1
|
Lee DM, Park HS, Choi NH, Victoroff BN. Tibial sided Anterolateral Ligament Injuries are Associated with Poor Healing and Residual Pivot Shift Testing Following Anterior Cruciate Ligament Reconstruction. Arthroscopy 2024:S0749-8063(24)00401-8. [PMID: 38849064 DOI: 10.1016/j.arthro.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE ; to investigate if tibial sided anterolateral ligament (ALL) injuries are associated with poor healing and residual pivot shift. METHODS ; Patients who underwent anterior cruciate ligament reconstructions within postinjury 6 weeks from January 2008 to March 2021 were included. They had concomitant ALL injury confirmed by preoperative magnetic resonance imaging (MRI) and were followed minimum 20 months. Preoperative ALL injury was graded by the Muramatsu classification and postoperative ALL healing were graded by a modification of the Lee classification (good, partial, and non-visualized). The patients were allocated to an improved group (IG) and an unimproved group (UG) based on a comparison of pre- and postoperative MRI. ALL tear site, postoperative knee stability, Lysholm score, and Tegner activity scale (PROs) were compared between the two groups. RESULTS ; 128 patients were enrolled. 94.5 % patients achieved the minimal clinically important difference (MCID) for PROs, respectively. The ALL was torn at the femoral side in 46.9% patients, at mid-substance in 31.2.%, and at tibial side in 21.9%, Preoperatively, 86 (67.2%) patients had a partial tear and 42 (32.8%) patients had a complete tear. Based on the postoperative MRI appearances, 38 (29.7%) and 90 (70.3%) patients were allocated to the IG and UG, respectively. The tibial side tears were significantly frequent in UG (p= .032). Pivot shift showed a significantly higher incidence in UG than IG (p=.004). Lachman test and PROs did not differ between the two groups. CONCLUSIONS ; Tibial-sided ALL tears occurred in 18.7% of the UG compared to 3.2% of the IG, and 45.6% of the UG had a postoperative grade 1 or 2 pivot shift, compared to 15.8% of the IG. Percentages of patients with the MCID for PROs did not differ between the two groups. However, the clinical relevance is limited by a high transfer bias.
Collapse
Affiliation(s)
- Dong-Min Lee
- Department of Orthopedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, South Korea
| | - Hoon-Sung Park
- Department of Orthopedic Surgery, Eulji Medical Center, Seoul, South Korea
| | - Nam-Hong Choi
- Department of Orthopedic Surgery, Eulji Medical Center, Seoul, South Korea.
| | - Brian N Victoroff
- Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
2
|
Guerreiro JPF, Rosa LB, Gonçalves EL, Curcio ARR, Bignardi PR, Danieli MV. Outcomes of Anterior Cruciate Ligament Reconstruction in Patients with Associated Anterolateral Ligament Injury. Rev Bras Ortop 2024; 59:e397-e402. [PMID: 38911889 PMCID: PMC11193583 DOI: 10.1055/s-0044-1785516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/06/2023] [Indexed: 06/25/2024] Open
Abstract
Objective To evaluate if there is a significant difference in the outcomes of isolated anterior cruciate ligament (ACL) reconstruction in patients with or without associated anterolateral ligament (ALL) injury. Methods We conducted a retrospective cross-sectional study through the analysis of medical records and the application of the questionnaires of the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) Subjective Knee Form to patients undergoing isolated ACL reconstruction. Results The 52 participants included were divided into two groups: 19 with associated ALL injury and 33 with no associated ALL injury. None of the patients with associated ALL injury suffered an ACL rerupture, and 21.1% presented injuries to other knee structures after surgery. Among the patients with no associated injury, 6.1% suffered ACL rerupture, and 18.2% presented injuries to other structures after surgery ( p = 0.544). Return to activities at the same level as that of the preoperative period occurred in 60% of the patients with associated ALL injury and in 72% of those with no associated injury ( p = 0.309). The mean score on the Lysholm Knee Scoring Scale was of 81.6 points in patients with associated ALL injury, and of 90.1 in those with no associated injury ( p = 0.032). The mean score on the IKDC Subjective Knee Form was of 70.3 points in patients with associated ALL injury and of 76.7 in those with no associated injury ( p = 0.112). Conclusion There was no statistically significant difference regarding graft injuries or new injuries to other structures, satisfaction with the operated knee, or the score on the IKDC Subjective Knee Form. Return to activity was similar in the groups with and without associated ALL injuries. The scores on the Lysholm Knee Scoring Scale were better, with a statistically significant difference in the group with no associated ALL injuries.
