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Yang JS, Prentice HA, Reyes CE, Lehman CR, Maletis GB. Risk of Revision and Reoperation After Quadriceps Tendon Autograft ACL Reconstruction Compared With Patellar Tendon and Hamstring Autografts in a US Cohort of 21,973 Patients. Am J Sports Med 2024; 52:670-681. [PMID: 38284229 DOI: 10.1177/03635465231222267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND The use of quadriceps tendon (QT) autografts has increased in the past 10 years. However, there remains a dearth of large studies examining the effects of graft selection on anterior cruciate ligament reconstruction (ACLR) that includes QT grafts. PURPOSE To evaluate the risk of subsequent surgical outcomes, including revision and reoperation, for a large cohort of patients with primary ACLR according to autograft selection. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Data from a US health care system ACLR registry were used to conduct a cohort study. Primary isolated autograft ACLRs were identified (2012-2021). The exposure of interest was autograft type: QT, bone-patellar tendon-bone (BPTB), and hamstring tendon (HT). Multivariable Cox regression models were used to evaluate the risk of aseptic revision (defined as a subsequent surgery where removal and replacement of the original graft for noninfectious reasons was required) and risk of aseptic reoperation (defined as any subsequent surgery for noninfectious reasons where the graft was left intact) according to autograft selection. RESULTS The study sample comprised 21,973 ACLRs performed by 290 surgeons at 53 hospitals. QT, BPTB, and HT autografts were used in 1103 (5.0%), 9519 (43.3%), and 11,351 (51.7%) ACLRs, respectively. In adjusted models, no significant differences were observed in revision risk (hazard ratio [HR], 1.06; 95% CI, 0.60-1.89; P = .837) or reoperation risk (HR, 1.00; 95% CI, 0.70-1.43; P = .993) within 4 years of follow-up when comparing QT ACLR with BPTB ACLR. Additionally, no differences in 4-year revision (HR, 0.62; 95% CI, 0.34-1.12; P = .111) or reoperation (HR, 1.24; 95% CI, 0.85-1.80; P = .262) risks were observed when comparing QT ACLR with HT ACLR. HT ACLRs were noted to have a higher risk of revision (HR, 1.52; 95% CI, 1.25-1.84; P < .001) compared with BPTB ACLRs but a lower risk of reoperation (HR, 0.86; 95% CI, 0.75-0.98; P = .024). CONCLUSION In this large multicenter study using data from an ACLR registry, the authors found no difference in the risk of revision or reoperation when QT was compared with BPTB or HT autograft with the numbers available, but they did find a 1.5 times higher risk of revision when HT autograft was compared with BPTB autograft. Surgeons may use this information when choosing the appropriate graft for ACLR in their patients.
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Affiliation(s)
- Justin S Yang
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Los Angeles, California, USA
| | - Heather A Prentice
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California, USA
| | - Chelsea E Reyes
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California, USA
| | - Christopher R Lehman
- Department of Orthopedic Surgery, Permanente Medical Group, South San Francisco, California, USA
| | - Gregory B Maletis
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Baldwin Park, California, USA
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Dadoo S, Meredith SJ, Keeling LE, Hughes JD, Keenan C, Viecelli M, Irrgang JJ, Lesniak BP, Musahl V. Surgeon anterior cruciate ligament reconstruction volume and rates of concomitant meniscus repair. J Exp Orthop 2023; 10:61. [PMID: 37289299 DOI: 10.1186/s40634-023-00626-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
