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Tischer T, Karlsson J, Seil R. Sport-specific differences in ACL injury, treatment and return to sports. Knee Surg Sports Traumatol Arthrosc 2024; 32:1359-1362. [PMID: 38586977 DOI: 10.1002/ksa.12174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Thomas Tischer
- Department of Orthopaedic and Trauma Surgery, Waldkrankenhaus Erlangen, Erlangen, Germany
- Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier-Clinique d'Eich and Luxembourg Institute of Health, Luxembourg
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Selcuk H, Baz AB, Egerci OF, Kose O. Peroneus longus tendon autograft versus allograft in revision ACLR: A retrospective comparison. Orthop Traumatol Surg Res 2024; 110:103775. [PMID: 38013008 DOI: 10.1016/j.otsr.2023.103775] [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: 03/21/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE The use of peroneus longus tendon (PLT) autografts in primary anterior cruciate ligament reconstruction (ACLR) has increased recently, but there is a lack of research on its use in revision ACLR. This study aimed to compare the clinical outcomes and complications between revision ACLR using allografts and PLT autografts. MATERIALS AND METHODS Fifty-nine patients who underwent arthroscopic revision of ACLR with complete clinical follow-ups between 2012 and 2021 were retrospectively reviewed. Allograft was used in 44 of these patients, and PLT autograft was used in 15 of them. Lysholm knee score, Tegner activity score, Lachman, and anterior drawer tests were performed after a mean follow-up of 60months (range: 19-116). The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to evaluate the donor ankle functions. Clinical outcomes and complications were compared between groups. RESULTS Both groups showed significantly improved functional outcomes compared to their preoperative assessments. However, both groups had similar clinical results at the final follow-up, including Lysholm knee score, Tegner activity scale, knee range of motion, return to sports, time to return to daily activities, and rate of re-rupture. No major complications were seen in any of the patients. The AOFAS score was 99.13±2.64 in the PLT autograft group without loss of ankle muscle strength, deformity, instability, and permanent iatrogenic neurovascular injuries. The cumulative cost of the allograft group was significantly higher than the PLT autograft group. CONCLUSIONS The PLT autograft might be an alternative autograft option to allografts due to similar clinical outcomes, low donor site morbidity, and reduced cost in ACLR revisions, especially if the primary ACLR was performed using grafts harvested around the knee. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Huseyin Selcuk
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey
| | - Ali Bulent Baz
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey.
| | - Omer Faruk Egerci
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey
| | - Ozkan Kose
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey
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Mann O, Al-Dadah O. Anterior cruciate ligament reconstruction: effect of graft type and gender on early to mid-term clinical outcomes. Musculoskelet Surg 2024:10.1007/s12306-024-00824-2. [PMID: 38809336 DOI: 10.1007/s12306-024-00824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 05/03/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture is a debilitating condition and often requires surgery to restore joint stability. Common autografts used for reconstruction include patella tendon and hamstring tendons. The primary aim of this study was to evaluate the early to mid-term clinical outcomes of ACL reconstruction using validated patient-reported outcome measures (PROMs). The secondary aim was to compare clinical outcomes between patella tendon and hamstring tendon autografts. The tertiary aim was to compare clinical outcomes between males and females. METHODS Patients with an ACL rupture were evaluated before and after surgery using PROM scores which included Lysholm, Tegner, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Short Form-12 Item (SF-12) and EQ-5D-5L. RESULTS A total of 87 patients were included in the study. All PROM scores significantly improved following surgery (p < 0.001) at a mean follow-up time of 28 months (range 12 to 88 months). The patella tendon subgroup (n = 27) had superior post-operative results as compared to the hamstring tendon subgroup (n = 60) for KOOS sport and recreation (p = 0.005), KOOS quality of life (p = 0.025), KOOS overall (p = 0.026), Tegner (p = 0.046) and IKDC (p = 0.021) scores. There was no significant difference of PROM scores between males (n = 60) and females (n = 27) (p > 0.05). CONCLUSIONS ACL reconstruction significantly improves clinical outcomes for patients with symptomatic instability consequent to ACL rupture. Overall, patella tendon autograft resulted in better clinical outcomes as compared to hamstring tendon autograft following surgery. Gender did not influence clinical outcome following ACL reconstruction.
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Affiliation(s)
- O Mann
- The Medical School, Newcastle University, Framlington Place, Newcastle-Upon-Tyne, NE2 4HH, UK.
| | - O Al-Dadah
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside, NE34 0PL, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle-Upon-Tyne, NE2 4HH, UK
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Cai Z, Liu D, Yang Y, Lu W, Pan L, Liu X, Liu G, Vithran DTA, Li Y, Xiao W. Outcomes from different aspects indicate the all-inside technique may serve as an ideal option for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38769796 DOI: 10.1002/ksa.12259] [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: 10/02/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE To evaluate the postoperative outcomes of the all-inside technique in arthroscopic anterior cruciate ligament reconstruction (ACLR). METHODS Patients who underwent ACLR using the all-inside technique between 2018 and 2021 were retrospectively assessed. All patients were followed up for at least 2 years. Functional recovery and pain relief were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS). Instrumented laxity was assessed via side-to-side difference using the Kneelax3 arthrometer. Graft maturity was estimated using the signal-to-noise quotient value based on magnetic resonance imaging (MRI). Adverse events during and after the surgery were recorded. RESULTS A total of 78 patients were included in this study, with a mean age of 28.1 ± 7.6 years. The IKDC (p < 0.001), Lysholm (p < 0.001) and KOOS (p < 0.001 for all subgroups) scores at the final follow-up were significantly higher than those before the surgery. The VAS scores (p < 0.05) were significantly lower than those before surgery. The side-to-side difference results indicated that 50 patients had a difference of less than 3 mm, indicating a tight graft, whereas only 1 patient had a difference of >5 mm, indicating a loose graft. The median signal-to-noise quotient of the graft on MRI was 1.4 (P25, P75: 1.0, 2.0). No intraoperative adverse events were observed. Postoperative adverse events included three cases of infection, three cases of graft rerupture, two cases of cyclops lesion and one case of surgical intervention for a meniscal tear. CONCLUSION ACLR using the all-inside technique offers promising results in patients with ACL rupture. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Zijun Cai
