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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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Isaji Y, Nakamura M, Mori K, Aoyama N. Trends and associations between kinesiophobia and knee function from preoperatively to three and six months postoperatively in patients post-ACL reconstruction surgery. J Bodyw Mov Ther 2024; 37:290-295. [PMID: 38432820 DOI: 10.1016/j.jbmt.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 09/24/2023] [Accepted: 11/24/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVE This study aimed to clarify the relationship between the transition of kinesiophobia and knee joint function from the preoperative period to three months postoperative, the time to resume running, six months post-ACLR, and the goal time to resume sports. METHODS 54 patients who underwent initial ACLR were included in this study. The Tampa Scale for Kinesiophobia-11 (TSK-11) was used to assess kinesiophobia. One-way ANOVA was performed for the preoperative, three-month postoperative, and six-month postoperative endpoints. To examine changes in knee function associated with changes in TSK-11, we calculated correlations between the differences at each time point. RESULTS TSK-11 decreased significantly at both three and six months postoperatively compared with the preoperative level, but there was no significant change between three months and six months postoperatively. Similar to the decrease in TSK-11 from preoperatively to three and six months postoperatively, there was an improvement in flexion ROM, Pain, Subjective knee function, but none of these changed significantly from three to six months postoperatively. CONCLUSION There may be significant improvements in knee function associated with TSK-11 reduction up to three months postoperatively.
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Affiliation(s)
- Yuichi Isaji
- Bukkyo university 7, Higashi-Tsugao-machi, Nishinokyo, Nakagyo-ku, Kyoto, 604-8418, Japan.
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Nishi Kyushu University, 4490-9 Ozaki, Kanzaki, Saga, 842-8585, Japan.
| | - Kazuaki Mori
- Medical Corporation Anshinkai, 1-4-12, Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Naoki Aoyama
- Medical Corporation Anshinkai, 1-4-12, Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
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Jackson GR, Mameri ES, Tuthill T, Wessels M, Asif S, Sugrañes J, Batra AK, McCormick JR, Obioha OA, Kaplan DJ, Knapik DM, Verma NN, Chahla J. Adverse Events and Complications After Primary ACL Reconstruction With Quadriceps Tendon Autograft: A Systematic Review. Orthop J Sports Med 2023; 11:23259671231199728. [PMID: 38145223 PMCID: PMC10748908 DOI: 10.1177/23259671231199728] [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: 03/28/2023] [Accepted: 05/19/2023] [Indexed: 12/26/2023] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) surgery with quadriceps tendon (QT) grafts, both with and without a patellar bone plug, have gained popularity in recent years in the primary and revision settings. Postoperative complications occur with the use of QT autografts. Purpose To systematically review the incidence of postoperative complications after primary ACLR QT autograft and compare complication rates in patients undergoing all-soft tissue QT grafts versus QT grafts with a patellar bone plug (QTPB). Study Design Systematic review; Level of evidence, 4. Methods A literature search using the 2020 PRISMA guidelines was performed by querying PubMed, Embase, and Scopus databases from database inception through August 2022. Included were evidence level 1 to 4 human clinical studies in English that reported complications after primary ACLR with QT autograft. The incidence of complications within the included studies was extracted. Differences in the incidence of postoperative complications between ACLR with QT with and without a patellar bone plug were calculated. Results A total of 20 studies from 2004 to 2022, comprised of 2381 patients (2389 knees; 68.3% male) with a mean age of 27 years (range, 12-58 years), were identified. The mean follow-up was 28.5 months (range, 6-47 months). The total incidence of complications was 10.3%, with persistent postoperative knee pain being the most common (10.8%). Patients who underwent ACLR with all-soft tissue QT grafts had a 2.7-times increased incidence of anterior knee pain (23.3% vs 8.6%) and reoperations (5.9% vs 3.2%) when compared with QTPB grafts (P < .01 for both). There was no appreciable difference in total complications, graft failures, ACLR revisions, cyclops lesions, or range of motion deficit (P > .05 for all). Patellar fractures occurred exclusively after QTPB (2.2%). Conclusion Complications after primary ACLR using QT autograft were recorded in 10.5% of knees, with anterior knee pain being the most common. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts; however, anterior knee pain was 2.7 times greater with use of a soft tissue quadriceps graft.
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Affiliation(s)
- Garrett R. Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Enzo S. Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Instituto Brasil de Tecnologia da Saúde, Rio de Janeiro, Brazil
- Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Trevor Tuthill
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Morgan Wessels
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shaan Asif
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joan Sugrañes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Anjay K. Batra
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Johnathon R. McCormick
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Obianuju A. Obioha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel J. Kaplan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M. Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, USA
| | - Nikhil N. Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Rahardja R, Love H, Clatworthy MG, Young SW. Comparison of Knee Pain and Difficulty With Kneeling Between Patellar Tendon and Hamstring Tendon Autografts After Anterior Cruciate Ligament Reconstruction: A Study From the New Zealand ACL Registry. Am J Sports Med 2023; 51:3464-3472. [PMID: 37775983 PMCID: PMC10623603 DOI: 10.1177/03635465231198063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/24/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The bone-patellar tendon-bone (BTB) autograft is associated with difficulty with kneeling after anterior cruciate ligament (ACL) reconstruction; however, it is unclear whether it results in a more painful or symptomatic knee compared with the hamstring tendon autograft. PURPOSE To identify the rate and risk factors for knee pain and difficulty with kneeling after ACL reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Primary ACL reconstruction procedures prospectively recorded in the New Zealand ACL Registry from April 2014 to May 2021 were analyzed. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to identify patients reporting consequential knee pain (CKP), defined as a KOOS Pain subscore of ≤72 points, and severe kneeling difficulty (SKD), defined as a self-report of "severe" or "extreme" difficulty with kneeling. Absolute values of the KOOS Pain and Symptoms subscales were also compared. RESULTS A total of 10,999 patients were analyzed. At 2-year follow-up, 9.3% (420/4492) reported CKP, and 12.0% (537/4471) reported SKD. The most important predictor of CKP at 2-year follow-up was having significant pain before surgery (adjusted odds ratio, 4.10; P < .001). The most important predictor of SKD at 2-year follow-up was the use of a BTB autograft rather than a hamstring tendon autograft (21.3% vs 9.4%, respectively; adjusted odds ratio, 3.12; P < .001). There was no difference between the BTB and hamstring tendon grafts in terms of CKP (9.9% vs 9.2%, respectively; P = .494) or in absolute values of the KOOS Pain (mean, 88.7 vs 89.0, respectively; P = .37) and KOOS Symptoms (mean, 82.5 vs 82.1, respectively; P = .49) subscales. CONCLUSION At 2-year follow-up after primary ACL reconstruction, 9.3% of patients reported CKP, and 12.0% reported SKD. The BTB autograft was associated with difficulty with kneeling, but it did not result in a more painful or symptomatic knee compared with the hamstring tendon autograft.
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Affiliation(s)
- Richard Rahardja
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Mark G. Clatworthy
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Simon W. Young
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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Isaji Y, Yamada T, Oka T, Mori K, Aoyama N. Association between knee function and kinesiophobia 6 months after anterior cruciate ligament reconstruction. J Phys Ther Sci 2023; 35:128-132. [PMID: 36744197 PMCID: PMC9889214 DOI: 10.1589/jpts.35.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/09/2022] [Indexed: 02/04/2023] Open
Abstract
[Purpose] Kinesiophobia after anterior cruciate ligament reconstruction has been identified as an inhibitor of return to sports. This study aimed to clarify the relationship between kinesiophobia and knee function 6 months after anterior cruciate ligament reconstruction when the patient intends to return to sports. [Participants and Methods] A total of 66 patients who underwent primary anterior cruciate ligament reconstruction (mean age 17.3 ± 2.6 years, 17 males and 49 females, Tegner activity score ≥7) were included in the study. The 11-item version of Tampa scale of kinesiophobia was used to evaluate kinesiophobia 6 months postoperatively. Knee function was evaluated with knee extension muscle strength, tibial anterior displacement, heel buttock distance, heel height difference, anterior knee pain score, and single-leg hop test. The relationship between Tampa scale of kinesiophobia, patient characteristics, and knee function was investigated. [Results] A low Anterior knee pain score and low single-leg hop test, male gender, and age were significant factors associated with kinesiophobia. [Conclusion] Kinesiophobia was associated with a low anterior knee pain score and low single-leg hop test 6 months after anterior cruciate ligament reconstruction. Patients with a low single-leg hop test score or severe pain may need rehabilitation to reduce kinesiophobia.
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Affiliation(s)
- Yuichi Isaji
- Department of Rehabilitation, Anshin Clinic: 4-1-4
Asahi-dori, Chuo-ku, Kobe-shi, Hyogo 651-0095, Japan,Corresponding author. Yuichi Isaji (E-mail: )
| | - Takumi Yamada
- Department of Physical Therapy, Tokyo Metropolitan
University, Japan
| | - Tomohiro Oka
- Department of Physical Therapy, Department of
Rehabilitation Science, Faculty of Health and Welfare, Osaka Health Science University,
Japan
| | - Kazuaki Mori
- Department of Rehabilitation, Anshin Hospital, Japan
| | - Naoki Aoyama
- Department of Orthopedics, Anshin Hospital, Japan
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Chantrelle M, Menu P, Crenn V, Grondin J, Daley P, Louguet B, Fouasson-Chailloux A, Dauty M. Consequences of anterior knee pain after anterior cruciate ligament reconstruction: A 2015-2020 cohort study. PLoS One 2023; 18:e0280146. [PMID: 36603016 PMCID: PMC9815630 DOI: 10.1371/journal.pone.0280146] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) graft aims to stabilise the knee, but it may bring some complications like anterior knee (AKP) pain that can have consequences on the functional aspect of this surgery. The aim of this study was to compare isokinetic knee strength and functional outcomes between patients with and without AKP following an ACLR using HT graft during the first-year post-surgery. Three hundred and thirty subjects operated by ACLR using hamstring tendon graft were included in our retrospective cohort and divided into two groups: a group with AKP (AKP+ group) and one without AKP (AKP-group). In our population, 14.8% of the patients had AKP. At 4 post-operative months, subjects with pain had lower isokinetic strength limb symmetry index (LSI) for knee flexors and extensors, and a lower Lysholm score than subjects without pain (p < 0.0001). These differences did not persist at 7 post-operative months, and there was no difference in the one-leg hop test. After multivariate analysis, we highlighted the impact of time on the evolution of these parameters. Yet, the exact definition of AKP after ACLR remains to be clearly defined since an imprecise diagnosis may lead to inappropriate management. Pre-operative information about this type of complication, which evolves favourably with time, could be useful for patients. Indeed, AKP can occur after ACLR, even if a HT graft has been used, compared to other surgical procedures using the knee extensor apparatus as patellar tendon graft (AKP is associated with the donor site morbidity). In case of AKP after ACLR, monitoring the muscle inhibition by isokinetic tests may enable clinicians to adapt the retraining and the return to sport.