PURPOSE The purpose of this study was to assess the effect of surgeon anterior cruciate ligament reconstruction (ACLR) volume on rates of ACLR with concomitant meniscus repair versus meniscectomy and subsequent meniscus surgeries. METHODS A retrospective review was conducted from a database of all ACLR performed between 2015 and 2020 at a large integrated health care system. Surgeon volume was categorized as < 35 ACLR per year (low-volume), and ≥ 35 ACLR per year (high-volume). Rates of concomitant meniscus repair and meniscectomy were compared between low-volume and high-volume surgeons. Subgroup analyses compared the rates of subsequent meniscus surgery and procedure time based on surgeon volume and meniscus procedure type. RESULTS A total of 3,911 patients undergoing ACLR were included. High-volume surgeons performed concomitant meniscus repair statistically significantly more often than low-volume surgeons (32.0% vs 10.7%, p < 0.001). Binary logistic regression indicated 4.15 times higher odds of meniscus repair among high-volume surgeons. Subsequent meniscus surgery occurred more commonly following ACLR with meniscus repair among low-volume surgeons (6.7% vs 3.4%, p = 0.047), but not high-volume surgeons (7.0% vs 4.3%, p = 0.079). Low-volume surgeons also had longer procedure times for concomitant meniscus repair (129.9 vs 118.3 min, p = 0.003) and meniscectomy (100.6 vs 95.9 min, p = 0.003). CONCLUSIONS Data from this study shows that surgeons with lower volume of ACLR select meniscus resection statistically significantly more often than higher-volume surgeons. However, an abundance of literature is available to show that meniscus loss negatively affects the development of post-traumatic osteoarthritis in patients Therefore, as demonstrated in this study by high-volume surgeons, the meniscus should be repaired and protected whenever possible. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sahil Dadoo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laura E Keeling
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher Keenan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark Viecelli
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Lai S, Zhang Z, Li J, Fu WL. Comparison of Anterior Cruciate Ligament Reconstruction With Versus Without Anterolateral Augmentation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop J Sports Med 2023; 11:23259671221149403. [PMID: 37025126 PMCID: PMC10071203 DOI: 10.1177/23259671221149403] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/21/2022] [Indexed: 04/08/2023] Open
Abstract
Background It is clear that the anterolateral ligament has an important role in rotational knee stability. However, whether patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) can benefit from anterolateral augmentation (ALA) is still controversial. Purpose To compare the effects of isolated ACLR versus ACLR combined with ALA (ACLR+ALA) on clinical outcomes and knee stability. Study Design Systematic review; Level of evidence, 1. Methods The methodology followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of the PubMed, Embase, and Cochrane Library Central Register of Controlled Trials databases was undertaken to identify all randomized controlled trials (RCTs) comparing isolated ACLR with ACLR+ALA for the treatment of ACL injuries in the last 15 years. The Cochrane Collaboration risk-of-bias tool and the revised Jadad scale were utilized by 2 independent reviewers to determine the quality of RCTs. Relevant data were extracted and compared between procedures, and heterogeneity across the RCTs was assessed using the I 2 statistic. Results The initial search yielded 849 articles. A total of 14 studies (1850 patients; 941 ACLR and 909 ACLR+ALA) satisfied the eligibility criteria for the meta-analysis. There were no significant differences between the procedures in terms of patient-reported outcomes (International Knee Documentation Committee score, Tegner score, Knee injury and Osteoarthritis Outcome Score) or return-to-sport rates. However, patients who underwent ACLR+ALA had better knee stability based on the pivot-shift test (risk ratio [RR], 1.06 [95% CI, 1.02 to 1.10]; P = .0008), Lachman test (RR, 1.03 [95% CI, 1.00 to 1.07]; P = .04), and side-to-side difference in anterior laxity (standardized mean difference, -0.55 [95% CI, -0.98 to -0.12]; P = .01) as well as a lower incidence of graft failure (RR, 0.30 [95% CI, 0.19 to 0.45]; P < .01) compared with patients who underwent isolated ACLR. Conclusion ALA can be considered as a reinforcement of ACLR to improve anteroposterior and anterolateral rotational stability of the knee and reduce the risk of failure. The patient-reported outcomes of isolated ACLR were similar to those of ACLR+ALA, and both procedures provided improved knee function.
