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Dadoo S, Herman ZJ, Hughes JD. Surgical Techniques in Primary ACL Reconstruction: Getting It Right the First Time. Clin Sports Med 2024; 43:399-412. [PMID: 38811118 DOI: 10.1016/j.csm.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The ideal anterior cruciate ligament reconstruction (ACLR) is an individualized anatomic approach aimed at restoring the native structure and function of the knee. Surgeons are tasked with difficult decisions during operative planning, including the optimal graft choice for the patient and appropriate anatomic tunnel placement. Special considerations should additionally be given for skeletally immature patients and those at high-risk for failure, including younger, active patients participating in pivoting sports. The purpose of this review is to provide an overview of the individualized approach to ACLR, including the necessary preoperative and operative considerations to optimize patient outcomes.
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Affiliation(s)
- Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA.
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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2
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Dadoo S, Benvegnu N, Herman ZJ, Yamamoto T, Hughes JD, Musahl V. Revision Anterior Cruciate Ligament Reconstruction and Associated Procedures. Clin Sports Med 2024; 43:449-464. [PMID: 38811121 DOI: 10.1016/j.csm.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Failure of anterior cruciate ligament reconstruction (ACLR) is a common yet devastating complication due to inferior clinical outcomes associated with revision ACLR. Identifying the cause and associated risk factors for failure is the most important consideration during preoperative planning. Special attention to tunnel quality, concomitant injuries, and modifiable risk factors will help determine the optimal approach and staging for revision ACLR. Additional procedures including lateral extra-articular tenodesis and osteotomy may be considered for at-risk populations. The purpose of this review is to explore causes of ACLR failure, clinical indications and appropriate patient evaluation, and technical considerations when performing revision ACLR.
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Affiliation(s)
- Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA 15203, USA.
| | - Neilen Benvegnu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA 15203, USA
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA 15203, USA
| | - Tetsuya Yamamoto
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA 15203, USA; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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3
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Yaari L, Singer J, Goldberg D, Yassin M, Agar G, Lindner D, Beer Y, Haviv B. Eighteen-year outcome of anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Arch Orthop Trauma Surg 2024; 144:2189-2195. [PMID: 38630253 DOI: 10.1007/s00402-024-05317-2] [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] [Received: 03/09/2023] [Accepted: 04/04/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To evaluate patient reported outcomes and radiographic arthritic changes of transtibial anterior cruciate ligament reconstruction (ACLR) with either bone-patellar tendon-bone (BPTB) or hamstrings (HS) auto-grafts at a minimum of 15-year follow-up. METHODS Ninety-four patients (51 of the HS group, 43 of BPTB group) who were operated between the years 2000 to 2005 in two tertiary referral hospitals were contacted and invited to a retrospective evaluation. The interview included subjective outcomes using the Lysholm knee scoring questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Tegner activity level scale, Visual Analogue Scale (VAS) for pain and patients' satisfaction scale. Knee examination included measurements of motion and stability. Knee radiographs were evaluated for osteoarthritic changes according to the Kellgren-Lawrence (KL) score. RESULTS The average evaluation time from surgery was 18.6 years. Subjectively, there was no significant difference between groups except for a better post-operative level of activity and satisfaction in the HS group. Objectively, there was no significant difference between groups in knee stability and range of motion. Most patients had grade KL ≤ 1 radiographic osteoarthritits changes and there was no significant difference between groups. Recurrent complete tear of the reconstructed graft occurred in 3 patients of each group. In both groups 84% had no further surgery while the indications for further surgery were mostly a meniscal tear or tibial hardware removal. CONCLUSIONS Very long-term outcomes and clinical stability of transtibial HS or BPTB graft ACL reconstruction are good with low rate of graft failure and radiographic osteoarthritis.
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Affiliation(s)
- Lee Yaari
- Arthroscopy and Sports Injuries Unit, Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Jonathan Singer
- Arthroscopy and Sports Injuries Unit, Orthopedic Division, Assaf Harofeh-Shamir Medical Center, Tzrifin, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Dan Goldberg
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Mustafa Yassin
- Arthroscopy and Sports Injuries Unit, Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Gabriel Agar
- Arthroscopy and Sports Injuries Unit, Orthopedic Division, Assaf Harofeh-Shamir Medical Center, Tzrifin, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Dror Lindner
- Arthroscopy and Sports Injuries Unit, Orthopedic Division, Assaf Harofeh-Shamir Medical Center, Tzrifin, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Yiftah Beer
- Arthroscopy and Sports Injuries Unit, Orthopedic Division, Assaf Harofeh-Shamir Medical Center, Tzrifin, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Barak Haviv
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, 7 Keren Kayemet St, Petach-Tikva, 49372, Israel.
- Arthroscopy and Sports Injuries Unit, Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel.
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel.
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Daniel AV, Sheth CD, Shubert DJ, Smith PA. Primary Anterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Case Series of 252 Patients. J Knee Surg 2024; 37:381-390. [PMID: 37451280 DOI: 10.1055/a-2129-8893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) using suture tape augmentation to internally brace is a relatively new technique. The primary goal of this study was to prospectively collect patient-reported outcomes (PROs) and surgical history from patients who underwent primary ACLR with internal bracing to determine if internal bracing resulted in a low graft failure rate while maintaining acceptable PROs. A total of 252 patients with a mean age of 23.6 years (95% confidence interval [CI]: 22.1-25.1) and a mean follow-up of 37.9 months (95% CI: 35.8-40.0) were included in this study. Patients who underwent primary ACLR with internal brace augmentation between July 12, 2016 and July 31, 2021 were eligible. A total of 222 patients were contacted via telephone and administered the visual analog scale (VAS), the single assessment numeric evaluation (SANE), the Lysholm knee score scale, and, if applicable, the short version ACL return to sport after injury (SV-ACL-RSI) survey. Additionally, patients were asked to give an updated orthopaedic history. Thirty additional patients were included from either our institution's registry or by completing their surveys in-office or by e-mail. The minimal clinically important difference (MCID) and patient-acceptable symptom states (PASS) were calculated based on our patient population and applied to each individual patient. The patients' electronic health record (EHR) was searched for pre- and postoperative clinical data including KT-1000 arthrometer measurements. Two patients (0.8%) had subsequent graft failures and one patient (0.4%) required a revision surgery. MCID was achieved in 242 patients (96.0%) for the Lysholm, 227 patients (90.1%) for the SANE, and 146 patients (57.9%) for the VAS. PASS was achieved in 214 patients (84.9%) for the Lysholm, 198 patients (78.6%) for the SANE, and 199 (80.0%) patients for the VAS, postoperatively. Of note, 65 patients (25.8%) exceeded the PASS threshold for the VAS preoperatively. A total of 127 patients (84.4%) met the cutoff of ≥60/100 for the SV-ACL-RSI survey postoperatively. Postoperative KT-1000 measurements showed near-identical side-to-side differences at both the 13.6-kg pull and manual maximum pull. When stratifying patients based on age at the time of surgery, it was noted that patients younger than 25 years had significantly higher SANE scores (91.6 [95% CI: 90.2-92.9] vs. 82.6 [95% CI: 79.0-86.2]; p < 0.0001) and lower VAS pain scores (0.7 [95% CI: 0.5-0.8] vs. 1.2 [95% CI: 0.8-1.5]; p = 0.004). Primary ACLR with internal bracing led to acceptable patient outcomes and a graft failure rate of less than 1%. LEVEL OF EVIDENCE:: case series, IV.
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Affiliation(s)
- Adam V Daniel
- Department of Orthopaedic Surgery, Columbia Orthopaedic Group, Columbia, Missouri
| | - Chirag D Sheth
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, Missouri
| | - Daniel J Shubert
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, Missouri
| | - Patrick A Smith
- Department of Orthopaedic Surgery, Columbia Orthopaedic Group, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, Missouri
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Yang JS, Prentice HA, Reyes CE, Lehman CR, Maletis GB. Risk of Revision and Reoperation After Quadriceps Tendon Autograft ACL Reconstruction Compared With Patellar Tendon and Hamstring Autografts in a US Cohort of 21,973 Patients. Am J Sports Med 2024; 52:670-681. [PMID: 38284229 DOI: 10.1177/03635465231222267] [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: 01/30/2024]
Abstract
BACKGROUND The use of quadriceps tendon (QT) autografts has increased in the past 10 years. However, there remains a dearth of large studies examining the effects of graft selection on anterior cruciate ligament reconstruction (ACLR) that includes QT grafts. PURPOSE To evaluate the risk of subsequent surgical outcomes, including revision and reoperation, for a large cohort of patients with primary ACLR according to autograft selection. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Data from a US health care system ACLR registry were used to conduct a cohort study. Primary isolated autograft ACLRs were identified (2012-2021). The exposure of interest was autograft type: QT, bone-patellar tendon-bone (BPTB), and hamstring tendon (HT). Multivariable Cox regression models were used to evaluate the risk of aseptic revision (defined as a subsequent surgery where removal and replacement of the original graft for noninfectious reasons was required) and risk of aseptic reoperation (defined as any subsequent surgery for noninfectious reasons where the graft was left intact) according to autograft selection. RESULTS The study sample comprised 21,973 ACLRs performed by 290 surgeons at 53 hospitals. QT, BPTB, and HT autografts were used in 1103 (5.0%), 9519 (43.3%), and 11,351 (51.7%) ACLRs, respectively. In adjusted models, no significant differences were observed in revision risk (hazard ratio [HR], 1.06; 95% CI, 0.60-1.89; P = .837) or reoperation risk (HR, 1.00; 95% CI, 0.70-1.43; P = .993) within 4 years of follow-up when comparing QT ACLR with BPTB ACLR. Additionally, no differences in 4-year revision (HR, 0.62; 95% CI, 0.34-1.12; P = .111) or reoperation (HR, 1.24; 95% CI, 0.85-1.80; P = .262) risks were observed when comparing QT ACLR with HT ACLR. HT ACLRs were noted to have a higher risk of revision (HR, 1.52; 95% CI, 1.25-1.84; P < .001) compared with BPTB ACLRs but a lower risk of reoperation (HR, 0.86; 95% CI, 0.75-0.98; P = .024). CONCLUSION In this large multicenter study using data from an ACLR registry, the authors found no difference in the risk of revision or reoperation when QT was compared with BPTB or HT autograft with the numbers available, but they did find a 1.5 times higher risk of revision when HT autograft was compared with BPTB autograft. Surgeons may use this information when choosing the appropriate graft for ACLR in their patients.
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Affiliation(s)
- Justin S Yang
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Los Angeles, California, USA
| | - Heather A Prentice
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California, USA
| | - Chelsea E Reyes
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California, USA
| | - Christopher R Lehman
- Department of Orthopedic Surgery, Permanente Medical Group, South San Francisco, California, USA
| | - Gregory B Maletis
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Baldwin Park, California, USA
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Lawrence KW, Okewunmi JO, Chakrani Z, Cordero JK, Li X, Parisien RL. Randomized Controlled Trials Comparing Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction Surgery Are Statistically Fragile: A Systematic Review. Arthroscopy 2024; 40:998-1005. [PMID: 37543146 DOI: 10.1016/j.arthro.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/07/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To assess the statistical fragility of recently published randomized controlled trials (RCTs) comparing the use of hamstring tendon autograft with bone-patellar tendon-bone autograft for anterior cruciate ligament (ACL) reconstruction. METHODS The PubMed, Embase, and MEDLINE databases were queried for RCTs published since 2010 comparing autograft type (bone-patellar tendon-bone vs hamstring tendon) in ACL reconstruction surgery. The fragility index (FI) and reverse FI (rFI) were determined for significant and nonsignificant outcomes, respectively, as the number of outcome reversals required to change statistical significance. The fragility quotient (FQ) and reverse FQ, representing fragility as a proportion of the study population, were calculated by dividing the FI and rFI, respectively, by the sample size. RESULTS We identified 19 RCTs reporting 55 total dichotomous outcomes. The median FI of the 55 total outcomes was 5 (interquartile range [IQR], 4-7), meaning a median of 5 outcome event reversals would alter the outcomes' significance. Five outcomes were reported as statistically significant with a median FI of 4 (IQR, 2-6), meaning a median of 4 outcome event reversals would change outcomes to be nonsignificant. Fifty outcomes were reported as nonsignificant with a median rFI of 5 (IQR, 4-7), meaning a median of 5 outcome event reversals would change outcomes to be significant. The FQ and reverse FQ for significant and nonsignificant outcomes were 0.025 (IQR, 0.018-0.045) and 0.082 (IQR, 0.041-0.106), respectively. For 61.8% of outcomes, patients lost to follow-up exceeded the corresponding FI or rFI. CONCLUSIONS There is substantial statistical fragility in recent RCTs on autograft choice in ACL reconstruction surgery given that altering a few outcome events is sufficient to reverse study findings. For over half of outcomes, maintaining patients lost to follow-up may have been sufficient to reverse study conclusions. CLINICAL RELEVANCE We recommend co-reporting FIs and P values to provide a more comprehensive representation of a study's conclusions when conducting an RCT.