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Affiliation(s)
- Marie Chantrelle
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Département de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
| | - Vincent Crenn
- Clinique Chirugicale Othopédique et Traumatologique, CHU Nantes, Nantes Université, Nantes, France
| | - Jérôme Grondin
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
| | - Bastien Louguet
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
- * E-mail:
| | - Marc Dauty
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
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Yoon WK, Kim KI, Kim JH, Lee SH, Jo MG. Does Degeneration of the Patellofemoral Joint After Medial Open-Wedge High Tibial Osteotomy Affect Clinical Outcomes? Am J Sports Med 2022; 50:2972-2979. [PMID: 35914309 DOI: 10.1177/03635465221113324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although biomechanical and clinical studies have reported adverse effects on the patellofemoral joint after medial open-wedge high tibial osteotomy (MOWHTO), there is a paucity of literature that describes outcomes longer than midterm follow-up. PURPOSE We aimed to evaluate the mid- to long-term radiologic and clinical outcomes of the patellofemoral joint after MOWHTO and to assess whether radiologic deterioration of the patellofemoral joint affected clinical outcomes or survivorship after MOWHTO. STUDY DESIGN Case series; Level of evidence, 4. METHODS We retrospectively reviewed 170 knees that underwent MOWHTO and had a minimum 5-year follow-up. In radiologic evaluation, serial postoperative changes in the patellofemoral joint compared with the preoperative status were evaluated on the Merchant view according to the Kellgren-Lawrence grade. The American Knee Society (AKS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Kujala score, incidence of anterior knee pain, and survivorship were used to assess clinical outcomes. Using radiologic assessment of the patellofemoral joint, we divided the patients into a radiologic progression group and a radiologic nonprogression group to evaluate whether radiologic progression of patellofemoral arthritis affected long-term clinical outcomes and survivorship after MOWHTO. RESULTS The mean follow-up period was 96.3 months (range, 60-163 months). Arthritic progression of the patellofemoral joint on the Merchant view was observed in 44.9%, 56.3%, 66.0%, and 84.0% of the cases at 5, 7, 9, and 11 years, respectively. Clinical outcomes such as AKS scores and KOOS significantly improved after MOWHTO (P < .001) at the latest follow-up. The incidence of anterior knee pain was 5.3% (9/170 knees). One knee (0.6%) underwent conversion to TKA due to progressive medial osteoarthritis, so the survival rate was 99.4% at a mean follow-up of 96.3 months. Despite patellofemoral degeneration over time, there were no significant differences in clinical outcomes or survivorship between patients with and without radiologic progression at the latest follow-up. CONCLUSION Although degeneration of the patellofemoral joint was observed with time after MOWHTO, the related symptoms were minimal and arthritic changes in the patellofemoral joint did not affect the clinical outcomes or survivorship after MOWHTO over a mid- to long-term follow-up.
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Affiliation(s)
- Wan-Keun Yoon
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Myeong-Guk Jo
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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The Dynamic Effect of Anterior Cruciate Ligament Deficiency on Patellar Height. Indian J Orthop 2022; 56:1403-1409. [PMID: 35928660 PMCID: PMC9283625 DOI: 10.1007/s43465-022-00632-5] [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: 12/27/2021] [Accepted: 03/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The anterior tibial translation (ATT) in case of Anterior Cruciate Ligament (ACL) tear can lead to dynamic alterations of the extensor apparatus biomechanics. The aim of this study is to evaluate the dynamic effect of isolated ACL deficiency on patellar height. The hypothesis is that the ATT of ACL-insufficient knees dynamically reduces patellar height. METHODS Skeletally mature patients who underwent ACL reconstruction using hamstring graft between January and December 2018 were included in this study. The Posterior Tibial Slope (PTS), Caton-Deschamps (CDI), modified Insall-Salvati (MISI), and Blackburne-Peel (BPI) indices were calculated in standard lateral and TELOS X-rays. The mean of the measurements calculated between two observers was used to compare these parameters. RESULTS 95 patients (M: 57; F: 38; 95 knees) were included in the study with a mean age of 31.8 years (16-56 years old). Significant patellar height reduction (CDI: 0.11 [- 0.32; 0.31]; MISI: 0.09 [- 0.66; 0.30]) was reported in TELOS compared with standard lateral knee radiography (p < 0.001). 20.0% of the study knees reported an abnormal CDI and 84.2% (16/19 knees) of them reduced this index to within normal limits in TELOS. 20.0% of the knees with mild patella alta reduced CDI in TELOS but always remained above 1.2. CONCLUSIONS The abnormal ATT in case of ACL-deficient knees results in a lowering effect of the patella in TELOS X-rays. In patients with ACL tear and anterior pain the reconstructive ligament surgery should be performed to avoid also chronic anterior knee pain. LEVEL OF EVIDENCE Basic Science Study (Case Series). CLINICAL RELEVANCE The decrease in patellar height in stress-X-rays compared with standard lateral knee radiography in ACL deficient knees, should be considered as a possible contributing cause of anterior pain in these patients.
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Betsch M, Hoit G, Dwyer T, Whelan D, Theodoropoulos J, Ogilvie-Harris D, Chahal J. Postoperative Pain Is Associated With Psychological and Physical Readiness to Return to Sports One-Year After Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2021; 3:e1737-e1743. [PMID: 34977628 PMCID: PMC8689248 DOI: 10.1016/j.asmr.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 08/03/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose To identify whether any patient factors, injury factors, or symptom severity scores are associated with either psychological or physical readiness to return to sport after anterior cruciate ligament reconstruction (ACLR). Methods Consecutive patients with an ACL injury that required surgical treatment were included in this study. All patients completed the single-legged hop testing and the Anterior Cruciate Ligament Return to Sport Index (ACL-RSI) at 1 year postoperatively. Multivariable regression analysis models were used to determine whether an independent relationship existed between baseline patient factors (age, sex, BMI, preinjury Marx Activity Score), injury factors (meniscal tear and chondral injury), physical symptoms (Knee Injury and Osteoarthritis Outcome Score [KOOS] for pain and symptoms), and the dependent variables of physical and psychological readiness to return to sport (single-legged hop and ACL-RSI). Results Of the 113 patients who were included, 37% were female, and the mean age of our population was 28.2 years (SD = 8.1). Multivariable regression models demonstrated that patient-reported pain symptoms at 1 year postoperatively, as measured by the KOOS pain subscale, was significantly associated with both ACL-RSI score (Beta estimate: 1.11 [95% CI: .62-1.60] P < .001) and the ability to pass the single-legged hop test (OR: 1.07 [95% CI: 1.004-1.142] P = .037). Conclusions Patients with higher reported pain levels at 1 year following ACLR have lower psychological and physical readiness to return to sport. Level of Evidence Level 3, retrospective cohort study.
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Affiliation(s)
- Marcel Betsch
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada.,Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University Heidelberg, Mannheim, Germany
| | - Graeme Hoit
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
| | - Tim Dwyer
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
| | - Daniel Whelan
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
| | - John Theodoropoulos
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
| | - Darrell Ogilvie-Harris
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
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10
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Rambaud AJ, Neri T, Dingenen B, Parker D, Servien E, Gokeler A, Edouard P. The modifying factors that help improve anterior cruciate ligament reconstruction rehabilitation: A narrative review. Ann Phys Rehabil Med 2021; 65:101601. [PMID: 34757010 DOI: 10.1016/j.rehab.2021.101601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The goal of a rehabilitation programme after anterior cruciate ligament (ACL) reconstruction is to manage a patient's goals and expectations (i.e., returning to physical activities and sports) while minimizing the risk of new injury, particularly a new ACL injury. Although general rehabilitation programmes have been proposed, some factors can lead to adapting each programme to each patient. OBJECTIVE To describe how different variables, including surgical techniques, sports participation, psycho-social and contextual factors can modify the rehabilitation programme. METHODS We performed a narrative review with input from experts in the field (level of evidence 5). CONCLUSIONS Modifying factors of the ACL rehabilitation programme are related to the initial lesion or surgery, to sports, or to psychological or social aspects. Regarding the type of graft, the rehabilitation is mainly different in the early postoperative phase; the other phases are not graft-based but rather goal-based rehabilitation. Depending on the meniscal or cartilage repair, the rehabilitation protocol will initially take priority over the anterior cruciate ligament reconstruction protocol. The ACL reconstruction rehabilitation programme should meet the requirements of the anticipated sports, to optimize the athlete's ability to return to the expected level and minimize the risk of reinjury. Psycho-social and contextual factors must also be considered in rehabilitation care to individualize and optimize each patient's programme.
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Affiliation(s)
- Alexandre Jm Rambaud
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023 Saint-Etienne, France; Motion Analysis Lab, Physiotherapy and Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland; SFMKS-Lab, Société Française des Masseurs-kinésithérapeutes du Sport, Pierrefitte/Seine, France.
| | - Thomas Neri
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023 Saint-Etienne, France; Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, Faculty of medicine Saint-Etienne, France
| | - Bart Dingenen
- Reval Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan A, 3590 Diepenbeek, Belgium
| | - David Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Elvire Servien
- Univ Lyon, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023 Lyon, France; Department of orthopaedic surgery and sports medicine, FIFA medical center of excellence, Lyon University Hospital, Lyon, France
| | - Alli Gokeler
- Exercise Science & Neuroscience Unit, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Pascal Edouard
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023 Saint-Etienne, France; Department of Clinical and Exercise Physiology, Sports Medicine Unity, University Hospital of Saint-Etienne, Faculty of medicine, Saint-Etienne. France
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11
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Sanada T, Uchiyama E, Iwaso H, Fukai A. Muscle strength after the anterior cruciate ligament reconstruction via contralateral bone-tendon-bone autograft. J Exp Orthop 2021; 8:86. [PMID: 34617148 PMCID: PMC8494824 DOI: 10.1186/s40634-021-00399-y] [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: 06/15/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The anterior cruciate ligament (ACL) reconstruction via a contralateral bone-tendon-bone (C-BTB) autograft was introduced to encourage early return to sports. The purpose of this study is to evaluate whether primary contralateral BTB ACL reconstruction can be adapted for early return-to-sports modification by investigating the chronological changes of muscle strength after surgery. Methods Fifteen patients who had underwent C-BTB ACL reconstruction were compared with a matched group of 15 patients of ipsilateral BTB (I-BTB) ACL reconstruction. The clinical outcomes of the time of return-to-sports, Tegner activity scale and the rate of second ACL injuries, the tibial anterior translation measurement, and knee extension and flexion muscle strength were assessed. Results Within 12 months after surgery, 14 of 15 patients from both groups returned to preinjury sports. The median time to return to sports after surgery was 6.5 months in the C-BTB group and 8.0 months in the I-BTB group (p = 0.021). No significant difference was noted with regard to the Tegner activity scale, reinjury rate or mean instrumental anterior tibial translation. The quadriceps muscle strength in the ACL-reconstructed knee compared with the opposite knee in both groups at 5 months after surgery was 120.6% in the C-BTB group and 70.0% in the I-BTB group (p < 0.001). However, the quadriceps muscle strength of the non-reconstructed limb, which instructed the graft harvested knee in the C-BTB and the intact knee in the I-BTB group, compared with that of the preoperative uninjured limb, was 74.5% in the C-BTB group and 118.7% in the I-BTB group (p = 0.0021) 5 months after surgery. Moreover, the quadriceps muscle strength of the reconstructed knee compared with the preoperative normal limb was 88.8% and 81.5% in the C-BTB and I-BTB groups, respectively (p = 0.38). Conclusions ACL reconstruction via the C-BTB autograft indicated better quadriceps muscle strength from early stage after surgery compared with I-BTB ACL reconstruction. However, the ostensible rapid symmetrical muscle strength recovery was attributed to strength deficits compared to the preoperative condition at the donor site limb and ACL-reconstructed limb. Level of evidence Level: Level: 4.
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Affiliation(s)
- Takaki Sanada
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshicho, Nakahara-Ku, Kawasaki, Kanagawa Prefecture, 211-8510, Japan.
| | | | - Hiroshi Iwaso
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshicho, Nakahara-Ku, Kawasaki, Kanagawa Prefecture, 211-8510, Japan
| | - Atsushi Fukai
- Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Phatama KY, Darmawansa R, Oktafandi IGNAA, Cendikiawan F, Pribadi A, Siahaan LD, Rhatomy S, Mustamsir E. Higher Rate of Patellofemoral Problems After Anterior Cruciate Ligament Reconstruction using Hamstring Autograft. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Patellofemoral problems are not uncommon among post-anterior cruciate ligament (ACL) reconstruction patients. Hamstring autograft harvesting-related factor is one of the suspected causes. A lack of tibiofemoral internal rotation force due to strength deficit causes the patella tends to shift laterally.
