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Kocazeybek E, Ersin M, Yılmaz M, Ekinci M. Preoperative estimation of hamstring autograft graft diameter in anterior cruciate ligament reconstruction with a new simple method using magnetic resonance imaging. Knee 2025; 53:193-199. [PMID: 39787724 DOI: 10.1016/j.knee.2024.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 10/25/2024] [Accepted: 12/18/2024] [Indexed: 01/12/2025]
Abstract
BACKGROUND The aim of this study was to predict intraoperative graft diameter with our new method by evaluating the cross-sectional areas (CSAs) of the hamstrings in axial sections of MRI. METHODS This study included 78 patients who underwent single-bundle ACLR between 2022 and 2023. MRIs of the patients were evaulated preoperatively and four CSAs of the hamstring tendons were measured in two different regions by two participants. CSA measurements were calculated manually and the total area was measured by adding up these cross-sectional areas separately. This value was considered as the area of a single circle and the radius was calculated using the area formula of the circle (A = πr2) RESULTS: For participant I, perfect agreement was found in semitendinosus measurement (κ = 0.849), moderate agreement was detected at the medial condyle level (κ = 0.520). For participant II, perfect agreement was found in the medial condyle region (κ = 0.849), substantial agreement was obtained at the joint level (0.631). In the gracilis tendon evaluation of both participants, substantial and moderate agreement was found at the joint level and at the medial condyle level, respectively. CSA of hamstring tendons measured at the joint level by both participants were found to be positively correlated with the intraoperative graft diameter (r = 0.51) (P < 0.05) CONCLUSIONS: Preoperative MRI assesment could be a effective tool for determing preliminary information about the hamstring graft diameters. Moreover, it is observed that quadruple hamstring graft sizes were more correlated with MRI measurements at the joint level than medial condyle level by using circle area formula.
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Affiliation(s)
- Emre Kocazeybek
- Department of Orthopaedics and Traumatology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Mehmet Ersin
- Department of Orthopaedics and Traumatology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Yılmaz
- Department of Orthopaedics and Traumatology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Ekinci
- Department of Orthopaedics and Traumatology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Sarakatsianos V, Cristiani R, Edman G, Stålman A. Diameter of Quadrupled Semitendinosus Autograft in Primary Anterior Cruciate Ligament Reconstruction Did Not Impact Early Revision Rate or Functional Outcome in a Large Cohort of Patients. Arthroscopy 2025; 41:239-245. [PMID: 39069025 DOI: 10.1016/j.arthro.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To determine whether the diameter of the quadrupled semitendinosus tendon (ST) graft in primary anterior cruciate ligament reconstruction (ACLR) is related to the risk of revision ACLR within 2 years of primary ACLR, postoperative knee laxity, and patient-reported knee outcome. Furthermore, to investigate whether smaller graft than estimated is related to revision ACLR. METHODS Patients who underwent primary ACLR with a quadrupled ST autograft at our institution from January 2005 to December 2017 were identified. Data from the Swedish National Knee Ligament Registry were collected up to 2 years or until revision surgery was registered within 2 years after primary ACLR. Knee laxity was assessed preoperatively and at 6-month follow-up using the KT-1000 arthrometer (134 N anterior tibial load). The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 2 years postoperatively from Swedish National Knee Ligament Registry. On the basis of anthropometric measurements (body height and weight) and sex, the estimated quadrupled ST graft diameter was calculated. RESULTS A total of 4,519 patients who underwent ACLR with a quadrupled ST autograft were included. The mean graft diameter was 8.3 ± 0.7 mm; 8.0 ± 0.6 mm for women and 8.6 ± 0.7 mm for men. The quadrupled ST graft diameter was not significantly correlated to revision ACLR. There was no significant difference in the ST graft diameter regarding postoperative knee laxity. The correlations between ST graft diameter and KOOS were weak, except for the "sport and recreation" subscale (P = .012). CONCLUSIONS The quadrupled ST graft diameter was not significantly related to the need for early revision ACLR, nor was it related to postoperative knee laxity or patient-reported outcome except for the KOOS "sport and recreation" subscale. Smaller ST graft than estimated was not a risk factor for revision ACLR. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Vasileios Sarakatsianos
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Solna, Sweden.
| | - Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Solna, Sweden; Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden
| | - Gunnar Edman
- Research and Development, Norrtälje Hospital, Tiohundra AB, Norrtälje, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Stålman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Solna, Sweden; Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden
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Yahagi Y, Iriuchishima T, Iwama G, Suruga M, Horaguchi T, Aizawa S, Nakanishi K. Size Comparison of the Cadaveric Anterior Cruciate Ligament Midsubstance Cross-Sectional Area and the Cross-Sectional Area of Semitendinosus Double-Bundle Anterior Cruciate Ligament Reconstruction Autografts in Surgery. J Knee Surg 2023; 36:1247-1252. [PMID: 35944571 DOI: 10.1055/s-0042-1755377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to compare the cadaveric midsubstance cross-sectional anterior cruciate ligament (ACL) area and the cross-sectional semitendinosus (ST) double-bundle ACL autograft area in surgery. Thirty-nine nonpaired formalin-fixed cadaveric knees and 39 subjects undergoing ST double-bundle ACL reconstruction were included in this study. After soft tissue resection, cadaveric knees were flexed at 90 degrees, and the tangential line of the femoral posterior condyles was marked and sliced on the ACL midsubstance. The cross-sectional ACL area was measured using Image J software. In the patients undergoing ACL surgery, the harvested ST was cut and divided into anteromedial (AM) bundle and posterolateral (PL) bundle. Each graft edge diameter was measured by a sizing tube, and the cross-sectional graft area was calculated: (AM diameter/2)2 × 3.14 + (PL diameter/2)2 × 3.14. Statistical analysis was performed for the comparison of the cross-sectional area between the cadaveric ACL midsubstance and the ST double-bundle ACL autografts. The cadaveric midsubstance cross-sectional ACL area was 49.0 ± 16.3 mm2. The cross-sectional ST double-bundle autografts area was 52.8 ± 7.6 mm2. The ST double-bundle autograft area showed no significant difference when compared with the midsubstance cross-sectional ACL area. ST double-bundle autografts were shown to be capable of reproducing the midsubstance cross-sectional ACL area.
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Affiliation(s)
- Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Spa Hospital, Minakami, Japan
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| | - Genki Iwama
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Makoto Suruga
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Takashi Horaguchi
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
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Ateş O, Bozkurt I, Uluyardimci E, Öçgüder DA, Uğurlu M. Relationship between graft failure following anterior cruciate ligament reconstruction and hamstring autograft diameter. Acta Orthop Belg 2023; 89:429-433. [PMID: 37935225 DOI: 10.52628/89.3.11518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
With the increase in the number of individuals participating in sports, anterior cruciate ligament (ACL) injuries are also increasing gradually and the number of patients requiring surgical treatment is increasing in parallel. The primary aim of this study was to investigate the relationship between the need for revision surgery and graft diameter following primary ACL reconstruction (ACLR) using hamstring autografts. The secondary aim of the study was to clarify relationships between anthropometric characteristics and graft diameter. Patients who underwent ACLR with hamstring autografts were included in this retrospective study. The age, body mass index, height, and weight of all patients were recorded preoperatively and the diameters of the grafts were recorded during surgery. The relationship between revision rate and graft diameter and the relationships between anthropometric measurements and graft diameter were investigated for these patients at least one year after surgery. This study included 58 people with graft diameters of ≤7 mm and 261 people with graft diameters of >7 mm. A statistically significant difference was found between the graft diameters of the group that needed revision surgery and the group that did not (p<0.001). A positive relationship was also found between the patient's height and graft diameter (r=0.168). In this study, it was found that the risk of ACL revision surgery increased by 5.5 times among patients with graft diameters of ≤7 mm. The positive relationship between the patient's height and graft diameter can make a significant difference in terms of the need for revision surgery.
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Kocazeybek E, Meric E, Ersin M, Ekinci M, Kizilkurt T, Sahinkaya T, Polat G. Clinical outcomes of three different techniques using adjustable-loop fixation in arthroscopic single-bundle anterior cruciate ligament reconstruction: A prospective randomized clinical trial. Knee 2023; 43:208-216. [PMID: 37467701 DOI: 10.1016/j.knee.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 06/14/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Adjustable femoral suspensory fixation for anterior cruciate ligament reconstruction (ACLR) become popular in recent years. The purpose of this study is to evaluate and compare the clinical outcomes of three different techniques using an adjustable-loop fixation in ACRL. METHODS This study included 38 patients who underwent ACLR using the adjustable-loop device for femoral fixation between January 2018 and November 2021. All the participants were randomly assigned to a standard (group 1), retensioning (group 2), retensioning and knot tying (group 3). Clinical outcome parametres included Tegner - Lysholm Score, IKDC score, KT-1000 displacement and isokinetic muscle function tests. RESULTS Overall, 38 patients (group 1: n = 13 [mean ± SD age, 30.1 ± 9.40 years]; group 2: n = 12 [mean ± SD age, 24.5 ± 7.79 years]; group 3 = 13 [mean ± SD age, 27.8 ± 6.59 years]) were included in the final analysis. The follow-up period was 9.7 ± 1.2; 9.5 ± 1.7 and 10 ± 1.5 months for groups 1, 2 and 3 respectively. From preoperatively to postoperatively, the mean Tegner-Lysholm scores improved significantly in all three groups (group 1: from 63.5 to 95.6; group 2: from 61.58 to 98.5; group 3: from 66.6 to 95.9, P < 0.0001 for all), as did the mean IKDC score (group 1: 53.9-88.8; group 2: 61.3-94.9; group 3: 60.7-94.6 (P < 0.0001 for all). CONCLUSION The retensioning with or without knot-tying method is believed to increase stability in graft fixation. However, there were no significant differences in clinical outcomes in each technique.
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Affiliation(s)
- Emre Kocazeybek
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey.
| | - Emre Meric
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
| | - Mehmet Ersin
- Department of Orthopedics and Traumatology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Ekinci
- Department of Orthopedics and Traumatology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Taha Kizilkurt
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
| | - Turker Sahinkaya
- Istanbul Faculty of Medicine, Department Sports Medicine, İstanbul, Turkey
| | - Gokhan Polat
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
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Fernandes TL, Souza MO, Albuquerque C, Araujo PH, Pedrinelli A, Hernandez AJ. ANTEROMEDIAL OR CENTRAL ANATOMIC ACL RECONSTRUCTION? A CADAVERIC HIP-TO-TOE STUDY. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e268195. [PMID: 37547231 PMCID: PMC10400003 DOI: 10.1590/1413-785220233104e268195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/17/2023] [Indexed: 08/08/2023]
Abstract
Objective To compare anatomic anterior cruciate ligament (ACL) reconstruction between two tunnel positions in knees with isolated ligament tears. Methods Anatomic ACL reconstruction was performed, from hip-to-toe, on 15 fresh cadaveric specimens. No associated lesions were created to enhance knee instability. The protocol was conducted in three states: (1) complete isolated ACL deficiency; (2) anatomic femoral and tibial anteromedial ACL reconstruction (AM REC); and (3) anatomic femoral and tibial central ACL reconstruction (Central REC). The reconstruction protocols were randomly assigned. The continuous mechanized pivot-shift test was recorded dynamically with a tracking system. Results The Central REC group showed a smaller degree of internal rotation (0.6° ± 0.3° vs. 1.8° ± 0.3°, respectively, P < 0.05) and no difference in anterior translation (4.7 mm ± 0.4 mm vs. 4.5 mm ± 0.4 mm, respectively, P > 0.05) in the pivot-shift test, compared with the AM REC group. Conclusion The central anatomic ACL reconstruction resulted in greater restriction of internal rotation than the anteromedial anatomic ACL reconstruction. Experimental Study on Cadaver.
