Research Institute of Taiwan, Taipei, 10489 Taiwan
| | - Wen-Pei Chang
- grid.412896.00000 0000 9337 0481Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan ,grid.412896.00000 0000 9337 0481School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chen-Kun Liaw
- grid.412896.00000 0000 9337 0481Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 235 Taiwan ,grid.412896.00000 0000 9337 0481Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 110 Taiwan ,grid.412896.00000 0000 9337 0481Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei City, 110 Taiwan
| | - Chih-Hwa Chen
- grid.412896.00000 0000 9337 0481Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 235 Taiwan ,grid.412896.00000 0000 9337 0481Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 110 Taiwan ,grid.412896.00000 0000 9337 0481Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei City, 110 Taiwan
| | - Pei-Wei Weng
- grid.412896.00000 0000 9337 0481Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 235 Taiwan ,grid.412896.00000 0000 9337 0481Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 110 Taiwan ,grid.412896.00000 0000 9337 0481Research Center of Biomedical Devices, Taipei Medical University, Taipei, 11031 Taiwan ,International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031 Taiwan
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Elmholt SB, Nielsen TG, Lind M. Fixed-loop vs. adjustable-loop cortical button devices for femoral fixation in ACL reconstruction - a systematic review and meta-analysis. J Exp Orthop 2022; 9:106. [PMID: 36269424 PMCID: PMC9587170 DOI: 10.1186/s40634-022-00544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Simone Birkebæk Elmholt
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Torsten Grønbech Nielsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Martin Lind
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Adjustable-Loop Cortical Suspensory Fixation Results in Greater Tibial Tunnel Widening Compared to Interference Screw Fixation in Primary Anterior Cruciate Ligament Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091193. [PMID: 36143870 PMCID: PMC9505006 DOI: 10.3390/medicina58091193] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022]
Abstract
Background: Although the use of adjustable-loop suspensory fixation has increased in recent years, the influence of the shortcomings of suspensory fixation, such as the bungee-cord or windshield-wiper effects, on tunnel widening remains to be clarified. Hypothesis/Purpose: The purpose of this study was to compare adjustable-loop femoral cortical suspensory fixation and interference screw fixation in terms of tunnel widening and clinical outcomes after anterior cruciate ligament reconstruction (ACLR). We hypothesized that tunnel widening in the adjustable-loop femoral cortical suspensory fixation (AL) group would be comparable to that in the interference screw fixation (IF) group. Methods: This study evaluated patients who underwent primary ACLR at our institution between March 2015 and June 2019. The femoral and tibial tunnel diameters were measured using plain radiographs in the immediate postoperative period and 2 years after ACLR. Tunnel widening and clinical outcomes (Lysholm score, 2000 International Knee Documentation Committee subjective score, and Tegner activity level) were compared between the two groups. Results: There were 48 patients (mean age, 29.8 ± 12.0 years) in the AL group and 44 patients (mean age, 26.0 ± 9.5 years) in the IF group. Tunnel widening was significantly greater in the AL group than that in the IF group at the tibia anteroposterior (AP) middle (2.03 mm vs. 1.32 mm, p = 0.017), tibia AP distal (1.52 mm vs. 0.84 mm, p = 0.012), tibia lateral proximal (1.85 mm vs. 1.00 mm, p = 0.001), tibia lateral middle (2.36 mm vs. 1.03 mm, p < 0.001), and tibia lateral distal (2.34 mm vs. 0.85 mm, p < 0.001) levels. There were no significant differences between the two groups with respect to femoral tunnel widening and clinical outcomes. Conclusions: Tibial tunnel widening was significantly greater in the AL group than in the IF group at 2 years after primary ACLR. However, the clinical outcomes in the two groups were comparable at 2 years.
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Khan MJ, Asif N, Aziz MH, Raza A, Anwar S, Nuhmani S, Alghadir AH, Khan M. Does an Adjustable-Loop Device Loosen following ACL Reconstruction with a Hamstring Graft? A Retrospective Study with a Follow-Up of Two Years. J Clin Med 2022; 11:jcm11133648. [PMID: 35806933 PMCID: PMC9267585 DOI: 10.3390/jcm11133648] [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: 04/04/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Arthroscopic anatomic anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for an ACL tear and requires the use of fixed or adjustable-loop devices to fix a femoral-side graft. Although the adjustable mechanism is designed to provide one-way tensioning, there is a concern that the adjustable loop will loosen and lengthen during cyclic loads, creating graft laxity. The present paper is a retrospective study of patients who underwent ACLR with the fixation of a hamstring graft with an adjustable loop on the femoral side from November 2016 to October 2018. The knee’s functional outcome was evaluated using an International Knee Documentation Committee (IKDC) score, Lysholm score, Lachman test, and pivot shift test. The patients were assessed preoperatively and finally postoperatively after two years of surgery. Thirty-two patients were analyzed. Significant improvement was obtained in the final clinical outcome of the patients. Twenty-seven patients (84.4%) were Lachman negative, and twenty-eight patients (87.5%) were pivot shift test negative, the mean Lysholm score was 96.91, and the IKDC score was 91.47 (p < 0.001). There was no infection, graft failure, or flexion restriction. Arthroscopic ACLR with an adjustable-loop suspensory device is a successful fixation method for femoral-side graft fixation and offers a similar functional outcome as with fixed-loop devices.
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Affiliation(s)
- Mohammad Jesan Khan
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Naiyer Asif
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Mohd Hadi Aziz
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Ariz Raza
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Shahzad Anwar
- Department of TB and Chest, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India;
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, Dammam 34221, Saudi Arabia;
| | - Ahmad H. Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
| | - Masood Khan
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
- Correspondence: or ; Tel.: +966-11-469-8544
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Adjustable-loop implants are non-inferior to fixed-loop implants for femoral fixation in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 31:1723-1732. [PMID: 35737010 DOI: 10.1007/s00167-022-07034-y] [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: 02/28/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Button implants with an adjustable-loop device (ALD) are often used in anterior cruciate ligament reconstruction (ACLR). Clinical research comparing ALDs with fixed-loop devices (FLD) has mainly been conducted in small patient populations with short follow-up times. To determine whether ALDs are safe to use in ACLR, a non-inferiority study with a large sample population and a long follow-up period would be beneficial. This study compared ALDs with FLDs to determine non-inferior revision surgery rates, knee stability, and patient-reported outcomes (PROM) in ACLRs. METHODS This non-inferiority register-based cohort study was conducted using data from the Danish Knee Ligament Reconstruction Registry (DKRR). A total of 12,723 patients > 15 years of age with primary ACLR using hamstring tendon autografts and either an FLD or ALD for femoral fixation were included: 9719 patients were in the FLD group, and 3014 patients were in the ALD group. The primary outcome was revision ACLR with a non-inferiority margin for ALDs at 4% at the 2-year follow-up. The secondary outcomes were anterior and rotatory knee stability and PROMs based on the Knee Injury and Osteoarthritis Outcome Score (KOOS) at the 1-year follow-up. RESULTS The crude cumulative revision rates in ALD implants at 2 and 5 years were 2.1% (95% CI 1.62-2.68) and 5.0% (95% CI 4.22-5.96), respectively. In the FLD group, the rates were 2.2% (95% CI 1.89-2.48) at 2 years and 4.7% (95% CI 4.31-5.20) at 5 years. The 1-year side-to-side differences were 0.97 mm (95% CI 0.90-1.03) in the ALD group and 1.45 mm (95% CI 1.41-1.49) in the FLD group. In the FLD group, 13% had a positive pivot shift, and in the ALD group, 6% had a positive pivot shift. There were no differences in KOOS. CONCLUSION ALDs were non-inferior to FLDs regarding revision rates, knee stability, and patient-reported outcomes. Based on this conclusion, ALDs are safe to use for femoral fixation in ACLR. LEVEL OF EVIDENCE III.
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15
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Moon HS, Choi CH, Yoo JH, Jung M, Lee TH, Hong KB, Kim SH. Graft isometry during anatomical ACL reconstruction has little effect on surgical outcomes. Knee Surg Sports Traumatol Arthrosc 2022; 30:1594-1604. [PMID: 34264371 DOI: 10.1007/s00167-021-06654-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/01/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the surgical outcomes of anatomical anterior cruciate ligament (ACL) reconstruction according to the graft isometry measured during surgery. METHODS Electrical medical records of patients who underwent an arthroscopic ACL reconstruction through the transportal technique using hamstring tendon autograft between 2012 and 2016 were retrospectively reviewed. The patients were classified into two groups based on the graft length change throughout the knee range of motion measured just before graft fixation (Group 1, graft length change ≤ 2 mm; Group 2, graft length change > 2 mm). Comparative analyses, including a non-inferiority trial, were performed regarding the clinical scores, knee laxity, and radiographic parameters between the groups. RESULTS A total of 67 patients were included in the study. The total change in the length of ACL graft throughout the knee range of motion was 1.4 ± 0.4 mm in Group 1 (range, 0.2-2.0 mm), and 3.0 ± 0.7 mm in Group 2 (range, 2.2-5.0 mm). Group 1 showed a relatively high (proximal) femoral tunnel and shallow (anterior) tibial tunnel compared to Group 2 (P < 0.001 and P = 0.028, respectively), but there were no apparent differences in the macroscopic view. There were no statistically significant differences in the clinical outcomes between groups at 2 years after surgery, which satisfied the non-inferiority criterion of Group 1 in terms of clinical scores and knee laxity compared to Group 2. CONCLUSION The surgical outcomes of anatomical ACL reconstruction in patients with non-isometric ACL graft were not inferior in terms of clinical scores and knee laxity, compared to those with nearly-isometric ACL graft. The graft tunnel placement in the isometric position during anatomical ACL reconstruction, which is technically challenging in the clinical setting, is not a crucial factor in terms of clinical outcomes. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Je-Hyun Yoo
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Ho Lee
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20 Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Kee-Bum Hong
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20 Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea.
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16
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Matsuo T, Kusano M, Uchida R, Tsuda T, Toritsuka Y. Anatomical rectangular tunnel anterior cruciate ligament reconstruction provides excellent clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2022; 30:1396-1403. [PMID: 34014338 DOI: 10.1007/s00167-021-06609-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to prospectively evaluate the clinical outcomes following anatomical rectangular tunnel anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BTB) graft using an adjustable-length femoral cortical fixation device with enough patients and a high follow-up rate. METHODS This study included 125 patients who underwent anatomical rectangular tunnel ACL reconstruction with a BTB graft. A BTB TightRope® was used for femoral graft fixation. Clinical evaluations were performed more than 2 years after surgery using the International Knee Documentation Committee (IKDC) Form. Patients interviewed by telephone were only subjectively evaluated. The side-to-side difference in anterior laxity at a manual maximum force was measured using the KT-2000 Arthrometer®. RESULTS Among the 125 patients, 99 were ultimately included and 26 were lost to follow-up (follow-up rate: 79%). Eight patients had re-tear (re-tear rate: 8%) and six patients had ACL injuries to the contralateral knee. Three patients did not follow our rehabilitation programme. One patient suffered septic arthritis. These 18 patients were considered ineligible for clinical evaluations. Therefore, clinical evaluations were performed in 81 of the 99 patients (64 were available for direct follow-up and 17 were available for a telephone interview). The follow-up period was 30 ± 10 months (range 24-68 months). According to the IKDC subjective assessment, 48 (59%) and 33 (41%) knees were graded as normal and nearly normal, respectively. A loss of extension (3°-5°) was observed in five patients (8%), whereas one patient (2%) exhibited a loss of flexion (3°-5°). The Lachman test was negative in 63 patients (98%). The pivot shift test was negative in 59 patients (92%). The side-to-side difference in KT value was 0.4 ± 0.7 mm (range - 1-4 mm). CONCLUSION Anatomical rectangular tunnel ACL reconstruction with a BTB graft using an adjustable-length femoral cortical fixation device provided excellent clinical outcomes both subjectively and objectively more than 2 years after surgery, whereas 8 of the 99 patients had re-tear of the graft. The adjustable-length femoral cortical fixation device could be safely used in anatomical rectangular tunnel ACL reconstruction with a BTB graft. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tomohiko Matsuo
- Department of Orthopedic Sports Medicine, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-0064, Japan
| | - Masashi Kusano
- Department of Orthopedics, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Osaka, 553-0003, Japan
| | - Ryohei Uchida
- Department of Orthopedic Sports Medicine, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-0064, Japan
| | - Takayuki Tsuda
- Department of Orthopedic Sports Medicine, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-0064, Japan
| | - Yukiyoshi Toritsuka
- School of Health and Sports Sciences, Mukogawa Women's University, 6-46, Ikebirakicho, Nishinomiya, Hyogo, 663-8558, Japan.
