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Bartek B, Völkner A, Oehme S, Fahy S, Winkler T, Jung T. No significant difference in skin contamination during anterior cruciate ligament reconstruction with and without preoperative skin cleaning. Knee Surg Sports Traumatol Arthrosc 2025; 33:1728-1735. [PMID: 39359237 PMCID: PMC12022823 DOI: 10.1002/ksa.12476] [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: 05/13/2024] [Revised: 09/05/2024] [Accepted: 09/06/2024] [Indexed: 10/04/2024]
Abstract
PURPOSE This prospective study aimed to assess whether preoperative antiseptic skin cleansing reduces bacterial contamination and surgical site infections (SSI) following anterior cruciate ligament reconstruction (ACLR). We hypothesized that antiseptic cleaning would lower bacterial load, reducing contamination and early infections. METHODS One hundred and nineteen patients scheduled for ACLR were included in this prospective, nonrandomized study. Individuals were divided into two groups. Patients in the intervention group applied octenisan® wash lotion daily for three days before surgery and used the wash solution instead of their usual shower gel. Additionally, they swiped their leg with octenisan® soaked gloves on the morning of the operation. The control group followed their usual wash routine with no specific instructions. Fluid samples were taken before surgery from the irrigation bag and at 15-min intervals from the reservoir of the sterile surgical drape during the procedure. Suture material used for the ACL graft and meniscus repair were also collected for testing. The samples were subjected to a 14-day incubation period. Follow-up included outpatient visits at 6 weeks, 12 weeks and 6 months with a final evaluation at 12 months. RESULTS Contamination rates showed no significant difference between the control and intervention groups. The mean contamination rate in the control group was 6.4% (n = 22) and 6.6% (n = 24) in the intervention group (p = 0.28). At 12-month follow-up, 110 out of 119 participants were included (52 control, 58 intervention). T tests for age (p = 0.19), BMI (p = 0.66), and surgery duration (p = 0.38) showed no significant differences. No early SSI were observed in either group postoperatively. CONCLUSION Our results indicate that the use of antiseptic wash lotion and gloves does not influence the risk of bacterial contamination during surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Benjamin Bartek
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Center for Musculoskeletal SurgeryBerlinGermany
| | - Alexandra Völkner
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Center for Musculoskeletal SurgeryBerlinGermany
| | - Stephan Oehme
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Center for Musculoskeletal SurgeryBerlinGermany
| | - Stephen Fahy
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Center for Musculoskeletal SurgeryBerlinGermany
| | - Tobias Winkler
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Center for Musculoskeletal SurgeryBerlinGermany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff InstituteBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin BerlinBerlinGermany
| | - Tobias Jung
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Center for Musculoskeletal SurgeryBerlinGermany
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Burton M, Barker T, Burnett Z, Magnussen R, Kaeding C, Milliron E, Cavendish P, Piscitani F, Seidt J, Flanigan D. Mechanical Properties of Tibialis Tendon Grafts Are Unchanged by Soaking in Tobramycin. Orthop J Sports Med 2025; 13:23259671251325663. [PMID: 40144302 PMCID: PMC11938474 DOI: 10.1177/23259671251325663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 11/06/2024] [Indexed: 03/28/2025] Open
Abstract
Background Tendon graft soaking in vancomycin solution minimizes surgical infection risk and has no effect on graft strength, but the intermittent vancomycin shortages, presence of vancomycin-resistant organisms, and treatment needs of patients with vancomycin hypersensitivity merit investigation of alternative antibiotics. Tobramycin prevents infection at low concentrations and is a cost-effective alternative, but it is unknown if tobramycin alters graft mechanical properties. Purpose/Hypothesis The purpose of this study was to investigate the effects of tobramycin soaking on tendon graft mechanical properties. It was hypothesized that tobramycin soaking will not affect tendon graft mechanical properties. Study Design Controlled laboratory study. Methods A total of 30 tibialis tendon grafts were wrapped in saturated gauze swabs containing saline (control; n = 10), vancomycin (n = 10; 5 mg/mL), or tobramycin (n = 10; 1 mg/mL) for 10 minutes. Grafts were then removed from the treated gauze swab wraps and mechanically tested under uniaxial tension loading conditions. Grafts were pulled at a rate of 10 mm/min to failure. Force and displacement data from each test were used to calculate the Young modulus (MPa), ultimate tensile stress (MPa), and elasticity limit (MPa). Results There were no significant differences in Young modulus (552 ± 108, 583 ± 98, and 660 ± 237 MPa; P = .62), ultimate tensile stress (91.5 ± 20.8, 96.6 ± 17.8, and 99.7 ± 33.3 MPa; P = .85), or elasticity limit (51.7 ± 16.4, 53.2 ± 13.8, and 52.3 ± 15.3 MPa; P = .98) between the control, vancomycin, and tobramycin groups, respectively. Conclusion Soaking of tibialis tendon grafts with tobramycin does not appear to alter mechanical properties of the tendon graft under uniaxial load conditions. Clinical Relevance If vancomycin use is not possible or contraindicated for certain patients, surgeons can soak grafts in tobramycin to achieve similarly effective infection mitigation without weakening the graft.