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Affiliation(s)
- Tiago Lazzaretti Fernandes
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Medicina Esportiva, Sao Paulo, SP, Brazil
- FIFA Medical Center of Excellence, Sao Paulo, SP, Brazil
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - Michel Oliveira Souza
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Medicina Esportiva, Sao Paulo, SP, Brazil
- FIFA Medical Center of Excellence, Sao Paulo, SP, Brazil
| | - Cyro Albuquerque
- Centro Universitario da Fundaçao Educacional Inaciana "Padre Saboia de Medeiros", Departamento de Engenharia Mecanica, Sao Bernardo do Campo, SP, Brazil
| | | | - Andre Pedrinelli
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Medicina Esportiva, Sao Paulo, SP, Brazil
- FIFA Medical Center of Excellence, Sao Paulo, SP, Brazil
| | - Arnaldo José Hernandez
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Medicina Esportiva, Sao Paulo, SP, Brazil
- FIFA Medical Center of Excellence, Sao Paulo, SP, Brazil
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Gómez Cáceres A, Mariño IT, Martínez Malo FJ, Vieitez Riestra I, Idiart RP. "Over-the-Top" Anterior Cruciate Ligament Reconstruction Associated With a Lateral Extra-Articular Tenodesis in Children. Arthrosc Tech 2023; 12:e441-e448. [PMID: 37138689 PMCID: PMC10149820 DOI: 10.1016/j.eats.2022.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/10/2022] [Indexed: 05/05/2023] Open
Abstract
Anterior cruciate ligament (ACL) tears are one of the most frequent injuries in growing children, and they are often associated with other injuries such as meniscal and chondral injuries. In the past, treatment of ACL tears in growing patients relied on activity modification and bracing. However, surgical treatment has prevailed over conservative treatment in recent years. A surgical technique is presented for ACL reconstruction using an "over-the-top" technique associated with a lateral extra-articular tenodesis procedure in children. An extra-articular lateral tenodesis is done first. The gracilis and semitendinous tendons are then extracted using a tenotome without releasing their distal desinsertions. The tibial guide is then centered over the ACL tibial footprint under arthroscopic vision and an image intensifier, proximal to the physis. Then, a Kocher-type forceps is used to pass a suture "over the top" from the posterolateral window to the tibial tunnel. The double-bundle graft and iliotibial tract graft are fixed within the tunnel in full extension and neutral rotation with an interference screw.
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Affiliation(s)
- Abel Gómez Cáceres
- Hospital HM Málaga, Málaga, Spain
- Málaga Football Club, Málaga, Spain
- Address correspondence to Abel Gómez Cáceres, M.D., Avenida Carlos Haya 121, 29010, Málaga, Spain.
| | - Iskandar Tamimi Mariño
- Hospital HM Málaga, Málaga, Spain
- Hospital Regional Universitario de Málaga, Málaga, Spain
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Volz R, Borchert GH. Re-rupture rate and the post-surgical meniscal injury after anterior cruciate ligament reconstruction with the Press-Fit-Hybrid®-technique in comparison to the interference screw technique: a retrospective analysis of 200 patients with at least 3 years follow-up. Arch Orthop Trauma Surg 2023; 143:935-949. [PMID: 35290503 PMCID: PMC9925573 DOI: 10.1007/s00402-022-04368-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/19/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND There is currently no consensus regarding the preferred surgical procedure for the reconstruction of anterior cruciate ligament (ACL). The interference screw technique is widely used, but has been associated with a risk of graft damage. The Press-Fit-Hybrid®-technique is one of the alternatives for biological ACL-reconstruction with minimal implant requirements. The hypothesis of this retrospective analysis is, that the Press-Fit-Hybrid®-technique leads to better results with respect to re-rupture rate and secondary meniscal lesion than the interference-screw-technique. METHODS To compare the re-rupture rate of the interference-screw-technique (IF) used until 2015 with the currently used Press-Fit-Hybrid®-technique (PFH), the last 100 patients of the IF-group and the first 100 patients of the PFH-group were retrospectively analyzed. Primary outcomes were re-rupture rate, complications and secondary meniscal injury. Additionally, laxity, Lachman and Pivot-shift and range of motion were evaluated. RESULTS A mean follow-up of 4.2 and 5.3 years revealed 4% and 9% re-rupture rates and 1% and 2% complication rates in the PFH- and IF-group, respectively. In the PFH-group there were no re-ruptures in patients older than 23 years. Secondary meniscal injury post-surgery was 6% and 9% for the PFH and IF-group, respectively. Knee stability was similar in both groups. Range of motion was significantly better in the PFH-group, with 136° of flexion, 6 months after surgery. CONCLUSION For ACL-reconstruction the Press-Fit-Hybrid®-technique is an alternative new method. Low level of secondary meniscal lesions after surgery and high stability, is known to prevent later arthrosis of the knee. The encouraging observed trend of the reduction of the re-rupture rate in revision surgery and in young patients using the Press-Fit-Hybrid®-technique in comparison to the interference-screw-technique must be confirmed with further studies. LEVEL OF EVIDENCE Therapeutic Level III, retrospective cohort study.
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Affiliation(s)
- Richard Volz
- Joint Practice Renz' Volz and Loewe, Center for Specialized Joint Surgery, Haegerstraße 4, 88662, Ueberlingen, Germany.
| | - Gudrun H. Borchert
- Dr. Borchert Medical Information Management, Egelsbacher Str. 39e, 63225 Langen, Germany
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Costa GG, Perelli S, Grassi A, Russo A, Zaffagnini S, Monllau JC. Minimizing the risk of graft failure after anterior cruciate ligament reconstruction in athletes. A narrative review of the current evidence. J Exp Orthop 2022; 9:26. [PMID: 35292870 PMCID: PMC8924335 DOI: 10.1186/s40634-022-00461-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/28/2022] [Indexed: 01/11/2023] Open
Abstract
Anterior cruciate ligament (ACL) tear is one of the most common sport-related injuries and the request for ACL reconstructions is increasing nowadays. Unfortunately, ACL graft failures are reported in up to 34.2% in athletes, representing a traumatic and career-threatening event. It can be convenient to understand the various risk factors for ACL failure, in order to properly inform the patients about the expected outcomes and to minimize the chance of poor results. In literature, a multitude of studies have been performed on the failure risks after ACL reconstruction, but the huge amount of data may generate much confusion.The aim of this review is to resume the data collected from literature on the risk of graft failure after ACL reconstruction in athletes, focusing on the following three key points: individuate the predisposing factors to ACL reconstruction failure, analyze surgical aspects which may have significant impact on outcomes, highlight the current criteria regarding safe return to sport after ACL reconstruction.
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Affiliation(s)
- Giuseppe Gianluca Costa
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, C.da Ferrante, 94100, Enna, Italy. .,Knee and Arthroscopy Unit, Institut Catalá de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain.
| | - Simone Perelli
- Knee and Arthroscopy Unit, Institut Catalá de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain.,Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autonoma de Barcelona, Hospital Del Mar, Barcelona, Spain
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Arcangelo Russo
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, C.da Ferrante, 94100, Enna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Juan Carlos Monllau
- Knee and Arthroscopy Unit, Institut Catalá de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain.,Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autonoma de Barcelona, Hospital Del Mar, Barcelona, Spain
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10
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Min BH, Song HK, Park KH, Kim TH, Park DY, Chung JY. Biomechanical Evaluation of Modified ACL Reconstruction with Over-the-Top Augmentation Technique. Indian J Orthop 2022; 56:812-820. [PMID: 35547346 PMCID: PMC9043071 DOI: 10.1007/s43465-021-00597-x] [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: 08/02/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Modified ACL reconstruction with over-the-top augmentation technique (OA-ACLR) was designed to allow one-stage revision regardless of tunnel conditions as well as to offer firm stability by hybrid double-fixation. Thus, the purpose of the study is to biomechanically evaluate its effect on knee stability by comparing it with single-bundle ACL reconstruction (SB-ACLR). METHODS Ten porcine knees were sequentially tested using a custom testing system for intact ACL, ACL deficiency, SB-ACLR and OA-ACLR. First, 134-N anterior tibial load was applied, and anterior tibial translation was measured at 30°, 60°, and 90°. Then, anterior tibial translation and relative tibial rotation were measured in a combined rotatory load of 5-Nm of internal tibial torque and 10-Nm of valgus torque. RESULTS Under anterior tibial load or combined anterior and rotatory loads, SB-ACLR and OA-ACLR resulted in no significant increase in anterior tibial translation at all flexion angles compared with an intact ACL group, and no significant difference was noted in anterior tibial translation between the two ACL reconstruction groups. In combined rotatory load, OA-ACLR resulted in enhanced rotational stability compared with SB-ACLR, and it more closely restored relative tibial internal rotation to the intact ACL group. CONCLUSIONS Our study showed that modified ACL reconstruction with over-the-top augmentation technique resulted in enhanced rotational stability compared to the conventional single-bundle ACL reconstruction, especially at lower flexion angle in a porcine model. Therefore, with several potential advantages as well as biomechanical superiority, our new technique could be clinically applicable in primary and revision ACL reconstruction. LEVEL OF EVIDENCE Experimental.
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Affiliation(s)
- Byoung-Hyun Min
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
| | - Hyung Keun Song
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
| | - Ki Hoon Park
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
| | - Tae Hun Kim
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
| | - Do Young Park
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
| | - Jun Young Chung
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
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11
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Sherman SL, Calcei J, Ray T, Magnussen RA, Musahl V, Kaeding CC, Clatworthy M, Bergfeld JA, Arnold MP. ACL Study Group presents the global trends in ACL reconstruction: biennial survey of the ACL Study Group. J ISAKOS 2021; 6:322-328. [PMID: 34272329 DOI: 10.1136/jisakos-2020-000567] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The primary objective of this survey was to gauge the current global trends in anterior cruciate ligament reconstruction (ACLR) as reported by the members of the Anterior Cruciate Ligament (ACL) Study Group (SG). METHODS A survey was created and distributed among the members of the ACL SG consisting of 87 questions and 16 categories related to ACLR, including member demographics, preoperative management, primary ACLR techniques and graft choice, use of concomitant procedures and biological augmentation, postoperative rehabilitation, and more. RESULTS The survey was completed by the 140 members of the ACL SG. Fifty per cent of members are from Europe, 29% from the USA, 15% from the Asia-Pacific and the remaining 6% are from Latin America, the Middle East, New Zealand and Africa. Most (92%) do not believe there is a role for non-operative management of ACL tears in higher level athletes; conversely, most agree there is a role for non-operative management in lower impact athletes (92%). A single-bundle (90%) technique with hamstring autograft (53%) were most common for primary ACLR. Tunnel position varied among respondents. Sixty-one per cent do not use allograft for primary ACLR. Fifty per cent of respondents use cortical suspensory fixation on the femur, with variable responses on the tibia. Most (79%) do not use biologics in primary ACLR, while 83% think there is a selective role for extra-articular augmentation in primary ACLR. Fifty per cent prefer bone-tendon-bone autograft for revision ACLR and extra-articular augmentation is more commonly used (13% always, 26% often) than in primary ACLR (0% always, 15% often). A majority (53%) use a brace after primary ACLR. The most common responses for minimal time to return to play after primary ACLR were 6-8 months (44%) and 8-12 months (41%). CONCLUSION We presented the thoughts and preferences of the ACL SG on the management of ACL injuries. This survey will help to facilitate an ongoing discussion with regard to ACLR by providing global insights into the current surgical trends in ACLR. LEVEL OF EVIDENCE Level V, Expert Opinion.
