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Zhang Z, Meng B, Li W, Cao J. The role of navigation technology in anterior cruciate ligament reconstruction bone tunnel positioning. J Robot Surg 2025; 19:90. [PMID: 40019692 DOI: 10.1007/s11701-025-02254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 02/18/2025] [Indexed: 03/01/2025]
Abstract
In the past decade, navigation technology-assisted bone tunnels positioning for anterior cruciate ligament reconstruction (ACLR) has received great attention. The purpose of this review is to summarize the navigation technologies applied in ACLR, describe the tunnel positioning accuracy of these technologies, and summarize their advantages and disadvantages, providing a basis for navigation technology to assist ACLR. This review discusses the limitations of traditional bone tunnel positioning methods in ACLR and further introduces various navigation techniques, focusing on their positioning accuracy and postoperative outcomes for patients. Additionally, it presents commercial systems utilizing reality-based technologies and examines their impact on the arthroscopic learning curve for less experienced surgeons. The osseous landmarks are currently the most used positioning method, but they still have shortcomings. Navigation technologies primarily focus on computer-assisted navigation, which, however, requires additional incisions. Virtual reality and augmented reality are mainly utilized in preoperative planning, with the best-reported positioning accuracy of augmented reality being 0.32 mm, while most other accuracies are within 3 mm. Mixed reality offers a novel approach for precise positioning, resulting in more optimal and consistent postoperative tunnel placement. Navigation technology improves the positioning accuracy of the bone tunnels and achieves good short-term results. Key to the future is long-term follow-up to assess clinical outcomes of navigation techniques.
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Affiliation(s)
- Zi Zhang
- Department of Sports Injury and Arthroscopy, Tianjin Hospital, Tianjin University, Tianjin, 300222, People's Republic of China
- Medical School of Tianjin University, Tianjin University, Tianjin, China
| | - Binyang Meng
- Department of Sports Injury and Arthroscopy, Tianjin Hospital, Tianjin University, Tianjin, 300222, People's Republic of China
- Medical School of Tianjin University, Tianjin University, Tianjin, China
| | - Wenhe Li
- Department of Sports Injury and Arthroscopy, Tianjin Hospital, Tianjin University, Tianjin, 300222, People's Republic of China
- Medical School of Tianjin University, Tianjin University, Tianjin, China
| | - Jiangang Cao
- Department of Sports Injury and Arthroscopy, Tianjin Hospital, Tianjin University, Tianjin, 300222, People's Republic of China.
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Bracken T, Veilleux A, Khalik HA, Johnson J, de SA D. Femoral tunnel length does not impact outcomes following ACL reconstruction using a single-bundle quadriceps tendon autograft: A systematic review. Knee Surg Sports Traumatol Arthrosc 2025; 33:567-580. [PMID: 39082876 PMCID: PMC11792107 DOI: 10.1002/ksa.12395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 07/06/2024] [Accepted: 07/15/2024] [Indexed: 02/05/2025]
Abstract
PURPOSE To determine whether femoral tunnel length (FTL) affects clinical or functional outcomes following primary Anterior cruciate ligament reconstruction (ACLR) with single-bundle quadriceps tendon autograft, both with and without a patellar bone block. METHODS An electronic search of MEDLINE, EMBASE, and Cochrane databases was carried out via OVID. Data pertaining to study characteristics, patient demographics, surgical techniques, femoral tunnel length, and subjective/objective clinical outcomes was abstracted. Studies were stratified into two groups based on FTL; a short femoral tunnel (S-FT) group of ≤25 mm, and a long femoral tunnel (L-FT) group of >25 mm. There was a high degree of heterogeneity between studies, prohibiting meta-analysis. RESULTS Seven studies comprising 368 total patients with a mean age of 30.3 years (range: 23.4-34 years) were included for analysis. The S-FT group included 126 patients and the L-FT group 242 patients. Both groups demonstrated statistically significant postoperative improvements across both subjective and objective clinical and functional outcomes. Average complication rates were 11.9% (range: 0%-29%) in the S-FT group and 4.5% (range: 1%-14%) in the L-FT group. Ranges of re-rupture rates were 0%-2% and 0%-3% for the S-FT and L-FT groups, respectively (n.s.). CONCLUSION Both S-FT and L-FT groups demonstrated comparable postoperative outcomes following primary ACLR with single bundle quadriceps tendon autograft. There were slightly superior, although non-significant, outcomes reported with short femoral tunnel length, however, this may have been confounded by the variation in surgical technique used. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Tess Bracken
- Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Alexandre Veilleux
- Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonOntarioCanada
| | | | - Jansen Johnson
- Division of Orthopaedic SurgeryMcMaster UniversityHamiltonOntarioCanada
| | - Darren de SA
- Division of Orthopaedic SurgeryMcMaster UniversityHamiltonOntarioCanada
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Miralles-Muñoz FA, de La Pinta-Zazo C, Albero-Catalá L, Vizcaya-Moreno MF. The method of femoral tunnel drilling in anterior cruciate ligament reconstruction does not influence the return to sport rate. J Orthop 2024; 56:87-91. [PMID: 38800591 PMCID: PMC11111841 DOI: 10.1016/j.jor.2024.05.017] [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: 05/01/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
Background Limited evidence is available comparing the modified transtibial (MTT) and transportal (TP) techniques in anterior cruciate ligament (ACL) reconstruction and their impact on returning to sports participation. The objective was to analyze the outcomes after arthroscopic reconstruction of the ACL in recreational athletes with a 2-year postoperative follow-up, comparing the MTT and TP techniques, based on the method used to drill the femoral tunnel. Hypotesis The rate of return to sport would be comparable regardless of the surgical technique used. Material and methods A retrospective study was conducted with 66 patients who underwent arthroscopic monofascicular ACL reconstruction between September 2016 and March 2020. Patients aged between 16 and 50 years old, recreational athletes at Tegner levels 6 and 7, with a 2-year follow-up were included. Groups were established for comparative analysis (MTT vs TP) based on the method for drilling the femoral tunnel. The main outcome variable was the return to sport at the same level. Secondary variables included patient satisfaction evaluated with a visual analogue scale (VAS) and knee function according to the Lysholm scale. Results At 2 years of postoperative follow-up, the return to sport rate was 30.3 % in the MTT group and 33.3 % in the TP group (p = 0.791). There were no significant differences between both groups in patient satisfaction (p = 0.664) and knee function (p = 0.113). Conclusion Drilling the femoral tunnel with the MTT and TP techniques did not influence the rate of return to sport, patient satisfaction, and knee function in recreational athletes with 2 years of postoperative follow-up. Level of evidence III.
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Affiliation(s)
| | - Carlos de La Pinta-Zazo
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra. Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Luis Albero-Catalá
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra. Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - María Flores Vizcaya-Moreno
- Faculty of Health Sciences, University of Alicante, Building 26 - University School of Nursing, Carr. de San Vicente del Raspeig, 03690, Alicante, Spain
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Khan ZA, Kerzner B, Kaplan DJ, Riff AJ, Chahla J, Bach BR. A Single-Surgeon 35-Year Experience With ACL Reconstruction Using Patellar Tendon Auto- and Allografts With the Transtibial Technique. Orthop J Sports Med 2024; 12:23259671241265074. [PMID: 39286523 PMCID: PMC11403700 DOI: 10.1177/23259671241265074] [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: 01/28/2024] [Accepted: 02/23/2024] [Indexed: 09/19/2024] Open
Abstract
Background Long-term follow-up for anterior cruciate ligament reconstruction (ACLR) is limited due to heterogeneity in the number of techniques utilized, the number of surgeons included, and attrition bias. Purpose To analyze a single surgeon's 35-year experience with ACLR using the transtibial technique, with an emphasis on temporal trends in graft selection and subanalyses on rates of revision surgery, contralateral ACLR, and nonrevision reoperation among different demographic cohorts of patients. Study Design Case series; Level of evidence, 4. Methods All patients who underwent arthroscopically assisted single-bundle ACLR between 1986 and 2021 were identified from a prospectively maintained single-surgeon registry. Outcomes of interest included revision, reoperation, and contralateral rupture rates. Results A total of 2915 ACLRs were performed during the senior surgeon's career. The mean age for primary ACLR was 29.4 ± 14.8 years. During primary ACLR, 98.4% of patients received a central-third bone-patellar tendon-bone (BPTB) graft. Increasing patient age was associated with increasing allograft usage (P < .01), with a significant temporal increase in allograft usage over the senior surgeon's career (P < .01). There was a higher revision rate among younger patients (P < .01), female patients aged 21 to 25 years (P = .01), and patients who received an allograft during the primary procedure (P = .04). The contralateral rupture rate showed no difference between sexes (P = .34); however, patients who underwent ACLR with autograft had a greater rate of contralateral injury compared with those with allograft (P < .01). The contralateral rupture rate was greater than the revision rate (P < .01). The most common causes of nonrevision reoperation were failed meniscal repair, new meniscal tears, arthrofibrosis, and painful hardware removal. Conclusion The findings of this single-surgeon registry reveal temporal trends in ACLR over a 35-year career. There was a trend toward increasing BPTB allograft use in ACLR, especially in older patients and revision cases. A greater revision rate was observed among younger patients, female patients, and those receiving allografts during primary surgery. Contralateral ACLR was more common than revision surgery.
