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Seppänen A, Kiekara T, Suomalainen P, Mäenpää H, Huhtala H, Järvelä T. No difference was found between double-bundle and single-bundle anterior cruciate ligament reconstructions in terms of osteoarthritis at 15-year follow-up. Knee Surg Sports Traumatol Arthrosc 2024; 32:2770-2779. [PMID: 38819943 DOI: 10.1002/ksa.12304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE The purpose of the study was to determine whether the grade of osteoarthritis (OA) is higher with single-bundle (SB) or double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. The hypothesis was that there will be no difference in the grade of OA between the techniques. METHODS This study was a randomised controlled trial (RCT) with a follow-up period of 15 years. Patients were randomly assigned to either the SB group (n = 78) or the DB group (n = 75). Surgical techniques were anatomic, and the rehabilitation protocol was standardised. Evaluation included Kellgren-Lawrence (KL) difference and absolute OA results. OA was defined as a KL grade of at least 2. RESULTS At 15-year follow-up, information was available on 101 patients (66%), of whom 56 (37%) were accepted in the final statistical analysis. No difference was found between the SB and DB techniques in terms of KL difference or absolute OA results. Significantly less OA was found in the contralateral knee (21%) than in the reconstructed knee (59%) (p < 0.001). Patients with meniscal tears who underwent partial meniscal resection during ACL reconstruction had a significantly higher rate of OA changes (82%) compared with patients with isolated ACL tears (33%) (p < 0.001). A longer delay between initial injury and surgery did not appear to affect the severity of the KL classification. CONCLUSION At 15-year follow-up, no difference was found between the DB and SB techniques in terms of OA. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Arttu Seppänen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tommi Kiekara
- Medical Imaging Center, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Piia Suomalainen
- Head of Tampere University Hospital Orthopaedics Trauma Unit, Tampere, Finland
| | - Heikki Mäenpää
- Department of Orthopaedics, Tampere University Hospital, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Timo Järvelä
- Sports Medicine and Arthroscopic Center, Hospital Mehiläinen, Tampere, Finland
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Yahagi Y, Iriuchishima T, Iwama G, Suruga M, Morimoto Y, Nakanishi K. Femoral Tunnel Length in Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction Is Correlated with Body Size and Knee Morphology. J Knee Surg 2024; 37:485-491. [PMID: 37739027 DOI: 10.1055/a-2180-2265] [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: 09/24/2023]
Abstract
The purpose of this study was to reveal the correlation between anteromedial (AM) and posterolateral (PL) femoral tunnel lengths in anatomical double-bundle anterior cruciate ligament (ACL) reconstruction and body size and knee morphology. Thirty-four subjects undergoing anatomical double-bundle ACL reconstruction were included in this study. Preoperative body size (height, body weight, and body mass index) was measured. Using preoperative magnetic resonance imaging (MRI), quadriceps tendon thickness and the whole anterior-posterior length of the knee were measured. Using postoperative computed tomography (CT), axial and sagittal views of the femoral condyle were evaluated. The correlation between measured intraoperative AM and PL femoral tunnel lengths, and body size and knee morphology using preoperative MRI and postoperative CT parameters was statistically analyzed. Both AM and PL femoral tunnel lengths were significantly correlated with height, body weight, posterior condylar length, and Blumensaat's line length. These results suggest that the femoral ACL tunnel length created using a transportal technique can be estimated preoperatively by measuring the subject's body size and/or the knee morphology using MRI or CT. For clinical relevance, surgeons should be careful to create femoral tunnel of sufficient length when using a transportal technique, especially in knees of subjects with smaller body size and knee morphology. Level of evidence is III.
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Affiliation(s)
- Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 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
| | - Yusuke Morimoto
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
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Moon HS, Choi CH, Jung M, Yoo JH, Kwon HJ, Hong YT, Kim SH. Small Intercondylar Notch Size Is Not Associated with Poor Surgical Outcomes of Anatomical Single-Bundle Anterior Cruciate Ligament Reconstructions. Clin Orthop Surg 2024; 16:73-85. [PMID: 38304206 PMCID: PMC10825255 DOI: 10.4055/cios23081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/25/2023] [Accepted: 06/25/2023] [Indexed: 02/03/2024] Open
Abstract
Background Although many studies have been conducted on the association between the intercondylar notch size and the risk of anterior cruciate ligament (ACL) injury, few studies have examined its relationship with the condition after surgical treatment. Therefore, this study aimed to investigate the surgical outcomes of anatomical single-bundle ACL reconstruction according to intercondylar notch volumes. Methods Medical records of patients who underwent anatomical single-bundle ACL reconstruction using a tibialis anterior allograft between 2015 and 2019 were retrospectively reviewed. For each sex, eligible patients were classified into two groups based on their percentile of intercondylar notch volumes, which were measured using postoperative three-dimensional computed tomography images (group S, ≤ 50th percentile of included patients; group L, > 50th percentile of included patients). Additional grouping was performed based on the group's percentiles of normalized values of intercondylar notch volumes to body heights. Between-group comparative analyses were performed on the perioperative data and surgical outcomes in both objective and subjective aspects. Results One hundred patients were included in the study. For male patients, there were no differences in the overall surgical outcomes between groups, whereas group L showed a significantly greater knee anteroposterior (AP) laxity than group S at the final follow-up (p = 0.042 for the side-to-side differences [SSD] at the maximum manual force). Similarly, there were no differences in the female patients in the overall surgical results between the groups, whereas group L showed a significantly greater knee AP laxity at the final follow-up (p = 0.020 for the SSD at 134 N; p = 0.011 for the SSD at the maximum manual force). Additional analyses based on the normalized values of the intercondylar notch volume showed consistent results for male patients, and additional grouping for female patients was identical to the existing grouping. Conclusions The surgical outcomes of anatomical single-bundle ACL reconstruction in patients with relatively small intercondylar notch volumes were comparable to those with large notch volumes, but rather showed favorable outcomes in postoperative knee AP laxity.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Je-Hyun Yoo
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyuk-Jun Kwon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Taek Hong
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Kawakami J, Hisanaga S, Yoshimoto Y, Mashimo T, Kaneko T, Yoshimura N, Shimada M, Tateyama M, Matsunaga H, Shibata Y, Tanimura S, Takata K, Arima T, Maeda K, Fukuma Y, Uragami M, Ideo K, Sugimoto K, Yonemitsu R, Matsushita K, Yugami M, Uehara Y, Nakamura T, Tokunaga T, Karasugi T, Sueyoshi T, Shukunami C, Okamoto N, Masuda T, Miyamoto T. Remnant tissue enhances early postoperative biomechanical strength and infiltration of Scleraxis-positive cells within the grafted tendon in a rat anterior cruciate ligament reconstruction model. PLoS One 2023; 18:e0293944. [PMID: 37939095 PMCID: PMC10631660 DOI: 10.1371/journal.pone.0293944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023] Open
Abstract
When ruptured, ligaments and tendons have limited self-repair capacity and rarely heal spontaneously. In the knee, the Anterior Cruciate Ligament (ACL) often ruptures during sports activities, causing functional impairment and requiring surgery using tendon grafts. Patients with insufficient time to recover before resuming sports risk re-injury. To develop more effective treatment, it is necessary to define mechanisms underlying ligament repair. For this, animal models can be useful, but mice are too small to create an ACL reconstruction model. Thus, we developed a transgenic rat model using control elements of Scleraxis (Scx), a transcription factor essential for ligament and tendon development, to drive GFP expression in order to localize Scx-expressing cells. As anticipated, Tg rats exhibited Scx-GFP in ACL during developmental but not adult stages. Interestingly, when we transplanted the flexor digitorum longus (FDP) tendon derived from adult Scx-GFP+ rats into WT adults, Scx-GFP was not expressed in transplanted tendons. However, tendons transplanted from adult WT rats into Scx-GFP rats showed upregulated Scx expression in tendon, suggesting that Scx-GFP+ cells are mobilized from tissues outside the tendon. Importantly, at 4 weeks post-surgery, Scx-GFP-expressing cells were more frequent within the grafted tendon when an ACL remnant was preserved (P group) relative to when it was not (R group) (P vs R groups (both n = 5), p<0.05), and by 6 weeks, biomechanical strength of the transplanted tendon was significantly increased if the remnant was preserved (P vsR groups (both n = 14), p<0.05). Scx-GFP+ cells increased in remnant tissue after surgery, suggesting remnant tissue is a source of Scx+ cells in grafted tendons. We conclude that the novel Scx-GFP Tg rat is useful to monitor emergence of Scx-positive cells, which likely contribute to increased graft strength after ACL reconstruction.
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Affiliation(s)
- Junki Kawakami
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Satoshi Hisanaga
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Yuki Yoshimoto
- Department of Molecular Craniofacial Embryology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
- Department of Molecular Biology and Biochemistry, Basic Life Sciences, Graduate School of Biomedical and Health Sciences, Minami-ku, Hiroshima, Japan
| | - Tomoji Mashimo
- Division of Animal Genetics, Laboratory Animal Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takehito Kaneko
- Graduate School of Science and Engineering, Iwate University, Morioka, Iwate, Japan
| | - Naoto Yoshimura
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Masaki Shimada
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Makoto Tateyama
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Hideto Matsunaga
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Yuto Shibata
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Shuntaro Tanimura
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Kosei Takata
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Takahiro Arima
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Kazuya Maeda
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Yuko Fukuma
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Masaru Uragami
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Katsumasa Ideo
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Kazuki Sugimoto
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Ryuji Yonemitsu
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Kozo Matsushita
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Masaki Yugami
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Yusuke Uehara
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Takayuki Nakamura
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Takuya Tokunaga
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Tatsuki Karasugi
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Takanao Sueyoshi
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Chisa Shukunami
- Department of Molecular Biology and Biochemistry, Basic Life Sciences, Graduate School of Biomedical and Health Sciences, Minami-ku, Hiroshima, Japan
| | - Nobukazu Okamoto
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Tetsuro Masuda
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Takeshi Miyamoto
- Faculty of Life Sciences, Department of Orthopaedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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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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Lording TD. Review of Cha et al. (2005) on "Arthroscopic Double Bundle Anterior Cruciate Ligament Reconstruction: An Anatomical Approach". J ISAKOS 2023; 8:140-144. [PMID: 36924827 DOI: 10.1016/j.jisako.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/20/2023] [Accepted: 02/16/2023] [Indexed: 03/17/2023]
Abstract
This classic discusses the original publication 'Arthroscopic double-bundle anterior cruciate ligament reconstruction (ACL): An anatomical approach', the first detailed description of the surgical technique popularised by Dr Freddie Fu. The technique, in which the anteromedial and posterolateral bundles of the ACL are reconstructed individually using two grafts with independent bone tunnels, was designed to more closely recreate the function of the native ACL by more closely reproducing the functional anatomy. This reconstruction was biomechanically superior to single-bundle reconstruction, particularly with regards to rotational control, leading to great interest from ACL surgeons around the world. Clinical superiority was more difficult to demonstrate; however, and the technical difficulty of the procedure has limited its use. Nevertheless, the pursuit of improved patient outcomes through attention to functional anatomical detail continues. 'Recreating the functional anatomy of the intact ACL remains the cornerstone of ACL reconstruction'.
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Affiliation(s)
- Timothy D Lording
- Melbourne Orthopaedic Group, Windsor, 3181, Australia; Monash University, Melbourne, 3800, Australia.
