[Mid-term effectiveness of arthroscopic anterior cruciate ligament reconstruction combined with meniscus allograft transplantation]

A Long-term Comparison of Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Bioabsorbable Interference Screw and Endobutton on Femur

Introduction

Arthroscopic anterior cruciate ligament (ACL) reconstruction is a very commonly done procedure in recent times. There is a need for a long-term outcome study of ACL reconstruction with a comparison between different types of fixation techniques. The graft fixation methods vary from aperture fixation (interference screws) to suspensory fixation methods (endobutton). Failure of graft incorporation and the development of tunnel widening (TW) after ACL reconstruction have been frequently reported in the long term in present literature. TW especially complicates revision ACL surgery. This is a prospective non-randomized clinical study of arthroscopic ACL reconstruction comparing the functional results between aperture fixation and suspensory fixation.

Materials and Methods

Two groups of 14 patients who underwent autogenous hamstring ACL reconstruction with a minimum of 2-year follow-up evaluation were included in the study. The first group underwent aperture fixation with bioabsorbable interference screw at tibial and femoral side. The second group underwent suspensory fixation with endobutton fixation on the femoral side and biointerference screw on the tibial side. Both group patients were examined clinically before surgery, and at 3 months, 6 months, 1 year, and at 2 years. They were compared for functional outcome with Tegner Lysholm knee score.

Observation and Results

There was a significant improvement in functional outcome in both the groups for base and at 3 months, also for 3 months and 6 months but for 6 months-1 year. Group 2 is almost significant. This improvement in outcome in Group 2 is consistent from 1 year to 2 years.

Conclusion

In our prospective study comparing the outcomes of functional outcomes of ACL reconstruction with aperture fixation versus suspensory fixation on the femur, which was evaluated using Tegner Lysholm knee score over a period of 2 years, suspensory fixation was found to be better. However, further studies involving a larger series of cases are required for a better evaluation of the outcome.

Acceptable clinical outcomes despite high reoperation rate at minimum 12-month follow-up after concomitant arthroscopically assisted anterior cruciate ligament reconstruction and medial meniscal allograft transplantation

BACKGROUND

Single-stage medial meniscus allograft transplantation (MAT) with concomitant anterior cruciate ligament reconstruction (ACLR) is a technically challenging procedure for management of knee pain and instability in younger patients, but clinical and functional outcomes data are sparse. The purpose of this study was to assess surgical and patient-reported outcomes following concomitant ACLR and medial MAT.

METHODS

We conducted a retrospective case series of patients who underwent medial MAT with concomitant primary or revision ACLR at our institution from 2010 to 2021 and had minimum 12-month follow-up. Complications, reoperations, visual analog scale (VAS) pain, satisfaction, Lysholm score, return to sport, and return to work outcomes were assessed. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Pain Intensity, and Physical Function Scores were used to measure patients' functional status relative to the US population. P-values < 0.05 were considered significant.

RESULTS

The cohort consisted of 17 knees of 16 individual patients. The cohort was majority male (82.4%) with mean age of 31.9 years (range 19-49 years) and mean body mass index (BMI) of 27.9 kg/m² (range 22.5-53.3 kg/m²). Mean follow-up time was 56.8 months (range 13-106 months). Most patients underwent revision ACLR (64.7%). The 1-year reoperation rate was high (23.5%), with two patients (11.8%) tearing their meniscus graft. Patient-reported outcomes indicated low VAS pain (mean 2.2), high satisfaction (mean 77.9%), and fair Lysholm score (mean 81.1). Return to work rate was high (92.9%), while return to sport rate was low (42.9%). Postoperative PROMIS scores were comparable or superior to the national average and correlated significantly with patient satisfaction (p < 0.05).

CONCLUSIONS

The concomitant ACLR and MAT procedure is associated with excellent knee pain and functional outcomes and high rate of return to work after surgery, though the 1-year reoperation rate is high and rate of return to sport is low.

LEVEL OF EVIDENCE

IV.

Arthroscopic Anterior Cruciate Ligament Injury in Clinical Treatment of Joint Complications and CT Observation

Arthroscopy is the gold standard for diagnosing ACL injuries. It is a dual clinical technique for examination and treatment, which can effectively target the injury site for repair and treatment and can also accurately identify the lesion site and determine the degree of ligament injury through visual and three-dimensional observation of ligament injuries that are difficult to detect on imaging. However, this technique is invasive, so the clinic still needs to improve the related auxiliary imaging examination. In this paper, we performed MPR and VRT on patients with ACL injury and postprocessed the data. The diagnostic compliance rate of dual-source CT was 91.67% (33/36), the true positive rate was 93.33% (28/30), the missed rate was 6.67% (2/30), the true negative rate was 83.33% (5/6), and the misdiagnosis rate was 83.33% (5/6). The rate of true negative was 83.33% (5/6), and the rate of false diagnosis was 16.67% (1/6). Kappa analysis of the consistency between dual-source CT and arthroscopy showed a Kappa value of 0.719, indicating a high degree of consistency between the two examinations. In conclusion, MPR and VRT images are of clinical value for the diagnosis of ACL injury. In addition, dual-source CT can measure the CT value of the ACL and the thickness of each segment by MPR and VRT postprocessing techniques to diagnose the ligament injury in an objective, quantitative, and noninvasive way and can use dual-energy staining techniques to predict the ligament injury in a more intuitive way, which is not available in some arthroscopes.