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Reinerink JM, Vendrig T, Keizer MNJ, Hoogeslag RAG, Brouwer RW. One type of graft for reconstruction of the ACL does not suit all patients based on their characteristics and sports: a scoping review. Musculoskelet Surg 2024:10.1007/s12306-024-00861-x. [PMID: 39249194 DOI: 10.1007/s12306-024-00861-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/17/2024] [Indexed: 09/10/2024]
Abstract
The selection of graft type for anterior cruciate ligament reconstruction remains a topic of debate, taking into consideration patient characteristics, as well as the type and level of sports involvement. The aim of this scoping review was to investigate patient characteristics that might influence the selection of graft type for anterior cruciate ligament reconstruction. PubMed and Scopus were searched to identify articles for inclusion. All included studies focused on one or more patient characteristics involved in the decision-making process regarding anterior cruciate ligament reconstruction autograft, including the hamstrings tendon (HT), patellar tendon (BPTB) and quadriceps tendon (QT). Out of the 1,977 initial studies, 27 studies were included in this review. The BPTB graft seems to be the preferred choice in young patients, females, and athletes-especially those engaged in pivoting sports. The HT graft seems to be the preferred choice in less active and older patients, along with those involved in sports where knee extensors are vital. The HT graft is not preferable in patients with a small body height and graft diameter. Moreover, surgeon preferences were also of importance for graft selection. The success of a specific graft type in anterior cruciate ligament reconstruction is highly dependent on the patient's characteristics and type of sport. Patient characteristics such as age, gender, body height, graft diameter, and the patient's activity level should all be considered when choosing the appropriate graft type.
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Affiliation(s)
- J M Reinerink
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG Sector F, FA 23,Antonius Deusinglaan 1, PO Box 317, 9713 AV, Groningen, The Netherlands.
| | - T Vendrig
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG Sector F, FA 23,Antonius Deusinglaan 1, PO Box 317, 9713 AV, Groningen, The Netherlands
| | - M N J Keizer
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG Sector F, FA 23,Antonius Deusinglaan 1, PO Box 317, 9713 AV, Groningen, The Netherlands
| | - R A G Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands
| | - R W Brouwer
- Department of Orthopedic Surgery, Martini Hospital Groningen, Groningen, The Netherlands
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Pearsall C, Chen AZ, Abdelaziz A, Saltzman BM, Piasecki DP, Popkin CA, Redler LH, Levine WN, Ahmad CS, Trofa DP. Patient Preferences for Graft Selection in Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2024; 12:23259671241258429. [PMID: 39157023 PMCID: PMC11328237 DOI: 10.1177/23259671241258429] [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: 03/21/2024] [Accepted: 04/26/2024] [Indexed: 08/20/2024] Open
Abstract
Background Selecting an appropriate graft for anterior cruciate ligament (ACL) reconstruction requires consideration of a patient's preferences, goals, age, and physical demands alongside the risks and benefits of each graft choice. Purpose To determine the most popular ACL reconstruction grafts among patients and the most important factors influencing their decisions. Study Design Cross-sectional study; Level of evidence, 3. Methods Patients undergoing ACL reconstruction between October 2022 and April 2023 completed a survey either before (nonconsult group) or after (consult group) speaking with their surgeon, who provided an evidence-based description of the pros and cons of an allograft and the following autografts: bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT). Patient characteristics, graft choice, information influencing their graft choice, and surgeon recommendation were collected and compared between the groups. Results Among the 100 included patients, 59.0% were male, and the mean age was 28.3 ± 10.4 years. The most popular grafts were the BPTB (56.0%), followed by the QT (29.0%), HT (8.0%), and allograft (7.0%). No significant difference was observed in the graft selection between the consult group (n = 60; BPTB, 46.7%; QT, 38.3%; HT, 8.3%; allograft, 6.7%) and nonconsult group (n = 40; BPTB, 70.0%; QT, 15.0%; HT, 7.5%; allograft, 7.5%) (P = .0757). In the consult group, 81.7% of patients selected the graft recommended to them by their surgeon. The top 2 graft selection reasons were usage in professional athletes and failure rates, while the top 2 ACL surgery concerns were returning to their desired level of athletics and graft failure risk. Among the 93 patients who researched their ACL graft options before their visit, the most popular information source was some form of media (72.0% [67/93]). Conclusion The study findings underscore the importance of patient preference and surgeon recommendation in a patient's graft selection and highlight the need to be cognizant of the information sources available to patients when researching their graft options.
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Affiliation(s)
- Christian Pearsall
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Aaron Z. Chen
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Abed Abdelaziz
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Dana P. Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Charles A. Popkin
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren H. Redler
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - William N. Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher S. Ahmad
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - David P. Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
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Mo IF, Harlem T, Faleide AGH, Strand T, Vindfeld S, Solheim E, Inderhaug E. ACL Reconstruction Using Quadrupled Semitendinosus Versus Double-Stranded Semitendinosus and Gracilis Autograft: 2-Year Results From a Prospective Randomized Controlled Study. Am J Sports Med 2024; 52:1927-1936. [PMID: 38845474 DOI: 10.1177/03635465241254048] [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: 07/02/2024]
Abstract
BACKGROUND A disadvantage of using hamstring tendon autograft consisting of the semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction is pain from tendon harvesting and persistent hamstring weakness. In the tendon-sparing all-inside technique, a quadrupled semitendinosus graft and adjustable-loop cortical fixation are suggested to give less postoperative flexion deficits while displaying overall similar clinical results to the traditional hamstring technique. However, there are a limited number of high-quality studies comparing these techniques with inconsistent results. PURPOSE To investigate differences between the all-inside (quadrupled semitendinosus) and traditional hamstring (double-stranded semitendinosus and gracilis) technique regarding (1) self-reported function, (2) hamstring strength, and (3) knee laxity. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 98 patients were randomized to either the all-inside or the traditional hamstring technique. Perioperatively, duration of surgery and graft size were obtained. The International Knee Documentation Committee 2000 Subjective Knee Form score, Knee injury and Osteoarthritis Outcome Score, Tegner Activity Scale score, knee laxity (KT-1000 arthrometer side-to-side difference and pivot shift), range of motion, isokinetic knee strength, and hop test score were collected preoperatively and 2 years postoperatively. Return-to-sport readiness was evaluated 9 months postoperatively. RESULTS A total of 89 patients completed 2-year follow-up, 45 patients with the all-inside technique and 44 patients with the traditional hamstring technique. There were no significant differences between groups in any of the outcome measures 2 years after surgery, but there was a tendency in the all-inside group toward having increased anterior translation (mean, 3.6 mm vs 2.7 mm), a higher number of revision surgeries (5 patients vs 2 patients), and more patients having +1 and +2 pivot-shift values (29 vs 18 patients) when compared with the traditional group. CONCLUSION The all-inside technique yields equivalent results to the traditional hamstring technique 2 years after surgery and should be considered a reliable technique to use for ACL reconstruction. Sparing the gracilis tendon does not lead to less persistent hamstring weakness. Long-term follow-up is needed to further determine whether the tendency of increased anterior translation seen at 2 years postoperatively will lead to a higher risk of graft failure.
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Affiliation(s)
- Ingunn Fleten Mo
- University of Bergen, Bergen, Norway
- Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | | | | | - Søren Vindfeld
- University of Bergen, Bergen, Norway
- Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Eirik Solheim
- University of Bergen, Bergen, Norway
- Aleris Hospital Nesttun Bergen, Bergen, Norway
| | - Eivind Inderhaug
- University of Bergen, Bergen, Norway
- Haraldsplass Deaconess Hospital, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
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Kuruvilla RS, Gunasekaran C, Jepegnanam TS, Kandagaddala M, Panwar J. Estimation of Diameter of Quadrupled Hamstring Graft for ACL Reconstruction using Pre-operative MRI Measurement as a Predictive Tool. Malays Orthop J 2024; 18:91-98. [PMID: 38638661 PMCID: PMC11023349 DOI: 10.5704/moj.2403.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 10/10/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction The diameter of the quadrupled Hamstring graft plays a significant role in the incidence of graft failures for ACL reconstruction. The ability to predict the graft size pre-operatively can prepare the surgeon for alternatives in the event of an inadequate graft diameter. Materials and methods We retrospectively measured the diameter of the Semitendinosus tendon (ST) on the MRI in all patients who underwent arthroscopic ACL reconstruction using quadrupled Semitendinosus as their graft. We also estimated any correlation between various anthropometric data with pre-operative MRI based Cross Sectional Area (CSA) of the Hamstring tendon and final graft diameter in the South Asian population. The patients were included from Jan 2018 - Dec 2020. Results The minimum CSA of ST to predict an eventual graft diameter of 7.5mm was 10.7mm2. The MRI based cross-sectional area measurement showed moderate correlation with the intra-operative graft diameter obtained. (r=0.62, p<0.001). The intra-class correlation coefficient between the radiologist and the surgeon was 0.82, 95% CI (0.57, 0.92) and a p-value <0.001. Conclusion Pre-operative MRI can be a useful tool to predict the graft diameter. This coupled with the anthropometric data of the patient can be used as an adjunct to estimate the probable graft diameter. Thus, the surgeon can be better prepared for the surgery and can seek alternate graft options if the graft size is deemed inadequate pre-operatively.
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Affiliation(s)
- R S Kuruvilla
- Department of Orthopaedics, Christian Medical College, Vellore, India
| | - C Gunasekaran
- Department of Orthopaedics, Christian Medical College, Vellore, India
| | - T S Jepegnanam
- Department of Orthopaedics, Christian Medical College, Vellore, India
| | - M Kandagaddala
- Department of Radiology, Christian Medical College, Vellore, India
| | - J Panwar
- Department of Radiology, Lumus Imaging, Brisbane, Australia
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Tang H, Xiao YF, Liu WJ, Meng JH, Wu YM, Xiong YL, Gao SG. Preferences in anterior cruciate ligament reconstruction: A survey among orthopedic surgeons in China. Medicine (Baltimore) 2024; 103:e36482. [PMID: 38363894 PMCID: PMC10869037 DOI: 10.1097/md.0000000000036482] [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: 09/17/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024] Open
Abstract
The purpose of this study was to reveal the current trends and preferences of Chinese orthopedic surgeons regarding anterior cruciate ligament (ACL) reconstruction through a nationwide web-based survey conducted in China. The survey questionnaire was distributed via WeChat to the chairmen of provincial orthopedic and sports medicine organizing committees in China, who then shared it in their respective WeChat workgroups. The questionnaire consisted of 52 multiple-choice questions covering 8 sections. Data collection was implemented by Questionnaire Star. A total of 812 valid questionnaires were returned: 94.21% of the respondents preferred single-bundle reconstruction of ACL, while 61.70% preferred autogenous semitendinosus plus gracilis reconstruction; 76.35% of the respondents preferred establishing the femoral tunnel first, while 47.29% preferred establishing the femoral tunnel through a medial auxiliary approach; and 85.10% of the respondents recommended patients to undergo surgery within 3 months after ligament injury. Besides, the vast majority of respondents chose to retain the ligamentous remnant bundle (92.98%) and recommended routine use of knee braces postoperatively (94.09%). It is recommended to perform arthroscopic single-bundle ACL reconstruction with the remnant preserving technique using a hamstring autograft within 3 months of ACL rupture, with support of postoperative functional braces.