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Affiliation(s)
- Seth L Sherman
- Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Jacob Calcei
- Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
| | - Taylor Ray
- Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | | | - Volker Musahl
- Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - John A Bergfeld
- Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Marcus P Arnold
- Orthopaedics, Practice LEONARDO, Hirslanden Clinic Birshot, Münchenstein, Switzerland
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12
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Kumar R, Kalra M, Garg AK, Choudhary R, Venishetty N, Verma S, Kumar A. Clinical Reliability of Adjustable Femoral Cortical Suspensory Fixation in Anterior Cruciate Ligament Reconstruction and Correlation of Clinical Outcomes With Demographic and Perioperative Factors. Cureus 2021; 13:e15345. [PMID: 34235023 PMCID: PMC8243633 DOI: 10.7759/cureus.15345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objective The primary goal of anterior cruciate ligament reconstruction (ACLR) is to protect the initial graft fixation against heavy loads encountered during the rehabilitation phase. The purpose of this study was to evaluate the functional outcomes (Lysholm score) and laxity [anterior tibial translation (ATT), anterior drawer test, Lachman test, and pivot shift test] of ACLR with adjustable-loop femoral cortical suspensory fixation (CSF) and tibial interferences crew fixation. Methods This study included 100 patients who underwent primary ACL reconstruction using quadruple hamstring grafts secured with TightRope® (Arthrex Inc, Naples, FL) femoral fixation and an interference screw on the tibial end. Six patients were excluded from the final analysis (four lost to follow-up, one suffered re-injury, and one had septic arthritis). The remaining 94 patients were evaluated for laxity and functional outcomes preoperatively, as well as at one, six, and 12 months postoperatively. Regression analysis was performed to determine the association between outcomes and 11 independent variables. This was designed as a prospective cohort study (level of evidence: II). Results The mean age of the participants was 28.46 ± 7.01 years. The median preoperative Lysholm knee score of 49 (mean ± SD: 48.2 ± 5.42) improved to 93 (92.7 ± 2.1) at six months and 98 (97.6 ± 2.1) at the one-year follow-up. The improvement was found to be statistically significant (p<0.01). The median ATT was 10 mm preoperatively, which decreased to 2 mm at one month, remained the same at six months, and rose to 3 mm at the one-year follow-up. ATT was found significantly reduced at one month postoperatively (p<.001) and did not show any significant further changes at subsequent follow-ups (p>0.05). Multiple linear regression revealed that one-year postoperative ATT (Rolimeter, Aircast Europa, Stephanskirchen, Germany) was independent of all demographic and perioperative variables tested. Conclusion Quadrupled hamstring graft ACLR with adjustable-loop fixation showed excellent subjective and objective outcomes with no residual laxity or failure of graft over mid-term follow-up. Postoperative laxity was not correlated with graft and tunnel dimensions.
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Affiliation(s)
- Ramesh Kumar
- Orthopaedics and Trauma, Pushpawati Singhania Research Institute, New Delhi, IND
| | - Mukesh Kalra
- Orthopaedics, Lady Hardinge Medical College, New Delhi, IND
| | - Ankit Kumar Garg
- Orthopaedics, All India Institute of Medical Sciences, Raipur, IND
| | | | | | - Shilp Verma
- Orthopaedics, All India Institute of Medical Sciences, Raipur, IND
| | - Ankush Kumar
- Orthopaedics, Lady Hardinge Medical College, New Delhi, IND
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Montreuil J, Saleh J, Cresson T, De Guise JA, Lavoie F. Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging. Orthop J Sports Med 2021; 9:2325967121989369. [PMID: 34250158 PMCID: PMC8239338 DOI: 10.1177/2325967121989369] [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: 09/13/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Nonanatomic graft placement is a frequent cause of anterior cruciate ligament
reconstruction (ACLR) failure, and it can be attributed to either tibial or
femoral tunnel malposition. To describe tibial tunnel placement in ACLR, we
used EOS, a low-dose biplanar stereoradiographic imaging modality, to create
a comprehensive grid that combines anteroposterior (AP) and mediolateral
(ML) coordinates. Purpose: To (1) validate the automated grid generated from EOS imaging and (2) compare
the results with optimal tibial tunnel placement. Study Design: Descriptive laboratory study. Methods: Using EOS, 3-dimensional models were created of the knees of 37 patients who
had undergone ACLR. From the most medial, lateral, anterior, and posterior
points on the tibial plateau of the EOS 3-dimensional model for each
patient, an automated and personalized grid was generated from 2 independent
observers’ series of reconstructions. To validate this grid, each observer
also manually measured the ML and AP distances, the medial proximal tibial
angle (MPTA), and the tibial slope for each patient. The ideal tibial tunnel
placement, as described in the literature, was compared with the actual
tibial tunnel grid coordinates of each patient. Results: The automated grid metrics for observer 1 gave a mean (95% CI) AP depth of
54.7 mm (53.4-55.9), ML width of 75.0 mm (73.3-76.6), MPTA of 84.9°
(83.7-86.0), and slope of 7.2° (5.4-9.0). The differences with corresponding
manual measurements were means (95% CIs) of 2.4 mm (1.4-3.4 mm), 0.5 mm
(–1.3 to 2.2 mm), 1.2° (–0.4° to 2.9°), and –0.4° (–2.1° to 1.2°),
respectively. The correlation between automated and manual measurements was
r = 0.78 for the AP depth, r = 0.68
for the ML width, r = 0.18 for the MPTA, and
r = 0.44 for the slope. The center of the actual tibial
aperture on the plateau was a mean of 5.5 mm (95% CI, 4.8-6.1 mm) away from
the referenced anatomic position, with a tendency toward more medial
placement. Conclusion: The automated grid created using biplanar stereoradiographic imaging provided
a novel, precise, and reproducible description of the tibial tunnel
placement in ACLR. Clinical Relevance: This technique can be used during preoperative planning, intraoperative
guidance, and postoperative evaluation of tibial tunnel placement in
ACLR.
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Affiliation(s)
- Julien Montreuil
- Laboratoire de recherche en Imagerie et Orthopédie de l'ETS, Montréal, Québec, Canada.,McGill Division of Orthopaedic Surgery, Montreal General Hospital, Montréal, Québec, Canada
| | - Joseph Saleh
- Faculté de Médecine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Thierry Cresson
- Laboratoire de recherche en Imagerie et Orthopédie de l'ETS, Montréal, Québec, Canada
| | - Jacques A De Guise
- Laboratoire de recherche en Imagerie et Orthopédie de l'ETS, Montréal, Québec, Canada
| | - Frédéric Lavoie
- Service de chirurgie orthopédique, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Combination of anterior tibial and femoral tunnels makes the signal intensity of antero-medial graft higher in double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:783-792. [PMID: 32350577 DOI: 10.1007/s00167-020-06014-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 04/17/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To elucidate whether sagittal graft tunnel affects the signal intensity in anatomical ACL reconstruction (ACLR) and to clarify the prevalence of intercondylar roof impingement. It was hypothesized that if the tunnel apertures are located within the anatomical footprint of ACL, tunnel position would not affect the signal intensity. METHODS A total of 132 patients who underwent anatomical double-bundle ACLR (DB-ACLR) using hamstring autograft were recruited. Tunnel position was determined by the quadrant method on three-dimensional computed tomography; the femoral tunnel position was defined as "high and low" or "deep and shallow", while that of the tibial side was defined as "anterior and posterior" or "medial and lateral". Subjects were divided into three groups according to the tertile of % deep-shallow. The signal intensity was evaluated by the region of interest value of the antero-medial bundle (AMB) and postero-lateral bundle on magnetic resonance imaging at 12 months after reconstruction. Linear regression analysis was conducted to elucidate the relationship between the percentage position of each tunnel and the graft signal intensity. RESULTS In the shallow tertile group, AMB signal intensity increased in the anterior position of the tibial tunnel (β = - 0.34; P = 0.025). In the intermediate and deep tertile groups, the tunnel position did not correlate with the signal intensity. CONCLUSIONS A more anterior tibial tunnel position increases AMB signal intensity in shallower femoral tunnel. Conversely, this correlation is attenuated for deeper femoral tunnels. Surgeons should pay attention to sagittal femoral tunnel position to create a more anterior tibial tunnel position. LEVEL OF EVIDENCE Level III.
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Chen J, Wang C, Xu C, Qiu J, Xu J, Tsai TY, Zhao J. Effects of Anterolateral Structure Augmentation on the In Vivo Kinematics of Anterior Cruciate Ligament-Reconstructed Knees. Am J Sports Med 2021; 49:656-666. [PMID: 33464924 DOI: 10.1177/0363546520981743] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Double-bundle anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-known treatment that restores the stability of ACL-deficient knees. However, some isolated ACL-reconstructed knees ultimately show rotatory laxity and develop osteoarthritis. Whether combined ACLR with anterolateral structure (ALS) augmentation (ALSA) can provide better improvement in the in vivo knee rotational kinematics remains unknown. HYPOTHESIS When compared with isolated double-bundle ACLR, combined double-bundle ACLR with ALSA can improve knee in vivo rotational kinematics and provide better restoration of knee kinematics. STUDY DESIGN Controlled laboratory study. METHODS Sixteen patients with unilateral ACL injury were randomly divided into 2 groups to receive either combined double-bundle ACLR and ALSA (ALSA group) or isolated double-bundle ACLR (ACLR group). All patients performed a single-leg lunge using the operative and nonoperative/contralateral legs under dual-fluoroscopic imaging system surveillance during a hospital visit at a minimum 1 year (12-13 months) of follow-up to assess the 6 degrees of freedom knee kinematics. Functional evaluation using the Lysholm and Marx rating scales and clinical examinations were also performed. RESULTS From full extension to approximately 90° of knee flexion at 5° intervals, the mean ± SD internal rotation of the reconstructed knees in the ALSA group (1.5°± 0.9°) was significantly smaller than that of the contralateral knees (8.2°± 1.9°; P = .008). The ALSA group knees also showed significantly (P = .045) more medial translation than the contralateral knees. In the ACLR group, the mean internal rotation of the reconstructed knee (6.0°± 2.1°) was significantly smaller than that of the contralateral knees (8.9°± 0.6°; P < .001). At full extension, the tibia was significantly more externally rotated than that of the contralateral legs (0.5°± 7.4° vs 7.6°± 3.4°, P = .049). CONCLUSION When compared with isolated double-bundle ACLR, double-bundle ACLR augmented with ALS reconstruction resulted in anterolateral rotatory overconstraint during the lunge motion. CLINICAL RELEVANCE Additional ALSA of double-bundle ACL-reconstructed knees overconstrained rotatory stability. Therefore, the use of ALSA for ACL-reconstructed knees should be considered with caution for patients with ACL deficiency and anterolateral rotatory instability. Longer-term follow-up to evaluate long-term outcomes and altered kinematics over time is recommended.
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Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cong Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiayu Qiu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Kumar R, Kumar S, Kumar A. Graft diameter as a predictor for functional outcome following arthroscopic anterior cruciate ligament reconstruction: A prospective study. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2021. [DOI: 10.4103/jodp.jodp_9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Diermeier T, Tisherman R, Hughes J, Tulman M, Baum Coffey E, Fink C, Lynch A, Fu FH, Musahl V. Quadriceps tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:2644-2656. [PMID: 32072203 DOI: 10.1007/s00167-020-05902-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/03/2020] [Indexed: 12/17/2022]
Abstract
Quadriceps tendon is a promising alternative graft option for anterior cruciate ligament (ACL) reconstruction, which can be harvested with or without a bone block as well as a full or partial thickness graft. Therefore, quadriceps tendon graft could be used in primary and revision ACL reconstruction based on the requirements (tunnel size, tunnel position, etc.). The all soft tissue, partial thickness quadriceps tendon graft in detail and pitfalls of the harvest are described in the present review. After quadriceps tendon harvest, especially in soccer players, who need a strong quadriceps to strike a ball with power, the postoperative rehabilitation may need to be adapted. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Theresa Diermeier
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA.,Department of Orthopaedic Sport Medicine, Technical University Munich, Munich, Germany
| | - Rob Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA.,Department of Orthopaedic Sport Medicine, Technical University Munich, Munich, Germany
| | - Jonathan Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Michael Tulman
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria.,Research Unit for Orthopedic Sports Medicine and Injury Prevention, UMIT Hall, Hall, Austria
| | - Andrew Lynch
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.,UPMC Centers for Rehab Services, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA.