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Sato D, Inoue M, Kasahara Y, Hamano H, Suzuki R, Kondo E, Iwasaki N. Effects of Preserving Anatomically Positioned and Adequate Remnant ACL Tissue in Double-Bundle ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231162389. [PMID: 37113140 PMCID: PMC10126626 DOI: 10.1177/23259671231162389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/24/2023] [Indexed: 04/29/2023] Open
Abstract
Background The advantages of remnant tissue preservation in anterior cruciate ligament (ACL) reconstruction (ACLR) remain controversial. Hypothesis It was hypothesized that a large amount of remnant tissue, especially if anatomically positioned, would improve patient-reported outcomes and second-look graft appearance after preserved double-bundle ACLR (DB-ACLR). Study Design Cohort study; Level of evidence, 3. Methods This retrospective study included 89 consecutive patients who underwent unilateral remnant-preserving DB-ACLR using 2 hamstring tendon autografts. The authors categorized the arthroscopic findings into 3 groups according to the location and volume of the ACL remnant tissue in the femoral notch: (1) anatomical attachment (group AA; n = 34); (2) nonanatomical attachment (group NA; n = 33); and (3) no remnant (group NR; n = 22). Based on second-look arthroscopy, the reconstructed graft was graded as excellent, fair, or poor. Patient-reported outcomes were evaluated at 2 years after surgery using the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Japanese Anterior Cruciate Ligament Questionnaire-25 (JACL-25). Results The AA and NA groups had a significantly shorter time from injury to surgery compared with the NR group (P = .0165). Considering the second-look arthroscopic findings, the authors found a significant difference in synovial coverage of the grafts between the 3 groups (P = .0018). There were no significant differences in the overall KOOS and JACL-25 score among the 3 groups; however, the KOOS-Sport and Recreation and KOOS-Quality of Life subscale scores were significantly higher in the AA group compared with the NA and NR groups (P = .0014 and .0039, respectively). The JACL-25 score for middle- to high-speed flexion and extension was significantly better in the AA group versus the NR group (P = .0261). Conclusion This study showed that preserving anatomically positioned and adequate remnant tissue during DB-ACLR improved second-look graft appearance and KOOS-Sport and Recreation and KOOS-Quality of Life scores.
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Affiliation(s)
- Dai Sato
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Masayuki Inoue
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
- Masayuki Inoue, MD, PhD,
Department of Orthopaedic Surgery, NTT East Japan Sapporo Hospital, Minami-1,
Nishi-15, Sapporo, Hokkaido, 060-0061, Japan (
)
| | - Yasuhiko Kasahara
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Hiroki Hamano
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Ryota Suzuki
- Department of Orthopaedic Surgery, NTT
East Japan Sapporo Hospital, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido
University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery,
Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo,
Japan
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Balasingam S, Karikis I, Rostgård-Christensen L, Desai N, Ahldén M, Sernert N, Kartus J. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Is Not Superior to Anatomic Single-Bundle Reconstruction at 10-Year Follow-up: A Randomized Clinical Trial. Am J Sports Med 2022; 50:3477-3486. [PMID: 36269582 DOI: 10.1177/03635465221128566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anatomic double-bundle (DB) technique is purported to be a superior technique due to its mimicking of the double-stranded anatomic formation of the anterior cruciate ligament (ACL). Previous studies with 2-, 5- and 10-year follow-up are conflicted as to whether this technique is superior to the previous gold standard method of ACL reconstruction, the anatomic single-bundle (SB) reconstruction. PURPOSE/HYPOTHESIS The aim of this prospective randomized study was to compare the outcomes of the anatomic DB technique and anatomic SB technique with independent drilling at 10 years after anterior cruciate ligament (ACL) reconstruction. We hypothesized that DB ACL reconstruction would result in a better outcome in terms of the pivot-shift test. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 105 patients (33 women, 72 men; median age, 27 years [range, 18-52 years]) were randomized and underwent ACL reconstruction (DB group: n = 53; SB group: n = 52). All reconstruction procedures were performed anatomically by identifying the ACL footprint, using the anteromedial portal for femoral tunnel drilling, and utilizing interference screws for tibial and femoral fixation. One blinded observer examined the patients both preoperatively and at follow-up (median, 120 months [range, 112-134 months]). Multiple subjective and objective clinical evaluations were used to assess the outcomes. Radiographic assessments of osteoarthritis were performed using the Ahlbäck, Kellgren-Lawrence, and Fairbank classification systems early postoperatively and at the final follow-up. RESULTS Preoperatively, no differences were found between the study groups. Overall, 70 patients (67%; DB group: n = 39; SB group: n = 31) were available for analysis at 10-year follow-up. No significant difference could be shown between the groups in terms of the pivot-shift grade, knee laxity measurements using the KT-1000 arthrometer, manual Lachman grade, single-leg hop test result, range of motion measurements, Lysholm knee score, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score (KOOS) score. Correspondingly, no differences were found between the groups regarding the presence of radiographic osteoarthritis at follow-up. Both groups improved at follow-up compared with preoperatively in terms of the pivot-shift grade, knee laxity measurements using the KT-1000 arthrometer, manual Lachman grade, Lysholm knee score, and KOOS score (P < .05 [highest P value for any comparison]). CONCLUSION The anatomic DB technique was not superior to the anatomic SB technique with independent drilling at 10-year follow-up in regard to objective and subjective measurements. As such, one could argue that there is no need for the continued use of the anatomic DB technique in an unselected population.
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Affiliation(s)
| | - Ioannis Karikis
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden
| | | | - Neel Desai
- Ortho Center Gothenburg, Gothenburg, Sweden
| | | | - Ninni Sernert
- Department of Research & Development, NU Hospital Group, Trollhättan, Sweden
| | - Juri Kartus
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden.,Department of Research & Development, NU Hospital Group, Trollhättan, Sweden
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9
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Ng FDJ, Lie DTT, Yew A. Relooking at double-bundle versus single-bundle anterior cruciate ligament reconstruction: A biomechanical model to evaluate which can confer better rotatory stability. Clin Biomech (Bristol, Avon) 2022; 99:105758. [PMID: 36113193 DOI: 10.1016/j.clinbiomech.2022.105758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 05/04/2022] [Accepted: 08/30/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND To treat anterior cruciate ligament (ACL) injuries, double-bundle ACL reconstruction has been proposed as a more anatomical approach relative to single-bundle reconstruction. However, controversy remains over which technique is superior in addressing knee instability, particularly rotational laxity. We hypothesize that double-bundle reconstruction better restores rotational knee laxity, while both methods are similar in restoring anterior knee laxity, to intact knee levels. METHODS A controlled laboratory study. Eight cadaveric knees were tested accordingly: (1) static anterior laxity testing under 150 N-anterior tibial loading at 20°, 60° and 90° knee flexion using a material testing machine, followed by (2) dynamic simulated pivot-shift with knee-specific loading involving iliotibial band forces, valgus and internal rotation torques, while the knee was brought from extension to 90° flexion on a 6°-of-freedom custom-designed rig. Tibiofemoral kinematics were recorded using an electromagnetic tracking system for the ACL-intact, ACL-deficient, single-bundle and double-bundle ACL-reconstructed knee conditions. FINDINGS Double-bundle reconstruction reduced internal rotation under pivot-shift to levels not significantly different from ACL-intact conditions (P > .173), unlike single-bundle that remained significantly higher at 10-40° flexion (P < .05). For anterior laxity, there was no significant difference between double-bundle, single-bundle, and ACL-intact conditions under static testing (P > .175) or pivot-shift (P = .219). The maximum extent of knee envelope laxity was significantly reduced for double-bundle relative to single-bundle, particularly for the rotatory component (P = .012). INTERPRETATION Double-bundle was biomechanically superior to single-bundle in addressing envelope of rotation, while both techniques restored anterior knee laxity to ACL-intact levels.
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Affiliation(s)
| | - Denny Tjiauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore.
| | - Andy Yew
- Division of Musculoskeletal Sciences, Singapore General Hospital, Outram Road, 169608, Singapore.
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10
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Yela-Verdú C, Ares O, Albareda D, Oller B, Sallent A, Jornet-Gibert M, Amillo JR. Anterior Cruciate Ligament Reconstruction with Autologous Hamstring Single- versus Double-Bundle Graft: A Prospective Study with 10-Year Follow-up. J Knee Surg 2022. [PMID: 35820434 DOI: 10.1055/s-0042-1748898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of the present study was to compare the clinical and subjective outcomes of anterior cruciate ligament (ACL) reconstruction using an autologous hamstring double bundle (DB) with a single bundle (SB) after a 10-year follow-up. A prospective comparative cohort study was performed of 47 consecutive patients with ACL rupture included between May 2006 and March 2008. Inclusion criteria were less than 2 years since the injury date, no previous surgery on the affected knee, and having closed growth plates. Patients were divided into two groups: (1) SB group (n = 25) and (2) DB group (n = 22). Patients underwent evaluation before surgery and at 1 and 10 years postoperatively. The clinical evaluation included the International Knee Documentation Committee (IKDC) Questionnaire, pivot shift test, and single hop test, as well as X-rays (anterior drawer X-rays on a Telos stress radiography). Range of motion (ROM) was assessed at 10-year follow-up. Both groups were similar in terms of baseline characteristics. Post hoc power analysis showed that among 30 and 226 patients would be needed for statistical significance, depending on the outcome. With the numbers available, no significant differences were observed in subjective IKDC, anterior stability (measured with Telos), and functional test outcomes (single hop test) between both groups at 1 and 10 years postoperatively. Regarding rotational instability (pivot-shift test), DB group was significantly superior (p = 0.002). Regarding ROM, no significant differences were observed between groups. No failure was registered in any of the groups. ACL reconstruction (ACLR) with an autologous hamstring, both with bundles and DB, shows overall better outcomes compared with the status before surgery. DB ACLR provides better rotational control of the knee, an outcome that is maintained after 10 years.
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Affiliation(s)
- Christian Yela-Verdú
- Department of Orthopedic Surgery and Traumatology, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Oscar Ares
- Department of Orthopedic Surgery and Traumatology, Hospital Clínic, Barcelona, Spain.,School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Albareda
- Department of Orthopedic Surgery and Traumatology, Clínica Albareda, Barcelona, Spain
| | - Bárbara Oller
- Department of Orthopedic Surgery and Traumatology, Hospital de Viladecans, Viladecans, Spain
| | - Andrea Sallent
- Department of Orthopedic Surgery and Traumatology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Juan R Amillo
- Department of Orthopedic Surgery and Traumatology, Hospital de Viladecans, Viladecans, Spain
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11
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Akmeşe R, Yoğun Y, Küçükkarapinar İ, Ertan MB, Çelebi MM, Akkaya Z. Radiological maturation and clinical results of double-bundle and single-bundle anterior cruciate ligament reconstruction. A 5-year prospective case-controlled trial. Arch Orthop Trauma Surg 2022; 142:1125-1132. [PMID: 34031709 DOI: 10.1007/s00402-021-03971-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of the study was to make a prospective comparison of the radiological and clinical outcomes of patients undergoing single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction. METHOD This prospective, case-controlled study included 65 patients, separated into 2 groups as 33 patients undergoing single bundle (SB), and 32 patients undergoing double bundle (DB) ACL reconstruction. The patients were evaluated clinically using the International Knee Documentation Committee (IKDC) and the Lysholm knee scores. Stability was evaluated with the KT-1000 Arthrometer Measurement, the Lachman and pivot shift tests. Magnetic resonance images (MRI) at 1 and 5 years postoperatively were evaluated by a musculoskeletal radiologist. All the operations were performed by a single surgeon and the clinical evaluations were made by an independent researcher. RESULTS Evaluation was made of a total of 53 patients (SB: 28, DB: 25). No statistically significant difference was determined between the groups regarding the postoperative IKDC and Lysholm scores. The pivot shift tests were negative in the DB group and positive in two patients of the SB group. The Lachman test was negative in all the patients. No significant difference was determined between the groups. No statistically significant difference was determined between the two groups in respect of the arthrometer measurements. In the SB group, revision surgery was performed in two patients due to graft failure. No graft failure findings were determined in the DB group, and no statistically significant difference was determined between the groups in respect of graft failure. On the MRIs taken at 1 year postoperatively, the ACL was seen to be hyperintense in 16 patients in the DB group and 6 patients in the SB group (p = 0.004). On the 5-year MRIs, ACL hypointensity could not be seen in three patients of the SB group and two of the DB group, with no difference determined between the groups (p > 0.05). CONCLUSION In the 5-year follow-up period, no difference was determined between patients undergoing SB ACL reconstruction and those undergoing DB ACL reconstruction regarding clinical scores, knee stability, and MRI findings, but graft maturation occurs later the patients undergoing DB reconstruction.