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Chiba D, Yamamoto Y, Kimura Y, Sasaki S, Sasaki E, Yamauchi S, Tsuda E, Ishibashi Y. Laterally shifted tibial tunnel can be the risk of residual knee laxity for double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:319-327. [PMID: 33938969 DOI: 10.1007/s00167-021-06546-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/19/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To elucidate the relationship between graft tunnel position and knee laxity in the cases of double-bundle ACL reconstruction. METHODS Total of 132 cases were included. Femoral and tibial tunnels were evaluated by quadrant method on 3D-CT. As additional reference of tibia, the distances from medial tibial spine to the tunnel center (DMS) and from Parsons' knob to the tunnel center (DPK) were evaluated; %DMS/ML and %DPK/AP were calculated (ML and AP: mediolateral and anteroposterior width of tibial plateau). Preoperative and postoperative (1 year from surgery) stabilities were evaluated by Lachman and pivot-shift procedures. If there was ≥ 2 mm side-to-side difference, the subject was defined as having anterior knee laxity (AKL); if the pivot-shift phenomenon was observed with IKDC grade ≥ 1, there was rotatory knee laxity (RKL). Multiple logistic regression analysis was conducted with the prevalence of AKL or RKL as the dependent variable and with tunnel positions as the independent variables. RESULTS Overall, 21 subjects (15.9%) showed AKL, and 15 subjects (11.4%) showed RKL. Those with postoperative laxity showed higher %DMS/ML and higher femoral position than those without laxity. Regarding posterolateral bundle, logistic regression model estimated that %DMS/ML was associated with the prevalence of AKL (B = 0.608; p < 0.001) and RKL (B = 0.789; p < 0.001); %high-low femoral tunnel position (B = - 0.127; p = 0.023) was associated with that of RKL. CONCLUSION There was the risk of residual knee laxity in ACL-reconstructed knee when tibial tunnel shifted more laterally or higher femoral tunnel was created with regard to posterolateral bundle. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shohei Yamauchi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Asif N, Khan MJ, Haris KP, Waliullah S, Sharma A, Firoz D. A prospective randomized study of arthroscopic ACL reconstruction with adjustable- versus fixed-loop device for femoral side fixation. Knee Surg Relat Res 2021; 33:42. [PMID: 34863318 PMCID: PMC8642980 DOI: 10.1186/s43019-021-00124-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 11/07/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Suspensory devices are extensively used in the management of anterior cruciate ligament (ACL) tear. They include fixed- and adjustable-loop devices. There are only a few studies comparing the efficacy of these two devices in the available literature. Therefore, the aim of this study is to compare clinical outcomes between the adjustable-loop device (group I) and fixed-loop device (group II). Materials and methods This was a prospective randomized study. Both groups were equivalent in demographic, preoperative, and intraoperative variables. Twenty-three patients underwent femoral side graft fixation with adjustable-loop and 20 with fixed-loop devices. Four patients were lost to follow-up. Assessment of clinical outcome was done with International Knee Documentation Committee (IKDC) score, Lysholm score, and knee stability tests (Lachman test and pivot shift test). Patient evaluation was performed preoperatively and finally postoperatively 2 years after surgery. Results Postoperative IKDC scores of group I and II were 91.9 ± 3.6 and 91.5 ± 3.6, respectively, and Lysholm scores were 91.0 ± 3.6 and 91.4 ± 3.5, respectively, after 2 years; however, the difference in the outcomes was statistically insignificant (p > 0.05). Twenty patients (87%) in group I and 17 patients (85%) in group II had a negative Lachman test (p = 0.8). Twenty-two patients (95.7%) in group I and 19 patients (95%) in group II had a negative pivot shift test (p = 0.9). Conclusion ACL reconstruction with fixed- and adjustable-loop suspensory devices for graft fixation gives equivalent and satisfactory clinical results. Level of evidence 1.
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Affiliation(s)
- Naiyer Asif
- Department of Orthopaedic Surgery, Faculty of Medicine, JNMCH, AMU, Aligarh, Uttar Pradesh, India
| | - Mohammad Jesan Khan
- Department of Orthopaedic Surgery, Faculty of Medicine, JNMCH, AMU, Aligarh, Uttar Pradesh, India.
| | - K P Haris
- Department of Orthopaedic Surgery, Faculty of Medicine, JNMCH, AMU, Aligarh, Uttar Pradesh, India
| | - Shah Waliullah
- Department of Orthopaedics, KGMU, Lucknow, Uttar Pradesh, India
| | - Anubhav Sharma
- Department of Orthopaedic Surgery, Faculty of Medicine, JNMCH, AMU, Aligarh, Uttar Pradesh, India
| | - Danish Firoz
- Department of Orthopaedic Surgery, Faculty of Medicine, JNMCH, AMU, Aligarh, Uttar Pradesh, India
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Ono Y, Akagi R, Mikami Y, Shinohara M, Hosokawa H, Horii M, Watanabe S, Ogawa Y, Sadamasu A, Kimura S, Yamaguchi S, Ohtori S, Sasho T. Effect of Systemic Administration of Granulocyte Colony-Stimulating Factor on a Chronic Partial-Thickness Cartilage Defect in a Rabbit Knee Joint. Cartilage 2021; 13:175S-184S. [PMID: 34105400 PMCID: PMC8804779 DOI: 10.1177/19476035211021905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Cartilage lesions in the knee joint can lead to joint mechanics changes and cause knee pain. Bone marrow stimulation (BMS) promotes cartilage regeneration by perforating the subchondral bone just below the injury and inducing bone marrow cells. This study aimed to investigate whether systemic administration of granulocyte colony-stimulating factor (G-CSF) with BMS improves repair of chronic partial-thickness cartilage defects (PTCDs). DESIGN Eighteen 6-month-old New Zealand white rabbits were divided into 3 groups: control (C, n = 6), BMS alone (n = 6), and BMS + G-CSF (n = 6). Partial cartilage defects with 5 mm diameter were created in the trochlear region of both knees; after 4 weeks, the BMS alone and BMS + G-CSF groups underwent BMS; G-CSF (50 µg/kg) or saline was administered subcutaneously for 5 days starting from 3 days before BMS. At 8 and 16 weeks after cartilage defect creation, the area of cartilage defects was macroscopically and histologically evaluated. RESULTS International Cartilage Repair Society (ICRS) grades for macroscopic assessment were 0, 0.7, and 0.7 at 8 weeks and 0, 1.2, and 1.3 at 16 weeks in the C, BMS, and BMS + G-CSF groups, respectively. Wakitani scores for histological assessment were 9.8, 8.7, and 8.2 at 8 weeks and 9.5, 9, and 8.2 at 16 weeks in the C, BMS, and BMS + G-CSF groups, respectively. The BMS + G-CSF group showed significantly more repair than the C group, but there was no difference from the BMS group. CONCLUSIONS The effect of BMS and G-CSF on chronic PTCDs in mature rabbit knees was limited.
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Affiliation(s)
- Yoshimasa Ono
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yukio Mikami
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Masashi Shinohara
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Hiroaki Hosokawa
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Manato Horii
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Shotaro Watanabe
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yuya Ogawa
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Aya Sadamasu
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Seiji Kimura
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Satoshi Yamaguchi
- Graduate School of Global and
Transdisciplinary Studies, College of Liberal Arts and Sciences, Chiba University,
Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan,Musculoskeletal Disease and Pain,
Center for Preventive Medical Sciences, Chiba University, Chiba, Japan,Takahisa Sasho, Department of Orthopaedic
Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku,
Chiba, 260-8670, Japan.
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20
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印 钰, 梅 宇, 王 泽, 宋 首, 刘 鹏, 何 鹏, 武 文, 谢 兴. [Lengths of the fixed loop and the adjustable loop in the coarse bone tunnel were compared to influence the widening of the femoral bone tunnel and the function of the knee joint]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:883-890. [PMID: 34650289 PMCID: PMC8517680 DOI: 10.19723/j.issn.1671-167x.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the effects of two different femoral cortical suspension devices (fixation loop and adjustable loop) on tunnel widening and knee function in patients following anterior cruciate ligament reconstruction for 12 months. METHODS A total of 60 patients who had undergone anterior cruciate ligament reconstruction were included in this study. According to the length of the loop(n)[n= total length of loop-(total length of femoral tunnel-total length of coarse tunnel)] in the rough bone tunnel, the patients were divided into A (adjustable loop was 0 mm in the coarse bone tunnel), B (fixation loop was greater than 0 mm and less than or equal to 10 mm in the coarse bone tunnel) and C (fixation loop was greater than 10 mm in the coarse bone tunnel) groups, of which 11 cases were in group A, 27 cases in group B and 22 cases in group C. In the three-dimensional reconstruction of the knee joint with multi-slice spiral CT, the widening of the bone tunnel in the three groups was compared. At the same time, IKDC, Lysholm and Tegner scores of the patients in the three groups were compared. RESULTS There were differences in the widening degree of the femoral canal among groups A, B and C, and the median difference of the widening degree of the femoral tunnel 12 months and immediately after the surgery was A < B < C. The difference of femoral canal widening in group A was significantly different from that in groups B and C (P < 0.05).According to the linear regression the relationship between the difference of the width of the femoral canal and the change of the length (n) of the loop in the coarse canal, it was found that there was a linear relationship between the value of n and the difference of the width of the bone canal. With the increase of the value of n, the difference of the width of the bone canal gradually became larger. The median difference of the width of the middle and superior tunnel was negative, while the median difference of the width of the middle and inferior tunnel was positive. During the follow-up, we found that there were no statistical differences in IKDC, Lysholm and Tegner scores among the three groups one year after surgery (P > 0.05). CONCLUSION Twelve months after surgery, compared with group B (fixed loop group) and group C (fixed loop group), group A (adjustable loop group) had less bone tunnel widening.In groups A, B and C, as the length of the loop in coarse bone tunnel gradually increased, the width of bone tunnel became more significant. At the end of 12 months follow-up after anterior cruciate ligament reconstruction, the medial and inferior femoral tunnel was significantly wider than immediately after surgery, and the medial and superior femoral tunnel had gradually begun to undergo tendon-bone healing. There was no significant difference in knee function scores among groups A, B, and C in the follow-up 12 months after surgery.