Purposes: Peroneus longus tendon has been proposed as an alternative graft source due to its adequate tensile strength and minimal donor site morbidity to the knee biomechanics, including the patellofemoral joint. This tendon does not cross the knee joint and thus does not affect patellofemoral alignment and biomechanics. This study aims to compare patellofemoral problems between hamstring and peroneus longus autograft harvested-patients following ACL reconstruction.
Material and methods: Thirty-one subjects who underwent primary single-bundle ACL reconstruction between September 2018 and September 2019 and met the inclusion criteria were grouped into the hamstring group (n=16) and peroneus longus group (n=15). Both groups were evaluated retrospectively. The follow-up assessment was conducted on the phase II rehabilitation program. The assessed variables were pain, crepitus, and the Indonesian-validated Kujala score.
Results: No significant differences in pain and crepitus were found between both groups. There were significant differences in the Kujala score between both groups (P < .001). The peroneus longus group reported an averagely higher score than the hamstring group.
Conclusion: Single bundle ACL reconstruction using peroneus longus tendon autograft produces less patellofemoral symptoms and functional limitation than using hamstring tendon autograft.
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Lee DW, Lee J, Jang S, Ro DH, Lee MC, Han HS. Long-term Outcomes of Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon-Patellar Bone Autograft. Orthop J Sports Med 2021; 9:23259671211017474. [PMID: 34179211 PMCID: PMC8193668 DOI: 10.1177/23259671211017474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022] Open
Abstract
Background: To date, there have been few studies on the outcomes of anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon–patellar bone (QTPB) autograft. Purpose: To evaluate the long-term clinical outcomes of ACLR using QTPB autograft. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed 139 patients who underwent primary ACLR with QTPB autografts and had at least 7 years of postoperative follow-up data. Instability, clinical scores, donor-site morbidity, radiographic progression of osteoarthritis, and any associated complications were assessed. Results: The proportion of knees classified as grade >1 on the anterior drawer, Lachman, and pivot-shift tests decreased significantly postsurgically (from 47.4% to 5.0%, 48.9% to 4.3%, and 53.3% to 5.0%, respectively; P < .001 for all). The mean clinical scores at the final follow-up were 89.8, 81.0, and 4.4 for the Lysholm, International Knee Documentation Committee, and Tegner Activity Scale, respectively. The results of the Cybex II dynamometer isokinetic test showed decreases in flexion and extension strength at both 60° and 180° per second, which persisted until the final follow-up visit. About one-fifth (19.4%) of the patients had osteoarthritis (Kellgren-Lawrence grade ≥1) before surgery, which increased to 33.8% at the final follow-up. The overall complication rate was 23.2%, and about one-third of the patients who experienced complications underwent revision surgery as a result of graft rupture and residual instability. Conclusion: In the current study, ACLR using QTPB autograft provided satisfactory long-term clinical results, with acceptable rates of complication and donor-site morbidity.
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Affiliation(s)
- Do Weon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joonhee Lee
- Department of Orthopedic Surgery, CM Hospital, Seoul, Republic of Korea
| | - Seonpyo Jang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Suh DK, Lee JH, Rhim HC, Cho IY, Han SB, Jang KM. Comparison of muscle strength and neuromuscular control up to 1 year after anterior cruciate ligament reconstruction between patients with dominant leg and non-dominant leg injuries. Knee 2021; 29:15-25. [PMID: 33524658 DOI: 10.1016/j.knee.2021.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/18/2020] [Accepted: 01/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND There has not been an investigation to determine whether leg dominance affects the recovery of quadriceps and hamstring strength, muscle reaction time (acceleration time, AT), and postural stability after anterior cruciate ligament (ACL) reconstruction in recreational-level athletic patients. METHODS A total of 100 patients with isolated ACL injuries (58 patients had dominant leg injuries; 42 patients had non-dominant leg injuries) participated. All patients received an anatomical single-bundle ACL reconstruction using an auto-hamstring tendon graft without preoperative rehabilitation. Leg dominance was defined as the kicking leg. The quadriceps and hamstring strength, AT, and postural stability (overall stability index (OSI)) of both legs were assessed at three different time points (preoperative, 6 months, 12 months), using an isokinetic dynamometer and postural stabilometry system. RESULTS All patients in both groups showed gradual improvement in quadriceps and hamstring muscle strength in the operated legs up to 1 year postoperatively. However, the mean value of quadriceps strength was lower in the operated non-dominant leg than the operated dominant leg 6 months postoperatively (P = 0.048). The AT and OSI of the operated legs in both groups recovered significantly 6 months postoperatively compared with their preoperative values; however, the AT and OSI values after 6 and 12 months were similar. CONCLUSION Quadriceps strength of the operated non-dominant leg was lower than that of the operated dominant leg 6 months postoperatively; however, the strength of the quadriceps and hamstring muscles was not different after 12 months between the operated dominant and non-dominant legs. Clinicians and physical therapists should consider these results during early rehabilitation and identify effective protocols to enhance quadriceps strength, especially in patients with non-dominant leg injuries.
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Affiliation(s)
- Dae Keun Suh
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jin Hyuck Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hye Chang Rhim
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Il-Yup Cho
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea; Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
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15
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Marques FDS, Barbosa PHB, Alves PR, Zelada S, Nunes RPDS, de Souza MR, Pedro MDAC, Nunes JF, Alves WM, de Campos GC. Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2020; 8:2325967120961082. [PMID: 33195725 PMCID: PMC7605008 DOI: 10.1177/2325967120961082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/08/2020] [Indexed: 01/13/2023] Open
Abstract
Background Anterior knee pain is a frequent condition after anterior cruciate ligament reconstruction (ACLR), but its origin remains uncertain. Studies have suggested that donor site morbidity in autologous bone-patellar tendon-bone reconstructions may contribute to patellofemoral pain, but this does not explain why hamstring tendon reconstructions may also present with anterior pain. Purpose To evaluate the prevalence of anterior knee pain after ACLR and its predisposing factors. Study Design Case-control study; Level of evidence, 3. Methods We evaluated the records of all patients who underwent ACLR between 2000 and 2016 at a private facility. The prevalence of anterior knee pain after surgery was assessed, and possible risk factors (graft type, patient sex, surgical technique, range of motion) were evaluated. Results The records of 438 patients (mean age, 30 years) who underwent ACLR were analyzed. Anterior knee pain was found in 6.2% of the patients. We found an increased prevalence of anterior knee pain with patellar tendon graft, with an odds ratio of 3.4 (P = .011). Patients who experienced extension deficit in the postoperative period had an odds ratio of 5.3 of having anterior pain (P < .001). Anterior knee pain was not correlated with patient sex or surgical technique. Conclusion The chance of having anterior knee pain after ACLR was higher when patellar tendon autograft was used compared with hamstring tendon graft, as well as in patients who experienced extension deficit in the postoperative period.
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Affiliation(s)
- Fabiano da Silva Marques
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Pedro Henrique Borges Barbosa
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Pedro Rodrigues Alves
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Sandro Zelada
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | | | | | | | | | - Wilson Mello Alves
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Gustavo Constantino de Campos
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,University of Campinas (UNICAMP), Campinas, Brazil
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16
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Anterior knee pain in ACL reconstruction with BPTB graft - Is it a myth? Comparative outcome analysis with hamstring graft in 1,250 patients. J Orthop 2020; 22:408-413. [PMID: 33029045 DOI: 10.1016/j.jor.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/03/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022] Open
Abstract
Anterior Knee Pain(AKP) has been quoted as the main disadvantage of Bone Patellar Tendon Bone (BPTB)graft in Anterior Cruciate Ligament Reconstruction (ACLR). We overcome the problem by harvesting BPTB graft by mini-open mobile window technique. Objectives To investigate postoperative incidence of AKP with BPTB graft in comparison with hamstring graft during primary ACLR. Methods Total of 1737 patients underwent ACLR in the study period of which 1250 met eligibility criteria (622-BPTB graft, , 628-Hamstring graft). Results Incidence of AKP, Lysholm score and IKDC score were analysed and found no statistically significant difference at 18-month followup. Conclusion BPTB graft harvested by mini-open mobile window technique has a low incidence of AKP as of hamstring graft.
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17
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Hacken BA, Keyt LK, Leland DP, LaPrade MD, Camp CL, Levy BA, Stuart MJ, Krych AJ. A Novel Scoring Instrument to Assess Donor Site Morbidity After Anterior Cruciate Ligament Reconstruction With a Patellar Tendon Autograft at 2-Year Follow-up Using Contemporary Graft-Harvesting Techniques. Orthop J Sports Med 2020; 8:2325967120925482. [PMID: 32587874 PMCID: PMC7294492 DOI: 10.1177/2325967120925482] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Donor site morbidity after anterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone (BTB) autograft is clinically significant, but evidence with contemporary techniques is lacking. Purpose: To (1) evaluate donor site morbidity at a single institution using modern techniques of BTB autograft harvest at 2-year follow-up, (2) develop a 10-question donor site morbidity instrument, and (3) compare this instrument against traditional outcome tools. Study Design: Case series; Level of evidence, 4. Methods: We analyzed the 2-year follow-up outcomes of 200 consecutive patients who underwent ACL reconstruction with a BTB autograft performed by 2 surgeons at a single institution. The surgical technique utilized modern and consistent BTB autograft harvest, including graft sizing, patellar tendon and peritenon closure, and patellar and tibial donor site bone grafting. There were 187 patients included, with 13 patients undergoing revision ACL reconstruction excluded. An original 10-question scoring instrument evaluating donor site morbidity was administered to each patient (score, 0-100) and compared against each patient’s International Knee Documentation Committee (IKDC) and Lysholm scores. Results: Overall, 13.9% of patients were noted to have anterior knee pain with activity at 2-year follow-up. Moreover, 3.7% of patients reported an inability to kneel on hard surfaces but had no problems on soft surfaces; 5.9% of patients reported mild discomfort but were able to kneel on all surfaces. Additionally, 75.4% of patients had a perfect (100/100) donor site morbidity score. The mean donor site morbidity score at 2-year follow-up was 98.3 ± 3.4. There was a very strong correlation between the IKDC and Lysholm scores but only a strong and moderate correlation when the donor site morbidity score was compared with the IKDC and Lysholm scores, respectively. Conclusion: Donor site morbidity after ACL reconstruction with a BTB autograft was less frequent than reported in the existing literature. Some patients developed anterior knee pain; therefore, an informed discussion is advised. IKDC and Lysholm scores may not capture donor site symptoms after surgery. The 10-question donor site morbidity instrument may provide a more accurate assessment.
