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Allott NEH, Oladipo FT, Cox KL, Finnerty CM, Banger MS, McGregor AH. The methods of quantifying knee laxity in the ACL injured population: A review. Knee 2025; 55:85-103. [PMID: 40280054 DOI: 10.1016/j.knee.2025.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 02/27/2025] [Accepted: 04/06/2025] [Indexed: 04/29/2025]
Abstract
INTRODUCTION Anterior Cruciate Ligament (ACL) injuries equate to a large proportion of Emergency Department attendances worldwide and continue to place significant burden on primary care services. Diagnosis of this injury relies on subjective physical examination tests such as the Lachman's and Pivot Shift test; results of which can vary depending on clinician experience and individual interpretation. AIMS This review seeks to identify current approaches past and present to objectively measuring knee laxity caused by ACL injury and appraise the methods of the current apparatus' available to do this within the clinical setting. METHODS A literature search across three databases (MEDLINE, EMBASE and CINAHL) was conducted, and an inclusion and exclusion criteria applied to the 780 retrieved texts to extract 19 papers fulfilling this objective. Articles published after the year 2000 were considered. The main technologies noted that quantified knee laxity were arthrometry devices, inertial motion units (IMUs), electromagnetic measurement systems (EMS), optical motion capture systems (OMC), and dynamic MRI. CONCLUSION Despite there being a multitude of technologies with capability to accurately measure aspects of knee laxity, there is no agreed objective measure for doing so in the clinical setting. This highlights a need for improved collaboration between the relevant stakeholders to achieve this aim.
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Wen Y, Wang X, Mao Y, Sun X, Xu N, Han X. Effectiveness of an intelligent weight-bearing rehabilitation robot in enhancing recovery following anterior cruciate ligament reconstruction. Front Public Health 2025; 13:1526105. [PMID: 40236317 PMCID: PMC11996826 DOI: 10.3389/fpubh.2025.1526105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 03/05/2025] [Indexed: 04/17/2025] Open
Abstract
Aim Orthopedic surgery patients frequently delay early rehabilitation due to postoperative discomfort. This is especially true for younger patients with anterior cruciate ligament injuries who are eager to return to sports after discharge. Despite the recognized benefits of early rehabilitation, a standardized protocol for determining safe weight-bearing timelines post-ACL reconstruction is lacking. This study aims to evaluate the effectiveness of an Intelligent Weight-Bearing Rehabilitation Robot in improving recovery outcomes for these patients. Design A retrospective cohort study comparing outcomes between individuals who received the intervention and those in the control group. Methods Ninety-two patients who underwent ACL reconstruction were chosen as subjects and separated into two groups: control and intervention, each with 46 patients, in the order of hospital admission. The control group got standard rehabilitation training, whereas the intervention group received rehabilitation training using the Intelligent Weight-Bearing Rehabilitation Robot. The intervention effects of both groups were compared. Results The intervention group demonstrated significant improvements in knee joint function post-surgery compared to the control group. The mean range of motion (ROM) in the experimental group increased from 41.63 ± 5.97° pre-intervention to 55.89 ± 5.13° post-intervention, while the control group's ROM improved from 40.65 ± 3.43° to 49.78 ± 5.27° (t = 5.635, p < 0.001). Similarly, the Health Status Score (HSS) increased from 43.07 ± 3.83 to 59.93 ± 3.30 in the experimental group, while the control group showed an increase from 43.76 ± 4.06 to 54.39 ± 4.39 (t = 6.850, p < 0.001). These findings indicate a more substantial recovery in knee joint functionality in the experimental group, suggesting that robotic-assisted rehabilitation facilitated enhanced functional recovery. Additionally, pain reduction was significantly better in the experimental group. At 24 h post-surgery, the Visual Analog Scale (VAS) pain score for the experimental group was 3.45 ± 0.96, compared to 3.98 ± 0.93 in the control group (t = -2.647, p = 0.010). At 48 h, the VAS score in the experimental group was 2.37 ± 0.49, significantly lower than the control group's 3.09 ± 0.66 (t = -5.923, p < 0.001). By discharge, however, the difference in VAS scores between the two groups was no longer statistically significant (p = 0.096). Furthermore, the intervention group had a significantly shorter hospital stay (7.07 ± 0.83 days) compared to the control group (7.96 ± 1.01 days) (t = -4.630, p < 0.001). No complications, such as secondary fractures or deep vein thrombosis, were reported in either group during hospitalization. Conclusion Utilizing the intelligent weight-bearing robot in post-ACL reconstruction rehabilitation significantly improves knee function, reduces discomfort, and shortens hospital stay, highlighting the importance of innovation in medical rehabilitation.
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Affiliation(s)
| | | | | | | | | | - Xiaoqing Han
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang, Shandong, China
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Azer A, Ge D, Chan FJ. Eccentric Reaming to Correct Nonanatomic Anterior Cruciate Ligament Tibial Tunnel Placement. Arthrosc Tech 2025; 14:103261. [PMID: 40207330 PMCID: PMC11977167 DOI: 10.1016/j.eats.2024.103261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 08/08/2024] [Indexed: 04/11/2025] Open
Abstract
Anatomic tibial tunnel placement remains an essential aspect of anterior cruciate ligament reconstruction success. Incorrect placement is a common cause of failure and revision reconstruction. Our technique allows repositioning a suboptimal tibial tunnel without the need to remove the initial guide pin for proper tunnel placement. The use of the eccentric reaming technique allows for this to take place, ensuring the more likely success of anterior cruciate ligament reconstruction procedures.
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Affiliation(s)
- Amanda Azer
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - David Ge
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Ferdinand J. Chan
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, U.S.A
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Bracken T, Veilleux A, Khalik HA, Johnson J, de SA D. Femoral tunnel length does not impact outcomes following ACL reconstruction using a single-bundle quadriceps tendon autograft: A systematic review. Knee Surg Sports Traumatol Arthrosc 2025; 33:567-580. [PMID: 39082876 PMCID: PMC11792107 DOI: 10.1002/ksa.12395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 07/06/2024] [Accepted: 07/15/2024] [Indexed: 02/05/2025]
Abstract
PURPOSE To determine whether femoral tunnel length (FTL) affects clinical or functional outcomes following primary Anterior cruciate ligament reconstruction (ACLR) with single-bundle quadriceps tendon autograft, both with and without a patellar bone block. METHODS An electronic search of MEDLINE, EMBASE, and Cochrane databases was carried out via OVID. Data pertaining to study characteristics, patient demographics, surgical techniques, femoral tunnel length, and subjective/objective clinical outcomes was abstracted. Studies were stratified into two groups based on FTL; a short femoral tunnel (S-FT) group of ≤25 mm, and a long femoral tunnel (L-FT) group of >25 mm. There was a high degree of heterogeneity between studies, prohibiting meta-analysis. RESULTS Seven studies comprising 368 total patients with a mean age of 30.3 years (range: 23.4-34 years) were included for analysis. The S-FT group included 126 patients and the L-FT group 242 patients. Both groups demonstrated statistically significant postoperative improvements across both subjective and objective clinical and functional outcomes. Average complication rates were 11.9% (range: 0%-29%) in the S-FT group and 4.5% (range: 1%-14%) in the L-FT group. Ranges of re-rupture rates were 0%-2% and 0%-3% for the S-FT and L-FT groups, respectively (n.s.). CONCLUSION Both S-FT and L-FT groups demonstrated comparable postoperative outcomes following primary ACLR with single bundle quadriceps tendon autograft. There were slightly superior, although non-significant, outcomes reported with short femoral tunnel length, however, this may have been confounded by the variation in surgical technique used. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Tess Bracken
- Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Alexandre Veilleux
- Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonOntarioCanada
| | | | - Jansen Johnson
- Division of Orthopaedic SurgeryMcMaster UniversityHamiltonOntarioCanada
| | - Darren de SA
- Division of Orthopaedic SurgeryMcMaster UniversityHamiltonOntarioCanada
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Issaoui W, Dergaa I, Ghouili H, El Omri A, Guelmami N, Chomier P, Ghrairi M, Ben Saad H, Moalla W. A comparative analysis of autograft choices of anterior cruciate ligament reconstruction and their effects on muscle strength and joint biomechanics. Front Sports Act Living 2025; 6:1444465. [PMID: 39981267 PMCID: PMC11841387 DOI: 10.3389/fspor.2024.1444465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 12/18/2024] [Indexed: 02/22/2025] Open
Abstract
Introduction Anterior cruciate ligament reconstruction (ACLR) is crucial to restore knee stability and function after ACL injuries, especially in physically active individuals. Despite advances in surgical techniques and rehabilitation protocols, the choice of autograft has a significant impact on postoperative recovery, particularly on muscle strength and joint biomechanics. In this study, the effects of four autografts are investigated: Iliotibial band (ITB), combined ITB and hamstring tendon (ITB + HT), hamstring tendon (HT) and bone-tendon-bone (BTB) on quadriceps and hamstring peak torque (QPT and HPT) recovery and hamstring to quadriceps ratio (H:Q) to assess knee stability and function. Methods Forty-two active males (mean ± standard deviation of age: 31.5 ± 6.1 years, height: 177 ± 6 cm, weight: 76 ± 11 kg, body mass index: 24.5 ± 2.2 kg/m²) with primary ACL ruptures were allocated to the four graft groups (ITB: n = 16, ITB + HT: n = 12, HT: n = 7, BTB: n = 7) and underwent a standardized rehabilitation protocol. Quadriceps and hamstring peak torque (QPT and HPT, respectively) as indicators of isokinetic muscle strength were assessed both postoperatively and follow-up after approximately six months (mean 6.29 ± 1.70 months). Results Significant differences in QPT and HPT recovery between the healthy and injured legs were found in all graft groups (P < 0.001). The BTB group showed the largest QPT deficit between healthy and injured legs (Δ = 133.4 Nm, Cohen's d = 8.05) and HPT deficit (Δ = 41.1 Nm, Cohen's d = 4.01). In contrast, the ITB + HT group showed the smallest deficits in QPT (Δ = 22.5 Nm, Cohen's d = 0.73) and HPT (Δ = 13.5 Nm, Cohen's d = 1.21). The BTB group also showed the largest deviation in H:Q ratios (Δ = -0.23, Cohen's d = 2.70), while the HT group showed a more balanced recovery with smaller significant deficits in H:Q ratios (Δ = -0.07, Cohen's d = 0.46). Conclusion The BTB graft showed the most pronounced variations in QPT and HPT between healthy and injured legs in the short term, indicating the importance of longitudinally monitoring knee stability to determine the best autograft choice for ACLR. While all graft types contribute to muscle strength recovery, the HT graft may provide advantages in balancing muscle strength and potentially enhancing knee stability.
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Affiliation(s)
- Wiem Issaoui
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
- Health Medical Services (HMS) FIFA Medical Centre of Excellence Dubai, Dubai, United Arab, Emirates
| | - Ismail Dergaa
- Research Unit “Sport Sciences, Health and Movement”, Higher Institute of Sports and Physical Education of Kef, University of Jendouba, El Kef, Tunisia
- Department of Preventative Health, Primary Health Care Corporation (PHCC), Doha, Qatar
- Departement of Biological Sciences, High Institute of Sport and Physical Education Ksar Saïd, University of Manouba, Manouba, Tunisia
| | - Hatem Ghouili
- Research Unit “Sport Sciences, Health and Movement”, Higher Institute of Sports and Physical Education of Kef, University of Jendouba, El Kef, Tunisia
| | | | - Noomen Guelmami
- Research Unit “Sport Sciences, Health and Movement”, Higher Institute of Sports and Physical Education of Kef, University of Jendouba, El Kef, Tunisia
| | - Philippe Chomier
- Health Medical Services (HMS) FIFA Medical Centre of Excellence Dubai, Dubai, United Arab, Emirates
| | - Mourad Ghrairi
- Health Medical Services (HMS) FIFA Medical Centre of Excellence Dubai, Dubai, United Arab, Emirates
| | - Helmi Ben Saad
- Service of Physiology and Functional Explorations, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
- Research Laboratory LR12SP09 “Heart Failure”, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Wassim Moalla
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
- Research Laboratory Education, Motricité, Sport et Santé (EM2S) LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
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Sopilidis A, Stamatopoulos V, Giannatos V, Taraviras G, Panagopoulos A, Taraviras S. Integrating Modern Technologies into Traditional Anterior Cruciate Ligament Tissue Engineering. Bioengineering (Basel) 2025; 12:39. [PMID: 39851313 PMCID: PMC11762506 DOI: 10.3390/bioengineering12010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Revised: 01/01/2025] [Accepted: 01/04/2025] [Indexed: 01/26/2025] Open
Abstract
The anterior cruciate ligament (ACL) is one of the most injured ligaments, with approximately 100,000 ACL reconstructions taking place annually in the United States. In order to successfully manage ACL rupture, it is of the utmost importance to understand the anatomy, unique physiology, and biomechanics of the ACL, as well as the injury mechanisms and healing capacity. Currently, the "gold standard" for the treatment of ACL ruptures is surgical reconstruction, particularly for young patients or athletes expecting to return to pivoting sports. Although ACL reconstruction boasts a high success rate, patients may face different, serious post-operative complications, depending on the type of graft and technique used in each one of them. Tissue engineering is a multidisciplinary field that could contribute to the formation of a tissue-engineered ACL graft manufactured by a combination of the appropriate stem-cell type, a suitable scaffold, and specific growth factors, combined with mechanical stimuli. In this review, we discuss the aspects that constitute the creation of a successful tissue-engineered graft while also underlining the current drawbacks that arise for each issue. Finally, we highlight the benefits of incorporating new technologies like artificial intelligence and machine learning that could revolutionize tissue engineering.