Collapse
Affiliation(s)
- João Paulo Fernandes Guerreiro
- Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
- Hospital de Ortopedia Uniort.e, Londrina, PR, Brasil
| | - Larissa Baldow Rosa
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
| | | | | | - Paulo Roberto Bignardi
- Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
| | - Marcus Vinicius Danieli
- Faculdade de Medicina, Pontifícia Universidade Católica do Paraná (PUCPR) – Câmpus Londrina, Londrina, PR, Brasil
- Hospital de Ortopedia Uniort.e, Londrina, PR, Brasil
| |
Collapse
|
3
|
Saithna A, Helito CP, Bin Abd Razak HR, Cristiani R. Secondary restraints in ACL reconstruction: State-of-the-art. J ISAKOS 2024:S2059-7754(24)00088-9. [PMID: 38734309 DOI: 10.1016/j.jisako.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 03/07/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
At-risk patients continue to experience a high likelihood of graft rupture after anterior cruciate ligament (ACL) reconstruction (ACLR). This narrative review seeks to provide the reader with an evidence-based synopsis of state-of-the-art concepts related to secondary restraint lesions, and how addressing them surgically might result in improved outcomes of ACLR.
Collapse
Affiliation(s)
- Adnan Saithna
- Department of Orthopedic Surgery, University of Arizona, Tucson, AZ, 85724, USA; AZBSC Orthopedics, 7649 E Pinnacle Peak Rd, Scottsdale, AZ, 85255, USA.
| | - Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333 - Cerqueira Cesar, São Paulo, SP, CEP: 05403-010, Brazil; Hospital Sírio Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, São Paulo, SP, CEP 01308-050, Brazil
| | - Hamid Rahmatullah Bin Abd Razak
- Total Orthopaedic Care & Surgery, Novena Medical Centre, 10 Sinaran Drive, 307506 Singapore; SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, 20 College Road, Academia Level 4, 169865, Singapore
| | - Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden; Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden
| |
Collapse
|
4
|
Chen D, Wu R, Lai Y, Xiao B, Lai J, Zhang M. Anterior Cruciate Ligament Rupture Combined with Complete Radial Tear of the Posterior Horn of the Lateral Meniscus: Suture or Resection? J Knee Surg 2024; 37:426-435. [PMID: 37722418 DOI: 10.1055/s-0043-1774800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Anterior cruciate ligament (ACL) rupture often presents with a tear of the posterior horn of the lateral meniscus. There is no clear preference between ACL reconstruction with suture and resection of the meniscus. We aimed to compare the clinical efficacy of ACL reconstruction with suture versus resection in patients presenting with arthroscopic ACL rupture and radial complete tear of the posterior corner of the lateral meniscus. We retrospectively analyzed 157 patients with ACL rupture and complete radial tear of the posterior horn of the lateral meniscus. Between May 2010 and April 2015, 86 of 157 patients underwent ACL reconstruction and meniscus suture (study group, 54.78%) and 71 of 157 patients underwent ACL reconstruction and meniscus resection (control group, 45.22%) in our department. All patients were monitored over the 12 to 72-month follow-up period. The primary evaluation indices were the Lysholm scores, the International Knee Documentation Committee (IKDC) scores, pivot shift test, the Barret criteria, and magnetic resonance imaging (MRI) findings of meniscal healing. The majority of 157 patients were relatively young men (29.64 ± 7.79 years) with low body mass index (BMI) (23.79 ± 2.74). The postoperative Lysholm and IKDC scores of the two groups were significantly improved over the corresponding preoperative scores (p < 0.05). The clinical results and excellent and good rates were significantly better for the study group than for the control group (both, p < 0.05). MRI showed that the meniscal healed rate of the study group was 96.51%. There was no significant difference in BMI between subgroups for any functional outcome. For patients with ACL rupture and complete radial tear of the posterior horn of the lateral meniscus, ACL reconstruction and both simultaneous suture and resection of the posterior horn of the lateral meniscus were found to be safe and effective. There was no association between outcomes and BMI. However, the former was associated with a superior long-term clinical effect and may restore the integrity of the meniscus and is particularly recommended for young patients.