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Affiliation(s)
- Michael Burton
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Tyler Barker
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Zachary Burnett
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert Magnussen
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher Kaeding
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric Milliron
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Parker Cavendish
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Franco Piscitani
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeremy Seidt
- Department of Mechanical and Aerospace Engineering, College of Engineering, The Ohio State University, Columbus, Ohio, USA
| | - David Flanigan
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Drake VE, Smith C, Watkins MO, Rudy SF, Joseph AW, Stucken CL, Brenner MJ, Kim JC, Moyer JS. Outcomes of Autologous Versus Irradiated Homologous Costal Cartilage Graft in Rhinoplasty. Facial Plast Surg Aesthet Med 2024; 26:575-581. [PMID: 38502836 DOI: 10.1089/fpsam.2023.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Background: Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are commonly used in septorhinoplasty when there is insufficient septal cartilage for grafting. Objective: To assess the surgical outcomes of patients who underwent septorhinoplasty with either ACC or IHCC as measured by rates of infection, resorption, warping, and revision rate. Methods: A retrospective analysis of patients who underwent rhinoplasty with ACC or IHCC at a single academic institution was performed. Demographic data, surgical details, antibiotic use, and outcomes, including surgical duration, infection, resorption, warping, and revision rate, were analyzed using Fisher's exact test, chi-squared test, and logistic regression. Results: One hundred forty-three patients were identified. The median age was 48 years (interquartile range: 35-57.5) and 62.2% (n = 89) were female, 61 patients (42.7%) underwent ACC, and 82 (57.3%) IHCC. Revision rate in both groups was similar (ACC = 14.8%, IHCC = 14.6%; p = 0.98). There was no difference in infection rate (ACC = 4.9%, IHCC = 3.7%; p = 0.71). Postoperative deformity and nasal obstruction were the most common indications for revision surgery. Surgical time was shorter with IHCC (p < 0.01). Mean follow-up time was 26.5 months (±25) for ACC, and 16 months (±12) for IHCC. Conclusions: ACC and IHCC are similar in terms of effectiveness and safety in septorhinoplasty.