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Affiliation(s)
- Aris Sopilidis
- Department of Physiology, School of Medicine, University of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (A.S.); (V.S.); (G.T.)
| | - Vasileios Stamatopoulos
- Department of Physiology, School of Medicine, University of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (A.S.); (V.S.); (G.T.)
| | - Vasileios Giannatos
- Department of Orthopedics and Traumatology, Sports Medicine Department, University Hospital of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (V.G.); (A.P.)
| | - Georgios Taraviras
- Department of Physiology, School of Medicine, University of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (A.S.); (V.S.); (G.T.)
| | - Andreas Panagopoulos
- Department of Orthopedics and Traumatology, Sports Medicine Department, University Hospital of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (V.G.); (A.P.)
| | - Stavros Taraviras
- Department of Physiology, School of Medicine, University of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (A.S.); (V.S.); (G.T.)
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Groothoff JD, Villa RS, Glover MA, Mason TW, Fiegen AP, van der List JP, Waterman BR. Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Autograft With Concomitant Meniscal Allograft Transplantation. VIDEO JOURNAL OF SPORTS MEDICINE 2025; 5:26350254241299456. [PMID: 40308343 PMCID: PMC11956872 DOI: 10.1177/26350254241299456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 10/17/2024] [Indexed: 05/02/2025]
Abstract
Background Primary arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) graft offers excellent long-term results for patients with ACL tears. When concurrent meniscal damage is present, the preferred treatment is repair of the meniscus. However, meniscectomy may be needed, which can result in insufficient meniscal function. Indications ACL reconstruction performed concomitantly with meniscal allograft transplantation (MAT) is indicated for patients with ACL tears and meniscal insufficiency. This procedure is typically reserved for younger, active patients, such as the 38-year-old woman in this presentation. Technique Description The patient was placed in the supine position. The BTB graft was harvested first using a standard medial midline incision. A posterior meniscus root tunnel was drilled, followed by drilling of the femoral tunnel for ACL reconstruction. The tibial tunnel for ACL reconstruction was subsequently created, after which tapping was performed for anterior meniscus root fixation. The meniscal allograft was secured using alternating vertical mattress inside-out sutures. Finally, the BTB graft was passed through the tibial and femoral tunnels. Results Outcomes following ACL reconstruction with BTB autograft and MAT are positive, with a 5-year survival between 84% and 91%. ACL reinjury and long-term development of osteoarthritis are the most common complications. In this case, the patient returned to work within 7 months and reported 0 out of 10 pain. Discussion/Conclusion ACL reconstruction with BTB autograft and concomitant MAT is a viable treatment option for patients with ACL tears in the context of meniscal deficiency. Patient Consent Disclosure Statement The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Affiliation(s)
| | - Richard S. Villa
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark A. Glover
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas W. Mason
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anthony P. Fiegen
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Jelle P. van der List
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Brian R. Waterman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
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Migliorini F, Cocconi F, Schäfer L, Vaishya R, Kämmer D, Maffulli N. Bone-patellar tendon-bone, hamstring, and quadriceps tendon autografts for anterior cruciate ligament reconstruction in skeletally immature patients: a systematic review. Br Med Bull 2024; 152:16-27. [PMID: 39333015 DOI: 10.1093/bmb/ldae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/20/2024] [Accepted: 09/12/2024] [Indexed: 09/29/2024]
Abstract
INTRODUCTION Historically, anterior cruciate ligament (ACL) ruptures in the paediatric age group were managed conservatively with bracing, casting, activity modification, and physical therapy. However, most of these patients had to reduce their sports activities, and secondary damages to the affected knee were prevalent. SOURCE OF DATA Published scientific literature in Embase, Web of Science, PubMed, and Google Scholar databases. AREAS OF AGREEMENT ACL reconstruction in children with open physes patients is debated. Any damage to the physes around the knee could lead to growth abnormalities and axial deviation of the knee. AREAS OF CONTROVERSY Different grafts are available and suitable for ACL reconstruction in skeletally immature patients; however, which graft performs better remains unclear. GROWING POINTS This systematic review compared bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT) autografts for ACL reconstruction in skeletally immature patients. The joint laxity, Patient-reported outcome measures (PROMs), return to sport, and complications were compared. AREAS TIMELY FOR DEVELOPING RESEARCH In skeletally immature patients, HT, BPTB, and QT autografts for ACL reconstruction yielded good outcomes. Comparative studies are strongly required to establish the most suitable autograft.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Via Lorenz Böhler 5, 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, Via del Casale di San Pio V, 00165 Rome, Italy
| | - Federico Cocconi
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Via Lorenz Böhler 5, 39100, Bolzano, Italy
| | - Luise Schäfer
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Kammerbruchstraße 8, 52152 Simmerath, Germany
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi Mathura Road, New Delhi, 110076 Delhi, India
| | - Daniel Kämmer
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Kammerbruchstraße 8, 52152 Simmerath, Germany
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University "La Sapienza" of Rome, Via di Grottarossa 1035, 00189 Roma, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent ST4 7QB, United Kingdom
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, E1 4DG London, UK
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Yu X, Hu J, Li Y, Wen Y, Li B. ACL injury management: a comprehensive review of novel biotherapeutics. Front Bioeng Biotechnol 2024; 12:1455225. [PMID: 39650235 PMCID: PMC11620901 DOI: 10.3389/fbioe.2024.1455225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 11/12/2024] [Indexed: 12/11/2024] Open
Abstract
The anterior cruciate ligament (ACL) is integral to the stability of the knee joint, serving to limit anterior tibial translation and regulate rotational movements. ACL injuries are among the most common and debilitating forms of knee trauma, often resulting in joint effusion, muscular atrophy, and diminished athletic capabilities. Despite the established efficacy of ACL reconstruction as the standard treatment, it is not uniformly successful. Consequently, there is a growing interest in novel biotherapeutic interventions as potential alternatives. This comprehensive review examines the latest advancements in ACL biotherapy, encompassing the application of hyaluronic acid, self-assembled short peptides, growth factors, stem cell therapy, gene therapy, platelet-rich plasma therapy, bone marrow aspirate concentrate cells, extracorporeal shock wave, electrical stimulation and cross bracing protocol. The collective aim of these innovative treatments is to facilitate the restoration of the ACL's native biological and biomechanical integrity, with the ultimate goal of enhancing clinical outcomes and the functional recovery of affected individuals.
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Affiliation(s)
- Xuezhi Yu
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China
| | - Jiahui Hu
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yifan Li
- Department of Histology and Embryology, College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Yu Wen
- Department of Histology and Embryology, College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Bin Li
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China
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Verdonk P, Verdonk R, Beca S. An Olympic Skier Returning to Competition After a Complex Knee Reconstruction: A Case Report. Cureus 2024; 16:e71879. [PMID: 39559666 PMCID: PMC11573363 DOI: 10.7759/cureus.71879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2024] [Indexed: 11/20/2024] Open
Abstract
Alpine skiing is a high-risk sport due to the possibility of severe injuries, particularly complex knee injuries. The most common injuries are ruptures of the anterior cruciate ligament (ACL), meniscal tears and fractures of the lower limbs. Managing these injuries requires ligament reconstructions and specific surgical interventions to optimize rehabilitation and ensure a return to competition. This case report describes the incident of a young Olympic skier who sustained a severe knee injury following a fall during training. The result was a fracture of the left posteromedial tibial plateau, a detachment of the medial collateral ligament, an ACL rupture, and tears of both menisci. Management involved a total of seven surgical procedures and months of intensive physiotherapy. ACL reconstruction was performed using an autologous patellar tendon graft. It took three years before the patient was able to come back to competition. ACL reconstruction and rehabilitation require varying recovery periods depending on the injury, with a possible return to practice after 4 to 12 months. Meniscal and multi-ligament injuries demand personalized protocols and precise management to optimize recovery. This case report highlights the complex challenges associated with knee surgery and rehabilitation in the context of sports injuries. The management of multiple ligament and meniscus injuries requires a sophisticated surgical approach, including the use of advanced grafts and techniques. Post-operative rehabilitation is equally crucial, requiring customized protocols to optimize recovery. This case illustrates the importance of integrated, rigorous management to enable a person's safe return to the sporting activity, while minimizing the risk of recurrence.
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Affiliation(s)
| | - Rene Verdonk
- Orthopedic Surgery, Hôpital Erasme, Brussels, BEL
| | - Sacha Beca
- Family Medicine, Université Libre de Bruxelles, Brussels, BEL
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11
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Yağar H, Cinaroglu S, Çiçek F, Ceranoğlu F, Karadağ H. Examination of the Tensile Strength of the Peroneus Longus Muscle. Cureus 2024; 16:e66683. [PMID: 39262512 PMCID: PMC11389650 DOI: 10.7759/cureus.66683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2024] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION The peroneus longus tendon (PLT) is increasingly used as a tendon autograft in ligament and tendon reconstructions. The aim of this study is to evaluate the biomechanical properties of the PLT to assess its usability in frequently performed reconstructions. METHODS Six fresh-frozen, below-knee cadavers with a mean age of 65 years, no previous surgical operation, and no history of chronic disease were used. PLTs were harvested, freed from muscle tissue, and prepared for tensile strength testing at a tensile force rate of 2 mm/min using a Shimadzu Autograph AG-IS 100 kN instrument (Shimadzu Corporation, Kyoto, Japan). RESULTS The maximum tensile force varied between 600.7 N and 1131.313 N, with a median of 758.185 N. All tendons had diameters of 8 mm or more. The elongation at maximum force ranged from 9.0 mm to 16.0 mm, with a median of 14.0 mm. CONCLUSION According to this study, PLT is a viable choice for surgeries involving autograft reconstruction. However, further clinical studies are needed to confirm its efficacy in reconstructive surgeries.
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Affiliation(s)
- Hilal Yağar
- Department of Orthopedics and Traumatology, Niğde Ömer Halisdemir University, Niğde, TUR
| | - Selim Cinaroglu
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, Niğde, TUR
| | - Fatih Çiçek
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, Niğde, TUR
| | - Faruk Ceranoğlu
- Department of Anatomy, Niğde Ömer Halisdemir University, Niğde, TUR
| | - Hüseyin Karadağ
- Department of Dentistry, İstanbul Gelişim University, İstanbul, TUR
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12
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Morales-Avalos R, Torres-González EM, Padilla-Medina JR, Monllau JC. ACL anatomy: Is there still something to learn? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T422-T427. [PMID: 38508380 DOI: 10.1016/j.recot.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The different bony and soft tissue reference points and the micro and macroscopic structures of the knee continue to be the object of focused study and analysis. Upon reviewing the most recent literature, we saw the wide spectrum of studies that seek to define the different anatomical aspects of the anterior cruciate ligament (ACL). PURPOSE The purpose of this paper is to review the most recent publications on the ACL and its morphology in which its microscopic composition and macroscopic anatomy are addressed. RESULTS The ACL consists of typeI (90%) and typeIII (10%) collagen matrix. Its length ranges from 27 to 38mm and its width from 10 to 12mm. The ACL cross-section area measures an average of 44mm2, and its shape resembles that of an hourglass or a bow tie. ACL bundles have been defined as anteromedial, intermediate, and posterolateral. Femoral and tibial footprints were seen to present a high degree of variability in shape and size. Furthermore, the blood supply is given by the medial genicular artery and innervation by the tibial nerve branches. Additionally, the ACL functionally prevents anterior translation of the tibia and stabilizes against the internal rotation of the tibia and valgus angulation of the knee. CONCLUSIONS There is great variability in the anatomy of the ACL as well as its attachment sites. At the same time, the shape and size of its footprint has become a factor in determining individualized ACL reconstruction. The persistence of morphological variability in the aging of the ACL and important aspects of surgical planning and decision making with respect to anatomical risk factors suggest that further studies are called for.
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Affiliation(s)
- R Morales-Avalos
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, México; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - E M Torres-González
- Departamento de Cirugía Ortopédica y Traumatología, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, México; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - J R Padilla-Medina
- Departamento de Cirugía Ortopédica y Traumatología, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, México; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - J C Monllau
- ICATKnee (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, España; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
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13
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Morales-Avalos R, Torres-González EM, Padilla-Medina JR, Monllau JC. ACL anatomy: Is there still something to learn? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:422-427. [PMID: 36787832 DOI: 10.1016/j.recot.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The different bony and soft tissue reference points and the micro and macroscopic structures of the knee continue to be the object of focused study and analysis. Upon reviewing the most recent literature, we saw the wide spectrum of studies that seek to define the different anatomical aspects of the anterior cruciate ligament (ACL). PURPOSE The purpose of this paper is to review the most recent publications on the ACL and its morphology in which its microscopic composition and macroscopic anatomy are addressed. RESULTS The ACL consists of type I (90%) and type III (10%) collagen matrix. Its length ranges from 27 to 38mm and its width from 10 to 12mm. The ACL cross-section area measures an average of 44mm2, and its shape resembles that of an hourglass or a bow tie. ACL bundles have been defined as anteromedial, intermediate, and posterolateral. Femoral and tibial footprints were seen to present a high degree of variability in shape and size. Furthermore, the blood supply is given by the medial genicular artery and innervation by the tibial nerve branches. Additionally, the ACL functionally prevents anterior translation of the tibia and stabilizes against the internal rotation of the tibia and valgus angulation of the knee. CONCLUSIONS There is great variability in the anatomy of the ACL as well as its attachment sites. At the same time, the shape and size of its footprint has become a factor in determining individualized ACL reconstruction. The persistence of morphological variability in the aging of the ACL and important aspects of surgical planning and decision making with respect to anatomical risk factors suggest that further studies are called for.
