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Ohji S, Aizawa J, Hirohata K, Ohmi T, Kawasaki T, Koga H, Yagishita K. Relationship Between Single-Leg Vertical Jump and Drop Jump Performance, and Return to Sports After Primary Anterior Cruciate Ligament Reconstruction Using Hamstring Graft. Int J Sports Phys Ther 2024; 19:1204-1215. [PMID: 39371195 PMCID: PMC11446733 DOI: 10.26603/001c.123479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 08/15/2024] [Indexed: 10/08/2024] Open
Abstract
Background After anterior cruciate ligament reconstruction (ACLR), asymmetry is likely to persist in single-leg (SL) vertical jump and drop jump performance than in SL hop distance. However, its relationship with the return to sport (RTS) remains unclear. Hypothesis/Purpose This study aimed to determine the association between vertical jump performance after primary ACLR using hamstring tendon autograft and RTS at a pre-injury competitive level. Study design Cross-sectional study. Methods Patients who underwent primary ACLR using hamstring tendon autograft were recruited for this study. Participants who returned to pre-injury competition after ACLR were recruited at least eight months postoperatively. Knee condition was assessed, including joint laxity, range of motion, muscle strength, and knee pain intensity during sports activities. Performance variables were also assessed, including SL hop distance, jump height in SL vertical jump, and reactive strength index (RSI; jump height/contact time) in SL drop jump. Participants were asked to subjectively report whether they had returned to the same level of competition as pre-injury and their perceived sport performance intensity. Those who answered "Yes" to the dichotomous question and had a postoperative subjective athletic performance of > 80% were categorized into the Yes-RTS group. The primary outcome was the ability to achieve RTS at the preinjury level. Results Sixty-five patients (female, 35; male, 30) at 13.0 (13.0) [median (interquartile)] months after ACLR participated in this study. Thirty-nine (60%) were assigned to the Yes-RTS group. Regarding knee conditions, the No-RTS group had a significantly higher knee pain intensity, as assessed using a numerical rating scale (p<0.001, effect size -0.45). In the performance tests, the No-RTS group exhibited a significantly lower limb symmetry index of RSI during the SL drop jump compared to the Yes-RTS group (p=0.002, effect size 0.81). Conclusion Patients unable to achieve RTS after primary ACLR using hamstring grafts are more likely to exhibit asymmetric performance during the SL drop jump test, suggesting the significance of assessing jump symmetry when evaluating post-ACLR rehabilitation success. Level of Evidence 3c.
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Affiliation(s)
- Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental University
| | - Junya Aizawa
- Department of Physical TherapyJuntendo University
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental University
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental University
| | - Tomoko Kawasaki
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental University
| | - Hideyuki Koga
- Department of Joint Surgery and Sports MedicineTokyo Medical and Dental University
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports DentistryTokyo Medical and Dental University
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Ohji S, Aizawa J, Hirohata K, Ohmi T, Mitomo S, Jinno T, Koga H, Yagishita K. Characteristics of landing impact in athletes who have not returned to sports at the pre-injury competition level after anterior cruciate ligament reconstruction. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 25:47-52. [PMID: 34141596 PMCID: PMC8187959 DOI: 10.1016/j.asmart.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/23/2021] [Accepted: 05/10/2021] [Indexed: 11/24/2022]
Abstract
Background Most patients with anterior cruciate ligament (ACL) injury undergo ACL reconstruction (ACLR) with the expectation of being able to return to sport (RTS) at the same level of the competition as before the injury. The magnitude and asymmetry of landing impact are important post-ACLR functional variables related to increased ACL strain and poor athletic performance. However, the association between the RTS status and landing impact in post-ACLR patients is unknown. Objective To investigate the association between RTS status and landing impact during single-leg landing in post-ACLR patients. Methods Forty-four patients after primary, unilateral ACLR participated in this study. They had already participated in sports post-ACLR. Questionnaires were used to assess whether the participants achieved the same competitive level of RTS as before the injury. The magnitude and symmetry of the peak vertical ground reaction force (pVGRF) were collected and analysed during single-leg jump landings. Additionally, knee functions (range of motion, laxity, effusion, strength, and single-leg hop distance) were measured. Results A total of 28 (64%) patients reported RTS at their pre-injury competition levels. The no-RTS group had a lower pVGRF magnitude on the operated side than the yes-RTS group (P = .019). The no-RTS group had a higher rate of pVGRF asymmetry (50%) than the yes-RTS group (18%) (P = .040). Logistic regression analysis revealed that pVGRF magnitude and asymmetry were significantly associated with the RTS status. Logistic regression analysis adjusted for knee function revealed that the pVGRF magnitude was significantly associated with the RTS status. Conclusion In patients who are unable to RTS at their pre-injury competition level after ACLR, the pVGRF is lower and more likely to be asymmetrical than in those able to RTS at their pre-injury competition level.