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Affiliation(s)
- Sike Lai
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
| | - Zhong Zhang
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
| | - Jian Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
- Jian Li, MD, or Wei-Li Fu, MD, Department of Orthopedic Surgery,
West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041,
China ( or
, respectively)
| | - Wei-Li Fu
- Department of Orthopedic Surgery, West China Hospital, Sichuan
University, Chengdu, China
- Orthopedic Research Institute, West China Hospital, Sichuan
University, Chengdu, China
- Jian Li, MD, or Wei-Li Fu, MD, Department of Orthopedic Surgery,
West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041,
China ( or
, respectively)
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4
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Huang Z, Cui J, Zhong M, Deng Z, Chen K, Zhu W. Risk factors of cartilage lesion after anterior cruciate ligament reconstruction. Front Cell Dev Biol 2022; 10:935795. [PMID: 36158222 PMCID: PMC9498578 DOI: 10.3389/fcell.2022.935795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Anterior cruciate ligament injury is the most common sports injury in orthopaedics, which can adversely affect knee joint function and exercise of patients. Using arthroscopy to reconstruct the anterior cruciate ligament has become the first choice for treating anterior cruciate ligament rupture. However, different degrees of articular cartilage injury of the knee can be observed in patients after anterior cruciate ligament reconstruction. More importantly, the articular cartilage injury after anterior cruciate ligament reconstruction indicates that it will develop into osteoarthritis in the long term. It is of great significance to fully understand the factors that lead to the occurrence and development of cartilage injury. This article reviews the effects of surgical methods, meniscus status, different grafts, time from injury to surgical intervention, postoperative knee joint stability, postoperative rehabilitation, knee joint anatomical factors, and demographic characteristics of patients on articular cartilage degeneration after anterior cruciate ligament reconstruction. The present review provides insights into the anterior cruciate ligament reconstruction, which can be used to investigate new treatment strategies to delay and prevent the progress of osteoarthritis. At the same time, it provides a holistic understanding of the influence of multiple factors on cartilage lesions after anterior cruciate ligament reconstruction.
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Affiliation(s)
- Zirong Huang
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jiaming Cui
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Jiaming Cui, ; Weimin Zhu,
| | - Mingjin Zhong
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Zhenhan Deng
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Kang Chen
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Weimin Zhu
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Jiaming Cui, ; Weimin Zhu,
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Chiba D, Yamamoto Y, Kimura Y, Sasaki E, Sasaki S, Tsuda E, Ishibashi Y. Association Between Early Postoperative Graft Signal Intensity and Residual Knee Laxity After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221109608. [PMID: 35898202 PMCID: PMC9310230 DOI: 10.1177/23259671221109608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Magnetic resonance imaging (MRI) graft signal intensity is associated with graft damage after anterior cruciate ligament reconstruction (ACLR). However, little is known about the relationship between graft signal intensity and residual laxity of the reconstructed knee based on patient age. Purpose/Hypothesis: To evaluate the relationship between graft signal intensity and residual laxity in younger and older patients who underwent ACLR. We hypothesized that higher graft signal intensity would be associated with reduced postoperative knee stability. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 192 patients who underwent double-bundle ACLR were recruited. Proton density–weighted and T2-weighted MRI was performed at 3, 6, and 12 months after surgery, and the signal intensity ratio (SIR) of the anteromedial and posterolateral bundles was measured as the graft signal intensity reference values. At 12 months after surgery, if the KT-1000 arthrometer measurement exhibited a side-to-side difference of ≥2 mm, the patient was determined as having anterior knee laxity. Rotatory knee laxity was defined as a positive pivot shift with International Knee Documentation Committee grade ≥1. The Mann-Whitney U test was used to compare the SIR in patients with and without residual laxity. The Spearman correlation coefficient was used to evaluate the relationship between demographic parameters and the SIR. Based on receiver operating characteristic curves, the optimal SIR cutoff values to predict residual laxity were calculated, and logistic regression analysis was conducted. Results: Of 192 patients, 26 (13.5%) had anterior knee laxity, and 20 (10.4%) had rotatory knee laxity. The SIR was negatively correlated with age. In younger patients (<30 years; n = 135), those with residual laxity had a significantly higher SIR than those without laxity; this relationship was not significant in older patients (≥30 years; n = 57). Based on receiver operating characteristic curves and logistic regression analysis, the cutoff values that were determined for the SIR were significantly associated with a higher odds ratio of residual laxity. Conclusion: Graft signal intensity decreased with patient age. Patients with higher graft signal intensity in the early postoperative phase after ACLR exhibited a higher prevalence of residual laxity, particularly in younger patients.
