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Cheng R, Yao G, Dimitriou D, Jiang Z, Yang Y, Tsai TY. The 45° and 60° of sagittal femoral tunnel placement in anterior cruciate ligament reconstruction provide similar knee stability. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38973630 DOI: 10.1002/ksa.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 06/03/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE The aim of the present study was to compare 45° and 60° of sagittal femoral tunnel angles in terms of anterior tibial translation (ATT), valgus angle and graft in situ force following anterior cruciate ligament reconstruction (ACLR). METHODS Ten porcine knees were subjected to the following loading conditions: (1) 89 N anterior tibial load at 35° (full extension), 60° and 90° of knee flexion and (2) 5 N m valgus tibial moment at 35° and 45° of knee flexion. ATT and graft in situ force of the intact anterior cruciate ligament (ACL) and ACLR were collected using a robotic universal force/moment sensor (UFS) testing system for (1) ACL intact, (2) ACL-deficient (ACLD) and (3) two different ACLR using different sagittal femoral tunnel angles (coronal 45°/sagittal 45° and coronal 45°/sagittal 60°). RESULTS During the anterior tibial load, the femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° and 60° had significantly higher ATT than that of the ACL-intact knees at 60° of knee flexion (p < 0.05). The femoral tunnel angle of ACLR knees at coronal 45°/sagittal 60° had significantly lower graft in situ force than that of the ACL-intact knees at 60° and 90° of knee flexion (p < 0.05). During the valgus tibial moment, the femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° and 60° had significantly lower graft in situ force than that of the ACL-intact knees at all knee flexions (p < 0.05). CONCLUSIONS The femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° provided similar ATT, valgus angle and graft in situ force to that of ACLR knees at coronal 45°/sagittal 60°. Therefore, both femoral tunnel angles could be used in ACLR, as the sagittal femoral tunnel angle does not appear to be relevant in post-operative knee stability. LEVEL OF EVIDENCE Not applicable.
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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 for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Gai Yao
- The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Dimitris Dimitriou
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Ziang Jiang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Yangyang Yang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to 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 for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
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Lombardo-Torre M, Espejo-Reina A, Sevillano-Pérez E, Verdejo-Parrilla M, Espejo-Reina MJ, Espejo-Baena A. Graft Reorientation and Lateral Extra-articular Tenodesis in Revision Surgery for Persistent Rotational Instability of a Verticalized Anterior Cruciate Ligament Graft. Arthrosc Tech 2024; 13:102872. [PMID: 38435265 PMCID: PMC10907980 DOI: 10.1016/j.eats.2023.10.014] [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: 08/01/2023] [Accepted: 10/30/2023] [Indexed: 03/05/2024] Open
Abstract
Persistent rotational instability after anterior cruciate ligament reconstruction is a relatively common postoperative complication, typically associated with graft verticalization due to improper femoral tunnel placement, especially with classic transtibial femoral tunnel techniques. This article describes a technique designed to reorient a verticalized anterior cruciate ligament graft at its femoral insertion to a more anatomic position in the coronal and sagittal planes, aiming to restore knee stability without the need for a complete revision operation. Additionally, a lateral extra-articular tenodesis with fascia lata is added to reinforce rotational stability.