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Affiliation(s)
- R Morales-Avalos
- Physiology Department, Faculty of Medicine, Universidad Autónoma de Nuevo León (U.A.N.L), Monterrey, Mexico; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - E M Torres-González
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L), Monterrey, Mexico; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - J R Padilla-Medina
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L), Monterrey, Mexico; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - J C Monllau
- ICATKnee (ICATME), Hospital Universitari Dexeus, Universitat Autónoma de Barcelona, Barcelona, Spain; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
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14
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Entezari B, Lex JR, Peck J, Igbokwe EN, Kubik JF, Backstein DJ, Wolfstadt JI. Intraoperative and Postoperative Outcomes of Patients Undergoing Total Knee Arthroplasty With Prior Anterior Cruciate Ligament Reconstruction: A Matched Cohort Analysis. Arthroplast Today 2024; 27:101330. [PMID: 39071823 PMCID: PMC11282402 DOI: 10.1016/j.artd.2024.101330] [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: 08/23/2023] [Revised: 12/11/2023] [Accepted: 01/27/2024] [Indexed: 07/30/2024] Open
Abstract
Background Previous anterior cruciate ligament (ACL) injury is a risk factor for the development of knee osteoarthritis. Despite advances in ACL reconstruction (ACLR) techniques, many patients with history of ACLR develop end-stage osteoarthritis necessitating total knee arthroplasty (TKA). The purpose of this study was to investigate the impact of prior ACLR on intraoperative and postoperative outcomes of TKA. Methods This was a single-centre matched cohort study of all patients with prior ACLR undergoing primary TKA from January 2000 to May 2022. Patients were matched 1:1 to patients undergoing TKA with no prior ACL injury based on age, sex, and body mass index. Outcomes investigated included TKA procedure duration, soft-tissue releases, implant design, and complications requiring reoperation. Results Forty-two ACLR patients were identified and matched to controls. Mean follow-up was 6.8 years and 5.0 years in the ACLR and control cohorts, respectively (P = .115). ACLR patients demonstrated longer procedure durations (122.8 minutes vs 87.0 minutes, P < .001) and more frequently required soft-tissue releases (40.5% vs 14.3%, P = .007), stemmed implants (23.8% vs 4.8%, P = .013), and patellar resurfacing (59.5% vs 26.2%, P = .002). There were no significant differences in postoperative clinical or surgical outcomes between groups. Ten-year implant survivorship was 92% and 95% in the ACLR and control cohorts, respectively (P = .777). Conclusions TKA is an effective procedure for the management of end-stage osteoarthritis with prior ACLR. The care team should be prepared for longer operative times and the utilization of advanced techniques to achieve satisfactory soft-tissue balance and implant stability.
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Affiliation(s)
- Bahar Entezari
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Queen’s University School of Medicine, Kingston, ON, Canada
| | - Johnathan R. Lex
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jonathan Peck
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Emmanuel N. Igbokwe
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jeremy F. Kubik
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - David J. Backstein
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jesse I. Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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15
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Zhang S, Cai G, Ge Z. The Efficacy of Anterior Cruciate Ligament Reconstruction with Peroneus Longus Tendon and its Impact on Ankle Joint Function. Orthop Surg 2024; 16:1317-1326. [PMID: 38650179 PMCID: PMC11144498 DOI: 10.1111/os.14060] [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: 10/30/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE Peroneus Longus Tendon (PLT), a viable anterior cruciate ligament (ACL) graft, shares similar biomechanics, making it suitable for reconstruction. Controversy exists over whether PLT transplants affects the donor ankle joint. The purpose of this study was to examine the recovery of knee joint function following arthroscopic ACL restoration using autologous PLT and its influence on the donor ankle joint. METHODS A retrospective analysis was conducted on 65 patients with ACL rupture who underwent PLT graft reconstruction in our hospital from January 2016 to December 2021. A three-dimensional gait analysis of the bilateral knee and ankle joints was performed postoperatively using an Opti_Knee three-dimensional motion measurement and analysis system-Yidong Medical Infrared Motion Gait Analyzer. Knee function scores and changes in the range of motion of the bilateral knee and ankle joints were collected. The analysis of preoperative and postoperative joint function scores, bilateral knee and ankle mobility was performed by t-tests. RESULTS One year after surgery, the patients' International Knee Documentation Committee (IKDC) scores, Knee Injury and Osteoarthritis Outcome Scores (KOOSs), and Lysholm scores were significantly improved compared to preoperative scores, with statistically significant differences (p < 0.05). There was no statistical difference in the American Orthopedic Foot and Ankle Society (AOFAS) score of the donor ankle joint before and after surgery (p > 0.05). During different gait cycles, there was no statistical difference in knee joint mobility between the affected and healthy sides (p > 0.05), but there was a statistical difference in the inversion and eversion angle of the donor ankle joint during the support phase (p < 0.05). CONCLUSION ACL reconstruction using the PLT can yield satisfactory knee joint function. However, it does affect inversion and eversion in the donor ankle joint, necessitating postoperative exercises. Similar subjective function ratings for both operated and non-operated feet, despite increased inversion-eversion motion in the operated foot, may be influenced by the subjective nature and margin of error in the AOFAS Ankle-hindfoot score, along with the relatively small variation in ankle inversion-eversion angles.
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Affiliation(s)
- Shichao Zhang
- Department of OrthopaedicsJinshan Hospital of Fudan UniversityShanghaiChina
| | - Guoping Cai
- Department of OrthopaedicsJinshan Hospital of Fudan UniversityShanghaiChina
| | - Zhe Ge
- Department of OrthopaedicsJinshan Hospital of Fudan UniversityShanghaiChina
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16
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Dave U, Ofa SA, Ierulli VK, Perez-Chaumont A, Mulcahey MK. Both Quadriceps and Bone-Patellar Tendon-Bone Autografts Improve Postoperative Stability and Functional Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthrosc Sports Med Rehabil 2024; 6:100919. [PMID: 38525287 PMCID: PMC10960083 DOI: 10.1016/j.asmr.2024.100919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/16/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose To compare postoperative knee stability, functional outcomes, and complications after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) versus quadriceps tendon autograft. Methods In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, the PubMed, Embase, and Cochrane Library databases were searched for studies published in 2002 or later. Studies were included if they met the following criteria: randomized controlled trials that included patients who underwent ACL reconstruction with BPTB or quadriceps tendon autograft including all soft tissue and bone-quadriceps tendon and in which measures of postoperative stability and functional outcomes were reported. Studies that were not written in English and those that analyzed animals or cadavers, were not randomized controlled trials, or used other grafts (e.g., hamstring) were excluded. Results The initial search identified 348 studies, 6 of which were included in this systematic review. Two of the six studies found no significant difference in performance outcomes or complications between quadriceps and BPTB autografts. One study found that patients receiving quadriceps autograft self-reported improved knee functional status compared with those receiving BPTB autograft. Another study found that quadriceps autograft resulted in a significantly reduced Quadriceps Index postoperatively compared with BPTB autograft (69.5 vs 82.8, P = .01) but found no difference in postoperative quadriceps strength. An additional study found that the outcomes of quadriceps tendon and BPTB autografts were equivalent per the International Knee Documentation Committee scale, but anterior knee pain was less severe in patients with quadriceps tendon autograft. Furthermore, one study revealed the overall International Knee Documentation Committee score was reported as normal significantly more often in patients who underwent ACL reconstruction with BPTB autograft (85% vs 50%, P < .001) and that donor-site morbidity was greater in patients with quadriceps autograft. No significant difference was found in complications requiring reoperation across studies. Conclusions Patients undergoing ACL reconstruction with either BPTB or quadriceps tendon autograft reported improved postoperative knee stability and functional outcomes. There is no significant difference in complications between quadriceps autograft use and BPTB autograft use. Level of Evidence Level III, systematic review of Level III retrospective studies.
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Affiliation(s)
- Udit Dave
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Sione A. Ofa
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Victoria K. Ierulli
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Andre Perez-Chaumont
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, U.S.A
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Gandhi KM, Ratnani G, Deodhe NP, Shende K. Enhancing Muscle Strength Post Anterior Cruciate Ligament Reconstruction: A Case Report Assessing the Effectiveness of Russian Current. Cureus 2024; 16:e54593. [PMID: 38524050 PMCID: PMC10959462 DOI: 10.7759/cureus.54593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
The effectiveness of Russian electrical stimulation in enhancing muscular strength after anterior cruciate ligament (ACL) restoration is examined in this case study. In addition to traditional physiotherapy, a 29-year-old male athlete having ACL repair took part in a Russian contemporary rehabilitation regimen. Subjective evaluations of pain and functional tests all showed a substantial increase in muscular strength following the intervention. The Russian current's distinct waveform and high-frequency bursts appeared to improve neuromuscular control and quicken the activation of skeletal muscle in the excitation-contraction phase. The evaluation conducted after the intervention revealed notable enhancements in muscular strength and scores on the lower extremity functional scale. The initial score of 32, indicating a moderate functional limitation, improved to 64, indicating a minimal functional limitation. Additionally, the use of Russian electrical stimulation in ACL rehabilitation programs resulted in a reduction in pain levels from 9/10 to 3/10, as measured by the visual analog scale. These findings suggest that the implementation of Russian electrical stimulation shows promise in ACL rehabilitation. However, to validate and further explore these results, it is necessary to conduct larger-scale research studies and randomized controlled trials.
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Affiliation(s)
- Khushi M Gandhi
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Grisha Ratnani
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishigandha P Deodhe
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Krishnayani Shende
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Yalın M, Key S, Yıldırım M, Agar A. Examining Postoperative Posterior Cruciate Ligament Index: A Structural Paradigm in Anterior Cruciate Ligament (ACL) Reconstructions With Hamstring Tendon Autograft. Cureus 2024; 16:e53089. [PMID: 38414686 PMCID: PMC10897742 DOI: 10.7759/cureus.53089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The current study aimed to compare the posterior cruciate ligament (PCL) index values of patients who underwent hamstring tendon (HT) autograft reconstruction due to an anterior cruciate ligament (ACL) tear. The comparison involved assessing these values in a similar cohort and evaluating the association between the alteration in the PCL index and functional results. METHODS Patients who were clinically diagnosed with a complete, unilateral ACL tear and underwent ACL reconstruction (ACLR) using HT autograft between January 2018 and January 2021 constituted the operated group (Group 1) of the study. The control group (Group 2) consisted of patients selected from a convenience sample without ACL rupture, meniscal lesion, or cartilage damage who underwent an MRI during an outpatient orthopaedic consultation for knee pain. The operated group was submitted for an MRI of the knee one year after the operation for any reason such as pain, graft healing, the presence of tunnel widening, or suspicion of re-rupture. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form and the Lysholm Scoring System were applied to the patients in the operated group in the preoperative and postoperative periods to evaluate their complaints, function, and participation in sports and to assess functional ability and functional capacity. A radiologist with five years of experience measured the PCL index in the sagittal section of an MRI. In the operated group, changes in PCL index, IKDC, and Lysholm values during the postoperative period were assessed, along with their correlation. Additionally, a comparison was made between the values of the operated group and the non-operated group. RESULTS No statistically significant correlation was found between the PCL index alteration and the functional score alteration (IKDC and Lysholm) in the operated group (p>0.05). In comparison to the non-operated group, the preoperative PCL index measures of the operated group were significantly lower (p: 0.000; p<0.05). The increase in the postoperative PCL index measurements of the operated group was similarly statistically significant (p: 0.000; p<0.05). CONCLUSION Although the PCL index appears to be a strong anatomical structural parameter in ACLR patients performing HT autograft in the postoperative period, its correlation with functional results is weak.
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Affiliation(s)
- Mustafa Yalın
- Department of Orthopedics and Traumatology, Elazığ Fethi Sekin City Hospital, Elazığ, TUR
| | - Sefa Key
- Department of Orthopedics and Traumatology, Fırat University, Elazığ, TUR
| | | | - Anıl Agar
- Department of Orthopedics and Traumatology, Fırat University, Elazığ, TUR
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Luo P, Wang Q, Cao P, Chen T, Li S, Wang X, Li Y, Gong Z, Zhang Y, Ruan G, Zhou Z, Wang Y, Han W, Zhu Z, Hunter DJ, Li J, Ding C. The association between anterior cruciate ligament degeneration and incident knee osteoarthritis: Data from the osteoarthritis initiative. J Orthop Translat 2024; 44:1-8. [PMID: 38174315 PMCID: PMC10762318 DOI: 10.1016/j.jot.2023.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Though anterior cruciate ligament (ACL) tear has been widely accepted as an important accelerator for knee osteoarthritis (KOA), the role of intrinsic ACL degeneration in developing KOA has not been fully investigated. PURPOSE To determine whether ACL degeneration, in the absence of ACL tear, is associated with incident KOA over 4 years. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Participants' knees in this nested case-control study were selected from the Osteoarthritis Initiative (OAI) study, with Kellgren-Lawrence grading (Kellgren-Lawrence grading) of 0 or 1 at baseline (BL). Case knees which had incident KOA (KLG ≥2) over 4 years, were matched 1:1 with control knees by gender, age and radiographic status. ACL signal intensity alteration (0-3 scale) and volume were assessed as compositional feature and morphology of ACL degeneration, using knee MRI at P0 (time of onset of incident KOA), P-1 (1 year prior to P0) and baseline. Conditional logistic regression was applied to analyze the association between measures of ACL degeneration and incident KOA. RESULTS 337 case knees with incident KOA were matched to 337 control knees. Participants were mostly female (68.5%), with an average age of 59.9 years old. ACL signal intensity alterations at BL, P-1 and P0 were significantly associated with an increased odds of incident KOA respectively (all P for trend ≤0.001). In contrast, ACL volumes were not significantly associated with incident KOA at any time points. CONCLUSIONS ACL signal intensity alteration is associated with increased incident KOA over 4 years, whereas ACL volume is not.The translational potential of this article: This paper focused on ACL signal intensity alteration which could better reflect ACL degeneration rather than ACL tear during the progression of KOA and explored this topic in a nested case-control study. Utilizing MR images from KOA participants, we extracted the imaging features of ACL. In addition, we established a semi-quantitative score for ACL signal intensity alteration and found a significant correlation between it and KOA incidence. Our findings confirmed that the more severe the ACL signal intensity alteration, the stronger relationship with the occurrence of KOA. This suggests that more emphasis should be placed on ACL degeneration rather than ACL integrity in the future.