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Affiliation(s)
- Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yi-fan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Wei-jie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Jia-hao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yu-mei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yi-lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Zhao BYH, Khan NA, Wichuk S, Sommerfeldt MF, Panu A, Jaremko JL, Hui C. The use of slice encoding for metal artifact correction (SEMAC) sequencing improves the diagnostic evaluation of graft integrity following anterior cruciate ligament reconstruction. J ISAKOS 2023; 8:318-324. [PMID: 37127091 DOI: 10.1016/j.jisako.2023.04.006] [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: 11/25/2022] [Revised: 03/24/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To determine whether magnetic resonance imaging (MRI) with metal artifact reduction sequencing is superior to conventional knee MRI in the evaluation of an injured anterior cruciate ligament (ACL) graft, where visualisation on conventional MRI can be limited by the metal artifact from fixation devices. METHODS Eighteen patients underwent conventional MRI sequence (proton density fat saturated [PDFS]) and two types of metal artifact reduction sequencing MRI (WARP, slice encoding for metal artifact correction (SEMAC); Siemens) following a secondary injury to their ACL reconstructed knee. Six raters with experience in knee MRI evaluation reviewed sagittal PDFS, WARP, and SEMAC sequences, providing semi-quantitative grades for visualisation and diagnostic confidence assessing the ACL, posterior cruciate ligament , menisci, tibial and femoral tunnel margins, and articular cartilage. Intra-class correlation coefficients for inter-rater reliability were evaluated. The 6-rater mean scores for the visualisation and diagnostic confidence derived from each sequence were compared using the Friedman test for multiple paired samples. RESULTS No statistically significant difference in the ACL visualisation among the sequences was found (p = 0.193). Further, a subgroup analysis was performed in cases evaluated as "moderately blurry" or "indistinct ACL visualisation" on PDFS (58% of cases). SEMAC significantly improved diagnostic confidence in ACL visualisation (p = 0.041) and ACL graft rupture (p = 0.044) compared to PDFS. There was no statistically significant difference in the inter-observer reliability between sequences. The WARP sequence added 2.84 ± 0.69 min, while SEMAC added 2.95 ± 0.40 min to the standard knee MRI scan time. CONCLUSION use of the SEMAC metal reduction sequence significantly improved diagnostic accuracy and confidence in the detection of ACL graft rupture in cases where the ACL was moderately blurry or indistinct on the PDFS sequence. This sequence should be considered as an adjunct to conventional PDFS in cases where graft visualisation is limited by the metal artifact from fixation devices. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Brandon Y H Zhao
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, T5H 3V9, Canada.
| | - Nabil A Khan
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, T5H 3V9, Canada
| | - Stephanie Wichuk
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Mark F Sommerfeldt
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, T5H 3V9, Canada; Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, AB, T6G 1Z1, Canada
| | - Anukul Panu
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Catherine Hui
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, T5H 3V9, Canada
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Çakır GH, Mutlu İ. A comparison of stress, contact pressure, and contact area on menisci in re-injury mechanisms after reconstruction of the anterior cruciate ligament with autograft and synthetic graft: a finite element study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2487-2496. [PMID: 37449986 DOI: 10.1007/s00264-023-05881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The anterior cruciate ligament (ACL) is crucial in maintaining knee stability. Some motion mechanisms, which are common in sports, cause excessive load to be passed on the ACL. In non-contact ACL injuries, the ACL cannot sustain the high stress and becomes injured or ruptures in the valgus-external rotation mechanism (VERM) and varus-internal rotation mechanism (VIRM). The mechanical strength of the grafts used to repair the torn ligament varies. The purpose of this study is to look at the alterations in the menisci after anterior cruciate ligament repair with autografts and synthetic grafts in cases of non-contact re-injury mechanisms. METHODS In the finite element analysis, VERM and VIRM motions of the injury were simulated with different ACL graft materials. During the simulations of these mechanism motions with polyethylene terephthalate (PET) and patellar tendon (PT), the contact pressures, contact areas, and von mises stress values created in the medial and lateral meniscus were compared. RESULTS The peak contact pressures on the menisci during the VERM are higher than the peak contact pressures during the VIRM, except for one variation. The peak contact pressure of the medial meniscus is almost the same for both graft materials and mechanisms. Furthermore, the peak contact pressures in the menisci are higher than in the VERM. For all injury mechanisms, the peak contact stresses on the lateral meniscus are higher than on the medial meniscus. CONCLUSIONS The findings suggest that VERM can induce further knee joint injury. It was found that the PET will lessen the pressure on the menisci even more. It is also advantageous since it does not damage the anterior extremities and transmits less pressure to the menisci. In conclusion, using a high-strength ACL is healthier for the menisci. Even though synthetic grafts are not clinically preferred, the study demonstrates that enhancing the material properties of synthetic grafts will increase the chance of their use in the future, based on the current results.
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Affiliation(s)
- Gül Hilal Çakır
- Department of Biomedical Engineering, Kocaeli University, Umuttepe Campus, Izmit, Kocaeli, Turkey.
| | - İbrahim Mutlu
- Department of Biomedical Engineering, Kocaeli University, Umuttepe Campus, Izmit, Kocaeli, Turkey
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Bregenhof B, Aagaard P, Nissen N, Creaby MW, Thorlund JB, Jensen C, Torfing T, Holsgaard-Larsen A. The Effect of Progressive Resistance Exercise on Knee Muscle Strength and Function in Participants with Persistent Hamstring Deficit Following ACL Reconstruction: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2023; 53:40-48. [PMID: 36306171 DOI: 10.2519/jospt.2022.11360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To investigate the effect of progressive resistance exercise compared with low-intensity home-based exercises on knee-muscle strength and joint function in people with anterior cruciate ligament (ACL) reconstruction and persistent hamstring strength deficits at 12-24 months after surgery. DESIGN: Randomized controlled superiority trial with parallel groups, balanced randomization (1:1), and blinded outcome assessment. METHODS: People with ACL reconstruction (hamstring autograft) and persistent hamstring muscle strength asymmetry were recruited 1 to 2 years postsurgery and randomized to either 12 weeks of supervised progressive strength training (SNG), or 12 weeks of home-based, low-intensity exercises (CON). The primary outcome was between-group difference in change in maximal isometric knee flexor muscle strength at 12-week follow-up. RESULTS: Fifty-one participants (45% women, 27 ± 6 years) were randomized to SNG (n = 25) or CON (n = 26), with 88% follow-up rate at 12 weeks. People in the SNG group improved their knee flexor muscle strength (0.18 N·m/kg, 95% confidence interval [CI]: 0.07, 0.29; P = .002) more than the CON group, from baseline to 12 weeks. The SNG group also had superior Knee Injury and Osteoarthritis Outcome Scores for Pain (4.6, 95% CI: 0.4, 8.7; P = .031) and daily living function (4.7, 95% CI: 1.2, 8.2; P = .010) compared to the CON group. CONCLUSION: In people with persistent hamstring muscle strength deficits after ACL reconstruction, 12 weeks of supervised progressive strength training was superior to low-intensity home-based exercises for improving maximal knee flexor muscle strength and some patient-reported outcomes. J Orthop Sports Phys Ther 2023;53(1):40-48. Epub: 17 October 2022. doi:10.2519/jospt.2022.11360.
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Comparative analysis of the results of the anterior cruciate ligament reconstruction using an autograft preparation by known and new methods. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.6.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background. To date, the problem of choosing the optimal graft for anterior cruciate ligament (ACL) reconstruction and the methods for its formation is one of the main trends in the surgical treatment of patients with anterior knee joint instability.The aim. To compare the results of the anterior cruciate ligament reconstruction using the known method and the new proposed method for autograft formation.Materials and methods. The results of treatment of ACL injury in 44 patients were assessed. In the main group (19 patients), an original technique of ACL reconstruction from 1/2 of the width of m. peroneus longus tendon was used. In the control group (25 patients), ACL reconstruction was performed using a graft from the m. semitendinosus tendon prepared by the Lubowitz method.Results. The mean difference in the circumference of the distal third of the hip in the main group was 1.57 ± 1.162 cm and was statistically significantly better than in the control group, where the mean difference in the hip circumference was 4.74 ± 1.7207 cm.The range of motion of the knee joint in the main group 3 months after the surgery was 128.42 ± 9.287°, and in the control group mean flection was 109.6 ± 9.120°.The functional results in the main group were assessed by the Lisholm scale and were statistically significantly better than the results in the control group. The functional results by the AOFAS (American Orthopedic Foot & Ankle Society) scale in the main group were 100 points before the surgery and at all terms after the surgery: this indicates that the use of 1/2 of the width of m. peroneus longus tendon does not cause the its functional impairement.Conclusion. Anterior cruciate ligament plasty with use of 1/2 of the width of m. peroneus longus tendon prepared by the proposed method showed statistically significantly better results compared to the preparation of autograft from semitendinous muscle tendon using known method.
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10
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Truong PN, Toan NV, Nam VH, Fang WH, Vangsness CT, Han B, Hoang BX. Preoperative Determination of the Size of the Semitendinosus and Gracilis Tendon by Multidetector Row CT Scanner for Anterior Cruciate Ligament Reconstruction. J Knee Surg 2022; 35:1556-1562. [PMID: 33853156 DOI: 10.1055/s-0041-1727112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accurately measuring the length and diameter of the hamstring tendon autograft preoperatively is important for planning anterior cruciate ligament (ACL) reconstructive surgery. The purpose of this study was to assess the reliability of three-dimensional computed tomography (3D CT) scanning technique to produce the actual measurement of the gracilis and semitendinosus (GT and ST, respectively) tendon grafts' length and diameter for surgery. Ninety patients were scheduled for ACL reconstruction with hamstring autograft. Before the surgery, patients were examined under the multidetector row CT scanner and the ST and GT tendons were qualitatively measured by a volume-rendering technique. The length of ST and GT was measured with 3D CT compared with the length of the harvested ST and GT. The cross-sectional area (CSA) of ST and GT measured with 3D CT compared with the ST and GT graft diameter. Tendon size measured preoperatively and during surgery were statistically compared and correlated. The GT tendons length and cross-sectional area measured during surgery was both shorter and smaller compared with the ST tendon. GT and ST tendon length were correlated to patients' body index such as the height and weight (p < 0.05). However, the correlation levels were low to medium (r = 0.23-0.49). There was strong correlation between the lengths of GT (r = 0.76; p < 0.001) and ST (r = 0.87; p < 0.001) measured with the 3D CT and tendon length at surgery. There was a moderate correlation between graft diameter measured at surgery and 3D CT cross-sectional area (r = 0.31; p < 0.05). A multidetector row CT scanner can determine the ST and GT tendons' length and diameter. These measurements can be used for preoperative planning to help determine the surgical method and counsel patients on appropriate graft choices prior to surgery.
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Affiliation(s)
- Pham N Truong
- Department of Trauma and Orthopeadic, 198 Hospital, Hanoi, Vietnam
| | - Ngo V Toan
- Department of Trauma and Orthopeadic 1, VietDuc Hospital, Hanoi, Vietnam
| | - Vũ H Nam
- Department of Trauma and Orthopeadic, 198 Hospital, Hanoi, Vietnam
| | - William H Fang
- Department of Translational Research, Western University of Health Sciences, Pomona, California
| | - C Thomas Vangsness
- Department of Orthopaedics, Keck School of Medicine, USC, Los Angeles, California
| | - Bo Han
- Department of Surgery, Keck School of Medicine USC, Los Angeles, California
| | - Ba X Hoang
- Department of Surgery, Keck School of Medicine USC, Los Angeles, California
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11
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Straub RK, Mandelbaum B, Powers CM. Predictors of Quadriceps Strength Asymmetry after Anterior Cruciate Ligament Reconstruction: A Chi-Squared Automatic Interaction Detection Decision Tree Analysis. Med Sci Sports Exerc 2022; 54:2005-2010. [PMID: 35797489 DOI: 10.1249/mss.0000000000002995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The influence of graft type on the restoration of quadriceps strength symmetry after ACL reconstruction (ACLR) has been widely studied. However, an important consideration when evaluating quadriceps symmetry is the fact that this measure can be influenced by numerous factors beyond graft type. This study sought to determine if graft type is predictive of quadriceps strength asymmetry during the first 12 months post-ACLR taking into consideration potentially influential factors (i.e., age, sex, body mass index, time post-ACLR). METHODS We retrospectively reviewed quadriceps strength data from 434 patients (303 female patients and 131 male patients) who had previously undergone ACLR with an autograft (hamstring tendon, quadriceps tendon [QT], patellar tendon [PT]) or allograft. Chi-Squared Automatic Interaction Detection decision tree analysis was used to evaluate if graft type is predictive of quadriceps strength asymmetry during the first 12 months post-ACLR taking into consideration age, sex, body mass index, and time post-ACLR. RESULTS The best predictor of quadriceps strength asymmetry was graft type. Specifically, three graft categories were identified: 1) allograft and hamstring tendon autograft, 2) PT autograft, and 3) QT autograft. The average quadriceps strength asymmetry for each of the three identified categories was 0.91, 0.87, and 0.81, respectively, and differed statistically from each other ( P < 0.001). The second-best predictor of quadriceps strength asymmetry was sex, albeit only in the PT and QT groups (with female patients having increased asymmetry). Female patients post-ACLR with a QT autograft were at highest risk for quadriceps strength asymmetry. CONCLUSIONS Graft type and sex are important predictors of quadriceps strength asymmetry after ACLR. Clinicians should take these factors into consideration when designing rehabilitation protocols to restore quadriceps strength symmetry during the postoperative period.