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Affiliation(s)
- Kyle W Lawrence
- Boston University School of Medicine, Boston, Massachusetts, U.S.A..
| | | | - Zakaria Chakrani
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - John K Cordero
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
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Nutarelli S, Rocchi JE, Salerno M, Sangiorgio A, Deabate L, Filardo G. Higher Eccentric Hamstring Muscle Fatigue After Participation in a Soccer Match in Young Female Athletes. Sports Health 2024:19417381241230613. [PMID: 38406840 DOI: 10.1177/19417381241230613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Hamstring (HS) strength deficits and imbalances have been identified as risk factors for sustaining anterior cruciate ligament (ACL) injuries and muscular strains, with HS injuries being the most prevalent muscle injuries in soccer athletes. The aim of this study was to investigate HS eccentric strength before and after a soccer match in both male and female soccer athletes. HYPOTHESIS Soccer athletes have changes in eccentric HS strength after a soccer game. STUDY DESIGN Cohort observational study. LEVEL OF EVIDENCE Level 3. METHODS HS eccentric strength (mean and absolute peak torque and total work) was measured in 64 healthy male and female competitive football athletes (14-25 years) with an automatic device during the execution of the Nordic hamstring exercise (NHE) test before and after a 90-minute soccer match. The anterior-knee laxity (AKL) was quantified with an arthrometer. RESULTS Mean and absolute eccentric HS peak torque decreased by 24.5 N.m (-12.34%; P < 0.01) and 21.9 N.m (-10.08%; P < 0.01) in female athletes, whereas their male peers improved by 19.9 N.m (+9.01%; P = 0.01) and by 20.9 N.m (+8.51%; P = 0.02), respectively. HS total work in female athletes decreased by 831.1 J (P < 0.01) compared with the male athlete reduction of 235.3 J. Both the pre- versus postmatch intersex mean and absolute eccentric HS peak torque changes were significant (P < 0.01), as were the changes in HS total work (P < 0.01). The pre- versus postmatch AKL difference and the dominant versus nondominant limb comparison of the strength parameters were not significantly different. Younger female athletes (14-19 years old) presented a greater decrease in mean and absolute peak HS eccentric strength compared with those in older female athletes and men. CONCLUSION HS eccentric strength and work differ based on athlete sex, as measured by the NHE test. Mean peak, absolute peak, and total work showed greater reductions in female athletes than those in their male peers. The subgroup of 14- to 19-year-old female athletes experienced the highest reduction in strength parameters.
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Affiliation(s)
- Sebastiano Nutarelli
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Jacopo Emanuele Rocchi
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy
- Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Rome, Italy
| | - Manuela Salerno
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Luca Deabate
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Williams AA, Koltsov JCB, Brett A, He J, Chu CR. Using 3D MRI Bone Shape to Predict Pre-Osteoarthritis of the Knee 2 Years After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:3677-3686. [PMID: 37936374 DOI: 10.1177/03635465231207615] [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: 11/09/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury increases risks for osteoarthritis (OA), a poorly modifiable and disabling condition. Joint changes of potentially reversible pre-OA have been described just 2 years after ACL reconstruction (ACLR) when early bone shape changes have also been reported. PURPOSE This study evaluates relationships between interlimb differences in tibiofemoral bone shape derived from statistical shape modeling (SSM) of magnetic resonance imaging (MRI) and participant factors on patient-reported outcomes 2 years after unilateral ACLR. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS SSM-derived tibiofemoral bone shape and subchondral bone area were assessed from bilateral knee MRI scans of 72 participants with unilateral ACLR (mean age, 34 ± 11 years; 32 women) and compared with a reference cohort of 398 older individuals without OA (mean age, 50 ± 3 years; 213 women). Multivariable logistic regression models examined relationships between participant and surgical factors with interlimb differences in bone shapes or subchondral bone areas. Relationships between patient-reported outcomes and the interlimb differences in bone shape and subchondral area were examined using similar models. RESULTS Bone shape scores and subchondral bone areas were greater (more OA-like) in ACLR knees than uninjured contralateral knees in every bone metric tested (P≤ .001). Interlimb differences in femur shape scores of participants with ACLR were 65% greater (P < .001) than those of the significantly older reference cohort. Taller height, medial meniscal tears, and decreasing age were associated with larger interlimb differences in shape scores and subchondral areas (P < .05). Bone-patellar tendon-bone (BPTB) autograft recipients demonstrated greater interlimb subchondral area differences compared with allograft recipients (P < .05). Interlimb differences for hamstring autograft recipients did not differ from those with BPTB or allograft. Greater interlimb differences in medial femur subchondral areas were associated with worse patient-reported Knee injury and Osteoarthritis Outcome Score Symptoms (R = 0.27; P = .040). CONCLUSION Even in the absence of radiographic OA, just 2 years after unilateral ACLR patients showed greater bone shape scores and subchondral areas consistent with pre-OA in their ACLR knees. Furthermore, greater medial femur bone areas were weakly associated with worse symptoms. Patients who are younger, are taller, have meniscal tears, or have BPTB grafts may be at increased risk for bony asymmetries 2 years after ACLR.
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Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jayme C B Koltsov
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | | | - Jade He
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Vivekanantha P, Nedaie S, Hassan Z, Abdel Khalik H, Carsen S, Nagai K, Hoshino Y, de Sa D. Contralateral hamstring autografts do not provide benefit compared to ipsilateral hamstring autografts in primary or revision anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5641-5651. [PMID: 37864773 DOI: 10.1007/s00167-023-07597-4] [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] [Received: 07/31/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of primary or revision ACL reconstruction (ACLR) after contralateral hamstring autografts versus ipsilateral hamstring autograft harvest. METHODS Three databases (MEDLINE, PubMed and EMBASE) were searched from inception to April 27th, 2023 for studies investigating contralateral hamstring autografts in primary or revision ACLR. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, strength measures, patient-reported outcome measures (PROMs), and rates of positive Lachman test, positive pivot-shift test and graft rupture were extracted. PROMs included Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores. RESULTS Nine studies comprising 371 patients were included in this review. In primary ACLR, there were no significant differences between contralateral and ipsilateral groups in isokinetic hamstring torque in the non-ACLR limb or isokinetic quadriceps torque in both limbs when tested at 60, 90, 120 or 180 degrees/second. Isokinetic hamstring torque in the non-ACLR limb was significantly weaker in the contralateral group at six months for primary ACLR; however, these deficits did not persist. There were no significant differences in postoperative median Tegner scores and Lysholm scores between contralateral and ipsilateral groups in primary ACLR. There were no significant differences in postoperative median Tegner, mean Lysholm and IKDC scores between groups in revision ACLR. There were no significant differences in positive Lachman, positive pivot-shift and rupture rates in primary ACLR between groups. Rates of positive Lachman and pivot-shift were slightly higher in the contralateral than ipsilateral group for revision ACLR. CONCLUSION Contralateral hamstring autografts results in comparable muscle strength to ipsilateral hamstring autografts, with the exception of weaker hamstring strengths in the early postoperative period. Patient-reported outcome measures were similar between the two groups across both primary and revision ACLR, with rates of instability and failure being similar between groups for primary ACLR. Contralateral hamstring grafts do not provide additional benefit when compared to ipsilateral options for either primary or revision ACLR, and should be used only in select circumstances including insufficient ipsilateral hamstring grafts or situations where quadriceps or patella autografts are not optimal. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Soroush Nedaie
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Zackariyah Hassan
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St West, Hamilton, ON, L8S 4L8, Canada.
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Aldag L, Dallman J, Henkelman E, Herda A, Randall J, Tarakemeh A, Morey T, Vopat BG. Various Definitions of Failure Are Used in Studies of Patients Who Underwent Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2023; 5:100801. [PMID: 37766857 PMCID: PMC10520319 DOI: 10.1016/j.asmr.2023.100801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose To conduct a literature review to assess the definitions of anterior cruciate ligament reconstruction (ACLR) failure used throughout the orthopaedic literature. Methods A systematic search of Embase, Ovid Medline, SPORTDiscus, and Web of Science was conducted by a university librarian to identity level I-IV clinical studies on ACLR failure. Inclusion criteria consisted of patients who underwent ACLR and included a definition of failure of ACLR. Patients who underwent anterior cruciate ligament (ACL) repairs, animal/cadaver studies, review studies, non-English language articles, and non-full text articles were excluded. Failure data were extracted from each study and categorized. Other data that were extracted included follow-up time after ACLR, failure reoperation rate, and failure reoperation procedure. Descriptive statistics was used to analyze the data. Results Out of 2,775 studies, 104 (3.75%) met inclusion criteria and were analyzed in this review. The most common definition of ACLR failure included the use of a physical examination, specifically Lachman's test (21/104 [20.2%]), anterior laxity assessment, or a Pivot-Shift test (24/104 [35.2%]) or undergoing or requiring revision ACLR (39/104 [37.5%]). Although some studies used quantitative tests or imaging to help define "failure," others simply defined it as graft rerupture that was otherwise not defined (22/104 [22.5%]). Other common definitions included: the use of imaging (magnetic resonance imaging/radiographs) to confirm graft re-rupture (37/104 [35.6%]), patient-reported outcomes (recurrent instability)/patient reported outcomes measures (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner) (18/104 [17.3%]), and the use of an arthrometer (KT-1000/2000, Rollimeter, or Kneelax) (17/104 [16.3%]). The least common definitions included graft failure or rerupture confirmed by arthroscopy (13/104 [12.5%]) and nonrevision surgery (2/104 [1.0%]). The failure rate of this procedure ranged from 0% to 100% depending on the definition of "failure." Conclusion In this study, we found that a variety of definitions of failure are used among studies published in the orthopaedic literature. The most common criteria for failure of ACLR were the results of physical examination tests (35%), the need for undergoing a revision ACLR (36%), and the use of imaging to diagnose the failure (34%). About 17% of studies included in this review used patient-reported outcomes, specifically recurrent instability, or PROMs (IKDC, KOOS, Tegner) in their assessment of failure of ACLR. The least used definitions of "failure" of ACLR included nonrevision ACLR surgery (2%). Although some studies used similar tests or categories in their definition of failure, there were a variety of score and grade cutoff points between them. Level of Evidence Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Levi Aldag
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Johnathan Dallman
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Erik Henkelman
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Ashley Herda
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, U.S.A
| | - Jeffrey Randall
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Armin Tarakemeh
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Tucker Morey
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Bryan G. Vopat
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
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11
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Liukkonen R, Vaajala M, Mattila VM, Reito A. Prevalence of post-traumatic osteoarthritis after anterior cruciate ligament injury remains high despite advances in surgical techniques. Bone Joint J 2023; 105-B:1140-1148. [PMID: 37907079 DOI: 10.1302/0301-620x.105b11.bjj-2023-0058.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims The aim of this study was to report the pooled prevalence of post-traumatic osteoarthritis (PTOA) and examine whether the risk of developing PTOA after anterior cruciate ligament (ACL) injury has decreased in recent decades. Methods The PubMed and Web of Science databases were searched from 1 January 1980 to 11 May 2022. Patient series, observational studies, and clinical trials having reported the prevalence of radiologically confirmed PTOA after ACL injury, with at least a ten-year follow-up, were included. All studies were analyzed simultaneously, and separate analyses of the operative and nonoperative knees were performed. The prevalence of PTOA was calculated separately for each study, and pooled prevalence was reported with 95% confidence intervals (CIs) using either a fixed or random effects model. To examine the effect of the year of injury on the prevalence, a logit transformed meta-regression analysis was used with a maximum-likelihood estimator. Results from meta-regression analyses were reported with the unstandardized coefficient (β). Results The pooled prevalence of PTOA was 37.9% (95% CI 32.1 to 44) for operatively treated ACL injuries with a median follow-up of 14.6 years (interquartile range (IQR) 10.6 to 16.7). For nonoperatively treated ACL injuries, the prevalence was 40.5% (95% CI 28.9 to 53.3), with a median of follow-up of 15 years (IQR 11.7 to 20.0). The association between the year of operation and the prevalence of PTOA was weak and imprecise and not related to the choice of treatment (operative β -0.038 (95% CI -0.076 to 0.000) and nonoperative β -0.011 (95% CI -0.101 to 0.079)). Conclusion The initial injury, irrespective of management, has, by the balance of probability, resulted in PTOA within 20 years. In addition, the prevalence of PTOA has only slightly decreased during past decades. Therefore, further research is warranted to develop strategies to prevent the development of PTOA after ACL injuries.
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Affiliation(s)
- Rasmus Liukkonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matias Vaajala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Aleksi Reito
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Rahardja R, Love H, Clatworthy MG, Young SW. Comparison of Knee Pain and Difficulty With Kneeling Between Patellar Tendon and Hamstring Tendon Autografts After Anterior Cruciate Ligament Reconstruction: A Study From the New Zealand ACL Registry. Am J Sports Med 2023; 51:3464-3472. [PMID: 37775983 PMCID: PMC10623603 DOI: 10.1177/03635465231198063] [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] [Received: 03/02/2023] [Accepted: 07/24/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The bone-patellar tendon-bone (BTB) autograft is associated with difficulty with kneeling after anterior cruciate ligament (ACL) reconstruction; however, it is unclear whether it results in a more painful or symptomatic knee compared with the hamstring tendon autograft. PURPOSE To identify the rate and risk factors for knee pain and difficulty with kneeling after ACL reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Primary ACL reconstruction procedures prospectively recorded in the New Zealand ACL Registry from April 2014 to May 2021 were analyzed. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to identify patients reporting consequential knee pain (CKP), defined as a KOOS Pain subscore of ≤72 points, and severe kneeling difficulty (SKD), defined as a self-report of "severe" or "extreme" difficulty with kneeling. Absolute values of the KOOS Pain and Symptoms subscales were also compared. RESULTS A total of 10,999 patients were analyzed. At 2-year follow-up, 9.3% (420/4492) reported CKP, and 12.0% (537/4471) reported SKD. The most important predictor of CKP at 2-year follow-up was having significant pain before surgery (adjusted odds ratio, 4.10; P < .001). The most important predictor of SKD at 2-year follow-up was the use of a BTB autograft rather than a hamstring tendon autograft (21.3% vs 9.4%, respectively; adjusted odds ratio, 3.12; P < .001). There was no difference between the BTB and hamstring tendon grafts in terms of CKP (9.9% vs 9.2%, respectively; P = .494) or in absolute values of the KOOS Pain (mean, 88.7 vs 89.0, respectively; P = .37) and KOOS Symptoms (mean, 82.5 vs 82.1, respectively; P = .49) subscales. CONCLUSION At 2-year follow-up after primary ACL reconstruction, 9.3% of patients reported CKP, and 12.0% reported SKD. The BTB autograft was associated with difficulty with kneeling, but it did not result in a more painful or symptomatic knee compared with the hamstring tendon autograft.