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Affiliation(s)
- Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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6
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Huang H, Li Z, Luo S, Zheng J, Zhou G, Wang G. Factors Influencing the Progression of Patellofemoral Articular Cartilage Damage After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221108362. [PMID: 35859648 PMCID: PMC9289919 DOI: 10.1177/23259671221108362] [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: 03/09/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Although anterior cruciate ligament reconstruction (ACLR) can restore the
stability and function of the knee joint, patellofemoral joint cartilage
damage still progresses. Currently, the clinically important factors that
lead to the progression of patellofemoral articular cartilage damage are not
fully understood. Purpose: To investigate the factors that affect the progression of patellofemoral
articular cartilage damage after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: Among 160 patients who underwent ACLR between January 2015 and December 2019,
the authors evaluated 129 patients for at least 1 year after surgery. Within
1 week before ACLR and at the last follow-up, patients underwent subjective
functional assessment and magnetic resonance imaging evaluations of
articular cartilage damage (modified Outerbridge assessment). At the last
follow-up, the side-to-side difference on KT-2000 arthrometer and bilateral
quadriceps muscle strength were measured. Univariate and multivariate
logistic regression analyses were performed. Results: The mean follow-up was 24.69 ± 10.74 months. Progression of patellar
cartilage damage from preoperatively to final follow-up was seen in 45
patients (P < .001). Logistic regression analysis
revealed that the follow-up period (P = .047; odds radio
(OR) = 0.953) (improvement of patellar cartilage damage with longer
follow-up), partial lateral meniscal resection (P = .004;
OR = 6.929), partial medial meniscal resection (P = .004;
OR = 6.032), and quadriceps muscle strength <80% of the contralateral
side (P = .001; OR = 4.745) were risk factors for the
progression of patellar cartilage damage. Conclusion: Cartilage damage at the patellofemoral joint, especially the patellar
cartilage, still progresses after ACLR. At a mean follow-up of 24.69 months
after ACLR, partial meniscal resection and quadriceps femoris muscle
strength were found to be the main risk factors for the progression of
patellofemoral articular cartilage damage after ACLR.
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Affiliation(s)
- Hui Huang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou City, Hainan Province, China
| | - Zhengzhao Li
- Department of Emergency Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou City, Hainan Province, China
| | - Shishi Luo
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou City, Hainan Province, China
| | - Jiaxuan Zheng
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou City, Hainan Province, China
| | - Gang Zhou
- Department of Joint Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou City, Hainan Province, China
| | - Guangji Wang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou City, Hainan Province, China
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Affiliation(s)
- Vishal Rajput
- University College London Hospitals, London, UK.,The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- University College London Hospitals, London, UK.,The Princess Grace Hospital, London, UK.,The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal , London, UK
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Nakamae A, Sumen Y, Tsukisaka K, Deie M, Fujimoto E, Ishikawa M, Omoto T, Adachi N. A larger side-to-side difference in anterior knee laxity increases the prevalence of medial and lateral meniscal injuries in patients with ACL injuries. Knee Surg Sports Traumatol Arthrosc 2022; 30:1560-1567. [PMID: 33970292 DOI: 10.1007/s00167-021-06601-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this study was to investigate factors that influence the prevalence of medial and lateral meniscal injuries at the time of anterior cruciate ligament (ACL) reconstruction in patients with ACL injuries. METHODS Patients with ACL injuries at 9 institutions were enrolled in this multicentre study. Age, sex, duration between injury and surgery, pivot shift test grade, anterior knee laxity determined using the Kneelax 3 arthrometer, and other variables were assessed by logistic regression analysis. Meniscal conditions were evaluated via arthroscopy. RESULTS In all, 830 patients were enrolled. The prevalence of medial and lateral meniscal tears was 32.0% (266 knees) and 26.5% (220 knees), respectively. Significant factors that influenced