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18
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Does Bone Plug and Graft Orientation (Inferior Versus Posterior) Alter Native Femoral Footprint Coverage in Bone Patellar Tendon Bone Anterior Cruciate Ligament Reconstruction? Arthroscopy 2020; 36:1875-1881. [PMID: 32061734 DOI: 10.1016/j.arthro.2020.01.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to compare the percentage of native femoral anterior cruciate ligament (ACL) footprint covered by the 2 most clinically relevant bone plug/graft orientations used with interference screw fixation in ACL reconstruction. A secondary purpose was to assess whether a transtibial or tibia-independent drilling technique would affect this outcome. METHODS Five matched pairs of cadaver knees were used. Each matched pair had 1 knee assigned to a 10-mm femoral socket prepared via a transtibial (TT) drilling technique and the other via an anteromedial (AM) drilling technique. The bone plug of each graft was press-fitted into the femoral socket with the graft collagen in 2 distinct clinically relevant orientations (collagen inferior or posterior). The digitized graft collagen cross-sectional area (CSA) in each orientation was overlaid onto the native femoral ACL footprint CSA to generate a percentage of native ACL footprint covered by graft collagen. RESULTS The average native ACL femoral footprint CSA was 110.5 ± 9.1 mm2, with no difference between knees assigned to TT or AM drilling (112.6 ± 2.7 vs 108.4 ± 13.0 mm2, P = .49). The average femoral socket CSA was 95.4 ± 8.7 mm2, with no difference between TT and AM tunnels (95.5 ± 9.9 vs 95.3 ± 8.4 mm2, P = .96). There was no difference between the percentage of native footprint covered between TT and AM sockets (76.8% ± 7.8% vs 82.2% ± 13.7%, P = .47). Irrespective of drilling technique, there was significantly greater native ACL footprint covered by graft collagen when the bone plug was oriented with graft collagen inferior rather than posterior (75.6% ± 6.3% vs 65.4% ± 11.4%, P = .02). CONCLUSION Orienting the femoral bone plug such that the graft collagen is inferior rather than posterior significantly increases native ACL femoral footprint coverage in bone-patellar tendon-bone ACL reconstruction. This effect is consistent across AM and TT drilling techniques. CLINICAL RELEVANCE Surgeons attempting to restore an anatomic ACL footprint should consider bone plug-graft orientation when performing ACL reconstruction. STUDY DESIGN Controlled laboratory study.
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19
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Goto K, Taketomi S, Shimizu N. Central patellar portal placement frequently provokes anterior knee compartment radiological abnormalities in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:2255-2260. [PMID: 31807833 DOI: 10.1007/s00167-019-05817-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 11/27/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE A central patellar (CP) portal can be used to view the native femoral insertion site of the anterior cruciate ligament (ACL). It aids in the drilling of an anatomical tunnel; however, its impact on the patellar tendon and the infrapatellar fat pad remains a concern. The aim of this study was to investigate complications associated with the CP portal use in arthroscopic ACL reconstruction (ACLR). METHODS A total of 105 patients (107 knees, 60 females) who underwent ACLR with a CP portal from 2012 to 2017 were included in this study. The mean age was 28.3 ± 12.4 years. All surgeries were single-bundle reconstructions using the trans-tibial technique via the CP and anteromedial portals. Post-operative events, magnetic resonance imaging (MRI), and arthroscopic findings associated with CP portal creation were evaluated. RESULTS Five patients (4.7%) had symptomatic postoperative complications, which included two patients with patellar tendonitis and three patients with fibrosis in the anterior knee compartment. Abnormal signal intensity of the patellar tendon on MRI and increased thickness at the CP portal area were found in 18 of 25 knees (72%). Three of 56 knees (5.4%) that underwent second-look arthroscopy showed fibrosis of the infrapatellar fat pad. Seven patients (12.5%) showed hypertrophy of the ligamentum mucosum. CONCLUSIONS The rate of symptomatic complications associated with CP portal placement was 4.7%; however, abnormal MRI or follow-up arthroscopy findings were much higher than clinically symptomatic patients. This study suggests that CP portal placement could provoke anterior knee compartment fibrosis or hypertrophy. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kazumi Goto
- Department of Orthopaedic Surgery, Toshiba Rinkan Hospital, 7-9-1, Kamitsuruma, Minami-ku, Sagamihara-shi, Kanagawa, 252-0385, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Naofumi Shimizu
- Department of Orthopaedic Surgery, Toshiba Rinkan Hospital, 7-9-1, Kamitsuruma, Minami-ku, Sagamihara-shi, Kanagawa, 252-0385, Japan
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20
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Grassi A, Di Paolo S, Lucidi GA, Macchiarola L, Raggi F, Zaffagnini S. The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation. Am J Sports Med 2019; 47:3203-3211. [PMID: 31613650 DOI: 10.1177/0363546519876648] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited in vivo kinematic information exists on the effect of clinical-based partial medial and lateral meniscectomy in the context of anterior cruciate ligament (ACL) reconstruction. HYPOTHESIS In patients with ACL deficiency, partial medial meniscus removal increases the anteroposterior (AP) laxity with compared with those with intact menisci, while partial lateral meniscus removal increases dynamic laxity. In addition, greater postoperative laxity would be identified in patients with partial medial meniscectomy. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 164 patients with ACL tears were included in the present study and divided into 4 groups according to the meniscus treatment they underwent: patients with partial lateral meniscectomy (LM group), patients with partial medial meniscectomy (MM group), patients with partial medial and lateral meniscectomy (MLM group), and patients with intact menisci who did not undergo any meniscus treatment (IM group). A further division in 2 new homogeneous groups was made based on the surgical technique: 46 had an isolated single-bundle anatomic ACL reconstruction (ACL group), while 13 underwent a combined single-bundle anatomic ACL reconstruction and partial medial meniscectomy (MM-ACL group). Standard clinical laxities (AP translation at 30° of knee flexion, AP translation at 90° of knee flexion) and pivot-shift (PS) tests were quantified before and after surgery by means of a surgical navigation system dedicated to kinematic assessment. The PS test was quantified through 3 different parameters: the anterior displacement of the lateral tibial compartment (lateral AP); the posterior acceleration of the lateral AP during tibial reduction (posterior acceleration); and finally, the area included by the lateral AP translation with respect to the flexion/extension angle (area). RESULTS In the ACL-deficient status, the MM group showed a significantly greater tibial translation compared with the IM group (P < .0001 for AP displacement at 30° [AP30] and 90° [AP90] of flexion) and the LM group (P = .002 for AP30 and P < .0001 for AP90). In the PS test, the area of LM group was significantly larger (57%; P = .0175) than the one of the IM group. After ACL reconstruction, AP translation at 30° was restored, while the AP90 remained significantly greater at 1.3 mm (P = .0262) in the MM-ACL group compared with those with intact menisci. CONCLUSION Before ACL reconstruction, partial medial meniscectomy increased AP laxity at 30° and 90° and lateral meniscectomy increased dynamic PS laxity with respect to intact menisci. Anatomic single-bundle ACL reconstruction decreased laxities, but a residual anterior translation of 1.3 mm at 90° remained in patients with partial medial meniscectomy, with respect to those with intact menisci.
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Affiliation(s)
- Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Raggi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Italy
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21
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Maffulli N, Oliviero A. Review of Jones (1963) on ‘Reconstruction of the anterior cruciate ligament. A technique using the central one-third of the patellar ligament‘. J ISAKOS 2019. [DOI: 10.1136/jisakos-2019-000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Iuchi R, Mae T, Tachibana Y, Shino K, Nakagawa S, Yoshikawa H, Nakata K. Mechanical Properties of an Adjustable-Loop Cortical Suspension Device for Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2018; 6:2325967118791183. [PMID: 30151403 PMCID: PMC6104212 DOI: 10.1177/2325967118791183] [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] [Indexed: 11/17/2022] Open
Abstract
Background: Various biomechanical properties of adjustable-loop cortical suspension devices have been observed among previous studies in which different experimental conditions were used to test each of these devices. However, no studies have investigated the biomechanical properties of single adjustable-loop cortical suspension devices under different cyclic loading protocols. It is necessary to clarify the problems associated with using this device and detect the best method of using it in the clinical setting. Hypothesis: The elongation of the loop of an adjustable-loop cortical suspension device with cyclic loading would be smaller with (1) an increase in the lower force limit and (2) lower speeds of cyclic loading. Study Design: Controlled laboratory study. Methods: Eighteen anterior cruciate ligament (ACL) adjustable-loop cortical suspension devices were tested under the following 3 cyclic loading protocols in a device-only model. Protocol A included cyclic loading between 10 and 50 N at 50 mm/min for 500 cycles. The upper force limit was then increased by 25-N increments every 500 cycles up to 250 N, for a total of 4500 cycles. Protocol B included cyclic loading between 30 and 50 N at 50 mm/min for 500 cycles. The upper force limit was then increased to 250 N, for a total of 4500 cycles, in the same manner as protocol A. Protocol C included cyclic loading between 30 and 50 N at 25 mm/min for 500 cycles. The upper force limit was then increased to 250 N, for a total of 4500 cycles, in the same manner as protocol A. Results: The elongation after 4500 cycles was 36.1, 18.5, and 8.6 mm for protocols A, B, and C, respectively. There were significant differences among the 3 protocols, with protocol C showing the smallest elongation with cyclic loading. The elongation in each group progressed with each 25-N cyclic load increment. Conclusion: The adjustable-loop cortical suspension device showed a smaller elongation of the loop with increases in the lower force limit and with lower cyclic loading speeds. Clinical Relevance: Care should be taken during rehabilitation after anatomic ACL reconstruction using adjustable-loop cortical suspension devices with a low initial tension at graft fixation. Slow and less intense exercises may be more desirable in the early stages of healing.
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Affiliation(s)
- Ryo Iuchi
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuta Tachibana
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
| | | | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ken Nakata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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23
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Aga C, Risberg MA, Fagerland MW, Johansen S, Trøan I, Heir S, Engebretsen L. No Difference in the KOOS Quality of Life Subscore Between Anatomic Double-Bundle and Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction of the Knee: A Prospective Randomized Controlled Trial With 2 Years' Follow-up. Am J Sports Med 2018; 46:2341-2354. [PMID: 30021073 DOI: 10.1177/0363546518782454] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The double-bundle reconstruction technique was developed to resemble the properties of the native anterior cruciate ligament (ACL) more closely than the conventional single-bundle technique. The clinical benefit of the operative procedure is controversial, and there is a need for studies with a focus on patient-reported outcomes (PROs). STUDY DESIGN Randomized controlled trial; Level of evidence, 1. HYPOTHESIS Anatomic double-bundle ACL reconstruction would be superior to anatomic single-bundle reconstruction regarding the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscore from baseline to 2-year follow-up. METHODS According to sample size calculations, 120 patients aged 18 to 40 years with a primary ACL injury of their knee were randomized to the anatomic double-bundle or anatomic single-bundle reconstruction groups. Patients with posterior cruciate ligament, posterolateral corner, or lateral collateral ligament injuries or with established osteoarthritis were excluded. Patients with residual laxity from a coexistent medial collateral ligament injury were excluded. Data were registered at baseline, 1 year, and 2 years. In 24 patients, postoperative 3-dimensional computed tomography was performed to verify the positioning of the bundles. The outcome measures were the change in KOOS subscores and the International Knee Documentation Committee 2000 subjective score, pivot-shift test result, Lachman test finding, KT-1000 arthrometer measurement, activity level, return-to-sports rate, and osteoarthritic changes on radiographs. A linear mixed model was used for the analysis of all the PROs, including the primary outcome. RESULTS The change in the KOOS QoL subscore from baseline to 2-year follow-up was not different between the double- and single-bundle groups (mean change, 29.2 points vs 28.7 points, respectively; -0.5-point difference; 95% CI, -8.4 to 7.4 points; P = .91). Neither were there any differences between the 2 groups in the remaining PROs, knee laxity measurements, or activity levels of the patients. Radiological signs of osteoarthritis were found in 2 patients. Eleven patients had a graft rupture: 8 in the single-bundle group and 3 in the double-bundle group ( P = .16). Three-dimensional computed tomography of the knees verified the positioning of the anteromedial bundle, posterolateral bundle, and single-bundle grafts to be within acceptable limits. CONCLUSION There was no difference in the KOOS QoL subscore, the remaining PROs, knee laxity measurements, or activity levels comparing the double- and single-bundle ACL reconstruction techniques. The number of bundles does not seem to influence clinical and subjective outcomes, as long as the tunnels are adequately positioned. Registration: NCT01033188 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Cathrine Aga
- Department of Orthopedic Surgery, Martina Hansens Hospital, Bærum, Norway.,Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - May Arna Risberg
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Sports Trauma Research Center, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Steinar Johansen
- Department of Orthopedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Ingrid Trøan
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Stig Heir
- Department of Orthopedic Surgery, Martina Hansens Hospital, Bærum, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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24
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Jurkonis R, Gudas R, Smailys A. Influence of Graft Diameter on Functional Outcomes After Anterior Cruciate Ligament Reconstruction: A Prospective Study with a 1-Year Follow-Up. Med Sci Monit 2018; 24:4339-4345. [PMID: 29936518 PMCID: PMC6048996 DOI: 10.12659/msm.908212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background The aim of this study was to determine whether graft size is associated with recurrent instability and insufficient functional outcomes after ACL reconstruction. Material/Methods We analyzed 214 consecutive patients with a completed follow-up of 12 months: 55 (25.7%) women and 159 (74.3%) men. Patients were divided into 3 groups according to the diameter of the middle of the hamstring graft. Follow-up examinations were performed pre-surgery and 3, 6, and 12-months postoperatively, and laxity assessments were performed using GNRB®. Differential laxity measured at 134N (Δ134=heathy vs. operated side). A “residual laxity” of the ACLR was defined as Δ134N>3 mm. Results The results of the General Linear Model (Repeated Measures) showed that there was a significant main effect of time factor (F=379.759, p<0.001, η2p=0.681) on differential laxity. We found statistically significant differences (p<0.001) in assessments of differential laxity pre-surgery and at 3, 6, and 12 months postoperatively (time factor). Tegner activity score at 12 months after reconstruction significantly differed when comparing patients with “residual laxity” (4.23±0.83) and others (4.85±1.17) (p=0.038). The study revealed a positive correlation between Tegner activity score at 12 months after surgery and pre-injury Tegner activity score (r=0.728, p<0.001) and negative correlation between age (r=−0.43, p<0.001) or BMI (r=−0.33, p<0.001). Conclusions Our study revealed that graft diameter is not associated with recurrent instability and does not affect laximetry results. The multiple regression model we developed made it possible to predict the Tegner activity score at 12 months after reconstruction based on pre-injury Tegner activity score, age (years), and BMI (kg/m2) of the patient.
