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Ikuta Y, Nakamae A, Shimizu R, Ishikawa M, Nakasa T, Ochi M, Adachi N. A Comparison of Central Anatomic Single-Bundle Reconstruction and Anatomic Double-Bundle Reconstruction in Anteroposterior and Rotational Knee Stability: Intraoperative Biomechanical Evaluation. J Knee Surg 2022; 35:273-279. [PMID: 32615614 DOI: 10.1055/s-0040-1713730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Postoperative anterior and rotational stability are still controversial when compared with single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. This study aimed to compare the central anatomical SB and anatomical DB ACL reconstruction in intraoperative knee kinematics during continuous knee flexion-extension. A total of 34 patients who underwent ACL reconstruction using the hamstring tendon were evaluated intraoperatively before and immediately after ACL reconstruction using OrthoPilot ACL Navigation System Version 3.0. The patients were prospectively randomized into the central anatomical SB (17 knees) and the anatomical DB reconstruction (17 knees) groups. The tibial translation and rotation were continuously measured during knee flexion-extension under conventional knee motion, anterior tibial load (100N), and internal-external torque (3 N·m). The anterior tibial translation and total range of tibial rotation were calculated from the measurement values from 20 to 50 degrees at each 5-degree point. The anterior tibial translation (p = 0.59; two-factor repeated measures analysis of variance; η 2G = 0.0077) and total range of tibial rotation (p = 0.95; η 2G = 0.0001) at each knee flexion angle showed no significant difference between the central anatomical SB and anatomical DB reconstruction groups. It is suggested that the central anatomical SB reconstruction is comparable with the anatomical DB reconstruction in biomechanical anteroposterior and rotational knee stability at time 0.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ryo Shimizu
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Nobuo Adachi
- Department of Orthopaedic Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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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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Kimura Y, Sasaki E, Yamamoto Y, Sasaki S, Tsuda E, Ishibashi Y. Incidence and Risk Factors of Subsequent Meniscal Surgery After Successful Anterior Cruciate Ligament Reconstruction: A Retrospective Study With a Minimum 2-Year Follow-up. Am J Sports Med 2020; 48:3525-3533. [PMID: 33125263 DOI: 10.1177/0363546520967670] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND One of the goals of anterior cruciate ligament (ACL) reconstruction is a meniscal protective effect on the knee. Despite the advancement of ACL reconstruction techniques, subsequent meniscal tears after ACL reconstruction remain a problem, and the risk factors for recurring lesions are still unclear. PURPOSE To investigate the incidence of subsequent meniscal surgery after primary ACL reconstruction without revision ACL surgery and to determine the risk factors associated with this reoperation. STUDY DESIGN Case series; Level of evidence, 4. METHODS Overall, 518 patients who underwent primary ACL reconstruction between 2004 and 2012 at one instution participated in this study. Data on body mass index, graft type and femoral tunnel-drilling technique of ACL reconstruction, and location and type of meniscal injury and its treatment at ACL reconstruction were collected from medical records. Clinical outcomes were investigated, including side-to-side difference of anterior laxity, pivot-shift grade, and subsequent meniscal surgery without ACL insufficiency (at minimum 2-year follow-up). RESULTS The prevalence of tears to the medial meniscus (MM) at the primary ACL reconstruction was 43.6% (226/518), 140 of which were repaired; on the contrary, tears of the lateral meniscus (LM) had a prevalence of 55.8% (289/518), 42 of which were repaired. At a mean 30.3 months (range, 8-124 months) after ACL reconstruction, 20 patients (3.9%; 14 MM tears, 3 LM tears, 3 MM + LM tears) required meniscal surgery without ACL reinjury or recurrence of instability. Of these, 14 MMs and 3 LMs had been repaired at primary ACL reconstruction. The failure rates of repaired MM and LM were 10.0% (14/140) and 7.1% (3/42), respectively. The failure rate of MM repair using the all-inside technique (6/36) was significantly higher compared with no treatment, inside-out repair, or partial resection (P = .045). In multiple regression analysis, the presence of MM injury at the time of ACL reconstruction (odds ratio [OR], 7.81; P = .003), the side-to-side difference of postoperative anterior tibial translation (OR, 1.91; P = .032), and follow-up period after ACL reconstruction (OR, 1.02; P = .003) were risk factors of subsequent meniscal surgery after ACL reconstruction. CONCLUSION Incidence of subsequent meniscal surgery after successful ACL reconstruction was <5%. Presence of MM tear at the time of ACL reconsturuction, small amount of increased anterior laxity, and long-term period after ACL reconstruction were predictive of subsequent meniscal surgery.
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Affiliation(s)
- Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Castelli A, Zanon G, Jannelli E, Ivone A, Ferranti Calderoni E, Combi A, Mosconi M, Benazzo F. The role of the anterolateral ligament in knee's biomechanics: a case-control retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2020; 30:653-658. [PMID: 31872345 DOI: 10.1007/s00590-019-02607-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/13/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to assess the functional and clinical results of patients who underwent ACL reconstruction surgery and were divided into subpopulations related to ACL-associated lesions and focused on ALL-associated lesion. METHODS Our retrospective analysis included 62 patients who underwent standard ACL reconstruction surgery in our hospital from 2014 to 2016. The mean follow-up period was 21 months (range 11-35). We divided the sample into two subpopulations due to the presence or absence of ALL tear at the preoperative MRI. In 42 patients out of 62 (68%), ALL lesion was evident. We evaluated in both subpopulations the ACL failure rate, the functional outcomes rated with IKDC, KOOS, Lysholm scores and the clinical assessment of anteroposterior and rotatory instability with the Lachman test and pivot-shift test. RESULTS The overall re-injury rate in our cohort of patients was 4.8% with a smaller but not a significant difference between the two groups. A statistically significant difference was observed for the three functional scores, favoring the isolated ACL-lesion group (p < 0.05). Similarly, a better Lachman score was observed in the isolated ACL-lesion group, without statistical significance (p = 0.77); overall, the rate of positive test was lower in the isolated ACL-lesion group. We observed a significant difference of residual rotatory instability (positive pivot-shift test) in the two subpopulations (p = 0.036), and 9% of patients in the ACL + ALL lesion group showed residual jerk or subluxation. CONCLUSION The additional ALL reconstruction/repair surgery should always be considered in patients with evident ALL tear at the preoperative MRI.
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Affiliation(s)
- Alberto Castelli
- Clinica Ortopedica E Traumatologica, Università Degli Studi Di Pavia, Fondazione IRCCS Policlinico San Matteo, via Golgi 19, 27100, Pavia, Italy
| | - Giacomo Zanon
- Clinica Ortopedica E Traumatologica, Università Degli Studi Di Pavia, Fondazione IRCCS Policlinico San Matteo, via Golgi 19, 27100, Pavia, Italy
| | - Eugenio Jannelli
- Clinica Ortopedica E Traumatologica, Università Degli Studi Di Pavia, Fondazione IRCCS Policlinico San Matteo, via Golgi 19, 27100, Pavia, Italy
| | - Alessandro Ivone
- Clinica Ortopedica E Traumatologica, Università Degli Studi Di Pavia, Fondazione IRCCS Policlinico San Matteo, via Golgi 19, 27100, Pavia, Italy
| | - Enrico Ferranti Calderoni
- Clinica Ortopedica E Traumatologica, Università Degli Studi Di Pavia, Fondazione IRCCS Policlinico San Matteo, via Golgi 19, 27100, Pavia, Italy.