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Affiliation(s)
- Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Junya Aizawa
- Department of Physical Therapy, Juntendo University, 3-2-12 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Sho Mitomo
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Kuršumović K, Charalambous CP. Relationship of Graft Type and Vancomycin Presoaking to Rate of Infection in Anterior Cruciate Ligament Reconstruction. JBJS Rev 2020; 8:e1900156. [DOI: 10.2106/jbjs.rvw.19.00156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Selim NM. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft through Single Femoral Tunnel and Single Branched Tibial Tunnel. Arthrosc Tech 2018; 7:e989-e998. [PMID: 30377578 PMCID: PMC6203690 DOI: 10.1016/j.eats.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/08/2018] [Indexed: 02/03/2023] Open
Abstract
Conventional single-bundle anterior cruciate ligament (ACL) reconstruction cannot improve the rotational stability of the knee. Traditional double-bundle ACL reconstruction requires is demanding, complex, time- and implant consuming, and associated with a high incidence of complications. Double-bundle ACL reconstruction using a free quadriceps tendon autograft through 3 independent tunnels provides some advantage, but the antegrade graft passage, tibial tunnel confluence, and graft site morbidity represent disadvantages. This Technical Note describes a modification of double-bundle ACL reconstruction using the hamstring tendon autograft through a single branched tibial tunnel and a single femoral tunnel using 2 interference screws (Arthrex, Naples, FL). The gracilis tendon autograft is passed through tibial tunnel stem to the posterolateral tibial tunnel branch to the posterolateral position in the femoral tunnel. The semitendinosus tendon autograft is passed through the tibial tunnel stem to the anteromedial tibial tunnel branch to the anteromedial position in the femoral tunnel. Both grafts are fixed by 2 interference screws: 1 at the femoral tunnel and 1 at the tibial tunnel stem with the knee at 20° flexion.
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Affiliation(s)
- Naser Mohamed Selim
- Knee Surgery-Arthroscopy and Sports Injuries Unit, Orthopedic Department, Mansoura University, Mansoura City, Egypt
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Sasaki Y, Chang SS, Fujii M, Araki D, Zhu J, Marshall B, Linde-Rosen M, Smolinski P, Fu FH. Effect of fixation angle and graft tension in double-bundle anterior cruciate ligament reconstruction on knee biomechanics. Knee Surg Sports Traumatol Arthrosc 2016; 24:2892-2898. [PMID: 25726160 DOI: 10.1007/s00167-015-3552-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the effect of graft fixation angle and tension in double-bundle anterior cruciate ligament (ACL) reconstruction on knee biomechanics. METHODS Fourteen cadaver knees were tested using a robotic system under two loadings: (1) an 89-N anterior tibial load (ATL) at full extension (FE), 15°, 30°, 45°, 60°, and 90°, and (2) combined 7 N m valgus and 5 N m internal tibial torques (simulated pivot-shift test) at FE, 15° and 30°. Four graft fixation angles and tensions were used for the anteromedial (AM) and posterolateral (PL) bundles, respectively: (Recon 1) 30°/20N and FE/20N, (Recon 2) 30°/30N and FE/10N, (Recon 3) 45°/20N and 15°/20N, and (Recon 4) 45°/30N and 15°/10N. RESULTS All fixation protocols closely restored the intact knee kinematics under ATL and simulated pivot-shift loading. For the AM bundle under ATL, the in situ force (ISF) with Recon 3 at the FE was significantly lower than that of the intact knee. For the PL bundle under ATL, the ISF with Recon 3 at the FE, 15° and 30° was significantly higher than that of the intact knee. In PL bundle under simulated pivot-shift loading, the ISF with Recon 1 and Recon 2 at FE was lower and the ISF of the PL bundle with Recon 3 at the 15° was higher than that of the intact knee. CONCLUSION The AM-45°/30N and PL-15°/10N fixation most closely matched intact knee kinematics; however, stabilizing the knee during anterior tibial translation may risk an imbalance of the AM and the PL bundle loading. The results indicate that ACL bundle forces may not be restored even if the clinical assessment shows good results with the Lachman test and pivot-shift test. This may alter the loading on other structures of the knee.