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Affiliation(s)
- Rachel K Straub
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA
| | | | - Christopher M Powers
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA
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Age-related changes in mechanical properties of semitendinosus tendon used for anterior cruciate ligament reconstruction. J Orthop Surg Res 2022; 17:501. [PMCID: PMC9675133 DOI: 10.1186/s13018-022-03395-9] [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: 04/15/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Hamstring tendons are a popular choice for autografts in anterior cruciate ligament (ACL) reconstruction. However, there is increasing evidence that hamstring tendon autografts carry a high risk of revision and residual instability in young patients. To elucidate the reasons for the inferior outcome of the reconstructed ACL with hamstring tendon autografts in young patients, we investigated the Young’s modulus and the extent of cyclic loading-induced slackening of the semitendinosus tendon used for ACL reconstruction across a broad range of ages. Methods Twenty-six male patients (aged 17–53 years), who were scheduled for ACL reconstruction surgery using the semitendinosus tendon autograft, participated in this study. The distal portion of the harvested semitendinosus tendon, which was not used to construct the autograft, was used for cyclic tensile testing to calculate the Young’s modulus and the extent of slackening (i.e., increase in slack length). Results Spearman correlation analysis revealed that the Young’s modulus of the semitendinosus tendon was positively correlated with the patient’s age (ρ = 0.559, P = 0.003). In contrast, the extent of tendon slackening did not correlate with the patient’s age. Conclusions We demonstrated that the Young’s modulus of the semitendinosus tendon increases with age, indicating that the semitendinosus tendon used for ACL reconstruction is compliant in young patients.
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Ammann E, Hecker A, Bachmann E, Snedeker JG, Fucentese SF. Evaluation of Tibial Fixation Devices for Quadrupled Hamstring ACL Reconstruction. Orthop J Sports Med 2022; 10:23259671221096107. [PMID: 35592018 PMCID: PMC9112421 DOI: 10.1177/23259671221096107] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Shortcomings to tibial-side fixation have been reported as causes of failure
after anterior cruciate ligament reconstruction. Adjustable-loop suspensory
devices have become popular; however, no comparison with hybrid fixation
(ie, interference screw and cortical button) exists to our knowledge. Purpose: The purpose of this study was to compare the biomechanical properties of
adjustable loop devices (ALDs) in full-tunnel and closed-socket
configurations in relation to hybrid fixation. We hypothesized that primary
stability of fixation by a tibial ALD will not be inferior to hybrid
fixation. Study Design: Controlled laboratory study. Methods: Tibial fixation of a quadrupled tendon graft was biomechanically investigated
in a porcine tibia–bovine tendon model using 5 techniques (n = 6 specimens
each). The tested constructs included hybrid fixation with a cortical
fixation button and interference screw (group 1), single cortical fixation
with the full-tunnel technique using an open-suture strand button (group 2)
or an ALD (group 3), or closed-socket fixation using 2 different types of
ALDs (groups 4 and 5). Each specimen was evaluated using a materials testing
machine (1000 cycles from 50-250 N and pull to failure). Force at failure,
cyclic displacement, stiffness, and ability to pretension the graft during
insertion were compared among the groups. Results: No differences in ultimate load to failure were found between the ALD
constructs (groups 3, 4, and 5) and hybrid fixation (group 1). Cyclic
displacement was significantly higher in group 2 vs all other groups
(P < .001); however, no difference was observed in
groups 3, 4, and 5 as compared with group 1. The remaining tension on the
construct after fixation was significantly higher in groups 3 and 4 vs
groups 1, 2, and 5 (P < .02 for all comparisons),
irrespective of whether a full-tunnel or closed-socket approach was
used. Conclusion: Tibial anterior cruciate ligament graft fixation with knotless ALDs achieved
comparable results with hybrid fixation in the full-tunnel and closed-socket
techniques. The retention of graft tension appears to be biomechanically
more relevant than tunnel type. Clinical Relevance: The study findings emphasize the importance of the tension at which fixation
is performed.
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Affiliation(s)
- Elias Ammann
- Balgrist University Hospital, Zürich, Switzerland
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Memmel C, Krutsch W, Szymski D, Pfeifer C, Henssler L, Frankewycz B, Angele P, Alt V, Koch M. Current Standards of Early Rehabilitation after Anterior Cruciate Ligament Reconstruction in German Speaking Countries-Differentiation Based on Tendon Graft and Concomitant Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074060. [PMID: 35409745 PMCID: PMC8997891 DOI: 10.3390/ijerph19074060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 02/01/2023]
Abstract
Background: Although anterior cruciate ligament reconstruction (ACLR) is a well-established procedure and is standardly performed by orthopedic surgeons all over the world, there does not seem to be a standard protocol for early rehabilitation. The purpose of this study was to give answers to the following questions: (i) Does (a) the use of a specific tendon graft, and (b) potentially additional therapy of concomitant pathologies influence surgeons’ choice of a distinct postoperative rehabilitation protocol after ACLR? (ii) To what extent do these rehabilitation recommendations differ? Methods: Retrospective analysis of currently used early rehabilitation protocols after ACLR in German-speaking countries (GER, AUT and SUI) was conducted. Rehabilitation criteria included weight bearing, range of motion (ROM), the utilization of braces, continuous passive/active motion therapy (CPM/CAM), rehabilitation training and sport-specific training. Tendon grafts were differentiated as hamstring (HAM) and bone−patellar tendon−bone grafts (BTB). Concomitant pathologies included meniscus injuries (+M) and unhappy triad injuries (+UTI). Results: Most of the surveyed protocols were differentiated according to the used tendon graft or additional therapy of concomitant injuries (ACLR-differentiated, n = 147 vs. ACLR without graft differentiation, n = 58). When comparing ACLR-HAM and ACLR-BTB, significant differences were found regarding weight bearing (p = 0.01), ROM (p = 0.05) and the utilization of braces (p = 0.03). Regarding ACLR+M, an overall significant decelerated rehabilitation could be detected. After ACLR+UTI-therapy, a significant delayed start to full weight bearing (p = 0.002) and ROM (p < 0.001) was found. Conclusions: Most orthopedic surgeons from German-speaking countries differentiate early rehabilitation after ACLR according to the tendon graft used and therapy of concomitant pathologies. No consensus about early rehabilitation after ACLR is available. However, tendencies for an accelerated rehabilitation after ACLR-BTB and a more restrained rehabilitation of multiple injured knees were detected.
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Affiliation(s)
- Clemens Memmel
- Department of Paediatric Surgery and Orthopaedics, Clinic St. Hedwig, Barmherzige Brueder Regensburg, KUNO Paediatric University Medical Centre and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Werner Krutsch
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- SportDocs Franken, 90455 Nuremberg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Christian Pfeifer
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- Department of Trauma Surgery, InnKlinikum Altoetting, 84503 Altoetting, Germany
| | - Leopold Henssler
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Borys Frankewycz
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Peter Angele
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Volker Alt
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Matthias Koch
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, 4101 Basel, Switzerland
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Modular Bioreactor Design for Directed Tendon/Ligament Tissue Engineering. Bioengineering (Basel) 2022; 9:bioengineering9030127. [PMID: 35324816 PMCID: PMC8945228 DOI: 10.3390/bioengineering9030127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Functional tissue-engineered tendons and ligaments remain to be prepared in a reproducible and scalable manner. This study evaluates an acellular 3D extracellular matrix (ECM) scaffold for tendon/ligament tissue engineering and their ability to support strain-induced gene regulation associated with the tenogenesis of cultured mesenchymal stromal cells. Preliminary data demonstrate unique gene regulation patterns compared to other scaffold forms, in particular in Wnt signaling. However, the need for a robust bioreactor system that minimizes process variation was also evident. A design control process was used to design and verify the functionality of a novel bioreactor. The system accommodates 3D scaffolds with clinically-relevant sizes, is capable of long-term culture with customizable mechanical strain regimens, incorporates in-line load measurement for continuous monitoring and feedback control, and allows a variety of scaffold configurations through a unique modular grip system. All critical functional specifications were met, including verification of physiological strain levels from 1–10%, frequency levels from 0.2–0.5 Hz, and accurate load measurement up to 50 N, which can be expanded on the basis of load cell capability. The design process serves as a model for establishing statistical functionality and reliability of investigative systems. This work sets the stage for detailed analyses of ECM scaffolds to identify critical differentiation signaling responses and essential matrix composition and cell–matrix interactions.
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Age-related differences in hamstring tendon used as autograft in reconstructive anterior cruciate ligament surgery. INTERNATIONAL ORTHOPAEDICS 2022; 46:845-853. [DOI: 10.1007/s00264-021-05285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
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Alomar AZ, Nasser ASB, Kumar A, Kumar M, Das S, Mittal S. Hamstring graft diameter above 7 mm has a lower risk of failure following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:288-297. [PMID: 33619635 DOI: 10.1007/s00167-021-06503-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Multi-stranded hamstring-tendon autografts have been widely used for anterior cruciate ligament reconstruction (ACLR) surgeries. Recently, smaller diameter hamstring autografts have been linked with the risk of failure or graft rupture. However, there is limited evidence concerning the optimal diameter of the hamstring autografts for ACLR. The current systematic review and meta-analysis analysed the association of ACLR failure with the diameter of hamstring autografts. METHODS A systematic search of three major scientific databases (Pubmed, EMBASE, and Cochrane library) was conducted to identify studies that presented ACLR failure-related outcomes with different diameters of hamstring autografts. The pooled data from the included studies were analysed to investigate the association between ACLR failure and the cut-off diameters of 6, 7, 8, and 9 mm. Subgroup analyses based on the level of evidence and follow-up duration were also performed at each cut-off diameter. RESULTS Of the 2282 studies screened, 16 reported failure rates with hamstring autografts of different diameters, 15 of which were included in the meta-analysis. A graft diameter ≥ 7 mm was associated with significantly lower ACLR failure rates than a graft diameter < 7 mm (p = 0.005), based on pooled data of 19,799 cases. Age < 20 years and higher physical activity were associated with significantly higher ACLR failure rates. CONCLUSION The current systematic review suggests that the hamstring graft diameter for ACLR should be more than 7 mm considering the significantly higher failure rates with graft diameters less than 7 mm. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | - Arvind Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India.
| | - Mukesh Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Saubhik Das
- Department of Orthopaedics, Rajendra Institute of Medical Sciences (RIMS), Ranchi, India
| | - Samarth Mittal
- Department of Orthopaedics, JPNATC, AIIMS New Delhi, New Delhi, India
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Mousavibaygei S, Gerami M, Haghi F, Pelarak F. Anterior cruciate ligament (ACL) injuries: A review on the newest reconstruction techniques. J Family Med Prim Care 2022; 11:852-856. [PMID: 35495824 PMCID: PMC9051673 DOI: 10.4103/jfmpc.jfmpc_1227_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/09/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022] Open
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Lindsay TA, Myers HR, Tham S. Ligamentization and Remnant Integration: Review and Analysis of Current Evidence and Implications for Scapholunate Reconstruction. J Wrist Surg 2021; 10:476-483. [PMID: 34877079 PMCID: PMC8635821 DOI: 10.1055/s-0040-1716863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Background Scapholunate interosseous ligament injuries are common but remain a therapeutic challenge. Current treatment modalities prioritize restoration of normal anatomy with reconstruction where appropriate. To date no reconstructive technique has been described that discusses the potential benefit of preservation of the scapholunate ligament remnant. Little is known about the "ligamentization" of grafts within the wrist. However, a growing body of knee literature suggests that remnant sparing may confer some benefit. In the absence of wrist specific studies, this literature must guide areas for potential augmentation of current surgical practices. Objective The purpose of this study was to perform a review of the process of ligamentization and a systematic review of the current literature on the possible role of ligament sparring and its effect on ligamentization. Methods A systematic search of the literature was performed to identify all the studies related to remnant sparing and the ligamentization of reconstructed tendons, regardless of graft type or joint involved from MEDLINE, EMBASE, and PubMed until February 1, 2016 using the following keywords: ligamentization, graft, remodelling, reconstruction, biomechan*, histolo∗, scapholunate ligament. Each selected study was evaluated for methodological quality and risk of bias according to a modified Systematic Review Center for Laboratory Animal Experimentation criteria. Conclusions The available literature suggests that ligament sparring demonstrated a trend toward improvements in vascularity, mechanoreceptors, and biomechanics that lessens in significance over time. Clinical Relevance This review suggests that remnant sparing may be one way to improve outcomes of scapholunate ligament reconstructive surgery. Level of Evidence This is a level I/II, review study.