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Affiliation(s)
- Ramazan Akmeşe
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Yener Yoğun
- Department of Orthopedics and Traumatology, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, Turkey.
| | - İbrahim Küçükkarapinar
- Department of Orthopedics and Traumatology, Yunus Emre Training and Research Hospital, Eskişehir, Turkey
| | - Mehmet Batu Ertan
- Department of Orthopedics and Traumatology, Yozgat City Hospital, Yozgat, Turkey
| | - Mehmet Mesut Çelebi
- Department of Sports Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Zehra Akkaya
- Department of Radiology, Faculty of Medicine, Ankara University, Ankara, Turkey
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12
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Moon HS, Choi CH, Yoo JH, Jung M, Lee TH, Hong KB, Kim SH. Graft isometry during anatomical ACL reconstruction has little effect on surgical outcomes. Knee Surg Sports Traumatol Arthrosc 2022; 30:1594-1604. [PMID: 34264371 DOI: 10.1007/s00167-021-06654-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/01/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the surgical outcomes of anatomical anterior cruciate ligament (ACL) reconstruction according to the graft isometry measured during surgery. METHODS Electrical medical records of patients who underwent an arthroscopic ACL reconstruction through the transportal technique using hamstring tendon autograft between 2012 and 2016 were retrospectively reviewed. The patients were classified into two groups based on the graft length change throughout the knee range of motion measured just before graft fixation (Group 1, graft length change ≤ 2 mm; Group 2, graft length change > 2 mm). Comparative analyses, including a non-inferiority trial, were performed regarding the clinical scores, knee laxity, and radiographic parameters between the groups. RESULTS A total of 67 patients were included in the study. The total change in the length of ACL graft throughout the knee range of motion was 1.4 ± 0.4 mm in Group 1 (range, 0.2-2.0 mm), and 3.0 ± 0.7 mm in Group 2 (range, 2.2-5.0 mm). Group 1 showed a relatively high (proximal) femoral tunnel and shallow (anterior) tibial tunnel compared to Group 2 (P < 0.001 and P = 0.028, respectively), but there were no apparent differences in the macroscopic view. There were no statistically significant differences in the clinical outcomes between groups at 2 years after surgery, which satisfied the non-inferiority criterion of Group 1 in terms of clinical scores and knee laxity compared to Group 2. CONCLUSION The surgical outcomes of anatomical ACL reconstruction in patients with non-isometric ACL graft were not inferior in terms of clinical scores and knee laxity, compared to those with nearly-isometric ACL graft. The graft tunnel placement in the isometric position during anatomical ACL reconstruction, which is technically challenging in the clinical setting, is not a crucial factor in terms of clinical outcomes. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Je-Hyun Yoo
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Ho Lee
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20 Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Kee-Bum Hong
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20 Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea.
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Lin L, Wang H, Wang Y, Wang J, Liu Y, Yu J. Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction in Patients With Significant Passive Anterior Tibial Subluxation. Am J Sports Med 2022; 50:943-950. [PMID: 35180006 DOI: 10.1177/03635465211072562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Passive anterior tibial subluxation (PATS) is often observed in patients with anterior cruciate ligament tears. Postoperative outcomes of double-bundle (DB) and single-bundle (SB) anterior cruciate ligament reconstruction (ACLR) with significant PATS (>6 mm) are unclear. HYPOTHESIS DB-ACLR could achieve better stability and clinical outcomes than SB-ACLR in patients with PATS >6 mm. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Retrospective analysis was peformed on 626 consecutive patients who underwent primary anatomic ACLR between October 2016 and November 2017. Anterior subluxation of the lateral and medial compartments in extension relative to the femoral condyles was measured on preoperative magnetic resonance imaging scans. Among patients who demonstrated significant PATS (>6 mm) in the lateral compartment, 54 who underwent DB-ACLR (study group) were matched to 54 who underwent SB-ACLR (control group). PATS, stability (pivot-shift test and KT-2000 arthrometer), the Lysholm score, and the International Knee Documentation Committee (IKDC) grade were investigated preoperatively and at 3- to 4-year follow-up. RESULTS The preoperative mean PATS values in the lateral and medial compartments were not significantly different between groups (control vs study: lateral compartment, 8.1 ± 1.8 vs 8.5 ± 2.1 mm; medial compartment, 5.2 ± 1.9 vs 5.4 ± 1.9 mm; P > .05). Postoperatively, mean PATS values in the lateral and medial compartments of the study group were significantly improved as compared with the control group (control vs study: lateral compartment, 5.9 ± 2.8 vs 3.2 ± 4.1 mm; medial compartment, 3.7 ± 2.9 vs 1.4 ± 2.3 mm; P < .05). Significantly superior results were found for knee stability in the study group regarding the Lachman test (grade 0/1/2/3, study vs control: 29/22/3/0 vs 16/28/10/0; P = .031), pivot-shift test (grade 0/1/2/3, study vs control: 44/9/1/0 vs 30/19/5/0; P = .023), and KT-2000 arthrometer (study vs control: 2.5 ± 1.5 vs 3.9 ± 1.4 mm; P < .001). Clinical scores showed significantly better results in the study group in terms of IKDC score (study vs control: 87.9 ± 8.7 vs 81.2 ± 15.0; P = .01), Tegner activity score (study vs control: 6.0 ± 1.4 vs 4.9 ± 1.5; P < .001), and Lysholm score (study vs control: 91.7 ± 7.0 vs 86.3 ± 11.4; P = .004). CONCLUSION DB-ACLR achieved better knee stability and clinical outcomes when compared with SB-ACLR in patients with PATS >6 mm at 3- to 4-year follow-up.
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Affiliation(s)
- Lin Lin
- Institute of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Haijun Wang
- Institute of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Yongjian Wang
- Institute of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Jian Wang
- Institute of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Yang Liu
- Institute of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Jiakuo Yu
- Institute of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
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Hishimura R, Kondo E, Matsuoka M, Iwasaki K, Kawaguchi Y, Suzuki Y, Onodera T, Momma D, Iwasaki N. Double-bundle anterior cruciate ligament reconstruction using autologous hamstring tendon hybrid grafts in a patient with hypermobile Ehlers-Danlos Syndrome: A case report. Knee 2022; 35:81-86. [PMID: 35220136 DOI: 10.1016/j.knee.2022.02.005] [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: 04/30/2021] [Revised: 12/29/2021] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) is a connective tissue disorder characterized by skin hyperextensibility, joint hypermobility, and tissue friability. Hypermobile type Ehlers-Danlos syndrome (hEDS) is considered one of the EDS subtypes characterized by generalized joint hypermobility. Although there have been a few case reports which described surgical considerations for anterior cruciate ligament (ACL) reconstructions in patients with other types of EDS, no reports have described those in patients with hEDS. CASE PRESENTATION We report a case of ACL injury in an 18-year-old male patient with hEDS. The patient was successfully treated with an anatomic double-bundle ACL reconstruction using autologous hamstring tendon hybrid grafts which consist of hamstring tendons connected in a series with commercially available polyester tape. The autogenous tendon portion of the anteromedial and posterolateral bundles were composed of 4 and 2 strands of hamstring tendons, respectively. After 2 weeks of knee joint immobilization, continuous passive motion exercise of the knee joint and partial weight-bearing was allowed. A hinged knee brace was used for a period of 5 months postoperatively. Second-look arthroscopy at 30 months showed that the ACL graft had no laceration and an excellent coverage of the synovium. At 36 months after surgery, the side-to-side differences in the anterior laxity was remarkably improved. The operated knee showed negative Lachman test and had a full range of motion. CONCLUSIONS To the best of our knowledge, this represents the first report of anatomic double-bundle ACL reconstruction in patients with hEDS and demonstrates excellent clinical and functional outcomes.
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Affiliation(s)
- Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, North 14 West 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan.
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Yasuyuki Kawaguchi
- Sports and Arthroscopy Center, Hanna Central Hospital, Ikoma, Nara 630-0243, Japan
| | - Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Daisuke Momma
- Centre for Sports Medicine, Hokkaido University Hospital, North 14 West 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
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Mok AC, Fancher AJ, Vopat ML, Baker J, Tarakemeh A, Mullen S, Schroeppel JP, Templeton K, Mulcahey MK, Vopat BG. Sex-Specific Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671221076883. [PMID: 35224122 PMCID: PMC8873558 DOI: 10.1177/23259671221076883] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Despite the significant difference between men and women in incidence of anterior cruciate ligament (ACL) injuries, there is a paucity of consistent information on the influence of patient sex on outcomes after ACL reconstruction. A previous meta-analysis has demonstrated that female patients have worse outcomes with regard to laxity, revision rate, Lysholm score, and Tegner activity score and are less likely to return to sports (RTS). Purpose: To conduct a systematic review and meta-analysis to evaluate and compare sex-specific outcomes after ACL reconstruction. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using PubMed, PubMed Central, Embase, OVID, and Cochrane databases per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following search terms were used: “anterior cruciate ligament reconstruction” OR “ACL reconstruction” OR “anterior cruciate ligament” OR “ACL” AND “gender” OR “sex” OR “male” OR “female” AND “outcome” AND “2015-Present” to gather all relevant articles between 2015 and 2020. A risk-of-bias assessment and quality assessment was conducted on included studies. Results: Of 9594 studies initially identified, 20 studies with 35,935 male and 21,455 female patients were included for analysis. The 7 studies reporting International Knee Documentation Committee (IKDC) scores showed that male patients had statistically significantly higher postoperative scores (mean difference, 3.02 [95% CI, 1.19-4.84]; P< .01; I2 = 66%), and 7 studies that reported the rate of ACL revision showed there was no significant difference between male and female patients (odds ratio, 0.85 [95% CI, 0.45-1.60]; P = .61; I2 = 94%). The 7 studies that reported rates of rerupture showed that males were significantly more likely than females to have a graft rerupture (odds ratio, 1.35 [95% CI, 1.22-1.50]; P < .01; I2 = 0%). Male patients reported a higher RTS rate than did their female counterparts (59.82% compared with 42.89%); however, no formal statistical analysis could be done because of the variability in reporting techniques. Conclusion: Male and female patients with ACL injuries demonstrated similar outcomes regarding their rates of revision; however, male patients were found to have statistically significantly higher postoperative IKDC scores but at the same time higher rerupture rates. Our findings suggest that sex-based differences in outcomes after ACL reconstruction vary based on which metric is used. These results must be considered when counseling patients with ACL injuries.
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Affiliation(s)
- Anthony C. Mok
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | | - Matthew L. Vopat
- Department of Orthopaedics, The Steadman Clinic, Vail, Colorado, USA
| | - Jordan Baker
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Scott Mullen
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - John P. Schroeppel
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Kim Templeton
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Mary K. Mulcahey
- Department of Orthopaedics, Tulane University, New Orleans, Louisiana, USA
| | - Bryan G. Vopat
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
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16
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Iriuchishima T, Goto B. Tibial Spine Location Influences Tibial Tunnel Placement in Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction. J Knee Surg 2022; 35:294-298. [PMID: 32643780 DOI: 10.1055/s-0040-1713736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to assess the influence of tibial spine location on tibial tunnel placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using three-dimensional computed tomography (3D-CT). A total of 39 patients undergoing anatomical single-bundle ACL reconstruction were included in this study (30 females and 9 males; average age: 29 ± 15.2 years). In anatomical single-bundle ACL reconstruction, the tibial and femoral tunnels were created close to the anteromedial bundle insertion site using a transportal technique. Using postoperative 3D-CT, accurate axial views of the tibia plateau were evaluated. By assuming the medial and anterior borders of the tibia plateau as 0% and the lateral and posterior borders as 100%, the location of the medial and lateral tibial spine, and the center of the tibial tunnel were calculated. Statistical analysis was performed to assess the correlation between tibial spine location and tibial tunnel placement. The medial tibial spine was located at 54.7 ± 4.5% from the anterior border and 41.3 ± 3% from the medial border. The lateral tibial spine was located at 58.7 ± 5.1% from the anterior border and 55.3 ± 2.8% from the medial border. The ACL tibial tunnel was located at 34.8 ± 7.7% from the anterior border and 48.2 ± 3.4% from the medial border. Mediolateral tunnel placement was significantly correlated with medial and lateral tibial spine location. However, for anteroposterior tunnel placement, no significant correlation was found. A significant correlation was observed between mediolateral ACL tibial tunnel placement and medial and lateral tibial spine location. For clinical relevance, tibial ACL tunnel placement might be unintentionally influenced by tibial spine location. Confirmation of the ACL footprint is required to create accurate anatomical tunnels during surgery. This is a Level III; case-control study.