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Affiliation(s)
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel J Kaplan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrew J Riff
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Wang J, Liu J, Wu L, Tao L, Liu X, Wang Z, Xiong Y. Accuracy of Femoral Tunnel Localization With Mixed Reality Technology-Assisted Single-Bundle ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231184399. [PMID: 37457048 PMCID: PMC10338724 DOI: 10.1177/23259671231184399] [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: 02/21/2023] [Accepted: 04/05/2023] [Indexed: 07/18/2023] Open
Abstract
Background It is clinically challenging to accurately drill femoral and tibial tunnels to reconstruct the anterior cruciate ligament (ACL). Mixed reality (MR) technology, a further development of virtual reality technology, presents virtual scene information in real time and establishes an interactive feedback information loop among the real world, the virtual world, and the user. Purpose/Hypothesis The purpose of this study was to investigate the structural and early clinical outcomes of ACL reconstruction assisted by MR technology. It was hypothesized that MR technology would improve the accuracy of tunnel localization. Study Design Cohort study; Level of evidence, 3. Methods Included were 44 patients at a single institution who underwent arthroscopic single-bundle ACL reconstruction between June 2020 and March 2022. Reconstruction with the aid of MR technology was performed in 21 patients (MR group), and conventional arthroscopic reconstruction was performed in 23 patients. Postoperatively, the parameters related to the bone tunnel positioning were compared by computed tomography imaging with 3-dimensional (3D) reconstruction, and 12-month postoperative clinical outcomes were assessed with the Lysholm and International Knee Documentation Committee scores. Results There was no statistically significant difference in projection angles in the coronal, axial, or sagittal plane between the preoperative virtually created tunnel guide pin and the actual tunnel (P > .05 for all). In the MR group, the center of the femoral tunnel exit was closer to the apex of the lateral femoral condyle along the proximal-distal axis (14.07 ± 4.12 vs 17.49 ± 6.24 mm for the conventional group; P < .05) and the graft bending angle was lower (117.71° ± 8.08° vs 127.81° ± 11.91° for the conventional group; P < .05). The scatterplot of the femoral tunnel location distribution showed that the entrance and exit points in the MR group were more concentrated and closer to the ideal location of the preoperative design than in the conventional group. Patients in both groups had significant preoperative-to-postoperative improvement based on outcome scores (P < .001 for all), with no significant difference between groups. Conclusion ACL reconstruction with the aid of MR technology allowed for more accurate positioning and orientation of the femoral tunnel during surgery when compared with conventional reconstruction.
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Affiliation(s)
- Jingkun Wang
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Jun Liu
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Liming Wu
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Lun Tao
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiangdong Liu
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Ziming Wang
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Yan Xiong
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, China
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Wang Y, Ren C, Bi F, Li P, Tian K. The hydroxyapatite modified 3D printed poly L-lactic acid porous screw in reconstruction of anterior cruciate ligament of rabbit knee joint: a histological and biomechanical study. BMC Musculoskelet Disord 2023; 24:151. [PMID: 36849968 PMCID: PMC9969685 DOI: 10.1186/s12891-023-06245-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND 3D printing technology has become a research hotspot in the field of scientific research because of its personalized customization, maneuverability and the ability to achieve multiple material fabrications. The focus of this study is to use 3D printing technology to customize personalized poly L-lactic acid (PLLA) porous screws in orthopedic plants and to explore its effect on tendon-bone healing after anterior cruciate ligament (ACL) reconstruction. METHODS Preparation of PLLA porous screws with good orthogonal pore structure by 3D printer. The hydroxyapatite (HA) was adsorbed on porous screws by electrostatic layer-by-layer self-assembly (ELSA) technology, and PLLA-HA porous screws were prepared. The surface and spatial morphology of the modified screws were observed by scanning electron microscopy (SEM). The porosity of porous screw was measured by liquid displacement method. Thirty New Zealand male white rabbits were divided into two groups according to simple randomization. Autologous tendon was used for right ACL reconstruction, and porous screws were inserted into the femoral tunnel to fix the transplanted tendon. PLLA group was fixed with porous screws, PLLA-HA group was fixed with HA modified porous screws. At 6 weeks and 12 weeks after surgery, 5 animals in each group were sacrificed randomly for histological examination. The remaining 5 animals in each group underwent Micro-CT and biomechanical tests. RESULTS The pores of PLLA porous screws prepared by 3D printer were uniformly distributed and connected with each other, which meet the experimental requirements. HA was evenly distributed in the porous screw by ELSA technique. Histology showed that compared with PLLA group, mature bone trabeculae were integrated with grafted tendons in PLLA-HA group. Micro-CT showed that the bone formation index of PLLA-HA group was better than that of PLLA group. The new bone was uniformly distributed in the bone tunnel along the screw channel. Biomechanical experiments showed that the failure load and stiffness of PLLA-HA group were significantly higher than those of PLLA group. CONCLUSIONS The 3D printed PLLA porous screw modified by HA can not only fix the grafted tendons, but also increase the inductivity of bone, promote bone growth in the bone tunnel and promote bone integration at the tendon-bone interface. The PLLA-HA porous screw is likely to be used in clinic in the future.
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Affiliation(s)
- Yafei Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, China
| | - Chengzhen Ren
- Department of Orthopedic Surgery, the First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, China
| | - Fanggang Bi
- Department of Orthopedic Surgery, the First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, China
| | - Pengju Li
- Department of Orthopedic Surgery, the Honghui Hospital of Xi'an, No. 76 Nanguo road, Nan Xiaomen, Xi'an, 710054, China
| | - Ke Tian
- Department of Orthopedic Surgery, the First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, China.
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Petersen W, Häner M, Guenther D, Lutz P, Imhoff A, Herbort M, Stein T, Schoepp C, Akoto R, Höher J, Scheffler S, Stöhr A, Stoffels T, Mehl J, Jung T, Eberle C, Vernacchia C, Ellermann A, Krause M, Mengis N, Müller PE, Best R, Achtnich A. Management after acute injury of the anterior cruciate ligament (ACL), part 2: management of the ACL-injured patient. Knee Surg Sports Traumatol Arthrosc 2022; 31:1675-1689. [PMID: 36471029 DOI: 10.1007/s00167-022-07260-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this consensus project was to create a treatment algorithm for the management of the ACL-injured patient which can serve as an aid in a shared decision-making process. METHODS For this consensus process, a steering and a rating group were formed. In an initial face-to-face meeting, the steering group, together with the expert group, formed various key topic complexes for which various questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS During this consensus process, 15 key questions were identified. The literature search for each key question resulted in 24 final statements. Of these 24 final statements, all achieved consensus. CONCLUSIONS This consensus process has shown that ACL rupture is a complex injury, and the outcome depends to a large extent on the frequently concomitant injuries (meniscus and/or cartilage damage). These additional injuries as well as various patient-specific factors should play a role in the treatment decision. The present treatment algorithm represents a decision aid within the framework of a shared decision-making process for the ACL-injured patient. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Wolf Petersen
- Department of Orthopedics, Sportsclinic Berlin, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, 14193, Berlin-GrunewaldBerlin, Germany
| | - Martin Häner
- Department of Orthopedics, Sportsclinic Berlin, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, 14193, Berlin-GrunewaldBerlin, Germany.
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine Cologne Merheim Medical Center (Witten/Herdecke University), Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Patricia Lutz
- Department of Orthopaedics and Trauma Surgery, State Hospital Feldkirch, Carinagasse 41, 6800, Feldkirch, Austria
| | - Andreas Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Mirco Herbort
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | - Thomas Stein
- SPORTHOLOGICUM® Frankfurt Am Main, Siesmayerstraße 44, 60323, Frankfurt Am Main, Germany
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt Am Main, Germany
| | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum, Duisburg gGmbH, Großenbaumer Allee 250, 47249, Duisburg, Germany
| | - Ralph Akoto
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
- Department of Orthopaedics, Trauma Surgery and Sports Medicine, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - Jürgen Höher
- SPORTSCLINIC COLOGNE, Ostmerheiemer Str. 200, 51109, Cologne, Germany
| | - Sven Scheffler
- Sporthopaedicum Berlin, Bismarckstrasse 45-47, 10627, Berlin, Germany
| | - Amelie Stöhr
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | | | - Julian Mehl
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Christian Eberle
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Cara Vernacchia
- Department of Physical Medicine and Rehabilitation, Shirley Ryan Ability Lab, Chicago, IL, USA
- McGaw/Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andree Ellermann
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Natalie Mengis
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
- KSA Aarau/Spital Zofingen, Mühlethalstrasse 27, 4800, Zofingen, Schweiz
| | - Peter E Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany
- Department of Sports Medicine and Orthopaedics, University of Tuebingen, Hoppe Seyler Strasse 5, 72074, Tuebingen, Germany
| | - Andrea Achtnich
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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Liu A, Cui W, Yang W, Li C, Yan S, Xin Z, Wu H. Anterior Tibial Subluxation of Lateral Compartment Is Associated With High-Grade Rotatory Instability for Acute But Not Chronic Anterior Cruciate Ligament Injuries: An Magnetic Resonance Imaging Case-Control Study. Arthroscopy 2022; 38:2852-2860. [PMID: 35550417 DOI: 10.1016/j.arthro.2022.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/07/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate whether anterior tibial subluxation obtained from magnetic resonance imaging (MRI) could be a predictor of high-grade rotatory instability for anterior cruciate ligament (ACL) injuries, including acute and chronic cases. METHODS From September 2016 to August 2018, we retrospectively investigated 163 patients with ACL injuries who subsequently underwent primary ACL reconstruction. Among them, 30 patients with high-grade rotatory instability (grade II/III pivot shift) were included in the high-grade group, and their age and sex were matched 1:2 to low-grade cases (<grade II pivot shift). On preoperative MRI, we measured anterior tibial subluxation, posterior tibial slope, as well as the time from injury to surgery. Meniscal lesions were documented from arthroscopy. Multivariable logistic regression was used to determine predictors of high-grade rotatory instability. Furthermore, subgroup comparisons between 2 groups were divided into acute (≤3 months) and chronic (>3 months) phases. RESULTS The high-grade group had a larger anterior tibial subluxation of lateral compartment (8.1 mm vs 5.9 mm; P =.004) than the low-grade group, whereas no significant difference was found in anterior tibial subluxation of medial compartment (P > .05). Moreover, high-grade anterior tibial subluxation of lateral compartment (≥6 mm) was found to be an independent predictor (odds ratio, 12.992; P = .011) associated with concomitant meniscal tears after ACL injuries. Anterior tibial subluxation of lateral compartment demonstrated statistical significance between the two groups when comparing subgroups within 3 months but not beyond 3 months. CONCLUSION In ACL-injured patients, high-grade anterior tibial subluxation of lateral compartment (≥6 mm) could be a unique predictor of high-grade knee rotatory instability for acute but not chronic injuries. Prolonged time from injury to surgery and lateral meniscus tears were risk factors for high-grade rotatory laxity in chronic patients. LEVEL OF EVIDENCE Level III, retrospective prognostic trial.
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Affiliation(s)
- An Liu
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Wushi Cui
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Weinan Yang
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Congsun Li
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Shigui Yan
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Zengfeng Xin
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China.
| | - Haobo Wu
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China.