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Affiliation(s)
- Ping Luo
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Spinal Surgery, The Fourth Hospital of Changsha, Changsha Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Qianyi Wang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Peihua Cao
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Tianyu Chen
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Shengfa Li
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoshuai Wang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yamin Li
- Department of Nephrology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ze Gong
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Zhang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Guangfeng Ruan
- Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zuoqing Zhou
- Department of Orthopedics, The First Affiliated Hospital, Shaoyang University, Shaoyang, Hunan, China
| | - Yuanyuan Wang
- Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Weiyu Han
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhaohua Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - David J. Hunter
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Rheumatology, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Australia
| | - Jia Li
- Division of Orthopaedic Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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20
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Guo Z, Liu F. Progress in research on and classification of surgical methods of arthroscopic reconstruction of the ACL and ALL using a shared tendon graft through the femoral tunnel. Front Surg 2023; 10:1292530. [PMID: 38186395 PMCID: PMC10766812 DOI: 10.3389/fsurg.2023.1292530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Anterior cruciate ligament (ACL) tear is a common clinical injury, and ACL reconstruction has reached a very mature stage. However, with the accumulation of cases, scholars have found that isolated ACL reconstruction may not completely solve the problem of knee rotational stability. With the increase in our understanding of knee joint structure, ACL combined with anterolateral ligament (ALL) reconstruction has become accepted by most scholars, and this operation has also achieved good clinical results. At present, there is no unified surgical method for ACL combined with ALL reconstruction. There are differences in bone tunnel location, reconstruction methods, and graft selection. Compared with the independent reconstruction of the ACL and ALL during the operation, shared tendon graft reconstruction of the ACL and ALL has the advantages of preserving tendon and avoiding tunnel convergence. So far, there is no relevant literature summarizing the reconstruction of the ACL and ALL with a shared tendon graft. This paper reviews the anatomic study of the ALL, the study of isometric points, surgical indications, and surgical methods and their classification for shared tendon graft reconstruction of the ACL and ALL.
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Affiliation(s)
- Ziteng Guo
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
- School of Graduate, Hebei Medical University, Shijiazhuang, China
| | - Fei Liu
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
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21
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Morales JRO, López L, Herrera JS, Martínez JT, Buitrago G. Three-Dimensional Orientation of the Native Anterior Cruciate Ligament in Magnetic Resonance Imaging. J Knee Surg 2023; 36:1438-1446. [PMID: 36116440 DOI: 10.1055/a-1946-6143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to describe the three-dimensional orientation of the native anterior cruciate ligament (ACL) in magnetic resonance imaging (MRI) by calculating the angles of inclination in relation to the axial plane which is given for the knee joint line in a group of healthy individuals. These could help to establish guidelines that may be used for the surgical positioning of bone tunnels during ACL reconstruction. A total of 290 MRI scans of patients with integrity of the ACL were evaluated; three observers identified the coordinates of the femoral and tibial insertion sites, then it is defined the vector and evaluated its angles with respect to axial axis and calculated the angles with trigonometric equations. The data were analyzed according to the age, sex, side, BMI, and height of the patients, and the interobserver reliability was calculated. The patient demographics were as follows: age average: 45 years old, BMI average: 27.1, 54% right knees, and 60% female. The average angle for all the measurements was 76.95 degrees (SD ± 6.8 degrees) in the sagittal plane, 81.65 degrees (SD ± 7.79 degrees) in the coronal plane and 33.17 degrees (SD ± 4.98 degrees) in the axial plane. No statistically significant differences were found between the categorical variables mentioned; moderate to substantial interobserver reliability strength was found with an average kappa of 0.791 for all measurements. The three-dimensional orientation of the native ACL in a group of healthy individuals was established. The findings can be helpful for performing anatomical reconstructions of the ACL in injured patients using as reference the average calculated angles, or measure of the contralateral non-injured knee for surgical planning; these results serve as a basis for the design of a technique that optimizes the three-dimensional position of the ACL when it undergoes reconstruction in the trend toward greater precision for better functional results. Biomechanical and clinical-surgical studies are required to further evaluate our results.
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Affiliation(s)
| | - Laura López
- Department of Orthopaedics and Traumatology, Universidad Nacional de Colombia, Bogotá D.C., Colombia
| | - Juan Sebastián Herrera
- Department of Orthopaedics and Traumatology, Universidad Nacional de Colombia, Bogotá D.C., Colombia
| | - José Tomás Martínez
- Department of Orthopaedics and Traumatology, Universidad Nacional de Colombia, Bogotá D.C., Colombia
| | - Giancarlo Buitrago
- Institute of Clinical Research, Universidad Nacional de Colombia, Bogotá D.C, Colombia
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Zhang H, Yang F, Xie B, Chen Z, Peng Y, Chen Y, Li T, Huang X, Xue J, Du J. Return to active duty after anterior cruciate ligament reconstruction (ACLR) in Chinese male military aircrews. Front Surg 2023; 10:1232176. [PMID: 37693639 PMCID: PMC10491009 DOI: 10.3389/fsurg.2023.1232176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Background Surgically treated anterior cruciate ligament (ACL) injuries may be a waivable condition and allow return to full flight status, but waivers are based on expert opinion rather than recent published data. The purpose of this study was to evaluate return to flight after anterior cruciate ligament reconstruction (ACLR) in male military aircrews with ACL injuries and to identify factors that affect flight clearance. Method A single-center retrospective review was conducted by the authors for all active-duty aircrew who underwent ACLR at an authorized military medical center from January 2010 to December 2019. Demographic characteristics, occupational information, surgical data, and flight readiness evaluation outcomes were collected. Based on the final medical evaluation, subjects were divided into a qualified group (N = 64) and a disqualified group (N = 9), and the difference in data collected between the two groups was then analyzed to identify factors affecting flight clearance. Results A total of 73 patients underwent successful ACLR with a mean age of 31.6 ± 5.6 years. Non-contact injury was the main type of ACL injury, accounting for 84.9% of the total injuries. 55 cases (75.3%) occurred during daily sports activities and 18 (24.7%) during military training. 64 of the 73 crewmembers (87.7%) were able to return to flight at their last follow-up evaluation. The preoperative interval time (PIT) was significantly less in the qualified group than in the disqualified group (P = 0.002). Patients who underwent ACLR within three months were more likely to return to flying than those who underwent the procedure three months later (97.4% vs. 76.5%, P = 0.010). The incidence of failure to return to flight duty was significantly higher in aircrews with ACL injuries combined with meniscal injuries than in aircrews with isolated ACL injuries (21.4% vs. 0.0%, P = 0.017). Conclusion ACLR appears to be safe for military aircrew suffering ACL injuries with or without meniscal injury, and return to flight status is the most likely outcome for the majority of postoperative pilots. Prolonged PIT, PIT > 3 months, and ACL injury combined with meniscus injury had a negative impact on postoperative flight readiness.
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Affiliation(s)
- Hongxing Zhang
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, China
- Air Force Clinical College, the Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Fengyuan Yang
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Bowen Xie
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, China
- Air Force Clinical College, the Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Zhiqiang Chen
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Ye Peng
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, China
| | - Yufei Chen
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, China
| | - Tianqi Li
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Xiaogang Huang
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, China
| | - Jing Xue
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, China
| | - Junjie Du
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, China
- Air Force Clinical College, the Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
- Graduate School of Medicine, China Medical University, Shenyang, China
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Zhao Y, Chen Z, Li L, Wu X, Li W. Changes in proprioception at different time points following anterior cruciate ligament injury or reconstruction. J Orthop Surg Res 2023; 18:547. [PMID: 37518000 PMCID: PMC10388458 DOI: 10.1186/s13018-023-04044-5] [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: 05/25/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023] Open
Abstract
PURPOSE To investigate the changes in 30° and 60° position sense in patients with anterior cruciate ligament (ACL) injury at different time points after injury and reconstruction. METHODS Patients were divided into six groups according to time after ACL injury and reconstruction: group A (ACL injury 1.5-6 months), group B (ACL injury 6-12 months), group C (ACL injury > 12 months), group D (postoperative ACL reconstruction 1-6 months), group E (postoperative ACL reconstruction > 6 months), and group F consisting of 14 healthy adults (control group). The ability of the affected leg to reproduce the same joint position during knee flexion was tested using active joint position sense assays to assess proprioception in both the lower extremities of the patient or between groups. RESULTS Proprioception decreased rapidly during the early stages of ACL injury. Significant difference in the affected side at 30° compared to the healthy side (Group A: 4.70 (4.78, 9.00) vs 4.15 (3.35, 6.13), P = 0.03; Group B: 2.90 (0.48, 4.56) vs 8.30 (4.18, 10.43), P = 0.001; Group E: 6.25 (2.55, 11.60) vs 9.60 (3.90, 12.73), P = 0.009). However, no significant differences were detected for a double lower limb contrast of 60° (Group A: 5.1 (1.00, 8.00) vs 3.00 (0.75, 3.55), P = 0.044). Finally, the affected side of patients in groups C, D and E had significant differences in position perception at 30° compared with healthy subjects (P < 0.01), and the affected side of patients in groups C and E had significant differences in position sense at 60° compared with healthy subjects (P < 0.01). CONCLUSION ACL injury had a greater impact on the patient's 30° position sense, with only a small impact for 60°. Further, the early and middle proprioception recovery stages after ACL injury were the best before surgery. Finally, proprioception recovery training should be performed soon after injury.
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Affiliation(s)
- Yixuan Zhao
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Ze Chen
- Tianjin Medical University, Tianjin, China
| | - Longfei Li
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Xipeng Wu
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Wei Li
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China.
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Cui H, Cao Z, Wang S, Zhang H, Chen Z, Wu X, Zhao Y, Qie S, Li W. Surface electromyography characteristics of patients with anterior cruciate ligament injury in different rehabilitation phases. Front Physiol 2023; 14:1116452. [PMID: 37051018 PMCID: PMC10083235 DOI: 10.3389/fphys.2023.1116452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Anterior cruciate ligament reconstruction (ACLR) is a common treatment for anterior cruciate ligament (ACL) injury. However, after ACLR, a significant proportion of patients do not return to pre-injury levels. Research on muscle function during movement has important implications in rehabilitation. Methods: Sixty patients with unilateral ACL injury were recruited for this study and assigned into three groups: group A, individuals with an ACL injury before 6 months; group B, individuals with ACLR from 6 months to 1 year; and group C, individuals with ACLR 1 year later. Surface electromyography (SEMG) signals were collected from the bilateral rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF), and semitendinosus (ST). The tasks performed during the experiment included straight leg raising (SLR) training at 30°, SLR training at 60°, ankle dorsiflexion, walking, and fast walking. Results: In the maximum muscle strength test, the affected side of the BF in group A (199.4 ± 177.12) was significantly larger than in group B (53.91 ± 36.61, p = 0.02) and group C (75.08 ± 59.7, p = 0.023). In the walking test, the contralateral side of the RF in group B (347.53 ± 518.88) was significantly greater than that in group C (139.28 ± 173.78, p = 0.029). In the SLR training (60°) test, the contralateral side of the RF in group C (165.37 ± 183.06) was significantly larger than that in group A (115.09 ± 62.47, p = 0.023) and smaller than that in group B (226.21 ± 237.17, p = 0.046); In the ankle dorsiflexion training test, the contralateral side of the RF in group B (80.37 ± 87.9) was significantly larger than that in group C (45.61 ± 37.93, p = 0.046). Conclusion: This study showed the EMG characteristics of patients with ACL injury helped to determine which muscle requires more training and which exercise model would be best suited for intervention.
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Affiliation(s)
- Hongxing Cui
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Zhijie Cao
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Shanshan Wang
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Hao Zhang
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Ze Chen
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Xipeng Wu
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Yixuan Zhao
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Shuyan Qie
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
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25
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El-Desouky MA, Ezzat M, Abdelrazek BH. Clinical outcomes in stump-preserving versus stump-sacrificing anterior cruciate ligament reconstruction; a randomized controlled study. BMC Musculoskelet Disord 2022; 23:703. [PMID: 35870924 PMCID: PMC9308271 DOI: 10.1186/s12891-022-05665-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Anterior Cruciate ligament (ACL) reconstruction (ACLR) aims to restore the anatomy and function of the knee. Although stump preservation during ACLR could be technically challenging, it may improve the revascularization and proprioceptive function of the graft. In this study, we aimed to compare the functional outcome after ACLR with and without stump preservation. Methods One hundred and twenty patients with acutely torn ACL and with intact tibial stump were included in this study. Half of them (60 cases) underwent ACLR with stump preservation. The other half (60 cases) had ACLR after total resection of the tibial stump. One hundred and nine out of 120 cases completed their 2 year-follow-up period. All patients were assessed by Tegner activity, Lysholm, and objective International Knee Documentation Committee (IKDC) scores. The side-to-side difference regarding stability was assessed by KT-1000 instrumented Lachman and proprioceptive function was measured by Passive angle reproduction test. Results There was no statistically significant difference between both groups regarding Tegner activity, Lysholm, and IKDC scores. Knee stability measured by KT-1000 and complication rate also showed no significant difference. But there was a significant difference in proprioception favoring stump preservation. On the other hand, the operative time was significantly shorter with stump resection. There was no significant difference in the complications rate between both groups and there were no cases with stiffness in either group. Conclusion Stump preservation ACLR is a safe technique that yields equivalent functional outcomes to standard ACLR. However; it provides better proprioception. It is more technically challenging, but in experienced hands; it is easily reproducible. Trial registration Registration number: NCT05364398. 06/05/2022.