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Di Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuntao Yang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenhao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Linyuan Pan
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xu Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Gaoming Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Djandan Tadum Arthur Vithran
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Oronowicz J, Frenzel G, Hörterer H, Moksnes H, Ekas GR, Cabri J, Tischer T, Seil R. Sport-specific differences in ACL injury, treatment and return to sports-Ski jumping. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38643402 DOI: 10.1002/ksa.12176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Jakub Oronowicz
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
- Department of Orthopaedics, University of Rostock, Rostock, Germany
| | | | - Hubert Hörterer
- Chairman Medical Committee FIS, Member Competition Equipment Committee FIS, Rottach-Egern, Germany
| | - Håvard Moksnes
- Norwegian School of Sport Sciences, Oslo Sports Trauma Research Center, Oslo, Norway
| | - Guri Ranum Ekas
- Norwegian School of Sport Sciences, Oslo Sports Trauma Research Center, Oslo, Norway
- Orthopaedic Department, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan Cabri
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg
- Dept. GERO, Faculty of Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thomas Tischer
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
- Department of Orthopaedics, University of Rostock, Rostock, Germany
| | - Romain Seil
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg
- Department of Orthopaedic Surgery, Division of Neurosciences and Musculoskeletal Diseases, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
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Oronowicz J, Seil R, Hörterer H, Moksnes H, Ekas GR, Cabri J, Mouton C, Frenzel G, Tischer T. Anterior cruciate ligament injuries in elite ski jumping reliably allow return to competition but severely affect future top performance. Knee Surg Sports Traumatol Arthrosc 2024; 32:616-622. [PMID: 38363010 DOI: 10.1002/ksa.12076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE In recent years, anterior cruciate ligament (ACL) injuries have been frequently observed in ski jumping. However, available data in this discipline are very scarce. Therefore, the purpose of this study was to investigate whether an ACL injury in elite-level ski jumping limits the performance level after ACL reconstruction (ACLR). METHODS Both male and female elite-level ski jumpers from five national A-teams who suffered an ACL injury were identified retrospectively by searching available media reports and Fédération Internationale de Ski (FIS) database. World Cup (WC) results and time-out-of-competition before ACL injury and after ACLR were compared. Only athletes who suffered the injury during or after the 2009-2010 season and who participated in at least one WC competition before the injury were included in this study. The level of athletes' performance from two full seasons before until three seasons after the injury was compared. RESULTS Eighteen elite-level ski jumpers (11 males/seven females) were eligible for the study. All male and four female athletes returned to professional competition after ACLR. One female athlete ended her career due to prolonged recovery and two have not yet recovered due to a recent injury. The mean return-to-competition (RTC) time was 14.6 months in males and 13.5 months in females. The mean WC placement decreased after the ACL injury: two seasons before injury the mean position was 17.9 ± 11.0 (n = 12), one season before it was 22.4 ± 12.8 (n = 15). After recovery, the mean placement in seasons 1-3 was: 26.4 ± 8.9 (n = 7), 25.7 ± 10.3 (n = 13), 33.6 ± 12.2 (n = 10) (p = 0.008). Among the athletes returning to competition, only six males and three females reached their preinjury level and only one male and one female (compared to seven males and three females preinjury) reached an individual top-3 placement after ACLR, accounting for less than 10% of podiums compared to preinjury. CONCLUSION Only 60% of the professional ski jumpers reached the preinjury level and less than 15% reached a top-3 placement after the ACL injury. These results support the fact that ACL tear during a ski jumping career may be a significant factor limiting high-level performance. In terms of clinical relevance, the findings implicate the need to analyse the reasons of these very low rates of return to elite-level performance, to analyse ACL injury and RTC rates at lower levels of performance and to develop specific prevention strategies in order to reduce the number of ACL injuries in this sport. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jakub Oronowicz
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg (CHL)-Clinique d'Eich, Luxembourg City, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxemburg City, Luxembourg
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health (LIH), Luxembourg City, Luxembourg
| | - Hubert Hörterer
- Chairman Medical Committee FIS; Member Competition Equipment Committee FIS, Rottach-Egern, Bayern, Germany
| | - Håvard Moksnes
- Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
| | - Guri R Ekas
- Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
- Orthopaedic Department, Akershus University Hospital, Nordbyhagen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Team Physician, Ski Jumping, Norwegian Ski Federation, Oslo, Norway
| | - Jan Cabri
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxemburg City, Luxembourg
- Faculty of Medicine and Pharmacy, GERO, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg (CHL)-Clinique d'Eich, Luxembourg City, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxemburg City, Luxembourg
| | | | - Thomas Tischer
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
- Department of Orthopaedics, University of Rostock, Rostock, Germany
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Zegzdryn M, Moatshe G, Engebretsen L, Drogset JO, Lygre SHL, Visnes H, Persson A. Increased risk for early revision with quadriceps graft compared with patellar tendon graft in primary ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 2024; 32:656-665. [PMID: 38375583 DOI: 10.1002/ksa.12081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Bone patella-tendon bone (BPTB) and hamstring tendon (HT) autografts are the most used grafts in primary anterior cruciate ligament (ACL) reconstructions (ACLR) in Norway. Quadriceps tendon (QT) autograft has gained more popularity during the past years. The purpose of this study is to compare revision rates and patient-reported outcomes of primary QT with BPTB and HT autograft ACL reconstructions in Norway at 2-year follow-up. It was hypothesized that there would be no difference in 2-year revision rates between all three autografts. METHODS Data included primary ACLR without concomitant ligament surgeries, registered in the Norwegian Knee Ligament Register from 2004 through 2021. Revision rates at 2 years were calculated using Kaplan-Meier analysis. Hazard ratios (HR) for revision were estimated using multivariable Cox regression