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Affiliation(s)
- 钰 印
- />北京大学第三医院运动医学科, 北京大学运动医学研究所, 运动医学关节伤病北京市重点实验室, 北京 100191Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 宇 梅
- />北京大学第三医院运动医学科, 北京大学运动医学研究所, 运动医学关节伤病北京市重点实验室, 北京 100191Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 泽刚 王
- />北京大学第三医院运动医学科, 北京大学运动医学研究所, 运动医学关节伤病北京市重点实验室, 北京 100191Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 首一 宋
- />北京大学第三医院运动医学科, 北京大学运动医学研究所, 运动医学关节伤病北京市重点实验室, 北京 100191Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 鹏飞 刘
- />北京大学第三医院运动医学科, 北京大学运动医学研究所, 运动医学关节伤病北京市重点实验室, 北京 100191Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 鹏峰 何
- />北京大学第三医院运动医学科, 北京大学运动医学研究所, 运动医学关节伤病北京市重点实验室, 北京 100191Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 文杰 武
- />北京大学第三医院运动医学科, 北京大学运动医学研究所, 运动医学关节伤病北京市重点实验室, 北京 100191Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - 兴 谢
- />北京大学第三医院运动医学科, 北京大学运动医学研究所, 运动医学关节伤病北京市重点实验室, 北京 100191Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
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21
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Kim Y, Kubota M, Muramoto K, Kunii T, Sato T, Inui T, Ohno R, Ishijima M. Clinical and radiographic results after ACL reconstruction using an adjustable-loop device. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 26:32-38. [PMID: 34584849 PMCID: PMC8437790 DOI: 10.1016/j.asmart.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/03/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
Background The femoral cortical suspension device such as fixed loop devices (FLD) and adjustable-loop device (ALD) are used for ACLR technique in recent days. However, there was few studies of clinical and radiographic results for ACLR using ALD. This study was conducted to clarify the clinical and radiographic results, stability and bone tunnel enlargement after ACLR using a ToggleLoc with a zip loop as ALD. Methods 80 patients who had data available from the most recent follow-up at ≥2 years since ACLR were evaluated both clinical and radiographic results. They were divided into single bundle reconstruction group (SBR) and double bundle reconstruction group (DBR). Clinical scores were included subjective scores and objective scores at pre- and postoperatively 2 years. The subjective scores were the Cincinnati knee rating system, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner activity score, Visual Analog Scale (VAS) and ACL-Return to Sport after Injury (RSI) scale. The objective scores were the isokinetic muscle strength, side-to-side difference in anterior instability and single hop test. In radiographical assessment, femoral and tibial tunnel enlargement was evaluated by three-dimensional computed tomography. Results In both SBR and DBR group, the postoperative subjective scores were significantly improved compared to the preoperative values, except for the Tegner activity score. Similarly, the side-to-side differences in muscle strength, anterior instability and single hop test were significantly improved after surgery. The changes in the femoral and tibial tunnel maximum cross section areas of SBR were 104.3 % ± 21.2 % and 89.2 % ± 15.2 %, respectively, at 2 years post-operatively. In DBR, in the femoral bone volume change of the antero medial (AM) and postero lateral (PL) bundle were 107.0 ± 3.5 % and 108.1 ± 3.3, and in the tibial bone volume change of AM and PL bundle were 90.6 ± 3.3 % and 87.0 ± 4.2 %. At the femoral site, the rate of tunnel enlargement increased for the first 12 months and then decreased through 24 months postoperatively. At the tibial site, by contrast, the rate of tunnel enlargement decreased consistently over the two-year postoperative follow-up. Conclusion This is the first study to include clinical data on ACLR using a ToggleLoc with a zip loop device. ACLR using these devices as ALDs resulted in good clinical outcomes and provided good stability of the knee with relatively little bone tunnel enlargement in both SBR and DBR group.
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Affiliation(s)
- Youngji Kim
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan.,Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Mitsuaki Kubota
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Keisuke Muramoto
- Department of Radiology, Koshigaya Municipal Hospital, Saitama, Japan
| | - Takuya Kunii
- Department of Radiology, Koshigaya Municipal Hospital, Saitama, Japan
| | - Taisuke Sato
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan.,Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Tetsuya Inui
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan.,Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Ryuichi Ohno
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Saitama, Japan.,Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
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22
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Panagopoulos A, Mylonas D, Kouzelis A, Zampakis P, Kraniotis P, Lakoumentas J, Gliatis J. No Difference in Outcomes Between Suspensory (Fixed-Loop Cortical Button) Versus Expandable Anteromedial Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Autologous Hamstring Tendons: A Prospective, Randomized, Controlled Study in Male Patients. Arthrosc Sports Med Rehabil 2021; 3:e1155-e1163. [PMID: 34430896 PMCID: PMC8365223 DOI: 10.1016/j.asmr.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To compare anterior cruciate ligament (ACL) autograft reconstruction using fixed-looped suspensory versus expandable femoral fixation through the anteromedial portal. Methods After we performed prospective power analysis and obtained institutional review board, 70 patients with ACL rupture were block randomized to the expandable or suspensory femoral fixation group (35 in each group). All patients received autologous hamstring autograft through the anteromedial portal and fixed with a sheath-screw system in the tibia. The primary outcome measures were anteroposterior knee stability at 2 years’ follow-up measured using the KT-1000 arthrometer and the degree of femoral and tibial tunnels’ widening measured by the use of computed tomography imaging performed immediately postoperative and 12 months postsurgery. Secondary outcome measures included pain score on a visual analog scale, the subjective International Knee Documentation Committee 2000 assessment form, the Lysholm score, and the Tegner activity scale at 3, 6, 12, and 24 months. Results Twenty-four patients were excluded from further analysis, leaving a total of 48 patients (24 in each group) for the final evaluation. The anteroposterior knee stability (KT-1000) showed no difference between groups at 24 months’ follow-up (P = .31). The percentile widening (%) of femoral and tibial tunnel at 1-year follow-up showed no difference also, except for greater values at the tibial coronal point T2 (P = .065) and tibial sagittal point T1 (P = .033) in the group of cortical buttons. Secondary clinical outcomes showed no statistical differences between groups at 3, 6, 12, and 24 months’ postoperatively. Numerical pain scale (visual analog scale) was similar in both groups except for postoperative day 7, where the AperFix group showed better results (P = .014). There were no major intraoperative and late postoperative complications in any of the groups. Conclusions Our results showed no significant differences in knee anteroposterior stability, tunnel enlargement or other clinical outcomes comparing expandable versus cortical button fixation in anteromedial hamstrings ACL reconstruction. Level of Evidence Level II, randomized controlled trial.
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Affiliation(s)
- Andreas Panagopoulos
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Dimitris Mylonas
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Antonis Kouzelis
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Petros Zampakis
- Department of Radiology, Patras University Hospital Greece, Patras, Greece
| | - Pantelis Kraniotis
- Department of Radiology, Patras University Hospital Greece, Patras, Greece
| | - John Lakoumentas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - John Gliatis
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
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23
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Kumar R, Kalra M, Garg AK, Choudhary R, Venishetty N, Verma S, Kumar A. Clinical Reliability of Adjustable Femoral Cortical Suspensory Fixation in Anterior Cruciate Ligament Reconstruction and Correlation of Clinical Outcomes With Demographic and Perioperative Factors. Cureus 2021; 13:e15345. [PMID: 34235023 PMCID: PMC8243633 DOI: 10.7759/cureus.15345] [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] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objective The primary goal of anterior cruciate ligament reconstruction (ACLR) is to protect the initial graft fixation against heavy loads encountered during the rehabilitation phase. The purpose of this study was to evaluate the functional outcomes (Lysholm score) and laxity [anterior tibial translation (ATT), anterior drawer test, Lachman test, and pivot shift test] of ACLR with adjustable-loop femoral cortical suspensory fixation (CSF) and tibial interferences crew fixation. Methods This study included 100 patients who underwent primary ACL reconstruction using quadruple hamstring grafts secured with TightRope® (Arthrex Inc, Naples, FL) femoral fixation and an interference screw on the tibial end. Six patients were excluded from the final analysis (four lost to follow-up, one suffered re-injury, and one had septic arthritis). The remaining 94 patients were evaluated for laxity and functional outcomes preoperatively, as well as at one, six, and 12 months postoperatively. Regression analysis was performed to determine the association between outcomes and 11 independent variables. This was designed as a prospective cohort study (level of evidence: II). Results The mean age of the participants was 28.46 ± 7.01 years. The median preoperative Lysholm knee score of 49 (mean ± SD: 48.2 ± 5.42) improved to 93 (92.7 ± 2.1) at six months and 98 (97.6 ± 2.1) at the one-year follow-up. The improvement was found to be statistically significant (p<0.01). The median ATT was 10 mm preoperatively, which decreased to 2 mm at one month, remained the same at six months, and rose to 3 mm at the one-year follow-up. ATT was found significantly reduced at one month postoperatively (p<.001) and did not show any significant further changes at subsequent follow-ups (p>0.05). Multiple linear regression revealed that one-year postoperative ATT (Rolimeter, Aircast Europa, Stephanskirchen, Germany) was independent of all demographic and perioperative variables tested. Conclusion Quadrupled hamstring graft ACLR with adjustable-loop fixation showed excellent subjective and objective outcomes with no residual laxity or failure of graft over mid-term follow-up. Postoperative laxity was not correlated with graft and tunnel dimensions.
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Affiliation(s)
- Ramesh Kumar
- Orthopaedics and Trauma, Pushpawati Singhania Research Institute, New Delhi, IND
| | - Mukesh Kalra
- Orthopaedics, Lady Hardinge Medical College, New Delhi, IND
| | - Ankit Kumar Garg
- Orthopaedics, All India Institute of Medical Sciences, Raipur, IND
| | | | | | - Shilp Verma
- Orthopaedics, All India Institute of Medical Sciences, Raipur, IND
| | - Ankush Kumar
- Orthopaedics, Lady Hardinge Medical College, New Delhi, IND
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24
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Furumatsu T, Hiranaka T, Kodama Y, Kamatsuki Y, Okazaki Y, Yamawaki T, Endo H, Ozaki T. Intraarticular lengths of double-bundle grafts can change during knee flexion: Intraoperative measurements in anatomic anterior cruciate ligament reconstructions. Orthop Traumatol Surg Res 2021; 107:102816. [PMID: 33484904 DOI: 10.1016/j.otsr.2021.102816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/11/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The lengths of the anteromedial bundle (AMB) and posterolateral bundle (PLB) change during knee motion in double-bundle anterior cruciate ligament (ACL) reconstruction. However, the actual intraarticular graft length would be affected by the bone tunnel position and tunnel creation angle during ACL reconstruction. The aim of this study was to investigate the intraarticular length change of the AMB and PLB in patients who underwent anatomic double-bundle ACL reconstruction. HYPOTHESIS We hypothesized that the PLB would show a more dynamic length change pattern than the AMB during knee flexion at ACL reconstruction. METHODS Thirty-two patients (16 men and 16 women) who had isolated ACL injuries with intact menisci were investigated. Anatomic double-bundle ACL reconstructions were performed using semitendinosus tendon autografts at a mean age of 30.6 years. The graft and tunnel lengths were measured intraoperatively. Intraarticular graft lengths and length changes were calculated at 0° and 90° of knee flexion during ACL reconstruction. Intraoperative data were collected prospectively, and analyses were performed retrospectively. RESULTS The intraarticular length of the AMB at 0° of knee flexion was 28.1±5.5mm. At 90° of knee flexion, the AMB intraarticular length decreased to 25.6±4.8mm. The intraarticular length of the PLB decreased to 17.7±4.6mm at 90° of knee flexion compared to 22.0±4.2mm at 0° of knee flexion. Changes in the intraarticular graft length during knee flexion were detected more in the PLB (4.1mm) than in the AMB (2.0mm, p=0.01). DISCUSSION This study demonstrated that the intraarticular length change of the PLB during knee motion was larger than that of the AMB in anatomic double-bundle ACL reconstructions with semitendinosus tendon autografts and suspensory femoral fixation devices. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan; Department of Orthopaedic Surgery, Sumitomo Besshi Hospital, 3-1 Oujicho, Niihama, 792-8543 Ehime, Japan; Department of Orthopaedic Surgery, Kousei Hospital, 3-8-35 Kouseicho, Kitaku, 700-0985 Okayama, Japan.