| | - Alberto Combi
- Clinica Ortopedica E Traumatologica, Università Degli Studi Di Pavia, Fondazione IRCCS Policlinico San Matteo, via Golgi 19, 27100, Pavia, Italy
| | - Mario Mosconi
- Clinica Ortopedica E Traumatologica, Università Degli Studi Di Pavia, Fondazione IRCCS Policlinico San Matteo, via Golgi 19, 27100, Pavia, Italy
| | - Francesco Benazzo
- Clinica Ortopedica E Traumatologica, Università Degli Studi Di Pavia, Fondazione IRCCS Policlinico San Matteo, via Golgi 19, 27100, Pavia, Italy
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Evaluation of the intraoperative kinematics during double-bundle anterior cruciate ligament reconstruction using a navigation system. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 19:11-16. [PMID: 31768329 PMCID: PMC6872809 DOI: 10.1016/j.asmart.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/11/2019] [Indexed: 12/04/2022]
Abstract
Background/objective There is controversy regarding the biomechanical function of the anteromedial (AM) and posterolateral (PL) bundles in isolated tibiofemoral rotation during double-bundle anterior cruciate ligament (ACL) reconstruction. This study aimed to evaluate the biomechanical function of the AM and PL bundles of the ACL using a computer navigation system. Methods This study involved 15 patients who underwent double-bundle ACL reconstruction. Anteroposterior and isolated rotational knee laxity were measured with a navigation system. The measurements were performed four times, namely, before fixation, after temporary PL bundle fixation, after AM bundle fixation, and after double-bundle reconstruction. With knee flexion ranging from 20° to 60°, we continuously measured the anterior tibial displacement under an anterior drawer stress (100 N using a spring balance). The total range of tibial rotation was also measured under an external and internal rotational torque of 3 Nm. Results Fixation of either the AM or the PL bundle significantly reduced the anteroposterior displacement at all knee flexion angles. Although the anteroposterior displacement after AM bundle fixation was relatively similar throughout the range of motion (2.4–3.2 mm), the anteroposterior displacement after PL bundle fixation increased continuously with knee flexion (2.2–4.6 mm). With respect to the total range of tibial rotation under external and internal rotational torque, there was no significant difference between AM and PL bundle fixation throughout the range of motion. The total range of tibial rotation was significantly reduced only on double-bundle reconstruction at 20° and 25° knee flexion compared to the pre-reconstruction range (P = 0.015 and 0.036, respectively). Conclusion The AM and PL bundles function differently for controlling anterior knee laxity throughout the range of motion. The function of the AM and PL bundles was similar for controlling isolated tibiofemoral rotation. Isolated tibiofemoral rotation was significantly controlled only on double-bundle reconstruction at knee flexion angles of 20° and 25°.
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Castelli A, Zanon G, Jannelli E, Ivone A, Ferranti Calderoni E, Combi A, Mosconi M, Benazzo F. The role of the anterolateral ligament in knee’s biomechanics: a case–control retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019. [DOI: doi 10.1007/s00590-019-02607-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yamamoto Y, Tsuda E, Maeda S, Naraoka T, Kimura Y, Chiba D, Ishibashi Y. Greater Laxity in the Anterior Cruciate Ligament-Injured Knee Carries a Higher Risk of Postreconstruction Pivot Shift: Intraoperative Measurements With a Navigation System. Am J Sports Med 2018; 46:2859-2864. [PMID: 30193083 DOI: 10.1177/0363546518793854] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The presence of pivot shift after anterior cruciate ligament (ACL) reconstruction is correlated with worse clinical outcomes. An orthopaedic navigation system is a useful tool for quantifying laxity in the ACL-deficient knee. PURPOSE To investigate the relationship between preoperative knee laxity measured by a navigation system and postoperative pivot shift (PPS) after ACL reconstruction. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS One hundred patients who underwent primary ACL reconstruction (62 hamstring tendon grafts, 38 patellar tendon grafts) were grouped according to the presence or absence of pivot shift at the 2-year follow-up, and the groups were compared retrospectively. Before surgery, knee laxity was assessed with a navigation system to quantify posterior tibial reduction (PTR) during pivot-shift tests and anterior tibial translation (ATT) during Lachman tests. PTR and ATT cutoff values were determined by receiver operator characteristic (ROC) analysis. RESULTS Preoperative PTR and ATT were significantly larger for patients with PPS (PPS-positive group) than those without (PPS-negative group). In the ROC analysis, the PTR had an area under the curve of 0.871 (95% CI, 0.763-0.979; P < .0001) for predicting a PPS; this was larger than that obtained for the ATT, which had an area under the curve of 0.825 (95% CI, 0.705-0.946; P = .001). Because the ROC curve of the ATT had 2 peaks, the ATT alone was not a suitable predictor for PPS. Based on the ROC curve, the optimal PTR cutoff value was 7 mm, with 88.9% sensitivity and 71.4% specificity for PPS (adjusted odds ratio = 19.7; 95% CI, 2.1-187.9; P = .009). Setting the cutoff value as a combination of the PTR (≧7 mm) and ATT (≧12 mm) improved the specificity (88.9% sensitivity and 84.6% specificity; adjusted odds ratio = 149.8; 95% CI, 5.9-3822.7; P = .002) over that with the PTR alone. CONCLUSION ACL injuries in knees with a large PTR had a higher risk of PPS. When reconstructing the ACL in a knee with a high degree of laxity, surgeons may need to adopt strategies to prevent PPS.
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Affiliation(s)
- Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shugo Maeda
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Naraoka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Li B, Wang GB, Wang YF, Zhou BZ. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. Knee 2018; 25:445-452. [PMID: 29685502 DOI: 10.1016/j.knee.2018.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/23/2017] [Accepted: 02/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effects of retaining residual bundles on surgical outcomes has not been observed, so we evaluated the effects of preoperative knee laxity on clinical outcomes after partial anterior cruciate ligament (ACL) reconstruction for partial ACL rupture in this study. PURPOSE To evaluate the effects of preoperative knee laxity on clinical outcomes after partial anterior cruciate ligament (ACL) reconstruction for partial ACL rupture. METHODS The data of 47 patients, who had partial ACL rupture and underwent partial ACL reconstruction, were retrospectively analyzed. According to preoperative kneelax arthrometer and pivot shift test, the 47 patients were divided into group A (kneelax arthrometer ≤5mm and pivot shift test <II grade, n=26) and group B (kneelax arthrometer >5mm and/or pivot shift test ≥II grade, n=21). The minimum follow-up duration lasted 2 years. The clinical outcomes were evaluated using IKDC (International Knee Documentation Committee) scoring systems, Lysholm knee scoring scale, Tegner activity rating, Lachman test, Pivot shift test and the kneelax arthrometer. RESULTS The function and stability examinations for the affected knee joint were significantly improved in both groups after partial ACL reconstruction as compared with preoperative ones (all P<0.01). There were no significant differences in the post-operative Lysholm and Tegner scores, Lachman and Pivot shift test results between both groups (all P>0.05). However, there were significant differences between the two groups in terms of the post-operative IKDC scoring system and kneelax arthrometer examination result (all P<0.05). CONCLUSIONS In the patients with partial ACL rupture, the mechanical strength of the remnant ligament has significant influence on the therapeutic effects of partial reconstruction. The patients with kneelax arthrometer >5mm and/or pivot shift test ≥II grade still have anterior instability in the affected knee after partial reconstruction.
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Affiliation(s)
- Bin Li
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China.
| | - Guang-Bin Wang
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yan-Fang Wang
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China
| | - Bing-Zheng Zhou
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China
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Current use of navigation system in ACL surgery: a historical review. Knee Surg Sports Traumatol Arthrosc 2016; 24:3396-3409. [PMID: 27744575 DOI: 10.1007/s00167-016-4356-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/07/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE The present review aims to analyse the available literature regarding the use of navigation systems in ACL reconstructive surgery underling the evolution during the years. METHODS A research of indexed scientific papers was performed on PubMed and Cochrane Library database. The research was performed in December 2015 with no publication year restriction. Only English-written papers and related to the terms ACL, NAVIGATION, CAOS and CAS were considered. Two reviewers independently selected only those manuscripts that presented at least the application of navigation system for ACL reconstructive surgery. RESULTS One hundred and forty-six of 394 articles were finally selected. In this analysis, it was possible to review the main uses of navigation system in ACL surgery including tunnel positioning for primary and revision surgery and kinematic assessment of knee laxity before and after different surgical procedures. In the early years, until 2006, navigation system was mainly used to improve tunnel positioning, but since the last decade, this tool has been principally used for kinematics evaluation. Increased accuracy of tunnel placement was observed using navigation surgery, especially, regarding femoral, 42 of 146 articles used navigation to guide tunnel positioning. During the following years, 82 of 146 articles have used navigation system to evaluate intraoperative knee kinematic. In particular, the importance of controlling rotatory laxity to achieve better surgical outcomes has been underlined. CONLUSIONS Several applications have been described and despite the contribution of navigation systems, its potential uses and theoretical advantages, there are still controversies about its clinical benefit. The present papers summarize the most relevant studies that have used navigation system in ACL reconstruction. In particular, the analysis identified four main applications of the navigation systems during ACL reconstructive surgery have been identified: (1) technical assistance for tunnel placement; (2) improvement in knowledge of the kinematic behaviour of ACL and other structures; (3) comparison of effectiveness of different surgical techniques in controlling laxities; (4) navigation system performance to improve the outcomes of ACL reconstruction and cost-effectiveness. LEVEL OF EVIDENCE IV.