analysis with revision within 2 years as endpoint. Mean change in patient-reported outcome was recorded preoperatively and at 2 years through the Knee Injury and Osteoarthritis Outcome Score (KOOS) subcategories 'Sport' and 'Quality of Life' was measured for patients that were not revised and analysed with multiple linear regression. RESULTS A total of 24,790 primary ACLRs were identified, 10,924 with BPTB, 13,263 with HT and 603 with a QT graft. Patients in the QT group were younger (23.5 years), more of them were women (58.2%) and over 50% had surgery <3 months after injury. The QT group had the highest prevalence of meniscal injuries (61.9%). Revision estimates at 2-years were 3.6%, 2.5% and 1.2% for QT, HT and BPTB, respectively (p < 0.001). In a Cox regression analysis with QT as reference, BPTB had a lower risk of revision (HR 0.4, 95% Cl 0.2-0.7, p < 0.001). No significant difference was observed in the revision risk between QT and HT (HR 1.1, 95% Cl 0.7-1.8, n.s.). The two most common reported reasons for revision were: traumatic graft rupture and nontraumatic graft failure. There were no differences between the groups in change of KOOS in subcategories 'Sport' and 'Quality of Life' at 2-years follow-up. CONCLUSION The 2-year risk of revision after ACLR with QT was higher than BPTB and similar to HT. No difference was found between the groups in patient-reported outcomes. This study provides valuable insights for both surgeons and patients when making decisions about the choice of autografts in primary ACL reconstructions. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Marek Zegzdryn
- Orthopaedic Department, Sørlandet Hospital Arendal, Arendal, Norway
| | - Gilbert Moatshe
- Orthopaedic Surgery Clinic, Oslo University Hospital Ullevål, Oslo, Norway
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Orthopeadic Division, University of Oslo, Oslo, Norway
| | - Lars Engebretsen
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Orthopeadic Division, University of Oslo, Oslo, Norway
| | - Jon Olav Drogset
- Orthopaedic Surgery, Trondheim University Hospital, Trondheim, Norway
- Norwegian Knee Ligament Register, Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Håkon Låstad Lygre
- Norwegian Knee Ligament Register, Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Håvard Visnes
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Norwegian Knee Ligament Register, Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Orthopeadic Department, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Andreas Persson
- Orthopaedic Surgery Clinic, Oslo University Hospital Ullevål, Oslo, Norway
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Norwegian Knee Ligament Register, Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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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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Sritharan P, Milantoni V, Abdel Khalik H, Kay J, Slawaska-Eng D, Johnson J, de Sa D. Evaluating the quality of systematic reviews of comparative studies in autograft-based anterior cruciate ligament reconstruction using the AMSTAR-2 tool: A systematic umbrella review. Knee Surg Sports Traumatol Arthrosc 2024; 32:583-598. [PMID: 38372015 DOI: 10.1002/ksa.12062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE There remains a lack of consensus around autograft selection in anterior cruciate ligament reconstruction (ACLR), though there is a large body of overlapping systematic reviews and meta-analyses. Systematic reviews and their methodological quality were aimed to be further assessed, using a validated tool known as assessing the methodological quality of systematic reviews (AMSTAR-2). METHODS MEDLINE, Embase and CENTRAL were searched from inception to 23 April 2023 for systematic reviews (with/without meta-analysis) comparing primary ACLR autografts. A final quality rating from AMSTAR-2 was provided for each study ('critically low', 'low', 'moderate' or 'high' quality). Correlational analyses were conducted for ratings in relation to study characteristics. RESULTS Two thousand five hundred and ninety-eight studies were screened, and 50 studies were ultimately included. Twenty-four studies (48%) were rated as 'critically low', 17 (34%) as 'low', seven (14%) as 'moderate' and two (4%) as 'high' quality. The least followed domains were reporting on sources of funding (1/50 studies), the impact of risk of bias on results of meta-analyses (11/36 studies) and publication bias (17/36 studies). There was a significant increase in the frequency of studies graded as 'moderate' compared to 'low' or 'critically low' quality over time (p = 0.020). CONCLUSION The methodological quality of systematic reviews comparing autografts in ACLR is low, with many studies being rated lower due to commonly absent aspects of systematic review methodology such as investigating sources of funding and publication bias. More recent studies were generally more likely to be of higher quality. Authors are advised to consult AMSTAR-2 prior to conducting systematic reviews in ACLR. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Praveen Sritharan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Vincent Milantoni
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hassaan Abdel Khalik
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jansen Johnson
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
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Ebert JR, Calvert ND, Radic R. A Prospective Randomized Controlled Trial Investigating Quadriceps Versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2024; 52:660-669. [PMID: 38284303 PMCID: PMC10905979 DOI: 10.1177/03635465231222279] [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: 07/15/2023] [Accepted: 11/06/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Numerous graft options are available when undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although a lack of high-quality evidence exists comparing quadriceps (QT) and hamstring (HT) autografts. PURPOSE To investigate patient outcomes in patients undergoing HT versus QT ACLR. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS After recruitment and randomization, 112 patients (HT = 55; QT = 57) underwent ACLR. Patients were assessed pre- and postoperatively (6 weeks and 3, 6, 12, and 24 months), with a range of patient-reported outcome measures (PROMs), graft laxity (KT-1000 arthrometer; primary outcome variable), active knee flexion and extension range of motion (ROM), peak isokinetic knee extensor and flexor strength, and a 6-hop performance battery. Limb symmetry indices (LSIs) were calculated for strength and hop measures. Secondary procedures, ACL retears, and contralateral ACL tears were reported. RESULTS All PROMs and knee ROM measures significantly improved (P < .0001), and no other group differences (P > .05) were observed-apart from the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score, which was significantly better in the HT group at 3 (P = .008), 6 (P = .010), and 12 (P = .014) months. No significant changes were observed in side-to-side laxity from 6 to 24 months (P = .105), and no group differences were observed (P = .487) at 6 (HT mean, 1.2; QT mean, 1.3), 12 (HT mean, 1.1; QT mean, 1.3), and 24 (HT mean, 1.1; QT mean, 1.2) months. While the HT group demonstrated significantly greater (P < .05) quadriceps strength LSIs at 