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Affiliation(s)
| | - Bunsei Goto
- Department of Orthopedic Surgery, Kamimoku Spa Hospital, Gunma, Japan
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17
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Double bundle ACL reconstruction leads to better restoration of knee laxity and subjective outcomes than single bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1795-1808. [PMID: 34595573 PMCID: PMC9033716 DOI: 10.1007/s00167-021-06744-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this meta-analysis is to compare arthroscopic single bundle (SB) and double bundle (DB) anterior cruciate ligament (ACL) reconstructions in the light of all available randomised controlled trials (RCTs). A meta-analysis of this well-researched topic was performed and subgroup analyses of the medial portal (MP) technique and the transtibial technique (TT) were added as a new idea. The hypothesis was that the DB technique is superior to the SB technique also in subgroup analyses of the MP and TT techniques. METHODS Instructions of the PRISMA checklist were followed. Systematic literature search from electronic databases, including PubMed, Cochrane library and Scopus was performed to find RCTs that compared the SB and DB techniques. Nine outcomes were used to compare these two techniques. Each study was assessed according to the Cochrane Collaboration's risk of bias tool and three subgroup analyses (minimum 2-years' follow-up, TT technique and MP technique) were performed. RESULTS A total of 40 studies were included in this meta-analysis. When analysing all the included studies, the DB technique was superior to the SB technique in KT-1000/2000 evaluation (p < 0.01), IKDC subjective evaluation (p < 0.05), Lysholm scores (p = 0.02), pivot shift (p < 0.01) and IKDC objective evaluation (p = 0.02). Similar results were also found in the subgroup analyses of minimum 2-years' follow-up and the TT technique. However, there were no differences between the two techniques in a subgroup analysis of the MP technique. CONCLUSION Generally, DB ACL reconstruction leads to better restoration of knee laxity and subjective outcomes than SB ACL reconstruction. The subgroup analysis of the MP technique revealed that surgeons can achieve equally as good results with both techniques when femoral tunnels are drilled through the medial portal. LEVEL OF EVIDENCE II.
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18
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Musahl V, Nazzal EM, Lucidi GA, Serrano R, Hughes JD, Margheritini F, Zaffagnini S, Fu FH, Karlsson J. Current trends in the anterior cruciate ligament part 1: biology and biomechanics. Knee Surg Sports Traumatol Arthrosc 2022; 30:20-33. [PMID: 34927221 DOI: 10.1007/s00167-021-06826-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022]
Abstract
A trend within the orthopedic community is rejection of the belief that "one size fits all." Freddie Fu, among others, strived to individualize the treatment of anterior cruciate ligament (ACL) injuries based on the patient's anatomy. Further, during the last two decades, greater emphasis has been placed on improving the outcomes of ACL reconstruction (ACL-R). Accordingly, anatomic tunnel placement is paramount in preventing graft impingement and restoring knee kinematics. Additionally, identification and management of concomitant knee injuries help to re-establish knee kinematics and prevent lower outcomes and registry studies continue to determine which graft yields the best outcomes. The utilization of registry studies has provided several large-scale epidemiologic studies that have bolstered outcomes data, such as avoiding allografts in pediatric populations and incorporating extra-articular stabilizing procedures in younger athletes to prevent re-rupture. In describing the anatomic and biomechanical understanding of the ACL and the resulting improvements in terms of surgical reconstruction, the purpose of this article is to illustrate how basic science advancements have directly led to improvements in clinical outcomes for ACL-injured patients.Level of evidenceV.
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Affiliation(s)
- Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA.
| | - Gian Andrea Lucidi
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA.,IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rafael Serrano
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | | | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Freddie H Fu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Jon Karlsson
- The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Mohamed A, Elfors E, Megahed AEAE, Saeid M. The role of transpaterllar viewing portal in anterior cruciate ligament reconstruction. TANTA MEDICAL JOURNAL 2022; 50:224. [DOI: 10.4103/tmj.tmj_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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20
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Iriuchishima T, Goto B, Fu FH. The radiographic tibial spine area is correlated with the occurrence of ACL injury. Knee Surg Sports Traumatol Arthrosc 2022; 30:78-83. [PMID: 33688977 DOI: 10.1007/s00167-021-06523-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to reveal the possible influence of the tibial spine area on the occurrence of ACL injury. METHODS Thirty-nine subjects undergoing anatomical ACL reconstruction (30 female, 9 male: average age 29 ± 15.2) and 37 subjects with intact ACL (21 female, 16 male: average age 29 ± 12.5) were included in this study. In the anterior-posterior (A-P) and lateral knee radiograph, the tibial spine area was measured using a PACS system. In axial knee MRI exhibiting the longest femoral epicondylar length, the intercondylar notch area was measured. Tibial spine area, tibial spine area/body height, and tibial spine area/notch area were compared between the ACL tear and intact groups. RESULTS The A-P tibial spine area of the ACL tear and intact groups was 178 ± 34 and 220.7 ± 58mm2, respectively. The lateral tibial spine area of the ACL tear and intact groups was 145.7 ± 36.9 and 178.9 ± 41.7mm2, respectively. The tibial spine area was significantly larger in the ACL intact group when compared with the ACL tear group (A-P: p = 0.02, lateral: p = 0.03). This trend was unchanged even when the tibial spine area was normalized by body height (A-P: p = 0.01, lateral: p = 0.02). The tibial spine area/notch area of the ACL tear and intact groups showed no significant difference. CONCLUSION The A-P and lateral tibial spine area was significantly smaller in the ACL tear group when compared with the ACL intact group. Although the sample size was limited, a small tibial spine might be a cause of knee instability, which may result in ACL injury. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Bunsei Goto
- Department of Orthopaedic Surgery, Kamimoku Spa Hospital, Minakami, Japan
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Iriuchishima T, Goto B. Systematic Review of Surgical Technique and Tunnel Target Points and Placement in Anatomical Single-Bundle ACL Reconstruction. J Knee Surg 2021; 34:1531-1538. [PMID: 32480416 DOI: 10.1055/s-0040-1710521] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this systematic review was to reveal the trend in surgical technique and tunnel targets points and placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, data collection was performed. PubMed, EMBASE, and Cochran Review were searched using the terms "anterior cruciate ligament reconstruction," "anatomic or anatomical," and "single bundle." Studies were included when they reported clinical results, surgical technique, and/or tunnel placement evaluation. Laboratory studies, technical reports, case reports, and reviews were excluded from this study. From these full article reviews, graft selection, method of creating the femoral tunnel, and femoral and tibial tunnel target points and placement were evaluated. In the 79 studies included for data evaluation, the selected grafts were: bone patella tendon bone autograft (12%), and hamstring autograft (83%). The reported methods of creating the femoral tunnel were: transportal technique (54%), outside-in technique (15%), and transtibial technique (19%). In the 60 studies reporting tunnel target points, the target point was the center of the femoral footprint (60%), and the center of the anteromedial bundle footprint (22%). In the 23 studies evaluating tunnel placement, the femoral tunnel was placed in a shallow-deep direction (32.3%) and in a high-low direction (30.2%), and the tibial tunnel was placed from the anterior margin of the tibia (38.1%). The results of this systematic review revealed a trend in anatomical single-bundle ACL reconstruction favoring a hamstring tendon with a transportal technique, and a tunnel target point mainly at the center of the ACL footprint. The level of evidence stated is Systematic review of level-III studies.
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Affiliation(s)
| | - Bunsei Goto
- Department of Orthopaedic Surgery, Kamimoku Spa Hospital, Minakami, Japan
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22
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Takahashi T, Watanabe S, Ito T. Current and future of anterior cruciate ligament reconstruction techniques. World J Meta-Anal 2021; 9:411-437. [DOI: 10.13105/wjma.v9.i5.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/09/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
In recent years, anterior cruciate ligament (ACL) reconstruction has generally yielded favorable outcomes. However, ACL reconstruction has not provided satisfactory results in terms of the rate of returning to sports and prevention of osteoarthritis (OA) progression. In this paper, we outline current techniques for ACL reconstruction such as graft materials, double-bundle or single-bundle reconstruction, femoral tunnel drilling, all-inside technique, graft fixation, preservation of remnant, anterolateral ligament reconstruction, ACL repair, revision surgery, treatment for ACL injury with OA and problems, and discuss expected future trends. To enable many more orthopedic surgeons to achieve excellent ACL reconstruction outcomes with less invasive surgery, further studies aimed at improving surgical techniques are warranted. Further development of biological augmentation and robotic surgery technologies for ACL reconstruction is also required.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Sports and Health Science, Ehime University, Matsuyama 790-8577, Ehime, Japan
| | - Seiji Watanabe
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan
| | - Toshio Ito
- Department of Orthopaedic Surgery, Murakami Memorial Hospital, Saijo 793-0030, Ehime, Japan
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Willinger L, Athwal KK, Williams A, Amis AA. An Anterior Cruciate Ligament In Vitro Rupture Model Based on Clinical Imaging. Am J Sports Med 2021; 49:2387-2395. [PMID: 34115540 PMCID: PMC8283191 DOI: 10.1177/03635465211017145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biomechanical studies on anterior cruciate ligament (ACL) injuries and reconstructions are based on ACL transection instead of realistic injury trauma. PURPOSE To replicate an ACL injury in vitro and compare the laxity that occurs with that after an isolated ACL transection injury before and after ACL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS Nine paired knees were ACL injured or ACL transected. For ACL injury, knees were mounted in a rig that imposed tibial anterior translation at 1000 mm/min to rupture the ACL at 22.5° of flexion, 5° of internal rotation, and 710 N of joint compressive force, replicating data published on clinical bone bruise locations. In contralateral knees, the ACL was transected arthroscopically at midsubstance. Both groups had ACL reconstruction with bone-patellar tendon-bone graft. Native, ACL-deficient, and reconstructed knee laxities were measured in a kinematics rig from 0° to 100° of flexion with optical tracking: anterior tibial translation (ATT), internal rotation (IR), anterolateral (ATT + IR), and pivot shift (IR + valgus). RESULTS The ACL ruptured at 26 ± 5 mm of ATT and 1550 ± 620 N of force (mean ± SD) with an audible spring-back tibiofemoral impact with 5o of valgus. ACL injury and transection increased ATT (P < .001). ACL injury caused greater ATT than ACL transection by 1.4 mm (range, 0.4-2.2 mm; P = .033). IR increased significantly in ACL-injured knees between 0° and 30° of flexion and in ACL transection knees from 0° to 20° of flexion. ATT during the ATT + IR maneuver was increased by ACL injury between 0° and 80° and after ACL transection between 0° and 60°. Residual laxity persisted after ACL reconstruction from 0° to 40° after ACL injury and from 0° to 20° in the ACL transection knees. ACL deficiency increased ATT and IR in the pivot-shift test (P < .001). The ATT in the pivot-shift increased significantly at 0° to 20° after ACL transection and 0° to 50° after ACL injury, and this persisted across 0° to 20° and 0° to 40° after ACL reconstruction. CONCLUSION This study developed an ACL injury model in vitro that replicated clinical ACL injury as evidenced by bone bruise patterns. ACL injury caused larger increases of laxity than ACL transection, likely because of damage to adjacent tissues; these differences often persisted after ACL reconstruction. CLINICAL RELEVANCE This in vitro model created more realistic ACL injuries than surgical transection, facilitating future evaluation of ACL reconstruction techniques.