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Affiliation(s)
- Tim A.J. Lindsay
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Harley R. Myers
- Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred, Melbourne, Victoria, Australia
| | - Stephen Tham
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
- St. Vincent's Hand Surgery Unit, St. Vincent's Hospital, Fitzroy, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute, St Vincents Hospital, Fitzroy, Victoria, Australia
- Hand Unit, Dandenong Hospital, Dandenong, Victoria, Australia
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20
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Comparing the Stiffness of Peroneus Longus Tendon Versus Hamstrings in Anterior Cruciate Ligament Reconstruction: A Biomechanical Study. Asian J Sports Med 2021. [DOI: 10.5812/asjsm.110160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The use of autografts originating from either hamstring tendons or peroneus longus tendons is a surgical option in anterior cruciate ligament (ACL) reconstruction. Objectives: This research aimed to compare the tensile strength between the hamstring tendon and the peroneus longus tendon in ACL reconstruction. The hypothesis of this study was: Peroneus longus grafts have tensile strength equal to hamstring grafts based on living donor patients. Methods: This cross-sectional study was a biomechanical study examining means and standard deviations (SD) by comparing the tensile strength of peroneus longus tendons and hamstring tendons when used as autograft donors in ACL reconstruction. Results: In this study, 51 patients with reconstructive ACL were enrolled. The mean diameter of the hamstring tendon was 7.86 with SD ± 0.69, while the mean diameter of peroneus longus tendon was 7.67 with SD ± 0.63. The mean diameter of the peroneus longus graft was not significantly different. The mean displacement on the hamstring tendon was 2.44 with SD ± 0.42, while the peroneus longus tendon was 2.06 with SD ± 0.14. The peroneus longus tendon had significantly more tensile strength compared to the hamstring tendon. Conclusions: Diameter of the peroneus longus graft was not significantly different from the hamstring graft. However, the peroneus longus graft had more tensile strength than the hamstring graft based on living donor patients.
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Eggeling L, Klepsch L, Akoto R, Frosch KH. Clinical results after very early, early and late arthroscopic arthrolysis of the knee. INTERNATIONAL ORTHOPAEDICS 2021; 46:265-271. [PMID: 34482440 PMCID: PMC8782794 DOI: 10.1007/s00264-021-05193-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022]
Abstract
Purpose Impaired patient outcome can be directly related to a loss of motion of the knee following surgical procedures. If conservative therapy fails, arthroscopic arthrolysis is an effective procedure to improve range of motion (ROM). The purpose of this study was to evaluate the outcome of patients undergoing very early (< 3 months), early (3 to 6 months), and late (> 6 months) arthroscopic arthrolysis of the knee. Methods With a follow-up on average at 35.1 ± 15.2 (mean ± SD, 24 to 87) months, 123 patients with post-operative motion loss (> 10° extension deficit/ < 90° of flexion) were included between 2013 and 2018 in the retrospective study, while eight patients were lost to follow-up. A total of 115 patients were examined with a minimum follow-up of two years. Twenty percent (n = 23) of patients of this study population had a post-operative motion loss after distal femoral fracture, 10.4% (n = 12) after tibial head fracture, 57.4% (n = 66) after anterior/posterior cruciate ligament (ACL/PCL) reconstruction, 8.7% (n = 10) after infection of the knee, and 3.4% (n = 4) after patella fracture. Thirty-seven patients received very early (< 3 months, mean 1.8 months) arthroscopic arthrolysis, and 37 had early (3 to 6 months, mean 4.3 months) and 41 late (> 6 months, mean 9.8 months) arthroscopic arthrolysis after primary surgery. Results The average ROM increased from 73.9° before to 131.4° after arthroscopic arthrolysis (p < 0.001). In the group of very early (< 3 months) arthroscopic arthrolysis 76% (n = 28) of the patients had a normal ROM (extension/flexion 0/140°), in the group of early (3–6 months) arthrolysis 68% (n = 25) of the patients and in the group of late arthrolysis 41.5% (n = 17) of the patients showed a normal ROM after surgery (p = 0.005). The total ROM after arthrolysis was also significantly increased in the group of very early and early arthrolysis (136.5° and 135.3° vs. 123.7°, p < 0.001). A post-operative flexion deficit occurred significantly less in the group of very early and early arthroscopic arthrolysis compared to the late arthroscopic arthrolysis (3.9° and 4.2° vs. 16.6°, p < 0.001). Patients treated with very early (< 3 months) and early (3 to 6 months) showed a significantly increased post-operative Tegner score of 4.8 ± 1 and 4.7 ± 1.1 compared to 3.8 ± 1.1 in the group of late arthroscopic arthrolysis (> 6 months, p < 0.001). Conclusions An arthroscopic arthrolysis is highly effective and leads to good to excellent mid-term results. An early arthroscopic arthrolysis within 6 months after primary surgery leads to significantly improved ROM and functional scores compared to the late arthrolysis (> 6 months).
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Affiliation(s)
- Lena Eggeling
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany.,Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Leonard Klepsch
- Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Ralph Akoto
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany.,University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany. .,Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Soni A, Gupta RK, Raghav M, Masih GD, Bansal P. Comparison of Bone-Patellar Tendon-Bone Graft, Semitendinosus-Gracilis Graft and Semitendinosus-Gracilis with Preserved Tibial Insertion Graft in Anterior Cruciate Ligament Reconstruction in Sports Persons. Malays Orthop J 2021; 15:12-17. [PMID: 34429817 PMCID: PMC8381676 DOI: 10.5704/moj.2107.003] [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: 03/30/2020] [Accepted: 04/04/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Bone-patellar tendon-bone (BPTB) and semitendinosus-gracilis (STG) are the commonest grafts used for ACL reconstruction. However even after having been debated for years, there is no consensus about the ideal graft. Moreover, the literature is deficient about STG graft with preserved tibial insertion (STGPI) which preserves the proprioception. Our aim is to compare the outcome of BPTB, free STG and STGPI grafts after ACL reconstruction in professional sports persons. We compared the outcome in terms of mechanical stability, functional outcome, return to sports activity and degenerative changes. Material and Methods Professional sports persons aged between 16-50 years operated for ACL tear using BPTB, free STG and STGPI grafts with minimum follow-up of two years were identified from hospital records. Patients with associated knee injuries were excluded. Patients, divided in three groups according to graft used, were compared in terms of mechanical stability (arthrometric examination KT-1000 score), functional outcome (Lysholm Score), return to sports activity (Tegner score and difference in thigh circumference) and degenerative changes (KL grading). Results BPTB graft group was found to be better than free STG and STGPI graft groups in terms of KT-1000 score. There was no statistically significant difference among the groups in terms of Lysholm score, Tegner score, difference in thigh circumference and KL grading. Conclusion BPTB graft is better than free STG and STGPI grafts in terms of knee stability. When compared for patient reported outcome, return to sports activity, osteoarthritic changes and graft failure there is no significant difference among the three types of grafts.
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Affiliation(s)
- A Soni
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - R K Gupta
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - M Raghav
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - G D Masih
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - P Bansal
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
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Fan D, Ma J, Zhang L. Patellar tendon versus artificial grafts in anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:478. [PMID: 34348750 PMCID: PMC8336077 DOI: 10.1186/s13018-021-02624-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background The aim of anterior cruciate ligament reconstruction (ACLR) is to restore the function of the knee joint, protect the cartilage, and reduce the occurrence of osteoarthritis. However, due to the structural limitations of the human body, it is not possible to perform ACLR with conventional sutures. To restore normal functioning of the anterior cruciate ligament (ACL), a new ligament must be reconstructed in the position of the previous ACL. Objective To compare autografts and synthetic grafts in terms of postoperative knee stability and function Search methods The protocol for this study was registered with PROSPERO (CRD42021243451). Two reviewers independently searched the PubMed, Embase, and the Cochrane Library databases from database inception though February 10, 2021. The following search method was used: ((Autograft) OR (Autologous) OR (Autotransplant)) OR Artificial Ligament AND (Anterior Cruciate Ligament Injury [MeSH Terms]) AND (Randomized controlled trial [MeSH Terms]). Methodological quality was assessed by the Cochrane risk of bias tool. Selection criteria We only included randomized controlled trials (level I) that compared autograft and synthetic graft interventions in participants with ACL injury. We included trials that evaluated ACLR using at least one outcome (Lachman test, pivot shift test, IKDC grades, or complications). Results A total of 748 studies were identified in the initial literature search, and seven studies that examined only bone-patellar tendon-bone (BPTB) grafts compared with artificial grafts met the predetermined inclusion criteria. The results showed that BPTB grafts were associated with significantly better pivot shift test and Lachman test results and better IKDC grades and lower complication rates than synthetic grafts. Conclusions This review indicates that for adults, BPTB grafts perform more favorably than synthetic grafts in ACLR in terms of knee stability, function, and complication. More research is needed to compare autologous tendons and allogeneic tendons with artificial ligaments, especially in elderly individuals. Level of evidence Level I, systematic review and meta-analysis
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Affiliation(s)
- DingYuan Fan
- Beijing University of Chinese Medicine, Beijing, China.,Department of Joint Surgery and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
| | - Jia Ma
- Department of Joint Surgery and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
| | - Lei Zhang
- Department of Joint Surgery and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China.
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Wu J, Kator JL, Zarro M, Leong NL. Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair. Sports Health 2021; 14:424-432. [PMID: 34344237 DOI: 10.1177/19417381211032949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Injury to the anterior cruciate ligament (ACL) is among the most common orthopaedic injuries, and reconstruction of a ruptured ACL is a common orthopaedic procedure. In general, surgical intervention is necessary to restore stability to the injured knee, and to prevent meniscal damage. Along with surgery, intense postoperative physical therapy is needed to restore function to the injured extremity. ACL reconstruction (ACLR) has been the standard of care in recent decades, and advances in surgical technology have reintroduced the prospect of augmented primary repair of the native ACL via a variety of methods. EVIDENCE ACQUISITION A search of PubMed database of articles and reviews available in English was performed through 2020. The search terms ACLR, anterior cruciate ligament repair, bridge enhanced acl repair, suture anchor repair, dynamic intraligamentary stabilization, internal bracing, suture ligament augmentation, and internal brace ligament augmentation were used. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS No exact consensus exists on effective rehabilitation protocols after ACL repair techniques, as the variation in published protocols seem even greater than the variation in those for ACLR. For some techniques such as internal bracing and dynamic interligamentary stabilization, it is likely permissible for the patients to progress to full weightbearing and discontinue bracing sooner. However, caution should be applied with regard to earlier return to sport than after ACLR as to minimize risk for retear. CONCLUSION More research is needed to address how physical therapies must adapt to these innovative repair techniques. Until that is accomplished, we recommend that physical therapists understand the differences among the various ACL surgery techniques discussed here and work with the surgeons to develop a rehabilitation protocol for their mutual patients. STRENGTH OF RECOMMENDATION TAXONOMY (SORT) C.
