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Yeo MHX, Seah SJS, Gatot C, Yew A, Lie D. Selective bundle versus complete anterior-cruciate ligament reconstruction: A systematic review and meta-analysis. J Orthop 2022; 33:124-130. [PMID: 35983549 PMCID: PMC9379500 DOI: 10.1016/j.jor.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/10/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Selective bundle reconstruction (SLB) refers to preservation of the intact bundle and reconstruction of the ruptured bundle in a partial tear while complete ACL reconstruction involves the removal of all remnant tissue and reconstruction of one or both bundles. As the evidence for SLB versus complete ACL reconstruction remains unclear, this study aimed to compare the two techniques. This study's hypothesis was that SLB reconstruction allows better function and stability compared to complete ACL reconstruction. Methods A systematic search of PubMed, EMBASE, Scopus and Cochrane Library was conducted, identifying studies that compared SLB ('selective' group) versus complete ('complete' group) ACL reconstruction. Meta-analysis was conducted for post-operative functional scores, stability outcomes and complications as well as pre-operative to post-operative change. Results Eleven studies were included in the meta-analysis, with 1107 patients and a pooled mean follow-up of 29.5 months. Post-operatively, the Selective group had significantly reduced anterior laxity, shown by a lower mean arthrometry side-to-side difference (p<0.01). Analysis of change results showed that the Selective group had a lower mean improvement in arthrometry side-to-side difference as well (p<0.01). No significant difference was shown for all other post-operative outcomes. Conclusion This study provides valuable insight to the management of partial tears. It has demonstrated that the preservation of the intact bundle offers stability and function that is as good as complete reconstruction and that SLB is a potentially viable option in the management of partial tears. Level of evidence Meta-analysis; Level of evidence, 4.
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Affiliation(s)
- Mark HX Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, Singapore
| | - Shawn JS Seah
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, Singapore
| | - Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
| | - Andy Yew
- Division of Musculoskeletal Science, Singapore General Hospital, 1 Outram Road, Singapore
| | - Denny Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
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Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci 2020; 25:6-45. [PMID: 31843222 DOI: 10.1016/j.jos.2019.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). METHODS The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature. CONCLUSIONS This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.
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Affiliation(s)
- Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Japan
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Lim CR, Henson T, Ebert J, Annear P. Anterior cruciate ligament reconstruction using a double bundle hamstring autograft configuration in patients under 30 years. World J Orthop 2019; 10:446-453. [PMID: 31908993 PMCID: PMC6937423 DOI: 10.5312/wjo.v10.i12.446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/21/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) has a high incidence of re-tear in younger patients. Despite comparable functional outcomes, the incidence of re-tear using single and double bundle ACLR methods has not been well reported.
AIM To hypothesize that double bundle hamstring ACLR has a lower graft rupture rate compared with single bundle hamstring ACLR grafts in young patients.
METHODS One hundred and twelve patients < 30 years of age at the time of primary double bundle ACLR were eligible for study participation. 91 (81.3%) could be contacted, with a mean age of 20.4 years (range 13-29) and mean post-operative follow-up time of 59 mo (range 25-107). Telephone questionnaires evaluated the incidence (and timing) of subsequent re-tear and contralateral ACL tear, further surgeries, incidence and time to return to sport, and patient satisfaction.
RESULTS Of the 91 patients, there were 6 (6.6%, 95%CI: 1.4-11.7) ACL graft re-ruptures, with a mean time to re-rupture of 28 mo (range 12-84). Fourteen patients (15.4%) experienced a contralateral ACL rupture and 14 patients (15.4%) required further surgery to their ipsilateral knee. fifty patients (54.9%) returned to pre-injury level of sport. Of those < 20 years (n = 45), 4 patients (8.9%, 95%CI: 0.4-17.3) experienced a re-rupture, with mean time to re-injury 15 mo (range 12-24). Comparative analysis with existing literature and revealed a non-significant Chi-squared statistic of 2.348 (P = 0.125).
CONCLUSION A trend existed toward lower graft rupture rates in young patients undergoing double bundle ACLR utilizing a hamstring autograft, compared with rates reported after single bundle ACLR.