6 and 12 months, the QT group showed significantly greater (P < .05) hamstring strength LSIs at 6, 12, and 24 months. The HT group showed significantly greater (P < .05) LSIs for the single horizontal (6 months), lateral (6 and 12 months), and medial (6 months) hop tests for distance. Up until 24 months, 1 patient (QT at 22 months) had a retear, with 2 contralateral ACL tears (QT at 19 months; HT at 23 months). Secondary procedures included 5 in the HT group (manipulation under anesthesia, notch debridement, meniscal repair, and knee arthroscopy for scar tissue) and 6 in the QT group (notch debridement, meniscal repair, knee arthroscopy for scar tissue, tibial tubercle transfer, and osteochondral autologous transplantation). CONCLUSION Apart from the ACL-RSI, the 2 autograft groups compared well for PROMs, knee ROM, and laxity. However, greater hamstring strength LSIs were observed for the QT cohort, with greater quadriceps strength (and hop test) LSIs in the HT cohort. The longer-term review will continue to evaluate return to sports and later-stage reinjury between the 2 graft constructs. REGISTRATION ACTRN12618001520224p (Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Jay R. Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
- HFRC Rehabilitation Clinic, Perth, Western Australia, Australia
- Perth Orthopaedic & Sports Medicine Research Institute, Perth, Western Australia, Australia
| | - Nicholas D. Calvert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
- Perth Orthopaedic & Sports Medicine Research Institute, Perth, Western Australia, Australia
- Department of Orthopaedics, Royal Perth Hospital, Perth, Western Australia, Australia
- Perth Orthopaedic & Sports Medicine Centre, Perth, Western Australia, Australia
| | - Ross Radic
- Perth Orthopaedic & Sports Medicine Research Institute, Perth, Western Australia, Australia
- Department of Orthopaedics, Royal Perth Hospital, Perth, Western Australia, Australia
- Perth Orthopaedic & Sports Medicine Centre, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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11
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Kaarre J, Herman ZJ, Drain NP, Ramraj R, Smith CN, Nazzal EM, Hughes JD, Lesniak BP, Irrgang JJ, Musahl V, Sprague AL. Strength symmetry after autograft anterior cruciate ligament reconstruction. J ISAKOS 2024; 9:3-8. [PMID: 37806659 PMCID: PMC11131415 DOI: 10.1016/j.jisako.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/08/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To compare postoperative isometric quadriceps strength indices (QI%) and hamstring strength limb symmetry indices (HI%) between partial thickness quadriceps tendon (pQT), full thickness quadriceps tendon (fQT), and bone-patellar-tendon bone (BPTB) autograft anterior cruciate ligament reconstruction (ACLR). METHODS Patients with primary ACLR with pQT, fQT, or BPTB autograft with the documentation of quantitative postoperative strength assessments between 2016 and 2021 were included. Isometric Biodex data, including QI% and HI% (calculated as the percentage of involved to uninvolved limb strength) were collected between 5 and 8 months and between 9 and 15 months postoperatively. RESULTS In total, 124 and 51 patients had 5-8- and 9-15-month follow-up strength data, respectively. No significant difference was detected between groups for sex. However, patients undergoing fQT were found to be older than those undergoing BPTB (24.6±7 vs 20.2±5; p = 0.01). There were no significant differences in the number of concomitant meniscus repairs between the groups (pQT vs. fQT vs. BPTB). No significant differences were detected in median (min-max) QI% between pQT, fQT, and BPTB 5-8 months [87 % (44%-130 %), 84 % (44%-110 %), 82 % (37%-110 %) or 9-15 months [89 % (50%-110 %), 89 % (67%-110 %), and 90 % (74%-140 %)] postoperatively. Similarly, no differences were detected in median HI% between the groups 5-8 months or 9-15 months postoperatively. CONCLUSION The study was unable to detect differences in the recovery of quadriceps strength between patients undergoing ACLR with pQT, fQT, and BPTB autografts at 5-8 months and 9-15-months postoperatively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Janina Kaarre
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicholas P Drain
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raghav Ramraj
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clair N Smith
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Andrew L Sprague
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
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12
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D'Ambrosi R, Milinkovic DD, Abermann E, Herbort M, Fink C. Quality of YouTube Videos Regarding Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autograft Is Unsatisfactory. Arthroscopy 2024:S0749-8063(24)00002-1. [PMID: 38185185 DOI: 10.1016/j.arthro.2024.01.002] [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: 10/09/2023] [Revised: 12/12/2023] [Accepted: 01/01/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE To assess the validity and informational value of teaching material regarding anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon (QT) autograft provided on the YouTube video platform. METHODS An extensive systematic search of the YouTube video platform was performed, and all videos that met the criteria were included in the analysis. The analysis of the video content was performed using the DISCERN instrument, Journal of American Medical Association (JAMA) benchmark criteria, and Global Quality Score (GQS). The duration of the videos, the date of publication, and the number of likes and views were recorded. Furthermore, videos were categorized based on the source (physicians, companies, patients), the subject (surgical technique, patient experience and overview [overview videos were videos in which multiple aspects were analyzed]), and the type of content (educational or subjective patient experience). RESULTS A total of 88 videos were included in the analysis. Seventy-one (80.7%) videos were published by physicians, 15 (17.0%) by patients, and 2 (2.3%) by companies. The majority of the videos described various surgical techniques (59%-67.0%), 80.7% of the videos (72%-81.8%) had an educational nature, and the remaining 18.2% described patient experiences. The mean length of the videos was 8.21 ± 7.88 minutes. The mean number of views was 3,988.51 ± 9,792.98 (range 9-56,047), whereas the mean numbers of comments and likes were 30.07 ± 70.07 (range 0-493) and 4.48 ± 14.22 (range 0-82), respectively. The mean DISCERN score, JAMA score, and GQS were 27.43 ±11.56 (95% confidence interval [CI] 25.01-29.85; range: 17-68), 1.22 ± 0.85 (95% CI 1.04-1.40; range 0-3), and 1.82 ± 0.93 (95% CI 1.63-2.01; range 1-4), respectively. For all scores, videos published by physicians had greater quality (DISCERN score, JAMA score, and GQS) (P < .05). Among all of the analyzed videos, overview videos were of the highest quality (P < .05). CONCLUSIONS YouTube is a fast and open-access source of mass information. The overall quality of the videos on ACLR performed using QT autograft was unsatisfactory, demonstrating low educational quality and reliability. Currently, YouTube cannot be recommended as a reliable source of information on ACLR with the QT.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milan, Italy.