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Affiliation(s)
- Maximiano Lombardo-Torre
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vithas Málaga, Málaga, Spain
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Alejandro Espejo-Reina
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vithas Málaga, Málaga, Spain
- Clínica Espejo, Málaga, Spain
| | | | | | | | - Alejandro Espejo-Baena
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vithas Málaga, Málaga, Spain
- Clínica Espejo, Málaga, Spain
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Moon HS, Choi CH, Yoo JH, Jung M, Lee TH, Hong KB, Kim SH. Graft isometry during anatomical ACL reconstruction has little effect on surgical outcomes. Knee Surg Sports Traumatol Arthrosc 2022; 30:1594-1604. [PMID: 34264371 DOI: 10.1007/s00167-021-06654-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/01/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the surgical outcomes of anatomical anterior cruciate ligament (ACL) reconstruction according to the graft isometry measured during surgery. METHODS Electrical medical records of patients who underwent an arthroscopic ACL reconstruction through the transportal technique using hamstring tendon autograft between 2012 and 2016 were retrospectively reviewed. The patients were classified into two groups based on the graft length change throughout the knee range of motion measured just before graft fixation (Group 1, graft length change ≤ 2 mm; Group 2, graft length change > 2 mm). Comparative analyses, including a non-inferiority trial, were performed regarding the clinical scores, knee laxity, and radiographic parameters between the groups. RESULTS A total of 67 patients were included in the study. The total change in the length of ACL graft throughout the knee range of motion was 1.4 ± 0.4 mm in Group 1 (range, 0.2-2.0 mm), and 3.0 ± 0.7 mm in Group 2 (range, 2.2-5.0 mm). Group 1 showed a relatively high (proximal) femoral tunnel and shallow (anterior) tibial tunnel compared to Group 2 (P < 0.001 and P = 0.028, respectively), but there were no apparent differences in the macroscopic view. There were no statistically significant differences in the clinical outcomes between groups at 2 years after surgery, which satisfied the non-inferiority criterion of Group 1 in terms of clinical scores and knee laxity compared to Group 2. CONCLUSION The surgical outcomes of anatomical ACL reconstruction in patients with non-isometric ACL graft were not inferior in terms of clinical scores and knee laxity, compared to those with nearly-isometric ACL graft. The graft tunnel placement in the isometric position during anatomical ACL reconstruction, which is technically challenging in the clinical setting, is not a crucial factor in terms of clinical outcomes. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Je-Hyun Yoo
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Ho Lee
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20 Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea
| | - Kee-Bum Hong
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 20 Eonju-ro 63-gil, Gangnam-gu, Seoul, 06229, Republic of Korea.
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Lee DK, Kim JH, Lee SS, Lee BH, Kim H, Kim J, Wang JH. Femoral Tunnel Widening After Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Autograft Produces a Small Shift of the Tunnel Position in the Anterior and Distal Direction: Computed Tomography-Based Retrospective Cohort Analysis. Arthroscopy 2021; 37:2554-2563.e1. [PMID: 33745939 DOI: 10.1016/j.arthro.2021.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the femoral tunnel position remains in an anatomical footprint after tunnel widening and shifting. METHODS Patients who underwent unilateral double-bundle anterior cruciate ligament reconstruction with hamstring autograft and performed computed tomography scan evaluation at the time of 5 days and 1 year postoperatively were included in this retrospective cohort study. Three-dimensional models of the femur and femoral tunnels were reconstructed from computed tomography scan data. The location of the tunnel center and tunnel margins in the anatomical coordinate system, and the mean shifting distance of tunnel center and margin were measured with image analysis software during the period. The change of tunnel center location in Bernard quadrant was confirmed if the tunnel center remained within the boundaries of anatomical position after tunnel widening. RESULTS A total of 56 patients satisfied the inclusion criteria. The mean shifting distance of AM and PL tunnel centers were 1.7 ± 0.9 mm and 1.6 ± 0.6 mm. The Tunnel margin of the anteromedial (AM) and posteromedial (PL) tunnels were shifted to 2.5 ± 1.3 mm and 2.6 ± 1.4 mm in the anterior direction, and 1.4 ± 0.9 mm and 1.0 ± 0.7 mm in the distal direction, respectively. Among the anatomical located tunnel, 97% (32/33) and 87.1% (27/31) of AM and PL tunnel centers remained in a range of anatomical footprint. The tunnel center was shifted from the anatomical position into a nonanatomical position in 3% (1/33) of the AM tunnel and 12.9% (4/31) of PL tunnel after tunnel widening. The tunnel location which shifted nonanatomically were relatively anterior and distal position. CONCLUSIONS Tunnel widening shifts the tunnel position to the anterior and distal direction, which could change the initial tunnel position. Nevertheless, the majority of tunnel positions remained in the anatomical position after tunnel widening and shifting. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Sung-Sahn Lee