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Sasaki Y, Chang SS, Fujii M, Araki D, Zhu J, Marshall B, Linde-Rosen M, Smolinski P, Fu FH. Effect of fixation angle and graft tension in double-bundle anterior cruciate ligament reconstruction on knee biomechanics. Knee Surg Sports Traumatol Arthrosc 2016; 24:2892-2898. [PMID: 25726160 DOI: 10.1007/s00167-015-3552-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the effect of graft fixation angle and tension in double-bundle anterior cruciate ligament (ACL) reconstruction on knee biomechanics. METHODS Fourteen cadaver knees were tested using a robotic system under two loadings: (1) an 89-N anterior tibial load (ATL) at full extension (FE), 15°, 30°, 45°, 60°, and 90°, and (2) combined 7 N m valgus and 5 N m internal tibial torques (simulated pivot-shift test) at FE, 15° and 30°. Four graft fixation angles and tensions were used for the anteromedial (AM) and posterolateral (PL) bundles, respectively: (Recon 1) 30°/20N and FE/20N, (Recon 2) 30°/30N and FE/10N, (Recon 3) 45°/20N and 15°/20N, and (Recon 4) 45°/30N and 15°/10N. RESULTS All fixation protocols closely restored the intact knee kinematics under ATL and simulated pivot-shift loading. For the AM bundle under ATL, the in situ force (ISF) with Recon 3 at the FE was significantly lower than that of the intact knee. For the PL bundle under ATL, the ISF with Recon 3 at the FE, 15° and 30° was significantly higher than that of the intact knee. In PL bundle under simulated pivot-shift loading, the ISF with Recon 1 and Recon 2 at FE was lower and the ISF of the PL bundle with Recon 3 at the 15° was higher than that of the intact knee. CONCLUSION The AM-45°/30N and PL-15°/10N fixation most closely matched intact knee kinematics; however, stabilizing the knee during anterior tibial translation may risk an imbalance of the AM and the PL bundle loading. The results indicate that ACL bundle forces may not be restored even if the clinical assessment shows good results with the Lachman test and pivot-shift test. This may alter the loading on other structures of the knee.
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Affiliation(s)
- Yusuke Sasaki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shih-Sheng Chang
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Masataka Fujii
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Daisuke Araki
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Junjun Zhu
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brandon Marshall
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Monica Linde-Rosen
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA.
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA.
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A systematic review of single- versus double-bundle ACL reconstruction using the anatomic anterior cruciate ligament reconstruction scoring checklist. Knee Surg Sports Traumatol Arthrosc 2016; 24:862-72. [PMID: 25344803 DOI: 10.1007/s00167-014-3393-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/15/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this systematic review was to apply the anatomic ACL reconstruction scoring checklist (AARSC) and to evaluate the degree to which clinical studies comparing single-bundle (SB) and double-bundle (DB) ACL reconstructions are anatomic. METHODS A systematic electronic search was performed using the databases PubMed (MEDLINE), EMBASE and Cochrane Library. Studies published from January 1995 to January 2014 comparing SB and DB ACL reconstructions with clinical outcome measurements were included. The items from the AARSC were recorded for both the SB and DB groups in each study. RESULTS Eight-thousand nine-hundred and ninety-four studies were analysed, 77 were included. Randomized clinical trials (29; 38%) and prospective comparative studies (29; 38%) were the most frequent study type. Most studies were published in 2011 (19; 25%). The most commonly reported items for both SB and DB groups were as follows: graft type (152; 99%), femoral and tibial fixation method (149; 97% respectively), knee flexion angle during graft tensioning (124; 8%) and placement of the tibial tunnel at the ACL insertion site (101; 66%). The highest level of documentation used for ACL tunnel position for both groups was often one dimensional, e.g. drawing, operative notes or o'clock reference. The DB reconstruction was in general more thoroughly reported. The means for the AARSC were 6.9 ± 2.8 for the SB group and 8.3 ± 2.8 for the DB group. Both means were below a proposed required minimum score of 10 for anatomic ACL reconstruction. CONCLUSIONS There was substantial underreporting of surgical data for both the SB and DB groups in clinical studies. This underreporting creates difficulties when analysing, comparing and pooling results of scientific studies on this subject.
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Intraoperative laxity measurements using a navigation system in anatomical double-bundle posterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23:3085-93. [PMID: 25377192 DOI: 10.1007/s00167-014-3418-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The objective of this study was to evaluate knee kinematics during double-bundle posterior cruciate ligament reconstruction (DB-PCLR) intraoperatively using a navigation system, and especially assess biomechanical behaviour of the anterolateral bundle (ALB) and posteromedial bundle (PMB) graft in DB-PCLR. Also, clinical results of minimum 2-year follow-up were investigated. METHODS Nine patients received DB-PCLR with hamstring graft. Before reconstruction, knee laxities, including posterior tibial translation (PTT) in neutral rotation at 15°, 30°, 45°, 60°, 75° and 90° of knee flexion, were measured using a kinematic-based navigation system. After the PMB or ALB was temporally fixed, the knee laxities were measured in the same manner. Each patient was evaluated pre- and post-operatively with side-to-side difference of tibial position in gravity sag view and Lysholm score. RESULTS Both ALB and PMB fixation restrained the PTT compared to PCL deficiency throughout all knee flexion angles. At 90° of knee flexion, ALB fixation significantly decreased PTT compare to PMB fixation (p = 0.014) and DB-PCLR significantly decreased PTT compare to ALB fixation (p = 0.045). The mean side-to-side difference of tibial position in gravity sag view was 12.0 ± 1.7 mm preoperatively and 2.3 ± 1.8 mm at final follow-up, and the mean Lysholm scores were 68.9 ± 20.9 and 96.3 ± 2.9, respectively. CONCLUSIONS There were no significant differences in the PTT between ALB and PMB fixations at 0° to 75° of knee flexion, and both ALB and PMB reconstructions are important for restraining PTT. At 90° of knee flexion, the ALB grafts may be more important to control PTT compared to PMB grafts; however, neither single-bundle reconstruction with ALB nor PMB could function as DB-PCLR did. In addition, PTT after DB-PCLR was strongly correlated side-to-side difference in posterior sag view at the final follow-up. The results from this study indicated that both ALB and PMB are important to stabilize PCL-deficient knees. LEVEL OF EVIDENCE Therapeutic study, Level III.
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Computer-assisted anterior cruciate ligament reconstruction. Four generations of development and usage. Sports Med Arthrosc Rev 2015; 22:229-36. [PMID: 25321334 DOI: 10.1097/jsa.0000000000000052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The purpose of this paper is to review the literature about the contribution of navigation in anterior cruciate ligament (ACL) reconstruction. The evolution of computer-assisted surgery (CAS) for ACL reconstruction has undergone several steps. These steps were divided into 4 subsequent developments: (1) positioning of ACL graft placement; (2) laxity measurement of ACL reconstruction (quality control); (3) kinematic evaluation during ACL reconstruction (navigated pivot shift); (4) case-specific individual ACL reconstruction with adjustments and additional reconstruction options. CAS has shown to improve femoral tunnel positioning, even if clinical outcomes do not improve results of manual techniques. CAS technology has helped researchers better understand the effects of different ACL reconstruction techniques and bundles replacements on joint laxity and to describe tunnel positioning in relation to native ACL insertion. CAS in ACL surgery can improve results at time zero and can improve knowledge in this field.