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Affiliation(s)
- Richard Rahardja
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Mark G. Clatworthy
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Simon W. Young
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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13
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Zhao D, Pan JK, Lin FZ, Luo MH, Liang GH, Zeng LF, Huang HT, Han YH, Xu NJ, Yang WY, Liu J. Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3053-3075. [PMID: 36189967 DOI: 10.1177/03635465221119787] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The rerupture or need for revision after anterior cruciate ligament reconstruction (ACLR) is a serious complication. Preventive strategies that target the early identification of risk factors are important to reduce the incidence of additional surgery. PURPOSE To perform a systematic review and meta-analysis to investigate risk factors for revision or rerupture after ACLR. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Literature searches were performed in PubMed, Embase, and Web of Science from database inception to November 2021 and updated in January 2022. Quantitative, original studies reporting potential adjusted risk factors were included. Odds ratios (ORs) were calculated for potential risk factors. RESULTS A total of 71 studies across 13 countries with a total sample size of 629,120 met the inclusion criteria. Fifteen factors were associated with an increase in the risk of revision or rerupture after ACLR: male sex (OR, 1.27; 95% CI, 1.14-1.41), younger age (OR, 1.07; 95% CI, 1.05-1.08), lower body mass index (BMI) (OR, 1.03; 95% CI, 1.00-1.06), family history (OR, 2.47; 95% CI, 1.50-4.08), White race (OR, 1.32; 95% CI, 1.08-1.60), higher posterolateral tibial slope (OR, 1.15; 95% CI, 1.05-1.26), preoperative high-grade anterior knee laxity (OR, 2.30; 95% CI, 1.46-3.64), higher baseline Marx activity level (OR, 1.07; 95% CI, 1.02-1.13), return to a high activity level/sport (OR, 2.03; 95% CI, 1.15-3.57), an ACLR within less than a year after injury (OR, 2.05; 95% CI, 1.81-2.32), a concomitant medial collateral ligament (MCL) injury (OR, 1.62; 95% CI, 1.31-2.00), an anteromedial portal or transportal technique (OR, 1.36; 95% CI, 1.22-1.51), hamstring tendon (HT) autografts (vs bone-patellar tendon-bone [BPTB] autografts) (OR, 1.60; 95% CI, 1.40-1.82), allografts (OR, 2.63; 95% CI, 1.65-4.19), and smaller graft diameter (OR, 1.21; 95% CI, 1.05-1.38). The other factors failed to show an association with an increased risk of revision or rerupture after ACLR. CONCLUSION Male sex, younger age, lower BMI, family history, White race, higher posterolateral tibial slope, preoperative high-grade anterior knee laxity, higher baseline Marx activity level, return to a high activity level/sport, an ACLR within less than a year from injury, a concomitant MCL injury, an anteromedial portal or transportal technique, HT autografts (vs BPTB autografts), allografts, and smaller graft diameter may increase the risk of revision or rerupture after ACLR. Raising awareness and implementing effective preventions/interventions for risk factors are priorities for clinical practitioners to reduce the incidence of revision or rerupture after ACLR.
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Affiliation(s)
- Di Zhao
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jian-Ke Pan
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang-Zheng Lin
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-Hui Luo
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gui-Hong Liang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ling-Feng Zeng
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - He-Tao Huang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Hong Han
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nan-Jun Xu
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Yi Yang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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Sollberger VD, Korthaus A, Barg A, Pagenstert G. Long-term results after anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon autograft with a minimum follow-up of 10 years-a systematic review. Arch Orthop Trauma Surg 2023; 143:4277-4289. [PMID: 36441213 PMCID: PMC10293370 DOI: 10.1007/s00402-022-04687-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/28/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A lot of research addresses superiority of the two commonly used autografts bone-patellar tendon-bone (BPTB) and hamstring tendon for anterior cruciate ligament (ACL) reconstruction, without getting to consensus. While there are numerous studies and reviews on short- to mid-term follow-up, not much literature is available on long-term follow-up. As patients suffering ACL injuries are often of young age and high athletic activity, it is crucial to have the best evidence possible for graft choice to minimize consequences, like osteoarthritis later on. MATERIALS AND METHODS A search of the online databases, PubMed and Embase, was carried out last on 31st March 2022 for studies comparing BPTB and hamstring tendon (HT) autografts for ACL reconstruction in human patients with a minimum follow-up of 10 years. The methodological quality of each study has been evaluated using the modified Coleman Methodology Score. Results on the three variables patient-oriented outcomes, clinical testing and measurements and radiographic outcomes were gathered and are presented in this review. RESULTS Of 1299 records found, nine studies with a total of 1833 patients were identified and included in this systematic review. The methodological quality of the studies ranged from a Coleman Score of 63-88. Many studies reported no or only few statistically significant differences. Significant results in favour of BPTB were found for activity levels and for instrumented laxity testing with the KT-1000 arthrometer. Better outcomes for HT were found in IKDC-SKF, the KOOS, donor site morbidity, pivot shift test, radiographic osteoarthritis (IKDC C or D) and contralateral ACL rupture. No studies presented significant differences in terms of Lysholm Score or Tegner Activity Score, Lachman test, single-legged hop test, deficits in range of motion, osteoarthritis using the Kellgren and Lawrence classification or graft rupture. CONCLUSION We cannot recommend one graft to be superior, since both grafts show disadvantages in the long-term follow-up. Considering the limitation of our systematic review of no quantitative analysis, we cannot draw further conclusions from the many insignificant results presented by individual studies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- V. D. Sollberger
- CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Clarahofweg 19a, 4058 Basel, Switzerland
| | - A. Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Germany, Martinistr. 52, 20251 Hamburg, Germany
| | - A. Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Germany, Martinistr. 52, 20251 Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - G. Pagenstert
- CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Clarahofweg 19a, 4058 Basel, Switzerland
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Chalatsis G, Mitrousias V, Siouras A, Panteliadou F, Tziolas I, Solomou C, Hantes M. Long-term Quality of Life in Patients After ACL Reconstruction With Concomitant Meniscal Injury Treatment: Patient-Reported Outcomes at Minimum 10-Year Follow-up. Orthop J Sports Med 2023; 11:23259671231177279. [PMID: 37347018 PMCID: PMC10280537 DOI: 10.1177/23259671231177279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/09/2023] [Indexed: 06/23/2023] Open
Abstract
Background Long-term studies of patients after anterior cruciate ligament (ACL) reconstruction with or without concomitant meniscal tear treatment are limited. Purposes To (1) report postoperative outcomes after anatomic ACL reconstruction with a hamstring autograft, (2) investigate how concomitant treatment of meniscal injury could affect these outcomes, and (3) evaluate the association between quality of life and activity levels at a minimum 10-year follow-up. Study Design Cohort study; Level of evidence, 3. Methods Patients treated with a unilateral, anatomic ACL reconstruction between 2005 and 2011 were investigated. The following patient-reported outcome measures (PROMs) were reported for the overall sample as well as a subsample of patients with meniscal injury: International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, Tegner activity scale, 5-level EQ-5D (EQ-5D-5L), and patient satisfaction. Sex, age, body mass index (BMI), and meniscal injury treatment (meniscectomy vs meniscal repair) were examined as patient-specific risk factors regarding long-term activity and quality of life. Results Overall, 106 patients, 90 men (85%) and 16 women (15%), were enrolled in the study, with a mean follow-up of 13.2 years. The ACL retear rate was 2.8%. The mean scores were 80.6 ± 16.7 (IKDC-SKF), 87.4 ± 15.0 (KOOS), 90.5 ± 11.5 (Lysholm), 5.6 ± 1.9 (Tegner), and 91.8 ± 14.5 (EQ-5D-5L). The majority (90.6%) of patients considered their knee state satisfactory during follow-up. When compared with patients who underwent meniscal repair, patients who underwent meniscectomy had statistically significantly lower scores on all PROMs except for the Tegner and EQ-5D-5L (P < .05 for all). The mean difference between the 2 groups was ≥7 points on all PROM scores. Patient sex, age, and BMI did not affect PROM scores. There was a statistically significant, strong positive correlation between quality of life and activity. Conclusion Patients had few or no symptoms and considered their knee state satisfactory 13.2 years after anatomic ACL reconstruction. Patients with concomitant meniscal tears having undergone meniscal repair had improved PROMs compared with those treated with meniscectomy. Finally, participation in activities of daily living and sports was interrelated with quality of life and was not affected by patient age, sex, or BMI.
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Affiliation(s)
- Georgios Chalatsis
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Vasileios Mitrousias
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Athanasios Siouras
- Department of Computer Science and
Biomedical Informatics, School of Science, University of Thessaly, Lamia,
Greece
- AIDEAS OÜ, Tallinn, Estonia
| | - Freideriki Panteliadou
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Ioannis Tziolas
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Chrysovalantis Solomou
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Michael Hantes
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
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16
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Migliorini F, Torsiello E, Trivellas A, Eschweiler J, Hildebrand F, Maffulli N. Bone-patellar tendon-bone versus two- and four-strand hamstring tendon autografts for ACL reconstruction in young adults: a Bayesian network meta-analysis. Sci Rep 2023; 13:6883. [PMID: 37106008 PMCID: PMC10140035 DOI: 10.1038/s41598-023-33899-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Bone-patellar tendon-bone (BPTB), two- and four-strand hamstring tendon (4SHT and 2SHT, respectively) are the most common autografts used for anterior cruciate ligament (ACL) reconstruction. The present study compared BPTB, 2SHT, and 4SHT for ACL reconstruction in terms of joint laxity, patient reported outcome measures (PROMs), rate of failure and anterior knee pain (AKP). The time to return to sport and the peak torque between the autografts were also compared. Finally, prognostic factors leading to worse outcomes were also investigated. It was hypothesized that all grafts yield similar proprieties in terms of joint laxity, patient reported outcome measures (PROMs) and rate of failure, but that the BPTB autograft causes a greater rate of anterior knee pain (AKP). The literature search was conducted. All clinical trials comparing BTPB and/or 2SHT, and/or 4SHT were accessed. Grafts other than BTPB and/or 4SHT and/or 2SHT were not considered. Articles reporting outcomes of allografts or synthetic grafts were not eligible, nor were those concerning revision settings. Articles reporting ACL reconstruction in patients with multi-ligament damage were also not eligible. Data from 95,575 procedures were retrieved. The median length of follow-up was 36 months. The median age of the patients was 27.5 years. With regard to joint laxity, similarity was found in terms of Lachman and Pivot shift tests between all three autografts. The BPTB demonstrated the greatest stability in terms of instrumental laxity. BPTB demonstrated the greatest PROMs. BPTB demonstrated the greatest rate of AKP, while AKP in 2SHT and 4SHT was similar. Concerning failure, statistically significant inconsistency was found (P = 0.008). The 4SHT demonstrated the quickest return to sport, followed by BPTB, and 2SHT. There was evidence of a negative association between the time span between injury to surgery, Lysholm score (P = 0.04), and Tegner scale (P = 0.04). Furthermore, there was evidence of a weak positive association between the time span between injury to surgery and return to sport (P = 0.01). BPTB may result in lower joint laxity, greater PROMs, and greater peak flexion torque compared to 2SHT and 4SHT autografts. On the other hand, BPTB reported the lowest peak extension torque and the greatest rate of AKP. Finally, a longer time span between injury and surgery negatively influences outcome.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Ernesto Torsiello
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Andromahi Trivellas
- Department of Orthopaedic and Trauma Surgery, Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, 90095, USA
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
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Ruelos VCB, Masood R, Puzzitiello RN, Moverman MA, Pagani NR, Menendez ME, Salzler MJ. The reverse fragility index: RCTs reporting non-significant differences in failure rates between hamstring and bone-patellar tendon-bone autografts have fragile results. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07420-0. [PMID: 37093236 DOI: 10.1007/s00167-023-07420-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The reverse fragility index (RFI) is a novel metric to appraise the results of studies reporting statistically non-significant results. The purpose of this study was to determine the statistical robustness of randomized controlled trials (RCTs) reporting non-significant differences in anterior cruciate ligament reconstruction (ACLR) graft failure rates, defined as re-rupture/revision ACLR rate, between hamstring tendon (HT) and bone-patellar tendon-bone (BTB) autografts by calculating RFIs. METHODS A systematic review was performed to identify RCTs that compared HT to BTB grafts for ACLR through January 2022. Studies reporting non-significant differences in graft re-rupture and revision ACLR rate (n.s.) were included. The RFI, defined as the fewest number of event reversals needed to change the non-significant graft re-rupture/revision outcome to statistically significant (P < 0.05), was recorded for each study. In addition, the number of studies in which the loss to follow-up exceeded the RFI was recorded. RESULTS Among the 16 included RCTs, the median (interquartile range [IQR]) sample size was 71 (64-114), and the median (IQR) total number of graft re-rupture/revision ACLR events was 4 (4-6). The median (IQR) graft re-rupture/revision ACLR rate was 4.3% (3.0-6.4) overall, 4.1% (2.6-6.7) in the BTB group, and 5.4% (3.0-6.3) in the HT group. The median (IQR) RFI was 3 (3-4), signifying that a reversal of the outcome in 3 patients in one arm was needed to flip the studies' result from non-significant to statistically significant (P < 0.05). The median (IQR) number of participants lost to follow-up was 11 (3-13), and 13 (81.3%) of the included studies had a loss to follow-up greater than the studies' RFI. CONCLUSION The results of RCTs reporting statistically non-significant re-rupture/revision ACLR rates between HT and BTB autografts would become significant if the outcome were reversed in a small number of patients-a number that was less than the loss to follow-up in the majority of studies. Thus, the neutrality of these studies is fragile, and a true statistically significant difference in re-rupture/revision rates may have been undetected. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | - Raisa Masood
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA
| | - Mariano E Menendez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, 270 Tremont St Biewend Building, Boston, MA, 02111, USA.