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan; Department of Orthopaedic Surgery, Sumitomo Besshi Hospital, 3-1 Oujicho, Niihama, 792-8543 Ehime, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Tadashi Yamawaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan; Department of Orthopaedic Surgery, Kousei Hospital, 3-8-35 Kouseicho, Kitaku, 700-0985 Okayama, Japan
| | - Hirosuke Endo
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, 700-8558 Okayama, Japan
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25
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Adjustable suspension versus hybrid fixation in hamstring autograft anterior cruciate ligament reconstruction. Knee 2021; 28:1-8. [PMID: 33278738 DOI: 10.1016/j.knee.2020.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/25/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There has been increased use of adjustable suspensory fixation (ASF) for anterior cruciate ligament reconstruction (ACLR). Potential benefits are the ability to use a shorter graft and to prevent graft displacement and damage. The purpose of this study was to establish the efficacy of this fixation method and assess whether it leads to less tunnel widening, and avoids known complications of screw fixation. METHODS Thirty-eight patients who underwent ACLR with ASF on both the femoral and tibial sides met the inclusion criteria and were propensity matched demographically with 38 patients who underwent hybrid fixation with femoral suspensory and tibial screw and sheath. At one-year, KT-1000 knee laxity measurements were recorded and detailed MRI analysis looking at tunnel aperture widening, tunnel appearance, graft integration within the tunnels, and graft healing. RESULTS MRI comparison between ASF and hybrid cohorts revealed no significant differences in graft signal or integration, and clinically there were no differences in knee laxity between cohorts (mean 1.5 mm ± 2.0 and 1.5 mm ± 2.3 (n.s.) in the ASF and hybrid fixation respectively). Significantly less aperture tibial tunnel widening (2.2 mm versus 4.4 mm, p < 0.0001) and tibial cysts (2 versus 9, p = 0.047) were observed in the ASF cohort, whilst mean femoral tunnel widening was comparable between both cohorts (ASF 2.8 mm, hybrid 3.2 mm; n.s.). CONCLUSIONS Hamstring autografts for ACLR fixed using either ASF or a hybrid fixation technique provided comparable knee stability and MRI graft signal intensity. Tibial ASF demonstrated significantly less tibial aperture widening and tunnel cyst formation when compared to screw and sheath fixation.
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26
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Choi NH, Lee SJ, Oh WK, Victoroff BN. Hamstring Anterior Cruciate Ligament Reconstruction Using an Adjustable-Loop Cortical Suspension Device: Immediate Postoperative Magnetic Resonance Imaging. J Knee Surg 2020; 33:1147-1151. [PMID: 31269522 DOI: 10.1055/s-0039-1692648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study is to determine whether the hamstring grafts are fully inserted into the femoral tunnel with the adjustable loop using immediate postoperative magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) reconstructions. A total of 62 consecutive patients underwent hamstring ACL reconstruction using an adjustable-loop cortical suspension device for the femoral fixation and the Intrafix sheath and screw for the tibial fixation. Multiplanar reformatted images of 3-T MRI scans were obtained at the 1st postoperative day before weight bearing is initiated in all patients to evaluate the gap (the tunnel-graft gap) between the top of the hamstring graft and top of the femoral tunnel. Postoperative MRI scans showed that the tunnel-graft gap was 1.5 ± 2.7 mm (range, 0-12 mm). In 43 (69.4%) patients, there was no gap between the top of the femoral tunnel and hamstring graft. In 19 (30.6%) patients, there was a gap between the tunnel and graft, and nine patients demonstrated a tunnel-graft gap greater than 5 mm. Immediate postoperative MRI scans demonstrated that an adjustable-loop cortical suspension device may not pull the hamstring graft completely into the femoral tunnel.
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Affiliation(s)
- Nam-Hong Choi
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea
| | - Seung-Joo Lee
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea
| | - Whang-Kyun Oh
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea
| | - Brian N Victoroff
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio
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Sohn S, Koh IJ, Kim MS, In Y. Confirmation of Femoral Button Deployment Under Direct Visualization During ACL Reconstruction Is Not Beneficial. Orthopedics 2020; 43:270-276. [PMID: 32745225 DOI: 10.3928/01477447-20200721-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 03/31/2020] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine whether direct visualization of adjustable-loop cortical suspensory button deployment onto the lateral femur increases the cortical contact rate of the button, thereby improving clinical outcomes after anterior cruciate ligament (ACL) reconstruction. Sixty-five single-bundle anteromedial portal ACL reconstructions using an adjustable-loop button were retrospectively divided into 2 groups according to use of the blind pulling technique (control group; 32 patients) or the direct visualization technique (visualization group; 33 patients) when confirming deployment of the button. Cortical contact rate of the button on immediate and 2-year postoperative radiographs, knee stability measured using a KT-1000 arthrometer, and functional scores (Lysholm score and International Knee Documentation Committee score) at 2 years postoperative were compared between the groups. There was no significant difference in femoral cortical contact rate between the groups immediately (56% control group vs 55% visualization group; P=1.000) and at 2 years postoperative (78% control group vs 82% visualization group; P=.764). At 2 years postoperative, there was no difference between the groups regarding knee stability (1.3±0.9 mm vs 1.5±0.8 mm, respectively; P=.404), Lysholm score (P=.436), and International Knee Documentation Committee score (P=.507). Confirmation of adjustable-loop button deployment under direct visualization during anteromedial portal ACL reconstruction neither increased cortical contact rate nor improved clinical outcomes. [Orthopedics. 2020;43(5);270-276.].
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Loop changes after knee flexion-extension movement in a cadaveric anterior cruciate reconstruction model. Chin Med J (Engl) 2020; 133:1676-1679. [PMID: 32530878 PMCID: PMC7401748 DOI: 10.1097/cm9.0000000000000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Recently, adjustable-loop devices (ALDs) have been widely used, and their reliability has always been the focus of attention. This study compared loop length changes under pull stress caused by flexion and extension of the cadaver knee between ALDs and fixed-loop devices (FLDs) in terms of femoral fixation after anterior cruciate ligament (ACL) reconstruction. Methods ACL reconstruction in cadaveric knee joints was performed under arthroscopy with femoral suspension devices and tibial fixation by tying sutures on staples. The knee joint was repeatedly flexed and extended 30 times after fixation. According to the femoral fixation device used (Endobutton or Ultrabutton), the knee joints were divided into two groups: the ALD group (12 specimens) and the FLD group (ten specimens). The length of the loop before and after fixation was measured, and the loop length of the ALD group was re-measured 1 day after reconstruction. Results There was no significant difference in the length of the loop between the two groups (t = 0.579, P = 0.569). One day later, the loop length of the ALDs retracted by 0.29 ± 0.33 (0–1.1) mm, and there was no retraction in three specimens. Conclusion There was no significant difference in the loop length under flexion and extension stress after ACL reconstruction between ALDs and FLDs.
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Singh S, Ramos-Pascual S, Czerbak K, Malik M, Schranz PJ, Miles AW, Mandalia V. Biomechanical testing of fixed and adjustable femoral cortical suspension devices for ACL reconstruction under high loads and extended cyclic loading. J Exp Orthop 2020; 7:27. [PMID: 32394303 PMCID: PMC7214603 DOI: 10.1186/s40634-020-00235-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/23/2020] [Indexed: 01/12/2023] Open
Abstract
Purpose To compare loop elongation after 5000 cycles, loop-elongation at failure, and load at failure of the fixed-loop G-Lok device and three adjustable-loop devices (UltraButton, RigidLoop Adjustable and ProCinch RT), during testing over extended cycles under high loading. Methods Five devices of each type were tested on a custom-built rig fixed to an Instron machine. The testing protocol had four stages: preloading, cyclic preconditioning, incremental cyclic loading and pull-to-failure. Outcome measures were loop elongation after 5000 cycles, loop-elongation at failure, and load at failure. Results The loop elongation after 5000 cycles for G-Lok was 1.46 ± 0.25 mm, which was comparable to that of RigidLoop (1.51 ± 0.16 mm, p = 1.000) and ProCinch (1.60 ± 0.09 mm, p = 1.000). In comparison, the loop elongation for UltraButton was 2.66 ± 0.28 mm, which was significantly larger than all other devices (p = 0.048). The failure load for all devices ranged between 1455 and 2178 N. G-Lok was significantly stronger than all adjustable-loop devices (p = 0.048). The elongation at failure was largest for UltraButton (4.20 ± 0.33 mm), which was significantly greater than G-Lok (3.17 ± 0.33 mm, p = 0.048), RigidLoop (2.88 ± 0.20 mm, p = 0.048) and ProCinch (2.78 ± 0.08 mm, p = 0.048). There was no significant difference in elongation at failure for the rest of the devices. Conclusions Our study has shown that the G-Lok fixed-loop device and the three adjustable-loop devices (UltraButton, RigidLoop Adjustable and ProCinch RT) all elongated less than 3 mm during testing over an extended number of cycles at high loads, nonetheless, the fixed loop device performed best in terms of least elongation and highest load at failure.
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Affiliation(s)
- Sarvpreet Singh
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Sonia Ramos-Pascual
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, UK.
| | - Kinga Czerbak
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Muzaffar Malik
- Division of Medical Education, Brighton and Sussex Medical School, University of Brighton, BN1 9PH, Brighton, UK
| | - Peter J Schranz
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Anthony W Miles
- Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Vipul Mandalia
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
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Choi NH, Lee SJ, Park SC, Victoroff BN. Comparison of Postoperative Tunnel Widening After Hamstring Anterior Cruciate Ligament Reconstructions Between Anatomic and Nonanatomic Femoral Tunnels. Arthroscopy 2020; 36:1105-1111. [PMID: 31883708 DOI: 10.1016/j.arthro.2019.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of the location of the femoral tunnel on 3-dimensional (3D) computed tomography (CT) upon the postoperative tunnel widening after anterior cruciate ligament (ACL) reconstructions. METHODS Inclusion criteria were patients who underwent hamstring ACL reconstructions using an adjustable-loop cortical suspension device, underwent 3D CT at the day after surgery, and were followed for a minimum of 2 years after surgery. Exclusion criteria were patients with combined ligament injury and reinjury after reconstruction. Using 3D CT, the center of the femoral tunnel aperture was located on a standardized grid system. The center of the ACL footprint was defined from the literature. The femoral tunnel location was classified as anatomic if it located within 2 standard deviations of the center position. If it was outside the 2 standard deviations, the tunnel was classified as nonanatomic. The patients were divided into either anatomic or nonanatomic groups. Femoral tunnel angles on both sagittal and coronal planes were measured. Both femoral and tibial tunnels measured on anteroposterior and lateral radiographs at immediate postoperative day and at 2 years after surgery. Postoperative knee stability and patient-reported outcomes were evaluated. RESULTS There were 37 patients in anatomical group and 52 patients in nonanatomical group among enrolled 87 patients. There were no differences in demographics between the 2 groups. There were no differences in the femoral tunnel angles and postoperative tunnel widening between the 2 groups. A higher position correlated to the femoral tunnel widening at 2 years postoperatively. Postoperative knee stability and patient-reported outcomes showed no statistically significant differences between the 2 groups. CONCLUSIONS There was no significant difference in postoperative tunnel widening or clinical outcomes between anatomic and nonanatomic femoral tunnel location after hamstring ACL reconstructions. A higher position correlated to the femoral tunnel widening at 2 years postoperatively. LEVEL OF EVIDENCE Level III, Retrospective comparative study.