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Schaffer JC, Kuhns B, Reuter J, Sholtis C, Karnyski S, Goldblatt JP, Bronstein RD, Maloney MD, Baumhauer J, Mannava S. Clinically Depressed Patients Having Anterior Cruciate Ligament Reconstruction Show Improved but Inferior Rate of Achieving Minimum Clinically Important Difference for Patient-Reported Outcomes Measurement Information System Compared With Situationally Depressed or Nondepressed Patients. Arthroscopy 2022; 38:2863-2872. [PMID: 35550418 DOI: 10.1016/j.arthro.2022.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/07/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the preoperative diagnosis of depression predicted worse postoperative outcomes, including physical therapy (PT) compliance, return-to-sport, and patient-reported outcomes using the Patient-Reported Outcomes Measurement Information System (PROMIS) after anterior cruciate ligament (ACL) reconstruction. METHODS A multisurgeon series of consecutive patients who had undergone ACL reconstruction with minimum 2-year follow-up were included. Chart review was conducted to determine depression diagnosis status, demographic data, rehabilitation PT compliance, return to sports, and patient-reported outcome data using PROMIS. Patients who met the PROMIS threshold for mild depression but did not carry a clinical diagnosis of depression were classified as "situationally depressed." RESULTS Ninety-five of 115 consecutive patients (81%) met inclusion criteria with an average follow-up of 34 ± 1.9 months. Fourteen patients (15%) had a preoperative diagnosis of depression, whereas 21 (22%) were considered situationally depressed. Clinically depressed patients had a greater rate of PT noncompliance (33.2% ± 17.6% vs 21.9% ± 12.6%; P = .02) and a lower postoperative PROMIS Physical Function (50.8 ± 7.7 vs 57.8 ± 11.0; P = .03 compared with patients without depression. Situationally depressed patients had lower preoperative physical function (35.4 vs 42.5; P = .04) with no differences in postoperative outcomes scores compared to the non-depressed cohort.19/21 (90.5%) of situationally depressed patients had postoperative resolution of their depressive symptoms. CONCLUSIONS Situationally depressed patients without a clinical diagnosis of depression can expect significant improvements in both pain and function, as well as a resolution of their depressed mood based on PROMIS scores as they progress through recovery after ACL reconstruction. Clinically depressed patients also experience significant improvements; however, their rate of achieving the minimum clinically important difference for PROMIS outcomes may be less than their nondepressed or situationally depressed counterparts. LEVEL OF EVIDENCE III, prognostic comparative trial.
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Affiliation(s)
- Joseph C Schaffer
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Benjamin Kuhns
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A.
| | - John Reuter
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Connor Sholtis
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Steven Karnyski
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - John P Goldblatt
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Robert D Bronstein
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Michael D Maloney
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Judith Baumhauer
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Sandeep Mannava
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
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10
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Liu A, Ye X, Li C, Yang W, Yan S, Xin Z, Wu H. Preoperative excessive lateral anterior tibial subluxation is related to posterior tibial tunnel insertion with worse sagittal alignment after anterior cruciate ligament reconstructions. Front Surg 2022; 9:965505. [PMID: 36189385 PMCID: PMC9515393 DOI: 10.3389/fsurg.2022.965505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate whether preoperative lateral anterior tibial subluxation (LATS) measured from magnetic resonance imaging (MRI) can influence tibial insertion and postoperative sagittal alignment after anterior cruciate ligament reconstructions (ACLRs). Methods 84 patients who underwent single-bundle ACLRs were retrospectively investigated. Among them, 39 patients (LATS of <6 mm) 23 patients (LATS of ≥6 mm and <10 mm) and 22 patients (excessive LATS of ≥10 mm) were defined as group 1, 2 and 3, respectively. LATS, the position of graft insertion into tibia as ratio of anterior-posterior width (AP ratio) and the sagittal graft angle (SGA) were postoperatively assessed from MRI at 2-year follow-up. Following linear regression analyses were employed. Results The group 3 exhibited the largest preoperative LATS and remained the most postoperative LATS. Moreover, the group 3 possessed the most posteriorly located tunnel insertion with the largest AP ratio and the most vertical graft orientation. Of all included patients, a moderate correlation was demonstrated between pre- and postoperative LATS (r = 0.635). A low correlation was observed between preoperative LATS and AP ratio (r = 0.300) and a moderate correlation was displayed between AP ratio and SGA (r = 0.656). Conclusion For ACL injuries with excessive LATS (≥10 mm), most posteriorly located tibial insertion was found out, and worse sagittal alignment containing high residual LATS was associated with more vertical graft orientation following ACLRs.
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Affiliation(s)
- An Liu
- Department of Orthopedics, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Ye
- Department of Ultrasound, Hangzhou Women`s Hospital, Hangzhou, China
| | - Congsun Li
- Department of Orthopedics, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weinan Yang
- Department of Orthopedics, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shigui Yan
- Department of Orthopedics, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zengfeng Xin
- Department of Orthopedics, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Correspondence: Haobo Wu Zengfeng Xin
| | - Haobo Wu
- Department of Orthopedics, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Correspondence: Haobo Wu Zengfeng Xin
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11
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Similar outcomes and satisfaction after transtibial versus transportal femoral drilling for anterior cruciate ligament reconstruction in young adult recreational athletes. Knee Surg Sports Traumatol Arthrosc 2022; 30:1197-1203. [PMID: 33386427 DOI: 10.1007/s00167-020-06393-8] [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: 09/18/2020] [Accepted: 11/24/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE Controversy continues regarding whether the transtibial (TT) and transportal (TP) methods for anterior cruciate ligament (ACL) reconstruction provide similar or different outcomes, and the evidence on patient satisfaction is very limited. The objective of this study was to compare functional outcomes and patient satisfaction in young adult recreational athletes who underwent arthroscopic hamstring ACL reconstruction using either the TT or the TP femoral tunnel drilling method. METHODS A nonrandomized prospective study was designed to compare the outcomes of arthroscopic hamstring ACL reconstruction using TT or TP method. Functional outcome was assessed with the Lyshom score, and patient satisfaction with a 5-point Likert scale. Knee stability was measured with the KT-1000 arthrometer. RESULTS 42 patients in the TT group and 41 in TP group, with age ranged 18-40 years, were compared with a mean follow-up of 42 (range 24-60) months. There were no significant differences between groups in the Lysholm score (n.s.), sport return rate (n.s.) or patient satisfaction with the surgery (n.s.). Satisfaction was only significantly associated with the Lysholm score (OR 1.3; IC 95% 1.06-1.6; p = 0.012), but not with the return to sports (n.s.) or knee anterior laxity (n.s.). CONCLUSION This study showed no statistical differences between the TT and the TP method in functional outcomes or patient satisfaction in young adult recreational athletes. In those patients, satisfaction with the surgery was not influenced by the return to sport activities. This study can guide surgeons in the decision-making for ACL reconstruction in recreational athletes. LEVEL OF EVIDENCE Level II.
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12
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Luo Z, Hu Y, Han Q, Gao Z, Cheng S. Safe femoral condyle range for the reverse Rigidfix femoral fixation device in anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2022; 23:288. [PMID: 35337308 PMCID: PMC8951699 DOI: 10.1186/s12891-022-05250-8] [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: 12/08/2021] [Accepted: 03/21/2022] [Indexed: 12/05/2022] Open
Abstract
Background To determine the characteristics of cross-pin protrusion in patients treated with the reverse Rigidfix femoral fixation device for femoral tunnel preparation through the anteromedial portal in Arthroscopic anterior cruciate ligament reconstruction (ACLR), analyse the reasons for this outcome, and identify safety hazards of this surgical technique for improvement. Methods A retrospective analysis of patients who underwent ACLR using this technology at our hospital in 2018 was conducted. Patients with and without cross-pin protrusion were included in the protrusion positive and negative groups, respectively. The sex, age and imaging characteristics of the patients with cross-pin protrusion were identified, and the reasons for cross-pin protrusion were analysed. Results There were 64 and 212 patients in the protrusion positive and negative groups, respectively. The proportion of cross-pin protrusion cases was 23.19% (64/276). There was a significant difference in the ratio of males to females (P < 0.001, χ2 = 185.184), the mediolateral femoral condyle diameter (protrusion positive group, 70.59 ± 2.51 mm; protrusion negative group, 82.65 ± 4.16 mm; P < 0.001, t = 28.424), and the anteroposterior diameter of the lateral femoral condyle (protrusion positive group, 58.34 ± 2.89 mm; protrusion negative group, 66.38 ± 3.53 mm; P < 0.001, t = 16.615). The cross-pins did not penetrate the lateral femoral condyle cortex in patients with a mediolateral femoral condyle diameter ≥ 76 mm, but the cross-pins definitely penetrated the cortex when the diameter was ≤ 70 mm. The cross-pins did not penetrate when the anteroposterior lateral femoral condyle diameter was ≥ 66 mm, but the cross-pins definitely penetrated it when the diameter was ≤ 59 mm. Conclusion The patients with cross-pin protrusion after reverse Rigidfix femoral fixation treatment to prepare the femoral tunnel through the anteromedial portal in ACLR were mainly females with small femoral condyles. For patients with a mediolateral femoral condyle diameter ≥ 76 mm and an anteroposterior lateral femoral condyle diameter ≥ 66 mm, there is no risk of cross-pin protrusion, so this technique can be used with confidence. Levels of evidence III. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05250-8.