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Affiliation(s)
- Virginia E Drake
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Connor Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Mariel O Watkins
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Shannon F Rudy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Andrew W Joseph
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Jennifer C Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
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Al-Hourani K, Haddad FS. Allografts in soft-tissue knee surgery. Bone Joint J 2024; 106-B:516-521. [PMID: 38821497 DOI: 10.1302/0301-620x.106b6.bjj-2024-0081.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Affiliation(s)
- Khalid Al-Hourani
- Department of Orthopedics and Sports Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
- The Bone & Joint Journal , London, UK
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Princess Grace Hospital, London, UK
| | - Vanya Gant
- Department of Microbiology, University College Hospital, London, UK
| | - Dominic R M Meek
- Department of Trauma and Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Fares S Haddad
- Princess Grace Hospital, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
- The Bone & Joint Journal , London, UK
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Geethan I, HarriVishnu M, Sindhanai V, Subashankar A, KanniRaj M. In Vitro Study of Gentamicin Elution from Tendon Grafts. Indian J Orthop 2023; 57:1118-1125. [PMID: 37384018 PMCID: PMC10293150 DOI: 10.1007/s43465-023-00897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/18/2023] [Indexed: 06/30/2023]
Abstract
Background Though vancomycin-soaked graft reduces the infection rate after ACL reconstruction, concerns exist regarding this usage. Gentamicin has been used for graft soakage with satisfactory clinical results but gentamicin's elution characteristics are unknown. Methods Thirty Bovine tendon grafts were harvested from ten limbs under sterile conditions. Three tendons from each of the limbs were allotted into three groups and soaked in either saline, gentamicin or vancomycin. Pre-soakage and post-soakage swabs were cultured. Soaked grafts were immersed in a 10 ml saline solution for 5 min (initial washout) and then in another 10 ml saline solution (sustained release) for 10 min. No 1 Whatman filter paper was immersed in the solutions and placed on culture plates streaked with coagulase-negative Staphylococcus aureus (CONS) and methicillin-resistant Staphylococcus aureus (MRSA), and inhibition was noted. The difference between the two proportions was assessed by two proportion t-test for p < 0.05. Results No organism was cultured in the pre-soakage or post-soakage swab in any specimen. Specimens from one limb were excluded since saline-soakage showed inhibition. Elution from gentamicin-soaked graft inhibited CONS in eight out of nine samples in initial washout and all samples in sustained release solution but inhibited MRSA only in one sample in sustained release solution and the initial washout solution. Vancomycin elution inhibited both organisms in all samples. Conclusions Gentamicin elution from tendon graft achieves minimal inhibitory concentration against susceptible organisms. Though its clinical utility is restricted by limited antimicrobial spectrum, and it could be used where the risk of contamination by MRSA is low.
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Affiliation(s)
- I. Geethan
- Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Perambalur, 620021 India
- 20-A, Mahalakshmi Nagar, K K Nagar Post, Trichy, 620021 India
- Knee and Shoulder Surgery, Arthroscopy Centre Trichy, Tiruchirappalli, India
| | - M. HarriVishnu
- Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Perambalur, 620021 India
| | - V. Sindhanai
- Department of Microbiology, Dhanalakshmi Srinivasan Medical College, Perambalur, India
| | - A. Subashankar
- Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Perambalur, 620021 India
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Komnos GA, Chalatsis G, Mitrousias V, Hantes ME. Postoperative Infection after Anterior Cruciate Ligament Reconstruction: Prevention and Management. Microorganisms 2022; 10:microorganisms10122349. [PMID: 36557602 PMCID: PMC9781783 DOI: 10.3390/microorganisms10122349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/12/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Infection following anterior cruciate ligament (ACL) reconstruction can be one of the most debilitating complications following ACL reconstruction. Its reported incidence is around 1%. Utilization of vancomycin for presoaking the graft is considered an established method for infection prevention. The role of other agents, such as gentamycin needs further investigation. Staphylococci are the predominant causative pathogens, while particular attention should be paid to fungal infections due to their long-standing, occult process. Recent data demonstrate that hamstrings autograft may be at an elevated risk of being contaminated leading to subsequent septic arthritis. Diagnosis is set by clinical and laboratory findings and is usually confirmed by intraoperative cultures. Treatment varies, mainly depending on the intraoperative assessment. Satisfactory outcomes have been reported with both graft retaining and removal, and the decision is made upon the arthroscopic appearance of the graft and the characteristics of the infection. Of note, early management seems to lead to superior results, while persistent infection should be managed with graft removal in an attempt to protect the articular cartilage and the knee function.