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Affiliation(s)
- Nam-Hong Choi
- From the Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea.
| | - Seung-Joo Lee
- From the Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea
| | - Seong-Cheol Park
- From the Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea
| | - Brian N Victoroff
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, U.S.A
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Putnis S, Neri T, Grasso S, Linklater J, Fritsch B, Parker D. ACL hamstring grafts fixed using adjustable cortical suspension in both the femur and tibia demonstrate healing and integration on MRI at one year. Knee Surg Sports Traumatol Arthrosc 2020; 28:906-914. [PMID: 31209542 DOI: 10.1007/s00167-019-05556-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/05/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To present the clinical outcomes and magnetic resonance imaging (MRI) analysis of adjustable cortical suspensory fixation for the femur and tibia in hamstring autograft anterior cruciate ligament reconstruction. METHODS A cohort of 233 sequential patients was analysed for graft failure rate and subjective IKDC, Tegner and Lysholm scores. 144 validated 1-year MRIs assessed and correlated graft healing and tunnel widening. RESULTS At mean follow-up of 28 months ± 8.2 [median 26, range 12-49], the graft failure rate was 4.7%. Significant improvements were seen in all clinical scores (p < 0.001). MRI analysis showed 71% with fully integrated grafts in the tibia and 24% in the femur, with the remainder all showing greater than 50% integration. Graft signal was low and homogenous in 67% in the tibia, 29% in the intra-articular portion and 20% in the femur. One patient had greater than 50% high signal in the tibial graft and one in the intra-articular graft, all others demonstrated greater than 50% low signal. Both graft integration and signal were significantly better in the tibia than the femur (p < 0.01). Tunnel widening was 2.2 ± 1.4 mm and 2.7 ± 1.3 mm in the tibia and femur, respectively. Comparison of individual MRI appearances and overall clinical outcome at the same 12-month point demonstrated no consistent significant correlation. CONCLUSION Adjustable cortical suspensory fixation in both femoral and tibial tunnels provides good clinical outcomes and a low graft rupture rate. Grafts demonstrate healing with comparatively low tunnel widening. There was no consistent significant correlation between the appearances on MRI and clinical outcome. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- Sven Putnis
- Sydney Orthopaedic Research Institute, Level 1 The Gallery, 445 Victoria Avenue, Chatswood, Sydney, NSW, 2067, Australia.
| | - Thomas Neri
- Sydney Orthopaedic Research Institute, Level 1 The Gallery, 445 Victoria Avenue, Chatswood, Sydney, NSW, 2067, Australia
| | - Samuel Grasso
- Sydney Orthopaedic Research Institute, Level 1 The Gallery, 445 Victoria Avenue, Chatswood, Sydney, NSW, 2067, Australia
| | - James Linklater
- Castlereagh Imaging, 60 Pacific Hwy, St Leonards, NSW, 2065, Australia
| | - Brett Fritsch
- Sydney Orthopaedic Research Institute, Level 1 The Gallery, 445 Victoria Avenue, Chatswood, Sydney, NSW, 2067, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, Level 1 The Gallery, 445 Victoria Avenue, Chatswood, Sydney, NSW, 2067, Australia
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Götschi T, Rosenberg G, Li X, Zhang C, Bachmann E, Snedeker JG, Fucentese SF. Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction. Orthop J Sports Med 2020; 8:2325967120904322. [PMID: 32133387 PMCID: PMC7042561 DOI: 10.1177/2325967120904322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Implant fixation by means of a cortical fixation device (CFD) has become a routine procedure in anterior cruciate ligament reconstruction. There is no clear consensus whether adjustable-length CFDs are more susceptible to loop lengthening when compared with pretied fixed-length CFDs. PURPOSE To assess biomechanical performance measures of 3 types of CFDs when subjected to various loading protocols. STUDY DESIGN Controlled laboratory study. METHODS Three types of CFDs underwent biomechanical testing: 1 fixed length and 2 adjustable length. One of the adjustable-length devices is based on the so-called finger trap mechanism, and the other is based on a modified sling lock mechanism. A device-only test of 5000 cycles (n = 8 per group) and a tendon-device test of 1000 cycles (n = 8 per group) with lower and upper force limits of 50 and 250 N, respectively, were applied, followed by ramp-to-failure testing. Adjustable-length devices then underwent further cyclic testing with complete loop unloading (n = 5 per group) at each cycle, as well as fatigue testing (n = 3 per group) over a total of 1 million cycles. Derived mechanical parameters were compared among the devices for statistical significance using Kruskal-Wallis analysis of variance followed by post hoc Mann-Whitney U testing with Bonferroni correction. RESULTS All CFDs showed elongation <2 mm after 5000 cycles when tested in an isolated manner and withstood ultimate tensile forces in excess of estimated peak in vivo forces. In both device-only and tendon-device tests, differences in cyclic performance were found among the devices, favoring adjustable-length fixation devices over the fixed-length device. Completely unloading the suspension loops, however, led to excessive loop lengthening of the finger trap device, whereas the modified sling lock device remained stable throughout the test. The fixed-length device displayed superior ultimate strength over both adjustable-length devices. Both adjustable-length devices showed adequate fatigue behavior during high-cyclic testing. CONCLUSION All tested devices successfully prevented critical construct elongation when tested with constant tension and withstood ultimate loads in excess of estimated in vivo forces during the rehabilitation phase. The finger trap device gradually lengthened excessively when completely unloaded during cyclic testing. CLINICAL RELEVANCE Critical loop lengthening may occur if adjustable-length devices based on the finger trap mechanism are repeatedly unloaded in situ.
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Affiliation(s)
- Tobias Götschi
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Orthopedics, Balgrist University Hospital, Zurich,
Switzerland
| | | | - Xiang Li
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Chen Zhang
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Orthopedics, Second Affiliated Hospital of Xi’an
Jiaotong University, Xi’an, China
| | - Elias Bachmann
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Orthopedics, Balgrist University Hospital, Zurich,
Switzerland
| | - Jess G. Snedeker
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Orthopedics, Balgrist University Hospital, Zurich,
Switzerland
| | - Sandro F. Fucentese
- Department of Orthopedics, Second Affiliated Hospital of Xi’an
Jiaotong University, Xi’an, China
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Singh S, Shaunak S, Shaw SCK, Anderson JL, Mandalia V. Adjustable Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review. Indian J Orthop 2020; 54:426-443. [PMID: 32549958 PMCID: PMC7270319 DOI: 10.1007/s43465-019-00022-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a common sports injury. Symptomatic knee instability after this injury is usually treated operatively through ACL reconstruction. The surgery involves a tendon graft being fixed in bony tunnels drilled through femur and tibia. The fixation of the graft is of critical importance to achieving good results. One of the commonest devices used to fix the graft in the femoral bony tunnel is a fixed loop cortical suspensory device. More recently, adjustable loop cortical suspension devices have been introduced, and have gained popularity for ACL reconstruction. These allow for adjusting the length of the suspension loop after insertion. There is currently much debate concerning whether the adjustable loop devices are superior or inferior to the fixed loop devices. PURPOSE To critique and review the current biomechanical and clinical evidence on the use of adjustable loop devices in hamstring ACL reconstruction. To our knowledge, there have been no previous reviews of this topic. STUDY DESIGN Systematic review. METHODS This systematic review was conducted in accordance with PRISMA. Five databases were searched using multiple search terms and MeSH terms where possible. The following limits were applied: papers published in English and papers published in the last 21 years. RESULTS Eleven laboratory and six clinical studies were reviewed. The laboratory-based studies have frequently shown elongation of adjustable loop devices to more than 3 mm under loading protocols, whereas the clinical studies have not shown any significant differences between the patients with fixed loop and the ones with adjustable loop devices. CLINICAL SIGNIFICANCE This review shows a discrepancy between laboratory-based and clinical studies. The review of clinical studies in our paper would give future researchers confidence and act as a prompt to construct randomised clinical trials to investigate these devices further. CONCLUSION We feel that more robust clinical randomised studies and trials are needed to evaluate these new devices.
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Affiliation(s)
- Sarvpreet Singh
- Department of Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Cambridgeshire, UK
| | | | - Sebastian C. K. Shaw
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, East Sussex UK
| | | | - Vipul Mandalia
- Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK
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Ranjan R, Gaba S, Goel L, Asif N, Kalra M, Kumar R, Kumar A. In vivo comparison of a fixed loop (EndoButton CL) with an adjustable loop (TightRope RT) device for femoral fixation of the graft in ACL reconstruction: A prospective randomized study and a literature review. J Orthop Surg (Hong Kong) 2019; 26:2309499018799787. [PMID: 30235984 DOI: 10.1177/2309499018799787] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There is a lack of in vivo studies comparing the functional outcome and knee stability after anterior cruciate ligament reconstruction (ACLR) using fixed loop (EndoButton (EB) CL) and adjustable loop (TightRope (TR) RT) devices for femoral fixation of soft tissue grafts. MATERIALS AND METHODS Functional outcomes were assessed in terms of the International Knee Documentation Committee (IKDC) and Lysholm scores, knee stability by anteroposterior laxity and side-to-side difference (SSD) using KT-1000 arthrometer. The evaluation was performed preoperatively and post-operatively at 6 months and 2 years. RESULTS Both groups were matched in terms of demographic, preoperative, intraoperative and post-operative covariates. EB ( n = 52) appeared to have better IKDC and Lysholm scores at 6 months post-operative when compared to TR ( n = 50). However, at a final follow-up of 2 years, the results were similar. The anterior tibial translation and SSD were statistically insignificant between the two groups at 6 months and 2 years. CONCLUSION ACLR using EB or TR for femoral fixation gives substantially equivalent functional results and knee stability at mid-term follow-up.