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Affiliation(s)
- Zhongliu Luo
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, No. 232, Outer Ring East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province, China.,Department of Knee Joint Sports Injury, Sichuan Provincial Orthopedic Hospital, No. 132, West Section, First Ring Road, Sichuan Province, Chengdu, China
| | - Yong Hu
- Department of Knee Joint Sports Injury, Sichuan Provincial Orthopedic Hospital, No. 132, West Section, First Ring Road, Sichuan Province, Chengdu, China.
| | - Qingmin Han
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, No. 232, Outer Ring East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province, China
| | - Zhi Gao
- Department of Knee Joint Sports Injury, Sichuan Provincial Orthopedic Hospital, No. 132, West Section, First Ring Road, Sichuan Province, Chengdu, China
| | - Songmiao Cheng
- Department of Knee Joint Sports Injury, Sichuan Provincial Orthopedic Hospital, No. 132, West Section, First Ring Road, Sichuan Province, Chengdu, China
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13
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Tecame A, Buschini F, Dini F, Zampogna B, Ampollini A, Papalia R, Adravanti P. Failure rate analysis and clinical outcomes of two different femoral tunnel positions using anteromedial portal technique in anterior cruciate ligament reconstruction. Knee 2022; 35:45-53. [PMID: 35219217 DOI: 10.1016/j.knee.2022.02.010] [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: 03/17/2021] [Revised: 10/10/2021] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Abstract
AIM To analyze two different femoral tunnel positions and to evaluate their correlation with clinical, functional outcomes and surgical revision rate in patients who underwent primary arthroscopic anterior cruciate ligament (ACL) reconstruction with anteromedial (AM) portal technique. METHODS From January 2015 to October 2018, we recruited 244 patients that underwent primary single-bundle ACL reconstruction, using four strand-semitendinosus graft and AM portal technique for femoral tunnel placement. Patients were divided into two groups based on the different femoral tunnel positions: 117 patients of group A had ACL footprint center femoral tunnel position compared with 127 patients of group B, with femoral tunnel placement close to the AM bundle footprint. Preoperatively and at last follow up, all patients were assessed subjectively by Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores, while Lachman, Pivot-shift, and KT-1000 tests were performed to evaluate knee joint stability. RESULTS Group B patients showed significantly better results in Lysholm, objective, and subjective IKDC scores compared with patients of group A (P < 0.001). A significantly higher surgical failure rate was found in group A than in group B (10.26% vs. 2.3%; P < 0.001). A higher anterior knee laxity was recorded in patients of group A than in patients of group B (1.9 ± 1.1 vs. 1.3 ± 1 mm; P < 0.001); a reduction in mean anterior tibial translation from preoperative to final follow up was found in group B compared with group A (3.5 ± 1.2 vs. 2.7 ± 1.1 mm; P < 0.001). No significant differences in the Tegner scale were found between the two groups. CONCLUSION ACL reconstruction performed using the AM portal technique showed better and more satisfactory clinical and functional outcomes associated with a lower failure rate when the femoral tunnel had been placed more eccentrically in the footprint, in the AM bundle center position.
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Affiliation(s)
- A Tecame
- Department of Orthopaedic and Trauma Surgery, "Città di Parma" Clinic, Parma, Italy.
| | - F Buschini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - F Dini
- Department of Orthopaedic and Trauma Surgery, "Città di Parma" Clinic, Parma, Italy
| | - B Zampogna
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - A Ampollini
- Department of Orthopaedic and Trauma Surgery, "Città di Parma" Clinic, Parma, Italy
| | - R Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - P Adravanti
- Department of Orthopaedic and Trauma Surgery, "Città di Parma" Clinic, Parma, Italy
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14
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Predicting Subjective Failure of ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register and Patient Reported Outcomes. J ISAKOS 2022; 7:1-9. [DOI: 10.1016/j.jisako.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/15/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
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15
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Martin RK, Wastvedt S, Pareek A, Persson A, Visnes H, Fenstad AM, Moatshe G, Wolfson J, Lind M, Engebretsen L. Machine learning algorithm to predict anterior cruciate ligament revision demonstrates external validity. Knee Surg Sports Traumatol Arthrosc 2022; 30:368-375. [PMID: 34973096 PMCID: PMC8866372 DOI: 10.1007/s00167-021-06828-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/26/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE External validation of machine learning predictive models is achieved through evaluation of model performance on different groups of patients than were used for algorithm development. This important step is uncommonly performed, inhibiting clinical translation of newly developed models. Machine learning analysis of the Norwegian Knee Ligament Register (NKLR) recently led to the development of a tool capable of estimating the risk of anterior cruciate ligament (ACL) revision ( https://swastvedt.shinyapps.io/calculator_rev/ ). The purpose of this study was to determine the external validity of the NKLR model by assessing algorithm performance when applied to patients from the Danish Knee Ligament Registry (DKLR). METHODS The primary outcome measure of the NKLR model was probability of revision ACL reconstruction within 1, 2, and/or 5 years. For external validation, all DKLR patients with complete data for the five variables required for NKLR prediction were included. The five variables included graft choice, femur fixation device, KOOS QOL score at surgery, years from injury to surgery, and age at surgery. Predicted revision probabilities were calculated for all DKLR patients. The model performance was assessed using the same metrics as the NKLR study: concordance and calibration. RESULTS In total, 10,922 DKLR patients were included for analysis. Average follow-up time or time-to-revision was 8.4 (± 4.3) years and overall revision rate was 6.9%. Surgical technique trends (i.e., graft choice and fixation devices) and injury characteristics (i.e., concomitant meniscus and cartilage pathology) were dissimilar between registries. The model produced similar concordance when applied to the DKLR population compared to the original NKLR test data (DKLR: 0.68; NKLR: 0.68-0.69). Calibration was poorer for the DKLR population at one and five years post primary surgery but similar to the NKLR at two years. CONCLUSION The NKLR machine learning algorithm demonstrated similar performance when applied to patients from the DKLR, suggesting that it is valid for application outside of the initial patient population. This represents the first machine learning model for predicting revision ACL reconstruction that has been externally validated. Clinicians can use this in-clinic calculator to estimate revision risk at a patient specific level when discussing outcome expectations pre-operatively. While encouraging, it should be noted that the performance of the model on patients undergoing ACL reconstruction outside of Scandinavia remains unknown. LEVEL OF EVIDENCE III.
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Affiliation(s)
- R Kyle Martin
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
- Department of Orthopaedic Surgery, CentraCare, Saint Cloud, MN, USA.
| | - Solvejg Wastvedt
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ayoosh Pareek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andreas Persson
- Norwegian Knee Ligament Register, Haukeland University Hospital, Bergen, Norway
- Oslo Sport Trauma Research Center, Norwegian School of Sports Science, Oslo, Norway
- Orthopaedic Clinic, Oslo University Hospital Ullevål, Oslo, Norway
| | - Håvard Visnes
- Norwegian Knee Ligament Register, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie Fenstad
- Norwegian Knee Ligament Register, Haukeland University Hospital, Bergen, Norway
| | - Gilbert Moatshe
- Oslo Sport Trauma Research Center, Norwegian School of Sports Science, Oslo, Norway
- Orthopaedic Clinic, Oslo University Hospital Ullevål, Oslo, Norway
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Lars Engebretsen
- Oslo Sport Trauma Research Center, Norwegian School of Sports Science, Oslo, Norway
- Orthopaedic Clinic, Oslo University Hospital Ullevål, Oslo, Norway
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16
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Bhimani R, Shahriarirad R, Ranjbar K, Erfani A, Ashkani-Esfahani S. Transportal versus all-inside techniques of anterior cruciate ligament reconstruction: a systematic review. J Orthop Surg Res 2021; 16:734. [PMID: 34949188 PMCID: PMC8705139 DOI: 10.1186/s13018-021-02872-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background Transportal (TP) and all-inside techniques (AIT) are the most commonly used anterior cruciate ligament (ACL) reconstruction procedures in current clinical practice. However, there is an ongoing debate over which procedure is superior. Therefore, the purpose of this systematic review was to evaluate and compare the clinical outcomes and complications of these two techniques to propose recommendations for future application. Our primary hypothesis was that AIT is a superior ACLR technique compared to TP. Methods A systematic literature review, using PRISMA guidelines, was conducted using PubMed, Medline, Google Scholar, and EMBASE, up to February 2021 to identify studies focusing on AIT and TP techniques of ACL reconstruction. We excluded animal experiments, cadaveric studies, retrospective studies, case reports, technical notes, and studies without quantitative data. Patients’ characteristics, surgical technical features, along with postoperative follow-up and complications were extracted and reported accordingly. Methodological quality of the included studies was assessed using the Modified Coleman Methodology Score (MCMS). Results A total of 44 studies were selected for this review, of which four were comparative studies. A total of 923 patients underwent AIT and 1678 patients underwent the TP technique for ACLR. A single semitendinosus graft was commonly used in the AIT compard to combined semitendinosus and gracilis graft in the TP group. The postoperative increase in International Knee Documentation Committee (IKDC), Lysholm, KT-1000, and Short Form-12 (physical and mental) scores were similar in the AIT group and the TP group. Contrastingly, the VAS pain score was significantly lower in the AIT group compared to the TP group. Furthermore, the pooled complication rates from all studies were similar between the two groups (AIT: 54 patients, 8.26% vs. PT: 55 patients, 6.62%). However, the four studies that prospectively compared AIT and TP techniques showed lesser complications in the AIT group than the TP group. Conclusion Since the future trend in orthopedic surgery is toward less invasive and patients’ satisfaction with good outcomes, AIT is a good alternative method considering preserving bony tissue and gracilis tendon with less post-operative pain, along with more knee flexor strength and equal outcomes compared to conventional ACL reconstruction surgery. Level of Evidence II. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02872-x.