Collapse
Affiliation(s)
- Daohua Chen
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Rong Wu
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Yanqing Lai
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Bo Xiao
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Jiajing Lai
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Minghua Zhang
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| |
Collapse
|
5
|
Ateş O, Oğul A. Evaluation of anterolateral ligament healing in patients with anterior cruciate ligament injury without anterior cruciate ligament reconstruction and its relationship with clinical examination tests. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38686564 DOI: 10.1002/ksa.12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE This study radiologically investigated the potential of preoperative recovery of the anterolateral ligament (ALL) in patients who did not undergo anterior cruciate ligament reconstruction (ACLR) surgery in the early stages despite surgical indication. The secondary aim was to investigate the relationship between ALL injuries in magnetic resonance imaging (MRI) and the results of Lachman and pivot shift tests performed preoperatively and postoperatively under anaesthesia among patients who underwent ACLR in acute and chronic stages. METHODS The study examined 100 patients aged 19-51 years who underwent anatomic single bundle ACLR using hamstring autografts for the ACL. Based on the time between the injury and ACLR, they were divided into acute (≤6 months) and chronic (>6 months) groups. The chronic group had three subgroups of ACLR times: 7-12, 13-24 and >24 months. Complete recovery was defined as a change from grade B or C upon injury to grade A before surgery according to the Muramatsu MRI classification. The relationship between preoperative and postoperative Lachman grades and pivot shifting test results and the degree of ALL injury was evaluated. RESULTS In the chronic group, 19/61 patients (31.1%) had preoperative grade A, and 4/61 patients (6.5%) had grade A at the time of injury. In the acute group, 22/29 patients with grades B and C (76%) had grade 3 preoperative pivot shifting. In the acute group, grades 1 and 2 were more common in patients with grades B and C (10/29, 35%) than grade A (0/10, 0.0%). CONCLUSION The improvement rate was 24.6% among patients who did not receive ACLR in the acute phase and underwent ACLR in the chronic phase. In the acute group, the degree of ALL damage was related to the pivot shift results. However, the results in the chronic phase were not associated with the degree of injury. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Okan Ateş
- Orthopedic and Traumatology Deparment, Bower Hospital, Diyarbakır, Turkey
| | - Ahsen Oğul
- Eskişehir City Hospital, Department of Sports Medicine, Eskişehir, Turkey
| |
Collapse
|
6
|
Murgier J, Duthon V, Deygas A, Ehkirch FP. Does an early post traumatic knee brace reduce the incidence of knee rotational instability? Arch Orthop Trauma Surg 2024; 144:1161-1169. [PMID: 38253710 DOI: 10.1007/s00402-024-05206-8] [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: 07/22/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE Several anterolateral stabilization procedures have been developed recently to address rotational instability of the knee. Currently, these procedures tend to be systematically used by some practitioners. However, antero-lateral structures of the knee (including the anterolateral ligament, ALL) have a self-healing potential which can reduce the need to perform an antero-lateral procedure. In this study, it was hypothesized that early post-traumatic immobilization of the knee with a knee brace would allow partial healing of antero-lateral structures and also allow control of the pivot shift, thus avoiding antero-lateral extra-articular stabilization. The objective of this study was to compare the severity of pivot shift between two groups of patients who all experienced anterior cruciate ligament (ACL) tear and respectively underwent post-traumatic immobilization of the knee versus no immobilization. METHODS This was a comparative, multicentric (three centers' study) retrospective, consecutive study including 168 patients who underwent ACL reconstruction between May and September 2022. The application or not of post-traumatic immobilization and its duration, the severity of pivot shift observed in the operating room under general anesthesia, the presence of anterolateral lesions as revealed by MRI and the patients' pre-injury sport activity were recorded. RESULTS A grade 3 pivot shift was found in 44 patients (27%). It was more frequently observed in the group without a brace compared to the group with a knee brace (18 patients out of 36: 50% versus 26 patients out of 132: 19.7%; p = 0.0012). Wearing a brace, whether hinged (OR = 0.221, [0.070-0.652]; p = 0.006) or not (OR = 0.232, [0.076-0.667]; p = 0.0064), was protective from the risk of developing a significant pivot shift. CONCLUSION This study demonstrated that the presence of pivot-shift was lower in the patients that had an early post-injury knee brace before their ACL reconstruction. Based on this result, systematic brace placement could be advocated for in patients after knee trauma. LEVEL OF EVIDENCE III, prognostic retrospective case-control study.
Collapse
Affiliation(s)
- Jérôme Murgier
- Orthopedics Department, Aguiléra Clinic, 21 Rue de L'Estagnas, 64200, Biarritz, France.