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Affiliation(s)
- Lukas Willinger
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Orthopaedic Surgery Department, Technical University of Munich, Munich, Germany
| | - Kiron K. Athwal
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK
| | - Andy Williams
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Fortius Clinic, London, UK
| | - Andrew A. Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Andrew A. Amis, FREng, DSc(Eng), Mechanical Engineering Department, Imperial College London, London, SW7 2AZ, UK ()
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Fernandes TL, Moreira HH, Andrade R, Sasaki SU, Bernardo WM, Pedrinelli A, Espregueira-Mendes J, Hernandez AJ. Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211013327. [PMID: 34262978 PMCID: PMC8243110 DOI: 10.1177/23259671211013327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: There have been conflicting results about the theoretical advantages of
anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. Purpose: To evaluate the clinical and functional outcomes comparing anatomic single-
versus double-bundle techniques, anatomic versus nonanatomic techniques, and
transportal versus outside-in tunnel drilling for ACL reconstruction. Study Design: Systematic review; Level of evidence, 3. Methods: A search was performed in the MEDLINE and EMBASE databases up to August 2018
for clinical trials comparing anatomic ACL reconstruction (with tunnel
positioning demonstrated using gold standard radiologic techniques) with
another technique, with a minimum functional and biomechanical follow-up of
6 months. A meta-analysis was performed to compare clinical and functional
outcomes between anatomic single- versus double-bundle reconstruction and
between anatomic versus nonanatomic techniques, using the risk difference or
the mean difference. Risk of bias of the included studies was assessed using
the Newcastle-Ottawa Scale for cohort and case-control studies and the
Cochrane Risk of Bias tool and Jadad Score for randomized controlled
trials. Results: Included were 15 studies comprising 1290 patients (follow-up, 12-36 months).
No significant differences favoring anatomic double-bundle over anatomic
single-bundle reconstruction or outside-in over transportal techniques were
found. The meta-analyses showed significant differences in the International
Knee Documentation Committee (IKDC) objective score (risk difference, –0.14;
95% confidence interval, –0.27 to –0.01) favoring anatomic over nonanatomic
reconstruction. No statistically significant differences were found between
anatomic and nonanatomic surgical techniques on other functional scores or
clinical examination outcomes, including the IKDC subjective score, Lysholm
score, Tegner score, KT-1000 arthrometer test, or pivot-shift test. Conclusion: Double-bundle reconstruction was not superior to the single-bundle technique
in clinical and functional outcomes. Anatomic ACL reconstruction shows
significantly superior results over nonanatomic ACL reconstruction,
reinforcing the anatomic technique as the gold standard choice for clinical
practice.
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Affiliation(s)
- Tiago Lazzaretti Fernandes
- Group of Sports Medicine, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,FIFA Medical Center of Excellence, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hugo Henrique Moreira
- Group of Sports Medicine, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,FIFA Medical Center of Excellence, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Renato Andrade
- FIFA Medical Centre of Excellence, Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Faculty of Sports, University of Porto, Porto, Portugal
| | - Sandra Umeda Sasaki
- Public Employee Medical Assistance Institute of São Paulo State, Universidade Cidade de São Paulo, São Paulo, Brazil
| | | | - André Pedrinelli
- Group of Sports Medicine, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,FIFA Medical Center of Excellence, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - João Espregueira-Mendes
- FIFA Medical Centre of Excellence, Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,School of Medicine, Minho University, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, Portugal
| | - Arnaldo José Hernandez
- Group of Sports Medicine, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,FIFA Medical Center of Excellence, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Pontoh LAP, Ismail HD, Fiolin J, Yausep OE. Pain Following Single-bundle versus Double-bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) has been known to result in better functional outcomes, joint stability, and lower revision rates compared to single-bundle (SB) ACLR. However, given the increased invasiveness and damage to the surrounding tissue area, it is proposed that it may be associated with increased pain.
AIM: This review aims to gather all studies and literature that reported pain as an outcome when comparing SB versus DB ACLR.
METHODS: Literature searching was conducted across seven search engines for studies reporting pain as an outcome and comparing SB versus DB ACLR.
RESULTS: Eight studies met the eligibility criteria and were included in the study. Overall, the studies show variable findings regarding pain in DB compared to SB ACLR, with the only statistically significant results from two studies indicating that DB ACLR is associated with more pain than SB ACLR.
CONCLUSION: Based on the limited evidence available, no conclusions can be made regarding the pain experienced between people receiving either procedure. This constitutes a need for additional studies with increased follow-up time periods, larger sample size, and better study design.
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Takahashi T, Kimura M, Higuchi H, Suzuki K, Yamada Y, Takeshita K. A Histological Comparison Between Anterior Cruciate Ligament Remnant Tissue, Anatomically Reconstructed Graft, and Non-Anatomically Reconstructed Graft. Cureus 2021; 13:e13016. [PMID: 33542886 PMCID: PMC7847778 DOI: 10.7759/cureus.13016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: To our knowledge, no studies have investigated the histological comparison between primary injured anterior cruciate ligament (ACL), initially anatomically reconstructed grafts and non-anatomically reconstructed grafts at the time of revision ACL reconstruction. The purpose of this study was to histologically clarify the differences between ACL remnant tissue, reconstructed graft after anatomic double-bundle ACL reconstruction, and reconstructed graft after non-anatomic single-bundle ACL reconstruction. Methods: This histological study included five patients after anatomic double-bundle ACL reconstruction, three patients after non-anatomic single-bundle ACL reconstruction performed who injured their operated knees again, and five patients who injured their ACL for the first time and agreed to participate. All of the grafts and ACL remnant tissue were harvested, stained with hematoxylin and eosin, S-100, and alpha smooth muscle actin and evaluated using light microscopy. Results: There was no area of necrosis in the reconstructed graft after an anatomic double-bundle ACL reconstruction. However, there were obvious areas of necrosis in the reconstructed graft after non-anatomic single-bundle ACL reconstruction. Additionally, the collagen fibers were more longitudinally oriented, and most cells were spindle shaped like those in ACL remnant tissue after an anatomic double-bundle ACL reconstruction in contrast with the finding of the grafts after non-anatomic single-bundle ACL reconstruction. Conclusion: Initially reconstructed graft after an anatomic double-bundle ACL reconstruction may be beneficial if preserved at the time of the revision surgery.
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Affiliation(s)
| | | | - Hiroshi Higuchi
- Orthopaedic Surgery, Asakura Sports Rehabilitation Clinic, Maebashi, JPN
| | - Kosuke Suzuki
- Orthopaedic Surgery, Zenshukai Hospital, Maebashi, JPN
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Degree of Anterolateral Ligament Injury Impacts Outcomes After Double-Bundle Anterior Cruciate Ligament Reconstruction. Arthroscopy 2021; 37:222-230. [PMID: 32949631 DOI: 10.1016/j.arthro.2020.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of anterolateral ligament (ALL) injury identified on preoperative magnetic resonance imaging (MRI) on postoperative outcomes after double-bundle (DB) anterior cruciate ligament reconstruction (ACLR). METHODS For this retrospective study, the inclusion criteria were patients who were at least 3 years out of DB ACLR. Exclusion criteria included a delay in MRI over 4 weeks, delay in surgery over 6 months, single-bundle ACLR, and revision surgery. Enrolled patients were divided into 2 groups according to the ALL injury grade in preoperative MRI by a musculoskeletal radiologist who was blinded to the perioperative findings (the high-grade group with complete or nearly complete tear: n = 53 and the low-grade group with intact ALL or partial tear: n = 33). Knee laxity, clinical outcomes using the International Knee Documentation Committee (IKDC) examination form, and revision rates were compared at the last follow-up (8.1 ± 2.2 years). An independent t test was applied to compare continuous variables, and χ2 or Fisher exact test was used to compare the nominal variables. RESULTS The anterior translation was 3.2 ± 1.9 mm in the high-grade group and 1.6 ± 1.0 mm in the low-grade group (P < .001). The high-grade group showed 18 cases with a pivot-shift grade of 2 or 3 (40.0%); however, the low-grade group showed only 1 case with a pivot-shift grade 2 or 3 (3.0%) (P = .002). The high-grade group also showed inferior outcomes in the IKDC objective grade (grade A: 49.0%; grade B: 17.0%; grade C: 30.2%; grade D: 3.8% vs grade A: 90.9%; grade B: 6.1%; grade C: 3.0%; grade D: 0%, P = .001) and IKDC subjective score (87.5 ± 9.9 vs 93.9 ± 5.3, P < .001). In addition, the high-grade group showed a greater revision rate (11.3% vs 0%, P = .045). CONCLUSIONS DB ACLR for patients with high-grade ALL injury resulted in increased knee laxity, worse clinical outcomes, and higher revision rate compared to patients with low-grade ALL injury. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Anandan V, Goh TC, Zamri KS. Single-Bundle Versus Double-Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction: Comparison of Long-Term Functional Outcomes. Cureus 2020; 12:e12243. [PMID: 33500862 PMCID: PMC7819458 DOI: 10.7759/cureus.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To compare long-term functional results of ACL reconstruction with a single bundle (SB) and double bundle (DB). Methods Sixty patients who underwent ACL reconstructions from January 2007 to December 2008 were retrospectively evaluated (30 SB and 30 DB ACL reconstructions). Clinical and functional outcomes were measured pre- and postoperatively in terms of anterior drawer test, Lachman’s test, pivot shift test, KT1000 side-to-side difference, range of motion, International Knee Documentation Committee Scoring, Lysholm knee scoring scale (LKS), and Tegner activity level scale. The period of follow-up was 10 years. Results Clinical outcome measured showed that anterior drawer test result were equally normal for both groups (93.3%; p > 0.995); however, the Lachman test was 76.7% in the DB group and 56.7% in the SB group (p > 0.100), the pivot shift was 83% in the DB group and 50% in the SB group (p < 0.001), and KT1000 was 76.7% in the DB group and 56.7% in the SB group (p > 0.100). Regarding the functional outcome, it favored the DB group of patients, with the LKS being statistically significant (p < 0.007) and the Tegner activity level scale p-value being <0.001 Conclusions DB ACL reconstruction produces better rotational stability and gives superior functional outcome in terms of return to pre-injury activity level in comparison to SB reconstruction. DB ACL reconstruction using hamstring tendon autograft produces better functional results at 10 years follow-up.
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Affiliation(s)
- Vicknesh Anandan
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Teik Chiang Goh
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Kamarul Syariza Zamri
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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Eliya Y, Nawar K, Rothrauff BB, Lesniak BP, Musahl V, de SA D. Anatomical anterior cruciate ligament reconstruction (ACLR) results in fewer rates of atraumatic graft rupture, and higher rates of rotatory knee stability: a meta-analysis. J ISAKOS 2020. [DOI: 10.1136/jisakos-2020-000476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The occurrence of ACL injury influenced by the variance in width between the tibial spine and the femoral intercondylar notch. Knee Surg Sports Traumatol Arthrosc 2020; 28:3625-3630. [PMID: 32236676 DOI: 10.1007/s00167-020-05965-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/23/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study was to reveal the influence of the variance in width between the tibial spine and the femoral intercondylar notch on the occurrence of ACL injury. METHODS Thirty-nine subjects undergoing anatomical ACL reconstruction (30 female, 9 male; average age 29 ± 15.2) and 37 subjects with intact ACL (21 female, 16 male; average age 29 ± 12.5) were included in this study. In the anterior-posterior knee radiograph, tibial spine height, and the length between the top of the medial and lateral tibial spine (tibial spine width) were measured. In axial knee MRI exhibiting the longest femoral epicondylar length, intercondylar notch outlet length was measured and notch width index was calculated. Tibial spine width/notch outlet length, and tibial spine width/notch width index were compared between the ACL tear and intact groups. RESULTS Tibial spine width/notch outlet length of the ACL tear and intact groups was 0.6 ± 0.1 and 0.7 ± 0.1, respectively. Tibial spine width/notch width index of the ACL tear and intact groups was 0.4 ± 0.1, and 0.6 ± 0.1, respectively. Both parameters were significantly larger in the ACL intact group. CONCLUSION Both tibial spine width/notch outlet length and tibial spine width/notch width index were significantly smaller in the ACL tear group when compared with the ACL intact group. The occurrence of ACL injury influenced by the variance in width between the tibial spine and the femoral intercondylar notch. LEVEL OF EVIDENCE III.