| | - Danko Dan Milinkovic
- Department of Orthopedic and Trauma Surgery, Arcus Sportclinic, Pforzheim, Germany
| | - Elisabeth Abermann
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, Austria
| | - Mirco Herbort
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria; Orthopadische Chirurgie Munchen, Munchen, Germany
| | - Christian Fink
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, Austria; Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
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13
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Holmgren D, Noory S, Moström E, Grindem H, Stålman A, Wörner T. Weaker Quadriceps Muscle Strength With a Quadriceps Tendon Graft Compared With a Patellar or Hamstring Tendon Graft at 7 Months After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2024; 52:69-76. [PMID: 38164665 PMCID: PMC10762885 DOI: 10.1177/03635465231209442] [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: 03/15/2023] [Accepted: 09/06/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Impaired quadriceps muscle strength after anterior cruciate ligament reconstruction (ACLR) is associated with worse clinical outcomes and a risk of reinjuries. Yet, we know little about quadriceps muscle strength in patients reconstructed with a quadriceps tendon (QT) graft, which is increasing in popularity worldwide. PURPOSE To describe and compare isokinetic quadriceps strength in patients undergoing ACLR with a QT, hamstring tendon (HT), or bone-patellar tendon-bone (BPTB) autograft. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS We included patients with QT grafts (n = 104) and matched them to patients with HT (n = 104) and BPTB (n = 104) grafts based on age, sex, and associated meniscal surgery. Data were collected through clinical strength testing at a mean of 7 ± 1 months postoperatively. Isokinetic strength was measured at 90 deg/s, and quadriceps strength was expressed as the limb symmetry index (LSI) for peak torque, total work, torque at 30° of knee flexion, and time to peak torque. RESULTS Patients with QT grafts had the most impaired isokinetic quadriceps strength, with the LSI ranging between 67.5% and 75.1%, followed by those with BPTB grafts (74.4%-81.5%) and HT grafts (84.0%-89.0%). Patients with QT grafts had a significantly lower LSI for all variables compared with patients with HT grafts (mean difference: peak torque: -17.4% [95% CI, -21.7 to -13.2], P < .001; total work: -15.9% [95% CI, -20.6 to -11.1], P < .001; torque at 30° of knee flexion: -8.8% [95% CI, -14.7 to -2.9], P = .001; time to peak torque: -17.7% [95% CI, -25.8 to -9.6], P < .001). Compared with patients with BPTB grafts, patients with QT grafts had a significantly lower LSI for all variables (mean difference: peak torque: -6.9% [95% CI, -11.2 to -2.7], P < .001; total work: -7.7% [95% CI, -12.4 to -2.9], P < .001; torque at 30° of knee flexion: -6.3% [95% CI, -12.2 to -0.5], P = .03; time to peak torque: -8.8% [95% CI, -16.9 to -0.7], P = .03). None of the graft groups reached a mean LSI of >90% for peak torque (QT: 67.5% [95% CI, 64.8-70.1]; HT: 84.9% [95% CI, 82.4-87.4]; BPTB: 74.4% [95% CI, 72.0-76.9]). CONCLUSION At 7 months after ACLR, patients with QT grafts had significantly worse isokinetic quadriceps strength than patients with HT and BPTB grafts. None of the 3 graft groups reached a mean LSI of >90% in quadriceps strength.
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Affiliation(s)
- David Holmgren
- 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, Stockholm, Sweden
| | - Shiba Noory
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Eva Moström
- 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, Stockholm, Sweden
| | - Hege Grindem
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Anders Stålman
- 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, Stockholm, Sweden
| | - Tobias Wörner
- 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, Stockholm, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
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14
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Inoue J, Dadoo S, Nukuto K, Özbek EA, Lesniak BP, Sprague AL, Irrgang JJ, Musahl V. Near complete quadriceps tendon healing 2 years following harvest in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5747-5754. [PMID: 37930438 PMCID: PMC11181339 DOI: 10.1007/s00167-023-07638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Despite the recent increase in the use of quadriceps tendon (QT) autograft in anterior cruciate ligament reconstruction (ACLR); however, there remains a paucity of literature evaluating the postoperative morphology of the QT. The present study aimed to determine the postoperative morphologic change of the QT at a minimum of 2 years following harvesting during ACLR. METHODS Patients who underwent ACLR with QT autograft and underwent magnetic resonance imaging (MRI) at a minimum of 2 years following harvesting were retrospectively included in the study. The anterior-to-posterior (A-P) thickness, medial-to-lateral (M-L) width, cross-sectional area (CSA), and signal/noise quotient (SNQ) of the QT were assessed at 5 mm, 15 mm, and 30 mm proximal to the superior pole of the patella on MRI. The CSA was adjusted by the angle between the QT and the plane of the axial cut based on a cosine function (adjusted CSA). The A-P thickness, M-L width, adjusted CSA, and SNQ were compared pre- and postoperatively. In addition, defects or scar tissue formation in the harvest site were investigated on postoperative MRI. RESULTS Thirty patients were recruited for the study. The mean duration between postoperative MRI and surgery was 2.8 ± 1.1 years. The mean A-P thickness was 10.3% and 11.9% larger postoperatively at 5 mm and 15 mm, respectively. The mean M-L width was 7.3% and 6.5% smaller postoperatively at 5 mm and 15 mm, respectively. There were no significant differences in the adjusted CSA between pre- and post-operative states (275.7 ± 71.6 mm2 vs. 286.7 ± 91.8 mm2, n.s.). There was no significant difference in the postoperative change in the SNQ of the QT at all assessment locations. Defect or scar tissue formation at the harvest site was observed in 4 cases (13.3%), and 5 cases (16.6%), respectively. CONCLUSION At a minimum of 2 years following QT harvest during ACLR, the QT became slightly thicker and narrower (approximately 11% and 7%, respectively). While the current study demonstrates that QT re-harvesting can be considered due to nearly normalized tendon morphology, future histological and biomechanical studies are required to determine the re-harvesting potential of the QT. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA.