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Affiliation(s)
- Brittney A Hacken
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lucas K Keyt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Devin P Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew D LaPrade
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Yoon TH, Choi CH, Kim SJ, Kim SH, Kim NH, Jung M. Effect of Medial Open-Wedge High Tibial Osteotomy on the Patellofemoral Joint According to Postoperative Realignment. Am J Sports Med 2019; 47:1863-1873. [PMID: 31157981 DOI: 10.1177/0363546519851096] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No study has yet assessed the effect of medial open-wedge high tibial osteotomy (MOWHTO) on the patellofemoral joint according to postoperative alignment. PURPOSE To evaluate the effect of MOWHTO on the patellofemoral joint according to postoperative alignment by comparing the cartilage status before and after surgery and assessing the clinical and radiological outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 135 patients who underwent MOWHTO were retrospectively investigated. The patients were divided into 3 groups according to the postoperative weightbearing line ratio (WBLR): undercorrection (WBLR <58.3%, lowest quartile), acceptable correction (WBLR of 58.3%-66.3%, middle 2 quartiles), and overcorrection (WBLR >66.3%, highest quartile). The postoperative change in the cartilage status was assessed arthroscopically during implant removal at 2 years after MOWHTO. The clinical and radiological outcomes were evaluated at a mean follow-up of 52.1 months. A regression analysis was performed to identify the factors affecting the deterioration of the patellofemoral joint cartilage status. A receiver operating characteristic curve was employed to identify the cutoff point for the postoperative WBLR associated with the deterioration of the cartilage status in the patellofemoral joint. RESULTS Of all patients, progression of cartilage degeneration was noted in 39.3% for femoral trochlea and 23.7% for patella. The incidence of cartilage progression was significantly higher in the overcorrection group than in the undercorrection and acceptable correction groups (femoral trochlea: undercorrection group = 30.3%, acceptable correction group = 32.4%, and overcorrection group = 61.8% [P = .008]; patella: undercorrection group = 15.2%, acceptable correction group = 17.7%, and overcorrection group = 44.1% [P = .005]). The functional outcomes, including Lysholm knee score, Knee injury and Osteoarthritis Outcome Score (Pain, Symptoms, and Activities of Daily Living subscales), and Shelbourne and Trumper score, were significantly worse in the overcorrection group. The regression analysis showed that only the postoperative WBLR had a significant effect on cartilage deterioration. The cutoff point for the postoperative WBLR associated with progression of the International Cartilage Repair Society grade was 62.1% for the femoral trochlea (sensitivity = 61.5%, specificity = 62.7%, accuracy = 66.2%) and 62.2% for the patella (sensitivity = 59.4%, specificity = 60.2%, accuracy = 67.8%). CONCLUSION The patellofemoral joint was adversely affected by MOWHTO. Overcorrection causing excessive valgus alignment led to further progression of degenerative changes in the patellofemoral joint and inferior clinical outcomes. The postoperative WBLR can be used as a predictive factor for deterioration of the cartilage status in the patellofemoral joint after MOWHTO.
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Affiliation(s)
- Tae-Hwan Yoon
- The Arthroscopy and Joint Research Institute, The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chong Hyuk Choi
- The Arthroscopy and Joint Research Institute, The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jae Kim
- The Arthroscopy and Joint Research Institute, The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- The Arthroscopy and Joint Research Institute, The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam-Hoo Kim
- The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung
- The Arthroscopy and Joint Research Institute, The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Changes in patellar height due to bone-tendon-bone graft. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:337-342. [PMID: 30173729 DOI: 10.1016/j.recot.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 02/10/2018] [Accepted: 03/13/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Complications related to anterior cruciate ligament (ACL) graft are common. Change in height, especially patella baja, can be a cause of anterior knee pain. Several studies have related ACL reconstruction with bone-tendon-bone graft to patella baja. METHODS Forty-three patients with ACL reconstruction using a with bone-tendon-bone graft were included in this study. All patients underwent the same surgery, with closure of the paratenon of the patellar tendon. A radiological study was performed before surgery and 2 years after surgery. The Insall-Salvati index, axial view and patellar tilt were analyzed in all patients. The healthy contralateral knees were used as the control group. RESULTS No significant differences were observed from the preoperative measurements or at the 2-year follow-up. CONCLUSIONS The use of patellar tendon with closure of the paratenon in ACL reconstruction was not shown to modify patellar height within the radiological follow-up of two years.
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20
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Seijas R, Sallent A, Pons A, Cusco X, Catala J, Cugat R, Ares O. Changes in patellar height due to bone-tendon-bone graft. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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21
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Hughes L, Paton B, Haddad F, Rosenblatt B, Gissane C, Patterson SD. Comparison of the acute perceptual and blood pressure response to heavy load and light load blood flow restriction resistance exercise in anterior cruciate ligament reconstruction patients and non-injured populations. Phys Ther Sport 2018; 33:54-61. [DOI: 10.1016/j.ptsp.2018.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/07/2018] [Accepted: 07/07/2018] [Indexed: 01/20/2023]
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22
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Tian MQ, Yang XT, Tian XB, Sun YB, Duan YH, Sun L. Short-term Follow-up of Antibiotic-loaded Articulating Cement Spacers in Two-stage Revision of Infected Total Knee Arthroplasty: A Case Series. Orthop Surg 2018; 10:128-133. [PMID: 29770589 DOI: 10.1111/os.12381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Infection of total knee arthroplasty (TKA) is a rare but devastating complication. Two-stage revision is an effective treatment for late infected TKA. This study aimed to assess the short-term results of two-stage revision using articulating antibiotic-loaded spacers. METHODS Twenty-five patients (10 men and 15 women) were diagnosed with late infections after TKA and treated with two-stage revision from April 2006 to August 2010; 19 of these patients had TKA for osteoarthritis and 6 for rheumatoid arthritis. Median age was 64.9 (range, 56-83) years. In the first-stage surgery, the prosthesis and all bone cement was removed. After thorough debridement, bone cement with vancomycin and tobramycin was put into a die cavity and made into temporary femoral and tibial spacers, respectively. In the cases of good knee range of motion, the temporary spacers were affixed to the bone surface using the same antibiotic bone cement. In the second surgery, gentamycin Refobacin Bone Cement with vancomycin was used to fix the prosthesis. After two-stage revision, patients were followed up clinically and radiologically at 1, 3, and 6 months, and then annually. Knee Society Score (KSS), knee function score, knee pain score, and knee range of motion (ROM) were assessed. RESULTS Among the group, all spacers were easily removed, and bone defect degree showed no obvious change compared with pre-implant, 24 (96%) patients had been debrided once, and 1 patient had been debrided twice before reimplant prosthesis. Mean follow-up was 64.2 (range, 52-89) months. There was no infection recurrence at final follow-up. Compared with preoperative data, the KSS (66 [59, 71], 83 [80, 88] vs 46 [43, 57], P < 0.01), knee function score (43 [42, 49], 78 [73, 82] vs 32 [25, 37], P < 0.01), knee pain score (34 [33, 37], 42 [40, 45] vs 18 [16, 23], P < 0.01), and knee ROM (92° [86°, 96°], 94° [90°, 98°] vs 78° [67°, 86°], P < 0.01) were all improved during follow-up and at final visit. Three patients experienced complications in the interval period: one case had knee dislocation, one had knee instability, and one had a chip in the femoral component of the spacer. CONCLUSION Using articulating antibiotic-loaded spacers showed benefits for treating infected TKA in selected patients. No infection recurrence was observed during follow-up.
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Affiliation(s)
- Meng-Qiang Tian
- Department of Joint Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xian-Teng Yang
- Department of Orthopaedics, People's Hospital of Guizhou Province, Guiyang, China.,Medical College, Guizhou University, Guiyang, China
| | - Xiao-Bin Tian
- Department of Orthopaedics, People's Hospital of Guizhou Province, Guiyang, China
| | - Yun-Bo Sun
- Department of Joint Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Yuan-Hui Duan
- Department of Joint Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Li Sun
- Department of Orthopaedics, People's Hospital of Guizhou Province, Guiyang, China
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Sepúlveda F, Sánchez L, Amy E, Micheo W. Anterior Cruciate Ligament Injury: Return to Play, Function and Long-Term Considerations. Curr Sports Med Rep 2018; 16:172-178. [PMID: 28498226 DOI: 10.1249/jsr.0000000000000356] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Anterior cruciate ligament tears are common and affect young individuals who participate in jumping and pivoting sports. After injury many individuals undergo ligament reconstruction (ACLR) but do not return to play, suffer recurrent injury and osteoarthritis. Outcome studies show that after ACLR, 81% of individuals return to sports, 65% return to their preinjury level and 55% return to competitive sports. Systematic reviews place the risk of ipsilateral retears at 5.8% and contralateral injuries at 11.8%, with recent reports of over 20% failure rate. Approximately 20% to 50% of patients will have evidence of OA within 10 to 20 yr. Factors important in reducing complications include timing of surgery, individualized return to play protocols, and prevention programs for injury. Further understanding of the factors that increase return to play percentages, reduce the risk of recurrent injury and improve long-term outcomes after ACL injury is needed to reduce the burden of these injuries on society.
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Affiliation(s)
- Fernando Sepúlveda
- Department of Physical Medicine, Rehabilitation, and Sports Health, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
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Mukhopadhyay R, Shah N, Vakta R, Bhatt J. Anterior knee pain following BPTB graft harvest. Reality or overhyped. J Clin Orthop Trauma 2018; 9:307-311. [PMID: 30449976 PMCID: PMC6224633 DOI: 10.1016/j.jcot.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/26/2018] [Accepted: 03/08/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The patellar tendon graft has long been the gold standard for ACL reconstruction. Recently semitendinosus and gracilis tendons graft have been used increasingly. We hypothetise that the Bone-Patella Tendon-Bone graft is a good and economical graft for the Indian population with no adverse effects of anterior knee pain or patellar tendon shortening. We believe that the early squatting and cross-legged sitting causes early and constant stretching of the tendon in our patients. This is responsible for the lesser incidences of adverse effects in the Indian population. MATERIAL AND METHOD In a retrospective study, the hospital database was scrutinized to shortlist patients who had undergone a bone-patella tendon-bone harvest for ACL or PCL reconstruction before 2013. Each patient was evaluated using the Lysholm score and the KOOS Score. VAS was also used, to evaluate for the amount of pain experienced by patients. The analysis of the quadriceps power along with the presence or absence of any extensor lag was made too. The modified Insall Salvati index was also calculated. RESULTS Forty-seven patients were shortlisted of which 25 patients were followed up with an average follow up of 94.5 months. Although some patients did complain of occasional pain with the average VAS score of 1.45; on analyzing the data it was evident that all our patients had excellent quadriceps power (5/5) with no extensor lag. The mean Lysholm score was 95.55, while the mean KOOS score was 94.17. The mean Insall index of 1.05 showed no significant patella baja in any of our patients. CONCLUSION It is ascertained that no significant retro-patellar pain or shortening of the patellar tendon occurs following a bone patella tendon bone harvest. The bone patella bone tendon graft is a suitable graft for ligament reconstruction with good functional outcome, and no significant adverse effect of patella baja or anterior knee pain in the Indian patients. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Nishith Shah
- Aash Arthroscopy Centre, Ahmedabad, Gujarat, India
| | - Rohan Vakta
- Aash Arthroscopy Centre, Ahmedabad, Gujarat, India
| | - Jaymin Bhatt
- Aash Arthroscopy Centre, Ahmedabad, Gujarat, India
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Complications following harvesting of patellar tendon or hamstring tendon grafts for anterior cruciate ligament reconstruction: Systematic review of literature. Orthop Traumatol Surg Res 2017; 103:S245-S248. [PMID: 28888527 DOI: 10.1016/j.otsr.2017.09.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
UNLABELLED Anterior cruciate ligament (ACL) reconstruction can be performed with an autograft, which is most often harvested from the patient's hamstring tendon (HT) or patellar tendon (PT). However, autograft harvesting leads to morbidity that is by no means insignificant. A systematic review of literature was performed to define the incidence of complications related to graft harvesting and the methods to prevent these complications. In March 2017, a systemic review of literature was performed using the keywords"harvesting", "harvest", "morbidity", "complication", "cruciate ligament". No time limit was applied. The studies had to be written in French or English with their abstract available online. This initial search based on the title and abstract identified 133 articles. Two independent observers analyzed each article entirely, including the references. In all, 36 articles were retained. The main complication of HT harvesting was sensory deficit because of damage to the infrapatellar branches of the saphenous nerve. This complication occurred in 39.7% to 88% of patients. This risk can be reduced by using a horizontal or oblique incision. The main complication following PT harvesting is anterior knee pain, reported in up to 46% of patients. There are substantial numbers of short-, medium- and long-term complications related to the harvesting of the two main ACL autografts. Effective means of prevention exist to reduce the risk of these complications. LEVEL OF EVIDENCE II Systematic review of literature.