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Affiliation(s)
- Jocelyn Wu
- Department of Orthopaedic Surgery, University of Maryland Baltimore, Baltimore, Maryland
| | - Jamie L Kator
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Zarro
- Department of Physical Therapy, University of Maryland Baltimore, Baltimore, Maryland
| | - Natalie L Leong
- Department of Orthopaedic Surgery, University of Maryland Baltimore, Baltimore, Maryland.,Department of Surgery, Baltimore VA Medical Center, Baltimore, Maryland
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Funchal LFZ, Astur DC, Pizzolatti ALA, Grimaldi AP, Jimenez AE, Moré ADO, de Mello Roesler CR, Cohen M. Tendon grafts with preserved muscle demonstrate similar biomechanical properties to tendon grafts stripped of muscular attachments: a biomechanical evaluation in a porcine model. J Exp Orthop 2021; 8:57. [PMID: 34341872 PMCID: PMC8329107 DOI: 10.1186/s40634-021-00375-6] [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: 04/23/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose (1) To evaluate the biomechanical properties of a porcine flexor digitorum superficialis tendon graft with preserved muscle fibers and (2) to compare these results with the biomechanical properties of a porcine tendon graft after removal of associated muscle. Methods Eighty-two porcine forelegs were dissected and the flexor digitorum superficialis muscle tendons were harvested. The study comprised of two groups: Group 1 (G1), harvested tendon with preserved muscle tissue; and Group 2 (G2), harvested contralateral tendon with removal of all muscle tissue. Tests in both groups were conducted using an electro-mechanical material testing machine (Instron, model 23-5S, Instron Corp., Canton, MA, USA) with a 500 N force transducer. Yield load, stiffness, and maximum load were evaluated and compared between groups. Results The behavior of the autografts during the tests followed the same stretching, deformation, and failure patterns as those observed in human autografts subjected to axial strain. There were no significant differences in the comparison between groups for ultimate load to failure (p = 0.105), stiffness (p = 0.097), and energy (p = 0.761). Conclusion In this porcine model biomechanical study, using autograft tendon with preserved muscle showed no statistically significant differences for yield load, stiffness, or maximum load compared to autograft tendon without preserved muscle. The preservation of muscle on the autograft tendon did not compromise the mechanical properties of the autograft. Level of evidence Level III Controlled laboratory study
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Affiliation(s)
| | - Diego Costa Astur
- Universidade Federal de São Paulo, Hospital Samaritano and Instituto Astur, Av Pacaembu 1024, São Paulo, SP, 01234-000, Brazil.
| | | | - Arthur Paiva Grimaldi
- Biomechanical Laboratory From Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | | | | | - Moises Cohen
- Orthoapedic Surgeon From Universidade Federal de São Paulo, São Paulo, Brazil
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Dasgupta A, Sori N, Petrova S, Maghdouri-White Y, Thayer N, Kemper N, Polk S, Leathers D, Coughenour K, Dascoli J, Palikonda R, Donahue C, Bulysheva AA, Francis MP. Comprehensive collagen crosslinking comparison of microfluidic wet-extruded microfibers for bioactive surgical suture development. Acta Biomater 2021; 128:186-200. [PMID: 33878472 DOI: 10.1016/j.actbio.2021.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/30/2022]
Abstract
Collagen microfiber-based constructs have garnered considerable attention for ligament, tendon, and other soft tissue repairs, yet with limited clinical translation due to strength, biocompatibility, scalable manufacturing, and other challenges. Crosslinking collagen fibers improves mechanical properties; however, questions remain regarding optimal crosslinking chemistries, biocompatibility, biodegradation, long-term stability, and potential for biotextile assemble at scale, limiting their clinical usefulness. Here, we assessed over 50 different crosslinking chemistries on microfluidic wet-extruded collagen microfibers made with clinically relevant collagen to optimize collagen fibers as a biotextile yarn for suture or other medical device manufacture. The endogenous collagen crosslinker, glyoxal, provides extraordinary fiber ultimate tensile strength near 300MPa, and Young's modulus of over 3GPa while retaining 50% of the initial load-bearing capacity through 6 months as hydrated. Glyoxal crosslinked collagen fibers further proved cytocompatible and biocompatible per ISO 10993-based testing, and further elicits a predominantly M2 macrophage response. Remarkably these strong collagen fibers are amenable to industrial braiding to form strong collagen fiber sutures. Collagen microfluidic wet extrusion with glyoxal crosslinking thus progress bioengineered, strong, and stable collagen microfibers significantly towards clinical use for potentially promoting efficient healing compared to existing suture materials. STATEMENT OF SIGNIFICANCE: Towards improving clinical outcomes for over 1 million ligament and tendon surgeries performed annually, we report an advanced microfluidic extrusion process for type I collagen microfiber manufacturing for biological suture and other biotextile manufacturing. This manuscript reports the most extensive wet-extruded collagen fiber crosslinking compendium published to date, providing a tremendous recourse to the field. Collagen fibers made with clinical-grade collagen and crosslinked with glyoxal, exhibit tensile strength and stability that surpasses all prior reports. This is the first report demonstrating that glyoxal, a native tissue crosslinker, has the extraordinary ability to produce strong, cytocompatible, and biocompatible collagen microfibers. These collagen microfibers are ideal for advanced research and clinical use as surgical suture or other tissue-engineered medical products for sports medicine, orthopedics, and other surgical indications.
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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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Schagemann J, Koebrich T, Wendlandt R, Schulz AP, Gille J, Oheim R. Comparison of hamstring and quadriceps tendon autografts in anterior cruciate ligament reconstruction with gait analysis and surface electromyography. J Orthop Traumatol 2021; 22:20. [PMID: 34021423 PMCID: PMC8140171 DOI: 10.1186/s10195-021-00581-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tear is the most frequent ligamentous injury of the knee joint. Autografts of hamstring (HS) or quadriceps tendons (QT) are used for primary ACL reconstruction. In this study, we planned to examine whether harvesting an HS graft is related to a deficit in dynamic knee stabilisation and strength revealed by dynamic valgus as compared with QT graft or the uninjured leg. Furthermore, if this deficit exists, is it compensated by higher neuromuscular activity of the quadriceps muscle? MATERIALS AND METHODS Adult patients who had undergone ACL reconstruction with QT or HS autografts were included in this two-armed cohort study. Clinical outcome was assessed by clinical data analysis, physical examination and the Lysholm Score and Knee Injury and Osteoarthritis Score (KOOS). In addition, gait analysis and non-invasive surface electromyography were performed. RESULTS A complete data set of 25 patients (QT: N = 8, HS: N = 17) was analysed. There was no significant demographic difference between the groups. Time between surgery and follow-up was significantly longer for the QT group. Significant differences regarding clinical outcome were not found between the treated and untreated leg or between the two groups, with excellent scores at the time of follow-up. Gait analysis revealed no significant differences of varus-valgus angles. Significant differences in surface electromyography were only found in the QT group with increased vastus medialis obliquus activity of the treated legs (p < 0.01). CONCLUSIONS Our results suggest that harvesting of HS grafts for primary ACL reconstruction will not lead to a medial collapse and consequently impaired medial stabilisation of the knee when compared with QT grafts. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J Schagemann
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
| | - T Koebrich
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - R Wendlandt
- Clinic for Orthopedics and Trauma Surgery, Laboratory for Biomechanics, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee, 160, 23538, Luebeck, Germany
| | - A P Schulz
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.,Clinic for Orthopedics and Trauma Surgery, Laboratory for Biomechanics, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee, 160, 23538, Luebeck, Germany.,BG Klinikum Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
| | - J Gille
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.,BG Klinikum Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
| | - R Oheim
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.,BG Klinikum Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
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Venter SM, Dey R, Khanduja V, von Bormann RP, Held M. The management of acute knee dislocations: A global survey of orthopaedic surgeons' strategies. SICOT J 2021; 7:21. [PMID: 33812447 PMCID: PMC8019554 DOI: 10.1051/sicotj/2021017] [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: 09/24/2020] [Accepted: 02/28/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose: Great variety and controversies surround the management strategies of acute multiligament knee injuries (aMKLIs) and no established guidelines exist for resource-limited practices. The aim of this study was to compare the management approach of acute knee dislocations (AKDs) by orthopedic surgeons from nations with different economic status. Methods: This descriptive cross-sectional scenario-based survey compares different management strategies for aMLKIs of surgeons in developed economic nations (DEN) and emerging markets and developing nations (EMDN). The main areas of focus were operative versus non-operative management, timing and staging of surgery, graft choice and vascular assessment strategies. The members of the Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT) were approached to participate and information was collected regarding their demographics, experience, hospital setting and management strategies of aMLKIs. These were analyzed after categorizing participants into DEN and EMDN based on the gross domestic product (GDP) per capita. Results: One-hundred and thirty-eight orthopedic surgeons from 47 countries participated in this study, 67 from DEN and 71 (51.4%) from EMDN. DEN surgeons had more years of experience and were older (p < 0.05). Surgeons from EMDN mostly worked in public sector hospitals, were general orthopedic surgeons and treated patients from a low-income background. They preferred conservative management and delayed reconstruction with autograft (p < 0.05) if surgery was necessary. Surgeons from DEN favored early, single stage arthroscopic ligament reconstruction. Selective Computerized Tomography Angiography (CTA) was the most preferred choice of arterial examination for both groups. Significantly more EMDN surgeons preferred clinical examination (p < 0.05) and duplex doppler scanning (p < 0.05) compared to DEN surgeons. More surgeons from EMDN did not have access to a physiotherapist for their patients. Conclusions: Treatment of aMLKIs vary significantly based on the economic status of the country. Surgeons from DEN prefer early, single stage arthroscopic ligament reconstruction, while conservative management is favored in EMDN. Ligament surgery in EMDN is often delayed and staged. EMDN respondents utilize duplex doppler scanning and clinical examination more readily in their vascular assessment of aMLKIs. These findings highlight very distinct approaches to MLKIs in low-resource settings which are often neglected when guidelines are generated.
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Affiliation(s)
- Santa-Marie Venter
- Department of Orthopedic Surgery, Groote Schuur Hospital, Orthopedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
| | - Roopam Dey
- Department of Orthopedic Surgery, Groote Schuur Hospital, Orthopedic Research Unit, University of Cape Town, Cape Town 7925, South Africa - Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town 7925, South Africa
| | - Vikas Khanduja
- Consultant Orthopedic Surgeon, Addenbrooke's Hospital, Cambridge, University of Cambridge, Cambridge CB2 2QQ, United Kingdom
| | - Richard Pb von Bormann
- Cape Town Sports and Orthopaedic Clinic, Christian Barnard Memorial Hospital, Cape Town, 8001, South Africa
| | - Michael Held
- Department of Orthopedic Surgery, Groote Schuur Hospital, Orthopedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
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DeFazio MW, Curry EJ, Gustin MJ, Sing DC, Abdul-Rassoul H, Ma R, Fu F, Li X. Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120964919. [PMID: 33403206 PMCID: PMC7745570 DOI: 10.1177/2325967120964919] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow patients to return to prior levels of athletic performance. While existing literature suggests that patient-reported outcomes are similar between bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts, there is less information comparing return-to-sport (RTS) rates between the 2 graft types. Purpose To compare RTS rates among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft. Study Design Systematic review; Level of evidence, 4. Methods The MEDLINE, Embase, and Cochrane Library databases were searched, and studies that reported on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Studies that utilized ACL repair techniques, quadriceps tendon autografts, graft augmentation, double-bundle autografts, allografts, or revision ACL reconstruction were excluded. RTS information was extracted and analyzed from all included studies. Results Included in the review were 20 articles investigating a total of 2348 athletes. The overall RTS rate in our cohort was 73.2%, with 48.9% returning to preinjury levels of performance and a rerupture rate of 2.4%. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 81.0%, with 50.0% of athletes returning to preinjury levels of performance and a rerupture rate of 2.2%. Patients after primary ACL reconstruction with an HT autograft had an overall RTS rate of 70.6%, with 48.5% of athletes returning to preinjury levels of performance and a rerupture rate of 2.5%. Conclusion ACL reconstruction using BTB autografts demonstrated higher overall RTS rates when compared with HT autografts. However, BTB and HT autografts had similar rates of return to preinjury levels of performance and rerupture rates. Less than half of the athletes were able to return to preinjury sport levels after ACL reconstruction with either an HT or BTB autograft.