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyeonsoo Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jinwoo Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea; Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
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Stone AV, Chahla J, Manderle BJ, Beletsky A, Bush-Joseph CA, Verma NN. ACL Reconstruction Graft Angle and Outcomes: Transtibial vs Anteromedial Reconstruction. HSS J 2020; 16:256-263. [PMID: 33380955 PMCID: PMC7749890 DOI: 10.1007/s11420-019-09707-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The importance of creating an anatomic anterior cruciate ligament (ACL) reconstruction has been receiving significant attention. The best technique by which to achieve this anatomic reconstruction continues to be debated. The two most common methods are the transtibial (TT) and anteromedial (AM) techniques. Each has its advantages and disadvantages, and the literature comparing the two remains uncertain. QUESTIONS/PURPOSES In this prospective comparative study, we aimed to compare the ACL graft and tunnel angles achieved using the anatomic transtibial (TT) and anteromedial (AM) techniques; compare the ACL graft and tunnel angles in knees that have undergone ACL reconstruction and knees with intact ACLs; and determine whether differences in the graft or tunnel angle produce differences in clinical outcomes, as measured using both physical exam and patient-reported outcomes, after ACL reconstruction. METHODS Patients who underwent primary ACL reconstruction with bone-tendon-bone grafts using a TT or AM technique were included. Femoral graft angle (FGA), tibial graft angle (TGA), and sagittal orientation of the reconstructed ACL and contralateral native ACL were measured on post-operative magnetic resonance imaging. Post-operatively, patients underwent measurement of knee stability and completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) survey. RESULTS Twenty-nine patients were enrolled (AM group, 14; TT group, 15); at follow-up, KOOS data were available for 26 patients (13 in each group). There were no differences in sagittal ACL graft angle between groups or in comparison with the normal knee. The FGA was more vertical after TT reconstructions; the TGA was comparable between groups. There were no significant differences in 2-year post-operative physical exam measurements or in KOOS scores. CONCLUSION Anatomic ACL angle was restored after reconstruction with both the TT and AM techniques, despite different FGAs. No significant differences in clinical outcome were noted between groups on physical exam or KOOS at 2 years after surgery. These results suggest that TT reconstruction results in a graft position similar to that seen in AM reconstruction and that the location of the intra-articular tunnel aperture matters more than the orientation of the tunnel.
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Affiliation(s)
- Austin V. Stone
- grid.266539.d0000 0004 1936 8438Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY USA
| | - Jorge Chahla
- grid.240684.c0000 0001 0705 3621Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA
| | - Brandon J. Manderle
- grid.240684.c0000 0001 0705 3621Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA
| | - Alexander Beletsky
- grid.240684.c0000 0001 0705 3621Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA
| | - Charles A. Bush-Joseph
- grid.240684.c0000 0001 0705 3621Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA
| | - Nikhil N. Verma
- grid.240684.c0000 0001 0705 3621Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60616 USA
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Cho WJ, Kim JM, Kim DE, Lee JG, Park JW, Han YH, Seo HG. Accuracy of the femoral tunnel position in robot-assisted anterior cruciate ligament reconstruction using a magnetic resonance imaging-based navigation system: A preliminary report. Int J Med Robot 2018; 14:e1933. [PMID: 29952064 DOI: 10.1002/rcs.1933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 05/16/2018] [Accepted: 05/23/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Tunnel misplacement is a common cause of failed anterior cruciate ligament (ACL) reconstruction. In this study, the accuracy of the femoral tunnel position was evaluated in robot-assisted ACL reconstruction using a magnetic resonance imaging (MRI)-based navigation system. We hypothesized that a difference of less than 2 mm between the planned femoral tunnel position and the created one was achievable. METHODS Four cadaveric knees underwent robot-assisted ACL reconstruction. A 3-dimensional model using pre-operative MRI images was used for preoperative planning, and a computed tomography (CT) scan was performed postoperatively. The planned and the created femoral tunnels were compared to assess the accuracy of the femoral tunnel position. RESULTS The distance between the intra-articular points of the planned and the created tunnels was 7.78 mm in the first experiment and 1.47 mm in the last one. The difference in tunnel length was 4.62 mm in the first experiment and 0.99 mm in the last one. CONCLUSIONS Accuracy of the femoral tunnel position improved with each robot-assisted ACL reconstruction using an MRI-based navigation system. In the last experiment, the accuracy of the femoral tunnel position was satisfactory.