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Affiliation(s)
- Christopher Reece Lim
- Department of Orthopaedics, Sir Charles Gairdner Hospital, Western Australia, Nedlands 6009, Australia
| | - Tamalee Henson
- Fiona Stanley Hospital, Western Australia, Murdoch 6150, Australia
| | - Jay Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Western Australia, Crawley 6009, Australia
| | - Peter Annear
- Perth Orthopaedic and Sports Medicine Centre, Western Australia, West Perth 6005, Australia
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Lim CR, Henson T, Ebert J, Annear P. Anterior cruciate ligament reconstruction using a double bundle hamstring autograft configuration in patients under 30 years. World J Orthop 2019. [DOI: 10.5312/wjo.v10.i12.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Li B, Wang GB, Wang YF, Zhou BZ. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. Knee 2018; 25:445-452. [PMID: 29685502 DOI: 10.1016/j.knee.2018.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/23/2017] [Accepted: 02/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effects of retaining residual bundles on surgical outcomes has not been observed, so we evaluated the effects of preoperative knee laxity on clinical outcomes after partial anterior cruciate ligament (ACL) reconstruction for partial ACL rupture in this study. PURPOSE To evaluate the effects of preoperative knee laxity on clinical outcomes after partial anterior cruciate ligament (ACL) reconstruction for partial ACL rupture. METHODS The data of 47 patients, who had partial ACL rupture and underwent partial ACL reconstruction, were retrospectively analyzed. According to preoperative kneelax arthrometer and pivot shift test, the 47 patients were divided into group A (kneelax arthrometer ≤5mm and pivot shift test <II grade, n=26) and group B (kneelax arthrometer >5mm and/or pivot shift test ≥II grade, n=21). The minimum follow-up duration lasted 2 years. The clinical outcomes were evaluated using IKDC (International Knee Documentation Committee) scoring systems, Lysholm knee scoring scale, Tegner activity rating, Lachman test, Pivot shift test and the kneelax arthrometer. RESULTS The function and stability examinations for the affected knee joint were significantly improved in both groups after partial ACL reconstruction as compared with preoperative ones (all P<0.01). There were no significant differences in the post-operative Lysholm and Tegner scores, Lachman and Pivot shift test results between both groups (all P>0.05). However, there were significant differences between the two groups in terms of the post-operative IKDC scoring system and kneelax arthrometer examination result (all P<0.05). CONCLUSIONS In the patients with partial ACL rupture, the mechanical strength of the remnant ligament has significant influence on the therapeutic effects of partial reconstruction. The patients with kneelax arthrometer >5mm and/or pivot shift test ≥II grade still have anterior instability in the affected knee after partial reconstruction.
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Affiliation(s)
- Bin Li
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China.
| | - Guang-Bin Wang
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yan-Fang Wang
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China
| | - Bing-Zheng Zhou
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital, China Medical University, Shenyang, China
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Clinical outcomes and biomechanical analysis of posterolateral bundle augmentation in patients with partial anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 2017; 25:1279-1289. [PMID: 26162801 DOI: 10.1007/s00167-015-3691-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 06/30/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE To examine the clinical and biomechanical results of posterolateral (PL) augmentation to reconstruct damaged PL bundle while preserving the less-damaged anteromedial bundle for partial anterior cruciate ligament (ACL) tears in comparison with double-bundle ACL reconstruction. METHODS Sixteen patients who underwent PL augmentation for partial ACL tears (Group P) and 37 patients who underwent double-bundle ACL reconstructions for complete ACL tears were examined (Group D). Anterior tibial translation (ATT) was evaluated using the KT-1000 arthrometer. ATT during the Lachman test and acceleration of posterior tibial translation (APT) during the pivot shift test were evaluated using an electromagnetic measurement system (EMS). Clinical outcomes were evaluated using the Lysholm score. Second-look arthroscopy was performed 1 year after surgery. RESULTS The mean postoperative Lysholm scores were 91.7 ± 12.2 and 94.6 ± 7.2 in Groups P and D, respectively, and there was no statistically significant difference between the two groups. The mean side-to-side difference of ATT on the KT-1000 was significantly improved in both Groups P and D. In the EMS analysis, the mean side-to-side difference of ATT and the mean APT were significantly improved in both Groups P and D. There was no significant difference in the second-look evaluation between the two groups. CONCLUSIONS The clinical and biomechanical outcomes of PL augmentation were satisfactorily comparable to those of double-bundle ACL reconstruction. PL augmentation could be a useful treatment option for patients with partial ACL tears. LEVEL OF EVIDENCE IV.