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18
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Runer A, Keeling L, Wagala N, Nugraha H, Özbek EA, Hughes JD, Musahl V. Current trends in graft choice for primary anterior cruciate ligament reconstruction - part II: In-vivo kinematics, patient reported outcomes, re-rupture rates, strength recovery, return to sports and complications. J Exp Orthop 2023; 10:40. [PMID: 37014518 PMCID: PMC10073382 DOI: 10.1186/s40634-023-00601-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Postoperative patient satisfaction after anterior cruciate ligament reconstruction (ACL-R) is influenced mainly by the degree of pain, the need for reoperation, and functional performance in daily activities and sports. Graft choice has shown to have an influence on postoperative outcomes after ACL-R. While patient reported outcomes measurements do not differ between graft options, evidence shows that normal knee kinematics is not fully restored after ACL-R with an increase in postoperative anterior tibial translation (ATT). Postoperative graft rupture rates seem to favor bone-patella-tendon-bone (BPTB) and quadriceps tendon (QT) autografts over HT or allografts. While return to sports rates seem comparable between different graft types, postoperative extensor strength is reduced in patients with BPTB and QT whereas flexion strength is weakened in patients with HT. Postoperative donor site morbidity is highest in BPTB but comparable between HT and QT. With all graft options having advantages and drawbacks, graft choice must be individualized and chosen in accordance with the patient.
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Affiliation(s)
- Armin Runer
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.
- Department for Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Laura Keeling
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nyaluma Wagala
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hans Nugraha
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Udayana, / Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Emre Anil Özbek
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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19
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Kunze KN, Moran J, Polce EM, Pareek A, Strickland SM, Williams RJ. Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07402-2. [PMID: 37000243 DOI: 10.1007/s00167-023-07402-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE To perform a meta-analysis of RCTs evaluating donor site morbidity after bone-patellar tendon-bone (BTB), hamstring tendon (HT) and quadriceps tendon (QT) autograft harvest for anterior cruciate ligament reconstruction (ACLR). METHODS PubMed, OVID/Medline and Cochrane databases were queried in July 2022. All level one articles reporting the frequency of specific donor-site morbidity were included. Frequentist model network meta-analyses with P-scores were conducted to compare the prevalence of donor-site morbidity, complications, all-cause reoperations and revision ACLR among the three treatment groups. RESULTS Twenty-one RCTs comprising the outcomes of 1726 patients were included. The overall pooled rate of donor-site morbidity (defined as anterior knee pain, difficulty/impossibility kneeling, or combination) was 47.3% (range, 3.8-86.7%). A 69% (95% confidence interval [95% CI]: 0.18-0.56) and 88% (95% CI: 0.04-0.33) lower odds of incurring donor-site morbidity was observed with HT and QT autografts, respectively (p < 0.0001, both), when compared to BTB autograft. QT autograft was associated with a non-statistically significant reduction in donor-site morbidity compared with HT autograft (OR: 0.37, 95% CI: 0.14-1.03, n.s.). Treatment rankings (ordered from best-to-worst autograft choice with respect to donor-site morbidity) were as follows: (1) QT (P-score = 0.99), (2) HT (P-score = 0.51) and (3) BTB (P-score = 0.00). No statistically significant associations were observed between autograft and complications (n.s.), reoperations (n.s.) or revision ACLR (n.s.). CONCLUSION ACLR using HT and QT autograft tissue was associated with a significant reduction in donor-site morbidity compared to BTB autograft. Autograft selection was not associated with complications, all-cause reoperations, or revision ACLR. Based on the current data, there is sufficient evidence to recommend that autograft selection should be personalized through considering differential rates of donor-site morbidity in the context of patient expectations and activity level without concern for a clinically important change in the rate of adverse events. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, East 70th Street, New York, NY, 53510021, USA.
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA.
| | - Jay Moran
- Yale School of Medicine, New Haven, CT, USA
| | - Evan M Polce
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ayoosh Pareek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, East 70th Street, New York, NY, 53510021, USA
| | - Sabrina M Strickland
- Department of Orthopaedic Surgery, Hospital for Special Surgery, East 70th Street, New York, NY, 53510021, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA
| | - Riley J Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, East 70th Street, New York, NY, 53510021, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA
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20
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Kuliński K, Waśko MK, Tramś E, Malesa K, Pomianowski S, Kamiński R. Anterior Cruciate Ligament Reconstruction Using a 4-Strand Semitendinosus Tendon Graft or a Doubled Semitendinosus and Gracilis Tendon Graft: A 4.5-Year Prospective, Randomized, Double-Blind, Parallel-Group Study. Am J Sports Med 2023; 51:615-626. [PMID: 36856280 DOI: 10.1177/03635465221149738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Hamstring tendon grafts are the most common choice for anterior cruciate ligament (ACL) reconstruction (ACLR). Previous studies have provided evidence that offers conflicting opinions concerning the most favorable graft choice. PURPOSE To identify whether the use of a quadrupled semitendinosus tendon (ST) or doubled semitendinosus tendon and gracilis tendon (ST/G) graft provides comparable anterior tibial translation (ATT) with similar functional results and similar donor site morbidity. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This was a prospective, patient- and surgeon-blinded, randomized trial set in a busy orthopaedic and traumatology department at a university hospital. Between 2015 and 2017, a total of 162 patients with ACL lesions were randomized to undergo ACLR with either a quadrupled ST or doubled ST/G graft. The primary endpoint was ATT assessed with the KT-1000 arthrometer. Clinical outcomes were assessed using the patient-reported outcome measures (PROMs) of the visual analog scale (VAS), International Knee Documentation Committee (IKDC) subjective evaluation form, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, and Lysholm knee scoring scale. RESULTS Preoperative demographic data, ATT, and PROM scores showed no significant differences. At 4.5 years, no significant differences were found between the ST and ST/G groups with respect to PROM scores and KT-1000 arthrometer, Lachman test, and pivot-shift test findings. Differences in functional results between groups were significant (muscle strength). Subgroup analysis revealed significantly increased ATT in female patients undergoing ACLR with a quadrupled ST graft during the 4.5-year observation period, as assessed by the KT-1000 arthrometer, as well as inferior KOOS, IKDC, Lysholm, and VAS scores. CONCLUSION This study showed a significant increase in ATT as well as inferior results on PROMs during a 4.5-year observation period in female patients undergoing ACLR with a quadrupled ST graft. In male patients, the study provided evidence of the noninferiority of ACLR with an ST graft, with no influence on donor site morbidity. TRIAL REGISTRATION clinicaltrials.gov: NCT03626883.
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Affiliation(s)
- Krzysztof Kuliński
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Marcin K Waśko
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Tramś
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Kamila Malesa
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Stanisław Pomianowski
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Rafał Kamiński
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
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21
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Lai S, Zhang Z, Li J, Fu WL. Comparison of Anterior Cruciate Ligament Reconstruction With Versus Without Anterolateral Augmentation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop J Sports Med 2023; 11:23259671221149403. [PMID: 37025126 PMCID: PMC10071203 DOI: 10.1177/23259671221149403] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/21/2022] [Indexed: 04/08/2023] Open
Abstract
Background It is clear that the anterolateral ligament has an important role in rotational knee stability. However, whether patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) can benefit from anterolateral augmentation (ALA) is still controversial. Purpose To compare the effects of isolated ACLR versus ACLR combined with ALA (ACLR+ALA) on clinical outcomes and knee stability. Study Design Systematic review; Level of evidence, 1. Methods The methodology followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of the PubMed, Embase, and Cochrane Library Central Register of Controlled Trials databases was undertaken to identify all randomized controlled trials (RCTs) comparing isolated ACLR with ACLR+ALA for the treatment of ACL injuries in the last 15 years. The Cochrane Collaboration risk-of-bias tool and the revised Jadad scale were utilized by 2 independent reviewers to determine the quality of RCTs. Relevant data were extracted and compared between procedures, and heterogeneity across the RCTs was assessed using the I 2 statistic. Results The initial search yielded 849 articles. A total of 14 studies (1850 patients; 941 ACLR and 909 ACLR+ALA) satisfied the eligibility criteria for the meta-analysis. There were no significant differences between the procedures in terms of patient-reported outcomes (International Knee Documentation Committee score, Tegner score, Knee injury and Osteoarthritis Outcome Score) or return-to-sport rates. However, patients who underwent ACLR+ALA had better knee stability based on the pivot-shift test (risk ratio [RR], 1.06 [95% CI, 1.02 to 1.10]; P = .0008), Lachman test (RR, 1.03 [95% CI, 1.00 to 1.07]; P = .04), and side-to-side difference in anterior laxity (standardized mean difference, -0.55 [95% CI, -0.98 to -0.12]; P = .01) as well as a lower incidence of graft failure (RR, 0.30 [95% CI, 0.19 to 0.45]; P < .01) compared with patients who underwent isolated ACLR. Conclusion ALA can be considered as a reinforcement of ACLR to improve anteroposterior and anterolateral rotational stability of the knee and reduce the risk of failure. The patient-reported outcomes of isolated ACLR were similar to those of ACLR+ALA, and both procedures provided improved knee function.
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Affiliation(s)
- Sike Lai
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
| | - Zhong Zhang
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
| | - Jian Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
- Jian Li, MD, or Wei-Li Fu, MD, Department of Orthopedic Surgery,
West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041,
China ( or
, respectively)
| | - Wei-Li Fu
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
- Jian Li, MD, or Wei-Li Fu, MD, Department of Orthopedic Surgery,
West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041,
China ( or
, respectively)
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22
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Nagai K, Kamada K, Kay J, Hoshino Y, Matsushita T, Kuroda R, de Sa D. Clinical Outcomes After Anterior Cruciate Ligament Reconstruction in Patients With a Concomitant Segond Fracture: A Systematic Review. Am J Sports Med 2023; 51:525-533. [PMID: 34668790 DOI: 10.1177/03635465211045689] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Segond fracture can be observed in patients with an anterior cruciate ligament (ACL) tear. It is unclear whether the Segond fracture affects clinical outcomes after ACL reconstruction. PURPOSE To investigate whether the presence of a concomitant Segond fracture affects clinical outcomes after ACL reconstruction and to compare clinical outcomes when a Segond fracture is repaired surgically or left unrepaired. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Three databases (PubMed, Embase, Cochrane Library) were searched in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on July 27, 2020. Relevant studies regarding ACL injury with concomitant Segond fracture treated by primary ACL reconstruction were screened in duplicate. Data regarding patient characteristics and clinical outcomes were extracted. Descriptive data are presented, and a random-effects model was used to pool amenable data. RESULTS A total of 5 studies examining 2418 patients (987 female; 40.8%), mean age 25.4 years, were included in this study. There were 304 patients with a Segond fracture (mean age, 28.1 years; 35.9% female) and 2114 patients without a Segond fracture (mean age, 25.1 years; 41.5% female). Four studies directly compared outcomes between patients with an unrepaired Segond fracture and no Segond fracture. One study reported 12 patients who underwent ACL reconstruction and repair of a Segond fracture. Among 4 studies, 11 of 292 (3.8%) graft failures/revision surgeries were reported in the groups that had Segond fracture, whereas 145 of 2114 (6.9%) graft failures/revision surgeries were reported in groups that did not have Segond fracture. No significant difference was observed in the risk of graft failure between the 2 groups, with a pooled risk ratio of 0.59 (95% CI, 0.32-1.07; P = .08; I2 = 0%). No clinically significant differences were observed with regard to International Knee Document Committee score, Lysholm score, Tegner activity scale, and postoperative knee laxity between the group with Segond fracture and those without. CONCLUSION An unrepaired Segond fracture does not appear to have any significant negative effect on postoperative stability or risk of graft failure or revision surgery after ACL reconstruction. Future prospective studies may be warranted to confirm the finding that patients with combined ACL injury and Segond fracture may have outcomes comparable with those of ACL-injured patients without a Segond fracture when isolated ACL reconstruction is performed.
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Affiliation(s)
- Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kohei Kamada
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Shagawa M, Maruyama S, Sekine C, Yokota H, Hirabayashi R, Togashi R, Yamada Y, Osanami H, Sato D, Edama M. Knee Laxity in the Menstrual Cycle after Anterior Cruciate Ligament Reconstruction: A Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2277. [PMID: 36767641 PMCID: PMC9915399 DOI: 10.3390/ijerph20032277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to compare anterior knee laxity (AKL), genu recurvatum (GR), and muscle stiffness between reconstructed and contralateral sides in females who underwent anterior cruciate ligament (ACL) reconstruction during early follicular and ovulatory phases. AKL was measured as an anterior displacement of the tibia using a KS measure. GR was measured as the range of motion of knee hyperextension using a hyperextension apparatus. Muscle stiffness was measured for semitendinosus (ST) and biceps femoris long head (BF) using a MyotonPRO. The study investigated eighteen knees in nine females (Age, 20.4 ± 1.5 years; BMI, 21.5 ± 1.5) with normal menstrual cycles at least 1 year after reconstruction using hamstring autograft. E2 (Estradiol) concentration did not differ between the two phases, but AKL on the reconstructed side was lower during the ovulatory phase (8.3 [5.9-9.3] mm) than during the early follicular phase (9.4 [7.3-9.7] mm) (p = 0.044, r = 0.756), whereas there was no significant difference between the two phases on the contralateral side. AKL side-to-side difference, GR, and muscle stiffness (ST and BF) on both sides did not differ in either phase. These results indicate that AKL may behave differently on the reconstructed and contralateral sides during the menstrual cycle.