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31
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Chen K, Zhu W, Zheng Y, Zhang F, Ouyang K, Peng L, Liu H, Feng W, Huang Y, Zhang G, Deng Z, Lu W. A retrospective study to compare the clinical effects of individualized anatomic single- and double-bundle anterior cruciate ligament reconstruction surgery. Sci Rep 2020; 10:14712. [PMID: 32895461 PMCID: PMC7477567 DOI: 10.1038/s41598-020-71721-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022] Open
Abstract
To evaluate the clinical efficacy of single- and double- bundle individualized anatomic anterior cruciate ligament (ACL) reconstruction, we retrospectively analyzed the data and charts of 920 patients with ACL rupture who received individualized anatomic ACL reconstruction surgery at our center. All of the patients underwent arthroscopic ACL reconstruction with autologous hamstring tendons. The patients were divided into two groups: the single-bundle individualized anatomic reconstruction group (N = 539), and the double-bundle individualized anatomic reconstruction group (N = 381). The IKDC, Lysholm and Tegner scores were used to subjectively evaluate the function of the knee joint during the postoperative follow-up. The Lachman test, pivot shift test and KT-3000 were used to objectively evaluate the stability of the knee. All 920 patients participated in clinical follow-up (average duration: 27.91 ± 3.61 months) achieved satisfied outcomes with few complications. The postoperative IKDC, Lysholm and Tegner scores, and the objective evaluation of knee joint stability were significantly improved compared to the preoperative status in both groups (P < 0.05). No statistically significant difference was observed between the two groups at the final follow-up (P > 0.05). Therefore, no difference in terms of the IKDC, Lysholm and Tegner score, or KT-3000 was observed between the individualized anatomic single- and double-bundle ACL reconstruction techniques. Both techniques can be used to restore the stability and functionality of the knee joint with satisfactory short-term efficacy.
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Affiliation(s)
- Kang Chen
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China.,School of Medicine, Shenzhen University, Shenzhen, Guangdong, China
| | - Weimin Zhu
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China.,School of Medicine, Shenzhen University, Shenzhen, Guangdong, China.,Guangzhou Medical University, Guangzhou, Guangdong, China.,Clinical College of Anhui Medical University Affiliated Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Yizi Zheng
- Department of Thyroid and Breast Surgery, Shenzhen Breast Tumor Research Center for Diagnosis and Treatment, National Standardization Center for Breast Cancer Diagnosis and Treatment, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Fangjie Zhang
- Department of Emergency Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kan Ouyang
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China.,Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liangquan Peng
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China.,School of Medicine, Shenzhen University, Shenzhen, Guangdong, China.,Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Haifeng Liu
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China.,Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wenzhe Feng
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Yong Huang
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Greg Zhang
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Zhenhan Deng
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China. .,School of Medicine, Shenzhen University, Shenzhen, Guangdong, China. .,Guangzhou Medical University, Guangzhou, Guangdong, China. .,Clinical College of Anhui Medical University Affiliated Shenzhen Second People's Hospital, Shenzhen, Guangdong, China.
| | - Wei Lu
- Department of Sports Medicine, Key Laboratory of Tissue Engineering of Shenzhen, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China. .,School of Medicine, Shenzhen University, Shenzhen, Guangdong, China. .,Guangzhou Medical University, Guangzhou, Guangdong, China.
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Morphology of the resident's ridge, and the cortical thickness in the lateral wall of the femoral intercondylar notch correlate with the morphological variations of the Blumensaat's line. Knee Surg Sports Traumatol Arthrosc 2020; 28:2668-2674. [PMID: 32157361 DOI: 10.1007/s00167-020-05932-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to reveal the morphological correlation between the lateral wall of femoral intercondylar notch and the Blumensaat's line. METHODS Forty-one non-paired human cadaveric knees were included in this study (23 female, 18 male: median age 83). Knees were resected, and 3 dimensional computed tomography (3D-CT) was performed. In the axial CT image, bony protrusion (resident's ridge) and cortical thickness in the lateral wall of the femoral intercondylar notch were detected. The length between the top of the ridge, or the most anterior, middle, and most posterior border of cortical thickness and posterior femoral condylar line was measured. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight and hill types (small and large hill types). In the hill types, the length between the hilltop and the posterior border of the Blumensaat's line or the posterior border of the femoral condyle was evaluated. Statistical correlation was calculated between the top of the ridge location, cortical thickness location in the notch, and hilltop location. RESULTS There were 7 straight type knees and 34 hill type knees (9 small hill type knees and 25 large hill type knees). Only the hill types of knees were evaluated. The top of the ridge, anterior margin, middle, and posterior border of cortical thickness in the lateral wall of the femoral intercondylar notch existed at 61.8 ± 4.6%, 58.3 ± 12.3%, 42.1 ± 7.9%, and 25.5 ± 5.4% from the posterior condylar line, respectively. The hilltop existed at 24.9 ± 5.9% and 30.7 ± 5.0%, from the posterior border of the Blumensaat's line and from the posterior border of the femoral condyle, respectively. Significant correlation was observed between resident's ridge top, cortical thickness location and hilltop location. CONCLUSION In all cadaveric knees, cortical thickness was detected in the lateral wall of the femoral intercondylar notch. The resident's ridge and cortical thickness location had significant correlation with the hill location in the Blumensaat's line, indicating a continuation of the cortical bone from the posterior cortex of the femoral shaft via the hilltop of the Blumensaat's line to the cortical thickness in the lateral wall of the femoral intercondylar notch. For clinical relevance, hilltop location in the Blumensaat's line is a new bony landmark in anterior cruciate ligament surgery.
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Iriuchishima T, Suruga M, Yahagi Y, Iwama G, Aizawa S, Fu FH. The location of the femoral ACL footprint center is different depending on the Blumensaat's line morphology. Knee Surg Sports Traumatol Arthrosc 2020; 28:2453-2457. [PMID: 32514842 DOI: 10.1007/s00167-020-06087-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the difference in the center point of the femoral ACL footprint according to the morphological variations of the Blumensaat's line. METHODS Fifty-nine non-paired human cadaver knees were used. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch. Digital images were evaluated using the Image J software. The periphery of the femoral ACL footprint was outlined and the center point was measured automatically. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight and hill types (small and large hill types). The center of the femoral ACL footprint and hilltop placement were evaluated using the quadrant method. A quadrant grid was placed uniformly, irregardless of hill existence, and not including the articular cartilage. A correlation analysis was performed between the center point of the femoral ACL footprint and hilltop placement. RESULTS The straight type consisted of 19 knees, and the hill type 40 knees (small hill type 13 knees and large hill type 27 knees). The center of the femoral ACL footprint (shallow-deep/high-low) in the straight and hill type knees was 33.7/47.6%, and 37.2/50.3%, respectively. In the hill type, the ACL footprint center was significantly more shallow when compared to the straight type. Significant correlation was observed between the center point of the femoral ACL footprint and hilltop placement of the Blumensaat's line. CONCLUSION The center point of the femoral ACL footprint was significantly more shallow in the hill type knees when compared to the straight type. For clinical relevance, considering that the location of the femoral ACL footprint center is different depending on the Blumensaat's line morphology, to perform accurate ACL reconstruction, femoral ACL tunnel placement should be made based on Blumensaat's line morphological variations.
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Affiliation(s)
- Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Spa Hospital, Minakami, Japan. .,Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan.
| | - Makoto Suruga
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Genki Iwama
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Kaibara T, Kondo E, Matsuoka M, Iwasaki K, Onodera T, Momma D, Seito N, Mikami S, Iwasaki N. Large osteochondral defect in the lateral femoral condyle reconstructed by Atelocollagen-associated autologous chondrocyte implantation combined with anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2020; 21:494. [PMID: 32718337 PMCID: PMC7385883 DOI: 10.1186/s12891-020-03531-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/21/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Articular surface damage commonly associated with rupture of the anterior cruciate ligament (ACL). Large osteochondral defect, which consists of a severe depression fracture and a large cartilage defect, need to be treated due to deformation of the articular surface as it can impact the clinical outcome of ACL reconstruction. Although autologous chondrocyte implantation is one of the useful options in such cases, it can be questioned whether the reconstruction of the ACL and osteochondral defect should be performed in one procedure alone. CASE PRESENTATION We report a case of a 38-year-old male with a deep depression fracture extending to the edge of the lateral femoral condyle associated with ACL injury after twisting his right knee while skiing. The patient was successfully treated with tissue-engineered cartilage transplantation covered by the periosteum with an iliac bone graft combined with anatomic double-bundle ACL reconstruction. Histopathological examination of the transplanted cartilage taken at second-look arthroscopy showed a cartilage-like tissue in the middle to deep zone in which the extracellular matrix was largely stained with Safranin O. The patient was able to return to his previous level of skiing activity without any experience of knee pain. Magnetic resonance imaging at 4 years after surgery showed that the graft integrated to the border zone and subchondral bone. The operated knee showed negative Lachman test and had a full range of motion. CONCLUSIONS To our knowledge, this is the first report of anatomic double-bundle ACL reconstruction with tissue-engineered cartilage transplantation and an iliac bone graft to restore the lateral edge of the femoral condyle.
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Affiliation(s)
- Takuma Kaibara
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Eiji Kondo
- Center for Sports Medicine, Hokkaido University Hospital, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Koji Iwasaki
- Department of functional reconstruction for the knee joint, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Naoki Seito
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Susumu Mikami
- Department of Orthopaedic Surgery, Hokkaido Orthopaedic Memorial Hospital, 5-22, 7-Jo 13-Chome, Hiragishi, Toyohira-ku, Sapporo, Hokkaido, 062-0937, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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So SY, Suh DW, Lee SS, Jung EY, Ye DH, Ryu D, Kwon KB, Wang JH. Revision Anterior Cruciate Ligament Reconstruction After Primary Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Case Series of 40 Patients. Arthroscopy 2020; 36:546-555. [PMID: 31901397 DOI: 10.1016/j.arthro.2019.08.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/09/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the surgical methods according to the status of tunnels at the time of revision anterior cruciate ligament reconstruction (ACLR) and to evaluate clinical outcomes of revision ACLR in patients who underwent primary ACLR with the anatomic 4-tunnel double-bundle (DB) technique. METHODS A total of 487 patients who underwent primary anatomic DB ACLR from April 2010 to July 2016 were retrospectively reviewed, and among those knees, the patients who underwent revision ACLR were included in the study. The patients with concomitant posterior cruciate ligament injuries were excluded. Forty patients (40 knees) were identified and enrolled. The surgical methods were reviewed. The range of motion, objective laxity using KT-2000, Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, and Tegner score after revision ACLR were compared with those after primary ACLR in the same patient using paired t-test with Bonferroni correction. RESULTS The timing of reinjury after primary ACLR and mean interval between primary and revision ACLR were 18 months (range 1.5-80 months) and 24 months (range 4-82 months), respectively. Among 40 patients, 38 patients (95%) underwent 1-stage revision with the DB technique using pre-existing tunnels without compromised positioning of the grafts, and the other 2 patients (5%) underwent 2-stage revision. The postrevision range of motion, KT-2000, Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, and Tegner score were 137 ± 7°, 2.4 ± 1.2 mm, 91.4 ± 5.8, 98.9 ± 2.2, 78.6 ± 11.5, and 5.5 ± 1.2, respectively, and did not show any differences from those after primary ACLR. CONCLUSIONS In the revision setting after primary anatomic DB ACLR, most of the cases could be managed with 1-stage revision with DB technique using pre-existing tunnels, and the objective laxity and clinical scores after revision DB ACLR were comparable with those after primary DB ACLR. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Sang-Yeon So
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Dong Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-si, Gyeonggi-do, Korea
| | - Eui Yub Jung
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea
| | - Dong-Hee Ye
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongjin Ryu
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeu-Back Kwon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
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Ekås GR, Ardern CL, Grindem H, Engebretsen L. Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury. Br J Sports Med 2020; 54:520-527. [PMID: 31959673 DOI: 10.1136/bjsports-2019-100956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction. DESIGN Prognosis systematic review (PROSPERO registration number CRD42016036788). METHODS We searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google Scholar from inception to 3rd May 2018. Eligible articles included patients with ACL injury (diagnosis confirmed by MRI and/or diagnostic arthroscopy), reported the number of meniscal tears at the time of ACL injury diagnosis/start of treatment and reported the number of new meniscal tears that subsequently occurred. Articles with fewer than 20 patients at follow-up, and articles limited to ACL revision surgery or multi-ligament knee injuries were excluded. Two independent reviewers screened articles, assessed eligibility, assessed risk of bias and extracted data. We judged the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology. RESULTS Of 75 studies included in the systematic review, 54 studies with 9624 patients and 501 new meniscal tears were appropriate for quantitative analysis. Heterogeneity precluded data pooling. The risk of new meniscal tears was 0%-21% when follow-up was <2 years, 0%-29% when follow-up was 2 to 5 years, 5%-52% when follow-up was 5 to 10 years and 4%-31% when follow-up was longer than 10 years. The proportion of studies with high risk of selection, misclassification and detection bias was 84%, 69% and 68%, respectively. Certainty of evidence was very low. CONCLUSION New meniscal tears occurred in 0%-52% of patients between 4 months and 20 years (mean 4.9±4.4 years) following treatment for ACL injury. The certainty of evidence was too low to guide surgical treatment decisions. This review cannot conclude that the incidence of new meniscal tears is lower if ACL injury is treated with surgery compared with treatment with rehabilitation only.