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Pasquini A, Jacopetti M, Pogliacomi F, Ramazzina I, Costantino C. Neuromuscular recovery in ACL reconstruction with Bone-Tendon-Patellar-Bone and Semitendinosus-Gracilis autograft. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 29083355 PMCID: PMC6357651 DOI: 10.23750/abm.v88i4-s.6795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Several different types of grafts have been used in ACL rupture. The purpose of the study was to compare the recovery of lower limbs muscle strength and proprioception in athletes, who underwent ACL reconstruction with Bone-Patellar-Tendon-Bone (BPTB) versus semitendinosus and gracilis (HS) autografts. Methods: We enrolled 30 male amateur athletes. Each patient was evaluated by isokinetic test, triaxial accelerometer test and balance test with stabilometric platform. Isokinetic test evaluated quadriceps and hamstrings Peak Torque. Accelerometer test evaluated squat jump test (SJT) and stiffness test (ST). The recording on the balance platform was performed with open and closed eyes and evaluated medio-lateral and anterior-posterior pathways. Results:30 patients were selected (15 in group BPTB and 15 in group HS). In SJT we noticed a statistically significant difference in height of jump in the involved side in favour of Group BPTB (p=0.037) and not significant difference in the other parameters. In the ST, we did not observe significant statistical differences in the parameters of the test. The stabilometric platform data and isokinetic peak torque parameters did not show a significant difference. Discussion: Little high quality researches are available to help determine when patients can safely return to full activity and sport. Included evaluation criteria were a combination of factors regarding knee motion, muscles strength and neuromuscular function. Conclusion: In our study, despite a not full recovery of explosive strength in HS group , the balance and the other parameters after one year are comparable between the two graft. In our findings there isn’t clinical difference between the two grafts. We suggest that the evaluation of explosive strength and proprioception are the priority parameters in neuromuscular recovery after ACL reconstruction. (www.actabiomedica.it)
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Pasquini A, Jacopetti M, Pogliacomi F, Ramazzina I, Costantino C. Neuromuscular recovery in ACL reconstruction with Bone-Tendon-Patellar-Bone and Semitendinosus-Gracilis autograft. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:62-68. [PMID: 29083355 DOI: 10.23750/abm.v88i4 -s.6795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Several different types of grafts have been used in ACL rupture. The purpose of the study was to compare the recovery of lower limbs muscle strength and proprioception in athletes, who underwent ACL reconstruction with Bone-Patellar-Tendon-Bone (BPTB) versus semitendinosus and gracilis (HS) autografts. METHODS We enrolled 30 male amateur athletes. Each patient was evaluated by isokinetic test, triaxial accelerometer test and balance test with stabilometric platform. Isokinetic test evaluated quadriceps and hamstrings Peak Torque. Accelerometer test evaluated squat jump test (SJT) and stiffness test (ST). The recording on the balance platform was performed with open and closed eyes and evaluated medio-lateral and anterior-posterior pathways. RESULTS 30 patients were selected (15 in group BPTB and 15 in group HS). In SJT we noticed a statistically significant difference in height of jump in the involved side in favour of Group BPTB (p=0.037) and not significant difference in the other parameters. In the ST, we did not observe significant statistical differences in the parameters of the test. The stabilometric platform data and isokinetic peak torque parameters did not show a significant difference. DISCUSSION Little high quality researches are available to help determine when patients can safely return to full activity and sport. Included evaluation criteria were a combination of factors regarding knee motion, muscles strength and neuromuscular function. CONCLUSION In our study, despite a not full recovery of explosive strength in HS group , the balance and the other parameters after one year are comparable between the two graft. In our findings there isn't clinical difference between the two grafts. We suggest that the evaluation of explosive strength and proprioception are the priority parameters in neuromuscular recovery after ACL reconstruction.
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Ochiai S, Hagino T, Senga S, Yamashita T, Oda K, Haro H. Injury to infrapatellar branch of saphenous nerve in anterior cruciate ligament reconstruction using vertical skin incision for hamstring harvesting: risk factors and the influence of treatment outcome. J Orthop Surg Res 2017; 12:101. [PMID: 28655325 PMCID: PMC5488375 DOI: 10.1186/s13018-017-0596-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 06/14/2017] [Indexed: 12/17/2022] Open
Abstract
Background Injury to the infrapatellar branch of the saphenous nerve (IPBSN) is a high-frequency complication in anterior cruciate ligament (ACL) reconstruction. We analyzed the risk factor of IPBSN injury in ACL reconstruction. Moreover, we investigated the influence on treatment outcome by this complication. Methods One hundred twenty-three patients who underwent ACL reconstruction using semitendinosus tendon graft were studied. Gender, age, BMI, and additional use of gracilis tendon were recorded. Treatment outcome was assessed by Lysholm score, visual analog scale (VAS) pain score, anterior knee pain, knee range of motion (ROM), and the patient-based SF-36. Patients who developed sensory disturbance at 24 months after reconstruction were compared with those without sensory disturbance. Results Twenty-six of 123 patients (21.1%) developed postoperative sensory disturbance caused by IPBSN injury. Baseline parameters were not significantly different compared to those in the non-sensory disturbance group. In the sensory disturbance group, treatment outcome evaluated at 24 months post-reconstruction showed Lysholm score of 94.1, VAS of 9.8 mm, anterior knee pain in 7.7%, and limitation of knee extension of 5° in 7.7%. SF-36 scores in all subscales were above the mean national standard scores. Treatment outcome parameters were also not significantly different compared to those in the non-sensory disturbance group, and none of the patients had serious impairment of knee function and activities of daily living. Conclusion Injury to IPBSN in ACL reconstruction was not related to age, gender, and physique, and injury frequency did not increase. Evaluation of postoperative treatment outcome showed that IPBSN injury was not related to anterior knee pain or knee ROM limitation, and patients’ subjective evaluation confirmed no serious impact on physical and mental health.
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Affiliation(s)
- Satoshi Ochiai
- The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533, Japan.
| | - Tetsuo Hagino
- The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533, Japan
| | - Shinya Senga
- The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533, Japan
| | - Takashi Yamashita
- The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533, Japan
| | - Kotaro Oda
- The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi, 409-3898, Japan
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Cavaignac E, Coulin B, Tscholl P, Nik Mohd Fatmy N, Duthon V, Menetrey J. Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years. Am J Sports Med 2017; 45:1326-1332. [PMID: 28273424 DOI: 10.1177/0363546516688665] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone (BPTB) in randomized controlled trials, with a lesser incidence of complications. Up until now, only 2 studies have compared QT to hamstring tendon (HT) autograft. HYPOTHESIS The functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner, subjective International Knee Documentation Committee), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score), and isokinetic strength. Descriptive statistics are presented for these variables using the Student t test. RESULTS Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years. There were 4 reoperations in the QT group (including 1 ACL revision) and 3 in the HT group (including 2 ACL revisions) ( P > .05). The Lysholm (89 ± 6.9 vs 83.1 ± 5.3), KOOS Symptoms (90 ± 11.2 vs 81 ± 10.3), and KOOS Sport (82 ± 11.3 vs 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005). The negative Lachman component was higher in the QT group than in the HT group (90% vs 46%, P < .005). There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group (90% vs 64%, P = .052). The Shelbourne-Trumper score was the same in both groups. There was no difference between groups in terms of isokinetic strength. CONCLUSION The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft, without affecting morbidity.
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Affiliation(s)
- Etienne Cavaignac
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benoit Coulin
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Tscholl
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nik Nik Mohd Fatmy
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Victoria Duthon
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jacques Menetrey
- Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Wylie JD, Marchand LS, Burks RT. Etiologic Factors That Lead to Failure After Primary Anterior Cruciate Ligament Surgery. Clin Sports Med 2017; 36:155-172. [DOI: 10.1016/j.csm.2016.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lee JK, Lee S, Lee MC. Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction: Bone-Quadriceps Tendon Graft Versus Double-Bundle Hamstring Tendon Graft. Am J Sports Med 2016; 44:2323-9. [PMID: 27365373 DOI: 10.1177/0363546516650666] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The choice of graft type is an important factor to the outcome of anterior cruciate ligament (ACL) reconstruction. PURPOSE To compare knee joint stability and functional outcomes of anatomic ACL reconstruction with double-bundle hamstring tendon (DBHT) and bone-quadriceps tendon (BQT) autografts. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Ninety-six patients underwent ACL reconstruction with either DBHT (hamstring group) or BQT autograft (quadriceps group). Each group included 48 patients who were retrospectively matched on the basis of age, sex, and body mass index; there were no statistically significant differences between the 2 groups (all P > .05). All patients had a minimum follow-up of 2 years. Outcome evaluations included the manual laxity test, International Knee Documentation Committee subjective evaluation, Tegner activity score, modified Lysholm score, anterior knee pain questionnaire, KT-2000 arthrometer side-to-side difference, Cybex II isokinetic testing, and tunnel position evaluation by quadrant method. RESULTS Manual laxity test results were significantly improved in both groups after surgery (all P < .05). The maximum KT-2000 arthrometer side-to-side difference improved from 4.0 to 1.9 mm in the hamstring group and 3.9 to 2.1 mm in the quadriceps group (P = .65). Modified Lysholm scores in the hamstring and quadriceps groups improved from 69.4 and 70.2 to 88.4 and 92.1 (P = .30), and International Knee Documentation Committee subjective evaluation scores improved from 56.0 and 60.3 to 77.9 and 80.2 (P = .37), respectively. Tegner activity scores for the hamstring and quadriceps groups were 4.7 and 4.6 preoperatively and 4.6 and 4.7 (P = .80) at final follow-up, respectively. There were no between-group differences on postoperative anterior knee pain (P > .05 for all questionnaire categories), nor were there differences in recovered extensor muscle strength during isokinetic testing (82.9% vs 81.0% at 60 deg/s, P = .71; 85.1% vs 83.8% at 180 deg/s, P = .81). However, flexor muscle strength recovery was better in the quadriceps group (86.6% vs 92.2% at 60 deg/s, P = .22; 87.1% vs 99.6% at 180 deg/s, P = .01). There were no significant differences in tunnel positioning between the 2 groups (all P > .05). CONCLUSION Anatomic ACL reconstruction with the BQT autograft showed similar knee stability and functional outcome scores when compared with the DBHT autograft. Additionally, better flexor muscle strength recovery was found in the quadriceps group, indicating a potential advantage of the BQT autograft in ACL reconstruction.
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Affiliation(s)
- Joon Kyu Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang-si, Korea
| | - Sahnghoon Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
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Jones KJ, Lazaro LE, Taylor SA, Pardee NC, Dyke JP, Hannafin JA, Warren RF, Lorich DG. Quantitative assessment of patellar vascularity following bone-patellar tendon-bone autograft harvest for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:2818-2824. [PMID: 25609023 DOI: 10.1007/s00167-015-3510-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 01/12/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Recent anatomic studies have suggested that the dominant arterial supply of the patella enters through the inferior pole. Based upon these findings, we hypothesized that bone-patellar tendon-bone graft harvest can significantly diminish patellar vascularity. METHODS Nine matched pair cadaveric knee specimens (mean age 47.4 years) were dissected and cannulated. A single knee was selected to undergo routine graft harvest, and the contralateral knee was left intact to serve as a control. Gadolinium was injected, and magnetic resonance imaging (MRI) signal enhancement was quantified to determine differences in uptake. Each matched pair was subsequently injected with a urethane polymer compound and dissected to correlate vessel disruption with MRI findings. RESULTS We identified two predominating patterns of vessel entry. In one pattern, the vessel entered the inferomedial aspect (five o'clock/right, seven o'clock/left) of the patella and was disrupted by graft harvest in 2/9 (22.2 %) pairs. In the second pattern, the vessel entered further medial (four o'clock/right, eight o'clock/left) and was not disrupted (7/9, 78.8 %). The mean decrease in gadolinium uptake following disruption of the predominant vessel measured 56.2 % (range 42.6-69.5 %) compared to an average decrease of 18.3 % (range 7.1-29.1 %) when the dominant arterial supply to the inferior pole remained intact (p < 0.04). CONCLUSION Medial entry of the predominant vessel precluded vessel disruption. Disruption of the dominant arterial supply can result in a significant decrease in patellar vascularity. Modification of graft harvest techniques and areas of surgical dissection should be explored to minimize vascular insult. Further correlation with clinical studies/outcomes is necessary to determine a potential association between vascular insult and anterior knee pain.