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Koji Nukuto
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Emre Anil Özbek
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA
- Department of Orthopaedic Surgery, Ankara University, Ankara, Turkey
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Andrew L Sprague
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - James J Irrgang
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA
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15
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Asai K, Nakase J, Kuzumaki T, Ishikawa T, Ozaki N, Tsuchiya H. Differences in the microstructural and mechanical qualities of semitendinosus tendon grafts between skeletally immature and mature patients in anterior cruciate ligament reconstruction. J Orthop Sci 2023:S0949-2658(23)00318-4. [PMID: 37985294 DOI: 10.1016/j.jos.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND This study aimed to investigate the microstructural and mechanical properties of semitendinosus tendon graft tissues during anterior cruciate ligament reconstruction and the clinical outcomes in skeletally immature and mature patients. METHODS Twenty-two patients who underwent primary anterior cruciate ligament reconstruction using a hamstring tendon graft were analyzed and divided into skeletally immature (n = 7) and mature groups (n = 15) based on magnetic resonance imaging findings of the epiphyseal plate of the distal femur. Tissue samples were collected from the mid-portion of the semitendinosus tendon. The collagen fibril diameter, maximum stress, and strain at maximum stress point in the semitendinosus tendon tissues were calculated for comparison of the microstructural and mechanical properties between the two groups. Postoperative outcomes were also assessed between the two groups. RESULTS The mean and 60th and 80th percentiles of fibril diameters in the skeletally immature group were significantly smaller than those in the mature group (65.9 ± 13.0, 73.5 ± 19.3, and 91.3 ± 27.4 nm in the skeletally immature group; and 90.3 ± 14.7, 94.0 ± 18.4, and 125.3 ± 19.9 nm in the skeletally immature group; p = 0.001, 0.024, and 0.004, respectively). Additionally, the strain at maximum stress was higher in the skeletally immature group (237.2 ± 102.4% vs. 121.5 ± 51.9%, p = 0.024). However, there was no difference in maximum stress between the skeletally immature and mature groups (19.9 ± 14.3 MPa vs. 24.5 ± 23.4 MPa, p = 0.578). Strain was negatively correlated with the mean fibril diameter and the 60th and 80th percentiles of fibril diameters, whereas stress was positively correlated with the mean fibril diameter. The skeletally immature group had a higher pivot shift test-positive rate than the mature group at the last follow-up (p = 0.023). CONCLUSION Semitendinosus tendon graft tissues differed microstructurally and mechanically between skeletally immature and mature patients. LEVEL OF EVIDENCE Level Ⅳ.
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Affiliation(s)
- Kazuki Asai
- Department of Orthopaedic Surgery, School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8641, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8641, Kanazawa, Japan.
| | - Toru Kuzumaki
- Department of Mechanical Engineering & Department of Materials Science, School of Engineering, Tokai University, 4-1-1 Kitakaname, 259-1292, Hiratsuka, Japan
| | - Tatsuya Ishikawa
- Department of Functional Anatomy, School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8640 Kanazawa, Japan
| | - Noriyuki Ozaki
- Department of Functional Anatomy, School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8640 Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8641, Kanazawa, Japan
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16
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Inoue J, Takeuchi S, Dadoo S, Takaba K, Lesinak BP, Musahl V, Onishi K. Harvest location has a minimal impact on differences in cross-sectional area of quadriceps tendon in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:4791-4797. [PMID: 37555861 DOI: 10.1007/s00167-023-07513-w] [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: 05/16/2023] [Accepted: 07/13/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) reconstruction with quadriceps tendon (QT) has been gaining popularity. However, it is unknown how differences in harvest location of the QT affect its thickness and cross-sectional area (CSA). The present study aimed to clarify the differences in thickness and CSA of the QT based on location of tendon harvesting. METHODS Patients scheduled for, or who underwent, ACL reconstruction were prospectively included in the study. The short-axis images on ultrasound were used to assess the CSA of the QT at 30 and 60 mm proximal to the superior pole of the patella. QT autografts with CSAs greater than or equal to 10 mm of width were included and measured at three different locations, namely the center, medial one-third, and lateral one-third at the widest diameter of the QT. Patients with less than 10-mm width of the QT at 60 mm proximal to the superior pole of the patella were excluded. The thickness and CSA were compared based on the location of tendon harvest. RESULTS Thirty-seven patients were recruited for the study. The mean thickness and CSA were larger in the center of the QT compared to the lateral one-third at 30 mm proximal to the superior pole of the patella (thickness, 6.7 ± 1.3 mm vs. 5.9 ± 1.3 mm; P = 0.009; CSA, 65.6 ± 11.4 mm2 vs. 58.8 ± 11.9 mm2; P = 0.036). There were no significant differences in thickness and CSA of the QT among the three assessment locations at 60 mm proximal to the superior pole of the patella (n.s.). CONCLUSION The thickness and CSA of QT was greater in the center compared to the lateral one-third at 30 mm proximal to the QT insertion point. However, the difference in value was clinically non-significant, and therefore, harvest location of the QT autograft may not meaningfully impact intraoperative graft diameter. As a result, surgeons may choose the harvest location without concern for resultant graft diameter as long as the enough length of QT is secured. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Satoshi Takeuchi
- Department of Orthopaedic Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Keishi Takaba
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryson P Lesinak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kentaro Onishi
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
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17
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Engler ID, Chang AY, Kaarre J, Shannon MF, Curley AJ, Smith CN, Hughes JD, Lesniak BP, Musahl V. Revision Rates After Primary Allograft ACL Reconstruction by Allograft Tissue Type in Older Patients. Orthop J Sports Med 2023; 11:23259671231198538. [PMID: 37731958 PMCID: PMC10508052 DOI: 10.1177/23259671231198538] [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: 05/04/2023] [Accepted: 05/19/2023] [Indexed: 09/22/2023] Open
Abstract
Background While there is extensive literature on the use of allograft versus autograft in anterior cruciate ligament (ACL) reconstruction, there is limited clinical evidence to guide the surgeon in choice of allograft tissue type. Purpose To assess the revision rate after primary ACL reconstruction with allograft and to compare revision rates based on allograft tissue type and characteristics. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent primary allograft ACL reconstructions at a single academic institution between 2015 and 2019 and who had minimum 2-year follow-up were included. Exclusion criteria were missing surgical or allograft tissue type data. Demographics, operative details, and subsequent surgical procedures were collected. Allograft details included graft tissue type (Achilles, bone-patellar tendon-bone [BTB], tibialis anterior or posterior, semitendinosus, unspecified soft tissue), allograft category (all-soft tissue vs bone block), donor age, irradiation duration and intensity, and chemical cleansing process. Revision rates were calculated and compared by allograft characteristics. Results Included were 418 patients (age, 39 ± 12 years; body mass index, 30 ± 9 kg/m2). The revision rate was 3% (11/418) at a mean follow-up of 4.9 ± 1.4 years. There were no differences in revision rate according to allograft tissue type across Achilles tendon (3%; 3/95), BTB (5%; 3/58), tibialis anterior or posterior (3%; 5/162), semitendinosus (0%; 0/46), or unspecified soft tissue (0%; 0/57) (P = .35). There was no difference in revision rate between all-soft tissue versus bone block allograft (6/283 [2%] vs 5/135 [4%], respectively; P = .34). Of the 51% of grafts with irradiation data, all grafts were irradiated, with levels varying from 1.5 to 2.7 Mrad and 82% of grafts having levels of <2.0 Mrad. There was no difference in revision rate between the low-dose and medium-to high-dose irradiation cohorts (4% vs 6%, respectively; P = .64). Conclusion Similarly low (0%-6%) revision rates after primary ACL reconstruction were seen regardless of allograft tissue type, bone block versus all-soft tissue allograft, and sterilization technique in 418 patients with mean age of 39 years. Surgeons may consider appropriately processed allograft tissue with or without bone block when indicating ACL reconstruction in older patients.