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Affiliation(s)
- Mayuu Shagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Sae Maruyama
- Albirex Niigata Inc. 5-1923-23, Higashiko, Seiro-machi, Kitakanbara-gun, Niigata 957-0101, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Haruki Osanami
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Daisuke Sato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
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24
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Peez C, Greßmann M, Raschke MJ, Glasbrenner J, Briese T, Frank A, Herbst E, Kittl C. The Bone Bridge for Tibial ACL Graft Fixation: A Biomechanical Analysis of Different Tibial Fixation Methods for ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671221143478. [PMID: 36636032 PMCID: PMC9830095 DOI: 10.1177/23259671221143478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/13/2022] [Indexed: 01/09/2023] Open
Abstract
Background The tibial fixation site is considered the weak link in anterior cruciate ligament (ACL) reconstruction, and conflicting results regarding the biomechanical properties of various fixation methods have been reported. Purpose To examine knots tied over a bone bridge and its biomechanical properties as a suitable tibial fixation method in ACL reconstruction. Study Design Controlled laboratory study. Methods We divided 40 fresh-frozen porcine tibiae into 4 equal groups to evaluate flexor tendon grafts set with standard tibial fixation techniques: (1) bone bridge (BB group), (2) suspension button (SB group), (3) combined interference screw and bone bridge (IFS/BB group), and (4) combined interference screw and suspension button (IFS/SB group). Each construct was subjected to cyclic loading (1500 cycles, 50-250 N, 1 Hz) with a servohydraulic materials testing machine to measure elongation; load-to-failure testing (displacement rate: 25 mm/s) was then performed. Load to failure, stiffness, and yield load were compared between constructs using 1-way analysis of variance. Results The hybrid fixation constructs (IFS/BB and IFS/SB groups) showed significantly better biomechanical properties than the isolated extracortical fixation constructs (BB and SB groups) (P < .05 for all). There were no differences between the isolated extracortical fixation constructs or between the hybrid fixation constructs in elongation or load to failure; however, stiffness of the IFS/BB group was significantly higher than that of the IFS/SB group (175.3 ± 16.6 vs 144.9 ± 20.1 N/mm, respectively; P < .05). Stiffness between the SB and BB groups was not significantly different. Conclusion Hybrid fixation had superior biomechanical performance compared with isolated extracortical fixation. However, tibial graft fixation using a bone bridge either as isolated extracortical fixation or combined with an interference screw for hybrid fixation showed equivalent biomechanical properties compared with suspension button-based graft fixation. Clinical Relevance The clinical use of a bone bridge for tibial graft fixation could reduce the cost for ACL reconstruction and lower the rate of implant-associated issues.
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Affiliation(s)
- Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University
Hospital Münster, Münster, Germany
| | - Marvin Greßmann
- Department of Trauma, Hand and Reconstructive Surgery, University
Hospital Münster, Münster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University
Hospital Münster, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University
Hospital Münster, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University
Hospital Münster, Münster, Germany
| | - Andre Frank
- Department of Trauma, Hand and Reconstructive Surgery, University
Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University
Hospital Münster, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University
Hospital Münster, Münster, Germany.,Christoph Kittl, MD, Department of Trauma, Hand and
Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1,
Building W1, 48149 Münster, Germany (
)
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Peez C, Wermers J, Glasbrenner J, Briese T, Raschke MJ, Herbst E, Kittl C. Qualitative and Quantitative Assessment of the Medial Patellar Retinaculum Anatomy: the Anteromedial Side of the Knee Revisited. Orthop J Sports Med 2022; 10:23259671221134818. [PMID: 36419479 PMCID: PMC9676305 DOI: 10.1177/23259671221134818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/12/2022] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND In the current literature, studies on the anatomy of the anteromedial region of the knee are scarce. However, the anteromedial structures, especially the longitudinal medial patellar retinaculum (MPR), may play an important role in restraining external tibial rotation. PURPOSE To conduct a layer-by-layer dissection of the anteromedial side of the knee and describe qualitatively and quantitatively the MPR anatomy pertaining to surgically relevant landmarks. STUDY DESIGN Descriptive laboratory study. METHODS A total of 10 fresh-frozen human cadaveric knees (mean age 81 ± 16.3 years) without history of previous ligament injury were used in this study. A layer-by-layer dissection was performed, and measurements were obtained using a tactile 3-dimensional (3-D) measuring arm to define the anatomy of the MPR in relation to surgically relevant landmarks, such as the superficial medial collateral ligament (sMCL) and medial patellofemoral ligament (MPFL). The 3-D datasets were used for multiplanar reconstruction. RESULTS The tibial and femoral attachment of the MPR were identified in 100% of cases. Layer-by-layer dissection confirmed its close topography to the sMCL. The mean length of the MPR was 84.9 ± 9.1 mm. The average width of the tibial and femoral attachment was 23.8 ± 3.1 mm and 69.2 ± 8.2 mm, respectively. The distance from the midpoint of the MPR tibial attachment to the midpoint of the distal tibial attachment of the sMCL was 27.2 ± 5.8 mm. Femorally, the MPR attached at the anterior border of the MPFL over a mean distance of 52.3 ± 9.4 mm. CONCLUSION The MPR is a distinct tibiofemoral structure with well-defined tibial and femoral attachments, which could be consistently identified. Layer-by-layer dissection confirmed its close topography to the sMCL and MPFL. CLINICAL RELEVANCE As injuries to the anteromedial side of the knee may contribute to anteromedial rotational rotatory instability (AMRI), precise knowledge of the underlying anatomy of the MPR may be necessary to perform an anatomic reconstruction of the anteromedial side of the knee.
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Affiliation(s)
- Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Jens Wermers
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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Filbay SR, Skou ST, Bullock GS, Le CY, Räisänen AM, Toomey C, Ezzat AM, Hayden A, Culvenor AG, Whittaker JL, Roos EM, Crossley KM, Juhl CB, Emery C. Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus. Br J Sports Med 2022; 56:1465-1474. [PMID: 36171078 DOI: 10.1136/bjsports-2022-105626] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Determine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations. DESIGN Random-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed. DATA SOURCES MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021. ELIGIBILITY Studies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury. RESULTS Fifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2-14 years post-ACL injury. Pooled PCS scores were worse >10 years (50.8 (48.7 to 52.9)) compared with 2-5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (-1.5 (-2.9 to -0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some individuals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL). CONCLUSION There is a very-low certainty of evidence that PCS scores ≥2 years post-ACL injury are worse than uninjured controls and decline over time, whereas MCS scores remain high. ACL injury can result in prolonged work absenteeism and high health/economic costs. Further studies are needed to determine the long-term burden of traumatic meniscal injury.
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Affiliation(s)
- Stephanie Rose Filbay
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Christina Y Le
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Anu M Räisänen
- Department of Physical Therapy Education, Oregon, Western University of Health Sciences College of Health Sciences, Northwest, Lebanon, Oregon, USA.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Clodagh Toomey
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,School of Allied Health, University of Limerick, Limerick, Ireland
| | - Allison M Ezzat
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Jackie L Whittaker
- Arthritis Research Canada, Richmond, British Columbia, Canada.,Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Carolyn Emery
- Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Kremen TJ, Arnold MT, Trivellas M, Shi BY, Jones KJ, Garcia-Mansilla I. Combined Assessments of Patellar Tendon and Hamstring Tendon Parameters on Preoperative Magnetic Resonance Imaging Can Improve Predictability of Hamstring Tendon Autograft Diameter in the Setting of Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e1913-e1921. [PMID: 36579048 PMCID: PMC9791872 DOI: 10.1016/j.asmr.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/27/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose To evaluate whether preoperative magnetic resonance imaging (MRI) measurements of multiple tendon autograft sources could be used to improve estimates of intraoperative hamstring tendon autograft (HTA) diameter. Methods Patients who underwent anterior cruciate ligament reconstruction with HTA at our institution were identified through electronic health records. Preoperative MRI tendon measurements of the patellar tendon (PT) length, PT width, PT thickness, quadriceps tendon thickness, semitendinosus tendon (ST) cross-sectional area (CSA), and gracilis tendon (GT) CSA were conducted by 2 independent evaluators using digital imaging measurement tools. Results A total of 53 patients met the inclusion criteria, with a mean HTA diameter of 7.98 ± 0.7 mm. Height greater than 1.63 m, weight greater than 63.4 kg, PT length greater than 4.2 cm, PT thickness greater than 0.33 cm, ST CSA greater than 10.8 mm2, and GT CSA greater than 6.3 mm2 were associated with an HTA of 8 mm or greater (P < .005). Female sex was associated with an HTA of less than 8 mm (P < .05). PT length, PT thickness, and GT CSA were the strongest predictors of an HTA of 8 mm or greater and were combined into an additive logistic regression model: Score = -23.24 + (1.68 × PT length) + (20.104 × PT thickness) + (1.48 × GT CSA). If the score was greater than 0.237, the HTA graft diameter was predicted to be 8 mm or greater with 83% specificity, 91% sensitivity, and 87% accuracy. Conclusions By combining PT length and PT thickness measurements with GT CSA measurements in a logit function model, we were able to show improved overall specificity, sensitivity, and accuracy of estimated HTA diameters in our data set when compared with assessments of anthropometric, ST CSA, GT CSA, or combined ST-GT CSA measurements in isolation. Clinical Relevance Preoperative MRI measurements may be used to screen whether a patient is likely to have an 8-mm graft in the setting of anterior cruciate ligament reconstruction with HTA and thus may help guide graft choice.
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Affiliation(s)
- Thomas J. Kremen
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA,Address correspondence to Thomas J. Kremen Jr, M.D., Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1225 15th St, Ste 2100, Santa Monica, CA 90404, USA
| | - Michael T. Arnold
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Myra Trivellas
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Brendan Y. Shi
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Whittaker JL, Losciale JM, Juhl CB, Thorlund JB, Lundberg M, Truong LK, Miciak M, van Meer BL, Culvenor AG, Crossley KM, Roos EM, Lohmander S, van Middelkoop M. Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta-analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus. Br J Sports Med 2022; 56:1406-1421. [DOI: 10.1136/bjsports-2022-105496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/04/2022]
Abstract
ObjectiveTo identify and quantify potential risk factors for osteoarthritis (OA) following traumatic knee injury.DesignSystematic review and meta-analyses that estimated the odds of OA for individual risk factors assessed in more than four studies using random-effects models. Remaining risk factors underwent semiquantitative synthesis. The modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for prognostic factors guided the assessment.Data sourcesMEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to 2009–2021.EligibilityRandomised controlled trials and cohort studies assessing risk factors for symptomatic or structural OA in persons with a traumatic knee injury, mean injury age ≤30 years and minimum 2-year follow-up.ResultsAcross 66 included studies, 81 unique potential risk factors were identified. High risk of bias due to attrition or confounding was present in 64% and 49% of studies, respectively. Ten risk factors for structural OA underwent meta-analysis (sex, rehabilitation for anterior cruciate ligament (ACL) tear, ACL reconstruction (ACLR), ACLR age, ACLR body mass index, ACLR graft source, ACLR graft augmentation, ACLR+cartilage injury, ACLR+partial meniscectomy, ACLR+total medial meniscectomy). Very-low certainty evidence suggests increased odds of structural OA related to ACLR+cartilage injury (OR=2.31; 95% CI 1.35 to 3.94), ACLR+partial meniscectomy (OR=1.87; 1.45 to 2.42) and ACLR+total medial meniscectomy (OR=3.14; 2.20 to 4.48). Semiquantitative syntheses identified moderate-certainty evidence that cruciate ligament, collateral ligament, meniscal, chondral, patellar/tibiofemoral dislocation, fracture and multistructure injuries increase the odds of symptomatic OA.ConclusionModerate-certainty evidence suggests that various single and multistructure knee injuries (beyond ACL tears) increase the odds of symptomatic OA. Risk factor heterogeneity, high risk of bias, and inconsistency in risk factors and OA definition make identifying treatment targets for preventing post-traumatic knee OA challenging.
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Daneshvarhashjin N, Chizari M, Javad Mortazavi S, Rouhi G. Early post-operative performance of an anatomically designed hybrid thread interference screw for ACL reconstruction: A comparative study. J Biomech 2022; 135:111031. [DOI: 10.1016/j.jbiomech.2022.111031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
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Muench LN, Berthold DP, Archambault S, Slater M, Mehl J, Obopilwe E, Cote MP, Arciero RA, Chahla J, Lee Pace J. Anterior cruciate ligament (ACL) repair using cortical or anchor fixation with suture tape augmentation vs ACL reconstruction: A comparative biomechanical analysis. Knee 2022; 34:76-88. [PMID: 34875498 DOI: 10.1016/j.knee.2021.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose was to compare knee kinematics in a cadaveric model of anterior cruciate ligament (ACL) repair using an adjustable-loop femoral cortical suspensory (AL-CSF) or independent bundle suture anchor fixation (IB-SAF) with suture tape augmentation to a bone-patellar tendon-bone (BPTB) ACL reconstruction. METHODS Twenty-seven cadaveric knees were randomly assigned to one of three surgical techniques: (1) ACL repair using the AL-CSF technique with suture tape augmentation, (2) ACL repair using the IB-SAF technique with suture tape augmentation, (3) ACL reconstruction using a BPTB autograft. Each specimen underwent three conditions according to the state of the ACL (native, proximal transection, repair/reconstruction) with each condition tested at four different angles of knee flexion (0°, 30°, 60°, 90°). Anterior tibial translation (ATT) and internal tibial rotation (ITR) were evaluated using 3-dimensional motion tracking software. RESULTS ACL transection resulted in a significant increase in ATT and ITR when compared to the native state (P < 0.001, respectively). ACL repair with the AL-CSF or IB-SAF technique as well as BPTB reconstruction restored native ATT and ITR at all tested angles of knee flexion, while showing significantly less ATT at 0°, 30°, 60°, and 90° as well as significantly less ITR at 30°, 60°, and 90° of knee flexion when compared to the ACL-deficient state. There were no significant differences in ATT and ITR between the three techniques utilized. CONCLUSION ACL repair using the AL-CSF or IB-SAF technique with suture tape augmentation as well as BPTB ACL reconstruction each restored native anteroposterior and rotational laxity, without significant differences in knee kinematics between the three techniques utilized. LEVEL OF EVIDENCE Controlled Laboratory Study.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States; Department of Orthopedic Sports Medicine, Technical University of Munich, Germany
| | - Daniel P Berthold
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States; Department of Orthopedic Sports Medicine, Technical University of Munich, Germany
| | - Simon Archambault
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Maria Slater
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Julian Mehl
- Department of Orthopedic Sports Medicine, Technical University of Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Mark P Cote
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Robert A Arciero
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States
| | - Jorge Chahla
- Department of Orthopedics, Rush University, Chicago, IL 60612, United States
| | - J Lee Pace
- Department of Orthopedic Surgery, UConn Health Center, Farmington, CT 06030, United States; Elite Sports Medicine @ Connecticut Children's Medical Center, Farmington, CT 06032, United States.