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Affiliation(s)
- Rahul Ranjan
- 1 Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Sahil Gaba
- 2 All India Institute of Medical Sciences, New Delhi, India
| | - Lakshay Goel
- 1 Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Naiyer Asif
- 3 J.N. Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mukesh Kalra
- 1 Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Ramesh Kumar
- 1 Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Arvind Kumar
- 2 All India Institute of Medical Sciences, New Delhi, India
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Sohn S, Koh IJ, Kim MS, Song KY, In Y. Does non-contact or delayed contact of an adjustable-loop femoral button affect knee stability following anterior cruciate ligament reconstruction? Arch Orthop Trauma Surg 2019; 139:1407-1415. [PMID: 31134374 DOI: 10.1007/s00402-019-03213-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether cortical non-contact or delayed contact of an adjustable-loop button for femoral fixation could affect knee stability following anterior cruciate ligament (ACL) reconstruction. METHODS Eighty subjects who underwent single-bundle ACL reconstruction using an adjustable-loop femoral cortical button were retrospectively reviewed regarding patient demographics, graft size, combined surgery, and postoperative 2-year results of knee stability, functional scores, and radiographic tunnel widening. We compared the contact and the non-contact groups determined by position of the button observed in immediate postoperative radiographs. According to 2-year postoperative radiographs, the non-contact group was further divided into two subgroups (delayed contact and persisting non-contact subgroups) and results were compared. RESULTS The contact group had 46 patients and the non-contact group had 34 patients. The average gap distance in the non-contact group was 1.9 ± 0.6 (1.1-3.4) mm. There were no significant differences in KT-1000 arthrometric knee stability (p = .667) or Lysholm score (p = .198), or International Knee Documentation Committee (IKDC) score (p = .091) between the two groups. No significant differences in tunnel widening were found at femoral and tibial tunnels on anteroposterior and lateral radiographs (p > .1, all tunnels). In addition, delayed contact subgroup and persisting non-contact subgroup showed similar radiographic and clinical outcomes. CONCLUSION Surgeons should strive to obtain cortical contact of the adjustable-loop femoral button. Nevertheless, cortical non-contact with less than 3 mm of gap distance did not affect knee stability, radiographic outcomes, or clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sueen Sohn
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kwang Yun Song
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Rhatomy S, Horas JA, Asikin AIZ, Setyawan R, Prasetyo TE, Mustamsir E. Clinical Outcome of Arthroscopic Posterior Cruciate Ligament Reconstruction with Adjustable-Loop Femoral Cortical Suspension Devices. Open Access Maced J Med Sci 2019; 7:2791-2795. [PMID: 31844438 PMCID: PMC6901848 DOI: 10.3889/oamjms.2019.644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Incidence of isolated posterior cruciate ligament (PCL) injury is lower than PCL rupture is associated with other knee injuries. Adjustable loop femoral cortical suspension device is commonly used for femoral graft fixation during PCL reconstruction. AIM This study purpose is to describe the functional outcome of PCL reconstruction using an adjustable loop femoral cortical suspension device. METHODS This study used prospective design with consecutive sampling. All patients underwent PCL reconstruction with adjustable loop femoral cortical suspension devices using peroneus longus tendon autograft. Patients were evaluated at 6 months after surgery using posterior drawer test and functional outcome scoring system (Lysholm knee score, Cincinnati Score and International Knee Documentation Committee (IKDC) score). RESULTS 20 patients were enrolled in this study with a mean age of 27.65 ± 9.78. Lysholm knee means the score was improved from 59.80 ± 18.73 pre-operative and 80.55 ± 11.72 post-operative (p < 0.05). Cincinnati mean score was improved from 52.01 ± 20.29 pre-operative to 72.95 ± 15.26 post-operative (p < 0.05). IKDC mean score was improved from 48.36 ± 13.18 at pre-operative to 72.5 ± 13.13 post-operative (p < 0.05). CONCLUSION PCL reconstruction using adjustable loop femoral cortical suspension device using peroneus longus tendon autograft showed good clinical outcome and knee functional outcome (Lysholm, Cincinnati, and IKDC score) at 6 months follow-up.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jacky Ardianto Horas
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Asa Ibrahim Zainal Asikin
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Riky Setyawan
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Thomas Edison Prasetyo
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Edi Mustamsir
- Department of Orthopaedics and Traumatology, Dr Saiful Anwar General Hospital, Malang, Indonesia.,Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
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37
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Choi NH, Park TH, Oh WK, Victoroff BN. Radiologic and Clinical Outcomes After Hamstring Anterior Cruciate Ligament Reconstruction Using an Adjustable-Loop Cortical Suspension Device With Retensioning and Knot Tying. Arthroscopy 2019; 35:2629-2633. [PMID: 31402224 DOI: 10.1016/j.arthro.2019.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To report magnetic resonance imaging (MRI) findings and clinical outcomes after anterior cruciate ligament reconstruction using an adjustable-loop device (ALD) with retensioning and knot tying. METHODS The inclusion criteria were patients who underwent hamstring anterior cruciate ligament reconstruction using an ALD with retensioning and knot tying between May and December 2015 and were followed up for a minimum of 2 years. The exclusion criteria were patients with combined ligament injury, revision surgery, or reinjury after reconstruction. After initial tightening of the adjustable loop, retensioning and knot tying were performed and the graft was fixed at the tibia. Multiplanar reformatted images of 3-T MRI scans were obtained on the immediate postoperative day and at 6 months after surgery to measure the gap between the top of the graft and the top of the femoral tunnel (i.e., tunnel-graft gap). Differences in the tunnel-graft gap between the immediate postoperative day and 6 months after surgery (i.e., gap difference) were calculated and correlated with knee stability and functional outcomes. RESULTS Thirty-six patients were enrolled in this study. The mean tunnel-graft gap was 2.1 ± 2.8 mm on the immediate postoperative day and 4.6 ± 3.5 mm at 6 months after surgery (P < .001). The mean gap difference was 2.5 ± 2.0 mm. The mean KT-1000 measurement was 1.5 ± 2.2 mm, and mean Lysholm score and Tegner activity scale score were 93.6 ± 5.5 and 5.6 ± 1.5, respectively. The gap difference correlated negatively with the follow-up Lysholm score (P = .004); however, knee stability and the Tegner activity scale score were not correlated. CONCLUSIONS Although the ALD was secured by retensioning and knot tying, MRI showed that the graft was not fully inserted in some patients and the tunnel-graft gap increased at 6 months' follow-up. The increase in the tunnel-graft gap did not correlate with knee stability or the Tegner activity scale score but correlated negatively with the Lysholm score. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Nam-Hong Choi
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Republic of Korea.
| | - Tae-Hoon Park
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Republic of Korea
| | - Whang-Kyun Oh
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Republic of Korea
| | - Brian N Victoroff
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, U.S.A
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Glasbrenner J, Domnick C, Raschke MJ, Willinghöfer T, Kittl C, Michel P, Wähnert D, Herbort M. Adjustable buttons for ACL graft cortical fixation partially fail with cyclic loading and unloading. Knee Surg Sports Traumatol Arthrosc 2019; 27:2530-2536. [PMID: 30368561 DOI: 10.1007/s00167-018-5262-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/23/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE Despite good initial pullout strength, it is unclear whether adjustable button (AB) devices for anterior cruciate ligament (ACL) soft-tissue graft fixation, which are based on the Chinese finger trap technique, resist cyclic loading. Furthermore, they have never been tested in a cyclic protocol including complete unloading. It was hypothesized, that the displacement of AB devices with the Chinese finger trap technique would be greater than that of continuous suture loop devices and other available AB mechanisms in a cyclic loading with complete unloading protocol. METHODS ACL reconstruction was performed in a porcine knee model using three different types of cortical fixation devices: two different AB devices that use the Chinese finger trap design, one AB device that uses a locked suture loop mechanism and two different continuous loop devices as control groups (n = 40). Specimens were mounted in a material-testing machine (Instron Inc.) that permitted 2500 loading and complete unloading cycles to a maximum of 250 N, as well as continuous elongation recording. A one-way ANOVA was performed for statistical analysis. RESULTS The displacement of ABs with a Chinese finger trap loop (mean 8.1; SD 1.5 mm and mean 6.1; SD 1.4 mm) was significantly greater than that of AB with a locked suture loop (mean 4.7; SD 1.0 mm; p < 0.05) and devices with a continuous loop (mean 4.1; SD 0.5 mm and mean 4.4, SD 0.3 mm; p < 0.01). No significant differences were detected between the ABs with a locked suture loop and the continuous loops. CONCLUSION Cyclic loading and unloading of AB using the Chinese finger trap technique leads to significantly greater construct lengthening compared with other devices. Complete unloading of the ACL is very likely to occur during rehabilitation after ACL reconstruction. Lengthening of the AB device due to cyclic loading might be a potential mode of failure of the ACL graft fixation. Therefore, when using an AB femoral fixation technique, a locked suture loop design or a careful rehabilitation protocol should be considered.
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Affiliation(s)
- J Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - C Domnick
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - M J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - T Willinghöfer
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - C Kittl
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - P Michel
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - D Wähnert
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University, Waldeyer Strasse 1, 48149, Muenster, Germany.
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Onggo JR, Nambiar M, Pai V. Fixed- Versus Adjustable-Loop Devices for Femoral Fixation in Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2019; 35:2484-2498. [PMID: 31147109 DOI: 10.1016/j.arthro.2019.02.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare biomechanical and clinical outcomes between adjustable-loop devices (ALDs) and fixed-loop devices (FLDs) in the femoral fixation component of anterior cruciate ligament reconstruction (ACLR) using a hamstring autograft or allograft. METHODS A multi-database search was performed on July 18, 2018, according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All articles directly comparing ALDs and FLDs in ACLR using hamstring grafts were included. Non-English-language articles were excluded. RESULTS We included 13 biomechanical, 2 prospective, and 6 retrospective studies in this review. Retensioning of ALDs was performed in 4 of 13 biomechanical studies and in all clinical studies. Biomechanically, 11 studies showed a statistically significantly larger maximum irreversible displacement of the graft in the ALD group. Two studies showed no statistically significant difference with retensioning of the TightRope ALD, whereas all 3 studies that examined knotting of ALDs showed no statistically significant difference between the FLD and ALD groups. Five studies reported statistically significantly higher graft stiffness for FLDs than ALDs. Retensioning or knotting did not produce any significant change in construct stiffness. Nine studies reported a statistically significantly higher ultimate load to failure for FLDs. With knotting of ALDs, this difference was no longer statistically significant in only 1 study. Clinical studies showed no statistically significant differences in clinical, functional, radiologic, and complication outcomes between both groups. CONCLUSIONS Despite the superior biomechanical properties of FLDs, ALDs and FLDs yielded similar clinical outcome scores and graft rerupture rates. Biomechanical outcomes were improved with retensioning of ALDs after tibial fixation, as per manufacturer recommendations. LEVEL OF EVIDENCE Level III, systematic review of Level III and IV studies.
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Comparison of Clinical and Radiologic Outcomes and Second-Look Arthroscopic Findings After Anterior Cruciate Ligament Reconstruction Using Fixed and Adjustable Loop Cortical Suspension Devices. Arthroscopy 2019; 35:1736-1742. [PMID: 31072714 DOI: 10.1016/j.arthro.2019.01.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical and radiological outcomes, including tunnel widening, and to evaluate graft status by second-look arthroscopy after anterior cruciate ligament (ACL) reconstruction using 2 different femoral cortical suspension devices (fixed and adjustable loop). METHODS Seventy-nine patients were included for this study. The patients were divided into 2 groups, 41 patients of fixed loop group (EndoButton) and 38 patients of adjustable loop group (TightRope). The Tegner activity, Lysholm knee score, Lachman test, and pivot-shift test were compared between the 2 groups. Anterior stress radiographs and femoral tunnel widening on plain radiographs were also compared. Twenty-seven patients (66%) in the EndoButton group and 21 patients (55%) in the TightRope group underwent the second-look arthroscopy. RESULTS At the final follow-up, the mean Tegner activity, Lysholm, and International Knee Documentation Committee scores were improved in both groups and there were no statistically significant differences (5.1 ± 1.6 and 5.5 ± 2.1, P = .312; 90.4 ± 7.8 and 91.0 ± 6.5, P = .525; and 87.4 ± 6.7 and 88.7 ± 5.3, P = .127, respectively). There were no statistical significances in the both groups in terms of Lachman test and pivot-shift tests (P = .392, .559) as well as anterior stress radiographs (mean 3.2 ± 1.4 mm and 2.9 ± 1.1 mm, P = .343). Moreover, radiologic measurements comparing femoral tunnel widening at proximal and distal half also showed no significant differences (P = .540 and .412 on anteroposterior view; P = .254 and .437 on lateral view). In the second-look arthroscopy findings for graft tear and synovial coverage, there were no significant differences (P = .784 and .897). CONCLUSIONS Both fixed loop and adjustable loop devices in ACL reconstruction provided good clinical and radiological outcomes. In patients with both devices, femoral tunnel widening at proximal and distal portion have no significant differences after ACL reconstruction. Moreover, second-look arthroscopy revealed no significant differences in terms of synovial coverage and rupture of the graft. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Boileau P, Gastaud O, Wilson A, Trojani C, Bronsard N. All-Arthroscopic Reconstruction of Severe Chronic Acromioclavicular Joint Dislocations. Arthroscopy 2019; 35:1324-1335. [PMID: 31054712 DOI: 10.1016/j.arthro.2018.11.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the outcomes of all-arthroscopic coracoclavicular (CC) ligament reconstruction and simultaneous diagnosis and treatment of glenohumeral pathologies in patients with symptomatic, chronic (>6 weeks), complete (Rockwood type III-V) acromioclavicular joint (ACJ) separations. METHODS We prospectively followed up 57 consecutive patients treated arthroscopically for chronic Rockwood type III (n = 11), type IV (n = 19), and type V (n = 27) ACJ dislocations. Previous ACJ surgery failed in 11 (19%). The mean delay between injury and surgery was 39 months (range, 6 months to 17 years). The mean age at surgery was 42 years (range, 19-71 years). After glenohumeral exploration, an arthroscopic modified Weaver-Dunn procedure with CC suture button fixation (Twinbridge) was performed. The CC reduction and tunnel position were analyzed with radiographs and computed tomography. The mean follow-up period was 36 months (range, 12-72 months). RESULTS Intra-articular pathology was treated arthroscopically in 27 patients (48%): 17 labral tears, 8 rotator cuff tears (3 partial and 5 complete), and 15 biceps lesions (4 SLAP lesions and 11 subluxations). At last follow-up, 7 patients (12%) experienced recurrent ACJ instability: 2 frank dislocations (1 trauma and 1 infection) and 5 ACJ subluxations. There was no significant correlation between subluxation and clinical outcome. The rate of recurrent ACJ instability was significantly higher in patients with higher-grade ACJ dislocations (P < .01) and/or previous failed surgery (P < .001). Recurrent subluxation was observed in 3 cases of lateral migration of the coracoid button with lateral tunnel placement, as well as 2 cases of anterior migration of the clavicular button with anterior tunnel placement. The Constant score increased from 67 (range, 28-89) to 85.5 (range, 66-100), and the mean Subjective Shoulder Value increased from 54% to 85% (P < .001). At last follow-up, 95% of patients (54 of 57) were satisfied. CONCLUSIONS All-arthroscopic treatment allows successful CC ligament reconstruction and simultaneous diagnosis and treatment of frequently associated (48%) glenohumeral lesions. Higher-grade ACJ dislocations, previous ACJ surgery, and misplacement of bone tunnels are risk factors for recurrent instability. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Pascal Boileau
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France.