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Affiliation(s)
- Rokas Jurkonis
- Institute of Sports, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimtautas Gudas
- Institute of Sport, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alfredas Smailys
- Department of Orthopedic and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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25
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Ciccotti MC, Secrist E, Tjoumakaris F, Ciccotti MG, Freedman KB. Anatomic Anterior Cruciate Ligament Reconstruction via Independent Tunnel Drilling: A Systematic Review of Randomized Controlled Trials Comparing Patellar Tendon and Hamstring Autografts. Arthroscopy 2017; 33:1062-1071.e5. [PMID: 28359669 DOI: 10.1016/j.arthro.2017.01.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/29/2016] [Accepted: 01/05/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To collect the highest level of evidence comparing anatomic anterior cruciate ligament (ACL) reconstruction via independent tunnel drilling using bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts in terms of clinical outcome and failure rate. METHODS We performed a systematic review of clinical trials that randomized patients to ACL reconstruction with either BTB or HT autografts with a minimum 2-year follow-up. Only trials using independent tunnel drilling, including outside-in and anteromedial portal techniques, for both autografts were eligible for inclusion, whereas all transtibial studies were excluded. Study design, demographics, surgical technique, rehabilitation protocol, and clinical outcomes were compiled. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Quality assessment was performed using the Coleman Methodological Scale (CMS). RESULTS Six published studies reporting on 5 randomized controlled trials (RCTs) met the inclusion criteria. No study reported a difference in rerupture rate between BTB and HT. BTB-reconstructed knees experienced a greater incidence of anterior knee pain or crepitus in 2/7 trials and radiographic evidence of degenerative change in 3/7 trials. HT-reconstructed knees had increased instrumented laxity in 2/7 trials and less knee flexion strength postoperatively. CONCLUSIONS This study collects all available Level I and II evidence for anatomic ACL reconstruction using BTB and HT grafts. According to the data presented in these studies, clinical outcome scores and failure rates showed no differences for anatomic reconstruction using either autograft. However, in some studies, BTB-reconstructed knees experienced a greater incidence of anterior knee pain and radiographic evidence of degenerative change, and in others, HT-reconstructed knees had increased laxity and less knee flexion strength. In our opinion, both BTB and HT autografts remain valid options for ACL reconstruction when using anatomic drilling techniques, providing a stable knee with reliable return to activity. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
| | - Eric Secrist
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Fotios Tjoumakaris
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Michael G Ciccotti
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A..
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26
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Comparing Dimensions of Four-Strand Hamstring Tendon Grafts with Native Anterior and Posterior Cruciate Ligaments. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3795367. [PMID: 28105419 PMCID: PMC5220404 DOI: 10.1155/2016/3795367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 01/17/2023]
Abstract
Background. The aim of the study was to evaluate whether or not there was any incompatibility between four-strand hamstring tendons taken from the same knee and the dimensions of the ACL and PCL. Methods. 15 fresh frozen cadaver hamstrings were prepared as four-strand grafts and measurements made of the ACL and PCL circumferences in the midsection were made in the narrowest part of the midsection. The cross-section areas and diameters were calculated with geometric calculations used to measure the cross-sectional area of cylinders. Accepting that the geometric insertions were elliptical, the length, width, and area were calculated for entry areas. Results. A significant relationship at 96.2% was determined between the ACL mid and the hamstring diameter. A significant relationship at 96.7% was determined between the ACL and the hamstring mid area. A significant relationship at 96.4% was determined between the PCL mid and the hamstring diameter. A significant relationship at 95.7% was determined between the PCL and the hamstring mid area. Conclusion. For the reconstruction of ACL and PCL, it was determined that there is less incompatibility between the four-strand hamstring tendons taken from the same knee and the dimensions of the midsection PCL compared to the ACL dimensions.
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27
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Clinical advantages of image-free navigation system using surface-based registration in anatomical anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:3556-3564. [PMID: 27761623 DOI: 10.1007/s00167-016-4332-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/14/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the clinical advantages of a navigation system developed with an emphasis on attaining an appropriate femoral tunnel length and posterior wall margin with no posterior wall blowout, as well as having accurate tunnel positioning, in anatomical anterior cruciate ligament reconstruction (ACLR). METHODS Ten freshly frozen human knees were transected at mid-femur and mid-tibia. Each knee specimen underwent arthroscopic single-bundle anterior cruciate ligament reconstruction using the outside-in technique, with two knees by manual ACLR (control group) and another eight knees by only the navigational ACLR without arthroscopic assistance (experimental group). The position/orientation information of tunnel entry point, tunnel length, and posterior wall distance of pre-, intra-, and postoperative tunnel were recorded, and the reliability and errors among them were evaluated. RESULTS From comparison of the 3D models for preoperative planning and postoperative reconstruction, the mean differences for navigational femoral tunnelling and arthroscopic-assisted femoral tunnelling were recorded, respectively: (1) tunnel entry position, 1.4 mm (SD 0.3) versus 4.9 mm; (2) tunnel length, 0.7 mm (SD 0.2), similar to 0.6 mm in arthroscopic-assisted femoral tunnelling, and (3) posterior wall distance, 0.5 mm (SD 0.2), much smaller than 4.7 mm for arthroscopic-assisted femoral tunnelling. The intraclass correlation coefficients, calculated to determine the accuracy and reliability of navigational femoral tunnelling, showed excellent internal consistency that ranged from 0.965 to 0.989 for tunnel length and from 0.810 to 0.953 for posterior wall distance. CONCLUSION Navigation systems with enhancement of the registration accuracy by the developed system are feasible in anatomical ACLR, in reducing surgical failures such as short tunnel length or posterior wall breakage of distal femur. The present study revealed that computer navigation could aid in avoiding major mistakes in exact positioning and posterior wall blowout and help in attaining appropriate length for femoral tunnelling in anatomical ACLR.
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28
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Kim M, Choi YS, Kim H, Choi NH. Postoperative Evaluation after Anterior Cruciate Ligament Reconstruction: Measurements and Abnormalities on Radiographic and CT Imaging. Korean J Radiol 2016; 17:919-930. [PMID: 27833408 PMCID: PMC5102920 DOI: 10.3348/kjr.2016.17.6.919] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/05/2016] [Indexed: 12/30/2022] Open
Abstract
Reconstruction of a ruptured anterior cruciate ligament (ACL) is a well-established procedure for repair of ACL injury. Despite improvement of surgical and rehabilitation techniques over the past decades, up to 25% of patients still fail to regain satisfactory function after an ACL reconstruction. With development of CT imaging techniques for reducing metal artifacts, multi-planar reconstruction, and three-dimensional reconstruction, early post-operative imaging is increasingly being used to provide immediate feedback to surgeons regarding tunnel positioning, fixation, and device placement. Early post-operative radiography and CT imaging are easy to perform and serve as the baseline examinations for future reference.
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Affiliation(s)
- Minchul Kim
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea
| | - Yun Sun Choi
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea
| | - Hyoungseop Kim
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea
| | - Nam-Hong Choi
- Department of Orthopedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea
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29
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Malempati CS, Metzler AV, Johnson DL. Single-Bundle Anatomic Anterior Cruciate Ligament Reconstruction: Surgical Technique Pearls and Pitfalls. Clin Sports Med 2016; 36:53-70. [PMID: 27871661 DOI: 10.1016/j.csm.2016.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Anterior cruciate ligament (ACL) ruptures are some of the most common sports-related injuries. Treatment of these injuries with ACL reconstruction has evolved over the last several decades. Anatomic single-bundle ACL reconstruction offers an accurate and reproducible method to reproduce native knee anatomy, restore knee kinematics, and ultimately restore function and decrease long-term degenerative effects. The importance of adequate arthroscopic visualization and a thorough understanding of the native anatomic ACL landmarks are discussed in this article. Furthermore, surgical technique, pearls, pitfalls, potential complications, rehabilitation, and outcomes are reviewed.
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Affiliation(s)
- Chaitu S Malempati
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Kentucky School of Medicine, 740 South Limestone Street, Lexington, KY 40536-0284, USA
| | - Adam V Metzler
- Division of Sports Medicine, Commonwealth Orthopaedic Centers, 560 South Loop Road, Edgewood, KY 41017, USA
| | - Darren L Johnson
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Kentucky School of Medicine, 740 South Limestone Street, Lexington, KY 40536-0284, USA.
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30
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Fujii M, Sasaki Y, Araki D, Furumatsu T, Miyazawa S, Ozaki T, Linde-Rosen M, Smolinski P, Fu FH. Evaluation of the semitendinosus tendon graft shift in the bone tunnel: an experimental study. Knee Surg Sports Traumatol Arthrosc 2016; 24:2773-2777. [PMID: 25472684 DOI: 10.1007/s00167-014-3461-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/21/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to measure the semitendinosus tendon graft shift at the tunnel aperture with graft bending using a simulated femoral bone tunnel. METHODS Eight semitendinosus tendon grafts were used in this study. The median age of the specimen was 53 years (range 46-63). After stripping excess soft tissue, the semitendinosus tendon was doubled over the loop of the EndoButton CL (Smith and Nephew Inc.). The diameter of the graft was measured using a graft-sizing tube (Smith and Nephew Inc.) and verified to be 7.0 mm. A custom-made aluminium fixture, the size was 40.0 mm(3), with 7.0-mm-diameter hole was used as a simulated femoral bone tunnel. The graft was inserted to the tunnel, and EndoButton was positioned to the outside of the tunnel on the fixture. The distal end of the graft was tensioned with 30 N at an angle of 15°, 30°, 45°, 60°, 75° that reproduced the graft bending angle during knee range of motion. The photograph of the tunnel aperture was taken at each graft bending angle using a digital camera, and the graft shift amount in the simulated tunnel was analysed using the computer software (ImageJ). RESULTS The amount of the graft shift significantly increased when the graft bending angle was increased (P < 0.05). The biggest shift was observed when the graft bending angle was 75° in all specimens, and the value was 1.10 mm ± 0.12. CONCLUSION The present study suggests that even if the femoral tunnel was created in the centre of the ACL insertion site, the graft shifted within the tunnel in the direction of the tension applied to the graft during knee range of motion. Surgeons may have to consider the graft shift within the bone tunnel as well as the tunnel position in the restoration of the native ACL anatomy.