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26
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Peebles AM, Ganokroj P, Macey RL, Lilley BM, Provencher MT. Revision Anterior Cruciate Ligament, Lateral Collateral Ligament Reconstruction, and Osteochondral Allograft Transplantation for Complex Knee Instability. Arthrosc Tech 2022; 11:e2153-e2159. [PMID: 36632389 PMCID: PMC9826972 DOI: 10.1016/j.eats.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/10/2022] [Indexed: 11/19/2022] Open
Abstract
Anterior cruciate ligament (ACL) injuries rarely occur as an isolated event and often include associated meniscal, subchondral bone, and collateral ligament injuries. Concomitant pathology frequently complicates primary and revision ACL reconstruction and must be addressed to ensure comprehensive diagnosis and treatment. In this Technical Note, we describe our method for treatment of complex knee instability following multiple failed ACL reconstruction using a multiligament reconstruction technique with an osteochondral allograft transplantation to the lateral femoral condyle. This comprehensive repair technique restores the anatomic load bearing forces of the cruciate and collateral ligaments and promotes biological repair through incorporation of cartilage resurfacing to ultimately achieve optimal kinematics of the knee joint.
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Affiliation(s)
| | - Phob Ganokroj
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Reed L. Macey
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, U.S.A
| | | | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- the Steadman Clinic, Vail, Colorado, U.S.A
- Address correspondence to CAPT. Matthew T. Provencher, M.D., M.B.A., M.C., U.S.N.R. (Ret.), Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Dr., Ste 400, Vail, CO 81657.
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27
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Piedade SR, Leite Arruda BP, de Vasconcelos RA, Parker DA, Maffulli N. Rehabilitation And Advances In Surgical Reconstruction For Anterior Cruciate Ligament Insufficiency: What Has Changed Since The 1960s? - State Of The Art. J ISAKOS 2022:S2059-7754(22)00094-3. [PMID: 36410671 DOI: 10.1016/j.jisako.2022.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/29/2022] [Accepted: 10/10/2022] [Indexed: 11/20/2022]
Abstract
Anterior cruciate ligament (ACL) insufficiency can be disabling, given the physical and sports activity constraints that negatively impact the quality of life. Consequently, surgery is the main approach for most active patients. Nonetheless, ACL reconstruction (ACLR) cannot be successful without adequate preoperative and postoperative rehabilitation. Since the 1960s, post-ACLR rehabilitation has evolved, mainly from advances in surgery, coupled with a better understanding of the biological concepts of graft revascularization, maturation and integration, which have impacted ACL postoperative rehabilitation protocols. However, new technologies do involve a definite learning curve which could affect rehabilitation programs and produce inconsistent results. The development of rehabilitation protocols cannot be defined without an accurate diagnosis of ACL injury and considering the patient's main physical demands and expectations. This article discusses how postoperative rehabilitation following ACLR has changed from the 1960s to now, focussing on surgical technique (type of tendon graft, fixation devices, and graft tensioning), biological concepts (graft maturation and integration), rehabilitation protocols (prevention of ACL injuries, preoperative rehabilitation, postoperative rehabilitation), criteria to return to sports, patient's reported outcomes and outcome. Although rehabilitation plays an essential role in managing ACL injuries, it cannot be fully standardised preoperatively or postoperatively. Preoperative and postoperative rehabilitation should be based on an accurate clinical diagnosis, patients' understanding of their injury, graft tissue biology and biomechanics, surgical technique, the patient's physical demands and expectations, geographical differences in ACL rehabilitation and future perspectives.
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Affiliation(s)
- Sergio R Piedade
- Exercise and Sports Medicine, Department of Orthopedics, Rheumatology, and Traumatology, University of Campinas, UNICAMP, Campinas, SP, 13083-887, Brazil.
| | | | | | - David A Parker
- Sydney Orthopaedic Research Institute, Chatswood, NSW 206, Australia
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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28
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Liukkonen RJ, Ponkilainen VT, Reito A. Revision Rates After Primary ACL Reconstruction Performed Between 1969 and 2018: A Systematic Review and Metaregression Analysis. Orthop J Sports Med 2022; 10:23259671221110191. [PMID: 35958290 PMCID: PMC9358584 DOI: 10.1177/23259671221110191] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Numerous studies, including randomized controlled trials (RCTs), have been published on the optimal graft choice for primary anterior cruciate ligament (ACL) reconstruction. Purpose: To review existing studies to investigate whether advances in orthopaedics have affected revision rates after primary ACL reconstruction. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed database was searched from inception to December 31, 2020, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Patient series, observational studies, clinical trials, and registry-based studies investigating primary ACL reconstruction were included, as were high-quality RCTs from an additional study. The minimum required follow-up time for inclusion was 1 year. The primary outcome measure was the pooled prevalence of revision ACL reconstruction. The effect of the year the surgery was performed on revision rates was evaluated with metaregression analysis. All graft types were analyzed simultaneously, and all analyses were repeated separately for each graft type. Results: Overall, 330 articles with 52,878 patients were included, with a median patient age of 28 years (range, 15-57 years). The primary ACL reconstructions were performed between 1969 and 2018. At a median of 2.3 years of follow-up, the overall revision rate was 3.14% (95% CI, 2.76% to 3.56%); it was 2.71% (95% CI, 2.25% to 3.27%) for hamstring autografts, 2.38% (95% CI, 1.82% to 3.11%) for bone–patellar tendon–bone (BPTB) autografts, and 5.24% (95% CI, 4.02% to 6.80%) for other graft types. For hamstring grafts, the revision rate increased over time (year of surgery), with a 0.0434 (95% CI, 0.0150 to 0.0718) increase effect in the logit-transformed scale for every additional year. There was a slight decrease in revision rates for BPTB (β = –0.0049; 95% CI, –0.0352 to 0.0254) and other graft types (β = –0.0306; 95% CI, –0.0608 to −0.0005) over time; however, confidence intervals for BPTB included the zero change. Conclusion: Based on this systematic review and meta-analysis, ACL reconstruction is a reliable procedure with overall low historical revision rates. BPTB autograft had the lowest revision rate and a slightly decreasing trend of failures during the past 45 years, although both BPTB and hamstring autografts are reliable graft choices.
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Affiliation(s)
- Rasmus J. Liukkonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Aleksi Reito
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Cheng R, Wang H, Dimitriou D, Jiang Z, Cheng CK, Tsai TY. Central femoral tunnel placement can reduce stress and strain around bone tunnels and graft more than anteromedial femoral tunnel in anterior cruciate ligament reconstruction. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3590. [PMID: 35289106 DOI: 10.1002/cnm.3590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
The present study investigated the effects of anteromedial (AM) and central femoral footprint placement on stress and strain distribution around the femoral and tibial tunnel and graft following anterior cruciate ligament reconstruction (ACLR). A three-dimensional (3D) reconstructed knee model was validated and used for simulating ACLR by finite element analysis. A combined loading during normal human walking was applied to the knee models using different anatomic femoral tunnel placement at 20° knee flexion. The results of von Mises stress and principal strain at the entrances of the femoral and tibial tunnel and ACL graft was determined. The peak von Mises stress and the maximum principal strain in the AM footprint group were 8.78 MPa and 8850.89 μ-strain at the entrance of femoral tunnel, and 5.29 MPa and 5553.27 μ-strain at the entrance of tibial tunnel. The results in the AM footprint group were higher than that in the central footprint group. The peak von Mises stress around the ACL graft following AM footprint ACLR was 28.63 MPa, higher than that following the central footprint ACLR. The AM footprint ACLR generated more significant peak von Mises stress and maximum principal strain around the entrances of femoral and tibial tunnel and the graft than the central footprint. The present results are of clinical relevance as they can provide a better understanding of tunnel enlargement and graft failure.
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Affiliation(s)
- Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huizhi Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopedics Balgrist University Hospital, Forchstrasse, Zürich, Switzerland
| | - Ziang Jiang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Laddha MS, Gowtam S, Jain P. Single-Tunnel Double-Bundle-Like Effect With Footprint Enhancing Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2022; 11:e307-e314. [PMID: 35256968 PMCID: PMC8897561 DOI: 10.1016/j.eats.2021.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/28/2021] [Indexed: 02/03/2023] Open
Abstract
The anterior cruciate ligament (ACL) consists of an anteromedial bundle and a posterolateral bundle giving anteroposterior and rotational stability. It's one of the most commonly injured ligaments and also one of the most commonly performed arthroscopic procedures. Management of ACL injuries is one of the most frequently studied subjects in the literature. Surgical management of ACL injuries varies from extraarticular tenodesis to arthroscopic transtibial reconstruction to double-bundle reconstruction to anatomic single-bundle reconstruction. Although double-bundle ACL reconstruction gives more rotational stability than anatomic single-bundle, functional outcome of both are the same, but the complication rates are much higher for double-bundle reconstruction. Hence, anatomic single-bundle ACL reconstruction has gained popularity. The femoral and tibial footprint of the ACL varies in shape and size; it can be oval, elliptical, rectangular, C-shape, and more. But all available ACL reconstruction techniques prepare a circular tunnel; hence, the footprint coverage of the native ACL is maximum after double-bundle reconstruction and less after anatomic single-bundle reconstruction. So, to have the benefit of double-bundle reconstruction with a single tunnel, we propose our technique of a single-tunnel double-bundle-like effect, with the footprint enhancing ACL reconstruction using our newly designed tunnel dilators.
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Affiliation(s)
| | - S.V. Gowtam
- RNH Hospital, Balraj Marg, Dhantoli, Nagpur, Maharashtra, India
| | - Prakhar Jain
- RNH Hospital, Balraj Marg, Dhantoli, Nagpur, Maharashtra, India
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Rahim M, Ooi FK, Shihabudin MT, Chen CK, Musa AT. The Effects of Three and Six Sessions of Low Energy Extracorporeal Shockwave Therapy on Graft Incorporation and Knee Functions Post Anterior Cruciate Ligament Reconstruction. Malays Orthop J 2022; 16:28-39. [PMID: 35519531 PMCID: PMC9017919 DOI: 10.5704/moj.2203.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/01/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction One session of high energy extracorporeal shockwave therapy (ESWT) was found to improve the healing of anterior cruciate ligament (ACL) after reconstruction in animal and human studies. This study investigated the effects of three and six sessions of low energy ESWT on graft incorporation and knee functions post ACL reconstruction in humans. Materials and methods Thirty participants with ACL injuries were recruited and assigned equally into three groups with 10 participants per group (n=10). Participants in the control group received physiotherapy alone without low energy ESWT. Participants in the 3ESWT group underwent three sessions of low energy ESWT (one session per week) combined with physiotherapy, and participants in the 6ESWT group received six sessions of low energy ESWT (one session per week) combined with physiotherapy. However, five participants were lost to follow-up. Evaluations of graft incorporation of the tibial tunnel using magnetic resonance (MRI) and Lysholm score were carried out before ACL reconstruction and after six months post ACL reconstruction. Results The number of grafts with partial incorporation in the tibia tunnel in 6ESWT was significantly higher compared with the number of grafts with non-incorporation at six months post-operatively, X2 (1, N=9) =5.44, p =0.02. However, there was no significant difference between frequencies of graft incorporation in tibia tunnel in the control and 3ESWT groups, X2 (1, N=7) =3.57, p =0.06 and X2 (1, N=9) =2.78, p =0.10, respectively at 6 months postoperatively. Lysholm scores were significantly higher at 6 months post ACL reconstruction compared to the baseline value for each group (p<0.002, respectively). However, there was no significant difference in the Lysholm score between each group (F = 2.798, p = 0.083). Conclusions Six sessions of low energy ESWT improved graft incorporation in the tibial tunnel. Both three and six sessions of low energy of ESWT does not affect the knee function score at six months post ACL reconstruction.
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Affiliation(s)
- M Rahim
- Exercise and Sports Science Programme, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- School of Rehabilitation Sciences, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - FK Ooi
- Exercise and Sports Science Programme, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - MT Shihabudin
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - CK Chen
- Exercise and Sports Science Programme, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - AT Musa
- Department of Radiology, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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OMAR O, RIZVANOVIC D, WALDÉN M, ERIKSSON K, BARENIUS B, STÅLMAN A. Compensation claims following anterior cruciate ligament injuries reported to the patient insurance company in Sweden in 2005-2014. Acta Orthop 2022; 93:97-102. [PMID: 34726577 PMCID: PMC8815401 DOI: 10.1080/17453674.2021.1996102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Patients in the Swedish healthcare system are insured against avoidable adverse events via Landstingens Ömsesidiga Försäkringsbolag (LÖF). We assessed the reasons for compensation claims reported to LÖF following an ACL injury. Patients and methods - We searched the LÖF database for compensation claims related to ACL injuries reported in 2005-2014, and cross-matched claims with the Swedish National Knee Ligament Register. We then performed a review of the medical records. Results - We identified 530 eligible claims in 2005-2014. 352 (66%) claims were accepted by LÖF and 178 claims were rejected. Accepted claims corresponded to fewer than 1% of ACL surgeries performed in the same period. The most common reasons for an accepted claim were postoperative septic arthritis followed by suboptimal surgery and delay in diagnosis and treatment. Interpretation - There are different reasons for accepting a compensation claim following an ACL injury, which represents different treatment errors that can be avoided.