the prevalence of medial meniscal injuries were age [odds ratio (OR) 1.03; P = 0.000], side-to-side differences in instrumented anterior knee laxity before surgery (OR 1.12; P = 0.002), duration between injury and surgery (≥ 12 months) (OR 1.86; P = 0.023), and pivot shift test grade (OR 1.36; P = 0.014). Significant factors of lateral meniscal injury were side-to-side differences in anterior knee laxity before surgery (OR 1.12; P = 0.003) and the male sex (OR 1.50; P = 0.027). CONCLUSION Greater anterior knee laxity, age, a longer duration between injury and surgery, and a higher pivot shift test grade predicted medial meniscal injury. Greater anterior knee laxity and the male sex predicted lateral meniscal injury. In patients with ACL injuries, the importance of side-to-side differences in anterior knee laxity should be rediscovered from the viewpoint of meniscal conditions. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Yoshio Sumen
- Department of Orthopaedic Surgery, JA Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan
| | - Kazuhiro Tsukisaka
- Department of Orthopaedic Surgery, Mazda Hospital, 2-15, Aosakiminami, Huchu-cho, Aki-gun, Hiroshima, 735-8585, Japan
| | - Masataka Deie
- Department of Orthopedic Surgery, Aichi Medical University, 21 Karimata, Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Eisaku Fujimoto
- Department of Orthopedic Surgery, Chugoku Rosai Hospital, 1-5-1, Hiro-Tagaya, Kure, Hiroshima, 737-0193, Japan
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takenori Omoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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9
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An older age, a longer duration between injury and surgery, and positive pivot shift test results increase the prevalence of articular cartilage injury during ACL reconstruction in all three compartments of the knee in patients with ACL injuries. Knee Surg Sports Traumatol Arthrosc 2022; 30:219-230. [PMID: 33543356 DOI: 10.1007/s00167-021-06461-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate factors that influence the prevalence of articular cartilage injury in patients with anterior cruciate ligament (ACL) injury. METHODS This multicentre study included patients with ACL injury. Logistic regression analysis was conducted to identify factors that influence the prevalence of cartilage injury during ACL reconstruction. RESULTS A total of 811 patients were enrolled. The factors that significantly influenced the prevalence of cartilage injury were age (odds ratio [OR], 1.04; P = 0.000), a positive pivot shift test result (OR, 1.43; P = 0.021), medial meniscal injury (OR, 2.55; P = 0.000), and delayed surgery (≥ 12 months) (OR, 2.52; P = 0.028) in the medial compartment of the knee; age (OR, 1.05; P = 0.000), subjective grades of apprehension during the pivot shift test (OR, 1.46; P = 0.010), lateral meniscal injury (OR, 1.98; P = 0.003), femoro-tibial angle (FTA) (OR, 0.92; P = 0.006), and delayed surgery (≥ 12 months) (OR, 2.63; P = 0.001) in the lateral compartment; and age (OR, 1.06; P = 0.000), body mass index (OR, 1.07; P = 0.028), a positive pivot shift test result (OR, 1.60; P = 0.018), FTA (OR, 0.90; P = 0.006), and delayed surgery (≥ 12 months) (OR, 3.17; P = 0.008) in the patellofemoral compartment. CONCLUSION An older age, a longer duration between injury and surgery, and a positive pivot shift test result were positively associated with the prevalence of cartilage injury in three compartments in patients with ACL injuries. Early ACL reconstruction is recommended to prevent cartilage injury. LEVEL OF EVIDENCE Level III.
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10
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Baawa-Ameyaw J, Plastow R, Begum FA, Kayani B, Jeddy H, Haddad F. Current concepts in graft selection for anterior cruciate ligament reconstruction. EFORT Open Rev 2021; 6:808-815. [PMID: 34667652 PMCID: PMC8489469 DOI: 10.1302/2058-5241.6.210023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Graft selection for anterior cruciate ligament reconstruction (ACLR) is important for optimizing post-operative rehabilitation, facilitating return to full sporting function and reducing the risk of complications.The most commonly used grafts for ACLR include hamstring tendon autografts, bone-patellar tendon-bone autografts, quadriceps tendon autografts, allografts and synthetic grafts.This instructional review explores the existing literature on clinical outcomes with these different graft types for ACLR and provides an evidence-based approach for graft selection in ACLR.The existing evidence on the use of extra-articular tenodesis to provide additional rotational stability during ACLR is also revisited. Cite this article: EFORT Open Rev 2021;6:808-815. DOI: 10.1302/2058-5241.6.210023.