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Affiliation(s)
- Masataka Fujii
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Yusuke Sasaki
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Kobe University, Kobe, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Monica Linde-Rosen
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Shimodaira H, Tensho K, Akaoka Y, Takanashi S, Kato H, Saito N. Remnant-Preserving Tibial Tunnel Positioning Using Anatomic Landmarks in Double-Bundle Anterior Cruciate Ligament Reconstruction. Arthroscopy 2016; 32:1822-30. [PMID: 27134191 DOI: 10.1016/j.arthro.2016.01.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 01/17/2016] [Accepted: 01/27/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess (1) if 6 anatomic landmarks (ALs) could be arthroscopically confirmed with remnant preservation and (2) if creating tibial tunnels using these landmarks reduces individual variation and improves reproducibility in double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS We retrospectively reviewed data of patients who chronologically underwent double-bundle ACL reconstruction by either referencing the footprint after remnant dissection (non-AL group) or subsequently with the ALs (AL group). Using operative videos, 3 independent observers judged whether they could confirm 6 ALs (medial intercondylar ridge, medial and lateral intercondylar tubercles, anterior horn of lateral meniscus, Parsons' knob, and L-shaped ridge) in 20 patients randomly selected from the AL group. We then compared tunnel positions between the 2 groups, measured from the anterior and medial borders of the proximal tibia and expressed as percentage of the total depth and width of the proximal tibia using 3-dimensional computed tomography. RESULTS One hundred four patients (non-AL group, n = 54; AL group, n = 50) were included. All 6 ALs were arthroscopically confirmed in most cases (89.7% to 100%). The mean percentages of the anteroposterior (AP) depth for anteromedial (AM) tunnel, mediolateral (ML) width for AM tunnel, AP depth for posterolateral (PL) tunnel, and ML width for PL tunnel, respectively, were 27.8% ± 6.6%, 46.7% ± 2.8%, 41.4% ± 7.3%, and 46.1% ± 2.6% for the non-AL group and 30.7% ± 4.5%, 45.7% ± 2.2%, 45.2% ± 4.5%, and 46.9% ± 2.1% for the AL group, revealing significantly less variation in the AL group compared with the non-AL group, excluding the ML width of the PL tunnel (P = .007, .046, .002, .209, respectively). CONCLUSIONS Six landmarks could be reliably confirmed in cases with remnant preservation, and creating tibial tunnels using these landmarks were reproducible and resulted in less individual variation. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Yusuke Akaoka
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Seiji Takanashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoto Saito
- Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University School of Medicine, Matsumoto, Japan
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32
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Marchand JB, Ruiz N, Coupry A, Bowen M, Robert H. Do graft diameter or patient age influence the results of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 2016; 24:2998-3004. [PMID: 25912072 DOI: 10.1007/s00167-015-3608-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/16/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE Hamstring tendons are commonly used as a graft source for ACL reconstruction. This study seeks to determine whether either the diameter of the tendon graft or the age of the patient influences the outcome of the ACL reconstruction when measured using a standard, previously validated laxity measurement device. METHODS This is a retrospective study of 88 patients who underwent ACL reconstruction with a short, quadrupled tendon technique, using the semitendinosus ± gracilis tendons. Patients included in this study were sequential, unilateral, complete ACL ruptures. The patients were followed for a minimum of 1 year postoperatively, with a mean follow-up of 26 months. Patients were divided into three groups according to the diameter (Ø) of the graft: group 1 (32 patients): 8 mm ≤ Ø ≤ 9 mm; group 2 (28 patients): 9 mm < Ø ≤ 10 mm; and group 3 (28 patients): Ø > 10 mm. Three groups with differential laxity at 134 N (Δ134 = healthy side vs. operated side) measured with the laximeter GNRB(®) were compared. The risk of residual laxity (OR) between the three groups taking age, gender, BMI and meniscus status into account was calculated. A side-to-side laxity >3 mm was considered as a residual laxity. RESULTS The mean patient age at the time of reconstruction was 29.4 years. The three groups were comparable. Postoperative Δ134 was 1.50 ± 1.3, 1.59 ± 1.5 and 2 ± 1.7 mm for groups 1 through 3, respectively. Δ134 > 3 mm was observed in three patients in group 1, four patients in group 2 and nine patients in group 3. As compared to group 1, OR was 1.46 (95 % CI 0.35-6.05) and 3.31 (95 % CI 0.89-12.34) in groups 2 and 3, respectively. Adjustment for age, gender, BMI and meniscus did not change the estimates [OR 1.44 (95 % CI 0.34-6.16) and 3.92 (95 % CI 1-15.37)] in groups 2 and 3, respectively. Patients younger than 20 had a significantly higher average postoperative laximetry (2.4 ± 1.5 mm) compared to those aged 20 years and over (1.5 ± 1.5 mm) (p = 0.03), regardless of the diameter of the graft. CONCLUSION The diameter of the graft between 8 and 10 mm does not affect the laximetric results of an ACL reconstruction. Therefore, there does not appear to be a benefit to harvesting and adding further tissue to increase the diameter of the graft above 10 mm. Patients younger than 20 represent a population at risk of graft elongation. In these patients at risk, postoperative management needs to be modified (delayed weight bearing, articulated splinting, slower rehabilitation) in the first months. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Jean Baptiste Marchand
- Centre Hospitalier Départemental de La Roche sur Yon (La Roche-sur-Yon), Les Oudairies, 85100, La Roche-Sur-Yon, France
| | - Nicolas Ruiz
- Orthopaedic Department, North Mayenne Hospital, 53100, Mayenne, France
| | - Augustin Coupry
- Orthopaedic Department, North Mayenne Hospital, 53100, Mayenne, France
| | - Mark Bowen
- , 680 North Lake Shore Drive, Chicago, IL, 60611, USA
| | - Henri Robert
- Orthopaedic Department, North Mayenne Hospital, 53100, Mayenne, France.
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Abstract
The anatomic anterior cruciate ligament (ACL) reconstruction concept has developed in part from renewed interest in the insertional anatomy of the ACL, using surgical techniques that can reproduce this anatomy reliably and accurately during surgical reconstruction. Several technical tools are available to help identify and place the tibial and femoral grafts anatomically, including arthroscopic anatomic landmarks, a malleable ruler device, and intraoperative fluoroscopy. The changes in technique for anatomic tunnel placement in ACL reconstruction follow recent biomechanical and kinematic data that demonstrate improved time zero characteristics. A better re-creation of native ACL kinematics and biomechanics is achieved with independent femoral drilling techniques that re-create a central footprint single-bundle ACL reconstruction or double-bundle reconstruction. However, to date, limited short-term and long-term clinical outcome data have been reported that support using either of these techniques rather than a transtibial drilling technique. This lack of clear clinical advantage for femoral independent and/or double-bundle techniques may arise because of the potentially offsetting biologic incorporation challenges of these grafts when placed using these techniques or could result from modifications made in traditional endoscopic transtibial techniques that allow improved femoral and tibial footprint restoration.
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Spragg L, Chen J, Mirzayan R, Love R, Maletis G. The Effect of Autologous Hamstring Graft Diameter on the Likelihood for Revision of Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2016; 44:1475-81. [PMID: 27002103 DOI: 10.1177/0363546516634011] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) have become popular in the past 2 decades; however, it is difficult to predict the diameter of the harvested tendons before surgery. Previous biomechanical studies have suggested that a smaller graft diameter leads to a lower load to failure, but clinical studies looking at various predictors for failure, including graft size, have been inconclusive. PURPOSE To evaluate the relationship of hamstring graft diameter to ACL revision within a large cohort of patients, while controlling for sex, age, body mass index (BMI), and femoral and tibial fixation type. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A case-control study using patients registered in an ACLR registry was conducted. Revision was used as a marker for graft failure. A case was defined as a patient who underwent primary ACLR with a hamstring autograft that was revised during the study period (April 2006 to September 2012). Three controls, defined as patients who underwent primary ACLR with a hamstring autograft that was not revised, were matched to each of the cases according to age, sex, BMI, and femoral and tibial fixation type. Descriptive characteristics were employed, and conditional logistic regression was conducted to produce estimates of odds ratios and 95% CIs. RESULTS A total of 124 cases and 367 controls were identified. There were no significant differences between cases and controls in the distribution of sex (52.4% male vs 52.9% male, respectively; P = .932), median age (17.6 years [interquartile range (IQR), 15.9-20.4] vs 17.6 years [IQR, 15.9-20.4], respectively; P = .999), median BMI (23.4 kg/m(2) [IQR, 21.5-26.4] vs 23.4 kg/m(2) [IQR, 21.6-25.8], respectively; P = .954), femoral fixation (P = .459), and tibial fixation (P = .766). The mean (±SD) graft diameter was 7.9 ± 0.75 mm in the cases and 8.1 ± 0.73 mm in the controls. The likelihood of a patient needing revision ACLR in the study cohort was 0.82 times lower (95% CI, 0.68-0.98) for every 0.5-mm increase in the graft diameter from 7.0 to 9.0 mm. CONCLUSION In this study, within the range of 7.0 to 9.0 mm, there was a 0.82 times lower likelihood of being a revision case with every 0.5-mm incremental increase in graft diameter.
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Affiliation(s)
- Lindsey Spragg
- Los Angeles County + USC Medical Center, Los Angeles, California, USA
| | - Jason Chen
- Kaiser Permanente San Diego, San Diego, California, USA
| | - Raffy Mirzayan
- Kaiser Permanente Baldwin Park, Baldwin Park, California, USA
| | - Rebecca Love
- Kaiser Permanente San Diego, San Diego, California, USA
| | - Gregory Maletis
- Kaiser Permanente Baldwin Park, Baldwin Park, California, USA
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Domnick C, Raschke MJ, Herbort M. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques. World J Orthop 2016; 7:82-93. [PMID: 26925379 PMCID: PMC4757662 DOI: 10.5312/wjo.v7.i2.82] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/05/2015] [Accepted: 12/02/2015] [Indexed: 02/06/2023] Open
Abstract
The influences and mechanisms of the physiology, rupture and reconstruction of the anterior cruciate ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome.
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The effect of feedback from post-operative 3D CT on placement of femoral tunnels in single-bundle anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:154-60. [PMID: 25274095 DOI: 10.1007/s00167-014-3355-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/23/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the effect of feedback from post-operative 3D CT in the learning process of placing the femoral graft tunnel anatomically using the anteromedial (AM)-portal technique in single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS An experienced knee surgeon converting from transtibial to AM-portal technique was offered post-operative feedback on tunnel placement. Three groups of patients were included: transtibial drilling, (AM1) anteromedial drilling without feedback and (AM2) anteromedial drilling with post-operative CT feedback. Intra-articular landmarks were used as the only guidance for tunnel placement. Tunnel position was compared to an ideal anatomical ACL position using the Bernard and Hertel grid and visual feedback was given on tunnel placements. The effect of feedback was measured as the distance from the anatomical centre, and spread of tunnel placements on post-operative CT performed feedback was initiated. RESULTS When comparing the femoral tunnel placement to an ideal anatomical centre, there was an improvement in the mean tunnel position after (A) changing from a transtibial to an anatomical technique and a further improvement after (B) initializing the radiological feedback. There was a great variation of femoral tunnel localizations when initially only using intra-articular landmarks as guidance for tunnel placement--this variation, however, converged towards the anatomical centre throughout the feedback period and the AM2 group had a femoral tunnel closer (P = 0.001) to the anatomical centre than the AM1 group. CONCLUSIONS Post-operative 3D CT is effective in the learning process of placing femoral tunnels anatomically by giving post-operative feedback on tunnel placement. Bony landmarks and ACL remnants were found unreliable as the only guidance for femoral tunnel placement in the AM-portal technique-therefore, the use of an aid is recommended to reduce unwanted tunnel variations in a learning phase. LEVEL OF EVIDENCE Cohort Study, Level III.