| | - Olivier Gastaud
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
| | - Adam Wilson
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
| | - Christophe Trojani
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
| | - Nicolas Bronsard
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
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Uchida R, Nakamura N, Suzuki T, Kusano M, Mae T, Ohzono K, Toritsuka Y. Excellent bone plug–socket integration at 8 weeks after anterior cruciate ligament reconstruction using an adjustable-length loop cortical fixation device. J ISAKOS 2019. [DOI: 10.1136/jisakos-2018-000244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
ObjectivesRecently, adjustable-length loop cortical fixation devices (ALCFDs) have been developed. However, they are not frequently used for bone–patellar tendon–bone (BTB) grafting, mainly because it is uncertain whether an ALCFD enables sufficient integration of the bone plug. Thus, the purpose of this study was to evaluate bone plug–socket integration in anterior cruciate ligament reconstruction (ACL-R) with an ALCFD.MethodsTwenty consecutive patients with a mean age of 25±10 years underwent primary anatomic rectangular tunnel (ART) ACL-R with a BTB graft using BTB TightRope. The operated knees were evaluated by CT at 4 weeks and 8 weeks postoperatively. Union between the bone plug and the socket wall were assessed on 30 evaluation planes. No border between the plug and the socket wall, or trabecular continuity, were defined as complete union and a visible gap of >1 mm as incomplete union. When complete union was observed on >20, 11–20, 5–10 or <5 of the evaluation planes, bone integration was graded as excellent, good, fair or poor, respectively. In addition, the interface area between the plug and the socket wall was assessed by CT value index. Clinical evaluation was performed at 2 years postoperatively using the International Knee Documentation Committee (IKDC) form.ResultsThe proportion of patients with excellent bone integration was 20% at 4 weeks and 85% at 8 weeks, showing a significant difference (p=0.00015). Moreover, the CT value index of the interface area at 4 weeks was 25.8%±11.8% and that at 8 weeks was 15.3%±9.0%, again showing a significant difference (p=0.005). These suggest that bone integration of the interface area progresses over time and adequate at 8 weeks. Clinically, all 16 patients examined directly were rated their knees as normal or nearly normal with a mean side-to-side difference in anterior laxity at manual maximum force by KT-2000 of 0.2±0.3 mm.ConclusionExcellent bone plug–socket integration was observed at 8 weeks after ART ACL-R using an ALCFD with satisfactory clinical results. An ALCFD could be safely applied for ART ACL-R.Level of evidence4 (case series).
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Ra HJ, Celik H, Kim HJ, Lee DH. Femoral tunnel widening is similar between anteromedial portal and transtibial techniques following single-bundle anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2019; 27:626-635. [PMID: 30306239 DOI: 10.1007/s00167-018-5204-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE In anterior cruciate ligament (ACL) reconstruction, there is concern regarding the potential risk of femoral tunnel widening in the anteromedial portal (AMP) technique due to the acute graft-bending angle at the aperture and the more elliptical aperture shape of the femoral tunnel compared to the transtibial (TT) techniques. Therefore, the aim of the current systematic review and meta-analysis was to compare the femoral tunnel widening between the AMP and TT techniques in patients who underwent ACL reconstruction. METHODS It should be included the studies that reported on femoral tunnel widening in patients who underwent single-bundle ACL reconstruction, using soft-tissue tendon graft, with AMP and/or TT techniques. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACL reconstruction. RESULTS Twenty-one studies were finally included in this meta-analysis. The pooled changes of absolute millimeters of tunnel widening from the immediate postoperative status to the last follow-up did not differ significantly between the AMP and TT techniques at both the aperture [3.31 mm, 95% confidence interval (CI) 1.7-5.0. mm versus 2.9 mm, 95% CI 2.4-3.4 mm, P = n.s.] and the midportion (3.5 mm, 95% CI 0.8-6.3 mm versus 3.0 mm, 95% CI 2.2-3.9 mm, P = n.s.) of the femoral tunnel. No significant difference was observed between the two techniques in the relative percentage of femoral tunnel widening (AMP; 28.8%, 95% CI 14.8-42.9% vs. TT; 29.7%, 95% CI 15.6-43.7%, P = n.s.). CONCLUSION No significant difference in femoral tunnel widening was observed between the AMP and TT techniques, both in absolute millimeter and relative percentage, in patients who underwent single-bundle ACL reconstruction. This finding could alleviate the potential concerns associated with femoral tunnels being wider for the AMP than for the TT technique. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ho Jong Ra
- Department of Orthopaedic Surgery, College of Medicine, Gangneung Asan Hospital, Ulsan University, Gangneung, Republic of Korea
| | - Haluk Celik
- Department of Orthopaedic Surgery, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Hyun-Jun Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, 06351, Seoul, South Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, 06351, Seoul, South Korea.
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Sundararajan SR, Sambandam B, Singh A, Rajagopalakrishnan R, Rajasekaran S. Does Second-Generation Suspensory Implant Negate Tunnel Widening of First-Generation Implant Following Anterior Cruciate Ligament Reconstruction? Knee Surg Relat Res 2018; 30:341-347. [PMID: 30466254 PMCID: PMC6254873 DOI: 10.5792/ksrr.18.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/20/2018] [Accepted: 08/01/2018] [Indexed: 01/11/2023] Open
Abstract
Purpose Tunnel widening following anterior cruciate ligament (ACL) reconstruction is commonly observed. Graft micromotion is an important contributing factor. Unlike fixed-loop devices that require a turning space, adjustable-loop devices fit the graft snugly in the tunnel. The purpose of this study is to compare tunnel widening between these devices. Our hypothesis is that the adjustable-loop device will create lesser tunnel widening. Materials and Methods Ninety-eight patients underwent ACL reconstruction from January 2013 to December 2014. An adjustable-loop device was used in 54 patients (group 1) and a fixed-loop device was used in 44 patients (group 2). Maximum tunnel widening at 1 year was measured by the L’Insalata’s method. Functional outcome was measured at 2-year follow-up. Results The mean widening was 4.37 mm (standard deviation [SD], 2.01) in group 1 and 4.09 mm (SD, 1.98) in group 2 (p=0.511). The average International Knee Documentation Committee score was 78.40 (SD, 9.99) in group 1 and 77.11 (SD, 12.31) in group 2 (p=0.563). The average Tegner-Lysholm score was 87.25 (SD, 3.97) in group 1 and 87.29 in group 2 (SD, 4.36) (p=0.987). There was no significant difference in tunnel widening and functional outcome between the groups. Conclusions The adjustable-loop device did not decrease the amount of tunnel widening when compared to the fixed-loop device. There was no significant difference in outcome between the two fixation devices. Level of Evidence Level 3, Retrospective Cohort
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Affiliation(s)
| | - Balaji Sambandam
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospital, Coimbatore, India
| | - Ajay Singh
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospital, Coimbatore, India
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Kusano M, Kazui A, Uchida R, Mae T, Tsuda T, Toritsuka Y. Loop Length Change of an Adjustable-Length Femoral Cortical Suspension Device in Anatomic Rectangular Tunnel Anterior Cruciate Ligament Reconstruction With a Bone-Patellar Tendon-Bone Graft and Associated Clinical Outcomes. Arthroscopy 2018; 34:3063-3070. [PMID: 30301633 DOI: 10.1016/j.arthro.2018.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/07/2018] [Accepted: 06/10/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate loop length changes of an adjustable femoral cortical suspensory fixation device and assess the clinical results after anatomic rectangular tunnel anterior cruciate ligament (ART-ACL) reconstruction with a bone-tendon-bone (BTB) graft. METHODS The study included 50 patients who underwent ART-ACL reconstruction with a BTB graft fixed using the adjustable-length device BTB TightRope for femoral fixation between July 2013 and December 2014. Computed tomography examinations were performed at 1 and 12 weeks after the surgery. Loop length was measured in the reconstructed plane just parallel to the femoral tunnel, including the bone plug and the button. Measurement was performed thrice, and the mean value was used. Loop length change was defined as the difference in loop length between 1 and 12 weeks after the surgery. A paired t test was conducted with the effect size for statistical analysis. At 2 years postoperatively, clinical evaluations, including subjective and objective assessments, were performed. RESULTS The mean loop lengths at 1 and 12 weeks were 25.77 ± 3.88 mm and 25.81 ± 3.89 mm, respectively, with a significant difference (P = .01). However, the effect size was 0.01, suggesting that the difference was not meaningful. The mean individual loop length change was 0.04 ± 0.13 mm. All individual loop length changes were within the measurement error range. At 2 years postoperatively, 49 patients (98%) were graded as normal or nearly normal according to the International Knee Documentation Committee form. The mean side-to-side difference in anterior laxity at manual maximum force was 0.2 ± 0.5 mm. CONCLUSIONS The loop length change of an adjustable-length femoral cortical suspension device was negligible after ART-ACL reconstruction with a BTB graft. This ART-ACL reconstruction with a BTB graft using an adjustable-length device could safely provide sufficient stability to the operated knee. LEVEL OF EVIDENCE Level Ⅳ, therapeutic case series.
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Affiliation(s)
- Masashi Kusano
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Hyogo, Japan
| | - Arisa Kazui
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Seifu Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takayuki Tsuda
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Hyogo, Japan
| | - Yukiyoshi Toritsuka
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Hyogo, Japan.