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Affiliation(s)
- Joanna Baawa-Ameyaw
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Fahima Aarah Begum
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Hyder Jeddy
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Fares Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
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11
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Affiliation(s)
| | - Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal, London, UK
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12
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Tomihara T, Hashimoto Y, Takahashi S, Taniuchi M, Takigami J, Okazaki S, Shimada N. Risk Factors Related to the Presence of Meniscal Injury and Irreparable Meniscal Tear at Primary Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:2325967121989036. [PMID: 33748307 PMCID: PMC7940744 DOI: 10.1177/2325967121989036] [Citation(s) in RCA: 2] [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: 09/13/2020] [Accepted: 10/09/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Few studies have attempted to identify risk factors associated with irreparable meniscal tears at anterior cruciate ligament reconstruction (ACLR) and to describe follow-up data, such as the failure rate, after meniscal repair. Purpose: To investigate the associations of age, sex, body mass index (BMI), time to surgery (TTS), and preinjury Tegner score with the presence of meniscal injuries and irreparable meniscal tears at primary ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review was performed on 784 patients who underwent primary ACLR by a single surgeon between 2005 and 2017 (406 men and 378 women; mean age, 25.8 years; mean BMI, 23.1; median TTS, 3 months; median preinjury Tegner score, 7). All patients had a minimum follow-up of 12 months (mean postoperative follow-up, 33.0 months). Multivariate logistic regression analysis was conducted to determine the association of patient variables with the presence of meniscal injuries and irreparable meniscal tears during primary ACLR. Results: The risk factor for medial meniscal injuries was TTS ≥3 months (odds ratio [OR], 4.213; 95% CI, 3.104-5.719; P < .001). The presence of irreparable medial meniscal tears increased with older age (OR, 1.053; 95% CI, 1.024-1.084; P < .001), higher BMI (OR, 1.077; 95% CI, 1.003-1.156; P = .042), and TTS ≥3 months (OR, 1.794; 95% CI, 1.046-3.078; P = .034). On multivariate analysis, none of the variables were significantly associated with lateral meniscal injuries and irreparable meniscal tears. The failure rate, defined as patients who needed additional medial meniscal surgery after medial meniscal repair, was 4.6%. Conclusion: Time from ACL injury to reconstruction of ≥3 months was strongly associated with medial meniscal injuries and irreparable medial meniscal tears at primary ACLR. Older age and increased BMI were also risk factors for the presence of irreparable medial meniscal tears at ACLR.
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Affiliation(s)
- Tomohiro Tomihara
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Shiro Okazaki
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Nagakazu Shimada
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
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13
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Agnello KA, Hayashi K, Brown DC. Arthroscopic Articular Cartilage Scores of the Canine Stifle Joint with Naturally Occurring Cranial Cruciate Ligament Disease. Vet Comp Orthop Traumatol 2020; 34:153-160. [PMID: 33142348 DOI: 10.1055/s-0040-1719064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate frequency, location and severity of cartilage pathology in dogs with naturally occurring cranial cruciate ligament (CCL) disease. STUDY DESIGN Stifle arthroscopic video recordings (n = 120) were reviewed. A modified Outerbridge classification system (MOCS) (0-4) was used to score cartilage at 10 locations in the femorotibial (medial and lateral femoral condyles and tibial plateaus) and patellofemoral compartments (proximal, middle and distal locations of the patella and femoral trochlear groove) of the stifle joint. Synovial pathology was scored and the presence of a medial meniscal tear was recorded. A Kruskal-Wallis test was used to evaluate association of location and synovitis with cartilage score; and presence of meniscal tear with cartilage and synovitis scores. Bonferroni correction was utilized and p < 0.05 was considered significant. RESULTS Cartilage pathology and synovitis were identified in all joints. Overall cartilage severity scores were low (median MOCS 1). The median MOCS of the proximal trochlear groove (2) was significantly higher than all other locations evaluated. Higher synovitis scores were significantly associated with higher cartilage severity scores and a medial meniscal tear had no association with cartilage severity scores or synovitis. CONCLUSION Arthroscopic articular cartilage lesions are common in dogs with CCL disease at the time of surgical intervention, although the severity of cartilage damage is mild. The proximal trochlear groove of the femur had the most severe cartilage score in the stifle joint.