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Affiliation(s)
- Won-Joon Cho
- Bonbridge Hospital, Investigation performed at the University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Min Kim
- Asan Medical Center, Investigation performed at the University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Eun Kim
- Hospital Run, Investigation performed at the University of Ulsan College of Medicine, Seoul, South Korea
| | - June-Goo Lee
- Asan Medical Center, Investigation performed at the University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun-Woo Park
- Curexo Inc., Investigation performed at the University of Ulsan College of Medicine, Seongnam, South Korea
| | - Yong-Hee Han
- Curexo Inc., Investigation performed at the University of Ulsan College of Medicine, Seongnam, South Korea
| | - Hyun-Gi Seo
- Corelinesoft, Co., Ltd, Investigation performed at the University of Ulsan College of Medicine, Seoul, South Korea
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The iliotibial band and anterolateral capsule have a combined attachment to the Segond fracture. Knee Surg Sports Traumatol Arthrosc 2018; 26:1305-1310. [PMID: 28447141 DOI: 10.1007/s00167-017-4549-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/10/2017] [Indexed: 01/26/2023]
Abstract
The purpose of this report was to describe the injury mechanism, surgical findings, and outcomes in a 21-year-old professional female football player who presented with a complete anterior cruciate ligament (ACL) rupture and Segond fracture. Interview and video analysis were performed to elicit the injury mechanism. Clinical examination and imaging revealed a complete ACL tear, Segond fracture, lateral meniscus tear, MCL sprain, and posterolateral corner sprain. Examination under anaesthesia revealed Grade 2 pivot shift and varus/valgus instability. Surgical examination revealed attachment of the posterior fibres of the iliotibial band and the lateral capsule to the Segond fragment. The fracture was reduced with suture fixation, and an anatomic ACL reconstruction was performed. Follow-up demonstrated rotatory and anterior tibial translation stability, and imaging at 7 months post-operatively revealed no movement and continued osseous integration of the Segond fragment. Level of evidence V.
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8
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Mathew M, Dhollander A, Getgood A. Anterolateral Ligament Reconstruction or Extra-Articular Tenodesis: Why and When? Clin Sports Med 2017; 37:75-86. [PMID: 29173559 DOI: 10.1016/j.csm.2017.07.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Residual rotational laxity following anterior cruciate ligament (ACL) reconstruction has been identified as significant concern in many patients, despite evolution of techniques. The expanding body of knowledge on the anatomy and biomechanics of the anterolateral soft tissue restraints in rotational control of the knee has reignited an interest in extra-articular reconstruction techniques for augmenting ACL reconstruction. Reconstruction techniques currently used can be broadly categorized as either lateral extra-articular tenodesis or reconstruction of the anterolateral ligament. In this article, we outline the relevant anatomy, biomechanics, and rationale behind the indications and technique of our current extra-articular augmentation procedure.