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Affiliation(s)
- Osama OMAR
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm
| | - Dzan RIZVANOVIC
- Department of Orthopaedics, Växjö Central Hospital, Region Kronoberg, and Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm
| | - Markus WALDÉN
- Unit of Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Sweden, and Department of Orthopaedics, Hässleholm-Kristianstad Hospitals, Hässleholm
| | - Karl ERIKSSON
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm
| | - Björn BARENIUS
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm
| | - Anders STÅLMAN
- Capio Artro Clinic, and Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
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Posteriorly positioned femoral grafts decrease long-term failure in anterior cruciate ligament reconstruction, femoral and tibial graft positions did not affect long-term reported outcome. Knee Surg Sports Traumatol Arthrosc 2022; 30:2003-2013. [PMID: 35112176 PMCID: PMC9165258 DOI: 10.1007/s00167-022-06871-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/05/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the effect that femoral and tibial tunnel positions have on long-term reported and clinical outcome and to identify a safe zone based on favourable outcome. METHODS Seventy-eight patients from a previous randomised controlled trial were included and were followed with a mean follow-up of 11.4 years. All patients had primary trans-tibial anterior cruciate ligament reconstruction performed. The femoral and tibial tunnel positions were visualised and translated in percentages with three-dimensional computed tomography post-operatively. There were 3 separate outcome variables: patient-reported outcome measured with the IKDC Subjective Knee Form, overall failure, and radiographic osteoarthritis. The correlation between tunnel aperture positions and outcome was determined with multivariate regression. The area with best outcome was defined as the safe zone and was determined with Youden's index in conjunction with receiver operating characteristics. RESULTS No significant relationship was found between tunnel aperture positions and IKDC Subjective Knee Form at 10-year follow-up. The posterior-to-anterior femoral tunnel aperture position parallel to Blumensaat line showed a significant relationship (p = 0.03) to overall failure at 10-year follow-up. The mean posterior-to-anterior tunnel position of the group that did not fail was 37.7% compared to 44.1% in the overall failure group. Femoral tunnel apertures placed further anteriorly had more overall failures at long-term. The cut-off point lies at 35.0% from posterior-to-anterior parallel to Blumensaat. Of the 16 overall failures, 15 (93.8%) were placed further anteriorly than the cut-off point. No significant relationship was found between tunnel aperture positions and radiographic osteoarthritis. CONCLUSION Femoral and tibial tunnel positions were not associated with long-term patient-reported outcome and radiographic osteoarthritis. Long-term overall failure was more frequently seen in patients with a more anteriorly placed femoral tunnel. This study identified a safe zone located at the most posterior 35% of the femoral condyle parallel to Blumensaat. This knowledge offers guidance to surgeons to operate more precisely and accurately and reconstruct a long-lasting graft. LEVEL OF EVIDENCE Level III.
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Borjali A, Nourani A, Moeinnia H, Mohseni M, Korani H, Ghias N, Chizari M. Comparison of mechanical properties in interference screw fixation technique and organic anterior cruciate ligament reconstruction method: a biomechanical study. BMC Musculoskelet Disord 2021; 22:1047. [PMID: 34930185 PMCID: PMC8691038 DOI: 10.1186/s12891-021-04788-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/13/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Bone and Site Hold Tendon Inside (BASHTI) technique is an organic implant-less technique for anterior cruciate ligament (ACL) reconstruction with some clinical advantages, such as speeding up the healing process, over implantable techniques. The study aims to compare the mechanical properties of BASHTI technique with the conventional interference screw technique. METHODS To investigate the mechanical properties, 20 in-vitro experimental tests were conducted. Synthetic dummy bone, along with fresh digital bovine tendons, as a graft, were used for experiments. Three loading steps were applied to all specimens, including a preconditioning, a main cyclic, and a pull-out loading. RESULTS The mechanical characters of an interference screw technique using an 8 mm tendon diameter, including fixation strength, average cyclic stiffness (ACS), and average pull-out stiffness (APS) were found to be 439 ± 132 N, 10.3 ± 5.3 kN/mm, and 109 ± 40 N/mm, respectively. In the case of an interference screw using a 9 mm tendon, the fixation strength, ACS, and APS were obtained 549 ± 87 N, 10.3 ± 4.7 kN/mm, and 91 ± 13 N/mm, respectively. In parallel, the fixation strength, APS, and ACS of BASHTI technique using an 8 mm tendon were 360 ± 123 N, 3.3 ± 0.6 kN/mm, and 79 ± 27 N/mm, respectively, while, for 9 mm tendon 278 ± 103 N, 2.4 ± 1.2 kN/mm, and 111 ± 40 N/mm, were reported for fixation strength, APS, and ACS respectively when BASHTI technique was used. CONCLUSION About 50% of interference screw samples showed superior mechanical properties compared to BASHTI technique, but in another half of the samples, the differences were not significant (N.S.). However, due to organic advantages of BASHTI technique and lower cost, it could be used as a substitute for interference screw technique, especially where fast recovery is expected.
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Affiliation(s)
- Amirhossein Borjali
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Amir Nourani
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - Hadi Moeinnia
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mahdi Mohseni
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Hossein Korani
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Narges Ghias
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mahmoud Chizari
- Department of Engineering and Technology, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
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Wen Z, Zhang H, Yan W, Mohamed SI, Zhao P, Huang X, Xu Z, Zhang J, Zhou A. Anatomical Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autografts: A Comparative Study of Three Different Techniques. J Knee Surg 2021; 34:1243-1252. [PMID: 32369840 DOI: 10.1055/s-0040-1702164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The ideal procedure for anterior cruciate ligament (ACL) reconstruction is one that can achieve anatomical restoration for a better ACL function. This retrospective comparative study was conducted to evaluate the objective and subjective clinical results of the conventional single-bundle femoral round (SBR) tunnel technique, the single-bundle femoral oval (SBO) tunnel technique, and the double-bundle (DB) surgical technique for anatomical ACL reconstruction with hamstring tendon autografts. Patients who underwent the SBO, SBR, and DB ACL reconstructions from January 2016 to August 2017 were included in this study. A total of 163 patients underwent different surgical techniques; 41 patients underwent the SBO procedure, 78 patients received SBR, and the remaining 44 patients underwent the DB procedure. The Lachman's test, pivot-shift test, Lysholm's score, International Knee Documentation Committee (IKDC) score, and Tegner's score were compared among groups postoperatively. KT-1000 was used to measure the anterior laxity of the knee. Magnetic resonance imaging was used to compare the ACL graft maturity. Second-look arthroscopy was conducted to compare the graft status and synovial coverage. Significant differences among groups were found with respect to the Lysholm's score, Tegner's score, and IKDC score. Patients in the SBO and DB groups acquired higher functional scores than the SBR group. More patients with positive pivot-shift test were observed in the SBR group than other groups at 12- and 24-month postoperative follow-ups. The postoperative KT-1000 was better in the SBO and DB groups than in the SBR group. The mean signal/noise quotient (SNQ) of the SBO group was 2.70 ± 0.92, significantly lower than 3.58 ± 1.21 of the SBR group. Despite a higher proportion of patients with grade B or C synovial coverage and partial graft injury found in the SBR group, there were no significant differences among the groups. The SBO and DB technique achieved better clinical results than the SBR technique. The SBO technique was indeed an ideal surgical procedure for ACL reconstruction provided that the shortcoming of DB technique must be taken into account. This is a Level III, retrospective comparative study.
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Affiliation(s)
- Zhenxing Wen
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,The College of Clinical Medicine, Chongqing Medical University, Chongqing, People's Republic of China
| | - Hua Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Wenlong Yan
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Sheikh Ibrahimrashid Mohamed
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,The College of Clinical Medicine, Chongqing Medical University, Chongqing, People's Republic of China.,Department of Orthopaedics, Webuye County Hospital, Webuye, Kenya
| | - Pei Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiao Huang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zijie Xu
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,The College of Clinical Medicine, Chongqing Medical University, Chongqing, People's Republic of China
| | - Jian Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Aiguo Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Klontzas ME, Vassalou EE, Karantanas AH. MRI findings of acute anterior instability of the knee in the absence of recent trauma. Acta Radiol 2021; 63:1205-1213. [PMID: 34382430 DOI: 10.1177/02841851211035910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anterior knee instability is usually encountered in the context of trauma, with the clinical examination and imaging focusing on anterior cruciate ligament (ACL) disruption. Limited data exist on magnetic resonance imaging (MRI) of acute anterior knee instability in the absence of recent trauma. PURPOSE To provide the first comprehensive account of MRI findings in acute anterior knee laxity in the absence of acute trauma and to evaluate predictors of ACL integrity and pain. MATERIAL AND METHODS A total of 84 consecutive patients with non-traumatic knee instability were prospectively studied. Instability was assessed with Lachman's, pivot shift, and Lelli's tests. MRI findings were recorded, and ACL integrity was surgically confirmed in all 24 cases of MRI suggesting tear and in 21/60 cases of MRI suggesting no tear. Binary logistic regression models were used to identify predictors of ACL tears and pain, and Mann-Whitney U test served for comparisons between continuous variables. The study was approved by the institutional review board. RESULTS Osteoarthritis and notch bony outgrowth (NBO) were present in 44% and 42.9% of all knees, respectively. NBO did not correlate with osteoarthritis (P = 0.606). NBO (odds ratio [OR] = 4.157; P = 0.016) and ACL grafts (OR = 9.277; P = 0.01) predisposed to non-traumatic ACL tears (torn in 28.6% of total cases). Presence of osteoarthritis was predictive of pain (OR = 17.671; P < 0.001). CONCLUSION We present a comprehensive analysis of MRI findings in clinically significant non-traumatic anterior instability, showing that NBO and ACL grafts predispose in non-traumatic ACL tears, whereas osteoarthritis is the only predictor of pain.
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Affiliation(s)
- Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Greece
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece
| | - Evangelia E Vassalou
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
- Department of Radiology, General Hospital of Sitia, Sitia, Greece
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Greece
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece
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Loucas M, Loucas R, D'Ambrosi R, Hantes ME. Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211024591. [PMID: 34277881 PMCID: PMC8255613 DOI: 10.1177/23259671211024591] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/28/2021] [Indexed: 01/14/2023] Open
Abstract
Background: The drilling technique used to make a femoral tunnel is critically important for determining outcomes after anterior cruciate ligament (ACL) reconstruction. The 2 most common methods are the transtibial (TT) and anteromedial (AM) techniques. Purpose: To determine whether graft orientation and placement affect clinical outcomes by comparing clinical and radiological outcomes after single-bundle ACL reconstruction with the AM versus TT technique. Study Design: Systematic review; Level of evidence, 3. Methods: Articles in PubMed, EMBASE, the Cochrane Library, ISI Web of Science, Scopus, and MEDLINE were searched from inception until April 25, 2020, using the following Boolean operators: transtibial OR trans-tibial AND (anteromedial OR trans-portal OR independent OR three portal OR accessory portal) AND anterior cruciate ligament. Results: Of 1270 studies retrieved, 39 studies involving 11,207 patients were included. Of these studies, 14 were clinical, 13 were radiological, and 12 were mixed. Results suggested that compared with the TT technique, the AM technique led to significantly improved anteroposterior and rotational knee stability, International Knee Documentation Committee (IKDC) scores, and recovery time from surgery. A higher proportion of negative Lachman (P = .0005) and pivot-shift test (P = .0001) results, lower KT-1000 arthrometer maximum manual displacement (P = .00001), higher Lysholm score (P = .001), a higher incidence of IKDC grade A/B (P = .05), and better visual analog scale score for satisfaction (P = .00001) were observed with the AM technique compared with the TT technique. The AM drilling technique demonstrated a significantly shorter tunnel length (P = .00001). Significant differences were seen between the femoral and tibial graft angles in both techniques. Low overall complication and revision rates were observed for ACL reconstruction with the AM drilling technique, similar to the TT drilling technique. Conclusion: In single-bundle ACL reconstruction, the AM drilling technique was superior to the TT drilling technique based on physical examination, scoring systems, and radiographic results. The AM portal technique provided a more reproducible anatomic graft placement compared with the TT technique.
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Affiliation(s)
- Marios Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Rafael Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Michael Elias Hantes
- Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Mid-term outcomes of anterior cruciate ligament reconstruction across age groups: A national database study. J Orthop 2021; 23:150-154. [PMID: 33551608 DOI: 10.1016/j.jor.2021.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to examine the impact of age on complication risk after anterior cruciate ligament reconstruction. Methods The TriNetX research database was retrospectively queried for patients undergoing primary arthroscopic ACL reconstruction. Univariate logistic regression was performed to evaluate the risk of complication by age group. Results A total of 21,449 patients were included in the study. Patients ≥61 years old demonstrated significantly higher rates of repeat reconstruction. Rates of postoperative opioid related disorders and surgical site infection varied by age. Conclusion For patients undergoing ACL reconstruction, increasing age is associated with increased risk of developing opioid related disorders, and repeat reconstruction.