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Affiliation(s)
- Kristofer J Jones
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, 76-143 CHS, Los Angeles, CA, 90095, USA.
| | - Lionel E Lazaro
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA
| | - Samuel A Taylor
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA
| | - Nadine C Pardee
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA
| | - Jonathan P Dyke
- Citigroup Biomedical Imaging Center, Weill Medical College of Cornell University, 516 E. 72nd St, New York, NY, 10021, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA
| | - Russell F Warren
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA
| | - Dean G Lorich
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA
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Seijas R, Cuscó X, Sallent A, Serra I, Ares O, Cugat R. Pain in donor site after BTB-ACL reconstruction with PRGF: a randomized trial. Arch Orthop Trauma Surg 2016; 136:829-35. [PMID: 27146668 DOI: 10.1007/s00402-016-2458-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) tears are highly incident injuries in young athletes within our work area. The use of the patellar graft, despite being the treatment of choice, presents post-operative problems such as anterior knee pain, which limits its use and leads to preference being taken for alternative grafts. Our aim was to evaluate if the application of PRGF reduces anterior knee pain in donor site in BTB-ACL reconstruction. MATERIALS AND METHODS 43 patients were included in the double-blinded and randomized clinical trial comparing two patient groups who underwent ACL reconstruction using patellar tendon graft, comparing anterior knee pain with and without the application of PRGF at the donor site after harvesting the graft. RESULTS The PRGF group showed decreased donor site pain in comparison to the control group, with significant differences in the first two months of follow-up. CONCLUSION The application of PRGF decreased donor site pain compared to the control group.
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Affiliation(s)
- Roberto Seijas
- Orthopaedic Surgery, Artroscopia G.C., Fundación García-Cugat, Hospital Quirón Barcelona, Universitat Internacional de Catalunya Pza, Alfonso Comín 5-7, 08023, Barcelona, Spain.
| | - Xavier Cuscó
- Orthopaedic Surgery, Artroscopia G.C., Fundación García-Cugat, Hospital Quirón Barcelona, Universitat Internacional de Catalunya Pza, Alfonso Comín 5-7, 08023, Barcelona, Spain
| | | | - Iván Serra
- Veterinarian Surgery University of Valencia, Valencia, Spain
| | - Oscar Ares
- Orthopaedic Surgery, Artroscopia G.C., Fundación García-Cugat, Hospital Quirón Barcelona, Universitat Internacional de Catalunya Pza, Alfonso Comín 5-7, 08023, Barcelona, Spain.,Hospital Clínic Barcelona, Barcelona, Spain
| | - Ramón Cugat
- Orthopaedic Surgery, Artroscopia G.C., Fundación García-Cugat, Hospital Quirón Barcelona, Universitat Internacional de Catalunya Pza, Alfonso Comín 5-7, 08023, Barcelona, Spain
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Kim SJ, Yoon JY, Kim SM, Ha S, Kim SH, Cho I. A Comparative Study on the Postoperative Outcomes of Anterior Cruciate Ligament Reconstruction Using Patellar Bone-Tendon Autografts and Bone-Patellar Tendon-Bone Autografts. Arthroscopy 2016; 32:1072-9. [PMID: 26972628 DOI: 10.1016/j.arthro.2015.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/25/2015] [Accepted: 10/12/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate and compare the clinical outcomes of anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft and a patellar bone-tendon (PBT) autograft. METHODS Seventy-nine patients who underwent ACL reconstruction using either a BPTB autograft or a PBT autograft were retrospectively evaluated. The minimum follow-up period was 24 months after surgery. A graft selection was determined by the patellar tendon length as measured on preoperative magnetic resonance imaging. If the patellar tendon length was longer than or equal to 45 mm, a PBT graft attached with the EndoPearl device was used. Fifty-one patients used BPTB autografts (group B) and 28 patients used PBT autografts (group P). The Lachman test, pivot-shift test, and anterior translation tested with a KT2000 arthrometer were assessed. Functional outcomes were assessed with the use of the Lysholm score, International Knee Documentation Committee subjective score, and objective grade. Anterior knee pain including kneeling pain was assessed with the use of the Shelbourne and Trumper questionnaire. RESULTS There was no statistically significant difference between the 2 groups in the postoperative values of degree of anterior translation (P = .76), Lysholm score (P = .62), International Knee Documentation Committee subjective score (P = .91), and objective grade (P = .91). However, anterior knee pain assessed with the use of the Shelbourne and Trumper questionnaire (group B = 90 [range, 65 to 100], group P = 95 [range, 59 to 100], P = .02) and number of patients having kneeling pain (group B = 41%, group P = 18%, P = .04) differed significantly between the 2 groups. CONCLUSIONS ACL reconstruction using a PBT autograft provided reliable knee stability comparable to a BPTB autograft but with less kneeling pain. For patients who have a long patellar tendon that may cause graft-tunnel mismatch, a PBT can be an effective alternative graft option for arthroscopic ACL reconstruction. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopedic Surgery, Gangdong Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Ji-Young Yoon
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong-Min Kim
- Department of Orthopedic Surgery, Yonsei Mucheoknaeun Hospital, Seoul, Republic of Korea
| | - Seungjoo Ha
- Department of Orthopedic Surgery, Modu Hospital, Incheon, Republic of Korea
| | - Sung-Hwan Kim
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Inje Cho
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Patellofemoral Osteoarthritis: Are We Missing an Important Source of Symptoms After Anterior Cruciate Ligament Reconstruction? J Orthop Sports Phys Ther 2016; 46:232-4. [PMID: 27032529 DOI: 10.2519/jospt.2016.0603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anterior cruciate ligament (ACL) rupture is a well-established risk factor for knee osteoarthritis (OA). Fifty to ninety percent of individuals will develop radiographic tibiofemoral OA within a decade after ACL injury and anterior cruciate ligament reconstruction (ACLR). Although less well recognized, radiographic patellofemoral OA is present in approximately 50% of individuals at more than 10 years after ACLR. This early-onset OA and its associated pain and functional limitations pose a particular challenge to younger adults with OA compared to an older OA population. Targeted interventions need to be developed to reduce the burden of early-onset OA following ACLR. Emerging evidence suggests that such interventions should target both the patellofemoral and tibiofemoral joints.
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Kanamoto T, Tanaka Y, Yonetani Y, Kita K, Amano H, Kusano M, Hirabayashi S, Horibe S. Anterior knee symptoms after double-bundle ACL reconstruction with hamstring tendon autografts: an ultrasonographic and power Doppler investigation. Knee Surg Sports Traumatol Arthrosc 2015; 23:3324-9. [PMID: 24981990 DOI: 10.1007/s00167-014-3142-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 06/12/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Anterior knee pain related to the donor site is a frequent complication of anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone autograft tissue. Even when hamstring tendon (HT) grafts are used instead, symptoms such as mild pain and discomfort can still occur. The purpose of this study was to elucidate the pathophysiology of anterior knee symptoms after ACLR with HT autografts. METHODS Fifty-seven patients (22 men and 35 women; mean age, 24.7 years) who underwent anatomic double-bundle ACLR with HT autografts were examined 6 months post-operatively. The presence of anterior knee symptoms, anterior knee laxity, range of motion, and muscle strength were assessed. Changes in patellar tendon and infrapatellar fat pad (IFP) morphology and blood flow were also evaluated using ultrasound. Potential variables affecting the presence of anterior knee symptoms were subjected to univariate analysis and multivariate logistic regression analysis to identify independent risk factors. RESULTS Six months post-operatively, the total incidence of anterior knee symptoms was 56.1 % (32/57). According to univariate analysis, age, quadriceps strength, and increased blood flow in the IFP were significantly associated with the presence of anterior knee symptoms. Multivariate logistic regression analysis revealed that increased blood flow in the IFP was an independent factor for the presence of anterior knee symptoms (odds ratio 5.0; 95 % confidence interval 1.3-19.9). There were no significant findings inside the patellar tendon. CONCLUSIONS Increased blood flow in the IFP was identified as an independent factor for the presence of anterior knee symptoms 6 months after ACLR with HT autografts. The ultrasound evaluation can help to define precisely the origin of anterior knee symptoms after ACLR with HT autografts. LEVEL OF EVIDENCE Case series with no comparison groups, Level IV.
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Affiliation(s)
- Takashi Kanamoto
- Department of Rehabilitation, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka, 597-8025, Japan.
| | - Yoshinari Tanaka
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Yasukazu Yonetani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Keisuke Kita
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Hiroshi Amano
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Masashi Kusano
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Sakai, Japan
| | - Shinji Hirabayashi
- Department of Rehabilitation, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka, 597-8025, Japan
| | - Shuji Horibe
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
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Schroeder MJ, Krishnan C, Dhaher YY. The influence of task complexity on knee joint kinetics following ACL reconstruction. Clin Biomech (Bristol, Avon) 2015; 30:852-9. [PMID: 26101055 PMCID: PMC4568131 DOI: 10.1016/j.clinbiomech.2015.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/02/2015] [Accepted: 06/04/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous research indicates that subjects with anterior cruciate ligament reconstruction exhibit abnormal knee joint movement patterns during functional activities like walking. While the sagittal plane mechanics have been studied extensively, less is known about the secondary planes, specifically with regard to more demanding tasks. This study explored the influence of task complexity on functional joint mechanics in the context of graft-specific surgeries. METHODS In 25 participants (10 hamstring tendon graft, 6 patellar tendon graft, 9 matched controls), three-dimensional joint torques were calculated using a standard inverse dynamics approach during level walking and stair descent. The stair descent task was separated into two functionally different sub-tasks-step-to-floor and step-to-step. The differences in external knee moment profiles were compared between groups; paired differences between the reconstructed and non-reconstructed knees were also assessed. FINDINGS The reconstructed knees, irrespective of graft type, typically exhibited significantly lower peak knee flexion moments compared to control knees during stair descent, with the differences more pronounced in the step-to-step task. Frontal plane adduction torque deficits were graft specific and limited to the hamstring tendon knees during the step-to-step task. Internal rotation torque deficits were also primarily limited to the hamstring tendon graft group during stair descent. Collectively, these results suggest that task complexity was a primary driver of differences in joint mechanics between anterior cruciate ligament reconstructed individuals and controls, and such differences were more pronounced in individuals with hamstring tendon grafts. INTERPRETATION The mechanical environment experienced in the cartilage during repetitive, cyclical tasks such as walking and other activities of daily living has been argued to contribute to the development of degenerative changes to the joint and ultimately osteoarthritis. Given the task-specific and graft-specific differences in joint mechanics detected in this study, care should be taken during the rehabilitation process to mitigate these changes.
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Affiliation(s)
- Megan J. Schroeder
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, IL 60611, USA,Correspondence: Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Suite 1406, Chicago, IL 60611, USA. Tel.: +1 (312) 238-1408; Fax: +1 (312) 238-2208.