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Ochi M, Georgoulis AD, Nakamae A. ACL Augmentation. CONTROVERSIES IN THE TECHNICAL ASPECTS OF ACL RECONSTRUCTION 2017:313-324. [DOI: 10.1007/978-3-662-52742-9_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Is anterior cruciate ligament preservation surgery better than reconstructing both bundles? CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Ochi M, Nakamae A. History and Advantages of ACL Augmentation. ACL INJURY AND ITS TREATMENT 2016:335-348. [DOI: 10.1007/978-4-431-55858-3_27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Lu W, Wang D, Zhu W, Li D, Ouyang K, Peng L, Feng W, Li H. Placement of Double Tunnels in ACL Reconstruction Using Bony Landmarks Versus Existing Footprint Remnant: A Prospective Clinical Study With 2-Year Follow-up. Am J Sports Med 2015; 43:1206-14. [PMID: 25748471 DOI: 10.1177/0363546515570850] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The outcomes of double-bundle anterior cruciate ligament reconstruction (DB-ACLR) are becoming controversial. One of the main reasons for the controversy is the techniques for bone tunnel placement. The common technique to place the bone tunnels is to use bony landmarks, while a new approach uses footprint remnants. PURPOSE To investigate if placement of double tunnels using bony landmarks produces the same clinical results as that of using existing footprint remnants. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A total of 72 male patients were randomly divided into 2 groups of 36 patients each: (A) DB-ACLR tunnel placement using the footprint remnant procedure (EF group) and (B) DB-ACLR tunnel placement using the bony landmark procedure (BL group). All patients were evaluated before and after surgery. Outcomes were measured by KT-2000 arthrometer side-to-side difference, pivot-shift test, and Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores. Second-look arthroscopic evaluations were performed in 59 cases (28 and 31 cases in the EF and BL groups, respectively). RESULTS The mean follow-up time was 36.9±4.8 months. Postoperative 3-dimensional computed tomography scans showed that bone sockets were variable on both femoral and tibial sides in the EF group and almost consistent in the BL group. All of the evaluation indexes were significantly improved postoperatively in both groups. There were no revision cases in the EF group and 2 in the BL group. The EF group showed a faster range of motion (ROM) recovery (at 0° to 120°) than did the BL group. At final follow-up, there was no significant difference between the EF and BL groups in Tegner score (5.88±1.39 vs 5.16±1.76; P=.058) or pivot-shift test (34 vs 32; P=.067). The EF group had a larger proportion of patients with IKDC grade A (normal) (33 vs 24; P<.020), smaller side-to-side difference (0.68±0.38 mm vs 1.23±0.61 mm; P<.001), higher Lysholm score (91.29±4.90 vs 88.71±5.09; P=.032), and better second-look arthroscopic evaluations for graft quality in the anteromedial (P=.034), posterolateral (P=.015), and combined bundles (P=.029) compared with the BL group. CONCLUSION Although both techniques provided satisfactory clinical results, DB-ACLR using the existing footprint remnant for tunnel placement showed better functional results with respect to faster ROM recovery, higher subjective outcome scores, and better arthroscopic second-look with no revision cases.
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Affiliation(s)
- Wei Lu
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Daping Wang
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Weiming Zhu
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Dingfu Li
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Kan Ouyang
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Liangquan Peng
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Wenzhe Feng
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
| | - Hao Li
- Department of Sports Medicine, 1st Affiliated Hospital, Shenzhen University, Shenzhen, China
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