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31
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von Essen C, McCallum S, Eriksson K, Barenius B. Minimal graft site morbidity using autogenous semitendinosus graft from the uninjured leg: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 2022; 30:1639-1645. [PMID: 34368905 PMCID: PMC9033693 DOI: 10.1007/s00167-021-06686-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/28/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE To quantify the effect on strength of semitendinosus (ST) graft harvest by comparing isokinetic and isometric muscle strength. METHODS A cohort of 140 patients underwent anterior cruciate ligament (ACL) reconstruction (ACLR) and were randomized to ipsilateral or contralateral ST graft harvest. Isokinetic and isometric muscle strength testing using a dynamometer were collected for the operated and non-operated leg. Patients were assessed pre-surgery and at 6, 12 and 24 months after reconstruction. RESULTS ST graft harvest reduced isokinetic flexion muscle strength for 6 months. At 12 months follow up there was no significant difference between the two groups and they were all stronger than pre-injury. No other significant differences were found in any primary or secondary outcome measurements. CONCLUSION Solitary ST graft harvest does not appear to result in a permanent reduced isometric or isokinetic quadriceps muscle strength on the side where the graft is harvested. A reduction in hamstring muscle strength of less than 10% can be seen at short-term follow-up with full recovery by 12 months. Most patients report little or no donor site pain. Given these findings, ST autograft is an alternative graft choice that could be used for various reconstructions in terms of donor site morbidity. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Christoffer von Essen
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden.
- Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden.
| | - Sebastian McCallum
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Karl Eriksson
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Björn Barenius
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
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High Return to Play and Low Reinjury Rates in National Collegiate Athletic Association Division I Football Players Following Anterior Cruciate Ligament Reconstruction Using Quadrupled Hamstring Autograft. Arthroscopy 2022; 38:99-106. [PMID: 33957214 DOI: 10.1016/j.arthro.2021.04.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine the outcomes of anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring (QH) autograft in a cohort of National Collegiate Athletic Association (NCAA) Division I football players. METHODS A retrospective analysis was performed on NCAA Division I football players at a single institution who had transtibial ACL reconstruction using QH autograft between 2001 and 2016. Primary outcomes were ACL reinjury and return to play (RTP). Secondary outcomes were position, percent of eligibility used after surgery, graft diameter, Tegner-Lysholm scores, concomitant injuries/surgeries, and postcollegiate professional play. RESULTS Between 2001 and 2016, 34 players had QH autograft ACL reconstruction, and 29 players achieved RTP. Of the 29, 2 (6.9%) sustained ACL reinjuries. The average RTP was 318 days (range 115-628) after surgery. Players used 79.5% of their remaining collegiate eligibility after surgery. Nine players sustained multiligamentous knee injuries. This did not have a significant effect on RTP (P = 0.709; mean 306±24 days for isolated ACL, mean of 353±51 for 2 ligaments, mean of 324±114 for 3 + ligaments) and none sustained reinjury. Associated meniscal injuries were sustained by 28, and 8 sustained chondral injuries. The mean postoperative Tegner-Lysholm score was 90.7 of 100, with mean follow-up of 102 months. Of these players, 18 went on to play professionally, with 17 joining National Football League rosters and 1 an arena team roster. CONCLUSION QH demonstrated an ACL reinjury and RTP rates similar to those in previously published, predominantly bone-patella tendon-bone ACL reinjury data in elite athletes. This study demonstrates that QH autograft may be a viable option in elite athletes. LEVEL OF EVIDENCE IV, case series.
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Application and Surgical Technique of ACL Reconstruction Using Worldwide Registry Datasets: What Can We Extract? J Funct Morphol Kinesiol 2021; 7:jfmk7010002. [PMID: 35076508 PMCID: PMC8788449 DOI: 10.3390/jfmk7010002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 01/13/2023] Open
Abstract
Anterior cruciate ligament (ACL) injuries are among the most common knee injuries. The purpose of this study was to compare surgical reconstruction of the ACL between different countries and regions in order to describe differences regarding epidemiological data, reconstruction frequency, and graft choice. A systematic literature search was performed using the ACL study group website in order to identify the relevant knee ligament registers. Four national registries were included, comprising those from Sweden, the UK, New Zealand, and Norway. A large variation was found concerning the total number of primary ACL reconstructions with a reported range from 4.1 to 51.3 per 100,000 inhabitants. The country-specific delay between injury and reconstruction varied between an average of 6.0 months and 17.6 months. The leading sports activities resulting in ACL injury included soccer, alpine skiing, handball, rugby, and netball. Moreover, a strong variability in graft choice for primary reconstruction was found. The comparison of ACL registers revealed large differences, indicating different clinical implications regarding conservative or surgical therapy and choice of the preferable graft. ACL registers offer a real-world clinical perspective with the aim to improve quality and patient safety by investigating factors associated with subsequent surgical outcomes.
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Kyriakopoulos G, Manthas S, Vlachou M, Oikonomou L, Papadakis SA, Kateros K. Anterior Cruciate Ligament Reconstruction With the All-Inside Technique: Equivalent Outcomes and Failure Rate at Three-Year Follow-Up Compared to a Doubled Semitendinosus-Gracilis Graft. Cureus 2021; 13:e20508. [PMID: 35070545 PMCID: PMC8764460 DOI: 10.7759/cureus.20508] [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: 12/18/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: To compare in terms of failure rates, clinical and functional outcomes the all-inside anterior cruciate ligament (ACL) reconstruction with double suspensory fixation and quadrupled semitendinosus autograft with anteromedial portal doubled semitendinosus-gracilis autograft with suspensory femoral and tibial interference screw fixation. Methods: Forty-four patients were sequentially allocated into two groups and followed up prospectively for a 3-year period. The first group was the all-inside group and the second was the “classic” AM portal with S-G graft. Each group comprised 22 patients. All patients underwent KT-1000 testing preoperatively and at a minimum of six months postoperatively. Visual pain analog was recorded preoperatively and during both the immediate postoperative period and throughout the follow-up. The Lysholm knee score was used comparing the preoperative and 24-month timepoints. Results: The visual analog scale (VAS) pain scores showed a significant difference at two weeks (2.4 vs 1.8, p < 0.01 ) in favor of the all-inside group, but that difference disappeared in the later follow-up visits. Similarly, there was no significant difference with Lysholm knee scores at two years and the side-to-side anterior translation measured with the KT-1000. At the three-year mark, there were no failures in either of the groups. Conclusion: The all-inside technique appears to be equivalent in terms of outcomes to the classic S-G technique, and given the less-invasive nature and versatility in graft choices is a safe and effective technique for primary ACL reconstruction.
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Affiliation(s)
- George Kyriakopoulos
- A' Orthopaedic Department, General Hospital G. Gennimatas, Athens, GRC.,Department of Trauma and Orthopaedics, General Hospital of Livadeia, Livadeia, GRC
| | - Spyros Manthas
- A' Orthopaedic Department, General Hospital G.Gennimatas, Athens, GRC
| | - Maria Vlachou
- A' Orthopaedic Department, General Hospital G.Gennimatas, Athens, GRC
| | - Leon Oikonomou
- A' Orthopaedic Department, General Hospital G.Gennimatas, Athens, GRC
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Arnold MP, Calcei JG, Vogel N, Magnussen RA, Clatworthy M, Spalding T, Campbell JD, Bergfeld JA, Sherman SL. ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades. Knee Surg Sports Traumatol Arthrosc 2021; 29:3871-3876. [PMID: 33486558 DOI: 10.1007/s00167-021-06443-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/11/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Anterior cruciate ligament reconstruction (ACLR) aims to restore knee function and stability, allowing patients to return to the activities they enjoy and minimize further injury to the meniscus and cartilage and their ultimate progression to osteoarthritis. This study aims to present the evolution of graft choice over the last three decades according to members of the ACL Study Group (SG). METHODS Prior to the January 2020 ACL SG biannual meeting, a survey was administered consisting of 87 questions and 16 categories, including ACLR graft choice. A similar questionnaire has been administered prior to each meeting and survey results from the past 14 meetings (1992 through 2020, excluding 1994) are included in this work. Survey responses are reported as frequencies in percentages to quantify changes in practice over the surgery period. RESULTS In 1992, the most frequent graft choice for primary ACLR was bone-patellar tendon-bone (BTB) autograft, at nearly 90%. Hamstring tendon (HT) autografts have increased in popularity, currently over 50%, followed by just under 40% BTB autograft. Recently, quadriceps tendon (QT) autograft has increased in popularity since 2014. CONCLUSION Autograft (HT, BTB, QT) is an overwhelming favorite for primary ACLR over allograft. The preference for HT autograft increased over the study period relative to BTB autograft, with QT autograft gaining in popularity in recent years. Graft selection should be individualized for each patient and understanding the global trends in graft choice can help orthopaedic surgeons discuss graft options with their patients and determine the appropriate graft for each case. LEVEL OF EVIDENCE Level V, Expert Opinion.
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Affiliation(s)
- Markus P Arnold
- Practice LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Switzerland
| | - Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Nicole Vogel
- Practice LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Switzerland
| | - Robert A Magnussen
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| | - Mark Clatworthy
- Department of Orthopaedics, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Tim Spalding
- Department of Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - John D Campbell
- Bridger Orthopedics and Sports Medicine, PC, Montana State University, Bozeman, MT, USA
| | - John A Bergfeld
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
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Li N, Xue X, Tu H, Zhang M, He C. Anterior Cruciate Ligament Reconstruction with Hybrid Graft versus Autograft: A Systematic Review and Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:7562649. [PMID: 34659692 PMCID: PMC8514892 DOI: 10.1155/2021/7562649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/26/2021] [Accepted: 09/13/2021] [Indexed: 02/05/2023]
Abstract
Background The standard surgical treatment for ACL tear is ACL reconstruction. There is a debate of a choice between autograft or hybrid graft for treating ACL reconstruction. The purpose of this paper is to compare both case scenarios. Methods A lot of libraries were searched like PubMed, Cochrane, and EMBASE Library for clinical trials which were then compared and analyzed via meta-analysis. The systematic review and meta-analysis were performed as per PRISMA guidelines, and RevMan software was used to perform the meta-analysis. Results We analyzed 6 studies where patients of both autograft and hybrid graft were studied. The study outcomes, graft failures, graft diameters, reoperations, and so on were compared via forest plot and funnel plot. No significant difference was noted in both cases. Conclusions In this meta-analysis, the performance of both autograft and hybrid graft was similar. Though the diameters were larger in hybrid, other factors also had an influence like graft failures, reoperations, and age at reconstruction which must be further investigated in detail.
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Affiliation(s)
- Ning Li
- Center of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, Sichuan, China
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Xiali Xue
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Huan Tu
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chengqi He
- Center of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, Sichuan, China
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Sun T, Zhang H. Biomechanical Comparison of a Novel Tibial Fixation Technique Versus Interference Screw Fixation for ACL Reconstruction Using Soft Tissue Grafts. Orthop J Sports Med 2021; 9:23259671211028559. [PMID: 34458385 PMCID: PMC8392818 DOI: 10.1177/23259671211028559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Controversy remains regarding the optimal technique for tibial fixation of soft tissue grafts in anterior cruciate ligament (ACL) reconstruction. Purpose/Hypothesis: To compare the biomechanical outcomes of a novel transtibial tubercle fixation technique with those of a commonly utilized interference screw fixation at the tibial site. Our hypothesis was that transtibial tubercle fixation achieves higher ultimate failure loads than interference screw fixation. Study Design: Controlled laboratory study. Methods: We used 24 matched porcine tibias and digital extensor tendons, from which 12 grafts and tibial tunnels were prepared using the novel transtibial tubercle fixation technique and 12 were prepared using the interference screw fixation technique. The specimens underwent a cyclic loading test (50-250 N applied for 1000 cycles at a frequency of 1 Hz), followed by a load-to-failure test. The slippage, stiffness, and ultimate failure loads were compared between the techniques. Results: No differences in slippage were found during the cyclic loading test, and no graft fixation or tibial complex failures occurred during cyclic testing in either group. The transtibial tubercle fixation technique had higher ultimate failure loads (mean ± SD, 756.28 ± 123.43 N) as compared with interference screw fixation (602.15 ± 81.62 N; P < .05). The grafts in the transtibial tubercle fixation group were less stiff than those in the interference screw fixation group (84.43 vs 101.23 N/mm; P < .05). Conclusion: Transtibial tubercle fixation achieved higher ultimate failure loads than interference screw fixation in the load-to-failure test. Clinical Relevance: The novel transtibial tubercle fixation technique compared favorably with interference screw fixation during ACL reconstruction. This technique does not require hardware, has a low cost, theoretically eliminates the risk of complications associated with hardware implantation (eg, graft damage and pain attributed to retained hardware requiring removal), and is relatively easy to perform.