| | - Victoria Duthon
- Centre de Médecine du Sport et de L'Exercice, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Geneva, Switzerland
| | - Aymeric Deygas
- Orthopaedic Department, Clinique Maussins-Nollet, Paris, France
| | | |
Collapse
|
7
|
Lee DW, Lee DH, Cho SI, Yang SJ, Kim WJ, Lee JK, Kim JG. Comparison of ACL and Anterolateral Ligament Reconstruction With Isolated ACL Reconstruction Using Hamstring Autograft: Outcomes in Young Female Patients With High-Grade Pivot Shift. Orthop J Sports Med 2023; 11:23259671231178048. [PMID: 37781636 PMCID: PMC10536865 DOI: 10.1177/23259671231178048] [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: 02/25/2023] [Accepted: 03/10/2023] [Indexed: 10/03/2023] Open
Abstract
Background Inferior return to sports (RTS) and functional outcomes have been reported in women after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis The purpose was to evaluate the results of combined ACLR and anterolateral ligament reconstruction (ALLR) in young women with a high-grade pivot shift (grade ≥2). It was hypothesized that combined ACLR and ALLR would result in better RTS and rotational stability than isolated ACLR. Study Design Cohort study; Level of evidence, 3. Methods Two groups were retrospectively evaluated and compared. Group I (n = 39; mean age, 31.1 ± 5.7 years) underwent isolated ACLR using hamstring autografts; group C (n = 39; mean age, 30.4 ± 6.1 years) underwent combined ACLR and ALLR. Subjective outcome measures included the International Knee Documentation Committee subjective form, Lysholm, Tegner, and ACL-Return to Sport after Injury (ACL-RSI). Objective tests included a KT-2000 arthrometer stress test, a pivot-shift test, an isokinetic strength test, a Y-balance test, and a single-leg hop test. A postoperative questionnaire was administered to determine the rates and types of RTS, quality of sports performance, and reinjury and satisfaction rates. Subjective scores and clinical tests were performed at 2 years. Magnetic resonance imaging and second-look arthroscopy were conducted during the 1- and 2-year follow-ups, respectively. Results The mean follow-up for groups I and C were 30.4 ± 3.9 and 29.3 ± 3.5 months, respectively (P = .194). Patients in group C had better anteroposterior (P = .001) and rotational (P = .005) stability and higher ACL-RSI scores (P = .025) than those in group I. Group C had higher composite and posteromedial reach scores on the Y-balance test than group I (P = .014 and P = .010, respectively). A total of 26 (66.7%) patients in group C and 17 (43.6%) in group I returned to their prior level of sports (P = .040). Rerupture of the ACL graft and contralateral ACL rupture occurred in 2 (5.1%) and 2 (5.1%) patients in group I, respectively, compared with no rerupture or contralateral ACL rupture in group C. Conclusion Combined ACLR and ALLR in young women with a high-grade pivot shift was associated with better knee stability parameters, dynamic postural stability, and psychological readiness to RTS than isolated ACLR.
Collapse
Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dong Hwan Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seung Ik Cho
- Sports Medical Center, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang Jin Yang
- Department of Health and Exercise Management, Tongwon University, Gwangju-si, Gyeonggi-do, Republic of Korea
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| |
Collapse
|
8
|
Hess S, Hecker A, Egli RJ, Eberlein SC, Klenke FM. Standardized multi-planar reformation improves the reliability of the assessment of the anterolateral ligament in ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc 2023; 31:3799-3805. [PMID: 36820902 PMCID: PMC10435623 DOI: 10.1007/s00167-023-07343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The anterolateral ligament (ALL) is an important structure for controlling anterolateral rotatory stability of the knee. Its assessment, however, is difficult using standardized MRI images. The goal of this study was to assess the reliability of judging the integrity of the ALL on multi-planar reformatted (MPR) MRI images and on standard coronal reformatted (SCR) MRI images in knees with an anterior cruciate ligament (ACL) rupture. METHODS Forty-eight patients (14 females, 34 males, 30 ± 6 years (mean age ± standard deviation)) with acute ACL ruptures (< 2 weeks) and no additional knee injuries (except segond fractures) were included. Images were assessed by two independent raters twice with at least a 2-week interval in between. The assessment was first performed on SCR images and thereafter on MPR images. Images were judged for assessability of the ALL and then the integrity of the ALL was rated. RESULTS Depending on rater and read, the ALL was judged as "torn" in between 5 (10.4%) and 11 (22.9%) patients out of 48 patients on SCR images. On MRP images, the ALL was judged as "torn" in between 5 (10.4%) and 6 (12.5%) patients out of 48 patients, depending on rater and read. Inter- and intra-rater reliability for the assessment of the ALL using MPR images was "substantial" to "almost perfect". Inter- and intra-rater reliability for the assessment using SCR was "fair" to "substantial". CONCLUSION MPR images should be used when assessing the integrity of the ALL. Assessment quality is independent of patient positioning during MRI acquisition and the ALL can be displayed in full length on one image. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
| | - Andreas Hecker
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Rainer J Egli
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie C Eberlein
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Frank M Klenke
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| |
Collapse
|
9
|
Herbst E, Costello J, Popchak AJ, Tashman S, Irrgang JJ, Fu FH, Musahl V. Untreated Injuries to the Anterolateral Capsular Structures Do Not Affect Outcomes and Kinematics after Anatomic Anterior Cruciate Ligament Reconstruction. J Clin Med 2023; 12:4408. [PMID: 37445441 DOI: 10.3390/jcm12134408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/11/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Injuries to the anterolateral complex (ALC) may contribute to increased rotatory knee laxity. However, it has not been evaluated whether such injuries affect in vivo kinematics when treated in situ. The purpose of this study was to determine the grade of ALC injury and its effect on kinematic and clinical outcomes of ACL-injured patients 24 months after anatomic ACL reconstruction. It was hypothesized that injury to the ALC would be significantly related to patient-reported outcomes (PROs) and in vivo knee kinematics during downhill running. METHODS Thirty-five subjects (mean age: 22.8 ± 8.5 years) participating in a randomized clinical trial to compare single- and double-bundle ACL reconstruction were included in the study. Subjects were divided into two groups based on the presence or absence of injury to the ALC, as determined on MRI scans performed within 6 weeks of injury. None of the patients underwent treatment for these ALC injuries. At 24 months, PROs, including the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS) and in vivo knee kinematics during downhill running, were obtained. Pivot-shift test results, PROs and in vivo knee kinematics were compared between groups with and without ALC injury using the Pearson's Chi Squared test and Mann-Whitney U test with significance set at p < 0.05. RESULTS The average interval between injury and performing the MRI scans was 9.5 ± 10 days. ALC injury was observed in 17 (49%) study participants. No significant differences were detected in PROs and in vivo kinematics between subjects with and without ALC injury (n.s.). CONCLUSION The findings of this study demonstrate that MRI evidence of an ALC injury does not significantly affect in vivo knee kinematics and PROs even in individuals with a high-grade ALC injury. Injuries to the ALC as observed on MRI might not be a useful indication for an anterolateral procedure.