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Colombet P, Saffarini M, Bouguennec N. Clinical and Functional Outcomes of Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years Using Adjustable Suspensory Fixation in Both the Femur and Tibia: A Prospective Study. Orthop J Sports Med 2018; 6:2325967118804128. [PMID: 30364847 PMCID: PMC6198402 DOI: 10.1177/2325967118804128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: The success of anterior cruciate ligament (ACL) reconstruction requires reliable and rigid graft fixation. Cortical suspensory fixation (CSF) devices have become an acceptable alternative to interference screws for soft tissue ACL grafts. However, CSF devices have been reported to be associated with tunnel widening and increased postoperative anterior laxity compared with interference screw fixation. Adjustable CSF devices were introduced to avoid these problems but have been associated with graft lengthening and inconsistent outcomes. Purpose: To (1) report the side-to-side difference (SSD) in anterior laxity at 150 N, clinical scores, and failure rates 2 years after ACL reconstruction with 4-strand semitendinosus autografts using an adjustable CSF device and (2) determine the preoperative factors associated with clinical outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 131 patients who had undergone primary ACL reconstruction, performed with 4-strand semitendinosus grafts that were secured using Pullup adjustable-length CSF devices with femoral and tibial fixation techniques, were prospectively enrolled in this study; 34 patients were excluded because of contralateral instability or ipsilateral knee injuries that required additional surgery. This left a cohort of 97 patients who were evaluated preoperatively and at 6, 12, and 24 months. The evaluation consisted of measuring the SSD in anterior laxity and patient-reported outcome scores (International Knee Documentation Committee [IKDC] and Lysholm scores). Regression analyses were performed to determine associations between these outcomes and 9 preoperative variables. Results: Only 2 patients could not be reached, 2 could not be evaluated because of contralateral ACL tears, and 2 had graft failure. At 2-year follow-up, the remaining 91 patients had a mean SSD in anterior laxity of 0.8 ± 1.8 mm (range, –4.2 to 5.3 mm), mean IKDC score of 87.6 ± 10.6 (range, 43.7-100.0), and mean Lysholm score of 90.8 ± 9.3 (range, 56.0-100.0). At final follow-up, compared with knees with partial ruptures, those with complete ruptures had equivalent laxity (P = .266) and Lysholm scores (P = .352) but lower IKDC scores (P = .009). Multivariable regression revealed that the IKDC score decreased with increased preoperative laxity (β = –1.35 [95% CI, –2.48 to –0.23]; P = .019). Conclusion: The novel adjustable-length CSF device produced satisfactory anterior laxity and clinical outcomes, with a failure rate of 2.1%, which compare favorably with those reported for nonadjustable CSF devices.
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Houck DA, Kraeutler MJ, McCarty EC, Bravman JT. Fixed- Versus Adjustable-Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Biomechanical Studies. Orthop J Sports Med 2018; 6:2325967118801762. [PMID: 30364394 PMCID: PMC6196635 DOI: 10.1177/2325967118801762] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Fixed- and adjustable-loop femoral cortical suspension devices are commonly used for femoral graft fixation during anterior cruciate ligament reconstruction (ACLR). Purpose: To compare the biomechanical results of fixed- versus adjustable-loop femoral cortical suspension devices in studies simulating ACLR with an isolated device and/or specimen setup using porcine femora and bovine flexor tendons. Study Design: Systematic review. Methods: Two independent reviewers searched PubMed, Embase, and the Cochrane Library databases to find studies comparing the biomechanical strength of fixed- and adjustable-loop cortical suspension devices for ACLR with isolated device and/or specimen setups using porcine femora and bovine flexor tendons. Studies that compared both devices with similar biomechanical methods were included. Data extracted included displacement during cyclic loading, ultimate load to failure, and mode of failure of the different cortical suspension devices for ACLR. Results: Six studies were identified that met the inclusion criteria, including a total of 76 fixed-loop devices and 120 adjustable-loop devices. Load to failure was significantly different (P < .0001), with the strongest fixation device being the ToggleLoc with ZipLoop adjustable-loop device (1443.9 ± 512.3 N), compared with the Endobutton CL fixed-loop device (1312.9 ± 258.1 N; P = .04) and the TightRope RT adjustable-loop device (863.8 ± 64.7 N; P = .01). Cyclic displacement was significantly different, with Endobutton CL (3.7 ± 3.9 mm) showing the least displacement, followed by ToggleLoc with ZipLoop (4.9 ± 2.3 mm) and TightRope RT (7.7 ± 11.1 mm) (P < .0001). Mode of failure was statistically different between the 3 groups (P = .01), with suture failure accounting for 83.8% of TightRope RT devices, 69.4% of ToggleLoc with ZipLoop devices, and 60.3% of Endobutton CL devices. Conclusion: Current biomechanical data suggest that the ToggleLoc with ZipLoop device is the strongest fixation device at “time zero” in terms of ultimate load to mechanical failure. However, the Endobutton CL device demonstrated the least cyclic displacement, which may be a more clinically applicable measure of device superiority.
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Affiliation(s)
- Darby A Houck
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St Joseph's Regional Medical Center, Paterson, New Jersey, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Weiss WM. Editorial Commentary: Technical Advances in Fixation for Arthroscopic Anterior Cruciate Ligament Reconstruction Won't Take the Place of Good Technique…Or a Strong Arm! Arthroscopy 2018; 34:2675-2676. [PMID: 30173807 DOI: 10.1016/j.arthro.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 02/02/2023]
Abstract
Advances in fixation technology have improved the time-zero stability of grafts used for anterior cruciate ligament reconstruction, but the clinical impact of this is unclear. Adjustable-loop-length devices are the latest iteration of cortical fixation and offer retensioning of the graft after tibial fixation. This capability is absent in traditional closed-looped devices and interference screws, but there are concerns with the adjustable mechanism maintaining tension with cyclic loading. Although this advance may represent an additional tool for fine-tuning graft tension, it does not replace good technique in the use of anterior cruciate ligament fixation devices.
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Boutsiadis A, Panisset JC, Devitt BM, Mauris F, Barthelemy R, Barth J. Anterior Laxity at 2 Years After Anterior Cruciate Ligament Reconstruction Is Comparable When Using Adjustable-Loop Suspensory Fixation and Interference Screw Fixation. Am J Sports Med 2018; 46:2366-2375. [PMID: 30015501 DOI: 10.1177/0363546518784005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adjustable-loop suspensory fixation (ALSF) devices are commonly used in anterior cruciate ligament reconstruction (ACLR). However, concern exists regarding the potential for lengthening under cyclical loads. PURPOSE To compare the residual anterior laxity of 2 methods of femoral fixation, ALSF versus interference screw fixation, in patients undergoing isolated ACLR in the absence of meniscal injuries. To determine the preoperative risk factors associated with residual postoperative anterior laxity. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was performed comparing 2 groups of patients that underwent primary ACLR using ALSF versus bioabsorbable interference screw fixation. Anterior knee laxity was assessed with Telos stress radiography, while functional outcomes were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity level scale at a minimum of 2 years postoperatively. A multivariate analysis was performed to identify factors associated with residual postoperative laxity >3 mm. RESULTS Of the 1136 patients who underwent ACLR during the study period, 363 met the inclusion criteria. A total of 272 patients (75%) (mean age, 31.7 ± 10.7 years) with a mean follow-up of 25.7 ± 4.6 months (range, 24-36 months) consented to participate (screw group: n = 121; ALSF group: n = 151). The 2 groups were statistically comparable in terms of age, sex ratio, time from injury to surgery, graft diameter, preoperative laxity, preoperative objective International Knee Documentation Committee (IKDC) grade, and preoperative Tegner score. The mean postoperative laxity as a continuous variable was significantly different comparing the ALSF and screw groups (1.49 ± 1.98 mm and 2.32 ± 1.97 mm, respectively; P < .001). In the screw group, 76 patients (62.8%) had normal (<3 mm), 40 (33.1%) had nearly normal (3-6 mm), and 5 (4.1%) had abnormal (≥6 mm) postoperative knee laxity according to the IKDC grade, while in the ALSF group, 112 patients (74.2%) had normal, 37 (24.5%) had nearly normal, and 2 (1.3%) had abnormal laxity ( P = .0833). No significant difference was found in KOOS or Tegner scores comparing the 2 femoral fixation methods: KOOS, 90.6 ± 7.5 (ALSF group) and 90.6 ± 7.4 (screw group) ( P = .7631), versus Tegner, 6.5 ± 1.3 (ALSF group) and 6.3 ± 1.4 (screw group) ( P = .2992). A negative correlation was found between postoperative laxity and final Tegner ( rs = -0.303, P < .001) and KOOS scores ( rs = -0.168, P = .005). The initial univariate analysis showed differences between groups of patients with residual knee laxity ≥3 mm and <3 mm on preoperative pivot shift, preoperative laxity, age, fixation type, and preoperative objective IKDC grade. The multivariate analysis on these factors showed that the pivot shift remained the only significant predictor for residual laxity ≥3 mm for pivot shift grade 2 compared with grade 1 (odds ratio, 4.689 [95% CI, 2.465-9.286]) and for pivot shift grade 3 compared with grade 1 (odds ratio, 58.025 [95% CI, 12.757-557.741]) ( P < .001). CONCLUSION For primary ACLR, the use of an ALSF device for femoral fixation is associated with noninferior postoperative anterior knee laxity results compared with interference screw fixation at a minimum 2 years' follow-up. The preoperative pivot shift is the only significant risk factor for postoperative residual anterior knee laxity >3 mm.
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Affiliation(s)
- Achilleas Boutsiadis
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | - Jean-Claude Panisset
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | | | - Frédéric Mauris
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | | | - Johannes Barth
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
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Kubota M, Ohno R, Sato T, Yamada D, Fukusato S, Kaneko K. Pearls and Pitfalls of the ToggleLoc With ZipLoop for Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2018; 7:e863-e867. [PMID: 30167366 PMCID: PMC6112375 DOI: 10.1016/j.eats.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/13/2018] [Indexed: 02/03/2023] Open
Abstract
The ToggleLoc with ZipLoop is an adjustable suspensory device for anterior cruciate ligament reconstruction. However, there is no string to flip the button in the device because it has only one hole and one string. Therefore, the surgeon cannot use the button flip technique. The purpose of this article is to present the pearls and pitfalls of using ToggleLoc with ZipLoop. While preparing the ACL graft, we draw a 15- to 20-mm-width marking in the adjustable loop at the same length as the femoral tunnel depth. While passing of the graft, the tensioning sutures are placed at the anterior side to make sure they pass through the medial portal smoothly. The proximal passing suture and distal adjustable loop is pulled to the opposite direction by one surgeon's hands while passing the button. We stop pulling the sutures just at the marking while feeling the button being passed over the lateral femoral cortex. The distal artificial ligament is held distally with moderate tension while passing the graft. Although there are some pitfalls and knacks, the present technique is easy and certainly helps surgeons achieve appropriate positioning of the button.
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Affiliation(s)
- Mitsuaki Kubota
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Higashi-Koshigaya, Saitama, Japan,Address correspondence to Mitsuaki Kubota, M.D., Ph.D., 10-47-1, Higashi-Koshigaya, Saitama, 3430023, Japan.
| | - Ryuichi Ohno
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Higashi-Koshigaya, Saitama, Japan
| | - Taisuke Sato
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Higashi-Koshigaya, Saitama, Japan
| | - Daiju Yamada
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Higashi-Koshigaya, Saitama, Japan
| | - Shin Fukusato
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, Higashi-Koshigaya, Saitama, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery and Sports Medicine, Juntendo University, School of Medicine, Bunkyo-ku, Tokyo, Japan
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