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Affiliation(s)
- Ian D. Engler
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Central Maine Healthcare Orthopedics, Central Maine Medical Center, Lewiston, Maine, USA
| | - Audrey Y. Chang
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janina Kaarre
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael F. Shannon
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew J. Curley
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Clair N. Smith
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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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: 23] [Impact Index Per Article: 23.0] [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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19
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Niederer D, Keller M, Jakob S, Petersen W, Mengis N, Vogt L, Guenther D, Brandl G, Drews BH, Behringer M, Groneberg DA, Stein T. Quadriceps and hamstring anterior cruciate ligament reconstruction differ only marginally in function after the rehabilitation: a propensity score-matched case-control study. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07422-y. [PMID: 37120794 PMCID: PMC10149044 DOI: 10.1007/s00167-023-07422-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To determine potential quadriceps versus hamstring tendon autograft differences in neuromuscular function and return to sport (RTS)-success in participants after an anterior cruciate ligament (ACL) reconstruction. METHODS Case-control study on 25 participants operated on with an arthroscopically assisted, anatomic ipsilateral quadriceps femoris tendon graft and two control groups of 25 participants each, operated on with a semitendinosus tendon or semitendinosus-gracilis (hamstring) tendon graft ACL reconstruction. Participants of the two control groups were propensity score matched to the case group based on sex, age, Tegner activity scale and either the total volume of rehabilitation since reconstruction (n = 25) or the time since reconstruction (n = 25). At the end of the rehabilitation (averagely 8 months post-reconstruction), self-reported knee function (KOOS sum scores), fear of loading the reconstructed knee during a sporting activity (RSI-ACL questionnaire), and fear of movement (Tampa scale of kinesiophobia) were followed by hop and jump tests. Front hops for distance (jumping distance as the outcome) were followed by Drop jumps (normalised knee joint separation distance), and concluded by qualitative ratings of the Balanced front and side hops. Between-group comparisons were undertaken using 95% confidence intervals comparisons, effect sizes were calculated. RESULTS The quadriceps case group (always compared with the rehabilitation-matched hamstring graft controls first and versus time-matched hamstring graft controls second) had non-significant and only marginal higher self-reported issues during sporting activities: Cohen's d = 0.42, d = 0.44, lower confidence for RTS (d = - 0.30, d = - 0.16), and less kinesiophobia (d = - 0.25, d = 0.32). Small and once more non-significant effect sizes point towards lower values in the quadriceps graft groups in the Front hop for distance limb symmetry values in comparison to the two hamstring control groups (d = - 0.24, d = - 0.35). The normalised knee joint separation distance were non-significantly and small effect sized higher in the quadriceps than in the hamstring groups (d = 0.31, d = 0.28). CONCLUSION Only non-significant and marginal between-graft differences in the functional outcomes at the end of the rehabilitation occurred. The selection of either a hamstring or a quadriceps graft type cannot be recommended based on the results. The decision must be undertaken individually. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | | | - Sarah Jakob
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | - Natalie Mengis
- Arcus Sportklinik, Pforzheim, Germany
- KSA Aarau/Spital Zofingen, Aarau, Switzerland
- University Hospital, Basel, Switzerland
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Witten, Germany
| | - Georg Brandl
- Department of Orthopaedic Surgery II, Herz-Jesu Krankenhaus, Vienna, Austria
| | | | - Michael Behringer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Stein
- SPORTHOLOGICUM Frankfurt-Center for Sport and Joint Injuries, Frankfurt am Main, Germany
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
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20
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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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21
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Zhou Y, Fuimaono-Asafo A, Frampton C, van Niekerk M, Hirner M. Quadriceps tendon autograft is comparable to hamstring tendon and bone-patella-tendon-bone up to 2 years after isolated primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07370-7. [PMID: 36894784 DOI: 10.1007/s00167-023-07370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To evaluate the functional and graft survivorship outcomes of the three most common autograft options for primary anterior cruciate ligament reconstruction (ACLR)-hamstring tendon (HT), bone-patella-tendon-bone (BPTB), and quadriceps tendon (QT). METHODS Patients captured by the New Zealand ACL registry who underwent a primary ACLR from 2014 to 2020 were considered for the study. Patients with associated knee injury (including meniscus, chondral, osseous, and additional ligamentous injury) and previous knee surgery were excluded. Comparison was made between HT, BPTB, and QT autografts with respect to Marx and KOOS (Knee Osteoarthritis Outcome Score) scores at minimum 2 years follow-up. In addition, graft survivorship was evaluated by comparing all-cause revision per 100 graft years and revision-free proportion at 2 years post-surgery. RESULTS 2,582 patients (1,921 HT, 558 BPTB, 107 QT) were included in the study. Differences in adjusted functional outcomes between HT and BPTB were found at 12 months (mean Marx; HT 6.2; BPTB 7.1; P < 0.001) (mean KOOS Sport and Recreation; HT 75.1; BPTB 70.5; n.s.) and 24 months (mean KOOS Sports and Recreation; HT 79.2; BPTB 73.9; P < 0.001). QT was comparable to HT and BPTB in all functional scores at 12 months and 2 years. No statistically significant differences were found in revision rate between all three autograft groups up to 2 years post-surgery (revision rate per 100 graft years; HT 1.05; BPTB 0.80; QT 1.68; n.s. HT vs. BPTB; n.s. HT vs. QT; n.s. QT vs. BPTB). CONCLUSIONS QT was found to be comparable to both HT and BPTB in all functional scores and revision rates up to 2 years post-surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yushy Zhou
- Whangarei Hospital, Northland District Health Board, Maunu Road, Private Bag 9742, Whangarei, 0148, New Zealand.