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Affiliation(s)
- Matthew W DeFazio
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Michael J Gustin
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David C Sing
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Hussein Abdul-Rassoul
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Richard Ma
- Missouri Orthopaedic Institute, Columbia, Missouri, USA
| | - Freddie Fu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
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Differences in gait and muscle strength of patients with acute and chronic anterior cruciate ligament injury. Clin Biomech (Bristol, Avon) 2020; 80:105161. [PMID: 32961508 DOI: 10.1016/j.clinbiomech.2020.105161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/08/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is one of the most common injuries of the area surrounding the knee. Muscle strength deficiency is observed following an ACL injury. Determining differences in muscle strength and gait between patients with acute and chronic ACL injury will provide crucial information for assessments and treatment plans. METHODS We evaluated 60 patients with ACL rupture. Patients were classified into acute and chronic groups. We compared measurements of anthropometric parameters, muscle strength, gait and functional questionnaire. FINDINGS The muscle strength of both knee extensors and flexors was higher in the chronic group than in the acute group. The muscle strength index for extensors was 57% in the acute group and 73% in the chronic group. However, the hamstring-to-quadriceps ratio for peak torque of the injured leg in the acute and chronic groups was similarly high at 98% and 101%, respectively. In gait, asymmetry in the hip and knee was observed in the acute group but not in the chronic group. The Knee Injury and Osteoarthritis Outcome Scores (KOOS) for symptoms, pain, activities of daily living, sports and recreational activities were higher in the chronic group than in the acute group. INTERPRETATION Compared with the acute group, the gait of the chronic group is more symmetrical, and the score of KOOS is also higher. The muscle training protocols could be strategically planned according to these differences. Patients with ACL injury are characterized high hamstrings-to quadriceps peak torque ratio.
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Barajaa MA, Nair LS, Laurencin CT. Bioinspired Scaffold Designs for Regenerating Musculoskeletal Tissue Interfaces. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2020; 6:451-483. [PMID: 33344758 PMCID: PMC7747886 DOI: 10.1007/s40883-019-00132-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/14/2019] [Accepted: 09/13/2019] [Indexed: 12/17/2022]
Abstract
The musculoskeletal system works at a very advanced level of synchrony, where all the physiological movements of the body are systematically performed through well-organized actions of bone in conjunction with all the other musculoskeletal soft tissues, such as ligaments, tendons, muscles, and cartilage through tissue-tissue interfaces. Interfaces are structurally and compositionally complex, consisting of gradients of extracellular matrix components, cell phenotypes as well as biochemical compositions and are important in mediating load transfer between the distinct orthopedic tissues during body movement. When an injury occurs at interface, it must be re-established to restore its function and stability. Due to the structural and compositional complexity found in interfaces, it is anticipated that they presuppose a concomitant increase in the complexity of the associated regenerative engineering approaches and scaffold designs to achieve successful interface regeneration and seamless integration of the engineered orthopedic tissues. Herein, we discuss the various bioinspired scaffold designs utilized to regenerate orthopedic tissue interfaces. First, we start with discussing the structure-function relationship at the interface. We then discuss the current understanding of the mechanism underlying interface regeneration, followed by discussing the current treatment available in the clinic to treat interface injuries. Lastly, we comprehensively discuss the state-of-the-art scaffold designs utilized to regenerate orthopedic tissue interfaces.
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Affiliation(s)
- Mohammed A Barajaa
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Lakshmi S Nair
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Raymond & Beverly Sackler Center for Biomedical, Biological, Physical & Engineering Sciences, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Materials Science & Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT, USA
- Department of Chemical & Bimolecular Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Cato T Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Raymond & Beverly Sackler Center for Biomedical, Biological, Physical & Engineering Sciences, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Materials Science & Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT, USA
- Department of Chemical & Bimolecular Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT, 06030, USA
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Combined hamstrings and peroneus longus tendon for undersized graft in anterior cruciate ligament reconstruction: A report of two adolescence female patients. Int J Surg Case Rep 2020; 76:81-84. [PMID: 33017739 PMCID: PMC7533307 DOI: 10.1016/j.ijscr.2020.09.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/20/2020] [Indexed: 11/22/2022] Open
Abstract
Unpredictable graft size for anterior cruciate ligament reconstruction. Plan for graft augmentation is of great importance. Combined graft from hamstring and peroneus longus tendon for undersized graft.
Introduction Anterior cruciate ligament (ACL) rupture is a common injury in young and active population and reconstruction is the mainstay treatment to maintain stability of the knee. Hamstring tendon (HT) is the most popular graft for ACL reconstruction. In certain patient, particularly in women, the size of tendon graft to reconstruct the ACL is unpredictable. In the case of unqualified donor, we need a combined graft from another source to match the size requirement. Case presentation We present two cases of ACL reconstruction using combination of HT and PLT graft in adolescent female. We evaluate knee functional score and ankle donor site morbidity. In the second case we also did second look for the ACL graft integrity arthroscopically. This study has been reported in line with the Surgical Case Report (SCARE) criteria. Discussion One year after surgery, International Knee Documentation Committee (IKDC) score for both cases were improved and no ankle-donor site morbidity with good motoric power and 100% American Orthopedic Foot Ankle Score (AOFAS). Conclusion Additional peroneus longus tendon can be considered as an alternative in undersized hamstring tendon graft without significant donor site morbidity.
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Thwin L, Ho SW, Tan TJL, Lim WY, Lee KT. Pre-operative MRI measurements versus anthropometric data: Which is more accurate in predicting 4-stranded hamstring graft size in anterior cruciate ligament reconstruction? ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 22:5-9. [PMID: 32642442 PMCID: PMC7321968 DOI: 10.1016/j.asmart.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 01/12/2023]
Abstract
Background/objective Graft diameter has been shown to play an important role in anterior cruciate ligament (ACL) autograft failure rates. The roles of pre-operative MRI measurement of graft size and anthropometric data have been studied in the prediction of hamstring graft size. Pre-operative knowledge of hamstring graft diameter allows surgeons to perform better surgical planning and provides an opportunity to discuss with patients on alternative graft options such as allografts should the need arises. The purpose of this study was to compare the accuracy of pre-operative anthropometric data and MRI measurements in the prediction of 4-stranded hamstring autograft size in anterior cruciate ligament reconstruction. Method This was a cohort study involving 141 subjects (115 males and 26 females) who underwent a single bundle ACL reconstruction utilising a 4-stranded hamstring graft by a single surgeon from 2008 to 2012. Pre-operatively, the height, weight, body mass index (BMI), age, gender and smoking status was recorded. The MRI scans used for diagnosis were utilized to measure the gracilis (GT) and semi-tendinosus (ST) cross sectional area (CSA). Result We found the strongest correlation between Combined (ST + GT) CSA and intra-operative graft size (r = 0.596, p < 0.001). This was followed by ST CSA (r = 0.570,p < 0.001), Body surface area (r = 0.507,p < 0.001), and GT CSA (r = 0.460,p < 0.001). No significant correlation was found between 2 anthropometric data (Age and BMI). There was also no significant difference between different strengths of MRIs (1.5T vs 3.0T) in determining the intra-operative graft size (p = 0.438). Conclusion We conclude that pre-operative MRI is superior to anthropometric variables in predicting the size of 4-stranded hamstring autografts used in ACL reconstruction.
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Affiliation(s)
- Lynn Thwin
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Sean Wl Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Wei Yang Lim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Keng Thiam Lee
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Bashaireh KM, Audat Z, Radaideh AM, Aleshawi AJ. The Effectiveness of Autograft Used in Anterior Cruciate Ligament Reconstruction of the Knee: Surgical Records for the New Generations of Orthopedic Surgeons and Synthetic Graft Revisit. Orthop Res Rev 2020; 12:61-67. [PMID: 32612399 PMCID: PMC7323790 DOI: 10.2147/orr.s253985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
Objective In this article, we aim to revisit the synthetic graft and review the advantages and disadvantages between different types of grafts for patients who underwent anterior cruciate ligament (ACL) reconstruction in a tertiary medical institute for the new generations of surgeons. Patients and Methods Retrospectively, we identified 115 patients who underwent arthroscopic ACL reconstruction between 2006 and 2009. We were able to retrieve 74 patients from them. The 74 patients were divided into 32 patients who underwent primary arthroscopic ACL reconstruction with hamstring and patellar tendon autograft and 42 cases with an active biosynthetic composite (ABC) ligament. The mean the follow-up period for both groups was 7 years. The following information was obtained: standard demographic information (age, sex), clinical presentation, presence of trauma, associated injuries, types of grafts (autograft versus synthetic graft) and postoperative complications. Moreover, functional and clinical outcomes in addition to the satisfaction of patients using the international knee documentation committee (IKDC) score and knee injury and osteoarthritis outcome score (KOOS) were measured. Results We found that the natural (autograft) was better in terms of clinical and functional outcome than the synthetic one (the scores of KOOS and IKDC were better in natural grafts). Furthermore, the immediate postoperative results for the pivot and Lachman tests were better in natural grafts. On the other hand, the rate of re-rupture was similar for both groups. However, the long-term inflammatory changes and stiffness that is attributed to the immunological reactions were more in the synthetic grafts. Conclusion This study revisited the synthetic graft and provided evidence that the natural grafts are more beneficial with less complications, as they had better immediate and long-term postoperative clinical and functional outcomes. We recommend the utilization of autograft as first choice and the synthetic not to be used given the current criteria.
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Affiliation(s)
- Khaldoon M Bashaireh
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ziad Audat
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ahmad M Radaideh
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Abdelwahab J Aleshawi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
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Rahardja R, Zhu M, Love H, Clatworthy MG, Monk AP, Young SW. Factors associated with revision following anterior cruciate ligament reconstruction: A systematic review of registry data. Knee 2020; 27:287-299. [PMID: 32014408 DOI: 10.1016/j.knee.2019.12.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/28/2019] [Accepted: 12/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To identify the patient and surgical factors associated with revision anterior cruciate ligament (ACL) reconstruction as reported by all national and community ACL registries. METHODS A systematic review was performed on the MEDLINE, Embase and Cochrane Library databases. Eligibility criteria included English studies published by national or community ACL registries reporting on primary ACL reconstruction and risk factors associated with revision ACL reconstruction. RESULTS Thirty-three studies from the Swedish, Norwegian, Danish and Kaiser Permanente registries were included for review. Fourteen studies from all four registries reported younger age as a risk factor for revision ACL reconstruction. In addition, the Swedish registry reported concomitant medial collateral ligament (MCL) injury, undergoing earlier surgery, lower Knee Injury and Osteoarthritis Outcome Score (KOOS), smaller graft diameter and an anteromedial portal drilling technique as risk factors for revision. The risk factors reported by the Norwegian registry included lower body mass index (BMI), lower KOOS, hamstring tendon grafts and suspensory fixation. The Danish registry reported hamstring tendon grafts, anteromedial portal drilling and suspensory fixation as risk factors. The Kaiser Permanente registry reported male sex, lower BMI, ethnicity, hamstring tendon grafts, allografts, smaller graft diameter and an anteromedial portal technique as risk factors for revision. CONCLUSION Multiple patient and surgical factors were associated with increased risk of revision ACL reconstruction in registries. Younger age and the use of hamstring tendon grafts were consistently reported as risk factors for failure.