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 710 North Lake Shore Drive, Chicago, IL 60611, USA,Department of Physical Medicine and Rehabilitation, University of Michigan, 325 East Eisenhower Parkway, Ann Arbor, MI 48108, USA
| | - Yasin Y. Dhaher
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, IL 60611, USA,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 710 North Lake Shore Drive, Chicago, IL 60611, USA
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Inderhaug E, Strand T, Solheim E. The impact of sensory deficits after harvesting hamstrings autograft for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23:1060-4. [PMID: 24482218 DOI: 10.1007/s00167-014-2871-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 01/22/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of this study was threefold: to investigate the incidence of sensory deficits after harvesting hamstrings autografts, to localise and measure the area of altered sensibility and to investigate the impact of any sensory deficit on the patients daily life. METHODS A consecutive series of sixty-one patients were examined for sensory deficits related to harvest of hamstrings tendons 10 years after having had an anterior cruciate ligament reconstruction. A neurological examination of the leg was performed to investigate for potential altered sensibility and to quantify the extent of the lesion. The patients answered the anterior knee symptoms (AKS) questionnaire and additional questions regarding impact on activities of daily life by any sensory deficit. RESULTS Eighty-five per cent of the examined patients had sensory deficits--experienced as numbness (78 %) and paraesthesia (16 %)--distal to the site of tendon harvesting. The mean affected area was 70 (SD 62) cm(2). No patients experienced sensory deficit symptoms to such a degree that it affected their activities of daily life, but the group with sensory deficit had significantly more AKS than patients without sensory deficit, as evaluated by the AKS score (P = 0.02). The most commonly reported complaints were related to strenuous activities and kneeling knee position. CONCLUSIONS This long-term evaluation shows that sensory deficit after hamstring tendons harvesting affects a majority of patients and is probably permanent. Most patients reported this as being only mildly bothersome, but they have significantly more AKS as assessed by the AKS questionnaire. In clinical practice, patients should be counselled prior to tendon harvesting on the incidence and characteristic of the sensory deficit along with other possible peri- and postoperative complications. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Eivind Inderhaug
- Surgical Department, Haraldsplass Deaconess Hospital, Pb 6165, 5152, Bergen, Norway,
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Healing of donor site in bone-tendon-bone ACL reconstruction accelerated with plasma rich in growth factors: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 2015; 23:991-7. [PMID: 24280956 DOI: 10.1007/s00167-013-2787-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 11/17/2013] [Indexed: 01/15/2023]
Abstract
PURPOSE To determine whether the use of plasma rich in growth factors accelerates healing of the donor site in bone-tendon-bone anterior cruciate ligament (ACL) reconstruction (patellar graft). The use of the patellar graft presents post-operative problems such as anterior knee pain, which limits its use and leads to preference being taken for alternative grafts. METHODS A double-blind, randomized, clinical trial was performed comparing two groups of patients who underwent ACL reconstruction using patellar tendon graft and comparing the use of plasma rich in growth factors at the donor site after graft harvest in terms of local regeneration by ultrasound assessment. RESULTS The plasma rich in growth factors group shows earlier donor site regeneration in comparison with the control group (2 months earlier), with significant differences in the first 4 months of the follow-up. CONCLUSION The application of plasma rich in growth factors shows accelerated tissue regeneration processes with respect to the control group. This fact, together with the previously published with similar conclusions, can create a knowledge basis in order to set out new recovery guidelines following ACL reconstruction. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Sarzaeem MM, Najafi F, Razi M, Najafi MA. ACL reconstruction using bone-patella tendon-bone autograft: press-fit technique vs. interference screw fixation. Arch Orthop Trauma Surg 2014; 134:955-62. [PMID: 24756534 DOI: 10.1007/s00402-014-1999-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The gold standard in ACL reconstructions has been the bone-patellar tendon-bone autograft fixed with interference screws. This prospective, randomized clinical trial aimed to compare two methods of fixation for BPTB grafts: press-fit fixation vs. interference screw, over a 12-month follow-up interval. METHODS 158 patients with an average age of 29.8 years, between 2011 and 2012, were treated for torn ACL. 82 patients underwent reconstruction with BPTB autograft with a press fit fixation technique, and in 76 cases an interference screw was used. At the time of final follow-up, 71 patients in press-fit group and 65 patients in interference screw group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC score and complications. RESULTS At 12-month follow-up, 59 (83 %) and 55 (85 %) in press-fit and screw group, respectively had good-to-excellent IKDC score (p > 0.05). The mean laxity assessed using a KT-1000 arthrometer improved to 2.7 and 2.5 mm in press-fit and screw group, respectively. Regarding Lachman and pivot shift test, there was a statistically significant improvement in the integrity of the ACL in both the groups, but no significant differences was noted between groups. There were no significant differences in terms of femur circumference difference, effusion, knee range of motion, pain and complications. CONCLUSIONS The press-fit technique is an efficient procedure. Its outcome was comparable with the interference screw group. Furthermore it has unlimited bone-to-bone healing, no need for removal of hardware, ease for revision and cost effectiveness.
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Affiliation(s)
- M M Sarzaeem
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
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Cryotherapy with dynamic intermittent compression for analgesia after anterior cruciate ligament reconstruction. Preliminary study. Orthop Traumatol Surg Res 2014; 100:309-12. [PMID: 24679367 DOI: 10.1016/j.otsr.2013.12.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/07/2013] [Accepted: 12/16/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cryotherapy is a useful adjunctive analgesic measure in patients with postoperative pain following anterior cruciate ligament (ACL) surgery. Either static permanent compression or dynamic intermittent compression can be added to increase the analgesic effect of cryotherapy. Our objective was to compare the efficacy of these two compression modalities combined with cryotherapy in relieving postoperative pain and restoring range of knee motion after ligament reconstruction surgery. HYPOTHESIS When combined with cryotherapy, a dynamic and intermittent compression is associated with decreased analgesic drug requirements, less postoperative pain, and better range of knee motion compared to static compression. MATERIALS AND METHODS We conducted a case-control study of consecutive patients who underwent anterior cruciate ligament reconstruction at a single institution over a 3-month period. Both groups received the same analgesic drug protocol. One group was managed with cryotherapy and dynamic intermittent compression (Game Ready(®)) and the other with cryotherapy and static compression (IceBand(®)). RESULTS Of 39 patients, 20 received dynamic and 19 static compression. In the post-anaesthesia recovery unit, the mean visual analogue scale (VAS) pain score was 2.4 (range, 0-6) with dynamic compression and 2.7 (0-7) with static compression (P=0.3); corresponding values were 1.85 (0-9) vs. 3 (0-8) (P=0.16) after 6 hours and 0.6 (0-3) vs. 1.14 (0-3) (P=0.12) at discharge. The cumulative mean tramadol dose per patient was 57.5mg (0-200mg) with dynamic compression and 128.6 mg (0-250 mg) with static compression (P=0.023); corresponding values for morphine were 0mg vs. 1.14 mg (0-8 mg) (P<0.05). Mean range of knee flexion at discharge was 90.5° (80°-100°) with dynamic compression and 84.5° (75°-90°) with static compression (P=0.0015). CONCLUSION Dynamic intermittent compression combined with cryotherapy decreases analgesic drug requirements after ACL reconstruction and improves the postoperative recovery of range of knee motion. LEVEL OF EVIDENCE Level III, case-control study.
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Ntagiopoulos PG, Bonin N, Sonnery-Cottet B, Badet R, Dejour D. The incidence of trochlear dysplasia in anterior cruciate ligament tears. INTERNATIONAL ORTHOPAEDICS 2014; 38:1269-75. [PMID: 24515227 DOI: 10.1007/s00264-014-2291-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 01/25/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of the present epidemiologic study is to record the radiographic presence of trochlear dysplasia and patella alta in patients who undergo anterior cruciate ligament (ACL) reconstruction as a potential underlying factor for post-operative anterior knee pain (AKP). METHODS All consecutive cases of skeletally-mature ACL-deficient knees that would undergo ACL reconstruction in three different hospitals were prospectively included during a six-month period. Inclusion criteria were acute and sub-acute ACL injury with no previous ipsilateral knee operation. Patients with chronic ACL tears, prior-to-ACL-injury history of patellar instability or other PF disorders were excluded from the study. RESULTS A total of 299 knees were included (mean age 32 ± ten years). Forty-four (14.7 %) knees had a positive 'crossing sign' in the lateral X-rays and 255 (85.3 %) had no sign of trochlear dysplasia (p < 0.01). Among the cases with trochlear dysplasia, 41 (93 %) had type A trochlear dysplasia with the presence only of the 'crossing sign' and three (7 %) had type C trochlear dysplasia. Patellar height results included a mean Caton-Deschamps index of 1.0 ± 0.14 (0.5-1.4). Twenty (6.6 %) knees had an index of less than 0.8, and two (0.6 %) knees had an index less than 0.6. In contrast, 15 (5.0 %) knees had an abnormal value of more than 1.2, indicating patella alta. CONCLUSIONS The most important finding of the study is the increased prevalence of trochlear dysplasia and patella alta in patients with ACL injury, when compared to the incidence of trochlear dysplasia and patella alta in the general population in the literature. This finding could sound as an alert of a possible additional risk factor for post-operative anterior knee pain after ACL reconstruction.
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Paschos N, Vasiliadis HS. Allograft versus autograft for reconstruction of anterior cruciate ligament rupture in adults. Hippokratia 2013. [DOI: 10.1002/14651858.cd010661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nikolaos Paschos
- University of California Davis; Department of Biomedical Engineering; Genome and Biomedical Sciences Facility 451 East Health Sciences Drive Davis California USA 95616
| | - Haris S Vasiliadis
- University of Ioannina; Department of Orthopaedics; Ioannina Greece
- Sahlgrenska Academy, University of Gothenburg; Molecular Cell Biology and Regenerative Medicine; Gothenburg Sweden SE-413 45
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Ensuring face validity in patient-related outcome scores--a matter of content. Knee 2013; 20:72-8. [PMID: 23159150 DOI: 10.1016/j.knee.2012.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 07/13/2012] [Accepted: 10/09/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patient reported outcome (PRO) questionnaires are increasingly used to measure treatment effect in patients with knee pathology. PROs commonly used to assess outcome in patients with knee conditions can be generic, knee-specific, or condition-specific. Most PROs have been created based on clinician-based consensus and are not patient-centered. Items (questions plus their response options) in PROs can be generated by clinicians or through patient interviews. Items created by clinicians possess face validity. The objective of this study was to find all existing PRO items with potentially relevant content for patients with knee pathology. METHODS An exhaustive literature search was conducted for PRO questionnaires in English, German, and Scandinavian languages used to assess outcome in patients with knee pathology. The items from the collected PROs were assessed for content redundancy and item reduction was carried out to isolate items of unique content. These items were grouped into one of the components of the ICF classification system. RESULTS Thirty-one PROs used for assessment of patients with knee problems were identified, yielding 539 items. Approximately 70% of these items consisted of redundant content matter. The item pool was reduced to a pool of 157 items. CONCLUSION The search yielded 157 items of unique content. CLINICAL RELEVANCE The identified items can be used to build condition-specific PRO questionnaires for patients with knee pathology.
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Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W. A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament. Arch Orthop Trauma Surg 2012; 132:1287-97. [PMID: 22661336 DOI: 10.1007/s00402-012-1532-5] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Controversies exist over which type of graft is best for the reconstruction of the anterior cruciate ligament (ACL). The purpose of this systematic review was to evaluate the effectiveness of ACL reconstruction using either hamstring (HT) autografts or bone-patellar tendon-bone (BPTB) autografts. METHODS We searched the Cochrane Library, MEDLINE and EMBASE for published randomized controlled trials (RCT) comparing HT autografts with BPTB autografts for ACL reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0. RESULTS Nine RCTs (738 patients) met the inclusion criteria. The combined results of the meta-analysis indicated there was a significantly lower rate of negative Pivot test [relative risk (RR) 0.87, 95 % confidence intervals (CI) 0.79-0.96, P = 0.004], anterior knee pain (RR 0.66, 95 % CI 0.45-0.96, P = 0.03) and of kneeling pain (RR 0.49, 95 % CI 0.27-0.91, P = 0.02) in the HT group than in the BPTB group. CONCLUSIONS ACL reconstruction with HT autografts or BPTB autografts achieved similar postoperative effects in terms of restoring knee joint function. HT autografts were inferior to BPTB autografts for restoring knee joint stability, but were associated with fewer postoperative complications.