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Affiliation(s)
- Yusuke Sasaki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shih-Sheng Chang
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Masataka Fujii
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Daisuke Araki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Junjun Zhu
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brandon Marshall
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Monica Linde-Rosen
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA.
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA.
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A new behind-remnant approach for remnant-preserving double-bundle anterior cruciate ligament reconstruction compared with a standard approach. Knee Surg Sports Traumatol Arthrosc 2015; 23:3743-9. [PMID: 25209212 DOI: 10.1007/s00167-014-3300-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 09/02/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE To introduce a new behind-remnant approach for double-bundle (DB) anterior cruciate ligament (ACL) reconstruction and to compare the femoral tunnel positions of anteromedial (AM) and posterolateral (PL) bundles between the new and standard procedures by a three-dimensional computed tomography (3D-CT). METHODS During DB ACL reconstruction, two approaches for femoral tunnel creation were consecutively practiced from 2010 to 2012. The patients were evaluated retrospectively as a cohort study. A total of 200 primary ACL reconstructions have been performed using a transtibial approach. One approach was a standard approach from the front in which the ACL remnant was peeled off from the attachment, and two guide wires were inserted based on anatomic bony landmarks (standard group). The other approach was a new behind-remnant approach in which the ACL remnant was kept untouched and two guide wires were inserted at the posterior margin of the direct ACL insertion (behind-remnant group). The position of the AM and PL femoral tunnels was expressed on a 3D-CT reconstructive image using the quadrant method with a statistical analysis. RESULTS The depth of the AM center was 24 ± 6 % (mean and standard deviation) in the standard group and 22 ± 5 % in the behind-remnant group. The height of the AM tunnel center was 22 ± 8 % in the standard group and 31 ± 8 % in the behind-remnant group. The depth of the PL tunnel center was 32 ± 6 % in the standard group and 35 ± 5 % in the behind-remnant group. The height of the PL tunnel center was 47 ± 9 % in the standard group and 55 ± 7 % in the behind-remnant group. The AM and PL femoral tunnels in both groups were created within the normal anatomic footprint of the previous studies. The behind-remnant approach created a significantly lower femoral tunnel for both AM (p = 0.000) and PL tunnels (p = 0.000). The depth of both AM and PL tunnels was not significantly different between the two groups (n.s.). CONCLUSION The new behind-remnant procedure is technically simple and reproducible as a remnant-preserving ACL reconstruction. LEVEL OF EVIDENCE Cohort study, Level III.
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Abstract
Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using a four-strand semitendinosus tendon was started in our department in July 1994. The motivation for starting the procedure was that the EndoButton with an inside-out procedure instrument became available in Japan. A review article of our DB ACL reconstruction procedure was summarized for the twentieth anniversary of the surgical procedure. Initial tension setting of the two grafts was changed in the first 8 years to achieve better stability during DB ACL reconstruction. A randomized clinical trial (RCT) was started in July 2002 to clarify superiority of the DB procedure to single-bundle (SB) reconstruction under the concept of anatomic reconstruction. Several anatomic studies were performed to describe normal ACL anatomy, which is essential for realizing anatomic reconstruction. A remnant-preserving technique would be an additional option for our DB procedure to improve reconstruction outcomes. Thus, a new remnant-preserving DB procedure was started in 2012. The reproducibility of the new procedure was investigated using three-dimensional computed tomography images. More complex procedures were performed using a transtibial technique and EndoButtons. Initial tension balancing between the two grafts was important for a better outcome. Superiority of knee stability after the DB compared to that after the SB procedure was clarified by the RCT. However, no patient consensus has been reached on any subjective advantage to the DB procedure. Studies of normal ACL anatomy have left questions unresolved regarding where the two tunnels should be created for direct and indirect insertions based on normal anatomy. A new remnant-preserving DB ACL procedure has been practiced. The procedure was more reproducible with respect to creating the femoral tunnel. DB ACL reconstruction using a semitendinosus tendon is an attractive option when pursuing a better outcome for patients.