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Affiliation(s)
- Rohan Bhimani
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keivan Ranjbar
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Erfani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran. .,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Soheil Ashkani-Esfahani
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Lee DK, Kim JH, Lee BH, Kim H, Jang MJ, Lee SS, Wang JH. Influence of Graft Bending Angle on Femoral Tunnel Widening After Double-Bundle ACL Reconstruction: Comparison of Transportal and Outside-In Techniques. Orthop J Sports Med 2021; 9:23259671211035780. [PMID: 34708137 PMCID: PMC8543726 DOI: 10.1177/23259671211035780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Previous studies have suggested that increased mechanical stress due to acute
graft bending angle (GBA) is associated with tunnel widening and graft
failure after anterior cruciate ligament (ACL) reconstruction. Few studies
have compared the GBA between the outside-in (OI) and the transportal (TP)
techniques. Purpose: To evaluate the influence of GBA on clinical outcomes and tunnel widening
after ACL reconstruction with OI versus TP technique. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were 56 patients who underwent double-bundle ACL
reconstruction (n = 28 in the OI group and n = 28 in the TP group). Clinical
outcomes (Lysholm, International Knee Documentation Committee, Tegner score,
and knee laxity) 1 year postoperatively were evaluated. Computed tomography
scans at 5 days and 1 year postoperatively were used for imaging
measurements, and the femoral tunnel was divided into the proximal third,
middle, and aperture sections. The GBA and cross-sectional area (CSA) were
measured using image analysis software and were compared between groups. A
correlation analysis was performed to determine if the GBA affected clinical
outcomes or tunnel widening. Results: No significant difference was observed in clinical outcomes between the
groups. The GBA of both the anteromedial (AM) and posterolateral bundles
were more acute in the OI group compared with the TP group
(P < .05). The CSA at the AM tunnel aperture
increased significantly in the OI group (84.2% ± 64.3%) compared with the TP
group (51.4% ± 36.7%) (P = .04). However, there were no
differences in the other sections. In the Pearson correlation test, GBA was
not correlated with tunnel widening or clinical outcomes. Conclusion: Regardless of technique, the GBA did not have a significant influence on
tunnel widening or clinical outcomes. Considering a wider AM tunnel
aperture, a more proximal and posterior AM tunnel position might be
appropriate with the OI technique.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, South Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, South Korea
| | - Hyeonsoo Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
| | - Min Jae Jang
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
| | - Sung-Sahn Lee
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Science and Technology and Department of Medical Device Management and Research, SAIHST (Samsung Advanced Institute for Health Sciences & Technology), Sungkyunkwan University, Seoul, South Korea
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18
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Lee DK, Kim JH, Lee SS, Lee BH, Kim H, Kim J, Wang JH. Femoral Tunnel Widening After Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Autograft Produces a Small Shift of the Tunnel Position in the Anterior and Distal Direction: Computed Tomography-Based Retrospective Cohort Analysis. Arthroscopy 2021; 37:2554-2563.e1. [PMID: 33745939 DOI: 10.1016/j.arthro.2021.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the femoral tunnel position remains in an anatomical footprint after tunnel widening and shifting. METHODS Patients who underwent unilateral double-bundle anterior cruciate ligament reconstruction with hamstring autograft and performed computed tomography scan evaluation at the time of 5 days and 1 year postoperatively were included in this retrospective cohort study. Three-dimensional models of the femur and femoral tunnels were reconstructed from computed tomography scan data. The location of the tunnel center and tunnel margins in the anatomical coordinate system, and the mean shifting distance of tunnel center and margin were measured with image analysis software during the period. The change of tunnel center location in Bernard quadrant was confirmed if the tunnel center remained within the boundaries of anatomical position after tunnel widening. RESULTS A total of 56 patients satisfied the inclusion criteria. The mean shifting distance of AM and PL tunnel centers were 1.7 ± 0.9 mm and 1.6 ± 0.6 mm. The Tunnel margin of the anteromedial (AM) and posteromedial (PL) tunnels were shifted to 2.5 ± 1.3 mm and 2.6 ± 1.4 mm in the anterior direction, and 1.4 ± 0.9 mm and 1.0 ± 0.7 mm in the distal direction, respectively. Among the anatomical located tunnel, 97% (32/33) and 87.1% (27/31) of AM and PL tunnel centers remained in a range of anatomical footprint. The tunnel center was shifted from the anatomical position into a nonanatomical position in 3% (1/33) of the AM tunnel and 12.9% (4/31) of PL tunnel after tunnel widening. The tunnel location which shifted nonanatomically were relatively anterior and distal position. CONCLUSIONS Tunnel widening shifts the tunnel position to the anterior and distal direction, which could change the initial tunnel position. Nevertheless, the majority of tunnel positions remained in the anatomical position after tunnel widening and shifting. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Sung-Sahn Lee
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyeonsoo Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jinwoo Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea; Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
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Does radiological evaluation of endobutton positioning in the sagittal plane affect clinical functional results in single-bundle anterior cruciate ligament reconstruction? Arch Orthop Trauma Surg 2021; 141:977-985. [PMID: 33439301 DOI: 10.1007/s00402-020-03748-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Sports injuries are increasing today due to the increased interest in sports. The most common injured knee ligament is the anterior cruciate ligament (ACL) in sport injuries. Accordingly, surgical treatment of the ACL is performed frequently. In this study, it was aimed to retrospectively evaluate whether the location of an endobutton on lateral knee radiography was effective on knee functional scores in patients who underwent ACL reconstruction. MATERIALS AND METHODS One hundred thirty patients who underwent ACL reconstruction between January 2015 and February 2019 were identified. The patients were divided into three groups according to the location of the endobutton on lateral radiographs taken in the postoperative period. Group 1 patients were classified as anterior, group 2 as middle, and group 3 as posterior according to the location of the endobutton. Functional scoring, physical examination tests, comparative thigh diameter measurements, and single-leg hop tests were compared between the groups. It was evaluated as to whether there was a statistically significant difference between the groups. RESULTS There were 38 patients in group 1, 63 patients in group 2, and 29 patients in group 3. The mean age was 29.1 in group 1, 29.1 in group 2, and 29.7 in group 3. The mean follow-up period of the patients was 18.4 months in group 1, 19.1 months in group 2, and 21.4 months in group 3. The average Lysholm score was 92.9 in group 1, 93.3 in group 2, and 91.7 in group 3. The mean modified Cincinnati scores were 27.0, 27.1, and 26.6, respectively, in the groups. The mean IKDC score of the subjective knee assessments was 92.5, 92.8, and 91, respectively, according to the groups. The average thigh atrophy value was 1 cm, 1 cm, and 1.2 cm, respectively, in the groups. In the single-leg hop test, 34 patients in group 1 jump to over 85% of the distance compared with the intact side, while 58 patients in group 2, and 23 patients in group 3 were successfully able to jump this distance. The effect of the placement of the endobutton in the anterior, middle or posterior was not statistically significant on functional scores and physical examination results. In patients with endobuttons in the middle, functional scores were found better than in those with anterior or posterior placement. CONCLUSIONS No statistically significant differences were found in clinical functional results when comparing patients' endobutton location on femur. For this reason, surgical time should not be extended using unnecessary extra effort to change the orientation of the exit hole during surgery.
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Bierke S, Abdelativ Y, Hees T, Karpinksi K, Häner M, Park H, Petersen W. Risk of arthrofibrosis in anatomical anterior cruciate ligament reconstruction: the role of timing and meniscus suture. Arch Orthop Trauma Surg 2021; 141:743-750. [PMID: 32356171 DOI: 10.1007/s00402-020-03464-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal timing of anterior cruciate ligament (ACL) reconstruction remains controversial. Several studies have shown that early surgery leads to an increased rate of arthrofibrosis and poorer postoperative function. Other studies found no correlation between time of surgery and arthrofibrosis. The influence of simultaneous meniscus treatment is also discussed. Aim of this study was to ascertain whether the timing of surgery and treatment of meniscus influences the occurrence rate of arthrofibrosis. METHODS Two hundred and six patients could be included. These were split into two groups. Group 1: surgery within 6 weeks after ACL rupture (n = 68), group 2: surgery after more than 6 weeks (n = 68). In addition, 2 matched groups were created (n = 138 ). Follow-up was 12 months after surgery. The primary endpoint was the rate of subsequent arthrofibrosis procedures (arthroscopic arthrolysis). Secondary endpoints were knee function (knee osteoarthritis outcome score: KOOS), knee pain (numeric rating scale: NRS) and patient satisfaction measured on a 5 point Likert scale. RESULTS In 6 of the 68 patients in group 1 (8.8%) and 3 of the 138 patients in group 2 (2.2%) a subsequent arthroscopic arthrolysis was performed (OR 4.4). A simultaneous meniscal suture was performed in 58 patients (30 of them in group 1). Five of the six patients with subsequent arthrolysis in group 1 received meniscal repair (OR for arthrolysis 3.4). There was no difference between the groups in terms of knee function (KOOS), pain (NRS) and patient satisfaction. CONCLUSION The rate of subsequent arthroscopic arthrolysis was higher in the acute surgery group. However, most of these subsequent procedures were associated with meniscal repair at index surgery with a more restrictive rehabilitation protocol than after ACL reconstruction without meniscus repair. This allows the assessment that the meniscal suturing poses an increased risk. Therefore, this allows the conclusion that if using an anatomical surgical technique and considering the signs of inflammation with effusion, pain and movement deficit less than 90° there is no increased risk of arthrofibrosis.
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Affiliation(s)
- Sebastian Bierke
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Yasin Abdelativ
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Tilman Hees
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Katrin Karpinksi
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Martin Häner
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Hiun Park
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany
| | - Wolf Petersen
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar Theyss Strasse 27-31, 14193, Berlin, Germany.
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Li R, Li T, Zhang Q, Fu W, Li J. Comparison of Clinical Outcomes between Anteromedial and Transtibial Techniques of Single-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. JOURNAL OF SPORTS SCIENCE AND MEDICINE 2021; 20:237-249. [PMID: 34211316 DOI: 10.52082/jssm.2021.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/04/2021] [Indexed: 02/05/2023]
Abstract
This study compared clinical outcomes obtained after single-bundle anterior cruciate ligament (ACL) reconstruction using the anteromedial (AM) and transtibial (TT) techniques, which comprise the conventional transtibial (cTT) and modified transtibial (mTT) techniques. This study included clinical randomized controlled trials and prospective and retrospective controlled trials with AM and TT techniques from the PubMed and Embase databases and the Cochrane Library. All databases were searched from January 2010 to July 2020. Two independent evaluators verified the quality of the included studies using the Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa Scale (NOS). Outcome measures analysed included the Lachman test, pivot-shift test, side-to-side difference (SSD), Lysholm score, Tegner activity scale, International Knee Documentation Committee (IKDC) grade and score. Ten randomized controlled trials (RCTs) and 16 prospective and retrospective controlled trials were included with a total of 2202 patients. There were 1180 patients and 1022 patients in the AM and TT groups, respectively. Compared to the cTT group, superior postoperative results were observed in the AM group based on the negative rate of the Lachman test and the pivot-shift test, IKDC grade and score, Lysholm score, Tegner activity scale and SSD (p < 0.05). However, there was no significant difference between the AM and mTT groups (p > 0.05). Compared to the conventional TT technique, the AM technique exhibited superior clinical outcomes. Nevertheless, the modified TT and AM techniques had comparable results. With neither of the techniques (mTT or AM) producing significantly superior outcomes, surgeons can choose either of them depending on their preferences.