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8
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El-Kady RAEH, ElGuindy AMF. Septic Arthritis Complicating Arthroscopic Anterior Cruciate Ligament Reconstruction: An Experience from a Tertiary-Care Hospital. Infect Drug Resist 2022; 15:3779-3789. [PMID: 35859912 PMCID: PMC9289172 DOI: 10.2147/idr.s369240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Septic arthritis (SA) of the knee following anterior cruciate ligament reconstruction (ACLR) is considered a catastrophic complication in terms of reduced or loss function of the involved joint. The aims of this study were to gauge the incidence, risk factors, and causative organisms of SA after ACLR. Methods We conducted a retrospective review of 836 patients who underwent primary ACLR at our institution from October 2018 to September 2021. Patients’ demographics, onset of presentation, clinical symptoms, laboratory findings, and management details were obtained from patients’ electronic medical records. Results Out of the 836 primary ACLRs, 12 were complicated with SA (1.43%). Independent risk factors associated with SA included age (OR; 11.12, 95% CI; 1.3–94.97), obesity (OR; 8.51, 95% CI; 1.02–71.13), and diabetes mellitus (OR; 12.58, 95% CI; 2.39–66.3). Staphylococcus aureus was the most frequent culprit organism (66.7%), followed by Streptococcus species (25%), and Pseudomonas aeruginosa (8.3%). No fungal, mycobacterial, or polymicrobial growth were recovered from synovial fluid cultures. All of the infected cases underwent arthroscopic joint lavage and debridement in the operating room followed by intravenous antibiotics. Graft removal was not done in any of the involved patients, with eradication of infection in all cases. Conclusion SA after ACLR is uncommon, with S. aureus identified in about two-thirds of the patients. Prompt diagnosis and treatment are crucial to avoid graft loss and arthritis-associated joint damage. Orthopedic surgeons should consider rigorous implementation of infection control strategies to minimize the incidence of this devastating morbidity.
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Affiliation(s)
- Rania Abd El-Hamid El-Kady
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Department of Pathological Sciences, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Mahmoud Fouad ElGuindy
- Department of Orthopedic Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt.,Department of Orthopedic and Spine Surgery, Dr. Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia
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Affiliation(s)
- Vishal Rajput
- University College London Hospitals, London, UK.,The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- University College London Hospitals, London, UK.,The Princess Grace Hospital, London, UK.,The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal , London, UK
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Smolle MA, Fischerauer SF, Zötsch S, Kiegerl AV, Sadoghi P, Gruber G, Leithner A, Bernhardt GA. Long-term outcomes of surgery using the Ligament Advanced Reinforcement System as treatment for anterior cruciate ligament tears. Bone Joint J 2022; 104-B:242-248. [PMID: 35094581 DOI: 10.1302/0301-620x.104b2.bjj-2021-0798.r2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIMS The aim of this prospective study was to assess the long-term clinical, radiological, functional, and quality of life (QoL)-related outcome of patients treated with the synthetic Ligament Advanced Reinforcement System (LARS) device for anterior cruciate ligament (ACL) rupture. METHODS A total of 41 patients who underwent ACL reconstruction with the LARS device (mean age 39.8 years (SD 12.1 ); 32% females (n = 13)) were prospectively included between August 2001 and March 2005. MRI scans and radiographs were performed at a median follow-up of 2.0 years (interquartile range (IQR) 1.3 to 3.0; n = 40) and 12.8 years (IQR 12.1 to 13.8; n = 22). Functional and QoL-related outcome was assessed in 29 patients at a median follow-up of 12.8 years (IQR 12.0 to 14.0) and clinically reconfirmed at latest median follow-up of 16.5 years (IQR 15.5 to 17.9). International Knee Documentation Committee (IKDC) and Tegner scores were obtained pre- and postoperatively, and Lysholm score postoperatively only. At latest follow-up, range of motion, knee stability tests, 36-Item Short Form Health Survey (SF-36), and IKDC scores were ascertained. Complications and reoperations during follow-up were documented. RESULTS Cumulative complication rate was 66% (n = 27), with 11 developing within one year from surgery and 16 after one year (including five patients with both early and late complications). Ten graft failures (24%) and eight cases of reactive synovitis were observed (20%). All 11 patients with early complications and ten with late complications underwent reoperation (including five with another surgical procedure for early complications), amounting to a cumulative reoperation rate of 51% (n = 21). Revision ACL reconstruction was performed in one patient (2.4%). Median IKDC at latest follow-up was 89.7 (IQR 78.2 to 93.1), being significantly worse in the event of previous complications. Lachman test was positive in 56% (n = 15) of reconstructed knees. All norm-based SF-36 items were at or above median at latest follow-up, and did not differ depending on development of complications. CONCLUSION Despite good functional and QoL-related results in the long term, the cumulative complication rate of 66%, including graft failures and reactive synovitis, has to be viewed with great concern. Cite this article: Bone Joint J 2022;104-B(2):242-248.
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Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Stefan F Fischerauer
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Silvia Zötsch
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Anna V Kiegerl
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Gerald Gruber
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Gerwin A Bernhardt
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
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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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