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Affiliation(s)
- Kimberly A Agnello
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pennsylvania, United States
| | - Kei Hayashi
- Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, United States
| | - Dorothy Cimino Brown
- Companion Animal Research, Elanco Animal Health, Greenfield, Indiana, United States
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14
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Rodeo SA, Monibi F, Dehghani B, Maher S. Biological and Mechanical Predictors of Meniscus Function: Basic Science to Clinical Translation. J Orthop Res 2020; 38:937-945. [PMID: 31799733 DOI: 10.1002/jor.24552] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 11/03/2019] [Indexed: 02/04/2023]
Abstract
Progressive knee joint degeneration occurs following removal of a torn meniscus. However, there is significant variability in the rate of development of post-meniscectomy osteoarthritis (OA). While there is no current consensus on the risk factors for development of knee OA in patients with meniscus tears, it is likely that both biological and biomechanical factors play critical roles. In this perspective paper, we review the mechanical and the biological predictors of the response of the knee to partial meniscectomy. We review the role of patient-based studies, in vivo animal models, cadaveric models, bioreactor systems, and statistically augmented computational models for the study of meniscus function and post-meniscectomy OA, providing insight into the important interplay between biomechanical and biologic factors. We then discuss the clinical translation of these concepts for "biologic augmentation" of meniscus healing and meniscus replacement. Ultimately, collaborative studies between engineers, biologists, and clinicians is the optimal way to improve our understanding of meniscus pathology and response to injury and/or disease, and to facilitate effective translation of laboratory findings to improved treatments for our patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:937-945, 2020.
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Affiliation(s)
- Scott A Rodeo
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
| | - Farrah Monibi
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
| | - Bijan Dehghani
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
| | - Suzanne Maher
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
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15
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Patel NM, Bram JT, Talathi NS, DeFrancesco CJ, Lawrence JTR, Ganley TJ. Which Children Are at Risk for Contralateral Anterior Cruciate Ligament Injury After Ipsilateral Reconstruction? J Pediatr Orthop 2020; 40:162-167. [PMID: 30882565 DOI: 10.1097/bpo.0000000000001364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Following anterior cruciate ligament (ACL) reconstruction, children are at significant risk for complications, including contralateral ACL rupture. The purpose of this study is to determine which children are at risk for a contralateral ACL tear after ipsilateral reconstruction. METHODS After review of medical records, we contacted patients who underwent primary ACL reconstruction between 2009 and 2016. Patients were included in the study if they were able to provide follow-up data either in person or remotely at least 2 years after surgery. Demographic data, sports participation, and intraoperative findings and techniques were recorded. All patients were also asked to confirm returning to sport information and postoperative complications (including contralateral ACL tear). Univariate analysis consisted of χ and independent samples t tests. Purposeful entry logistic regression was then conducted to control for confounding factors. Kaplan-Meier analysis was performed to assess contralateral ACL survival. RESULTS A total of 498 children with average follow-up of 4.3±2.1 years were included in the analysis. The mean age was 15.0±2.3 years and 262 patients (52.6%) were female. Thirty-five subjects (7.0%) sustained a contralateral ACL tear at a mean of 2.7±1.7 years following index reconstruction. Kaplan-Meier analysis revealed the median contralateral ACL survival time to be 8.9 years [95% confidence interval (CI): 8.3, 9.5 y]. In univariate analysis, 11.5% of female patients had a contralateral rupture compared with 2.1% of male patient (P<0.001). Patients with a contralateral tear had a mean age of 14.4±2.0 years compared with 15.1±2.3 years for those without an ACL injury in the opposite knee (P=0.04). After controlling for numerous factors in a multivariate model, female patients had 3.5 times higher odds of sustaining a contralateral ACL tear than male patients (95% CI: 1.1, 10.6; P=0.03). Each year of decreasing age raised the odds of contralateral injury by a factor of 1.3 (95% CI: 1.1, 1.6; P=0.02). Furthermore, children younger than 15 years had 3.1 times higher odds of contralateral rupture than those aged 15 and older (95% CI: 1.3, 7.2; P=0.01). CONCLUSIONS After adjusting for confounding factors in a multivariate model, female patients were at increased risk of contralateral ACL tear following ipsilateral reconstruction, as were younger children. Specifically, ACL rupture in the opposite knee was more likely in patients below the age of 15 years. LEVEL OF EVIDENCE Level III-prognostic study.