Collapse
Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, 48149 Münster, Germany
| | - Joanna Costello
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Scott Tashman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
- Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| |
Collapse
|
10
|
Yi Z, Jiang J, Liu Z, Wang H, Yi Q, Zhan H, Liang X, Niu Y, Xiang D, Geng B, Xia Y, Wu M. The Association Between Bone Bruises and Concomitant Ligaments Injuries in Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis. Indian J Orthop 2023; 57:20-32. [PMID: 36660483 PMCID: PMC9789248 DOI: 10.1007/s43465-022-00774-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
Background Bone bruises and concomitant ligament injuries after anterior cruciate ligament (ACL) injuries have attracted attention, but their correlation and potential clinical significance remain unclear. Purpose To assess the relationship between bone bruises and concomitant ligamentous injuries in ACL injuries. Study design Systematic review. Methods A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library was completed from inception to October 20, 2021. All articles that evaluated the relationship between bone bruises and related ligaments injuries were included. Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment as well as Review Manager 5.3 was used for data analysis. Results A total of 19 studies evaluating 3292 patients were included. After meta-analysis, anterolateral ligament (ALL) injuries were associated with bone bruising on the lateral tibial plateau (LTP) (RR = 2.33; 95% CI 1.44-3.77; p = 0.0006), lateral femoral condyle (LFC) (RR = 1.97; 95% CI 1.37-2.85; p = 0.0003) and medial tibial plateau (MTP) (RR = 1.62; 95% CI 1.24-2.11; p = 0.0004); Moreover, medial collateral ligament (MCL) injuries were associated with bone bruising on the femur (RR = 1.49; 95% CI 1.17-1.90; p = 0.001), and no statistical significance was found between bone bruising on the MTP and Kaplan fiber (KF) injuries (RR = 1.58; 95% CI 1.00-2.49; p = 0.05). Nonetheless, the current evidence did not conclude that bone bruises were associated with lateral collateral ligament (LCL) injuries. Conclusion For individuals with an ACL injury, bone bruises of the LTP, LFC, and MTP can assist in the diagnosis of ALL injuries. Furthermore, femoral bruising has potential diagnostic value for MCL injuries. Knowing these associations allows surgeons to be alert to ACL-related ligament injuries on MRI and during operations in future clinical practice.
Collapse
Affiliation(s)
- Zhi Yi
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Jin Jiang
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Zhongcheng Liu
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Hong Wang
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Qiong Yi
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Hongwei Zhan
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Xiaoyuan Liang
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Yongkang Niu
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Dejian Xiang
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Bin Geng
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Yayi Xia
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Meng Wu
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| |
Collapse
|
11
|
The anterolateral capsule is infrequently damaged as evaluated arthroscopically in patients undergoing anatomic ACL reconstruction. J ISAKOS 2022; 7:189-194. [PMID: 35798285 DOI: 10.1016/j.jisako.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Concomitant anterolateral complex (ALC) injury may contribute to persistent rotatory knee instability following anterior cruciate ligament (ACL) reconstruction. There is no consensus on how to best identify concomitant ALC injury preoperatively, nor how well ALC injury identified on imaging modalities correlates with clinical examination of knee instability. The purpose of this retrospective study was to determine the incidence of concomitant ALC injury in ACL-injured knees, as determined by arthroscopy to preoperative radiography, ultrasound, and MRI. METHODS A total of 117 patients with a unilateral primary ACL injury who underwent individualized anatomic ACLR between June 2016 and May 2019 were enrolled. Preoperative imaging modalities, including X-ray, ultrasound, and MRI, were evaluated for concomitant ALC injury. Clinical examination under anesthesia, including the anterior drawer, Lachman, and pivot shift tests were performed. Anterolateral capsule injury, as defined by hemorrhage and/or capsular tearing on diagnostic arthroscopy, was also determined. Correlative analyses of ALC injury incidence and severity were performed across imaging modalities and against clinical examination grades. RESULTS ALC injury incidence across imaging modalities was as follows: X-ray (3%), arthroscopy (19%), MRI (53%), and US (63%). The ALC injury rate on arthroscopy was significantly less than MRI (p < 0.001) or ultrasound (p < 0.001). ALC injury incidence and severity were significantly correlated between MRI and US grading scales (p = 0.02), but no correlations among other imaging modalities were found. Similarly, no imaging modality meaningfully correlated with physical examination maneuvers. CONCLUSION The incidence of ALC injury varies across imaging modalities, with lower injury rates found on arthroscopy (19%) compared to MRI (53%) and US (63%). Increasing ALC injury severity grades on imaging does not predict increasing anterolateral knee laxity on clinical examination. LEVEL OF EVIDENCE V, retrospective case series.