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Affiliation(s)
- Takeshi Muneta
- Department of Joint Surgery and Sports Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Farè S, Torricelli P, Giavaresi G, Bertoldi S, Alessandrino A, Villa T, Fini M, Tanzi MC, Freddi G. In vitro study on silk fibroin textile structure for Anterior Cruciate Ligament regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2013; 33:3601-8. [DOI: 10.1016/j.msec.2013.04.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 03/28/2013] [Accepted: 04/15/2013] [Indexed: 01/24/2023]
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Koga H, Muneta T, Yagishita K, Ju YJ, Mochizuki T, Horie M, Nakamura T, Okawa A, Sekiya I. Effect of posterolateral bundle graft fixation angles on graft tension curves and load sharing in double-bundle anterior cruciate ligament reconstruction using a transtibial drilling technique. Arthroscopy 2013; 29:529-38. [PMID: 23343714 DOI: 10.1016/j.arthro.2012.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of posterolateral bundle (PLB) graft fixation angles on graft tension curves and load sharing between the anteromedial bundle (AMB) and the PLB in double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS Twenty-four patients who underwent double-bundle ACL reconstruction were included in this study. AMB and PLB were provisionally fixed to a graft tensioning system during surgery. The graft fixation settings were as follows: (1) AMB at 20° and PLB at 0° (A20P0), (2) AMB at 20° and PLB at 20° (A20P20), and (3) AMB at 20° and PLB at 45° (A20P45). Bundle tension was recorded during knee flexion-extension and in response to anterior or rotatory loads. A pivot-shift test, as well as factors affecting the residual pivot-shift, was also evaluated. RESULTS A20P45 created reciprocal tension curves and load sharing, in which the tension in both bundles was equivalent during flexion-extension and during each loading test at 30°. In A20P0, the tension of the AMB was constantly higher than that of the PLB. Seven patients showed grade 1 pivot-shift phenomenon in A20P0, whereas no patient showed a positive pivot-shift at other settings. Larger tension reduction of the PLB between 0° and 30° and smaller load sharing of the PLB were significant factors affecting residual pivot-shift. CONCLUSIONS In double-bundle ACL reconstruction, fixation of the AMB at 20° and the PLB at 45° created reciprocal tension curves and load sharing between the bundles. Fixation of the AMB at 20° and the PLB at 0° led to insufficient tension in the PLB, resulting in a residual pivot-shift phenomenon in 7 of 24 patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
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Tajima T, Chosa E, Yamamoto K, Yamaguchi N. Arthroscopic anatomical double-bundle anterior cruciate ligament reconstruction for asian patient using a bone-patellar tendon-bone and gracilis tendon composite autograft: a technical note. Sports Med Arthrosc Rehabil Ther Technol 2012; 4:9. [PMID: 22414219 PMCID: PMC3338359 DOI: 10.1186/1758-2555-4-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 03/14/2012] [Indexed: 01/01/2023]
Abstract
Background Recent years have seen anterior cruciate ligament (ACL) reconstruction being performed in a broad range of patients, regardless of age, sex and occupation, thanks to great advances in surgical techniques, surgical instruments and basic research. In cases of ACL reconstruction, bone-patellar tendon-bone (BTB) graft or hamstring graft are frequency used. However, potential complications associated with tunnel enlargement due to soft tissue graft such as hamstring were reported. On the other hand, an altered rotational axis resulting in significantly greater translation of the lateral compartment in the single bundle compared with double bundle ACL reconstruction was reported. Method and procedure A reconstruction procedure was modified for the ACL using a double bundle that is the combination of BTB and gracilis tendon composite autograft. Two tibial and two femoral bone tunnels are used to reconstruct two bundles of ACL; an anteromedial bundle (AMB) and a posterolateral bundle (PLB). The femoral bone tunnels are created just posterior to the resident's ridge. The tibial bone tunnels are created at the center of AM and PL tibial attachment, respectively. BTB is fixed in the AM tunnels produced on the anatomical points of tibia and femur. The gracilis graft is fixed in an anatomical PL tunnel produced. The mean width of BTB is 7 mm, since10 mm graft is sometimes not suitable for patients, especially small Asian people and females. For these patients, 10 mm graft is bigger than one third of patella tendon width. Conclusion The devised surgical procedure based on a combination of BTB and gracilis autograft is suitable reconstruction method for patients who have small or medium width of patellar tendon such as Asian people and females. This technique is also applicable to revision surgery.
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Affiliation(s)
- Takuya Tajima
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
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