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Affiliation(s)
- Guri Ranum Ekås
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Clare L Ardern
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,Unit of Physiotherapy, Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Hege Grindem
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.,Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lars Engebretsen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci 2020; 25:6-45. [PMID: 31843222 DOI: 10.1016/j.jos.2019.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). METHODS The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature. CONCLUSIONS This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.
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Affiliation(s)
- Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Japan
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Lim CR, Henson T, Ebert J, Annear P. Anterior cruciate ligament reconstruction using a double bundle hamstring autograft configuration in patients under 30 years. World J Orthop 2019; 10:446-453. [PMID: 31908993 PMCID: PMC6937423 DOI: 10.5312/wjo.v10.i12.446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/21/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) has a high incidence of re-tear in younger patients. Despite comparable functional outcomes, the incidence of re-tear using single and double bundle ACLR methods has not been well reported.
AIM To hypothesize that double bundle hamstring ACLR has a lower graft rupture rate compared with single bundle hamstring ACLR grafts in young patients.
METHODS One hundred and twelve patients < 30 years of age at the time of primary double bundle ACLR were eligible for study participation. 91 (81.3%) could be contacted, with a mean age of 20.4 years (range 13-29) and mean post-operative follow-up time of 59 mo (range 25-107). Telephone questionnaires evaluated the incidence (and timing) of subsequent re-tear and contralateral ACL tear, further surgeries, incidence and time to return to sport, and patient satisfaction.
RESULTS Of the 91 patients, there were 6 (6.6%, 95%CI: 1.4-11.7) ACL graft re-ruptures, with a mean time to re-rupture of 28 mo (range 12-84). Fourteen patients (15.4%) experienced a contralateral ACL rupture and 14 patients (15.4%) required further surgery to their ipsilateral knee. fifty patients (54.9%) returned to pre-injury level of sport. Of those < 20 years (n = 45), 4 patients (8.9%, 95%CI: 0.4-17.3) experienced a re-rupture, with mean time to re-injury 15 mo (range 12-24). Comparative analysis with existing literature and revealed a non-significant Chi-squared statistic of 2.348 (P = 0.125).
CONCLUSION A trend existed toward lower graft rupture rates in young patients undergoing double bundle ACLR utilizing a hamstring autograft, compared with rates reported after single bundle ACLR.
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Affiliation(s)
- Christopher Reece Lim
- Department of Orthopaedics, Sir Charles Gairdner Hospital, Western Australia, Nedlands 6009, Australia
| | - Tamalee Henson
- Fiona Stanley Hospital, Western Australia, Murdoch 6150, Australia
| | - Jay Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Western Australia, Crawley 6009, Australia
| | - Peter Annear
- Perth Orthopaedic and Sports Medicine Centre, Western Australia, West Perth 6005, Australia
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Lim CR, Henson T, Ebert J, Annear P. Anterior cruciate ligament reconstruction using a double bundle hamstring autograft configuration in patients under 30 years. World J Orthop 2019. [DOI: 10.5312/wjo.v10.i12.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Baba R, Kondo E, Iwasaki K, Joutoku Z, Onodera J, Onodera T, Yagi T, Iwasaki N, Yasuda K. Impact of Surgical Timing on Clinical Outcomes in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autografts. Orthop J Sports Med 2019; 7:2325967119880553. [PMID: 31799327 PMCID: PMC6859686 DOI: 10.1177/2325967119880553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: To date, no studies have analyzed the influence on clinical outcomes of the interval between an anterior cruciate ligament (ACL) injury and double-bundle (DB) reconstruction with hamstring tendon autografts. Hypotheses: (1) Performing ACL reconstruction sooner after an injury will reduce postoperative anterior and rotatory knee instability, (2) postoperative range of knee motion or functional results will not be affected by different intervals between injury and surgery, and (3) preoperative isokinetic peak torque of the quadriceps and hamstring muscles will be lower in patients undergoing surgery earlier, while postoperative muscle strength will not be affected by surgery timing. Study Design: Cohort study; Level of evidence, 3. Methods: This study was conducted on a total of 171 patients who had undergone anatomic DB ACL reconstruction with hamstring tendon autografts. The patients were divided into 3 groups based on the time to surgery: (1) ≤1 month after the injury (group E; n = 25), (2) between 1 and 3 months after the injury (group M; n = 72), and (3) >3 months after the injury (group D; n = 74). Patients were assessed for a minimum of 2 years after surgery. Results: Concerning postoperative anterior laxity, 1-way analysis of variance demonstrated a significant difference (P = .0274) among the 3 groups. Anterior laxity was significantly less in group E than in group D (P = .0206). Spearman rank correlation analysis showed a significant correlation (ρ = 0.200; P = .0327) between anterior knee laxity and time to surgery. Also, a significant correlation (P = .0461) was found between the degree of the pivot-shift phenomenon and time to surgery. There were no significant differences in loss of knee extension or flexion among the 3 groups, nor were there any differences in the Lysholm knee score or International Knee Documentation Committee grade. Postoperatively, there were no significant differences in peak torque of the quadriceps or hamstring muscles among the 3 groups. Conclusion: Early DB reconstruction led to significantly less anterior laxity compared with delayed reconstruction. There were no significant differences in postoperative range of knee motion or functional results among the 3 time intervals between injury and surgery in this study.
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Affiliation(s)
- Rikiya Baba
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Koji Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Zenta Joutoku
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Jun Onodera
- Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomonori Yagi
- Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazunori Yasuda
- Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital, Sapporo, Japan
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The Blumensaat's line morphology influences to the femoral tunnel position in anatomical ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:3638-3643. [PMID: 30915514 DOI: 10.1007/s00167-019-05492-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to reveal the influence of the morphological variations of the Blumensaat's line on femoral tunnel position in anatomical anterior cruciate ligament (ACL) reconstruction. METHODS Thirty-eight subjects undergoing anatomical single-bundle ACL reconstruction were included in this study (22 female, 16 male: median age 45: 15-63). Using a trans-portal technique, the femoral tunnel was targeted to reproduce the center of antero-medial bundle. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight and hill types (small and large hill types). Femoral ACL tunnel position was evaluated using the quadrant method. When the quadrant method grid was applied, the baseline of the grid was matched to the anterior part of the Blumensaat's line, without considering the existence of a hill. Using pre-operative 3D-CT data, the axial and sagittal morphology of the knee was also compared, establlishing straight and hill types. RESULTS There were 12 straight type knees and 26 hill type knees (7 small hill type knees and 19 large hill type knees). The femoral tunnel position in straight type knees was 23.6 ± 3.7% in the shallow-deep direction, and 41.3 ± 8.2% in the high-low direction. In hill type knees, the tunnel position was 27 ± 4.7% in the shallow-deep direction, and 51 ± 10.1% in the high-low direction. The femoral tunnel was placed significantly more shallow and lower in hill type knees when compared with straight type knees. CONCLUSION Femoral ACL tunnel placement was significantly influenced by the morphological variations of the Blumensaat's line. As detecting morphological variation in arthroscopic surgery is difficult, surgeons should confirm such variations pre-operatively using radiograph or CT so as to avoid making extremely shallow and low tunnels in hill type knees. LEVEL OF EVIDENCE Case-controlled study, III.
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Janko M, Verboket RD, Plawetzki E, Geiger EV, Lustenberger T, Marzi I, Nau C. Vergleichbare Ergebnisse nach arthroskopischem Ersatz des vorderen Kreuzbandes. Chirurg 2019; 91:67-75. [DOI: 10.1007/s00104-019-01050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Yahagi Y, Horaguchi T, Iriuchishima T, Suruga M, Iwama G, Aizawa S. Correlation between the mid-substance cross-sectional anterior cruciate ligament size and the knee osseous morphology. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:291-296. [PMID: 31552484 DOI: 10.1007/s00590-019-02552-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION One of the final goals of anatomical anterior cruciate ligament (ACL) reconstruction is the restoration of native anatomy. It is essential to obtain more accurate predictors of mid-substance ACL size before surgery. However, to the best of our knowledge, no study has reported correlation between the mid-substance cross-sectional ACL size and the knee osseous morphology. The purpose of this study was to reveal correlation between the mid-substance cross-sectional ACL size and the knee osseous morphology. MATERIALS AND METHODS We used 39 non-paired formalin fixed Japanese cadaveric knees. All surrounding muscles, ligaments and soft tissues in the knee were resected. After soft tissue resection, the knee was flexed at 90°, and a tangential plane of the femoral posterior condyles was marked and cut the ACL. Femoral ACL footprint size, Blumensaat's line length, lateral wall of the femoral intercondylar notch size, lateral wall of the femoral intercondylar notch height, tibial ACL footprint size, tibia plateau size, the whole anterior-posterior (AP) length, the medial and the lateral AP length of the tibia plateau, and the medial-lateral (ML) length of the tibia plateau were measured. The Pearson's product movement correlation was calculated to reveal correlation between the mid-substance cross-sectional ACL size and the measured parameters of the knee osseous morphology. RESULTS The measured mid-substance cross-sectional ACL size was 49.9 ± 16.3 mm2. The tibial ACL footprint size, the tibia plateau size, the whole AP length of the tibia plateau, the lateral AP length of the tibia plateau and the ML length of the tibia plateau were significantly correlated with the mid-substance cross-sectional ACL size. CONCLUSIONS For clinical relevance, some tibial sides of the knee osseous morphology were significantly correlated with the mid-substance cross-sectional ACL size. It might be possible to predict the mid-substance ACL size measuring these parameters.
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Affiliation(s)
- Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Takashi Horaguchi
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Spa Hospital, Minakami, 198-2, Ishikura Minakami-cho, Tone-Gun, Gunma-ken, 379-1311, Japan.,Department of Functional Morphology, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Makoto Suruga
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Genki Iwama
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
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Lee JCY, Yung PSH, Lam MH, Hung ASL, Fong DTP, Chan WY, Chan KM. A non-invasive biomechanical device to quantify knee rotational laxity: Verification of the device in human cadaveric specimens. Asia Pac J Sports Med Arthrosc Rehabil Technol 2019; 16:19-23. [PMID: 30984559 PMCID: PMC6445399 DOI: 10.1016/j.asmart.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/02/2018] [Accepted: 11/21/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Biomechanical measurement tools have been developed and widely used to precisely quantify knee anterior-posterior laxity after anterior cruciate ligament (ACL) injury. However, validated objective device to document knee rotational laxity, though being developed by different researchers, are not yet widely used in the daily clinical practice. A new biomechanical device was developed to quantify knee internal and external rotations. METHODS The reliability of the new biomechanical device which measures knee rotations were tested. Different torques (1-10Nm) were applied by the device to internally and externally rotate human cadaveric knees, which were held in a flexion angle of 30°. The rotations were measured by the device in degrees. There were two independent testers, and each tester carried out three trials. Intra-rater and inter-rater reliability were quantified in terms of intraclass correlation (ICC) coefficient among trials and between testers. The device was verified by the comparison with a computer assisted navigation system. ICC was measured. Mean, standard deviation and 95% confident interval of the difference as well as the root mean square difference were calculated. The correlations were deemed to be reliable if the ICC was above 0.75. RESULTS The intra-rater and inter-rater reliability achieved high correlation for both internal and external rotation, ranged from 0.959 to 0.992. ICC between the proposed meter and the navigation system for both internal and external rotation was 0.78. The mean differences were 2.3° and 2.5° for internal and external rotation respectively. CONCLUSIONS A new knee rotational laxity meter was proposed in this study. Its reliability was verified by showing high correlation among trials. It also showed good correlation to a gold standard of measurement. It might be used to document knee rotational laxity for various purposes, especially after ACL injury, after further validation of the device in human subjects.