Collapse
|
12
|
Athanasiou V, Panagopoulos A, Kouzelis A, Kokkalis ZT, Lakoumentas J, Katsanos K, Gliatis J. A Review of Current Concepts of the Anterolateral Complex of the Knee. Orthop Rev (Pavia) 2022; 14:38651. [PMID: 36213619 PMCID: PMC9536860 DOI: 10.52965/001c.38651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
The anterolateral complex (ALC) of the knee has gained increased interest over the last decades due to the high revision rates of anterior cruciate ligament reconstruction (ACLR). Furthermore, in patients with an ACL tear, the injury of at least one of the ALC's anatomic structures has been shown to be significantly higher, thus affecting its secondary stabilizing role at the knee joint. As such, ACLR augmentation techniques, that embrace the ALC, have been proposed recently, and indications for these procedures are still evolving. This review aims to present and discuss the most current anatomical, biomechanical, and imaging data, current reconstruction techniques, and the clinical results of ALC reconstruction.
Collapse
Affiliation(s)
| | | | | | | | - John Lakoumentas
- Medical Physics Department, Medical School, University of Patras, Patras, Greece
| | | | - John Gliatis
- Orthopaedic Department, Patras University Hospital, Greece
| |
Collapse
|
13
|
Hodel S, Torrez C, Flury A, Fritz B, Steinwachs MR, Vlachopoulos L, Fucentese SF. Tibial internal rotation in combined anterior cruciate ligament and high-grade anterolateral ligament injury and its influence on ACL length. BMC Musculoskelet Disord 2022; 23:262. [PMID: 35303847 PMCID: PMC8932291 DOI: 10.1186/s12891-022-05218-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/14/2022] [Indexed: 01/11/2023] Open
Abstract
Background Assessment of combined anterolateral ligament (ALL) and anterior cruciate ligament (ACL) injury remains challenging but of high importance as the ALL is a contributing stabilizer of tibial internal rotation. The effect of preoperative static tibial internal rotation on ACL -length remains unknown. The aim of the study was analyze the effect of tibial internal rotation on ACL length in single-bundle ACL reconstructions and to quantify tibial internal rotation in combined ACL and ALL injuries. Methods The effect of tibial internal rotation on ACL length was computed in a three-dimensional (3D) model of 10 healthy knees with 5° increments of tibial internal rotation from 0 to 30° resulting in 70 simulations. For each step ACL length was measured. ALL injury severity was graded by a blinded musculoskeletal radiologist in a retrospective analysis of 61 patients who underwent single-bundle ACL reconstruction. Preoperative tibial internal rotation was measured in magnetic resonance imaging (MRI) and its diagnostic performance was analyzed. Results ACL length linearly increased 0.7 ± 0.1 mm (2.1 ± 0.5% of initial length) per 5° of tibial internal rotation from 0 to 30° in each patient. Seventeen patients (27.9%) had an intact ALL (grade 0), 10 (16.4%) a grade 1, 21 (34.4%) a grade 2 and 13 (21.3%) a grade 3 injury of the ALL. Patients with a combined ACL and ALL injury grade 3 had a median static tibial internal rotation of 8.8° (interquartile range (IQR): 8.3) compared to 5.6° (IQR: 6.6) in patients with an ALL injury (grade 0–2) (p = 0.03). A cut-off > 13.3° of tibial internal rotation predicted a high-grade ALL injury with a specificity of 92%, a sensitivity of 30%; area under the curve (AUC) 0.70 (95% CI: 0.54–0.85) (p = 0.03) and an accuracy of 79%. Conclusion ACL length linearly increases with tibial internal rotation from 0 to 30°. A combined ACL and high-grade ALL injury was associated with greater preoperative tibial internal rotation. This potentially contributes to unintentional graft laxity in ACL reconstructed patients, in particular with concomitant high-grade ALL tears. Study design Cohort study; Level of evidence, 3. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05218-8.