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Affiliation(s)
| | - Mark Zhu
- University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, Auckland Hospital, Auckland, New Zealand
| | | | - Mark G Clatworthy
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Andrew Paul Monk
- University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, Auckland Hospital, Auckland, New Zealand
| | - Simon W Young
- University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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Ugwuoke A, Syed F, El-Kawy S. Predicting adequacy of free quadriceps tendon autograft, for primary and revision ACL reconstruction, from patients' physical parameters. Knee Surg Sports Traumatol Arthrosc 2020; 28:448-453. [PMID: 31363806 DOI: 10.1007/s00167-019-05640-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE Free quadriceps tendon autograft (QTA) has gained popularity for both primary and revision ACL reconstruction. The aim of this study is to measure the dimensions of quadriceps tendon and determine its correlation with patient's height, weight and BMI. This is to provide a guide for patients and surgeons in predicting the suitability of QTA for ACL reconstructions. METHODS A cross-sectional study in which the length and thickness of the quadriceps tendon was measured in 51 Caucasian patients who underwent primary total knee arthroplasty. Exclusion criteria include non-Caucasians and previous tendon pathology. Patients were selected from routine elective total knee arthroplasty list. Tendon length is taken from musculotendinous junction to its insertion. Thickness was measured at midpoint and at distal insertion. Patients' height, weight and BMI were recorded. The correlation between patient physical parameters and tendon dimensions were determined. RESULTS Subjects' median age was 65 years (range 44-87), with 34 females and 17 males. Median length of the tendon was 9 mm (range 70-110), and median insertional thickness was 9 mm (7-10 mm). Median thickness at midpoint was 7 mm (range 4-10 mm). There was moderately positive correlation between subjects' height and tendon length (correlation coefficient 0.50), and also between weight and tendon length (correlation coefficient 0.47). There was no significant correlation between subjects' BMI and the tendon length. There was also no significant correlation between tendon thickness and subject's physical parameters. CONCLUSION This study has shown that most patients could provide adequate QTA for ACL reconstruction. It also points to the fact that no investigation is required to predict the adequacy of QTA. Though further studies with larger sample size are required to confirm this, clinician can rely on analysing patients' physical parameter in predicting the adequacy of QTA for ACL reconstruction. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Anthony Ugwuoke
- Department of Orthopaedics, Warwick Hospital, Lakin Road, Warwick, CV34 5BW, UK.
| | - Farhan Syed
- Trauma and Orthopaedics, Warwick Hospital, Warwick, UK
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Zheng X, Hu Y, Xie P, Li T, Feng YE, Gu J, Gao S. Clinical outcomes and second-look arthroscopic findings of anterior cruciate ligament reconstruction with autograft, hybrid graft, and allograft. J Orthop Surg Res 2019; 14:380. [PMID: 31752931 PMCID: PMC6868796 DOI: 10.1186/s13018-019-1439-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/30/2019] [Indexed: 01/29/2023] Open
Abstract
Background There is no consensus as to the choice of grafts for primary anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the clinical and second-look arthroscopic outcomes after ACL reconstruction by use of autograft, hybrid graft, and γ-irradiated allograft. Methods Ninety-seven patients who underwent second-look arthroscopy after ACL reconstruction with autografts (28 patients, hamstring autograft), hybrid grafts (32 patients, hamstring autograft augmented with γ-irradiated tibialis anterior tendon allograft), or γ-irradiated allografts (37 patients, tibialis anterior tendons) were included in this study. The clinical outcomes were compared by using Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity score, and the side-to-side differences of KT-1000 measurement. Second-look arthroscopic findings were compared in terms of synovial coverage and graft tension. Results There were no statistical significances among the three groups in Lysholm score, IKDC score, or Tegner activity score (P > 0.05). The KT-1000 examination showed more anterior laxity in the γ-irradiated allograft group than in the autograft or hybrid graft groups (P = 0.006, and P = 0.013, respectively). Two patients in the autograft group, 2 patients in the hybrid graft group and 4 patients in the allograft group were evaluated as graft failure on second-look arthroscopy. The synovial coverage was superior in the autograft group than that in the hybrid graft group or the allograft group (P = 0.013 and P = 0.010, respectively), and was comparable between the hybrid graft group and allograft group (P = 0.876). With regard to graft tension, the autograft group and hybrid group were comparable (P = 0.883) but showed better results than the allograft group (P = 0.011 and P = 0.007, respectively). Conclusion The hamstring autografts and hybrid grafts used for ACL reconstruction produced equal efficacy but provided better knee stability than allografts. In addition, the hamstring autografts showed better synovial coverage than the other two graft types.
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Affiliation(s)
- Xiaozuo Zheng
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China. .,Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Yang Hu
- The Second Department of Intensive Care Unit, Children's Hospital of Hebei Province, No. 133 Jianhua Road, Shijiazhuang, 050030, China
| | - Peng Xie
- Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.,Department of Nuclear medicine, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Tong Li
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.,Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Yu-E Feng
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.,Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Juyuan Gu
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.,Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Shijun Gao
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China. .,Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
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Effects of Graft Selection in Arthroscopic Anterior Cruciate Ligament Reconstruction: Midterm Functional Results. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2019; 53:419-425. [PMID: 32377119 PMCID: PMC7192287 DOI: 10.14744/semb.2018.23281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/21/2018] [Indexed: 12/30/2022]
Abstract
Objectives: This study is a comparison of the midterm clinical results of patients who underwent anterior cruciate ligament (ACL) reconstruction using an allograft and those who had an autograft procedure. Methods: The results of 70 patients who underwent ACL reconstruction with an anterior tibial tendon (ATT) allograft (n=18) or a hamstring (HT) autograft (n=52) were evaluated retrospectively. At the last follow-up, International Knee Documentation Committee (IKDC) and Tegner-Lysholm scores were used to assess functional status, as well as results of the Lachman test, the anterior drawer test, and the pivot-shift test. Results: There was no significant difference between the 2 groups in terms of age, gender, length of time before operation, graft thickness, or femoral tunnel length (p>0.05). The results were satisfactory in both groups in the postoperative period in terms of the length of time until a return to sports, IKDC score, Tegner-Lysholm score, range of motion, quadriceps circumference, and laxity, with no significant difference between the groups (p>0.05). Conclusion: The results of this study suggested that midterm clinical outcomes of ACL reconstruction with an ATT allograft or an HT autograft are similar when the correct technique is used according to the appropriate indications by an experienced surgeon and a successful rehabilitation program implemented after the operation.
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Snaebjörnsson T, Hamrin-Senorski E, Svantesson E, Karlsson L, Engebretsen L, Karlsson J, Samuelsson K. Graft Diameter and Graft Type as Predictors of Anterior Cruciate Ligament Revision: A Cohort Study Including 18,425 Patients from the Swedish and Norwegian National Knee Ligament Registries. J Bone Joint Surg Am 2019; 101:1812-1820. [PMID: 31626005 DOI: 10.2106/jbjs.18.01467] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is important to investigate and compare graft diameters as well as graft types to identify risk factors for revision after an anterior cruciate ligament (ACL) reconstruction. We performed the current study in order to analyze the early ACL revision rate among patients treated with hamstring tendon (HT) autografts or patellar tendon (PT) autografts of different diameters. Our hypothesis was that an increase in both HT and PT autograft diameters would reduce the risk of early ACL revision. METHODS This retrospective study was based on prospectively collected data from the national knee ligament registries of Norway and Sweden and included patients who underwent primary ACL reconstruction during the period of 2004 through 2014. The primary end point was the 2-year incidence of ACL revision. The impact of graft type and diameter on the incidence of revision surgery was reported as relative risks (RRs) with 95% confidence intervals (CIs), estimated by using generalized linear models with a binomial distribution and log-link function. RESULTS Of 58,692 patients identified, a total of 18,425 patients were included in this study. The 2-year rate of ACL revision was 2.10% (PT autografts, 2.63%; HT autografts, 2.08%; RR = 0.93 [95% CI = 0.60 to 1.45]). There was an increased risk of ACL revision among patients treated with HT autografts with a diameter of <8 mm compared with larger HT autografts (RR = 1.25 [95% CI = 1.01 to 1.57]). Patients treated with HT autografts with a diameter of ≥9.0 mm or ≥10.0 mm had a reduced risk of early ACL revision compared with patients treated with PT autografts. CONCLUSIONS Patients treated with larger-diameter HT autografts had a lower risk of early ACL revision compared with those treated with HT autografts of <8 mm. Patients treated with HT autografts of ≥9 or ≥10 mm had a reduced risk of early ACL revision compared with patients treated with PT autografts. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thorkell Snaebjörnsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eric Hamrin-Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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Campos GCD, Nunes LFB, Arruda LRP, Teixeira PEP, Amaral GHA, Alves Junior WDM. CURRENT PANORAMA OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SURGERY IN BRAZIL. ACTA ORTOPEDICA BRASILEIRA 2019; 27:146-151. [PMID: 31452610 PMCID: PMC6699397 DOI: 10.1590/1413-785220192703182208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aims to establish the current panorama of the anterior cruciate ligament reconstruction surgery in Brazil. METHODS A survey that consisted of a 24-item questionnaire including surgeon's demographics, preferred technique, graft selection, graft positioning, use of braces, drains, antibiotic prophylaxis and most common complications was conducted at the last three editions of a national knee surgery event. RESULTS Six hundred eight questionnaires were analyzed. Brazilian knee surgeons are mostly male, with mean age of 42 years (26-68) and are affiliated to at least one orthopedic society. Thirty-six percent (36%) perform more than 50 reconstructions per year. The preferred graft is the hamstring tendons graft (64%). The frequency of use of anatomical technique increased approximately from 55% from 2011 to 2013, to 85.5% in 2015 (p<0.001). From 2011 to 2015, there was a progressive reduction from 56.8% to 18.1% in the frequency of use of transtibial femoral tunnel drilling (p<0.001). CONCLUSION Our findings show that Brazilian knee surgeons' preferences are evolving according to the current world practice. Level of Evidence V, Economic and Decision analysis study.
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Incidence of graft failure with Achilles tendon allograft combined with RetroScrewTM tibial fixation in primary anterior cruciate ligament reconstruction. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Oliveira EA, Andrade AO, Vieira MF. Linear and nonlinear measures of gait variability after anterior cruciate ligament reconstruction. J Electromyogr Kinesiol 2019; 46:21-27. [PMID: 30878649 DOI: 10.1016/j.jelekin.2019.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 02/15/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to assess gait variability after anterior cruciate ligament reconstruction (ACLR), as an indicative of possible altered gait pattern and a measure of recovery compared to control subjects. Forty subjects (32 male), divided into 4 groups of 10 participants, were enrolled in the study: a control group (CG), and observational groups OG-I (90 days), OG-II (180 days), and OG-III (360 days) after ACLR. All subjects underwent the same rehabilitation program for six months. For kinematic recording, each subject walked on a treadmill for 4 min at a preferred walking speed. Linear gait variability was assessed using average standard deviation (VAR) and normalized root mean square of medial-lateral (ML) trunk acceleration (RMSratio). Gait stability was assessed using the margin of stability (MoS) and local dynamic stability (LDS), and nonlinear variability was assessed using sample entropy (SEn). Compared to the CG, the VAR ML increased significantly in the OG-I group and decreased incrementally in OG-II and OG-III. MoS increased significantly in the OG-I group and tends to maintain in OG-II and OG-III, while LDS was greater in the CG and decreased incrementally in the OG groups. The SEn was higher in the OG groups than in the CG and increased in OG-II and OG-III. The results indicated that ACL reconstruction was followed by a progressive increase in stability and a progressive increase in variability over the postoperative rehabilitation period. In terms of stability and gait variability, six months of physiotherapy for rehabilitation after ACL reconstruction appears to be effective, but it is insufficient for a complete recovery as compared to healthy individuals.
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Affiliation(s)
| | - Adriano O Andrade
- Centre for Innovation and Technology Assessment in Health (NIATS), Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Marcus Fraga Vieira
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil.