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Pitaru AA, Lacombe JG, Cooke ME, Beckman L, Steffen T, Weber MH, Martineau PA, Rosenzweig DH. Investigating Commercial Filaments for 3D Printing of Stiff and Elastic Constructs with Ligament-Like Mechanics. MICROMACHINES 2020; 11:mi11090846. [PMID: 32933035 PMCID: PMC7570386 DOI: 10.3390/mi11090846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022]
Abstract
The current gold standard technique for treatment of anterior cruciate ligament (ACL) injury is reconstruction with autograft. These treatments have a relatively high failure and re-tear rate. To overcome this, tissue engineering and additive manufacturing are being used to explore the potential of 3D scaffolds as autograft substitutes. However, mechanically optimal polymers for this have yet to be identified. Here, we use 3D printing technology and various materials with the aim of fabricating constructs better matching the mechanical properties of the native ACL. A fused deposition modeling (FDM) 3D printer was used to microfabricate dog bone-shaped specimens from six different polymers—PLA, PETG, Lay FOMM 60, NinjaFlex, NinjaFlex-SemiFlex, and FlexiFil—at three different raster angles. The tensile mechanical properties of these polymers were determined from stress–strain curves. Our results indicate that no single material came close enough to successfully match reported mechanical properties of the native ACL. However, PLA and PETG had similar ultimate tensile strengths. Lay FOMM 60 displayed a percentage strain at failure similar to reported values for native ACL. Furthermore, raster angle had a significant impact on some mechanical properties for all of the materials except for FlexiFil. We therefore conclude that while none of these materials alone is optimal for mimicking ACL mechanical properties, there may be potential for creating a 3D-printed composite constructs to match ACL mechanical properties. Further investigations involving co-printing of stiff and elastomeric materials must be explored.
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Affiliation(s)
- Audrey A. Pitaru
- Division of Orthopaedic Surgery, McGill University, Montreal, QC H3A 1A1, Canada; (A.A.P.); (J.-G.L.); (M.E.K.); (M.H.W.); (P.A.M.)
- Department of Experimental Surgery, McGill University, Montreal, QC H3A 1A1, Canada
| | - Jean-Gabriel Lacombe
- Division of Orthopaedic Surgery, McGill University, Montreal, QC H3A 1A1, Canada; (A.A.P.); (J.-G.L.); (M.E.K.); (M.H.W.); (P.A.M.)
- Department of Experimental Surgery, McGill University, Montreal, QC H3A 1A1, Canada
| | - Megan E. Cooke
- Division of Orthopaedic Surgery, McGill University, Montreal, QC H3A 1A1, Canada; (A.A.P.); (J.-G.L.); (M.E.K.); (M.H.W.); (P.A.M.)
- Department of Experimental Surgery, McGill University, Montreal, QC H3A 1A1, Canada
| | - Lorne Beckman
- The Orthopaedics Research Lab, McGill University, Montreal, QC H3A 1A1, Canada; (L.B.); (T.S.)
| | - Thomas Steffen
- The Orthopaedics Research Lab, McGill University, Montreal, QC H3A 1A1, Canada; (L.B.); (T.S.)
| | - Michael H. Weber
- Division of Orthopaedic Surgery, McGill University, Montreal, QC H3A 1A1, Canada; (A.A.P.); (J.-G.L.); (M.E.K.); (M.H.W.); (P.A.M.)
- Department of Experimental Surgery, McGill University, Montreal, QC H3A 1A1, Canada
| | - Paul A. Martineau
- Division of Orthopaedic Surgery, McGill University, Montreal, QC H3A 1A1, Canada; (A.A.P.); (J.-G.L.); (M.E.K.); (M.H.W.); (P.A.M.)
- Department of Experimental Surgery, McGill University, Montreal, QC H3A 1A1, Canada
| | - Derek H. Rosenzweig
- Division of Orthopaedic Surgery, McGill University, Montreal, QC H3A 1A1, Canada; (A.A.P.); (J.-G.L.); (M.E.K.); (M.H.W.); (P.A.M.)
- Department of Experimental Surgery, McGill University, Montreal, QC H3A 1A1, Canada
- Injury, Repair and Recovery Program, Research Institute of McGill University Health Centre, Montreal, QC H3A 1A1, Canada
- Correspondence: ; Tel.: +01-514-934-1934 (ext. 43238)
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Bakirci E, Tschan K, May RD, Ahmad SS, Kleer B, Gantenbein B. The importance of plasmin for the healing of the anterior cruciate ligament. Bone Joint Res 2020; 9:543-553. [PMID: 32922763 PMCID: PMC7469513 DOI: 10.1302/2046-3758.99.bjr-2020-0048.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims The anterior cruciate ligament (ACL) is known to have a poor wound healing capacity, whereas other ligaments outside of the knee joint capsule such as the medial collateral ligament (MCL) apparently heal more easily. Plasmin has been identified as a major component in the synovial fluid that varies among patients. The aim of this study was to test whether plasmin, a component of synovial fluid, could be a main factor responsible for the poor wound healing capacity of the ACL. Methods The effects of increasing concentrations of plasmin (0, 0.1, 1, 10, and 50 µg/ml) onto the wound closing speed (WCS) of primary ACL-derived ligamentocytes (ACL-LCs) were tested using wound scratch assay and time-lapse phase-contrast microscopy. Additionally, relative expression changes (quantitative PCR (qPCR)) of major LC-relevant genes and catabolic genes were investigated. The positive controls were 10% fetal calf serum (FCS) and platelet-derived growth factor (PDGF). Results WCS did not differ significantly among no plasmin versus each of the tested concentrations (six donors). The positive controls with PDGF and with FCS differed significantly from the negative controls. However, we found a trend demonstrating that higher plasmin concentrations up-regulate the expression of matrix metalloproteinase 13 (MMP13), 3 (MMP3), and tenomodulin (TNMD). Conclusion The clinical relevance of this study is the possibility that it is not solely the plasmin, but also additional factors in the synovial fluid of the knee, that may be responsible for the poor healing capacity of the ACL. Cite this article: Bone Joint Res 2020;9(9):543–553.
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Affiliation(s)
- Ezgi Bakirci
- Tissue Engineering for Orthopaedics and Mechanobiology, Department for BioMedical Research (DBMR) of the Medical Faculty of the University of Bern, University of Bern, Bern, Switzerland.,Tissue Engineering for Orthopaedics and Mechanobiology, Department for BioMedical Research (DBMR) of the Medical Faculty of the University of Bern, University of Bern, Bern, Switzerland
| | - Karin Tschan
- Tissue Engineering for Orthopaedics and Mechanobiology, Department for BioMedical Research (DBMR) of the Medical Faculty of the University of Bern, University of Bern, Bern, Switzerland
| | - Rahel D May
- Tissue Engineering for Orthopaedics and Mechanobiology, Department for BioMedical Research (DBMR) of the Medical Faculty of the University of Bern, University of Bern, Bern, Switzerland
| | - Sufian S Ahmad
- Knee Team, Department for Orthopaedic Surgery and Traumatology, Insel University Hospital, University of Bern, Bern, Switzerland.,BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Barbara Kleer
- Knee Team, Department for Orthopaedic Surgery and Traumatology, Insel University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin Gantenbein
- Tissue Engineering for Orthopaedics and Mechanobiology, Department for BioMedical Research (DBMR) of the Medical Faculty of the University of Bern, University of Bern, Bern, Switzerland.,Knee Team, Department for Orthopaedic Surgery and Traumatology, Insel University Hospital, University of Bern, Bern, Switzerland
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Kosy JD, Walmsley K, Sharma AD, Gordon EA, Heddon SV, Anaspure R, Schranz PJ, Mandalia VI. A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study. Knee Surg Relat Res 2020; 32:17. [PMID: 32660634 PMCID: PMC7219201 DOI: 10.1186/s43019-020-00037-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background Graft malposition is a risk factor for failure of anterior cruciate ligament reconstruction. A 70° arthroscope improves visualisation of the medial wall of the lateral femoral condyle without switching portals. We investigated whether the use of this arthroscope affected the accuracy and precision of femoral tunnel placement. Methods Fifty consecutive adult patients were recruited. Following one withdrawal and two exclusions, 47 patients (30 in group 1 (70° arthroscope), 17 in group 2 (30° arthroscope)) underwent three-dimensional computed tomography imaging using a grid-based system to measure tunnel position. Results No difference was found in the accuracy or precision of tunnels (mean position: group 1 = 33.3 ± 6.0% deep–shallow, 27.2 ± 5.2% high–low; group 2 = 31.7 ± 6.9% deep–shallow, 29.0 ± 6.2% high–low; not significant). A post-hoc power analysis suggests a study of 106 patients would be required. Conclusions This pilot study suggests that tunnel position is not affected by the arthroscope used. An appropriately powered study could investigate this finding alongside other potential benefits of using a 70° arthroscope for this procedure. Trial registration ClinicalTrials.gov, NCT02816606. Registered on 28 June 2016.
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Affiliation(s)
- Jonathan D Kosy
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, EX2 5DW, UK.
| | - Katie Walmsley
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, EX2 5DW, UK
| | - Akash D Sharma
- Hip and Knee Unit, Nuffield Orthopaedic Centre, Oxford, UK
| | - Elizabeth A Gordon
- Research and Development Department, Royal Devon and Exeter Hospital, Exeter, UK
| | - Sadie V Heddon
- Research and Development Department, Royal Devon and Exeter Hospital, Exeter, UK
| | - Rahul Anaspure
- Department of Musculoskeletal Radiology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Peter J Schranz
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, EX2 5DW, UK
| | - Vipul I Mandalia
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, EX2 5DW, UK
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温 振, 张 华, 闫 文, 赵 沛, 黄 潇, 许 梓, 张 健, 周 爱. [Comparison of femoral oval tunnel technique and round tunnel technique in single-bundle anterior cruciate ligament reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:323-329. [PMID: 32174077 PMCID: PMC8171655 DOI: 10.7507/1002-1892.201908030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/16/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of femoral oval tunnel technique versus round tunnel technique in single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS Between March 2016 and February 2018, 125 patients who underwent anatomical single-bundle ACL reconstruction with hamstring tendon and met the inclusive criteria were included in the retrospective study. Of the included patients, 43 patients underwent ACL reconstruction using oval tunnel technique (group A) and 82 patients with round tunnel technique (group B). There was no significant difference between the two groups in terms of age, gender, body mass index, the interval between injury and operation, the injured side, the cause of injury, and preoperative Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner score, and the outcome of KT-1000 measurement ( P>0.05). At 3, 6, 12, and 24 months after operation, the knee function scores (Lysholm score, IKDC score, Tegner score) were recorded; and KT-1000 was used to evaluate the knee stability. The position and shape of the tunnels were evaluated by the three-dimensional CT (3D-CT) at 1 day after operation; and MRI was performed at 6, 12, and 24 months to calculate the signal/noise quotient (SNQ) of ACL grafts. Secondary arthroscopy was conducted to estimate the graft status, synovial coverage, and tension. RESULTS All patients were followed up 12-26 months (mean, 23 months). Two patients in group A and 5 patients in group B presented with redness and swelling of the surgical site, 1 patient in group B sustained a tibial tunnel fracture, and 1 patient in group A had postoperative stiffness. The Lysholm score, IKDC score, and Tegner score were significantly higher in group A than in group B at the different time points ( P<0.05) except for the Tegner score at 3 months. The outcomes of KT-1000 measurement were significantly lower in group A than in group B ( P<0.05). The entrances of the femoral tunnel and tibial tunnel in both groups were within the ACL anatomical footprint confirmed by 3D-CT. No re-rupture of ACL occurred confirmed by the MRI. There was no significant difference in SNQs of the middle and distal grafts between the two groups at 6 months ( P>0.05), whereas the SNQ of the proximal grafts in group A was significantly lower than that in group B ( P<0.05). The SNQs of the proximal, middle, and distal grafts in group A were significantly lower than those in group B at 12 and 24 months after operation ( P<0.05). Twenty-one patients in group A and 38 patients in group B underwent secondary arthroscopy and the results showed no significant difference in graft status, synovial coverage, and tension between the two groups ( P>0.05). CONCLUSION The effectiveness and graft maturity of the femoral oval tunnel technique were superior to the round tunnel technique. The single-bundle ACL reconstruction with femoral oval tunnel technique can obtain a better knee function.
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Affiliation(s)
- 振兴 温
- 重庆医科大学附属第一医院骨科（重庆 400016）Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
- 重庆医科大学（重庆 400016）Chongqing Medical University, Chongqing, 400016, P.R.China
| | - 华 张
- 重庆医科大学附属第一医院骨科（重庆 400016）Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - 文龙 闫
- 重庆医科大学附属第一医院骨科（重庆 400016）Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - 沛 赵
- 重庆医科大学附属第一医院骨科（重庆 400016）Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - 潇 黄
- 重庆医科大学附属第一医院骨科（重庆 400016）Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - 梓杰 许
- 重庆医科大学附属第一医院骨科（重庆 400016）Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
- 重庆医科大学（重庆 400016）Chongqing Medical University, Chongqing, 400016, P.R.China
| | - 健 张
- 重庆医科大学附属第一医院骨科（重庆 400016）Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - 爱国 周
- 重庆医科大学附属第一医院骨科（重庆 400016）Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
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Su CA, Knapik DM, Trivedi NN, Megerian MF, Salata MJ, Voos JE. Femoral Interference Screw Fixation in ACL Reconstruction Using Bone-Patellar Tendon-Bone Grafts. JBJS Rev 2020; 8:e0066. [PMID: 32105240 DOI: 10.2106/jbjs.rvw.19.00066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Anterior cruciate ligament (ACL) reconstruction is a commonly performed orthopaedic procedure with numerous reconstructive graft and fixation options. Interference screws have become one of the most commonly utilized methods of securing ACL grafts such as bone-patellar tendon-bone (BPTB) autografts.
» The composition of interference screws has undergone substantial evolution over the past several decades, and numerous advantages and disadvantages are associated with each design.