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Mascarenhas R, Cvetanovich GL, Sayegh ET, Verma NN, Cole BJ, Bush-Joseph C, Bach BR. Does Double-Bundle Anterior Cruciate Ligament Reconstruction Improve Postoperative Knee Stability Compared With Single-Bundle Techniques? A Systematic Review of Overlapping Meta-analyses. Arthroscopy 2015; 31:1185-96. [PMID: 25595691 DOI: 10.1016/j.arthro.2014.11.014] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/08/2014] [Accepted: 11/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Multiple meta-analyses of randomized controlled trials, the highest available level of evidence, have been conducted to determine whether double-bundle (DB) or single-bundle (SB) anterior cruciate ligament reconstruction (ACL-R) provides superior clinical outcomes and knee stability; however, results are discordant. The purpose of this study was to conduct a systematic review of meta-analyses comparing SB and DB ACL-R to discern the cause of the discordance and to determine which of these meta-analyses provides the current best available evidence. METHODS We evaluated available scientific support for SB as compared with DB ACL-R by systematically reviewing the literature for published meta-analyses. Data on patient clinical outcomes and knee stability (as measured by KT arthrometry and pivot-shift testing) were extracted. Meta-analysis quality was judged using the Oxman-Guyatt and Quality of Reporting of Meta-analyses systems. The Jadad algorithm was then applied to determine which meta-analyses provided the highest level of evidence. RESULTS Nine meta-analyses were included, of which 3 included Level I Evidence and 6 included both Level I and Level II Evidence. Most studies found significant differences favoring DB reconstruction on pivot-shift testing, KT arthrometry measurement of anterior tibial translation, and International Knee Documentation Committee objective grading. Most studies detected no significant differences between the 2 techniques in subjective outcome scores (Tegner, Lysholm, and International Knee Documentation Committee subjective), graft failure, or complications. Oxman-Guyatt and Quality of Reporting of Meta-analyses scores varied, with 2 studies exhibiting major flaws (Oxman-Guyatt score <3). After application of the Jadad decision algorithm, 3 concordant high-quality meta-analyses were selected, with each concluding that DB ACL-R provided significantly better knee stability (by KT arthrometry and pivot-shift testing) than SB ACL-R but no advantages in clinical outcomes or risk of graft failure. CONCLUSIONS The current best available evidence suggests that DB ACL-R provides better postoperative knee stability than SB ACL-R, whereas clinical outcomes and risk of graft failure are similar between techniques. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
- Randy Mascarenhas
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Gregory L Cvetanovich
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eli T Sayegh
- College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Charles Bush-Joseph
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Stability Outcomes following Computer-Assisted ACL Reconstruction. Minim Invasive Surg 2015; 2015:638635. [PMID: 25883804 PMCID: PMC4391525 DOI: 10.1155/2015/638635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 03/15/2015] [Accepted: 03/17/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. The purpose of this study was to determine whether intraoperative prereconstruction stability measurements and/or patient characteristics were associated with final knee stability after computer-assisted ACL reconstruction. Methods. This was a retrospective review of all patients who underwent computer-assisted single-bundle ACL reconstruction by a single surgeon. Prereconstruction intraoperative stability measurements were correlated with patient characteristics and postreconstruction stability measurements. 143 patients were included (87 male and 56 female). Average age was 29.8 years (SD ± 11.8). Results. Females were found to have significantly more pre- and postreconstruction internal rotation than males (P < 0.001 and P = 0.001, resp.). Patients with additional intra-articular injuries demonstrated more prereconstruction anterior instability than patients with isolated ACL tears (P < 0.001). After reconstruction, these patients also had higher residual anterior translation (P = 0.01). Among all patients with ACL reconstructions, the percent of correction of anterior translation was found to be significantly higher than the percent of correction for internal or external rotation (P < 0.001). Conclusion. Anterior translation was corrected the most using a single-bundle ACL reconstruction. Females had higher pre- and postoperative internal rotation. Patients with additional injuries had greater original anterior translation and less operative correction of anterior translation compared to patients with isolated ACL tears.
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Is double-bundle anterior cruciate ligament reconstruction superior to single-bundle? A comprehensive systematic review. Knee Surg Sports Traumatol Arthrosc 2015; 23:696-739. [PMID: 24037314 DOI: 10.1007/s00167-013-2666-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 08/31/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE To describe current evidence on single- and double-bundle anterior cruciate ligament (ACL) reconstruction, in terms of differences in knee kinematics, functional outcomes, patient-reported outcomes and graft failures. METHODS An electronic search was made using PubMed (MEDLINE), EMBASE and Cochrane Library. Studies published from January 1995 to August 2011 were included, and an updated search was made in PubMed in July 2012. Therapeutic studies, level of evidence I-III, for isolated primary ACL tears written in English comparing single- and double-bundle reconstruction reporting clinical outcome were included. Quality appraisal based on Cochrane Collaboration's tool for assessing risk of bias was performed. RESULTS Of 7,154 potentially eligible studies, 60 papers were included (25 randomised controlled trials, 21 prospective comparative studies, 14 retrospective comparative studies), comprising 4,146 patients (2,072 single-bundle, 2,074 double-bundle). Minor differences were found between study types. An analysis of graft failures revealed fewer re-ruptures in double-bundle reconstruction than single-bundle, 19 and 44, respectively. Up to 45 % of the studies reported a superior outcome in double-bundle reconstruction in terms of antero-posterior laxity, measured with the Lachman, anterior drawer, KT-1000/2000 and navigation. Measurements of rotatory laxity revealed superior results in double-bundle reconstruction measured with pivot shift and navigation in 18/42 (8/15 anatomically reconstructed) and 9/20 studies, respectively. Patient-reported outcome measures and functional outcomes did not differ to a large extent; however, differences when identified were almost exclusively in favour of double-bundle reconstruction. CONCLUSION Based on current evidence, double-bundle reconstruction appears to have fewer re-ruptures and less antero-posterior and rotatory laxity. Furthermore, no differences were found in short-term patient-reported outcome measures or objective findings. However, detailed statistical analyses of the included studies divided into homogeneous groups are needed to avoid reporting bias and to confirm any statistical difference.
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Kopf S, Musahl V, Bignozzi S, Irrgang JJ, Zaffagnini S, Fu FH. In vivo kinematic evaluation of anatomic double-bundle anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42:2172-7. [PMID: 24961443 DOI: 10.1177/0363546514538958] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is controversy regarding the functional role of the posterolateral (PL) bundle of the anterior cruciate ligament (ACL). PURPOSE To evaluate the in vivo function of the PL and anteromedial (AM) bundles of the ACL during anatomic double-bundle (DB) ACL reconstruction for acute, isolated ACL tears utilizing a computer navigation system to track intraoperative knee kinematics. STUDY DESIGN Controlled laboratory study. METHODS Fifteen patients with acute, isolated ACL tears who underwent anatomic DB ACL reconstruction formed the sample for this study. During surgery, knees were examined by a clinician preoperatively, after fixation of the PL bundle, and after fixation of both the PL and AM bundles. An image-free computer navigation system with custom-made software recorded the data during kinematic tests. The examination consisted of the Lachman and anterior drawer tests, internal-external rotation at 30° of knee flexion, and varus-valgus rotation at 30° of knee flexion. Paired Wilcoxon tests were performed to evaluate the effects of each bundle. The comparisons included ACL-deficient to PL bundle-reconstructed knees, ACL-deficient to DB ACL-reconstructed knees, and PL bundle-reconstructed to DB ACL-reconstructed knees. Significance was set at P < .017 to account for the multiple comparisons. RESULTS Fixation of the PL bundle significantly improved knee laxity during the Lachman and anterior drawer tests as well as internal-external rotation at 30° of knee flexion (P < .017 for all tests). The addition of the AM bundle further improved knee laxity during the Lachman and anterior drawer tests compared with PL bundle fixation as well as during varus-valgus rotation at 30° of knee flexion compared with ACL-deficient knees (P < .017 for all tests). CONCLUSION This in vivo study demonstrates that isolated PL bundle reconstruction improves laxity in an ACL-deficient knee and that the addition of the AM bundle improves laxity parameters further. CLINICAL RELEVANCE Abnormal knee kinematics is known to be linked to the earlier onset of osteoarthritis and lower rates of return to sport. This study suggests that both the AM and PL bundles are important to stabilize ACL-deficient knees.