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Affiliation(s)
| | - Hangzhou Zhang
- Department of Orthopedics, Joint Surgery and Sports Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
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Ehlers CB, Curley AJ, Fackler NP, Minhas A, Chang ES. The Statistical Fragility of Hamstring Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies. Am J Sports Med 2021; 49:2827-2833. [PMID: 33211555 DOI: 10.1177/0363546520969973] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Evidence-based medicine utilizes data to inform clinical decision making, despite the ability of a small number of outcome reversals to change statistical significance. P values are common measurements of statistical significance that possess inherent flaws. The inclusion of the fragility index (FI) and fragility quotient (FQ) may provide a clearer conveyance of statistical strength. PURPOSE/HYPOTHESIS The purpose was to examine the statistical stability of studies comparing hamstring tendon and bone-patellar tendon-bone autografts in primary single-bundle anterior cruciate ligament reconstruction with independent tunnel drilling. We hypothesized that the findings of these studies are vulnerable to a small number of outcome event reversals, often fewer than the number of patients lost to follow-up. STUDY DESIGN Systematic review. METHODS Comparative studies and randomized controlled trials (RCTs) published in 10 leading orthopaedic journals between 2000 and 2020 were analyzed. Statistical significance was defined as a P value ≤.05. FI for each outcome was determined by the number of event reversals necessary to alter significance. FQ was calculated by dividing the FI by the respective sample size. RESULTS Of the 1803 studies screened, 643 met initial search criteria, with 18 comparative studies ultimately included for analysis, 8 of which were RCTs. A total of 114 outcomes were examined. Overall, the mean (interquartile range) FI and FQ were 3.77 (2-4) and 0.040 (0.016-0.055), respectively. The FI was less than the number of patients lost to follow-up for 76.3% of outcomes. CONCLUSION Studies examining graft choice for anterior cruciate ligament reconstruction may not be as statistically stable as previously thought. Comparative studies and RCTs are at substantial risk for statistical fragility, with few event reversals required to alter significance. The reversal of <4 outcome events in a treatment group can alter the statistical significance of a given result; this is commonly fewer than the number of patients lost to follow-up. Future comparative study analyses might consider including FI and FQ with P values in their statistical analysis.
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Affiliation(s)
- Cooper B Ehlers
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Andrew J Curley
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Arjun Minhas
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Edward S Chang
- INOVA Orthopaedics and Sports Medicine, Fairfax, Virginia, USA
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Matar HE, Platt SR, Bloch BV, James PJ, Cameron HU. A Systematic Review of Randomized Controlled Trials in Anterior Cruciate Ligament Reconstruction: Standard Techniques Are Comparable (299 Trials With 25,816 Patients). Arthrosc Sports Med Rehabil 2021; 3:e1211-e1226. [PMID: 34430902 PMCID: PMC8365213 DOI: 10.1016/j.asmr.2021.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/24/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To provide an overview of all published randomized controlled trials (RCTs) in anterior cruciate ligament reconstruction (ACLR) summarizing the available evidence. METHODS Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the Cochrane FIGCentral Register of Controlled Trials, Ovid MEDLINE, and Embase for RCTs of ACLR from their inception to August 26, 2020. Outcome measure was whether RCTs reported statistically significant findings. RCTs were then classified according to their intervention groups in a narrative synthesis of the evidence. RESULTS In total, 299 RCTs met the inclusion criteria and were included with a total number of 25,186 patients. Only 30 RCTs (10%) reported significant differences between the intervention and the control groups. These included 101 RCTs on grafts, 20 RCTs on tunnel placements, 48 RCTs on graft fixation, 42 RCTs on single-bundle compared with double-bundle reconstructions, 11 RCTs on additional procedures, 11 RCTs on graft tensioning, 5 RCTs on timing of surgery, 25 RCTs on technical variations from standard techniques, 6 RCTs on ACL repair, 5 RCTs on navigation, 16 RCTs on perioperative management, and 9 RCTs on other aspects of ACLR. Only 14 RCTs (4.7%) reported outcomes beyond 10 years with greater allograft failures compared with autografts, high incidence of osteoarthritic changes in reconstructed knees (22%-100%), with no significant differences in outcomes between bioabsorbable or metal screws for graft fixation, patellar versus hamstrings or single- versus double-bundle reconstructions. CONCLUSIONS The evidence indicates that a standard arthroscopic single- or double-bundle ACLR with hamstrings/patella autografts, transportal technique, and fixation techniques familiar to the surgeon leads to comparable results. This evidence offers surgeons the flexibility to use standard and cost-effective techniques and achieve comparable outcomes. LEVEL OF EVIDENCE Level II; systematic review of Level I-II randomized controlled trials.
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Affiliation(s)
- Hosam E. Matar
- Nottingham Elective Orthopedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Simon R. Platt
- Department of Orthopedic Surgery, Gold Coast University Hospital, Southport, Australia
| | - Benjamin V. Bloch
- Nottingham Elective Orthopedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Peter J. James
- Nottingham Elective Orthopedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Hugh U. Cameron
- Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, Canada
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Lameire DL, Abdel Khalik H, Zakharia A, Kay J, Almasri M, de Sa D. Bone Grafting the Patellar Defect After Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction Decreases Anterior Knee Morbidity: A Systematic Review. Arthroscopy 2021; 37:2361-2376.e1. [PMID: 33771689 DOI: 10.1016/j.arthro.2021.03.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/05/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this systematic review was to evaluate the impact of bone grafting of patellar defects on reported anterior knee morbidity and subjective outcomes after bone-patellar tendon-bone autograft reconstruction of the anterior cruciate ligament. METHODS A systematic electronic search of MEDLINE, Embase, Web of Science, and the Cochrane Library was carried out. All English-language prospective randomized clinical trials published from January 1, 2000, to July 24, 2020, were eligible for inclusion. All studies addressing patellar defect grafting were eligible for inclusion regardless of the timing of surgery, graft type, surgical technique, or rehabilitation protocol. RESULTS A total of 39 studies with 1,955 patients were included for analysis. There were 796 patients in the no patellar grafting (NPG) group, with a mean age range of 22.7 to 33.0 years, and 1,159 patients in the patellar grafting (PG) group, with a mean age range of 17.8 to 34.7 years. The visual analog scale pain score ranged from 1.2 to 5.1 in the NPG group compared with 0.3 to 3.7 in the PG group. The proportion of patients with anterior knee pain ranged from 19% to 81% in the NPG group and from 15% to 32% in the PG group. Moderate to severe kneeling pain was reported in 22% to 57% of patients in the NPG group and 10% of those in the PG group. The percentage of patients with at least 3° of extension loss ranged from 4% to 43% in the NPG group and from 2% to 11% in the PG group. CONCLUSIONS PG favors decreased anterior knee pain, kneeling pain, and extension loss compared with non-grafted defects; however, the functional outcomes are comparable. Owing to the heterogeneity in reporting, statistical conclusions could not be drawn. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
- Darius L Lameire
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hassaan Abdel Khalik
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alexander Zakharia
- MacSports Research Program, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mahmoud Almasri
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada; Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, Ohio, U.S.A
| | - Darren de Sa
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
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DeFroda SF, Karamchedu NP, Budacki R, Wiley T, Fadale PD, Hulstyn MJ, Shalvoy RM, Badger GJ, Fleming BC, Owens BD. Evaluation of Graft Tensioning Effects in Anterior Cruciate Ligament Reconstruction between Hamstring and Bone-Patellar Tendon Bone Autografts. J Knee Surg 2021; 34:777-783. [PMID: 31962350 PMCID: PMC7371493 DOI: 10.1055/s-0039-3402046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article investigates the clinical, functional, and radiographic outcomes in anterior cruciate ligament (ACL) reconstruction patients over 7 years to determine the effects of initial graft tension on outcomes when using patellar tendon (bone-tendon-bone [BTB]) and hamstring tendon (HS) autografts. Ninety patients, reconstructed with BTB or HS, were randomized using two initial graft tension protocols: (1) normal anteroposterior (AP) laxity ("low-tension"; n = 46) and (2) AP laxity overconstrained by 2 mm ("high-tension"; n = 44). Seventy-two patients had data available at 7 years, with 9 excluded for graft failure. Outcomes included the Knee Injury and Osteoarthritis Outcome Score, Short-Form-36 (SF-36), and Tegner activity scale. Clinical outcomes included KT-1000S and International Knee Documentation Committee examination score; and functional outcomes included 1-leg hop distance and peak knee extensor torque. Imaging outcomes included medial joint space width, Osteoarthritis Research Society International radiographic score, and Whole-Organ Magnetic Resonance Score. There were significantly improved outcomes in the high-tension compared with the low-tension HS group for SF-36 subset scores for bodily pain (p = 0.012), social functioning (p = 0.004), and mental health (p = 0.014) 84 months postsurgery. No significant differences in any outcome were found within the BTB groups. Tegner activity scores were also significantly higher for the high-tension HS group compared with the low-tension (6.0 vs. 3.8, p = 0.016). Patients with HS autografts placed in high tension had better outcomes relative to low tension for Tegner activity score and SF-36 subset scores for bodily pain, social functioning, and mental health. For this reason, we recommend that graft fixation be performed with the knee at 30-degree flexion ("high-tension" condition) when reconstructing the ACL with HS autograft.
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Affiliation(s)
- Steven F. DeFroda
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Naga Padmini Karamchedu
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Ross Budacki
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Taylor Wiley
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Paul D. Fadale
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Michael J. Hulstyn
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Robert M. Shalvoy
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Gary J. Badger
- Department of Biostatistics, University of Vermont,
Burlington VT 05405
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI,School of Engineering, Brown University, Providence, RI
02903
| | - Brett D. Owens
- Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
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Holliday CL, Martin R, Grant JA. Comparing the Efficacy of Kneeling Stress Radiographs and Weighted Gravity Stress Radiographs to Assess Posterior Cruciate Ligament Insufficiency. Am J Sports Med 2021; 49:1017-1022. [PMID: 33599526 DOI: 10.1177/0363546520988114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Kneeling posterior cruciate ligament (PCL) stress radiographs are commonly used to evaluate PCL laxity. Patients, however, report significant pain, and the method's reproducibility may be challenged due to its dependence on patient body weight distribution to produce posterior tibial displacement. Weighted gravity stress radiography may offer better reproducibility and comfort than the kneeling technique, but its efficacy has not been studied. HYPOTHESIS Weighted gravity PCL stress radiographs will be more comfortable and produce similar measurements of side-to-side difference in posterior tibial displacement when compared with the kneeling technique. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS A total of 40 patients with nonoperatively or >6 months postoperatively treated PCL injuries (isolated or multiligamentous) underwent bilateral stress radiographs. Weighted gravity and kneeling stress radiographs were acquired, in random order, for each patient, as well as side-to-side difference in posterior tibial displacement between each knee, patient-reported visual analog scale knee pain (100 mm), time to acquire the images, and patient preference for technique. Paired t tests were used to compare the side-to-side difference, pain score, and time to complete the radiographs. RESULTS There was no difference between the 2 radiographic methods in the mean side-to-side difference (gravity: 6.45 ± 4.61 mm, kneeling: 6.82 ± 4.60 mm; P = .72), time required to acquire radiographs (kneeling: 307.3 ± 140.5 seconds, gravity: 318.7 ± 151.1 seconds; P = .073), or number of radiographs taken to obtain acceptable images (kneeling: 3.6 ± 1.6, gravity: 3.7 ± 1.7; P = .73). Patients reported significantly less knee pain during the weighted gravity views (kneeling: 31.8 ± 26.6, gravity: 4.0 ± 12.0; P < .0001). Of the patients, 88% preferred the weighted gravity method. CONCLUSION Weighted gravity stress radiographs produce similar side-to-side differences in posterior tibial translation compared with the kneeling stress technique, but do not rely on patient weightbearing and provide significantly better patient comfort. Clinicians should therefore consider the use of weighted gravity stress radiographs in clinical practice to minimize the pain associated with stress radiography while allowing for accurate decision making.
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Affiliation(s)
| | - Ryan Martin
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - John A Grant
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Yang W, Huang X, Wang S, Wang H, Huang W, Shao Z. The long-term outcomes of different grafts in anterior cruciate ligament reconstruction: a network meta-analysis. J Orthop Translat 2021; 26:16-30. [PMID: 33437619 PMCID: PMC7773980 DOI: 10.1016/j.jot.2020.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 03/08/2020] [Accepted: 03/15/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To compare the long-term prognosis of patients with different types of grafts used in anterior cruciate ligament reconstruction (ACLR). METHODS PubMed, Ovid (MEDLINE and Embase) and the Cochrane library were searched up to Feb 2020. Eligible studies about different grafts in ACLR were searched for identifying the evidence comparing the long-term (mean or median follow-up time or the general description of the follow-up time≥2 years) knee outcomes of different grafts for ACLR. The final included articles and evaluation criteria were confirmed by the authors and senior clinicians to ensure the validity of the included articles. Lysholm score, the results of pivot shift test, Lachman test and International Knee Documentation Committee (IKDC) evaluation were selected as prognostic indicators. A Bayesian network meta-analysis was conducted. RESULTS A total of 30 articles were included in our network meta-analysis. Finally, we found that artificial graft or augmentation can provide the not bad Lysholm score but the worse result of IKDC evaluation for patients with ACLR compared with other types of grafts. Double-bundle hamstring autograft can provide a good Lysholm score as well as lower positive rate of pivot shift test and Lachman test. Patellar tendon autograft can provide the better result of IKDC evaluation. The patients with allogeneic tendon graft may get the higher positive rate of pivot shift test and Lachman test. Patients with single-bundle hamstring autograft may get the ordinary result of IKDC evaluation and Lysholm score. CONCLUSIONS Double-bundle hamstring autograft may be a better choice because of more items of good prognosis for the patients with ACLR. Patellar tendon autograft is a right choice which only shows the disadvantage on the Lysholm score. The prognosis of patients with single-bundle hamstring autograft is ordinary. The effect of artificial graft or augmentation needs more evidence to prove. Allogeneic tendon graft is not a better choice when compared with other grafts referred in our network meta-analysis. TRANSLATIONAL POTENTIAL STATEMENT In this study, we made a comprehensive comparison of the grafts commonly used in anterior cruciate ligament reconstruction. The evidence presented in this study provides a reference for clinicians to select a suitable anterior cruciate ligament graft.