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Affiliation(s)
- Ran Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University
| | - Tao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University
| | - Qiuping Zhang
- Rheumatism Immunology Laboratory, West China Hospital, Sichuan University
| | - Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University
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Stone AV, Chahla J, Manderle BJ, Beletsky A, Bush-Joseph CA, Verma NN. ACL Reconstruction Graft Angle and Outcomes: Transtibial vs Anteromedial Reconstruction. HSS J 2020; 16:256-263. [PMID: 33380955 PMCID: PMC7749890 DOI: 10.1007/s11420-019-09707-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The importance of creating an anatomic anterior cruciate ligament (ACL) reconstruction has been receiving significant attention. The best technique by which to achieve this anatomic reconstruction continues to be debated. The two most common methods are the transtibial (TT) and anteromedial (AM) techniques. Each has its advantages and disadvantages, and the literature comparing the two remains uncertain. QUESTIONS/PURPOSES In this prospective comparative study, we aimed to compare the ACL graft and tunnel angles achieved using the anatomic transtibial (TT) and anteromedial (AM) techniques; compare the ACL graft and tunnel angles in knees that have undergone ACL reconstruction and knees with intact ACLs; and determine whether differences in the graft or tunnel angle produce differences in clinical outcomes, as measured using both physical exam and patient-reported outcomes, after ACL reconstruction. METHODS Patients who underwent primary ACL reconstruction with bone-tendon-bone grafts using a TT or AM technique were included. Femoral graft angle (FGA), tibial graft angle (TGA), and sagittal orientation of the reconstructed ACL and contralateral native ACL were measured on post-operative magnetic resonance imaging. Post-operatively, patients underwent measurement of knee stability and completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) survey. RESULTS Twenty-nine patients were enrolled (AM group, 14; TT group, 15); at follow-up, KOOS data were available for 26 patients (13 in each group). There were no differences in sagittal ACL graft angle between groups or in comparison with the normal knee. The FGA was more vertical after TT reconstructions; the TGA was comparable between groups. There were no significant differences in 2-year post-operative physical exam measurements or in KOOS scores. CONCLUSION Anatomic ACL angle was restored after reconstruction with both the TT and AM techniques, despite different FGAs. No significant differences in clinical outcome were noted between groups on physical exam or KOOS at 2 years after surgery. These results suggest that TT reconstruction results in a graft position similar to that seen in AM reconstruction and that the location of the intra-articular tunnel aperture matters more than the orientation of the tunnel.
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Affiliation(s)
- Austin V. Stone
- grid.266539.d0000 0004 1936 8438Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY USA
| | - Jorge Chahla
- grid.240684.c0000 0001 0705 3621Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA
| | - Brandon J. Manderle
- grid.240684.c0000 0001 0705 3621Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA
| | - Alexander Beletsky
- grid.240684.c0000 0001 0705 3621Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA
| | - Charles A. Bush-Joseph
- grid.240684.c0000 0001 0705 3621Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA
| | - Nikhil N. Verma
- grid.240684.c0000 0001 0705 3621Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA
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23
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Yoon KH, Lee HW, Park JY, Kim SJ, Kim SG. Clinical Outcomes and the Failure Rate of Revision Anterior Cruciate Ligament Reconstruction Were Comparable Between Patients Younger Than 40 Years and Patients Older Than 40 Years: A Minimum 2-Year Follow-Up Study. Arthroscopy 2020; 36:2513-2522. [PMID: 32554076 DOI: 10.1016/j.arthro.2020.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes and failure rates of revision anterior cruciate ligament reconstruction (ACLR) between young and middle-aged surgery patients. METHODS Patients who underwent revision ACLRs between January 2008 and June 2017 with a minimum 2-year follow-up were retrospectively evaluated. Patients were divided into 2 groups according to age: ≥40 years (group A) and <40 years (group B). Detailed patient demographic data, preoperative radiographic data, and concurrent meniscal and chondral lesion were reviewed. Clinical scores, laxity tests results, and graft failures were compared between groups at the final follow-up. RESULTS Eighty-six patients (group A, n = 24, 46.6 ± 4.5 years; group B, n = 62, 26.2 ± 6.3 years) were included in this study. Demographic data showed that the time interval from primary to revision ACLR was longer in group A than in group B (96.2 ± 80.9 vs. 52.0 ± 42.1 months, P = .011). Group A had a higher prevalence of chondral defects of the trochlea (P = .016). No significant differences were identified in the prevalence and severity of meniscal lesions. At the final follow-up, all clinical scores were improved postoperatively but did not differ significantly between the groups. No significant differences were identified in side-to-side difference on Telos stress radiographs (group A, 6.3 ± 5.0 mm; group B, 5.6 ± 3.8 mm; P = .403) and graft failure rate (group A, 33.3%; group B, 30.6%; P = .358) at the final follow-up. CONCLUSIONS The current study showed that the clinical outcomes of revision ACLRs in patients improved significantly in patients younger than 40 years and were comparable to those observed in patients older than 40 years at a minimum 2-year follow-up. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sang Jun Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sang-Gyun Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Gyeongki-do, Korea.
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Garcia S, Pandya NK. Anterior Cruciate Ligament Re-tear and Revision Reconstruction in the Skeletally Immature Athlete. Curr Rev Musculoskelet Med 2020; 13:369-378. [PMID: 32388725 PMCID: PMC7251003 DOI: 10.1007/s12178-020-09627-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW With an increase in high-demand sporting activity, the rate of pediatric and adolescent anterior cruciate ligament (ACL) reconstruction is increasing. Yet, the failure rates after reconstruction are much higher than the adult population. The purpose of this paper is to understand failure rates, reasons for graft failure, and strategies for successful revision surgery. RECENT FINDINGS A complete understanding of the failure etiology is essential for the clinician treating this population prior to revision. This begins with an assessment of post-operative patient compliance and sporting activity. Surgical technique must then be scrutinized for non-anatomic tunnel placement and poor graft size/type. Concurrent bony deformity must also be addressed including lower extremity valgus alignment and tibial slope abnormalities. Meniscus and chondral injury must be aggressively treated. Furthermore, imaging must be examined to look for missed posterolateral corner injury. Lateral extra-articular tenodesis (in the setting of ligamentous laxity or rotational instability) may be also indicated as well. The surgeon can then choose a graft type and surgical technique that optimizes outcome and respects skeletal growth. Prior to surgical intervention, the clinician must also counsel patients in regard to the guarded prognosis and outcomes in this setting. Prolonged rehabilitation protocols/return-to-play timing as well as sporting activity modification in the post-operative period after revision are critical. There is limited literature on revision ACL reconstruction in the skeletally immature athlete. An understanding of all the risk factors for failure is essential in order to achieve treatment success.
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Affiliation(s)
- Steven Garcia
- Department of Orthopedic Surgery, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
| | - Nirav K. Pandya
- Department of Orthopedic Surgery, Benioff Children’s Hospital, University of California San Francisco, 747 52nd Street, Oakland, CA 94609 USA
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Techniques for Femoral Socket Creation in ACL Reconstruction. Sports Med Arthrosc Rev 2020; 28:56-65. [PMID: 32345927 DOI: 10.1097/jsa.0000000000000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anterior cruciate ligament (ACL) injury is common and affects a wide variety of individuals. An ACL reconstruction is the treatment of choice for patients with subjective and objective symptoms of instability and is of particular importance to cutting or pivoting athletes. With many variables involved in ACL reconstruction, femoral tunnel placement has been found to affect clinical outcomes with nonanatomic placement being identified as the most common technical error. Traditionally the femoral tunnel was created through the tibial tunnel or transtibial with the use of a guide and a rigid reaming system. Because of proximal, nonanatomic tunnel placement using the transtibial technique, the use of the anteromedial portal and outside-in drilling techniques has allowed placement of the tunnel over the femoral footprint. In this paper, we discuss the difference between the 3 techniques and the advantages and disadvantages of each. The authors then explore the clinical differences and outcomes in techniques by reviewing the relevant literature.
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Femoral tunnel position in chronic anterior cruciate ligament rupture reconstruction: randomized controlled trial comparing anatomic, biomechanical and clinical outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1501-1509. [PMID: 31161241 DOI: 10.1007/s00590-019-02455-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/27/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to compare the outcomes between anteromedial (AM) and transtibial (TT) femoral tunnel positioning techniques for the reconstruction of chronic anterior cruciate ligament (ACL) rupture. MATERIALS AND METHODS It is a randomized prospective study of 106 patients who underwent ACL reconstruction because of a chronic ACL rupture (55 AMT, 51 TT). Minimum follow-up was 2 years. Demographic, clinical and radiological data, including MRI grafts' anatomy and biomechanics intraoperative navigation system evaluation, were analyzed. Also, International Knee Documentation Committee score, Tegner Knee score, Lysholm Knee Score, Short-Form Health Survey and 4-point Likert Scale were evaluated. RESULTS The AM technique achieves a more anatomic graft than TT technique in both sagittal and coronal plane (6° approximately). Immediate postoperative biomechanical evaluation of the graft showed both techniques significantly improved translational and rotational laxity (p = 0.000). AMT showed superiority only in controlling internal rotation (p = 0.016). Both techniques reported significant improvement in all evaluated score scales, without differences between techniques. Independently of the femoral tunnel positioning technique, patients with cartilage lesion had worse clinical outcomes. CONCLUSIONS Our findings suggest that AMT achieves a more anatomical and biomechanically accurate graft allowing better control over internal rotation laxity; however, this does not lead to better clinical outcomes if we compare with TT in the reconstruction of chronic ACL rupture. Patients with chronic ACL rupture and cartilage lesion had worse clinical outcomes, independently the femoral tunnel positioning technique.
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Ra HJ, Celik H, Kim HJ, Lee DH. Femoral tunnel widening is similar between anteromedial portal and transtibial techniques following single-bundle anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2019; 27:626-635. [PMID: 30306239 DOI: 10.1007/s00167-018-5204-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE In anterior cruciate ligament (ACL) reconstruction, there is concern regarding the potential risk of femoral tunnel widening in the anteromedial portal (AMP) technique due to the acute graft-bending angle at the aperture and the more elliptical aperture shape of the femoral tunnel compared to the transtibial (TT) techniques. Therefore, the aim of the current systematic review and meta-analysis was to compare the femoral tunnel widening between the AMP and TT techniques in patients who underwent ACL reconstruction. METHODS It should be included the studies that reported on femoral tunnel widening in patients who underwent single-bundle ACL reconstruction, using soft-tissue tendon graft, with AMP and/or TT techniques. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACL reconstruction. RESULTS Twenty-one studies were finally included in this meta-analysis. The pooled changes of absolute millimeters of tunnel widening from the immediate postoperative status to the last follow-up did not differ significantly between the AMP and TT techniques at both the aperture [3.31 mm, 95% confidence interval (CI) 1.7-5.0. mm versus 2.9 mm, 95% CI 2.4-3.4 mm, P = n.s.] and the midportion (3.5 mm, 95% CI 0.8-6.3 mm versus 3.0 mm, 95% CI 2.2-3.9 mm, P = n.s.) of the femoral tunnel. No significant difference was observed between the two techniques in the relative percentage of femoral tunnel widening (AMP; 28.8%, 95% CI 14.8-42.9% vs. TT; 29.7%, 95% CI 15.6-43.7%, P = n.s.). CONCLUSION No significant difference in femoral tunnel widening was observed between the AMP and TT techniques, both in absolute millimeter and relative percentage, in patients who underwent single-bundle ACL reconstruction. This finding could alleviate the potential concerns associated with femoral tunnels being wider for the AMP than for the TT technique. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ho Jong Ra
- Department of Orthopaedic Surgery, College of Medicine, Gangneung Asan Hospital, Ulsan University, Gangneung, Republic of Korea
| | - Haluk Celik
- Department of Orthopaedic Surgery, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Hyun-Jun Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, 06351, Seoul, South Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, 06351, Seoul, South Korea.