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Affiliation(s)
- Sebastian Kopf
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Simone Bignozzi
- Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Imbert P, Belvedere C, Leardini A. Human knee laxity in ACL-deficient and physiological contralateral joints: intra-operative measurements using a navigation system. Biomed Eng Online 2014; 13:86. [PMID: 24961322 PMCID: PMC4099024 DOI: 10.1186/1475-925x-13-86] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/11/2014] [Indexed: 12/02/2022] Open
Abstract
Background The comprehension of human knee laxity and of the failures of relevant surgical reconstructions of the anterior cruciate ligament (ACL) can be enhanced by the knowledge of the laximetric status of the contralateral healthy knee (CHK). Rarely this is available in patients, directly from the skeletal structures, and for a number of the standard clinical tests. The general aim of this study was to measure the extent to which laxity occurs immediately before surgery in the ACL deficient knee (ADK) with respect to CHK, in a number of standard clinical evaluation tests. Method Thirty-two patients with ACL deficiency were analyzed at ADK and at CHK by a navigation system immediately before reconstructions. Knee laxity was assessed based on digitized anatomical references during the antero-posterior drawer, Lachman, internal-external rotation, varus-valgus, and pivot-shift tests. Antero-posterior laxity was normalized based on patient-specific length of the tibial plateau. Results In the drawer test, statistical significance (p < 0.05) was found for the larger antero-posterior laxity in ADK than in CHK, on average, of 54' in the medial and 47' in the lateral compartments, when measured in normalized translations. In the Lachman test, these were about 106' and 68'. The pivot-shift test revealed a significant 70' larger antero-posterior central laxity and a 32' larger rotational laxity. No statistically relevant differences were observed in the other tests. Conclusion The first conclusion is that it is important to measure also the antero-posterior and rotational laxity of the uninjured contralateral knee in assessing the laxity of the injured knee. A second is that the Lachman test shows knee laxity better than the AP drawer, and that the pivot-shift test was the only one able to reveal rotational instability. The present original measurements and analyses contribute to the knowledge of knee joint mechanics, with possible relevant applications in biomedical and clinical research.
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Affiliation(s)
| | | | - Alberto Leardini
- Movement Analysis Laboratory, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
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Desai N, Björnsson H, Musahl V, Bhandari M, Petzold M, Fu FH, Samuelsson K. Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2014; 22:1009-23. [PMID: 24343279 DOI: 10.1007/s00167-013-2811-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 11/30/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine whether anatomic double-bundle anterior cruciate ligament (ACL) reconstruction compared to anatomic single-bundle ACL reconstruction more effectively restored antero-posterior (A-P) laxity, rotatory laxity and reduced frequency of graft rupture. Our hypothesis was that anatomic double-bundle ACL reconstruction results in superior rotational knee laxity and fewer graft ruptures due to its double-bundle tension pattern, compared with anatomic single-bundle ACL reconstruction. METHODS An electronic search was performed using the PubMed, EMBASE and Cochrane Library databases. All therapeutic trials written in English reporting knee kinematic outcomes and graft rupture rates of primary anatomic double- versus single-bundle ACL reconstruction were included. Only clinical studies of levels I-II evidence were included. Data regarding kinematic tests were extracted and included pivot-shift test, Lachman test, anterior drawer test, KT-1000 measurements, A-P laxity measures using navigation and total internal-external (IRER) laxity measured using navigation, as well as graft failure frequency. RESULTS A total of 7,154 studies were identified of which 15 papers (8 randomized controlled trials and 7 prospective cohort studies, n = 970 patients) met the eligibility criteria. Anatomic ACL double-bundle reconstruction demonstrated less anterior laxity using KT-1000 arthrometer with a standard mean difference (SMD) = 0.36 (95% CI 0.214-0.513, p < 0.001) and less A-P laxity measured with navigation (SMD = 0.29 95% CI 0.01-0.565, p = 0.042). Anatomic double-bundle ACL reconstruction did not lead to significant improvements in pivot-shift test, Lachman test, anterior drawer test, total IRER or graft failure rates compared to anatomic single-bundle ACL reconstruction. CONCLUSION Anatomic double-bundle ACL reconstruction is superior to anatomic single-bundle reconstruction in terms of restoration of knee kinematics, primarily A-P laxity. Whether these improvements of laxity result in long-term improvement of clinical meaningful outcomes remains uncertain. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Neel Desai
- Department of Orthopaedics, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden
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Komzák M, Hart R, Okál F, Safi A. AM bundle controls the anterior-posterior and rotational stability to a greater extent than the PL bundle - a cadaver study. Knee 2013; 20:551-5. [PMID: 23647795 DOI: 10.1016/j.knee.2013.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 03/14/2013] [Accepted: 03/31/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the influence of both bundles of the anterior cruciate ligament (ACL) on knee stability, anterior-posterior translation (APT) and internal (IR) and external (ER) rotation in cadaveric knees using a computer navigation system. METHODS The APT, IR, and ER of the knees were recorded in the intact condition, the anterolateral bundle (AM) or the posterolateral bundle (PL) deficit condition and in the ACL-deficient condition. The KT-1000 arthrometer was used for APT evaluation. The measurement of rotational movements was done using a rollimeter. All tests were performed at 30°, 60° and 90° of flexion. RESULTS At 30° of flexion: In the intact knee APT was 5.8mm, IR 12.1°, ER 10.1°. After the AM was cut, the APT increased to 9.1mm, IR to 13.9° and ER to 12.6°. After the PL was cut, the APT was 6.4mm, IR 13.1° and ER 10.6°. After the AM and PL were cut, the APT was 10.8mm, IR 15.7° and the ER was 12.9° on average. CONCLUSIONS The AM has a greater impact on the APT than the PL in all knee joint flexion angles. The PL does not resist the rotational stability more than the AM. The rotational stability is better controlled by both bundles of ACL as compared to one bundle of the ACL. CLINICAL RELEVANCE This study acknowledges the fact that the both bundles of the ACL are importants for AP and rotational stability of the knee joint.
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Affiliation(s)
- Martin Komzák
- Department of Orthopaedic and Traumatologic Surgery, Hospital Znojmo, MUDr. Jana Jánského 11, Znojmo, 669 02, Czech Republic.