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Affiliation(s)
| | | | | | - Hong Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wei Huang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Utilizing a contralateral hamstring autograft facilitates earlier isokinetic and isometric strength recovery after anterior cruciate ligament reconstruction: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 2021; 29:2684-2694. [PMID: 33604735 PMCID: PMC8298236 DOI: 10.1007/s00167-021-06491-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/03/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE To compare muscle strength and patient reported outcomes following ACLR using a semitendinosus (ST) graft from the ipsilateral (IL) leg compared to a graft from the contralateral (CL) leg. METHODS One-hundred and forty patients with an ACL injury were randomized to IL or CL ACLR. Patients were assessed at 6, 12 and 24 months with isokinetic and isometric muscle strength measured using Biodex. Patient-reported outcomes and manual stability measurements were also recorded. RESULTS Patient-related outcomes improved over time for both groups with no significant differences between groups at any time point. No differences between groups in objective knee assessment scores or rerupture rates were found. The IL group was significantly weaker in knee flexion strength at all time points compared to the CL group, additionally the IL group did not recover flexor strength within 2 years. CONCLUSION This study demonstrated that utilizing an ST graft harvested from the uninjured limb for ACLR facilitates early isokinetic and isometric strength recovery, with no significant adverse outcomes demonstrated in other measurements and therefore be performed to reduce the risk of long-term strength deficits in the injured leg LEVEL OF EVIDENCE: II.
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45
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Bangert Y, Jaber A, Wünnemann F, Berrsche G, Streich N, Rehnitz C, Ott H, Barié A. Clinical and radiological outcome after anterior cruciate ligament reconstruction using the T-lock Osteotrans resorbable tendon anchor: early experience and midterm follow-up. BMC Musculoskelet Disord 2020; 21:844. [PMID: 33339540 PMCID: PMC7749500 DOI: 10.1186/s12891-020-03863-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/04/2020] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Reconstruction of the Anterior cruciate ligament (ACL) using tendon grafting is an established method for restoring knee function and stability. Multiple methods are established for graft fixation. Several involve anchoring the autograft distant to the joint with hardware that remains implanted. This study reports the first early to midterm results in patients who received ACL reconstruction (ACLR) using the T-Lock Osteotrans femoral near joint fixation method with a tibial fixation using the BioactIF Osteotrans interference screw. METHODS This consecutive prospective series included 20 Patients (14 Male, 6 Female) with a primary ACL rupture. All patients were treated with an ACLR using a semitendinosus autograft fixated with the T-Lock Osteotrans and were followed-up postoperatively. The following parameters were assessed: Side-to-side difference of the posterior-anterior translation measured using the KT-1000 arthrometer, Tegner activity score, Lysholm score, IKDC subjective knee evaluation form. Magnetic resonance imaging (MRI) was done to assess tunnel enlargement and integrity of the anchoring device. RESULTS The average follow-up duration was 2 years (range 1-4.2 years). One patient was lost to follow-up. Two Patients suffered a traumatic ACL re-rupture 2 years postoperatively and received a 2-stage revision ACLR. Difference in the posterior-anterior translation was 1.8 mm (range 0-5). The median Tegner score was 6 (range 4-10) and 9 patients (45%) returned to their preinjury level of activity. The mean IKDC subjective knee evaluation form scored 91 points (range 77-100). The mean Lysholm score was 86 points (74-96). All mentioned scores were significantly better compared to preoperative values. No relevant tunnel enlargement was seen on MRI. The anchoring device was evaluated to be intact in all patients. CONCLUSION ACLR with the aforementioned procedure leads to good clinical and radiological outcome.
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Affiliation(s)
- Y Bangert
- Department of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - A Jaber
- Department of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - F Wünnemann
- Department of diagnostic and interventional radiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - G Berrsche
- Department of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - N Streich
- Center for Joint Surgery and Sport injuries, Sportopaedie Heidelberg, Clinic St. Elisabeth Heidelberg, Max-Reger-Straße 5-7, 69121, Heidelberg, Germany
| | - C Rehnitz
- Department of diagnostic and interventional radiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - H Ott
- Sporthologicum - Center for Sport and Joint injuries, Siesmayerstraße 44, 60323, Frankfurt am Main, Germany
| | - A Barié
- Department of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.,Center for Joint Surgery and Sport injuries, Sportopaedie Heidelberg, Clinic St. Elisabeth Heidelberg, Max-Reger-Straße 5-7, 69121, Heidelberg, Germany
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Zhao L, Lu M, Deng M, Xing J, He L, Wang C. Outcome of bone-patellar tendon-bone vs hamstring tendon autograft for anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials with a 5-year minimum follow-up. Medicine (Baltimore) 2020; 99:e23476. [PMID: 33235137 PMCID: PMC7710199 DOI: 10.1097/md.0000000000023476] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/19/2020] [Accepted: 10/31/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many systematic reviews have compared the short-term outcomes of anterior cruciate ligment (ACL)reconstruction with hamstring and patellar tendon autograft,but few differences have been observed. The purpose of this meta-analysis was to compare the medium-term outcome of bone-patellar tendon-bone and hamstring tendon autograft for anterior cruciate ligament reconstruction in terms of clinical function, knee stability, postoperativecomplications, and osteoarthritis changes. METHODS This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, and the Cochrane Library databases were searched from inception to November 2, 2019. This meta-analysis included only randomized controlled trials that compared BPTB and HT autografts for ACL reconstruction with a 5-year minimum follow-up. The Cochrane Collaboration's risk-of-bias tool was used to estimate the risk-of-bias for all included studies. RevMan 5.3 software was used to performed statistical analysis of the outcomes. RESULTS Fifteen RCTs, involving 1298 patients (610 patients in the BPTB group and 688 patients in the HT group) were included. In terms of clinical function, no significant difference was found in the objective International Knee Documentation Committee score (OR = 0.94, 95%CI: 0.64-1.37, P = .75), Lysholm knee score (MD = -2.26, 95%CI: -4.56 to 0.05, P = .06), return to preinjury activity level (OR = 1.01, 95%CI: 0.67-1.52, P = .96), and Tegner activity level (OR = 0.03, 95%CI: -0.36 to 0.41, P = .89). There was no statistically significant difference in the Lachman test (OR = 0.86, 95%CI: 0.5-1.32, P = .50), pivot-shift test (OR = 0.68, 95%CI: 0.44-1.06, P = .09), and side-to-side difference (MD = -0.32, 95%CI: -0.81 to 0.16, P = .19). As for postoperative complications and OA changes, there were no statistically significant difference in flexion loss (OR = 1.09, 95%CI: 0.47-2.54, P = .85) and OA changes (OR = 0.76, 95%CI: 0.52-1.10, P = .15), but we found significant differences in favor of the HT group in the domains of kneeling pain (OR = 1.67, 95%CI: 1.04-2.69, P = .03), anterior knee pain (OR = 2.90, 95%CI: 1.46-5.77, P = .002), and extension loss (OR = 1.75, 95%CI: 1.12-2.75, P = .01). There was a significant difference in favor of the BPTB group in the domain of graft failure (OR = 0.59, 95%CI: 0.38-0.91, P = .02). CONCLUSIONS Based on the results above, HT autograft is comparable with the BPTB autograft in terms of clinical function, postoperative knee stability, and OA changes, with a medium-term follow-up. The HT autograft for ACL reconstruction carries a lower risk of complications, such as anterior knee pain, kneeling pain, and extension loss, but an increased incidence of graft failure. Patients should be informed of the differences when deciding on graft choice with their physician.
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Affiliation(s)
- Lilian Zhao
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan
| | - Mingfeng Lu
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan
| | - Mingcong Deng
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jisi Xing
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan
| | - Lilei He
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan
| | - Changbing Wang
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan
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Eliya Y, Nawar K, Rothrauff BB, Lesniak BP, Musahl V, de SA D. Anatomical anterior cruciate ligament reconstruction (ACLR) results in fewer rates of atraumatic graft rupture, and higher rates of rotatory knee stability: a meta-analysis. J ISAKOS 2020. [DOI: 10.1136/jisakos-2020-000476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Early clinical and neuromuscular properties in patients with normal or sub-normal subjective knee function after anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 2020; 140:1231-1239. [PMID: 32270278 DOI: 10.1007/s00402-020-03436-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Indexed: 02/09/2023]
Abstract
PURPOSE To determine clinical and neuromuscular properties in patients with normal or sub-normal subjective knee function after finalisation of 6 months' post-operative rehabilitation following anterior cruciate ligament reconstruction (ACLR). METHODS Sixty patients after primary anatomical single-bundle hamstring ACLR were prospectively enrolled. Demographics, subjective, clinical and functional status of the injured knee were recorded at baseline, 6 and 12 months post-operatively. Return to pre-injury activities time (months) was monitored. Tensiomyography and isokinetic dynamometry of thigh muscles were performed at 6 months, when standard ACLR rehabilitation is finalized. Based on their IKDC Subjective Knee Evaluation scores at 6 months, they were assigned into "Normal" or "Sub-normal" group. All the above measured parameters were then compared between the two groups. RESULTS At 6 months' timeline, 21 patients (35%) perceived their knee function as "Normal", while 39 (65%) were "Sub-normal". There were no differences in clinical status between both groups, but patients in Normal group achieved higher IKDC, Lysholm, Tegner scores as well as higher single-leg hop test. They were taller, had lower body mass index and more of them achieved their preinjury level of activity at 12 months (67% vs. 33%). Tensiomyography revealed higher biceps femoris as well as semitendinosus and semimembranosus radial displacement values on the operated leg in Normal group. Isokinetic dynamometry showed significantly higher normalised peak torque and average power of knee extensor muscles. CONCLUSIONS Patients who perceive their knee function as normal at 6 months following ACLR presented with better neuromuscular properties of the thigh muscles. Decreased hamstring stiffness seems to be the key to higher return-to-preinjury activity. Postoperative rehabilitation should be more focused on reducing hamstring stiffness in addition to improving knee extensor muscle strength. Level of evidence II (prospective cohort study).
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Chen H, Liu H, Chen L. Patellar Tendon Versus 4-Strand Semitendinosus and Gracilis Autografts for Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Randomized Controlled Trials With Mid- to Long-Term Follow-Up. Arthroscopy 2020; 36:2279-2291.e8. [PMID: 32387652 DOI: 10.1016/j.arthro.2020.04.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare patellar tendon (PT) autografts with 4-strand semitendinosus and gracilis (STG) autografts concerning knee stability, functional outcomes, as well as complications after anterior cruciate ligament (ACL) reconstruction at minimal follow-up of 5 years. METHODS A systematic search of the literature was performed in PubMed, Embase, and the Cochrane Library to identify published prospective randomized controlled trials on clinical studies comparing PT autograft and 4-strand STG autografts for ACL reconstruction. The results of the eligible studies were analyzed in terms of knee stability (laxity measurements, Lachman test, and pivot-shift test), functional outcomes (Lysholm score, International Knee Documentation Committee score, Cincinnati score, Tegner score, single-legged hop test, and return to preinjury activity level), and complications (loss of range of motion [ROM], pain, graft re-rupture, revision, and osteoarthritis [OA]). RESULTS Nine clinical studies with 630 patients (313 PT and 317 STG autografts) met the inclusion criteria. No statistically significant differences were found between the PT and STG group in Lachman test, pivot-shift test, International Knee Documentation Committee score, Cincinnati score, loss of ROM, kneeling pain, graft re-rupture rate, revision rate, and OA rate. The STG group was found with less anterior knee pain (P = .003). There were no clinically significant differences for the outcomes of SSD, Lysholm score, and Tegner score. CONCLUSIONS Except for significantly greater risk of anterior knee pain, PT autograft had comparable results with 4-strand STG autograft in terms of knee stability and functional outcomes after ACL reconstruction with mid- to long-term follow-up. Besides, we found no statistically significant difference in loss of ROM, kneeling pain, graft re-rupture rate, revision rate, and OA change, but these results were underpowered. LEVEL OF EVIDENCE Level I, meta-analysis of Level I studies.
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Affiliation(s)
- Haitao Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hankun Liu
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Liaobin Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Transphyseal anterior cruciate ligament reconstruction using living parental donor hamstring graft: excellent clinical results at 2 years in a cohort of 100 patients. Knee Surg Sports Traumatol Arthrosc 2020; 28:2511-2518. [PMID: 32002563 DOI: 10.1007/s00167-019-05842-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine outcomes of transphyseal ACL reconstruction using a living parental hamstring tendon allograft in a consecutive series of 100 children. METHODS One hundred consecutive juveniles undergoing ACL reconstruction with a living parental hamstring allograft were recruited prospectively and reviewed 2 years after ACL reconstruction with IKDC Knee Ligament Evaluation, and KT1000 instrumented laxity testing. Skeletally immature participants obtained annual radiographs until skeletal maturity, and long leg alignment radiographs at 2 years. Radiographic Posterior tibial slope was recorded. RESULTS Of 100 juveniles, the median age was 14 years (range 8-16) and 68% male. At surgery, 30 juveniles were graded Tanner 1 or 2, 21 were Tanner 3 and 49 were Tanner 4 or 5. There were no cases of iatrogenic physeal injury or leg length discrepancy on long leg radiographs at 2 years, despite a median increase in height of 8 cm. Twelve patients had an ACL graft rupture and 9 had a contralateral ACL injury. Of those without further ACL injury, 82% returned to competitive sports, IKDC ligament evaluation was normal in 52% and nearly normal in 48%. The median side to side difference on manual maximum testing with the KT1000 was 2 mm (range - 1 to 5). A radiographic PTS of 12° or more was observed in 49%. CONCLUSIONS ACL reconstruction in the juvenile with living parental hamstring tendon allograft is a viable procedure associated with excellent clinical stability, patient-reported outcomes and return to sport over 2 years. Further ACL injury to the reconstructed and the contralateral knee remains a significant risk, with identical prevalence observed between the reconstructed and contralateral ACL between 12 and 24 months after surgery. LEVEL OF EVIDENCE III (Cohort Study).
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