» The composition, geometry, and insertional torque of interference screws have important implications for screw biomechanics and may ultimately influence the strength, stability of graft fixation, and biologic healing in ACL reconstruction.
» This article reviews the development and biomechanical properties of interference screws while examining outcomes, complications, and gaps in knowledge that are associated with the use of femoral interference screws during BPTB ACL reconstruction.
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Affiliation(s)
- Charles A Su
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nikunj N Trivedi
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Michael J Salata
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James E Voos
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Zhang P, Han F, Chen T, Wu Z, Chen S. "Swiss roll"-like bioactive hybrid scaffolds for promoting bone tissue ingrowth and tendon-bone healing after anterior cruciate ligament reconstruction. Biomater Sci 2020; 8:871-883. [PMID: 31820744 DOI: 10.1039/c9bm01703h] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The choice of grafts for anterior cruciate ligament (ACL) reconstruction is a critical issue in sports medicine. Previous studies have revealed that scaffolds prepared from a single material could not achieve complete integration between the graft and autogenous bone tunnel. To solve this problem, we hypothesize that combining degradable scaffolds with nondegradable scaffolds can produce a novel hybrid ligament with the advantages of both types of scaffolds. In this study, a bone morphogenetic protein 7 (BMP-7)-loaded polycaprolactone (PCL) nanofibrous membrane was first manufactured as the degradable part of the hybrid ligament by using layer-by-layer (LbL) self-assembly. Then, we fabricated a multifunctional novel hybrid ligament by rolling up this nanofibrous membrane and polyethylene terephthalate (PET) mesh fabric (nondegradable part) into a "swiss roll" structure. The in vitro experimental results showed that this hybrid ligament could significantly improve the biocompatibility of pure PET ligament and further promote cell mineralization. The in vivo experimental results showed that this unique structure significantly promoted the integration of hybrid ligaments and bone tunnels, thereby achieving real "ligamentization" after ACL reconstruction surgery. These results suggest that this novel hybrid biomimetic artificial ligament scaffold provides a new direction for graft selection for ACL reconstruction.
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Affiliation(s)
- Peng Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, PR China.
| | - Fei Han
- Institute for Translational Medicine, Institute for Biomedical Engineering and Nanoscience, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200092, PR China
| | - Tianwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, PR China.
| | - Ziying Wu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, PR China.
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, PR China.
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Van Zyl R, Van Schoor AN, Du Toit PJ, Suleman FE, Velleman MD, Glatt V, Tetsworth K, Hohmann E. The Association Between Anterior Cruciate Ligament Length and Femoral Epicondylar Width Measured on Preoperative Magnetic Resonance Imaging or Radiograph. Arthrosc Sports Med Rehabil 2020; 2:e23-e31. [PMID: 32266355 PMCID: PMC7120849 DOI: 10.1016/j.asmr.2019.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine whether femoral epicondylar width (FECW) obtained from either magnetic resonance imaging (MRI) or plain radiographs could be used to predict anterior cruciate ligament (ACL) length. A secondary purpose was to develop a formula to use maximum FECW on either MRI or plain radiographs to estimate ACL length preoperatively. METHODS The MRIs and radiographs of 40 patients (mean age 41.0 years), with no apparent knee pathology, surgery, or trauma were included. The ACL length was measured on MRI followed by FECW on both MRI and radiograph of the same patient. This allowed the development of equations able to predict ACL length according to the FECW measured on either an MRI or radiograph. RESULTS The mean ACL length was 40.6 ± 3.6 mm. FECW measured on both MRIs and radiographs was sufficient to predict ACL length. Pearson's correlations revealed a high positive relationship between ACL length and FECW on MRI (r = 0.89, P < .0001) and ACL length and FECW on radiograph (r = 0.83, P < .0001). The coefficient of determination (R2) was calculated to be MRI: R2 = 0.78 and radiograph: R2 = 0.68 and confirmed that FECW measured on both MRI and radiograph were sufficient to predict ACL length. Based on these models, ACL length can be predicted by FECW using the following formulas: MRI: ACL length = 0.47 (FECW) + 1.93 and radiograph: ACL length = 0.31 (FECW) + 11.33. CONCLUSIONS This study demonstrated that FECW measured on either MRI or anteroposterior radiograph could reliably estimate ACL length on a sagittal MRI. There was a high positive relationship between ACL length and FECW on both MRI and radiographs, although MRIs do predict ACL length more reliably. CLINICAL RELEVANCE Preoperative ACL length assessment, using FECW on MRI or radiograph, is useful in graft selection and in preventing inadequate graft harvesting for ACL reconstruction, especially if an individualized anatomical approach is pursued.
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Affiliation(s)
- Reinette Van Zyl
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Albert-Neels Van Schoor
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Peet J. Du Toit
- Department of Physiology, Faculty of Health Sciences, Associate of the Institute for Food, Nutrition and Well-being, Associate of the Institute for Cellular and Molecular Medicine, Associate of Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa
| | - Farhana E. Suleman
- Department of Radiology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Mark D. Velleman
- Department of Radiology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Vaida Glatt
- Department of Orthopaedic Surgery, University of Texas Health Science Center, San Antonio, Texas, U.S.A
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Sydney, Australia
- Department of Surgery, School of Medicine, University of Queensland, Queensland, Sydney, Australia
- Orthopaedic Research Institute of Australia, Sydney, Australia
| | - Erik Hohmann
- School of Medicine, University of Pretoria, Pretoria, South Africa
- Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates
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Dalmau-Pastor M, Malagelada F, Calder J, Manzanares MC, Vega J. The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments. Knee Surg Sports Traumatol Arthrosc 2020; 28:34-39. [PMID: 31754730 DOI: 10.1007/s00167-019-05794-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE A deep knowledge of lateral ankle ligaments is necessary to understand its function, pathophysiology and treatment options. The ankle lateral collateral ligament is formed by the anterior talofibular ligament (ATFL), the calcaneofibular (CFL) and the posterior talofibular ligament (PTFL). Although previous studies have reported connections between these ligaments on its lateral side, no studies have specifically assessed connections on the medial side. The aim of this study was to assess the morphology and consistency of the medial connections between the components of the lateral collateral ligament complex of the ankle. METHODS Forty fresh-frozen ankle specimens were dissected to look for connections between the three lateral ankle ligaments. After visualization of the lateral ligaments was achieved, the fibula was amputated and ligament insertions were released at the talar and calcaneal insertion points. Observation of the connections and video analysis of the dynamic relationships of ligament connections were performed. RESULTS Connections were found in all cases between the ATFL and PTFL, the ATFL and CFL, and the CFL and PTFL. Connections between ATFL and PTFL were not homogeneous. Although connections between the ATFLif and PTFL were noted in all cases (40), only 17 ankles (42.5%) had connections between the ATFLsf and PTFL. The amount of fibres of connection was also variable. CONCLUSION Connections between the three components of the lateral collateral ligament of the ankle may be observed from the medial aspect of the ankle, and this may have important implications for arthroscopic lateral ligament repair.
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Affiliation(s)
- M Dalmau-Pastor
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain. .,GRECMIP, MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, Minimally Invasive Foot and Ankle Society), Merignac, France. .,Vilamèdic Medical Center, Santa Coloma de Gramanet, Barcelona, Spain.
| | - F Malagelada
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain.,Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Calder
- Trauma and Orthopaedics, Chelsea and Westminster Hospital, London, UK
| | - M C Manzanares
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain
| | - J Vega
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain.,GRECMIP, MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, Minimally Invasive Foot and Ankle Society), Merignac, France.,Foot and Ankle Unit, iMove Tres Torres, Barcelona, Spain
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Seshadri DR, Magliato S, Voos JE, Drummond C. Clinical translation of biomedical sensors for sports medicine. J Med Eng Technol 2019; 43:66-81. [PMID: 31119965 DOI: 10.1080/03091902.2019.1612474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The digital health field has seen a surge in product development over the last decade, with product introductions ranging from wrist monitors, epidermal electronics, electronic pills and smart garments, much of these precipitated through the commercialisation and commoditisation of sensor technology. The emergence of wearable technology has recently garnered heightened interest by physicians and the general public. The convenient use of wireless technology to track and monitor physiological parameters, such as heart rate, distance, sleep and stress, has emerged to become relevant to patient care and human performance assessment. However, collecting data is not enough to inform clinical decision-making. It is essential to translate the acquired data into information relevant to clinicians. Our experiences tell us that team competencies must mirror the interdisciplinary technology itself. Thus, an interdisciplinary team blending expertise from engineering, medicine, and nursing is believed to be essential in translating wearable technology into the field. This review discusses the application of wearable sensors to monitor human performance assessment in domains necessitating accurate, reliable, and timely transmission of acquired bio-metric and bio-vital data. A key result disseminating from our investigations is the need to develop predictive models based off of the data acquired from wearable devices to necessitate the development of athlete-centred treatment plans to expedite the return-to-play time and to maximise performance.
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Affiliation(s)
- Dhruv R Seshadri
- a Department of Biomedical Engineering , Case Western Reserve University , Cleveland , OH , USA
| | - Samantha Magliato
- a Department of Biomedical Engineering , Case Western Reserve University , Cleveland , OH , USA
| | - James E Voos
- b University Hospitals Sports Medicine Institute , Cleveland , OH , USA
| | - Colin Drummond
- a Department of Biomedical Engineering , Case Western Reserve University , Cleveland , OH , USA
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Incidence of graft failure with Achilles tendon allograft combined with RetroScrewTM tibial fixation in primary anterior cruciate ligament reconstruction. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pękala Ł, Podgórski M, Shukla A, Winnicka M, Biernacka K, Grzelak P. Do variants of the intercondylar notch predispose children to the injury of the anterior cruciate ligament? Clin Anat 2019; 32:706-709. [DOI: 10.1002/ca.23382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/17/2019] [Accepted: 04/02/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Łukasz Pękala
- Department of Diagnostic ImagingPolish Mother's Memorial Hospital‐Research Institute Rzgowska 281/289, 93‐338 Lodz Poland
| | - Michał Podgórski
- Department of Diagnostic ImagingPolish Mother's Memorial Hospital‐Research Institute Rzgowska 281/289, 93‐338 Lodz Poland
| | - Abhinav Shukla
- Department of Diagnostic ImagingPolish Mother's Memorial Hospital‐Research Institute Rzgowska 281/289, 93‐338 Lodz Poland
| | - Monika Winnicka
- Department of Diagnostic ImagingPolish Mother's Memorial Hospital‐Research Institute Rzgowska 281/289, 93‐338 Lodz Poland
| | - Katarzyna Biernacka
- Department of Diagnostic ImagingPolish Mother's Memorial Hospital‐Research Institute Rzgowska 281/289, 93‐338 Lodz Poland
| | - Piotr Grzelak
- Department of Diagnostic ImagingPolish Mother's Memorial Hospital‐Research Institute Rzgowska 281/289, 93‐338 Lodz Poland
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Başdelioğlu K, Meriç G, Pündük Z, Akseki D, Atik A, Sargın S. Outcomes of isokinetic tests and functional assessment of anterior cruciate ligament reconstruction: Transtibial versus single anatomic femoral tunnel technique. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:86-91. [PMID: 30745028 PMCID: PMC6510667 DOI: 10.1016/j.aott.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 01/15/2023]
Abstract
Objective The aim of the study was to compare the outcomes of the transtibial and anatomical femoral single tunnel surgical techniques in ACL reconstruction. Methods A total of 30 patients, with 16 patients (15 males and 1 female; mean age: 27.2 ± 7.04) with anatomical femoral single-tunnel technique (AFT) and 14 (12 males and 2 females; mean age: 29.4 ± 8.82) with transtibial technique (TT) were included into the study. All patients were evaluated with isokinetic tests at an angular velocity of 60°/s and 180°/s and the IKDC and Lysholm tests were performed preoperatively and in third, sixth, and 12th months postoperatively. The results were compared between the groups. The mean follow-up time was 17.1 ± 6.48 months. Results Postoperative third month changes in extension parameters of peak torque (AFT: −93.286, TT: −61.500), peak work (AFT: −77.071, TT: −47.500), peak torque ext/kg (AFT: −1.182, TT: −0.773), peak work ext/kg (AFT: −0.982, TT: −0.604), peak work (AFT: −55.143 TT: −33.063) at an angular velocity of 60°/s and postoperative third month change in extension parameter of peak power (AFT: −86.786 TT: −54.875) at an angular velocity of 180°/s were found to be better in the transtibial group (p < 0.05) and postoperative sixth month peak torque (AFT: 1.429, TT: −5.688) value at an angular velocity of 60°/s was found to be less in the anatomical femoral single-tunnel group (p < 0.05). The IKDC (AFT: 94.671, TT: 90.025) (p < 0.05) and Lysholm (AFT: 96.714, TT: 92.375) (p < 0.05) scores of the anatomical femoral single-tunnel group were better than the transtibial group regarding to the postoperative final follow-up. There are positive intermediate correlations between preoperative IKDC and Lysholm scores with preoperative and postoperative some isokinetic test ratio (r = 0.539; p = 0.031), and preoperative peak power extension (r = 0.541; p = 0.030) at the both angular velocity of 60°/s and 180°/s in the transtibial group. There was no significant difference between the two groups with regards to the Lachman, anterior drawer and pivot shift tests (p < 0.05). Conclusion There were differences in terms of isokinetic parameters in early outcomes but there was no statistical difference between isokinetic parameters at the end of 1st year between two groups. There were some correlations between IKDC and Lysholm scores with some isokinetic parameters. Level of Evidence Level III, Therapeutic Study.
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