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Araki D, Kuroda R, Matsushita T, Matsumoto T, Kubo S, Nagamune K, Kurosaka M. Biomechanical analysis of the knee with partial anterior cruciate ligament disruption: quantitative evaluation using an electromagnetic measurement system. Arthroscopy 2013; 29:1053-62. [PMID: 23602014 DOI: 10.1016/j.arthro.2013.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 02/05/2013] [Accepted: 02/12/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the biomechanical function of anterior cruciate ligament (ACL) remnants in ACL-deficient knees with both partial and complete tears. METHODS Twenty partial ACL-deficient (group P), 20 complete ACL-deficient (group C), and 40 contralateral ACL-intact knees were examined. The end point during the Lachman test, side-to-side differences of KT-1000 measurements, and the pivot shift test were evaluated. Additionally, the side-to-side difference of anterior tibial translation during the Lachman test and the acceleration during the pivot shift test were calculated using an electromagnetic measurement system (EMS). RESULTS The end point was found in 9 patients in group P, whereas it was not detected in group C. In KT-1000 measurements, the mean side-to-side differences were 3.8 ± 2.4 mm in group P and 5.4 ± 2.3 mm in group C. There was a significant difference between these 2 groups (P < .05). In the pivot shift test evaluation in group P, one patient was evaluated as grade 0, 17 patients as grade 1+, and 2 patients as grade 2+. In group C, 10 patients were evaluated as grade 1+, 9 patients as grade 2+, and one patient as grade 3+. Using the EMS, mean side-to-side differences during the Lachman test were 3.1 ± 2.1 mm in group P and 7.2 ± 3.2 mm in group C. The anterior-posterior displacement in group P was significantly less than that in group C (P < .05). In the quantitative pivot shift test, the mean acceleration in the contralateral ACL-intact knees was -632.7 ± 254.5 mm/s(2), whereas it was -1107.5 ± 398.9 mm/s(2) in group P and -1652.2 ± 754.9 mm/s(2) in group C. Significant differences were detected between the 3 knee conditions (P < .05). CONCLUSIONS The quantitative assessments of knees with partial ACL ruptures during the Lachman test and the pivot shift test using the EMS showed less laxity than did knees with complete ACL tears, whereas their laxity was greater than the contralateral knees with intact ACLs. LEVEL OF EVIDENCE Level III, diagnostic study of nonconsecutive patients.
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Affiliation(s)
- Daisuke Araki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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Signorelli C, Bonanzinga T, Lopomo N, Marcheggiani Muccioli GM, Bignozzi S, Filardo G, Zaffagnini S, Marcacci M. Do pre-operative knee laxity values influence post-operative ones after anterior cruciate ligament reconstruction? Scand J Med Sci Sports 2013; 23:e219-24. [PMID: 23438253 DOI: 10.1111/sms.12059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2012] [Indexed: 11/30/2022]
Abstract
The objective of this study was to verify whether pre-reconstruction laxity condition effects post-reconstruction outcome. A total of 100 patients who underwent navigated Anterior Cruciate Ligament (ACL) reconstruction were included in the study and knee laxity analysed retrospectively. The knee was assessed in six different laxity tests before and after ACL reconstruction, namely antero-posterior (AP) and internal-external (IE) at 30° and 90°, and varus-valgus (VV) rotations at 0° and 30° of flexion. For each test, the least square (LS) fitting line based on pre-operative-to-post-operative laxity value was calculated. To what degree the post-operative laxity value is explainable by the corresponding pre-operative condition was evaluated by the LS line slope. Post-operatively, for each single patient, the grade of laxity decreased at any evaluated test. The strongest influence of pre-operative-to-post-operative laxity values was found during IE30 and IE90 tests. While AP30 and VV0 tests seem to be those in which the post-reconstruction laxity was barely affected by the pre-surgery condition. The analysis of the global laxity reduction confirms the previous results. Following this hypothesis, our study remarks on the importance of combined lesions to secondary restraints and the importance of fully understanding the residual laxity to optimize the surgical technique.
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Affiliation(s)
- C Signorelli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
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Komzák M, Hart R, Okál F, Safi A. Does the posterolateral bundle influence rotational movement more than the anteromedial bundle in anterior cruciate ligament reconstruction? ACTA ACUST UNITED AC 2012; 94:1372-6. [DOI: 10.1302/0301-620x.94b10.28673] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The biomechanical function of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) remains controversial. Some studies report that the AM bundle stabilises the knee joint in anteroposterior (AP) translation and rotational movement (both internal and external) to the same extent as the PL bundle. Others conclude that the PL bundle is more important than the AM in controlling rotational movement. The objective of this randomised cohort study involving 60 patients (39 men and 21 women) with a mean age of 32.9 years (18 to 53) was to evaluate the function of the AM and the PL bundles of the ACL in both AP and rotational movements of the knee joint after single-bundle and double-bundle ACL reconstruction using a computer navigation system. In the double-bundle group the patients were also randomised to have the AM or the PL bundle tensioned first, with knee laxity measured after each stage of reconstruction. All patients had isolated complete ACL tears, and the presence of a meniscal injury was the only supplementary pathology permitted for inclusion in the trial. The KT-1000 arthrometer was used to apply a constant load to evaluate the AP translation and the rolimeter was used to apply a constant rotational force. For the single-bundle group deviation was measured before and after ACL reconstruction. In the double-bundle group deviation was measured for the ACL-deficient, AM- or PL-reconstructed first conditions and for the total reconstruction. We found that the AM bundle in the double-bundle group controlled rotation as much as the single-bundle technique, and to a greater extent than the PL bundle in the double-bundle technique. The double-bundle technique increases AP translation and rotational stability in internal rotation more than the single-bundle technique.
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Affiliation(s)
- M. Komzák
- General Hospital, Department
of Orthopaedic and Traumatologic Surgery, Jana Janského
11, Znojmo 66902, Czech
Republic
| | - R. Hart
- Hospital Znojmo, Department
of Orthopaedic and Traumatologic Surgery, Jana Janského
11, Znojmo 66902, Czech
Republic
| | - F. Okál
- Hospital Znojmo, Department
of Orthopaedic and Traumatologic Surgery, Jana Janského
11, Znojmo 66902, Czech
Republic
| | - A. Safi
- Hospital Znojmo, Department
of Orthopaedic and Traumatologic Surgery, Jana Janského
11, Znojmo 66902, Czech
Republic
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Lam MH, Fong DTP, Yung PSH, Chan KM. Biomechanical techniques to evaluate tibial rotation. A systematic review. Knee Surg Sports Traumatol Arthrosc 2012; 20:1720-9. [PMID: 21912885 DOI: 10.1007/s00167-011-1665-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 09/01/2011] [Indexed: 12/26/2022]
Abstract
PURPOSE This article systematically reviewed the biomechanical techniques to quantify tibial rotation, for an overview of how to choose a suitable technique for specific clinical application. METHODS A systematic search was conducted and finally 110 articles were included in this study. The articles were categorized by the conditions of how the knee was examined: external load application, physical examination and dynamic task. RESULTS The results showed that two-thirds of the included studies measured tibial rotation under external load application, of which over 80% of the experiments employed a cadaveric model. The common techniques used included direct displacement measurement, motion sensor, optical tracking system and universal force moment sensor. Intra-operative navigation system was used to document tibial rotation when the knee was examined by clinical tests. For dynamic assessment of knee rotational stability, motion analysis with skin reflective markers was frequently used although this technique is less accurate due to the skin movement when compared with radiographic measurement. CONCLUSION This study reports various biomechanical measurement techniques to quantify tibial rotation in the literatures. To choose a suitable measurement technique for a specific clinical application, it is suggested to quantify the effectiveness of a new designed surgical technique by using a cadaveric model before applying to living human subjects for intra-operative evaluation or long-time functional stability assessment. Attention should also be paid on the study's purpose, whether to employ a cadaveric model and the way of stress applied to the knee. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Mak-Ham Lam
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 2012; 20:870-7. [PMID: 21877296 DOI: 10.1007/s00167-011-1640-8] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 07/26/2011] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the kinematics changes of the knee after cutting of the ACL with or without injury of the anterolateral structures. METHODS In this study, the role of the ACL and one of the secondary restraints in controlling knee stability using a navigation system was evaluated. The kinematics of the knee was evaluated in different conditions of instability: ACL intact, after dissection of the posterolateral (PL) bundle, after dissection of the anteromedial (AM) bundle, and after lesion of the lateral capsular ligament (LCL). Anterior tibial translation and rotation were measured with a computer navigation system in 10 fresh-frozen cadaveric knees by use of a manual maximum load. Anterior translation was evaluated at 30°, 60°, and 90° of flexion; rotation at 0°, 15°, 30°, 45°, 60°, and 90°. RESULTS Cutting the PL bundle does not increase anterior translation and rotation of the knee. Cutting the AM bundle significantly increased the anteroposterior (AP) translation at 30° and 60° (P = 0.01), but does not increase rotation of the knee. Cutting the LCL increased anterior translation at 60° (P = 0.04) and rotation at 30°, 45°, and 60° (P = 0.03). CONCLUSIONS Within the testing conditions of this study, the PL bundle does not affect anterior translation and rotation of the knee; the AM bundle is the primary restraint of the anterior translation but does not affect rotation of the knee while the lesion of the LCL increases tibial rotation and could be related to the pivot shift phenomenon, so it is more correct and biomechanical valid to assess and repair the associated lesion of the antero-lateral structure of the knee at the time of ACL surgery.