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Herbort M, Domnick C, Raschke MJ, Lenschow S, Förster T, Petersen W, Zantop T. Comparison of Knee Kinematics After Single-Bundle Anterior Cruciate Ligament Reconstruction via the Medial Portal Technique With a Central Femoral Tunnel and an Eccentric Femoral Tunnel and After Anatomic Double-Bundle Reconstruction: A Human Cadaveric Study. Am J Sports Med 2016; 44:126-32. [PMID: 26574601 DOI: 10.1177/0363546515611646] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anatomic femoral tunnel placement in anterior cruciate ligament (ACL) reconstruction is considered to be a key to good primary stability of the knee. There is still no consensus on whether a centrally placed single bundle in the anatomical femoral footprint can compare with anatomic double-bundle (DB) reconstruction. PURPOSE/HYPOTHESIS The purpose of this study was to determine knee kinematics after single-bundle ACL reconstruction via the medial portal technique using 2 different femoral tunnel positions and to compare results with those of the anatomic DB technique. The hypotheses were that (1) single-bundle reconstruction using the medial portal technique with a centrally placed femoral tunnel relative to the native footprint (SB-central technique) would more closely restore intact knee kinematics compared with the same reconstruction technique with an eccentric femoral tunnel drilled in the anteromedial bundle footprint (SB-AM technique) and (2) DB reconstruction would result in superior kinematics compared with the SB-central technique. STUDY DESIGN Controlled laboratory study. METHODS Knee kinematics was examined in 10 fresh-frozen human cadaveric knees using a robotic/universal force-moment sensor system. Kinematics in simulated pivot-shift and 134-N anterior tibial loading tests were determined in different conditions within the same specimen: (1) intact ACL, (2) deficient ACL, (3) SB-AM, (4) SB-central, and (5) DB. RESULTS All reconstruction techniques significantly reduced anterior tibial translation (ATT) compared with a deficient ACL at 0°, 15°, 30°, 60°, and 90° in the anterior tibial loading test (P < .01, repeated-measures analysis of variance) and at 0°, 15°, and 30° in the simulated pivot-shift test (P < .001). There were no significant differences in the SB-central group and the DB group compared with the intact ACL. Reconstruction in the SB-AM group resulted in significantly increased ATT compared with the intact ACL in near-to-extension angles in both tests (0°, 15°, and 30°; P < .01). SB-central and DB reconstructions both resulted in significantly reduced ATT, in some tests at ≤30°, compared with SB-AM reconstruction (P < .05). No significant differences between the SB-central and DB groups were found (P > .05). CONCLUSION The SB-central technique restored intact knee kinematics more closely than did SB-AM reconstruction at time zero. There were no differences in knee kinematics between the DB and SB-central techniques. CLINICAL RELEVANCE Anatomic single-bundle ACL reconstruction provides similar knee kinematics as anatomic double-bundle reconstruction.
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Affiliation(s)
- Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Christoph Domnick
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Michael Johannes Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Simon Lenschow
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Tim Förster
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | | | - Thore Zantop
- Department of Orthopedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
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Arilla FV, Yeung M, Bell K, Rahnemai-Azar AA, Rothrauff BB, Fu FH, Debski RE, Ayeni OR, Musahl V. Experimental Execution of the Simulated Pivot-Shift Test: A Systematic Review of Techniques. Arthroscopy 2015; 31:2445-54.e2. [PMID: 26321110 DOI: 10.1016/j.arthro.2015.06.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/09/2015] [Accepted: 06/18/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To conduct a systematic review to identify and summarize the various techniques that have been used to simulate the pivot-shift test in vitro. METHODS Medline, Embase, and the Cochrane Library were screened for studies involving the simulated pivot-shift test in human cadaveric knees published between 1946 and May 2014. Study parameters including sample size, study location, simulated pivot-shift technique, loads applied, knee flexion angles at which simulated pivot shift was tested, and kinematic evaluation tools were extracted and analyzed. RESULTS Forty-eight studies reporting simulated pivot-shift testing on 627 cadaveric knees fulfilled the criteria. Reviewer inter-rater agreement for study selection showed a κ score of 0.960 (full-text review). Twenty-seven studies described the use of internal rotation torque, with a mean of 5.3 Nm (range, 1 to 18 Nm). Forty-seven studies described the use of valgus torque, with a mean of 8.8 Nm (range, 1 to 25 Nm). Four studies described the use of iliotibial tract tension, ranging from 10 to 88 N. Regarding static simulated pivot-shift test techniques, 100% of the studies performed testing at 30° of knee flexion, and the most tested range of motion in the continuous tests was 0° to 90°. Anterior tibial translation was the most analyzed parameter during the simulated pivot-shift test, being used in 45 studies. In 22% of the studies, a robotic system was used to simulate the pivot-shift test. Robotic systems were shown to have better control of the loading system and higher tracking system accuracy. CONCLUSIONS This study provides a reference for investigators who desire to apply simulated pivot shift in their in vitro studies. It is recommended to simulate the pivot-shift test using a 10-Nm valgus torque and 5-Nm internal rotation torque. Knee flexion of 30° is mandatory for testing. LEVEL OF EVIDENCE Level IV, systematic review of basic science studies.
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Affiliation(s)
- Fabio V Arilla
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, University Hospital of Canoas, Canoas, Rio Grande Do Sul, Brazil
| | - Marco Yeung
- Division of Orthopaedic Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Kevin Bell
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Ata A Rahnemai-Azar
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Richard E Debski
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A..
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Robb C, Kempshall P, Getgood A, Standell H, Sprowson A, Thompson P, Spalding T. Meniscal integrity predicts laxity of anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23:3683-90. [PMID: 25217313 DOI: 10.1007/s00167-014-3277-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 08/26/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to evaluate the incidence of failure of anterior cruciate ligament (ACL) reconstruction and to assess the prognostic factors for such an outcome. METHODS A prospective inception cohort of patients undergoing ACL reconstruction was analysed for failure (patient reported symptoms of rotational instability, a clinically positive pivot shift, MRI or arthroscopy showing ACL graft rupture). Risk factors evaluated included medial and lateral meniscal deficiency, medial and lateral meniscal repair, age, gender, BMI, graft size and time to surgery. Survival analysis was performed using the Kaplan-Meier method. Prognostic factors were assessed using the Cox proportional hazard model to investigate whether covariate risk factors influenced graft survival. RESULTS One hundred and twenty-three patients were available for final analysis at a follow-up of 2 years. Eighteen patients satisfied the criteria of failure (15.4 %). Risk factors for failure were medial meniscal deficiency (hazard ratio 4.5; 95 % CI 1.8-11.5; p = 0.002), or lateral meniscal deficiency (hazard ratio 3.5; 95 % CI 1.3-9.3; p = 0.01). At 2-year follow-up, ACL survival was 94.5 % (95 % CI 89-100) for patients with intact menisci and 69 % (95 % CI 56-86) for those with deficiency of the medial or lateral meniscus (log-rank test p = 0.017). Patients were 4.9 times more likely to fail if they had a deficient medial or lateral meniscus. Those patients who underwent meniscal repair did not demonstrate any increased risk of failure. CONCLUSION Medial and lateral meniscal tears are important prognostic factors that influence the survival of ACL reconstruction. Surgeons should endeavour to repair all meniscal tears associated with ACL reconstruction. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Curtis Robb
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK.
| | - Peter Kempshall
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario, London, Ontario, Canada
| | - Hayley Standell
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK
| | - Andrew Sprowson
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK
| | - Peter Thompson
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK
| | - Tim Spalding
- University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK
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Rezansoff AJ, Caterine S, Spencer L, Tran MN, Litchfield RB, Getgood AM. Radiographic landmarks for surgical reconstruction of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23:3196-201. [PMID: 24934928 DOI: 10.1007/s00167-014-3126-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/04/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE To determine the radiographic landmarks of the anterolateral ligament (ALL) on the femur and tibia to assist in intraoperative graft placement during ALL reconstruction. METHODS The footprints of the ALL, fibular collateral ligament (FCL), popliteus insertion, lateral gastrocnemius insertion, and Gerdy's tubercle were isolated and centrally marked with tantalum beads in thirteen fresh-frozen cadaveric knees. Measurements were taken from the true lateral fluoroscopic images. On the femur, the mean distances from the ALL origin to the FCL origin and from the ALL origin to the popliteus insertion were measured. On the tibia, the mean distances from the ALL insertion to Gerdy's tubercle and from the ALL insertion to the lateral tibial plateau were measured. Furthermore, radiographic descriptions of the ALL origin and insertion were developed. RESULTS The ALL origin on the femur averaged 3.3 ± 1.5 mm anterior-distal to the FCL origin in one anatomical variant and 5.4 ± 1.4 mm posterior-proximal to the FCL origin in a second variant. The ALL origin was 9.9 ± 2.7 mm from the popliteus insertion. The ALL origin is described as overlying the posterior femoral cortical line, between Blumensaat's line and a line from the posterior condylar articular edge parallel to Blumensaat's line. The ALL insertion on the tibia averaged 24.7 ± 4.5 mm posterior to Gerdy's tubercle and 11.5 ± 2.9 mm distal to the lateral tibial plateau. The tibial ALL insertion is described between the posterior tibial cortical line and a parallel line drawn down from the apex of the tibial spine, and overlying a line drawn perpendicular to the posterior tibial cortical line starting from the apex of the posterior tibial condyles. CONCLUSIONS Using direct lateral fluoroscopy, radiographic landmarks of the ALL origin and insertion have been described.
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Affiliation(s)
- Alex J Rezansoff
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Scott Caterine
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Luke Spencer
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Michael N Tran
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Robert B Litchfield
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Alan M Getgood
- Fowler-Kennedy Sport Medicine Clinic, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
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Mahajan PS, Chandra P, Ahamad N, Hussein SA. Effects of extremity positioning on radiographic evaluation of femoral tunnel location with digitally reconstructed femoral lateral radiographs after anterior cruciate ligament reconstruction. BMC Med Imaging 2015; 15:47. [PMID: 26498379 PMCID: PMC4620026 DOI: 10.1186/s12880-015-0093-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 10/19/2015] [Indexed: 01/24/2023] Open
Abstract
Background Radiographic imaging is a valuable tool in clinical practice for quick anatomical assessment. We aimed to radiographically assess (A) the anterior cruciate ligament (ACL) graft tunnel location after anatomic single-bundle (SB) reconstruction and (B) the effects of extremity positioning on the localization of the orifice of the tunnel in the distal femur in comparison with Blumensaat’s line (BL). Methods Three-dimensional computed tomography (3D CT) scan examinations of 22 knees of 22 subjects were evaluated. The 3D CT scan data was used to digitally reconstruct the true lateral radiographs. Graft tunnel location on the distal femoral shaft along the Blumensaat’s line and perpendicular to it were assessed on these radiographs. The femur was digitally rotated to simulate varus, valgus, internal rotation and external rotation in 5-degree increments from 0 to 20-degree. At each incremental rotated position of the femur, position of the ACL graft tunnel was calculated relative to BL and the difference from the true lateral x-ray was estimated. Results The position of the tunnel in the distal femur was 30.6 (±4.4) % along BL and 33.1 (±5.4) % perpendicular to BL. Ten and more degree of external, internal, valgus and varus rotations significantly affected the estimates of tunnel position (P < 0.05). Conclusions Femoral tunnel location can be reliably estimated from lateral radiographs after anatomic SB ACL reconstruction. Although, ten or more degree of rotations can introduce significant inaccuracies in tunnel location estimates, our study suggests that BL is overall reliable for assessing location of the distal femoral tunnel. Level of evidence: Level 2b (Retrospective Cohort Study).
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Affiliation(s)
- Parag Suresh Mahajan
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar. .,Medical Research Center, Hamad Medical Corporation, Doha, Qatar.
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar.
| | - Nazeer Ahamad
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar.
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Harms SP, Noyes FR, Grood ES, Jetter AW, Huser LE, Levy MS, Gardner EJ. Anatomic Single-Graft Anterior Cruciate Ligament Reconstruction Restores Rotational Stability: A Robotic Study in Cadaveric Knees. Arthroscopy 2015; 31:1981-90. [PMID: 26033460 DOI: 10.1016/j.arthro.2015.04.081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 03/20/2015] [Accepted: 04/09/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE First, we aimed to investigate the ability of a single bone-patellar tendon-bone graft placed in the anatomic center of the femoral and tibial attachment sites to restore normal tibiofemoral compartment translations and tibial rotation. Second, we aimed to investigate what combination of anterior load and internal rotation torque applied during a pivot-shift test produces maximal anterior tibiofemoral subluxations. METHODS We used a 6-df robotic simulator to test 10 fresh-frozen cadaveric specimens under anterior cruciate ligament (ACL)-intact, ACL-sectioned, and ACL-reconstructed conditions measuring anterior translations of the medial, central, and lateral tibiofemoral compartments and degrees of tibial rotation. Specimens were loaded under Lachman, anterior limit, and internal rotation conditions, as well as 3 different pivot-shift conditions. RESULTS On ACL sectioning, compartment translations in the Lachman and 3 pivot-shift tests increased significantly and were restored to ACL-intact values after single-graft ACL reconstruction. In the pivot-shift tests, the single graft restored lateral and medial compartment translations (e.g., group 3, within 1.3 ± 0.6 mm and 0.8 ± 0.6 mm, respectively, of the ACL-intact state and internal rotation within 0.7° ± 1.2°). Anterior subluxation of the medial compartment during pivot-shift loading was reduced when internal rotation torque was increased from 1 to 5 Nm (P < .0001). CONCLUSIONS A single-graft ACL reconstruction performed at the central femoral and tibial ACL attachment sites restored anterior-posterior translation and tibial rotation motion limits. In addition, rotational knee stability as defined by tibiofemoral compartment translations was restored under all simulated pivot-shift testing conditions. CLINICAL RELEVANCE This study provides in vitro evidence to support the clinical use of single-graft ACL reconstructions in restoring tibiofemoral compartment translations. It also shows the advantage of describing ACL insufficiency in terms of medial and lateral compartment subluxations as compared with the common approach of describing changes in central tibial translations and rotations.