| | - Atua Fuimaono-Asafo
- Whangarei Hospital, Northland District Health Board, Maunu Road, Private Bag 9742, Whangarei, 0148, New Zealand
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Otago, New Zealand
| | - Michael van Niekerk
- Whangarei Hospital, Northland District Health Board, Maunu Road, Private Bag 9742, Whangarei, 0148, New Zealand
| | - Marc Hirner
- Whangarei Hospital, Northland District Health Board, Maunu Road, Private Bag 9742, Whangarei, 0148, New Zealand
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22
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Brinkman JC, Tummala SV, Moore ML, Economopoulos KJ. All-Soft Tissue Quadriceps Tendon Autograft in Revision Anterior Cruciate Ligament Reconstruction in Athletes: Comparison to Bone-Patellar Tendon-Bone Autograft With at Least a 2-Year Follow-up. Am J Sports Med 2022; 50:3770-3777. [PMID: 36285655 DOI: 10.1177/03635465221126523] [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: 01/31/2023]
Abstract
BACKGROUND Revision anterior cruciate ligament (ACL) reconstruction is being performed at an increasing rate. Previous literature has suggested that autograft ACL reconstruction is a better option than allograft in revision surgery, although the optimal autograft choice remains unknown. The all-soft tissue quadriceps tendon (ASTQT) autograft has been found to be an effective option for primary ACL reconstruction. However, few studies have evaluated ASTQT autograft in revision ACL reconstruction. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the ASTQT autograft in revision ACL reconstruction in athletes compared with bone-patellar tendon-bone (BTB) autograft. We hypothesized that the ASTQT autograft would lead to similar return to play, time to return to play, retear rate, and patient-reported outcomes compared with BTB autograft. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective study was performed on all athletes undergoing revision ACL reconstruction between August 2013 and December 2019 at a single institution. Patients participating in high school or college athletics undergoing first-time revision with either ASTQT or BTB autograft with ≥2 years of follow-up were included. Demographic variables, complications, return to sports, and outcome scores including the International Knee Documentation Committee (IKDC) and Lysholm were collected and compared between the 2 cohorts. RESULTS A total of 58 revision ACL reconstructions were included, with 32 in the ASTQT cohort and 26 in the BTB cohort. Return to sports at the same level occurred in 62.5% of the ASTQT group and 53.8% of the BTB group. The ASTQT group returned to sports significantly faster than the BTB group (8.9 vs 10.3 months; P = .020). There was no difference in retear rates (3.1%, ASTQT; 7.7%, BTB) or other complications between the 2 groups. The IKDC scores were significantly higher at the 6- and 12-month follow-up for the ASTQT autograft group compared with the BTB group (6 months: ASTQT, 71.3; BTB, 61.7, P = .001; 12 months: ASTQT, 82.7; BTB, 78.6; P = .021). Lysholm scores were also greater in the ASTQT cohort at these time points (6 months: ASTQT, 75.1; BTB, 63.6; P < .001; 12 months: ASTQT, 82.0; BTB, 74.5; P < .001). However, IKDC and Lysholm scores were similar between both groups at final follow-up (IKDC: ASTQT, 82.9; BTB, 81.7; P = .344; Lysholm: ASTQT, 83.0; BTB, 81.0; P = .104) There was no significant clinical difference in the absolute difference in scores or rate of achieving clinical thresholds between the 2 cohorts. CONCLUSION ASTQT autograft for revision ACL in athletes has similar outcomes compared with BTB autograft. However, the ASTQT may possibly afford quicker return to sports and better early improvements in patient-reported outcomes that normalize by 1 year. The soft tissue quadriceps autograft should be considered a viable graft option in revision ACL reconstruction in athletes.
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Affiliation(s)
- Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Michael L Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
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23
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Anterior cruciate ligament reconstruction with all-soft tissue quadriceps tendon versus quadriceps tendon with bone block. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07254-2. [PMID: 36449046 DOI: 10.1007/s00167-022-07254-2] [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: 09/07/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether there was a difference in clinical outcomes between patients who underwent primary ACL reconstruction (ACLR) with all-soft tissue quadriceps tendon (sQT) autograft versus QT with bone block (bQT). METHODS A retrospective cohort study of 708 patients who underwent QT ACLR was conducted. Primary ACLR patients with at least 1 year of follow-up were identified and those who received sQT were compared to those who received bQT. Data collection entailed patient demographics, surgical variables, patient reported outcomes (PROs), knee stability testing, and complications. The primary outcome of interest was International Knee Documentation Committee (IKDC) score, reported as mean score, pre- and postoperative difference, and number who met minimum clinically important difference (MCID). Secondary outcomes included Lachman and pivot shift grade, other patient reported outcomes (PROs), complication rates, and return to sport (RTS). RESULTS A total of 195 patients (147 sQT, 48 bQT) who underwent primary QT ACLR met criteria for analysis, with mean follow-up of 17.0 ± 7.9 months. No difference was detected between cohorts with respect to postoperative IKDC score (sQT: n = 120, 81.0 ± 18.9, bQT: n = 10, 80.9 ± 20.4, n.s.), proportion of patients who met MCID (sQT: 68/78 [87%], bQT: 6/7 [86%], n.s.), or results of stability testing. In the sQT cohort, 86% (106/123) of athletes achieved full RTS, compared to 85% (34/40) in the bQT cohort (n.s.). Time to RTS was less than a year in both cohorts (sQT: 10.5 ± 3.8 months [n = 106], bQT: 11.1 ± 3.9 months [n = 31], n.s.). Graft rupture occurred in 7 (5%) sQT patients and 3 (6%) bQT patients (n.s.), and all clinical failures were due to graft rupture (n.s.). No differences were detected for rates of postoperative complications. CONCLUSION No differences in clinical outcomes were detected between patients who underwent primary ACLR with sQT autograft versus bQT autograft. Currently, the decision to employ sQT or bQT is largely determined by surgeon preference. This study demonstrates excellent outcomes with both preparations and supports the use of either graft type at the discretion of the treating surgeon. LEVEL OF EVIDENCE III.
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