Collapse
Affiliation(s)
- Sandro Hodel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Carlos Torrez
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Andreas Flury
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Matthias R Steinwachs
- SportClinic Zurich Hirslanden Clinic, Witellikerstrasse, 40, 8032, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| |
Collapse
|
14
|
Kim JN, Park HJ, Kim MS, Won SY, Kim M, Park JH, Kim E, Park JY. Prevalence of anterolateral ligament injuries and lateral meniscus tear on MR imaging in patients with both-bundle tear vs. selective bundle incomplete tear of the anterior cruciate ligament. Eur Radiol 2022; 32:3954-3962. [PMID: 35020013 DOI: 10.1007/s00330-021-08472-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We investigated the prevalence of anterolateral ligament (ALL) injury and lateral meniscus (LM) tear in cases with both-bundle tear and selective bundle incomplete tear of the anterior cruciate ligament (ACL). METHODS A total of 174 cases of magnetic resonance (MR) images that had an ACL tear and underwent arthroscopic ACL reconstruction were retrospectively reviewed. ACL injury was classified into both bundle, anteromedial bundle, and posterolateral bundle (PL) on arthroscopic finding. The ALL was divided into three portions: femoral, meniscal, and tibial. ALL injury was scored into three groups: grade 0 is intact; grade 1 is stranding and edema surrounds the expected location of the ALL; grade 2 is clear discontinuity of the ALL consistent with rupture. Traumatic LM tear was also assessed on MR images. RESULTS The total prevalence of ALL injury was 36.2% (reader 1) and 42.0% (reader 2). ALL injury was statistically related to the selective bundle tear (p = 0.002 and 0.004, readers 1 and 2). PL bundle tear was significantly correlated with the ALL injury (p value < 0.001, readers 1 and 2, both). The location and grade of ALL injury were not significantly correlated with the type of ACL injury. LM tear was not significantly related to the types of ACL tear (p = 0.208 and 0.907, readers 1 and 2) and ALL injury (p value = 0.096 and 0.383, readers 1 and 2). CONCLUSIONS ALL injury was significantly related to the PL bundle tear of the ACL. LM tear was not significantly correlated with the types of ACL injury and ALL injury. KEY POINTS • Anterolateral ligament (ALL) injury was significantly related to the posterolateral bundle (PL) tear of the anterior cruciate ligament (ACL). • Lateral meniscus (LM) tear was not significantly correlated with the types of ACL injury and ALL injury. • Clinicians and radiologists should be aware of these relationships and scrutinize ALL injury in cases with PL bundle tears, even with an incomplete ACL injury.
Collapse
Affiliation(s)
- Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea.
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - So Yeon Won
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Minchul Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Yeon Park
- Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, Gyeonggido, Republic of Korea
| |
Collapse
|
15
|
Ward P, Chang P, Radtke L, Brophy RH. Clinical Implications of Bone Bruise Patterns Accompanying Anterior Cruciate Ligament Tears. Sports Health 2021; 14:585-591. [PMID: 34231443 DOI: 10.1177/19417381211029583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are common injuries; they are often associated with concomitant injuries to other structures in the knee, including bone bruises. While there is limited evidence that bone bruises are associated with slightly worse clinical outcomes, the implications of bone bruises for the articular cartilage and the risk of developing osteoarthritis (OA) in the knee are less clear. Recent studies suggest that the bone bruise pattern may be helpful in predicting the presence of meniscal ramp lesions. EVIDENCE ACQUISITION A literature review was performed in EMBASE using the keyword search phrase (acl OR (anterior AND cruciate AND ligament)) AND ((bone AND bruise) OR (bone AND contusion) OR (bone AND marrow AND edema) OR (bone AND marrow AND lesion) OR (subchondral AND edema)). STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS The literature search returned 93 articles of which 25 were ultimately included in this review. Most studies identified a high prevalence of bone bruises in the setting of acute ACL injury. Individual studies have found relationships between bone bruise volume and functional outcomes; however, these results were not supported by systematic review. Similarly, the literature has contradictory findings on the relationship between bone bruises and the progression of OA after ACL reconstruction. Investigations into concomitant injury found anterolateral ligament and meniscal ramp lesions to be associated with bone bruise presence on magnetic resonance imaging. CONCLUSION Despite the ample literature identifying the prevalence of bone bruises in association with ACL injury, there is little evidence to correlate bone bruises to functional outcomes or progression of OA. Bone bruises may best be used as a marker for concomitant injury such as medial meniscal ramp lesions that are not always well visualized on magnetic resonance imaging. Further research is required to establish the longitudinal effects of bone bruises on ACL tear recovery. STRENGTH OF RECOMMENDATION TAXONOMY 2.