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Affiliation(s)
- Jeffrey Chun-Yin Lee
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Mak-Ham Lam
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Aaron See-Long Hung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Daniel Tik-Pui Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Wood Yee Chan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai-Ming Chan
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Kim BK, Kim TW, Hwang CH, Park HK, Hwang KH, Sim JA, Lee YS, Lee BK. Analysis of Mechanical Loading after Anatomic Anterior Cruciate Ligament Reconstruction Using Combined Single-Photon Emission Computerized Tomography and Conventional Computerized Tomography. Knee Surg Relat Res 2019; 31:37-43. [PMID: 30871291 PMCID: PMC6425891 DOI: 10.5792/ksrr.18.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 09/24/2018] [Accepted: 10/22/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was to evaluate changes of the mechanical loading pattern after anatomic anterior cruciate ligament (ACL) reconstruction by analyzing uptake patterns using combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT). Materials and Methods On SPECT/CT, high signal intensity of the articular surface which shows biological activity and mean increase of mechanical loading was compared with that of the tibiofemoral shaft as a comparative signal. The proportion of positive signals was evaluated in all compartments of the operated knee. Analysis was performed according to combined injury. Results A relatively high proportion of positive signals was detected in the posterior zone of the lateral tibial plateau (23.5%) and trochlear groove (23.5%) although increased signal intensity was detected in all compartments. There was no statistical difference depending on the presence of combined injury and between single-bundle and double-bundle ACL reconstruction. Conclusions Following anatomic ACL reconstruction, higher signal intensity was detected, particularly in the posterior part of the lateral tibial plateau and trochlear groove. Close observation for further signal changes or osteoarthritic changes would be required even if there was no combined injury and anatomic reconstruction was performed.
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Affiliation(s)
- Byung Kag Kim
- Department of Orthopedic Surgery, Joint Center, Sungmin Hospital, Incheon
| | - Tae Won Kim
- Department of Orthopedic Surgery, Gil Medical Center, Incheon
| | - Chul Ho Hwang
- Department of Orthopedic Surgery, Gil Medical Center, Incheon
| | - Hong Ki Park
- Department of Orthopedic Surgery, Gil Medical Center, Incheon
| | | | - Jae Ang Sim
- Department of Orthopedic Surgery, Gil Medical Center, Incheon
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam
| | - Beom Koo Lee
- Department of Orthopedic Surgery, The Armed Forces Capital Hospital, Incheon, Korea
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Suruga M, Horaguchi T, Iriuchishima T, Iwama G, Yahagi Y, Tokuhashi Y, Aizawa S. The correlation between the femoral anterior cruciate ligament footprint area and the morphology of the distal femur: three-dimensional CT evaluation in cadaveric knees. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:849-854. [PMID: 30701307 DOI: 10.1007/s00590-019-02387-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS "Anatomical" anterior cruciate ligament (ACL) reconstruction is defined as the functional restoration of the ACL to its native dimensions. It is essential to obtain more accurate predictors of ACL size before surgery. The purpose of this study was to investigate the correlation between the native femoral ACL footprint size and the morphology of the distal femur using three-dimensional CT (3D-CT). METHODS Thirty non-paired Japanese human cadaver knees were used. All soft tissues around the knee were resected except the ACL. For the evaluation of femoral condyle morphology, trans-epicondylar length (TEL), notch outlet length, axial notch area, and notch width index were measured using 3D-CT. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch. The ACL was carefully dissected, and the boundaries of the ACL insertion site were outlined on the femoral side. An accurate lateral view of the femoral condyle was photographed with a digital camera. The size of the femoral ACL footprint, length of Blumensaat's line, and the height and area of the lateral wall of the femoral intercondylar notch were measured with ImageJ software. RESULTS Notch height, lateral notch area, and TEL were significantly correlated with the femoral ACL footprint area. Both axial notch area and notch outlet length were significantly correlated with the femoral mid-substance insertion area. CONCLUSION Morphological evaluation using 3D-CT preoperatively may be useful in predicting the femoral ACL footprint size.
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Affiliation(s)
- Makoto Suruga
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-0032, Japan. .,Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan.
| | - Takashi Horaguchi
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | | | - Genki Iwama
- Department of Orthopaedic Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-0032, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
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Iriuchishima T, Goto B, Okano T, Ryu K, Fu FH. Femoral tunnel length in anatomical single-bundle ACL reconstruction is correlated with height, weight, and knee bony morphology. Knee Surg Sports Traumatol Arthrosc 2019; 27:93-99. [PMID: 29968189 DOI: 10.1007/s00167-018-5046-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to reveal the correlation between femoral tunnel length in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction and body size and/or knee morphology. METHODS Thirty-one subjects undergoing anatomical single-bundle ACL reconstruction were included in this study (20 female, 11 male; median age 46, 15-63). Pre-operative height, body weight, and body mass index (BMI) were measured. In pre-operative magnetic resonance imaging, the thickness of the quadriceps tendon and the whole anterior-posterior (AP) length of the knee were measured using the sagittal slice. Using post-operative three-dimensional computed tomography, accurate axial and lateral views of the femoral condyle were evaluated. The correlation of femoral tunnel length, which was measured intra-operatively, with the height, weight, BMI, quadriceps tendon thickness, AP length of the knee, trans-epicondylar length, the notch area (axial), length of Blumensaat's line, and the height and area of the lateral wall of the femoral intercondylar notch were statistically analyzed. Tunnel placement was also evaluated using a Quadrant method. RESULTS The average femoral tunnel length was 35.6 ± 4.4 mm. The average height, body weight, and BMI were 162.7 ± 7.2 cm, 61.9 ± 10 kg, and 23.4 ± 3.5, respectively. Femoral tunnel length was significantly correlated with height, body weight and the height and area of lateral wall of the femoral intercondylar notch, and the length of the Blumensaat's line. CONCLUSION For clinical relevance, the risk of creating a femoral tunnel of insufficient length in anatomical single-bundle ACL reconstruction exists in subjects with small body size. Surgeons should pay careful attention to prevent this from occurring. LEVEL OF EVIDENCE Case-controlled study, Level III.
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Affiliation(s)
- Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Ishikura 198-2, Minakami, Japan.
| | - Bunsei Goto
- Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Ishikura 198-2, Minakami, Japan
| | - Tatsumasa Okano
- Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Ishikura 198-2, Minakami, Japan
| | - Keinosuke Ryu
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Iriuchishima T, Ryu K, Fu FH. Evaluation of age-related differences in anterior cruciate ligament size. Knee Surg Sports Traumatol Arthrosc 2019; 27:223-229. [PMID: 30539304 DOI: 10.1007/s00167-018-5336-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/07/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to reveal the relation between age and the morphological characteristics of the anterior cruciate ligament (ACL) using magnetic resonance imaging (MRI). METHODS Thirty-seven young subjects who were diagnosed with a meniscus injury without ACL tear using MRI (15 male and 22 female, median age 26, range 15-49), and 33 elderly subjects for whom knee MRI was performed before uni-compartmental knee arthroplasty (11 male and 22 female, median age 77, range 60-83), were included in this study. In the elderly group, healthy ACL gross morphology was confirmed macroscopically during surgery. In all knees, ACL was detected without any intensity alteration. In the MRI evaluation, using the axial slice revealing the greatest length between the medial and lateral epicondyle of the femur, axial ACL size was evaluated. Using the coronal plane image, the sagittal image was sliced parallel with the native ACL. In the sagittal image of the MRI, the largest area of the ACL was measured. Statistical analysis was performed to reveal the correlation between age and ACL size. Both axial and sagittal ACL areas were compared between the young and elderly groups. RESULTS Age and sagittal ACL area were significantly correlated (Pearson's coefficient correlation: - 0.353, P = 0.003). The sagittal ACL area was significantly larger in the young group when compared with the elderly group (P = 0.001). However, when the sagittal ACL area was normalized by the length of Blumensaat's line, no significant difference was observed. CONCLUSION For clinical relevance, sagittal ACL size was significantly larger in young subjects. The reason for this difference is likely the difference in knee size. When performing anatomical studies of the ACL using cadaveric knees of elderly specimens, there is the possibility that the ACL size will be underestimated. Considering that the ACL surgery is mainly performed for young subjects, cadavers of younger age should be used in such studies. LEVEL OF EVIDENCE Diagnostic study, Level III.
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Affiliation(s)
| | - Keinosuke Ryu
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Masuda T, Kondo E, Onodera J, Kitamura N, Inoue M, Nakamura E, Yagi T, Iwasaki N, Yasuda K. Effects of Remnant Tissue Preservation on Tunnel Enlargement After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using the Hamstring Tendon. Orthop J Sports Med 2018; 6:2325967118811293. [PMID: 30547042 PMCID: PMC6287319 DOI: 10.1177/2325967118811293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background The effects of remnant tissue preservation on tunnel enlargement after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction have not yet been established. Hypothesis The preservation of ACL remnant tissue may significantly reduce the degree and incidence of tunnel enlargement after anatomic double-bundle ACL reconstruction, while the remnant-preserving procedure may not significantly increase the incidence of tunnel coalition after surgery. Study Design Cohort study; Level of evidence, 2. Methods A total of 79 patients underwent anatomic double-bundle ACL reconstruction. Based on the Crain classification of ACL remnant tissue, 40 patients underwent the remnant-preserving procedure (group P), and the remaining 39 patients underwent the remnant-resecting procedure (group R). There were no differences between the 2 groups concerning all background factors, including preoperative knee instability and intraoperative tunnel positions. All patients were examined using computed tomography and a standard physical examination at 2 weeks and 1 year after surgery. Results During surgery, the femoral and tibial anteromedial (AM) tunnel sizes in both groups averaged 6.6 and 6.5 mm, respectively. The femoral and tibial posterolateral (PL) tunnel sizes in both groups averaged 6 and 6 mm, respectively. There were no differences in the intraoperative tunnel positions and tunnel sizes between groups. Concerning the femoral AM tunnel, the degree of tunnel enlargement in the oblique coronal and oblique axial views in group P was significantly less than that in group R (P = .0068 and .0323, respectively). Regarding the femoral AM tunnel cross-sectional area, the degree and incidence of tunnel enlargement in group P were significantly less than those in group R (P = .0086 and .0278, respectively). There were no significant differences in tunnel coalition between groups. In each group, there were no significant relationships between tunnel enlargement and each clinical outcome. Conclusion Remnant preservation in anatomic double-bundle ACL reconstruction reduced enlargement of the femoral AM tunnel and did not increase the incidence of tunnel coalition. This is one of the advantages of remnant-preserving ACL reconstruction.
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Affiliation(s)
- Tetsuro Masuda
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiji Kondo
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Advanced Therapeutic Research for Sports Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Jun Onodera
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuto Kitamura
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masayuki Inoue
- Department of Orthopaedic Surgery, NTT East Sapporo Hospital, Sapporo, Japan
| | - Eiichi Nakamura
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomonori Yagi
- Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazunori Yasuda
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, Sapporo, Japan
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Association of the Graft Size and Arthrofibrosis in Young Patients After Primary Anterior Cruciate Ligament Reconstruction. J Am Acad Orthop Surg 2018; 26:e483-e489. [PMID: 30148751 DOI: 10.5435/jaaos-d-17-00177] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study investigated the association of graft-related surgical factors and patient characteristics with the odds of arthrofibrosis after primary anterior cruciate ligament reconstruction (ACL-R). METHODS A retrospective case-control study assessed consecutive patients who underwent primary ACL-R in one tertiary pediatric hospital. Each arthrofibrosis case was matched to three controls for sex, calendar year, and age at the time of ACL-R, as well as the primary surgeon. Conditional multivariable logistic regression assessed the independent association of graft diameter, time from injury to ACL-R, concomitant knee pathologies, and body mass index. RESULTS Twenty arthrofibrosis cases of 1,121 ACL-R patients (incidence 1.8%) were matched to 60 controls resulting in the mean age of 14.5 years. An increase of 1 mm graft diameter was associated with 3.2-times increased odds of arthrofibrosis. Other variables were not independently associated with arthrofibrosis. CONCLUSION For young patients, the decision on the graft size must consider the possibility of arthrofibrosis with a larger graft versus reinjury with a smaller graft.
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