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Affiliation(s)
- Shuzhen Li
- Department of Orthopedic Surgery, The Affiliated Ruikang Hospital of Guangxi Traditional Chinese Medical College, Nanning, 530011, China
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Niki Y, Hakozaki A, Iwamoto W, Kanagawa H, Matsumoto H, Toyama Y, Suda Y. Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20:1543-9. [PMID: 22057356 DOI: 10.1007/s00167-011-1746-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 10/21/2011] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the prevalence of anterior knee pain in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction and to identify critical factors affecting postoperative anterior knee pain development. METHODS Subjects comprised 171 patients (171 knees) who underwent anatomic double-bundle ACL reconstruction with a follow-up period of ≥2 years. The procedure used bone-patellar tendon-bone plus gracilis tendon (BTB-G) in 56 knees, semitendinosus tendon (ST) in 71 knees, and ST-G in 44 knees. Clinical results and prevalence and severity of anterior knee pain were assessed at 3 months and 2 years postoperatively. Clinical variables influencing anterior knee pain development at each postoperative period were subjected to univariate analysis, followed by logistic regression analysis to identify risk factors for anterior knee pain. RESULTS Overall prevalences of anterior knee pain at 3 months and 2 years postoperatively were 42.0 and 11.1%, respectively. Use of BTB-G graft represented the highest prevalence of anterior knee pain between the 3 different grafts (P = 0.001); however, this statistical significance disappeared at 2 years postoperatively. Prevalence of postoperative extension deficit was significantly higher in anterior knee pain-positive cohort than in anterior knee pain-negative cohort at 3 months postoperatively. Level of quadriceps strength was significantly lower, and Lysholm score was significantly worse in anterior knee pain-positive cohort than in anterior knee pain-negative cohort at 2 years postoperatively. According to logistic regression analysis, knee extension deficit was a predisposing factor for the development of anterior knee pain at 3 months postoperatively (odds ratio, 2.76; P = 0.004); however, there was no significant predisposing factor for anterior knee pain at 2 years postoperatively. CONCLUSIONS Knee extension deficit was an important predisposing factor for postoperative anterior knee pain in the early postoperative period, and anterior knee pain was associated with impaired quadriceps function and inferior subjective results over 2 years postoperatively. Early recovery of full extension may prevent postoperative development of anterior knee pain and achieve successful outcomes for ACL reconstruction. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Yasuo Niki
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
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Widuchowski W, Widuchowska M, Koczy B, Dragan S, Czamara A, Tomaszewski W, Widuchowski J. Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: results at 15 years follow-up. BMC Musculoskelet Disord 2012; 13:115. [PMID: 22738187 PMCID: PMC3492212 DOI: 10.1186/1471-2474-13-115] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 06/15/2012] [Indexed: 01/13/2023] Open
Abstract
Background If anterior cruciate ligament (ACL) reconstruction is to be performed, decision regarding graft choice and its fixation remains one of the most controversial. Multiple techniques for ACL reconstruction are available. To avoid disadvantages related to fixation devices, a hardware-free, press-fit ACL reconstruction technique was developed. The aim of this study was to evaluate clinical outcome and osteoarthritis progression in long term after ACL reconstruction with central third patellar-tendon autograft fixed to femur by press-fit technique. Methods Fifty two patients met inclusion/excusion criteria for this study. The patients were assessed preoperatively and at 15 years after surgery with International Knee Documentation Committee Knee Ligament Evaluation Form, Lysholm knee score, Tegner activity scale and radiographs. Results Good overall clinical outcomes and self-reported assessments were documented, and remained good at 15 years. The mean Lysholm and Tegner scores improved from 59.7 ± 18.5 and 4.2 ± 1.0 preoperatively to 86.4 ± 5.6 (p = 0.004) and 6.9 ± 1.4 (p = 0.005) respectively at follow-up. The IKDC subjective score improved from 60.1 ± 9.2 to 80.2 ± 8.1 (p = 0.003). According to IKDC objective score, 75% of patients had normal or nearly normal knee joints at follow-up. Grade 0 or 1 results were seen in 85% of patients on laxity testing. Degenerative changes were found in 67% of patients. There was no correlation between arthritic changes and stability of knee and subjective evaluation (p > 0.05). Conclusions ACL reconstruction with patellar tendon autograft fixed to femur with press-fit technique allows to achieve good self-reported assessments and clinical ligament evaluation up to 15 years. Advantages of the bone-patellar-tendon-bone (BPTB) press-fit fixation include unlimited bone-to-bone healing, cost effectiveness, avoidance of disadvantages associated with hardware, and ease for revision surgery. BPTB femoral press-fit fixation technique can be safely applied in clinical practice and enables patients to return to preinjury activities including high-risk sports.
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Affiliation(s)
- Wojciech Widuchowski
- District Hospital of Orthopedics and Trauma Surgery, Department of the Knee Surgery, Arthroscopy and Sports Traumatology, Piekary Slaskie, Poland.
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Bone-patellar tendon-bone graft via a single minimally-invasive approach versus a classical approach in anterior cruciate ligament reconstruction: a prospective study. Orthop Traumatol Surg Res 2012; 98:426-31. [PMID: 22560789 DOI: 10.1016/j.otsr.2012.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 02/25/2012] [Accepted: 03/06/2012] [Indexed: 02/02/2023]
Abstract
UNLABELLED Harvesting the patellar ligament for anterior cruciate ligament reconstructions can be a source of anterior knee pain and hypoesthesia of the lateral side of the knee. We analyzed the feasibility of a minimally-invasive technique via a single patellar approach and postulate that it reduces anterior pain and limits the hypoesthesia area. PATIENTS AND METHODS A prospective, comparative, non-randomized, single-center study was conducted on two groups: one undergoing surgery with the classical anteromedial approach, the other with the minimally-invasive approach. Each group included 20 patients. Both series were reviewed between the 6th and 8th month after surgery. The revision was clinical, radiological, and ultrasonographic. RESULTS The grafts harvested via the classical approach in all 20 cases presented good characteristics, versus eight out of 18 for the grafts harvested via the minimally-invasive approach. A prominent anterior tibial tuberosity improved the quality of the tibial bone block. A hypoesthesia zone was found in 16 cases out of 18 in the classical approach group, it measured a mean 10.3 ± 5.6 cm(2). A surface area of 3 cm(2) was noted in one case from the minimally-invasive group. No significant difference was found for the subjective and objective IKDC and Lille patellofemoral scores between the two groups. Anterior pain was present in four patients in the classical group and six in the minimally-invasive group. DISCUSSION The minimally-invasive technique reduces the risk of cutaneous hypoesthesia. It does not prevent anterior pain related to harvesting the patellar tendon and a good-quality transplant can be obtained if the anterior tibial tuberosity is prominent. LEVEL OF EVIDENCE Level III: case-control study.
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Tibial tubercle advancement osteotomy with bone allograft for patellofemoral arthritis: a retrospective cohort study of 50 knees. Arch Orthop Trauma Surg 2012; 132:437-45. [PMID: PMID: 22113435 DOI: 10.1007/s00402-011-1433-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Indexed: 02/09/2023]
Abstract
PATIENTS AND METHODS Forty consecutive patients (21 females and 19 males) in a single centre underwent 50 tibial tubercle advancement osteotomy procedures for patellofemoral arthritis between January 1993 and April 2007. Twenty knees with patellar maltracking also underwent medialisation of the tibial tubercle (6-12 mm) in addition to the standard 10-15 mm elevation. Femoral head bone allograft blocks were utilised in all cases, and all patients achieved bony union without further surgery. Forty-five knees had previously undergone arthroscopy, 18 with arthroscopic lateral releases. RESULTS Ninety-four percentage of knees had sustained improvement in visual analogue pain scores (mean improvement of 37.4, P < 0.05) at a mean follow-up of 81 months (range 26-195 months), with 96% of patients still satisfied; and 92% of knees had sustained improvement in Shelbourne and Trumper anterior knee function scores (mean improvement of 39.8, P < 0.05). Overall clinical outcomes were rated excellent/good in 77%, fair in 35% and poor in 8% of knees. Two knees required arthroplasty surgery over the follow-up period (at 18 months and 8 years), and their anterior knee pain and function scores were not included in the analyses. Six knees (12%) suffered major complications: 1 temporary common peroneal neuropraxia; 2 intraoperative tibial metaphyseal fractures; and 3 tibial tuberosity fractures (at 8 days, 3 weeks and 3 months). Four knees (8%) suffered superficial wound infections, 31 knees had some numbness around the midline scar, 7 knees had scar pain lasting up to 12 months, and 22 knees (44%) experienced some discomfort relating to the metalwork, which was removed in all these cases. CONCLUSIONS Tibial tubercle advancement osteotomy can be an effective treatment for anterior knee pain and for patients with arthroscopic evidence of patellar chondral damage. It can provide excellent/good long-term functional results in the majority of patients, with very high satisfaction levels and sustained improvement in pain symptoms. The use of femoral head bone allograft is both effective in obtaining bony union and by definition avoids the donor-site morbidity. Knees with patellar malalignment may also undergo individualised medialisation of the tibial tubercle such that the patella lies in the centre of the femoral trochlea, and may benefit from lateral trochleaplasty surgery in the presence of trochlear dysplasia. However, the major operative complication rate is high at 12%, and fracture of the tibial tubercle is associated with a poorer outcome. One can expect 10% of operated knees to have had some clinical deterioration in the patellofemoral joint by a mean follow-up of 93 months.
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Robertson GA, Coleman SG, Keating JF. The surgical treatment of knee stiffness following anterior cruciate ligament reconstruction. Scott Med J 2012; 56:156-60. [PMID: 21873721 DOI: 10.1258/smj.2011.011114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Knee stiffness following anterior cruciate ligament (ACL) reconstruction remains a common complication, which can substantially impair knee function. The aim of this study was to assess the effectiveness of arthroscopic arthrolysis, in conjunction with manipulation under anaesthetic (MUA), in treating stiffness post-ACL reconstruction. We reviewed the records of 18 patients who underwent arthroscopic arthrolysis to treat established stiffness following primary isolated ACL reconstruction. Eight of these patients underwent concomitant MUA at time of arthrolysis. The median time between reconstruction and arthrolysis was nine months. Seven patients had arthrolysis performed within eight months of reconstruction, while 11 patients underwent arthrolysis greater than eight months postreconstruction. Following arthrolysis, the mean extension loss improved from 7° to 1°. In patients with mild extension stiffness (prearthrolysis extension deficits <10°), the mean improvement to extension was 3°. In patients with severe extension stiffness (prearthrolysis extension deficit ≥10°), the mean improvement to extension was 10°. Arthroscopic arthrolysis was significantly more effective in restoring extension loss if carried out within eight months of the primary reconstruction (P < 0.03). In the patients who underwent MUA at time of arthrolysis, the mean flexion loss improved from 16° to 4°. In conclusion, arthroscopic arthrolysis, in conjunction with MUA, is an effective treatment for knee stiffness post-ACL reconstruction but ideally should be carried out within eight months.
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Affiliation(s)
- G A Robertson
- Department of Orthopaedic Trauma, Royal Infirmary of Edinburgh, Little France, Old Dalkeith Road, Edinburgh EH16 4SU, Scotland, UK
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