Collapse
Affiliation(s)
- Patrick Ward
- Washington University School of Medicine, St Louis, Missouri
| | - Peter Chang
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Logan Radtke
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
16
|
Saithna A, Helito CP, Vieira TD, Sonnery-Cottet B, Muramatsu K. The Anterolateral Ligament Has Limited Intrinsic Healing Potential: A Serial, 3-Dimensional-Magnetic Resonance Imaging Study of Anterior Cruciate Ligament-Injured Knees From the SANTI Study Group. Am J Sports Med 2021; 49:2125-2135. [PMID: 34015246 DOI: 10.1177/03635465211013015] [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 Recent imaging studies demonstrate that the anterolateral ligament (ALL) is frequently injured at the time of anterior cruciate ligament (ACL) rupture. The intrinsic healing potential of these injuries after ACL reconstruction (ACLR) has not been defined. PURPOSE/HYPOTHESIS The primary objective was to evaluate the rate and duration of the healing process of injured ALLs after ACLR using serial 3-dimensional magnetic resonance imaging (3D-MRI). The secondary objective was to investigate whether any patient, injury, or surgical factors influenced the healing rate. The hypothesis was that serial imaging would demonstrate that the ALL has limited healing potential. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients enrolled in the study underwent 3D-MRI (slice thickness 0.5 mm) preoperatively and at 1, 6, 12, and 24 months after ACLR. Three observers determined the grade of ALL injury according to the Muramatsu classification. Inter- and intraobserver reliabilities were calculated. The rates of injury and time points for healing were determined. Full healing was defined as a change from a preoperative Muramatsu grade of B or C (indicating partial or complete injury) to grade A (normal). Multivariate analysis was used to investigate the association of aforementioned factors with the risk of incomplete healing. RESULTS A total of 44 patients were enrolled in the study. Of them, 71.2% had an ALL injury on preoperative imaging. Overall, full healing of ALL injuries occurred at a rate of 3.2%, 15.2%, and 30.3% at 1, 6, and 12 months, respectively. There were no changes in the Muramatsu grade in any patient beyond 12 months postoperatively. None of the complete lesions demonstrated full healing, but the proportion of patients with a grade C injury decreased from 13.6% preoperatively to 4.5% at 12 months due to an improvement to grade B in 4 of 6 patients (66%). Inter- and intraobserver reliabilities of the classification system were almost perfect at 0.81-0.94 and 0.95-1.00, respectively. None of the potential risk factors investigated were predictive of an increased risk of nonhealing. CONCLUSION ALL injuries occurred in the majority of ACL-injured knees. They had limited intrinsic healing potential, with only 30.3% healing by 12 months after ACLR. The process of healing took >6 months in half of the patients in whom it occurred. No new cases of full healing occurred beyond 12 months postoperatively. No significant risk factors for failure of full healing to occur were identified, but it is likely that this aspect of the study was underpowered.
Collapse
Affiliation(s)
- Adnan Saithna
- AZBSC Orthopedics, Scottsdale, Arizona, USA.,School of Science & Technology, Nottingham Trent University, Clifton Campus, Nottingham, UK
| | - Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | | |
Collapse
|
17
|
Sobrado MF, Giglio PN, Bonadio MB, Helito PVP, Guimarães TM, Pécora JR, Gobbi RG, Helito CP. Outcomes After Isolated Acute Anterior Cruciate Ligament Reconstruction Are Inferior in Patients With an Associated Anterolateral Ligament Injury. Am J Sports Med 2020; 48:3177-3182. [PMID: 33017174 DOI: 10.1177/0363546520956266] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Isolated reconstruction of the anterior cruciate ligament (ACL) does not reestablish the normal knee biomechanics in cases of associated injuries to the anterolateral structures. Studies evaluating the potential clinical effect of anterolateral ligament (ALL) injury on the treatment of ACL injuries are necessary to validate the findings of biomechanical studies. PURPOSE To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed using magnetic resonance imaging. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL group) or absence (no-ALL group) of ALL injury on preoperative magnetic resonance imaging scans. Both groups underwent anatomic reconstruction of the ACL with autologous hamstring tendon grafts. The Lysholm and subjective IKDC scores (International Knee Documentation Committee), KT-1000 arthrometer and pivot-shift test results, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. RESULTS A total of 182 patients were evaluated. Postoperative mean ± SD follow-up was 33.6 ± 7.1 and 36.1 ± 8.1 months for the ALL and no-ALL groups, respectively. No significant differences were found between the groups in terms of age, sex, knee hyperextension, duration of injury before reconstruction, follow-up time, or associated meniscal injuries. In the preoperative evaluation, the pivot-shift grade was similar, and the ALL group had worse KT-1000 arthrometer values (7.9 ± 1.2 mm vs 7.2 ± 1.1 mm; P < .001). In the postoperative evaluation, patients in the no-ALL group had a lower reconstruction failure rate (10.2% vs 1.4%; P = .029) and better clinical outcomes according to the IKDC subjective (85.5 ± 10.7 vs 89.1 ± 6.6; P = .035) and Lysholm scores (85.9 ± 10.1 vs 92.0 ± 6.3; P < .001). There was no postoperative difference in the KT-1000 or pivot-shift results. CONCLUSION Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 2 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores.
Collapse
Affiliation(s)
- Marcel Faraco Sobrado
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Pedro Nogueira Giglio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Batista Bonadio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Victor Partezani Helito
- Hospital Sírio Libanês, São Paulo, Brazil.,Grupo de radiologia musculoesqueléticas, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Tales Mollica Guimarães
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Ricardo Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Riccardo Gomes Gobbi
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| |
Collapse
|