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Monaco E, Redler A, Fabbri M, Proietti L, Gaj E, Daggett M, Ferretti A. Isokinetic flexion strength recovery after ACL reconstruction: a comparison between all inside graft-link technique and full tibial tunnel technique. PHYSICIAN SPORTSMED 2019; 47:132-135. [PMID: 30347173 DOI: 10.1080/00913847.2018.1537535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Recently, a new minimally invasive single bundle technique for anatomic ACL reconstruction has been described, called the 'All-Inside graft-link technique'. One of the advantages of this procedure is the reduced morbidity at the donor site as the graft choice is the quadrupled semitendinosus, thus sparing the gracilis tendon. The aim of this study was to evaluate isokinetic flexion strength recovery in patients who underwent a gracilis sparing technique compared to those with a full-tibial tunnel technique using a doubled gracilis and semitendinosus tendons (DGST) graft. METHODS Patients were divided into two groups: Group A (22 patients) who underwent ACL reconstruction performed with an All-Inside graft-link technique; Group B (22 patients) who underwent ACL reconstruction with an Out-In technique and DGST graft. At a mean follow-up of 13 months, quadriceps and hamstring isokinetic peak torque deficits were recorded. RESULTS In group A, the mean side to side peak torque flexion difference between the operated and non-operated limbs was -3% and the mean torque at 30° was -7.5% at high angular velocity (180°/sec); the mean peak flexion torque was 7.2% and the mean torque at 30° was 3.1% at low angular velocity (60°/sec). In group B, the mean side to side peak flexion torque was -3.5% and the mean torque at 30° was -7.6% at high angular velocity (180°/sec); the mean peak flexion torque was -7.2% and the mean torque at 30° was -11% at low angular velocity (60°/sec). A statistically significant difference was found between the two groups at lower angular velocity both for the mean peak flexion torque and the mean torque at 30° (p = 0.009), with better results in the study group. DISCUSSION/CONCLUSION Gracilis sparing technique is a minimally invasive technique for ACL reconstruction and yielded a significantly better flexion strength recovery at lower angular velocity compared to a full tibial tunnel technique with DGST for ACL reconstruction.
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Affiliation(s)
- Edoardo Monaco
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
| | - Andrea Redler
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
| | - Mattia Fabbri
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
| | - Lorenzo Proietti
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
| | - Edoardo Gaj
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
| | - Matthew Daggett
- b Kansas City University of Medicine and Biosciences , Kansas City , MO , USA
| | - Andrea Ferretti
- a University of Rome la Sapienza, Sant'Andrea Hospital, Kirk Kilgour Sports Injury Center , Rome , Italy
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Sakti M, Yurianto H, Pasallo P, Hidayatullah S, Faisal A, Subagio ES. Anthropometric parameters measurement to predict 4-strand hamstring autograft size in single bundle anterior cruciate ligament reconstruction of South Sulawesi population. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Grassi A, Carulli C, Innocenti M, Mosca M, Zaffagnini S, Bait C. New Trends in Anterior Cruciate Ligament Reconstruction: A Systematic Review of National Surveys of the Last 5 Years. JOINTS 2018; 6:177-187. [PMID: 30582107 PMCID: PMC6301855 DOI: 10.1055/s-0038-1672157] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 08/10/2018] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to analyze national surveys of orthopaedic surgeons on anterior cruciate ligament (ACL) reconstruction to determine their preferences related to the preferred graft, femoral tunnel positioning, fixation and tensioning methods, antibiotic and anti-thromboembolic prophylaxis, and use of tourniquet and drains. A systematic search of PubMed, Web of Science, and Cochrane Library was performed. Inclusion criteria were surveys of ACL reconstruction trends and preferences published in the past 5 years (2011–2016), involving members of national societies of orthopaedics. Information regarding survey modalities, population surveyed, graft choice both in the general or in the athletic population, surgical technique, fixation, use of antibiotic, tourniquet, drains, and anti-thromboembolic prophylaxis was extracted. Eight national surveys were included from Europe (three), North or Latin America (three), and Asia (two). Overall, 7,420 questionnaires were sent, and 1,495 participants completed the survey (response rate ranging from 16 to 76.6%). All surveys reported the hamstring tendon (HT) autograft as the preferred graft, ranging from 45 to 89% of the surveyed population, followed by bone-patellar tendon-bone (BPTB) graft (2–41%) and allograft (2–17%). Only two surveys focusing on graft choice in athletic population underlined how in high-demand sportive population the graft choices changes in favor of BPTB. Single-bundle reconstruction was the preferred surgical technique in the four surveys that investigated this issue. Five surveys were in favor of anteromedial (AM) portal and two in favor of trans-tibial technique. Suspension devices for femoral fixation were the preferred choice in all but one survey, while interference screws were the preferred method for tibial fixation. The two surveys that investigated graft tensioning were in favor of manual tensioning. The use of tourniquet, antibiotics, drains, and anti-thromboembolic prophylaxis were vaguely reported. A trend toward the preference of HT autograft was registered in all the surveys; however, sport participation has been highlighted as an important variable for increased use of BPTB. Single-bundle reconstruction with AM portal technique and suspension femoral fixation and screws fixation for the tibia seem the preferred solution. Other variables such as tensioning, antibiotic, anti-thromboembolic prophylaxis, tourniquet use, and drains were investigated scarcely among the surveys; therefore, no clear trends could be delineated. This is a Level V, systematic review of expert opinion study.
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Affiliation(s)
- Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Christian Carulli
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Massimiliano Mosca
- II Clinica Ortopedica e Traumatologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Corrado Bait
- Joint Surgery and Sport Medicine Unit, Istituto Clinico Villa Aprica, Como, Italy
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Pelegrinelli ARM, Guenka LC, Dias JM, Dela Bela LF, Silva MF, Moura FA, Brown LE, Cardoso JR. ISOKINETIC MUSCLE PERFORMANCE AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A CASE-CONTROL STUDY. Int J Sports Phys Ther 2018; 13:882-889. [PMID: 30276020 PMCID: PMC6159501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND and Purpose: Knee muscle strength deficits have been reported in individuals who have undergone anterior cruciate ligament reconstruction (ACLR). Isokinetic testing is a valid way to assess muscle strength. Some isokinetic variables, including the range of motion in the phases to attain a specific velocity, load range (sustained specific velocity), time to achieve deceleration, and qualitative analysis of the torque-angle velocity relationship, may contribute to understanding recovery of these individuals after surgery. Thus, the purpose of this study was to compare the load range (LR), time to attain velocity (TTAV), deceleration time (DT) phases, total range of motion (ROM), peak torque/body mass (PT/BM), angle of peak torque (AngPT) during LR and torque-angle-velocity relationships (TAV3D) between post ACLR and matched control subjects.Study design: Case-control. METHODS Seven men who underwent ACLR and seven matched controls were evaluated from four to six months after surgery. Testing was performed on a Biodex System 4 isokinetic dynamometer in concentric mode at 60, 120 and 300 °/s, for knee flexion and extension. RESULTS Statistically significant differences were seen for extension ROM at 60 °/s where ROM was greater in the control group. PT/BM for extensors was also significantly greater in controls by 20 % compared to ACLR at 60 and 120 °/s. PT/BM for flexors was significantly greater for controls at 60 °/s (∼15 %). TAV3D showed differences in torque and, specifically, the control group sustained knee flexion torque for a greater range of motion when compared to the ACLR group. CONCLUSION The ACL group presented with lower ROM and PT/BM, therefore exhibiting worse muscle performance in comparison to the control group.Level of Evidence: 3.
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Affiliation(s)
| | | | | | | | | | | | - Lee E Brown
- California State University Fullerton, Fullerton, CA, USA
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Gupta R, Sood M, Malhotra A, Masih GD, Kapoor A, Raghav M, Dhillon M. Low re-rupture rate with BPTB autograft and semitendinosus gracilis autograft with preserved insertions in ACL reconstruction surgery in sports persons. Knee Surg Sports Traumatol Arthrosc 2018; 26:2381-2388. [PMID: 29138919 DOI: 10.1007/s00167-017-4790-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the results of bone-patellar tendon-bone graft (BPTB), semitendinosus-gracilis graft with preserved insertions (STGPI) and semitendinosus-gracilis-free graft (STGF) in terms of graft failure, objective mechanical stability, functional outcome, and return to sports in elite and recreational sports persons. It was hypothesized that the STGPI graft provided superior outcome as compared to the other two grafts. METHODS Two hundred and forty-nine elite and recreational players who underwent ACL reconstruction surgery, with BPTB graft (N = 80), STGPI graft (N = 85), and STGF graft (N = 84) with a minimum follow-up of 2 years, were assessed using clinical tests, knee arthrometer (KT 1000™), single-leg hop test, Lysholm knee score, Tegner's activity scale, and return to sports. Groups were matched in terms of age, gender, mode of injury, side involved, the level of sports, associated injuries, and mean follow-up. RESULTS The median age of the patients was 24 years (range 16-46 years), with 227 males and 22 females, with a mean follow-up of 61.8 ± 25.9 months. At the final follow-up, the mean side-to-side difference by KT 1000™ was significantly superior in BPTB group (1.4 ± 2.1 mm) as compared to STGPI (1.9 ± 2.0 mm) and STGF group (2.5 ± 2.0 mm) (p = 0.002). The mean Lysholm knee score, Limb symmetry index (LSI) using single-leg hop test and the mean difference in pre-injury and post-surgery level of Tegner's activity scale were not significantly different. The rate of graft failure was significantly higher in STGF group (7.1%) as compared to BPTB (1.2%) and STGPI (1.2%) groups (p = 0.043). CONCLUSION BPTB graft is a better graft in terms of mechanical stability than STGPI and STGF grafts. STGPI graft and BPTB graft are superior to STGF graft in terms of graft failure rate. However, there is no statistically significant difference amongst the three grafts in terms of return to sports and clinical tests of instability. STGPI graft is another option in the clinical setting with low graft failure rate like that of BPTB graft and with the added advantage of not having significant donor site morbidity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ravi Gupta
- Department Of Orthopaedics, Government Medical College Hospital, Chandigarh, 160030, India.
| | - Munish Sood
- Department Of Orthopaedics, Government Medical College Hospital, Chandigarh, 160030, India
| | - Anubhav Malhotra
- Department Of Orthopaedics, Government Medical College Hospital, Chandigarh, 160030, India
| | - Gladson David Masih
- Department Of Orthopaedics, Government Medical College Hospital, Chandigarh, 160030, India
| | - Anil Kapoor
- Department Of Orthopaedics, Government Medical College Hospital, Chandigarh, 160030, India
| | - Mukta Raghav
- Department Of Orthopaedics, Government Medical College Hospital, Chandigarh, 160030, India
| | - Mehar Dhillon
- Department Of Orthopaedics, Government Medical College Hospital, Chandigarh, 160030, India
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Luiso F, Tromponi C, Pozza P, Cavazza E, Vecchini E, Ricci M. Anterior cruciate ligament injury in amateur football players: risk factors and return to sport after surgical reconstruction. SPORT SCIENCES FOR HEALTH 2018. [DOI: 10.1007/s11332-018-0443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vasta S, Papalia R, Albo E, Maffulli N, Denaro V. Top orthopedic sports medicine procedures. J Orthop Surg Res 2018; 13:190. [PMID: 30064451 PMCID: PMC6069744 DOI: 10.1186/s13018-018-0889-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 07/12/2018] [Indexed: 12/14/2022] Open
Abstract
Orthopedic sports medicine is a subspecialty of Orthopedics that focuses on managing pathological conditions of the musculoskeletal system arising from sports practice. When dealing with athletes, timing is the most difficult issue to face. Typically, athletes aim to return to play as soon as possible and at the pre-injury level. This means that management should be optimized to combine the need for prompt return to sport and to the biologic healing time of the musculo-skeletal. This poses a great challenge to sport medicine surgeons, who need to follow with attention to the latest scientific evidence to offer their patients the best available treatment options. We briefly review the most commonly performed orthopedic sports medicine procedures, outlining the presently available scientific evidence on their indications and outcomes.
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Affiliation(s)
- Sebastiano Vasta
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico, University of Rome, Via Alvaro del Portillo, 200, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico, University of Rome, Via Alvaro del Portillo, 200, Rome, Italy.
| | - Erika Albo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico, University of Rome, Via Alvaro del Portillo, 200, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico, University of Rome, Via Alvaro del Portillo, 200, Rome, Italy
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