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Ohkawa S, Adachi N, Deie M, Nakamae A, Nakasa T, Ochi M. The relationship of anterior and rotatory laxity between surgical navigation and clinical outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20:778-84. [PMID: 22261994 DOI: 10.1007/s00167-012-1900-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/10/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Recently, a computer-assisted navigation system has been used for the quantitative evaluation not only of anterior-posterior (AP) laxity but also rotational laxity of the tibia intraoperatively. The purpose of this study was to investigate how intraoperative AP or rotational laxities measured by the navigation system could correlate with postoperative AP and rotational laxities of the patients. METHODS 125 patients who underwent primary isolated anatomical single- or double-bundle ACL reconstruction or augmentation using multistranded autologous hamstring tendons were included in the study after a minimum of 2-year follow-up. Clinically, absolute value and side-to-side difference (SSD) of AP translation of the tibia were measured by KT-2000 preoperatively and postoperatively. Intraoperative measurement of AP translation of the tibia and total range of tibial rotation of the ACL-injured knee were carried out using the computer-assisted navigation system. We have investigated the relationship between intraoperative measurements using the navigation system and AP laxity measurements using the KT-2000 knee arthrometer as well as rotational laxity measurements using the manual pivot shift test. RESULTS There was a positive correlation between the SSD of preoperative AP translation of the tibia measured by KT-2000 arthrometer and the reduction in AP laxity following ACL reconstruction measured by the navigation system. However, we found no significant correlation between the reduction in AP laxity measured by the navigation system and the SSD of AP translation of the tibia measured by the KT-2000 arthrometer at final follow-up. Postoperatively, eight patients had a positive pivot shift test. Using the navigation system pre- and post-ACL reconstruction, these patients could not be identified by high absolute values for AP laxity nor rotational laxity. CONCLUSION Although AP and rotational laxities vary largely among the patients, and AP and rotational stabilization are successfully achieved immediately after ACL reconstruction, intraoperative AP and rotational laxity measured by the navigation system did not influence the postoperative AP and rotational laxities after ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shingo Ohkawa
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Gadikota HR, Seon JK, Chen CH, Wu JL, Gill TJ, Li G. In vitro and intraoperative laxities after single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 2011; 27:849-60. [PMID: 21624681 PMCID: PMC3105362 DOI: 10.1016/j.arthro.2010.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 09/14/2010] [Accepted: 12/02/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to objectively evaluate whether double-bundle anterior cruciate ligament (ACL) reconstruction can better restore the normal translational and rotational laxities than the conventional single-bundle ACL reconstruction among the reported biomechanical studies. METHODS A systematic literature search was conducted to identify in vitro and in vivo (intraoperative) biomechanical studies that compared the laxities (anterior or anteroposterior or rotational) between single- and double-bundle ACL reconstructions. Because of large variability among the loading conditions and testing methods used to determine the rotational laxities among the studies, a meta-analysis of rotational laxities was not feasible. RESULTS Seven in vitro and three in vivo studies were included in this analysis based on the predefined inclusion criteria. The overall mean differences calculated by the random effects model in anteroposterior laxity between the single-bundle and double-bundle ACL reconstruction techniques at 0°, 30°, 60°, and 90° of flexion were 0.99 mm, 0.38 mm, 0.34 mm, and 0.07 mm, respectively. No statistically significant difference was noted between the 2 treatments at all flexion angles. Among the 9 studies that compared the rotational laxity of single-bundle and double-bundle ACL reconstructions, 4 reported that double-bundle reconstruction can provide better rotational control than single-bundle reconstruction. The other 5 studies could not identify any significant difference between the 2 reconstructions in terms of rotational laxity. CONCLUSIONS Both single- and double-bundle treatment options for ACL injury result in similar anteroposterior knee joint laxity at time 0. No conclusive evidence on the superiority of 1 reconstruction technique over the other in terms of rotation laxity can be obtained because of several variations in the experimental protocol and the kinematics used to measure the rotational laxity among the studies. LEVEL OF EVIDENCE Level III, meta-analysis.
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Affiliation(s)
- Hemanth R Gadikota
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jong Keun Seon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Department of Orthopaedic, Chonnam National University Hwasun Hospital, Jeonnam, South Korea
| | - Chih-Hui Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Jia-Lin Wu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Thomas J Gill
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Yamamoto Y, Ishibashi Y, Tsuda E, Tsukada H, Maeda S, Toh S. Comparison between clinical grading and navigation data of knee laxity in ACL-deficient knees. BMC Sports Sci Med Rehabil 2010; 2:27. [PMID: 21059224 PMCID: PMC2988045 DOI: 10.1186/1758-2555-2-27] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 11/08/2010] [Indexed: 11/29/2022]
Abstract
Background The latest version of the navigation system for anterior cruciate ligament (ACL) reconstruction has the supplementary ability to assess knee stability before and after ACL reconstruction. In this study, we compared navigation data between clinical grades in ACL-deficient knees and also analyzed correlation between clinical grading and navigation data. Methods 150 ACL deficient knees that received primary ACL reconstruction using an image-free navigation system were included. For clinical evaluation, the Lachman, anterior drawer, and pivot shift tests were performed under general anesthesia and were graded by an examiner. For the assessment of knee stability using the navigation system, manual tests were performed again before ACL reconstruction. Navigation data were recorded as anteroposterior (AP) displacement of the tibia for the Lachman and anterior drawer tests, and both AP displacement and tibial rotation for the pivot shift test. Results Navigation data of each clinical grade were as follows; Lachman test grade 1+: 10.0 mm, grade 2+: 13.2 ± 3.1 mm, grade 3+: 14.5 ± 3.3 mm, anterior drawer test grade 1+: 6.8 ± 1.4 mm, grade 2+: 7.4 ± 1.8 mm, grade 3+: 9.1 ± 2.3 mm, pivot shift test grade 1+: 3.9 ± 1.8 mm/21.5° ± 7.8°, grade 2+: 4.8 ± 2.1 mm/21.8° ± 7.1°, and grade 3+: 6.0 ± 3.2 mm/21.1° ± 7.1°. There were positive correlations between clinical grading and AP displacement in the Lachman, and anterior drawer tests. Although positive correlations between clinical grading and AP displacement in pivot shift test were found, there were no correlations between clinical grading and tibial rotation in pivot shift test. Conclusions In response to AP force, the navigation system can provide the surgeon with correct objective data for knee laxity in ACL deficient knees. During the pivot shift test, physicians may grade according to the displacement of the tibia, rather than rotation.
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Affiliation(s)
- Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
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Monaco E, Maestri B, Labianca L, Speranza A, Kelly MJ, D'Arrigo C, Ferretti A. Navigated knee kinematics after tear of the ACL and its secondary restraints: preliminary results. Orthopedics 2010; 33:87-93. [PMID: 20954638 DOI: 10.3928/01477447-20100510-58] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this study we evaluated the role of the anterior cruciate ligament (ACL) and its secondary restraint in controlling knee stability using a navigation system. The purpose of this study was to evaluate the kinematics of the knee in different conditions of instability: ACL intact, after transection of the posterolateral (PL) bundle, after transection of the anteromedial (AM) bundle, and after lesion of the anterolateral femorotibial ligament (ALFTL). Anterior tibial translation and rotation were measured with a computer navigation system in 6 knees in whole fresh-frozen human cadavers by use of a manual maximum load. Anterior translation was evaluated at 30°, 60°, and 90° of flexion; rotation at 0°, 15°, 30°, 45°, 60°, and 90° of flexion. Cutting the PL bundle does not increase anterior translation and rotation of the knee. Cutting the AM bundle significantly increased the anteroposterior (AP) translation at 30° and 60° of flexion (P=.01), but does not increase rotation of the knee. Cutting the ALFTL increased anterior translation at 60° of flexion (P=.04) and rotation at 30°, 45°, and 60° of flexion (P=.03). The PL bundle does not affect anterior translation and rotation of the knee. The AM bundle is the primary restraint of the anterior translation but does not affect rotation of the knee. The lateral compartment becomes the primary restraint of rotation after ACL cut. The primary kinematic effect of an ACL injury is an increase in anterior tibial translation, but there is no significant change in maximum internal or external rotation. The lesion of the ALFTL increases tibial rotation and could be correlated to the pivot shift phenomenon.