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Affiliation(s)
- Neeraj M Patel
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Joshua T Bram
- The Children's Hospital of Philadelphia, Philadelphia, PA
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16
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Evaluation of the intraoperative kinematics during double-bundle anterior cruciate ligament reconstruction using a navigation system. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 19:11-16. [PMID: 31768329 PMCID: PMC6872809 DOI: 10.1016/j.asmart.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/11/2019] [Indexed: 12/04/2022]
Abstract
Background/objective There is controversy regarding the biomechanical function of the anteromedial (AM) and posterolateral (PL) bundles in isolated tibiofemoral rotation during double-bundle anterior cruciate ligament (ACL) reconstruction. This study aimed to evaluate the biomechanical function of the AM and PL bundles of the ACL using a computer navigation system. Methods This study involved 15 patients who underwent double-bundle ACL reconstruction. Anteroposterior and isolated rotational knee laxity were measured with a navigation system. The measurements were performed four times, namely, before fixation, after temporary PL bundle fixation, after AM bundle fixation, and after double-bundle reconstruction. With knee flexion ranging from 20° to 60°, we continuously measured the anterior tibial displacement under an anterior drawer stress (100 N using a spring balance). The total range of tibial rotation was also measured under an external and internal rotational torque of 3 Nm. Results Fixation of either the AM or the PL bundle significantly reduced the anteroposterior displacement at all knee flexion angles. Although the anteroposterior displacement after AM bundle fixation was relatively similar throughout the range of motion (2.4–3.2 mm), the anteroposterior displacement after PL bundle fixation increased continuously with knee flexion (2.2–4.6 mm). With respect to the total range of tibial rotation under external and internal rotational torque, there was no significant difference between AM and PL bundle fixation throughout the range of motion. The total range of tibial rotation was significantly reduced only on double-bundle reconstruction at 20° and 25° knee flexion compared to the pre-reconstruction range (P = 0.015 and 0.036, respectively). Conclusion The AM and PL bundles function differently for controlling anterior knee laxity throughout the range of motion. The function of the AM and PL bundles was similar for controlling isolated tibiofemoral rotation. Isolated tibiofemoral rotation was significantly controlled only on double-bundle reconstruction at knee flexion angles of 20° and 25°.
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17
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Vaquero-Picado A, Rodríguez-Merchán EC. Arthroscopic repair of the meniscus: Surgical management and clinical outcomes. EFORT Open Rev 2018; 3:584-594. [PMID: 30595844 PMCID: PMC6275851 DOI: 10.1302/2058-5241.3.170059] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
From the biomechanical and biological points of view, an arthroscopic meniscal repair (AMR) should always be considered as an option. However, AMR has a higher reoperation rate compared with arthroscopic partial meniscectomy, so it should be carefully indicated. Compared with meniscectomy, AMR outcomes are better and the incidence of osteoarthritis is lower when it is well indicated. Factors influencing healing and satisfactory results must be carefully evaluated before indicating an AMR. Tears in the peripheral third are more likely to heal than those in the inner thirds. Vertical peripheral longitudinal tears are the best scenario in terms of success when facing an AMR. ‘Inside-out’ techniques were considered as the gold standard for large repairs on mid-body and posterior parts of the meniscus. However, recent studies do not demonstrate differences regarding failure rate, functional outcomes and complications, when compared with the ‘all-inside’ techniques. Some biological therapies try to enhance meniscal repair success but their efficacy needs further research. These are: mechanical stimulation, supplemental bone marrow stimulation, platelet rich plasma, stem cell therapy, and scaffolds and membranes. Meniscal root tear/avulsion dramatically compromises meniscal stability, accelerating cartilage degeneration. Several options for reattachment have been proposed, but no differences between them have been established. However, repair of these lesions is actually the reference of the treatment. Meniscal ramp lesions consist of disruption of the peripheral attachment of the meniscus. In contrast, with meniscal root tears, the treatment of reference has not yet been well established.
Cite this article: EFORT Open Rev 2018;3:584-594. DOI: 10.1302/2058-5241.3.170059
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Affiliation(s)
- F E Rowan
- University College London Hospitals NHS Foundation Trust, 235 Euston Rd, Fitzrovia, London NW1 2BU, UK
| | - F S Haddad
- NIHR University College London Hospitals Biomedical Research Centre, UK
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