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Helito CP, Camargo DB, Sobrado MF, Bonadio MB, Giglio PN, Pécora JR, Camanho GL, Demange MK. Combined reconstruction of the anterolateral ligament in chronic ACL injuries leads to better clinical outcomes than isolated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:3652-3659. [PMID: 29610972 DOI: 10.1007/s00167-018-4934-2] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/26/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the results of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction in patients with chronic ACL injury. It was hypothesized that patients who underwent combined ACL and ALL reconstruction would exhibit less residual laxity and better clinical outcomes. METHODS Two groups of patients were evaluated and compared retrospectively. Both groups consisted only of patients with chronic (more than 12 months) ACL injuries. Patients in group 1 underwent anatomical intra-articular reconstruction of the ACL and patients in group 2 underwent anatomic intra-articular ACL reconstruction combined with ALL reconstruction. The presence of associated meniscal injury, the subjective International Knee Documentation Committee (IKDC) and Lysholm functional outcome scores in the postoperative period, KT-1000 evaluation, the presence of residual pivot shift and graft rupture rate were evaluated. RESULTS One hundred and one patients who underwent reconstruction of chronic ACL injuries were evaluated. The median follow-up was 26 (24-29) months for group 1 and 25 (24-28) months for group 2. There were no significant differences between groups regarding gender, age, duration of injury until reconstruction, follow-up time or presence of associated meniscal injuries in the preoperative period. Regarding functional outcome scores, patients in group 2 presented better results on both the IKDC (p = 0.0013) and the Lysholm (p < 0.0001) evaluations. In addition, patients in group 2 had better KT-1000 evaluation (p = 0.048) and a lower pivot shift rate at physical examination, presenting only 9.1% positivity versus 35.3% in the isolated ACL reconstruction (p = 0.011). Regarding re-ruptures, group 1 presented 5 (7.3%) cases, and group 2 presented no cases. CONCLUSION The combined ACL and ALL reconstruction in patients with chronic ACL injury is an effective and safety solution and leads to good functional outcomes with no increase in complication rate. The clinical relevance of this finding is the possibility to indicate this type of procedure when patients present with more than 12 months after injury for surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Danilo Bordini Camargo
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcel Faraco Sobrado
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Batista Bonadio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Nogueira Giglio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Ricardo Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gilberto Luis Camanho
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Kawamura Demange
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Bombaci H, Aykanat F. Drilling through anteromedial portal with a femoral aiming device ensures a sufficient length and a proper graft position, and prevents posterior wall breakage during anterior cruciate ligament reconstruction. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1403-1409. [PMID: 29705911 DOI: 10.1007/s00590-018-2211-1] [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: 01/09/2018] [Accepted: 04/14/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the characteristics of the femoral tunnel (FT) which was drilled through the AM portal by using a femoral aimer device and AP stability of the knee. METHODS Thirty-eight patients, with the mean age 29.6 (range: 20-43) years, were evaluated after ACL reconstruction. The mean follow-up time was 31.9 (range: 16-57) months. The FT was drilled using a femoral aimer with different offset according to the graft size measured, through the AM portal. The semitendinous and gracilis tendon autograft was used for reconstruction. The angles of FT and the exit point on the lateral condyle were measured on AP views of the knee. AP stability of the knee was measured with the KT-2000. RESULTS The mean angle of FT was 46.5° (± 8.4°), on the AP view. The mean distance between the exit point of FT and the most distal end of the femoral condyles was 46.7 (± 4.9) mm. The mean FT length was 36.1 (± 3.1) mm. The mean difference of anterior translation compared to the intact knee was 1.9 (± 1.6) mm. Except the three patients, with "one positive" pivot shift test, in the remaining 35 knees stability was equal to the healthy knee. CONCLUSIONS Femoral drilling by using a femoral aimer device through AM portal provided long enough FT for safe graft fixation and appropriate coronal plan obliquity. The exit point was far proximal from the insertion site of the popliteus tendon and lateral collateral ligament. Furthermore, the AM portal technique significantly improved AP stability of the knee.
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Affiliation(s)
- Hasan Bombaci
- Orthopaedics and Traumatology Department, Haydarpasa Numune Education and Research Hospital, Tibbiye Cad., 34671, Üsküdar, Istanbul, Turkey.
| | - Faruk Aykanat
- Sani Konukoglu Hospital, Sanko University, Gaziantep, Turkey
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Persson A, Gifstad T, Lind M, Engebretsen L, Fjeldsgaard K, Drogset JO, Forssblad M, Espehaug B, Kjellsen AB, Fevang JM. Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts. Acta Orthop 2018; 89:204-210. [PMID: 29171322 PMCID: PMC5901519 DOI: 10.1080/17453674.2017.1406243] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - A large number of fixation methods of hamstring tendon autograft (HT) are available for anterior cruciate ligament reconstruction (ACLR). Some studies report an association between fixation method and the risk of revision ACLR. We compared the risk of revision of various femoral and tibial fixation methods used for HT in Scandinavia 2004-2011. Materials and methods - A register-based study of 38,666 patients undergoing primary ACLRs with HT, with 1,042 revision ACLRs. The overall median follow-up time was 2.8 (0-8) years. Fixation devices used in a small number of patients were grouped according to design and the point of fixation. Results - The most common fixation methods were Endobutton (36%) and Rigidfix (31%) in the femur; and interference screw (48%) and Intrafix (34%) in the tibia. In a multivariable Cox regression model, the transfemoral fixations Rigidfix and Transfix had a lower risk of revision (HR 0.7 [95% CI 0.6-0.8] and 0.7 [CI 0.6-0.9] respectively) compared with Endobutton. In the tibia the retro interference screw had a higher risk of revision (HR 1.9 [CI 1.3-2.9]) compared with an interference screw. Interpretation - The choice of graft fixation influences the risk of revision after primary ACLR with hamstring tendon autograft.
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Affiliation(s)
- Andreas Persson
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway,University of Bergen, Faculty of Medicine and Dentistry, Department of Clinical Medicine, Bergen, Norway,Correspondence:
| | - Tone Gifstad
- Department of Orthopaedic Surgery, Trondheim University Hospital, Trondheim, Norway,Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin Lind
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway,Faculty of Medicine, University of Oslo, Oslo, Norway,Oslo Sports Trauma Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Knut Fjeldsgaard
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jon Olav Drogset
- Department of Orthopaedic Surgery, Trondheim University Hospital, Trondheim, Norway,Norwegian University of Science and Technology, Trondheim, Norway
| | - Magnus Forssblad
- Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Birgitte Espehaug
- Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
| | - Asle B Kjellsen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jonas M Fevang
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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Hu B, Shen W, Zhou C, Meng J, Wu H, Yan S. Cross Pin Versus Interference Screw for Femoral Graft Fixation in Hamstring Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Arthroscopy 2018; 34:615-623. [PMID: 29066266 DOI: 10.1016/j.arthro.2017.07.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the effectiveness of a cross pin and interference screw for femoral graft fixation in primary anterior cruciate ligament reconstruction (ACLR) and provide an appropriate reference for orthopaedic surgeons. METHODS The Medline, Cochrane Library, Web of Science, Scopus, and PubMed databases were searched in March 2016, and comparative trials using cross-pin and interference screw devices for femoral graft fixation in primary hamstring ACLR with clinical outcome measurements were included in the review. Trials with no controlled groups, hybrid fixation, no clinical outcomes, or follow-up of less than 1 year were excluded. The quality of the included studies was assessed with the Cochrane Back Review Group 12-item scale. Abstracted data were pooled with fixed or random effects depending on the detected heterogeneity. The outcome measures were the scoring system and physical examination findings, including the Lysholm score, International Knee Documentation Committee score or grade, Tegner score, negative Lachman test, negative pivot-shift test, and instrumented side-to-side anterior-posterior laxity difference. RESULTS All the studies reviewed were of prospective design. Within the cross-pin group, patients who underwent hamstring ACLR showed a significantly smaller instrumented side-to-side anterior-posterior laxity difference when compared with interference screw fixation (weighted mean difference, 0.38 mm [95% confidence interval, 0.08-0.67 mm]; P = .01), whereas the results of a negative Lachman test and negative pivot-shift test were comparable. Outcomes regarding the scoring system did not reach a significant difference between the 2 groups. CONCLUSIONS The statistically decreased instrumented side-to-side anterior-posterior laxity difference achieved by cross-pin transfixation appears to be of limited clinical significance when compared with interference screw fixation in primary hamstring ACLR. Clinically, the performance of cross-pin devices did not show a significant advantage over that of the interference screw for femoral graft fixation in hamstring ACLR. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Bin Hu
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, and Orthopedics Research Institute, Zhejiang University, Hangzhou, China
| | - Weiliang Shen
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, and Orthopedics Research Institute, Zhejiang University, Hangzhou, China
| | - Chenhe Zhou
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, and Orthopedics Research Institute, Zhejiang University, Hangzhou, China
| | - Jiahong Meng
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, and Orthopedics Research Institute, Zhejiang University, Hangzhou, China
| | - Haobo Wu
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, and Orthopedics Research Institute, Zhejiang University, Hangzhou, China
| | - Shigui Yan
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, and Orthopedics Research Institute, Zhejiang University, Hangzhou, China.
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Patel KA, Chhabra A, Makovicka JL, Bingham J, Piasecki DP, Hartigan DE. Anterior Cruciate Ligament Tunnel Placement Using the Pathfinder Guide. Arthrosc Tech 2017; 6:e1291-e1296. [PMID: 29354431 PMCID: PMC5622279 DOI: 10.1016/j.eats.2017.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/11/2017] [Indexed: 02/03/2023] Open
Abstract
Reconstruction techniques for the anterior cruciate ligament (ACL) have evolved considerably over the past 3 decades. The femoral tunnel is most commonly made via a transtibial or separate anteromedial portal approach. Benefits and drawbacks for each of these techniques exist. Improper tunnel placement is the cause of failure for ACL reconstruction 70% of the time. We present a hybrid technique for femoral tunnel placement using the Pathfinder ACL guide, which attempts to give the surgeon many of the benefits of both the transtibial and anteromedial portal techniques without the drawbacks.