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Affiliation(s)
- Edoardo Monaco
- "Sapienza" University of Rome, II School of Medicine, Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant' Andrea Hospital, Rome, Italy
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Miura K, Ishibashi Y, Tsuda E, Fukuda A, Tsukada H, Toh S. Intraoperative comparison of knee laxity between anterior cruciate ligament-reconstructed knee and contralateral stable knee using navigation system. Arthroscopy 2010; 26:1203-11. [PMID: 20810078 DOI: 10.1016/j.arthro.2010.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Revised: 01/02/2010] [Accepted: 01/05/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to compare knee laxity between anterior cruciate ligament (ACL)-reconstructed knees and contralateral stable knees by use of intraoperative navigation. METHODS Five patients with ipsilateral ACL-deficient knees with contralateral stable knees without any ligament injuries were included in this study. Anteroposterior (AP) knee laxity during anterior drawer force applied manually and range of tibial rotation and AP knee laxity during internal and external rotational torque applied manually in both the ACL-deficient knee and the contralateral stable knee were measured by use of a navigation system from 15 degrees to 90 degrees of knee flexion. After the temporary fixation of the posterolateral bundle, anteromedial bundle (AMB), or double-bundle (DB) reconstruction, knee laxity was measured again and compared with that of the stable knee. RESULTS The mean laxities for PLB reconstruction were significantly greater than those of the contralateral stable knee at more than 75 degrees of knee flexion (P < .05). The mean laxities for AMB or DB reconstruction were not significantly different from those of the contralateral stable knee at all knee flexion angles. Those for AMB reconstruction were within +1.6 mm and those for DB reconstruction were within -2.0 mm of those of the contralateral stable knee. The mean rotations for all reconstructions were significantly less than those of the contralateral stable knee at less than 30 degrees of knee flexion (P < .05). CONCLUSIONS DB and AMB reconstructions could restore knee laxity closer to the level of the contralateral stable knee. Because normal knee laxity is different in each individual, evaluation of contralateral stable knee laxity during ACL reconstruction surgery would be helpful for restoration to the level of the specific preinjury knee laxity. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Kazutomo Miura
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Japan.
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van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH. "Anatomic" anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 2010; 26:S2-12. [PMID: 20810090 DOI: 10.1016/j.arthro.2010.03.005] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 03/04/2010] [Accepted: 03/05/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this systematic review was to evaluate studies published on anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS A systematic electronic search was performed by use of the Medline and Embase databases. Studies that were published from January 1995 to April 2009 were included. The selection criteria were studies that reported on a surgical technique for "anatomic double-bundle ACL reconstruction" on skeletally mature living human subjects and were written in English. Data collected and analyzed included a variety of surgical data. Tables were created to provide an overview of surgical techniques for anatomic ACL reconstruction. RESULTS Seventy-four studies were included in this review. Some surgical factors were adequately reported in the majority of the articles: visualizing the native ACL insertion sites, placing the tunnels in the footprint, graft type, and fixation method. However; ACL insertion site measurement, femoral intercondylar notch measurement, individualization of surgery, and intraoperative/postoperative imaging were poorly reported. The most variety was seen in knee flexion angle during femoral tunnel drilling and tensioning pattern of the grafts. CONCLUSIONS For most surgical data, there was a gross under-reporting of specific operative technique data. We believe that the details of an "anatomic" operative technique are crucial for the valid interpretations of the outcomes. Thus we encourage authors to report their surgical technique in a specific and standardized fashion.
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Affiliation(s)
- Carola F van Eck
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-3221, USA
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Zaffagnini S, Klos TV, Bignozzi S. Computer-assisted anterior cruciate ligament reconstruction: an evidence-based approach of the first 15 years. Arthroscopy 2010; 26:546-54. [PMID: 20362837 DOI: 10.1016/j.arthro.2009.09.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Revised: 09/17/2009] [Accepted: 09/17/2009] [Indexed: 02/02/2023]
Abstract
In the last 15 years, computer-assisted surgery (CAS) has been used for many purposes during anterior cruciate ligament (ACL) reconstruction, such as tunnel positioning, joint laxity evaluation, and biomechanical studies. This article is an evidence-based literature review of the contribution of such technology to ACL surgery. A search of the PubMed and Medline databases was performed. Articles were classified according to the study design and to the research topic: anatomy, laxity, kinematics, and comparison of surgical techniques. An evidence-based approach was used to verify the clinical usefulness of CAS to ACL surgery. The use of CAS for research purposes was also evaluated. CAS was shown to improve femoral tunnel positioning, even if clinical outcomes showed no differences compared with manual techniques. CAS technology was found to be useful for research purposes in terms of providing a better comprehension of the effect of different ACL reconstructions and of the different bundles on joint laxity, as well as describing tunnel positioning in relation to native ACL insertion. CAS in ACL surgery can improve results at time 0 and can improve knowledge about ACL anatomy and kinematics. Its application remains limited mostly to research purposes because of the invasiveness of the system and the absence of improved clinical results at follow-up.
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Affiliation(s)
- Stefano Zaffagnini
- Laboratorio di Biomeccanica, Istituto Ortopedico Rizzoli, Bologna, Italy
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Tsuda E, Ishibashi Y, Fukuda A, Tsukada H, Toh S. Comparable results between lateralized single- and double-bundle ACL reconstructions. Clin Orthop Relat Res 2009; 467:1042-55. [PMID: 18989731 PMCID: PMC2650066 DOI: 10.1007/s11999-008-0604-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Accepted: 10/17/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Patellar tendon autografts are not suitable for multibundle ACL reconstruction, a procedure that reportedly enhances postoperative knee stability. Biomechanical studies recommend lateral placement of the femoral tunnel for single-bundle reconstruction to improve postoperative knee kinematics. We asked whether a lateralized single-bundle patellar tendon graft (LSBP) would provide good short-term results of ACL reconstruction comparable to double-bundle hamstring tendon grafts (DBH). We prospectively followed 144 patients with unilateral ACL rupture treated with either LSBP or DBH in a nonrandomized fashion. Twenty-four female and 31 male patients with LSBP and 44 female and 26 male patients with DBH were followed for a minimum of 24 months (average, 38 months; range, 24-56 months). The patients with LSBP recovered knee extension better at 1 month compared with the patients with DBH, but extension was similar after 3 months. We observed no differences in the side-to-side difference of KT1000 measurement, pivot shift test, or anterior drawer test between LSBP and DBH. Although better recovery of hamstring strength in LSBP and better recovery of quadriceps strength in DBH were observed in the early postoperative period, these differences disappeared after 12 months. There was no difference in International Knee Documentation Committee objective evaluation between LSBP and DBH at the final followup. LEVEL OF EVIDENCE Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eiichi Tsuda
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, Aomori 036-8562, Japan.
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Yamamoto Y, Ishibashi Y, Tsuda E, Tsukada H, Toh S. Single- Versus Double-Bundle Anterior Cruciate Ligament Reconstruction Results Using Navigation: The Japanese Experience. ACTA ACUST UNITED AC 2008. [DOI: 10.1053/j.oto.2008.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tsuda E, Ishibashi Y. Computer-Navigated Double-Bundle Anterior Cruciate Ligament Reconstruction. OPER TECHN SPORT MED 2008. [DOI: 10.1053/j.otsm.2008.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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