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Affiliation(s)
- Samuel P Harms
- Cincinnati Sports Medicine and Orthopedic Center, Mercy Health, College of Business, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Frank R Noyes
- Cincinnati Sports Medicine and Orthopedic Center, Mercy Health, College of Business, University of Cincinnati, Cincinnati, Ohio, U.S.A.; Noyes Knee Institute, College of Business, University of Cincinnati, Cincinnati, Ohio, U.S.A..
| | - Edward S Grood
- Noyes Knee Institute, College of Business, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Andrew W Jetter
- Cincinnati Sports Medicine and Orthopedic Center, Mercy Health, College of Business, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Lauren E Huser
- Cincinnati Sports Medicine and Orthopedic Center, Mercy Health, College of Business, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Martin S Levy
- Department of Operations and Business Analytics, College of Business, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Eric J Gardner
- Cincinnati Sports Medicine and Orthopedic Center, Mercy Health, College of Business, University of Cincinnati, Cincinnati, Ohio, U.S.A
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Kang HJ, Wang XJ, Wu CJ, Cao JH, Yu DH, Zheng ZM. Single-bundle modified patellar tendon versus double-bundle tibialis anterior allograft ACL reconstruction: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2015; 23:2244-2249. [PMID: 24770382 DOI: 10.1007/s00167-014-3021-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to prospectively compare the outcomes of single-bundle (SB) anterior cruciate ligament (ACL) reconstruction with modified bone-patellar tendon-bone (BPTB) allograft and double-bundle (DB) reconstruction with tibialis anterior allograft. METHODS With 94 patients enroled in the study, 43 subjects who had SB ACL reconstruction with modified BPTB allograft (group S) and 41 subjects of DB ACL reconstruction with tibialis anterior allograft (group D) were followed up for a minimum of 2 years. Clinical outcomes including Lachman and pivot-shift tests, KT-1000 arthrometer measurements, and the International Knee Documentation Committee (IKDC) classification, Lysholm and Tegner activity scores were compared between the two groups at the last follow-up. RESULTS The mean graft size of the group S, the anteromedial bundle and posterolateral bundle in group D were 9.9 ± 0.2, 7.5 ± 0.4 and 6.6 ± 0.4 mm, with statistically significant difference between the group S graft to either bundle of group D grafts (p < 0.001). At the last follow-up, there was no statistical difference between the two groups for the Lachman test, pivot-shift test and side-to-side difference. Substantial improvements in the subjective knee function scores were achieved in both groups, but without significant difference between the two groups. CONCLUSIONS After a 2-year minimum follow-up, SB ACL reconstruction based on modified BPTB allograft achieved similar clinical outcomes to DB reconstruction with tibialis anterior allograft in knee stability, both anterior-posterior and rotational, as well as knee function. The modified BPTB allograft was recommended as an ideal graft option for the SB ACL reconstruction. LEVEL OF EVIDENCE Therapeutic, randomized controlled study, Level II.
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Affiliation(s)
- Hui Jun Kang
- Department of Orthopaedic Surgery, Shijiazhuang No.1 Hospital, Shijiazhuang, Hebei, 050011, China
| | - Xiao Jing Wang
- Department of Orthopaedic Surgery, Shijiazhuang No.1 Hospital, Shijiazhuang, Hebei, 050011, China
| | - Chun Juan Wu
- Department of Orthopaedic Surgery, Shijiazhuang No.1 Hospital, Shijiazhuang, Hebei, 050011, China
| | - Jian Hui Cao
- Department of Orthopaedic Surgery, Shijiazhuang No.1 Hospital, Shijiazhuang, Hebei, 050011, China.
| | - Da Hai Yu
- Department of Orthopaedic Surgery, Shijiazhuang No.1 Hospital, Shijiazhuang, Hebei, 050011, China
| | - Zhi Min Zheng
- Department of Orthopaedic Surgery, Shijiazhuang No.1 Hospital, Shijiazhuang, Hebei, 050011, China
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Fitzgerald J, Saluan P, Richter DL, Huff N, Schenck RC. Anterior Cruciate Ligament Reconstruction Using a Flexible Reamer System: Technique and Pitfalls. Orthop J Sports Med 2015; 3:2325967115592875. [PMID: 26673860 PMCID: PMC4622330 DOI: 10.1177/2325967115592875] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Anatomic reconstruction of the anterior cruciate ligament (ACL) has been shown to improve stability of the knee, particularly rotational stability, potentially leading to superior clinical outcomes and a shorter return to sport. Nonanatomic ACL reconstruction has been linked to graft failure and abnormal cartilage loading thought to contribute to progression of degenerative joint disease. Use of the far anteromedial portal (FAMP) to uncouple the tibial and femoral tunnels has led to improved reproduction of the femoral footprint and facilitates drilling of the femoral tunnel in an anatomic position. The use of the FAMP and straight reamer systems introduces its own set of potential complications, including short femoral tunnels and peroneal nerve injury. These potential complications have been addressed by drilling the femoral tunnel in a hyperflexed position, which can lead to difficulty with positioning the operative extremity, visualization, and identification of anatomic landmarks. The purpose of this case report was to review the advantages and technical aspects of using a flexible reamer system and the FAMP to achieve an anatomic ACL reconstruction while avoiding potential complications and pitfalls. Flexible reamer systems allow an additional way of uncoupling the tibial and femoral tunnels to clearly visualize and establish an anatomic starting point within the femoral footprint of the native ACL while avoiding the complications associated with knee hyperflexion and straight reamers with the far anteromedial portal. In the authors’ experience, an anatomic reconstruction of the ACL can be achieved safely using flexible reamers while avoiding some of the difficulties seen with straight reamers used in conjunction with an uncoupled, far anteromedial approach.
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Affiliation(s)
- Judd Fitzgerald
- Department of Orthopaedics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Paul Saluan
- Division of Sports Medicine, Department of Orthopaedics, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Dustin L Richter
- Department of Orthopaedics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Nathan Huff
- Department of Orthopaedics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Robert C Schenck
- Department of Orthopaedics, University of New Mexico, Albuquerque, New Mexico, USA
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Moon DK, Yoon CH, Park JS, Kang BJ, Cho SH, Jo HS, Hwang SC. Effect of anteromedial portal entrance drilling angle during anterior cruciate ligament reconstruction: a three-dimensional computer simulation. Yonsei Med J 2014; 55:1584-91. [PMID: 25323895 PMCID: PMC4205698 DOI: 10.3349/ymj.2014.55.6.1584] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. MATERIALS AND METHODS Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured. RESULTS In tunnels drilled at a coronal angle of 45°, an axial angle of 45°, and a sagittal angle of 45°, the mean femoral tunnel length was 39.5±3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4±2.6 mm. The tunnel length at a coronal angle of 30°, an axial angle of 60°, and a sagittal angle of 45°, was 34.0±2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7±1.3 mm, which was significantly shorter than the standard angle (p<0.001). CONCLUSION Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal.
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Affiliation(s)
- Dong Kyu Moon
- Department of Orthopaedic Surgery, Military Hospital, Hongcheon, Korea
| | - Chul Ho Yoon
- Department of Rehabilitation Medicine and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin Seung Park
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Bun Jung Kang
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Seong Hee Cho
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Ho Seung Jo
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Sun Chul Hwang
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea.
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Fernandes TL, Ribeiro DB, da Rocha DC, Albuquerque C, Pereira CAM, Pedrinelli A, Hernandez AJ. Descrição de sistema de avaliação da cinemática do joelho em lesões ligamentares a partir de rastreamento óptico e tomografia 3D. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Fernandes TL, Ribeiro DB, da Rocha DC, Albuquerque C, Pereira CAM, Pedrinelli A, Hernandez AJ. Description of an evaluation system for knee kinematics in ligament lesions, by means of optical tracking and 3D tomography. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2014; 49:513-9. [PMID: 26229854 PMCID: PMC4487496 DOI: 10.1016/j.rboe.2014.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/03/2013] [Indexed: 11/25/2022]
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Conte EJ, Hyatt AE, Gatt CJ, Dhawan A. Hamstring autograft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure. Arthroscopy 2014; 30:882-90. [PMID: 24951356 DOI: 10.1016/j.arthro.2014.03.028] [Citation(s) in RCA: 292] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/21/2014] [Accepted: 03/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of this systematic review were (1) to determine whether there is a minimum hamstring autograft size for anterior cruciate ligament (ACL) reconstruction that significantly decreases the risk of failure and (2) to evaluate the methods to accurately and reliably predict the size of hamstring grafts. METHODS We performed a systematic review of Level III and IV studies using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies assessing failure of quadrupled-strand autograft hamstring ACL reconstruction as a function of graft diameter with at least 1 year of follow-up and those that assessed the use of imaging or anthropometric patient-specific factors to predict hamstring autograft size were included. RESULTS We identified 4 clinical studies that directly compared graft size and failure rate. These correlated with a 6.8 times greater relative risk of failure if the graft diameter was equal to or less than 8 mm (P = .008). All 9 anthropometric-based prediction studies were able to significantly correlate at least 1 parameter with intraoperative graft size. Height was the most common correlation, with r = 0.45 (P < .00001). Five of 6 imaging-based prediction studies showed signification correlation, with r = 0.66 (P < .00001), between cross-sectional area and graft size. The most common method of imaging prediction was magnetic resonance imaging-derived cross-sectional area of both the semitendinosus and gracilis tendons. CONCLUSIONS On the basis of the available evidence, ACL reconstruction with a quadrupled-strand hamstring autograft with a diameter equal to or larger than 8 mm decreases failure rates. In addition, grafts larger than 8 mm decrease failure rates in patients aged younger than 20 years, a group identified to be at increased risk of failure. Both patient height and magnetic resonance imaging-derived cross-sectional area of the hamstring tendons can be used preoperatively to reliably predict the hamstring autograft diameter. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Evan J Conte
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, U.S.A
| | - Adam E Hyatt
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, U.S.A
| | - Charles J Gatt
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, U.S.A
| | - Aman Dhawan
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, U.S.A..
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The influence of femoral tunnel position in single-bundle ACL reconstruction on functional outcomes and return to sports. Knee Surg Sports Traumatol Arthrosc 2014; 22:97-103. [PMID: 23132410 DOI: 10.1007/s00167-012-2288-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 10/26/2012] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study was to radiographically investigate the influence of femoral tunnel placement in ACL reconstruction on early outcomes and return to sports due to anatomic and nonanatomic positioning. METHODS A prospective study was conducted from 2008 to 2010, with 86 athletes who underwent ACL reconstruction between anteromedial (AM) footprint and high AM position. Knee functional outcomes (IKDC objective and subjective, Tegner score, and Lysholm scale) return to sports and complications were analyzed at 6- and 12-month follow-up. RESULTS At follow-up, it was observed that tunnel projection along Blumensaat's line was correlated with functional outcomes on Tegner scale (at 6 and 12 months) and IKDC subjective (at 12 months). There was a significant difference in mean tunnel projection along Blumensaat's line when analyzing return to sports (73 ± 1.4 and 79 ± 1.7 %, respectively, for projections on return vs. no return to sports, p = 0.02) and complications (73 ± 1.3 vs. 78 ± 1.6 %, respectively, for projections on no complications vs. complications, p = 0.03). No differences were stated on coronal view. These correlations between tunnel positioning on functional outcomes could not be explained by demographic or baseline characteristics. CONCLUSION The clinical relevance of this study is that tunnel positioning along AM footprint and high AM position represented by tunnel projection along Blumensaat's line is associated with early return to sports on previous Tegner level and better functional outcome in athletes.
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