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Affiliation(s)
- Karan A. Patel
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Anikar Chhabra
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, U.S.A
| | | | - Joshua Bingham
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, U.S.A
| | | | - David E. Hartigan
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, U.S.A.,Address correspondence to David E. Hartigan, M.D., Department of Orthopedics, Mayo Clinic, Phoenix, AZ 85054, U.S.A.Department of OrthopedicsMayo ClinicPhoenixAZ85054U.S.A.
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Lacey M, Lamplot J, Walley KC, DeAngelis JP, Ramappa AJ. Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling. World J Orthop 2017; 8:379-384. [PMID: 28567341 PMCID: PMC5434344 DOI: 10.5312/wjo.v8.i5.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/03/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail.
METHODS Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL’s anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft’s outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip stitched, quadrupled and shaped to match the diameter of the prepared femoral tunnel. If the diameter of the patient’s autologous hamstring graft is insufficient to fill the prepared femoral tunnel, the autograft may be supplemented with an allograft. The remainder of the reconstruction is performed according to surgeon preference.
RESULTS The presence of retained hardware presents a challenge for surgeons treating patients with knee instability. In cruciate ligament reconstruction, distal femoral and proximal tibial implants hardware may confound tunnel placement, making removal of hardware necessary, unless techniques are adopted to allow for anatomic placement of the graft.
CONCLUSION This report demonstrates how the femoral tunnel can be created using the anteromedial portal instead of a transtibial approach for reconstruction of the ACL.
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Cury RDPL, Sprey JWC, Bragatto ALL, Mansano MV, Moscovici HF, Guglielmetti LGB. Comparative evaluation of the results of three techniques in the reconstruction of the anterior cruciate ligament, with a minimum follow-up of two years. Rev Bras Ortop 2017; 52:319-324. [PMID: 28702391 PMCID: PMC5497004 DOI: 10.1016/j.rboe.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/12/2016] [Indexed: 01/17/2023] Open
Abstract
Objective To compare the clinical results of the reconstruction of the anterior cruciate ligament by transtibial, transportal, and outside-in techniques. Methods This was a retrospective study on 90 patients (ACL reconstruction with autologous flexor tendons) operated between August 2009 and June 2012, by the medial transportal (30), transtibial (30), and “outside-in” (30) techniques. The following parameters were assessed: objective and subjective IKDC, Lysholm, KT1000, Lachman test, Pivot-Shift and anterior drawer test. Results On physical examination, the Lachman test and Pivot-Shift indicated a slight superiority of the outside-in technique, but without statistical significance (p = 0.132 and p = 0.186 respectively). The anterior drawer, KT1000, subjective IKDC, Lysholm, and objective IKDC tests showed similar results in the groups studied. A higher number of complications were observed in the medial transportal technique (p = 0.033). Conclusion There were no statistically significant differences in the clinical results of patients undergoing reconstruction of the anterior cruciate ligament by transtibial, medial transportal, and outside-in techniques.
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Affiliation(s)
- Ricardo de Paula Leite Cury
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
| | - Jan Willem Cerf Sprey
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
| | - André Luiz Lima Bragatto
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
| | - Marcelo Valentim Mansano
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
| | - Herman Fabian Moscovici
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
| | - Luiz Gabriel Betoni Guglielmetti
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia de Joelho, São Paulo, SP, Brazil
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Avaliação comparativa dos resultados de três técnicas na reconstrução do ligamento cruzado anterior com seguimento mínimo de dois anos. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Helito CP, Helito PVP, Leão RV, Demange MK, Bordalo-Rodrigues M. Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2017; 25:1140-1148. [PMID: 28293698 DOI: 10.1007/s00167-017-4498-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/27/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Few studies have used MRI to identify the ALL. As it was shown that it is not possible to precisely characterize this ligament in all examination, it is important to identify concomitant lesions that can help in diagnosing ALL abnormalities. It is important to characterise this injury due to its association with anterolateral knee instability. Thus, the present study was performed to determine the frequency of ALL injuries in patients with acute ACL rupture and to analyse its associated knee lesions. METHODS Patients with acute ACL injuries were evaluated by MRI. Among this population, the ALL was classified as non-visualised, injured or normal. The possible abnormalities of the meniscus, collateral ligaments, popliteus tendon, posterior cruciate ligament, Iliotibial band (ITB), anterolateral capsule and osseus injuries were evaluated. The association of an ALL injury with these other knee structures as well as sex and age was calculated. RESULTS Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury. CONCLUSION ALL injuries are present in approximately 40% of ACL injuries, and a minority of these are Segond fractures. These injuries are associated with peripheral ligament injuries, anterolateral structures lesions and bone contusions, but there is no association with meniscal injuries. Surgeons must be aware of these associations to consider an ALL lesion even if it is not completely clear in imaging evaluation, especially if a high degree of anterolateral instability is present on physical examination. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Camilo Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil. .,Knee Surgery Division, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil.
| | - Paulo Victor Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil.,Musculoskeletal Radiology Department, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | | | - Marco Kawamura Demange
- Knee Surgery Division, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Marcelo Bordalo-Rodrigues
- Hospital Sírio-Libanês, São Paulo, Brazil.,Musculoskeletal Radiology Department, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
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Burnham JM, Herbst E, Pauyo T, Pfeiffer T, Johnson DL, Fu FH, Musahl V. Technical Considerations in Revision Anterior Cruciate Ligament (ACL) Reconstruction for Operative Techniques in Orthopaedics. ACTA ACUST UNITED AC 2017; 27:63-69. [PMID: 28989265 DOI: 10.1053/j.oto.2017.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
As the incidence of anterior cruciate ligament (ACL) reconstruction continues to increase, the rate of revision surgery continues to climb. Revision surgery has inherent challenges that must be addressed in order to achieve successful results. The cause of the primary ACL reconstruction failure should be determined, and careful preoperative planning should be performed to address the cause(s) of failure. Each patient undergoing revision surgery should undergo a thorough history and physical examination, receive full length alignment radiographs, lateral radiographs, 45-degree flexion weight-bearing postero-anterior radiographs, and patellofemoral radiographs. 3-dimensional computed topography (CT) scan should be performed to assess tunnel position and widening. Magnetic resonance imaging (MRI) should be used to assess for intra-articular soft tissue pathology. Meniscal tears, meniscal deficiency, anterolateral capsule injuries, bony morphology, age, activity level, connective tissue diseases, infection, graft choice, and tunnel position can all impact the success of ACL reconstruction surgery. Meniscal lesions should be repaired, and in cases of persistent rotatory instability, extra-articular procedures may be indicated. Furthermore, osteotomies may be needed to correct malalignment or excess posterior tibial slope. Depending on the placement and condition of the original femoral and tibial tunnels, revision surgery may be performed in a single procedure or in a staged manner. In most cases, the surgery can be performed in one procedure. Regardless, the surgeon must communicate with the patient openly regarding the implications of revision ACL surgery and the treatment plan should be developed in a shared fashion between the surgeon and the patient.
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Affiliation(s)
- Jeremy M Burnham
- Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USA
| | - Elmar Herbst
- Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USA
| | - Thierry Pauyo
- Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USA
| | - Thomas Pfeiffer
- Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USA
| | - Darren L Johnson
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky Medical Center, 740 S. Limestone, K401, Lexington, KY 40536 USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, USA
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Abstract
Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears.
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Affiliation(s)
| | - Emily Naclerio
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA,Address for correspondence: Dr. Seth L Sherman, Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave., Columbia, MO 65212, USA. E-mail:
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Zhang Y, Xu C, Dong S, Shen P, Su W, Zhao J. Systemic Review of Anatomic Single- Versus Double-Bundle Anterior Cruciate Ligament Reconstruction: Does Femoral Tunnel Drilling Technique Matter? Arthroscopy 2016; 32:1887-904. [PMID: 27184099 DOI: 10.1016/j.arthro.2016.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 02/29/2016] [Accepted: 03/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide an up-to-date assessment of the difference between anatomic double-bundle anterior cruciate ligament (ACL) reconstruction (DB-ACLR) and anatomic single-bundle ACL reconstruction (SB-ACLR). We hypothesized that anatomic SB-ACLR using independent femoral drilling technique would be able to achieve kinematic stability as with anatomic DB-ACLR. METHODS A comprehensive Internet search was performed to identify all therapeutic trials of anatomic DB-ACLR versus anatomic SB-ACLR. Only clinical studies of Level I and II evidence were included. The comparative outcomes were instrument-measured anterior laxity, Lachman test, pivot shift, clinical outcomes including objective/subjective International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale and complication rates of extension/flexion deficits, graft failure, and early osteoarthritis. Subgroup analyses were performed for femoral tunnel drilling techniques including independent drilling and transtibial (TT) drilling. RESULTS Twenty-two clinical trials of 2,261 anatomically ACL-reconstructed patients were included in the meta-analysis. Via TT drilling technique, anatomic DB-ACLR led to improved instrument-measured anterior laxity with a standard mean difference (SMD) of -0.42 (95% confidence interval [CI] = -0.81 to -0.02), less rotational instability measured by pivot shift (SMD = 2.76, 95% CI = 1.24 to 6.16), and higher objective IKDC score with odds ratio (OR) of 2.28 (95% CI = 1.19 to 4.36). Via independent drilling technique, anatomic DB-ACLR yielded better pivot shift (SMD = 2.04, 95% CI = 1.36 to 3.05). Anatomic DB-ACLR also revealed statistical significance in subjective IKDC score compared with anatomic SB-ACLR (SMD = 0.27, 95% CI = 0.05 to 0.49). CONCLUSIONS Anatomic DB-ACLR showed better anterior and rotational stability and higher objective IKDC score than anatomic SB-ACLR via TT drilling technique. Via independent drilling technique, however, anatomic DB-ACLR only showed superiority of rotational stability. All clinical function outcomes except subjective IKDC score were not significantly different between anatomic DB-ACLR and SB-ACLR. LEVEL OF EVIDENCE Level II, meta-analysis of Level I and II studies.
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Affiliation(s)
- Yang Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Caiqi Xu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiqui Dong
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Peng Shen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Biswal UK, Balaji G, Nema S, Poduval M, Menon J, Patro DK. Correlation of tunnel widening and tunnel positioning with short-term functional outcomes in single-bundle anterior cruciate ligament reconstruction using patellar tendon versus hamstring graft: a prospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:647-55. [DOI: 10.1007/s00590-016-1809-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/20/2016] [Indexed: 01/20/2023]
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