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Affiliation(s)
- Manoj Mathew
- The Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Aad Dhollander
- The Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Alan Getgood
- The Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
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Evaluation of pivot shift phenomenon while awake and under anaesthesia by different manoeuvres using triaxial accelerometer. Knee Surg Sports Traumatol Arthrosc 2017; 25:2377-2383. [PMID: 26233597 DOI: 10.1007/s00167-015-3740-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/24/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Evaluating pivot shift phenomenon is difficult due to its subjectivity, wide variation of testing manoeuvres, and difficulty in evaluating patients while awake. The purpose of this study was to evaluate the pivot shift phenomenon using a triaxial accelerometer by two different manoeuvres, the pivot shift test as representative of flexion manoeuvre and N test as a representative of extension manoeuvre, and in two different conditions, awake and under anaesthesia. METHODS Twenty-nine patients with unilateral anterior cruciate ligament (ACL)-injured knee were included. Pivot shift test and N test were performed for both injured and uninjured legs while awake and under anaesthesia, with the acceleration measurements using a triaxial accelerometer (KiRA). The tests were also subjectively graded on a scale of 0-6 based on the modification of IKDC criteria. RESULTS Under anaesthesia, acceleration of ACL-injured knees was greater than that of uninjured knees in both pivot shift test (P < 0.001) and N test (P < 0.001) , whereas the acceleration value was greater in the N test. Furthermore, there were significant positive correlations between the acceleration and subjective grading in both tests, whereas the N test was more significant than the pivot shift test. On the other hand, there was no statistical significance in acceleration between ACL-injured and uninjured knees in either test while the patient was awake. CONCLUSION The triaxial accelerometer was useful to objectively detect and quantitatively evaluate the pivot shift phenomenon by both the pivot shift test and N test under anaesthesia. The acceleration of ACL-injured knees was greater than that of uninjured knees, and the acceleration was correlated with the subjective manual grading, especially in the N test. On the other hand, its use while the patient was awake was likely limited. LEVELS OF EVIDENCE Diagnostic study of non-consecutive patients without a universally applied gold standard, Level III.
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Wang JH, Lee DK, Chung ST, Lee BH. Influence of change of tunnel axis angle on tunnel length during double-bundle ACL reconstruction via the transportal technique. BMC Musculoskelet Disord 2017; 18:237. [PMID: 28569166 PMCID: PMC5452363 DOI: 10.1186/s12891-017-1599-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Commercially available flexible reamer and curved guide systems allow a certain degree of control over intra-articular tunnel orientation, therefore allows a wide range of intra-osseous femoral tunnel orientations, contrary to the femoral tunneling technique using a straight guide pin, which are determined by knee flexion angle. We sought to find the clinical relevance of intra-osseous femoral tunnel orientations in the respect of tunnel length. To evaluate the relationship between the tunnel axis angle in three orthogonal planes and tunnel length in the anteromedial (AM) and posterolateral (PL) femoral tunnels in patients who underwent anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the transportal (TP) technique with a 42o curved guide. METHODS A total of 40 patients who underwent primary DB-ACLR with the TP technique using a curved guide were evaluated retrospectively. The tunnel axis angle in three orthogonal planes were evaluated on a three-dimensional surface model constructed using an axial computed tomography scan obtained after reconstruction. Then, correlations with tunnel length were analyzed. RESULTS In the AM tunnel, tunnel axis angles in the coronal (β = 0.0252, p = 0.022) and sagittal (β = 0.0168, p = 0.029) plane showed significant correlations with tunnel length, while the axial plane did not (p = 0.493) (adjusted R2 = 0.801). In the PL tunnel, only tunnel axis angles in the axial plane (β = 0.0262, p = 0.008) showed a significant relationship with tunnel length (adjusted R2 = 0.700). CONCLUSION Drilling at a higher angle in the coronal and sagittal planes in AM tunnels and at a higher angle in the axial plane in PL tunnels decreases the incidence of short femoral tunnels.
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Affiliation(s)
- Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea
| | - Do Kyung Lee
- Department of Orthopaedic Surgery, Konyang University Hospital, 158, Gwanjeodong-ro, Seo-gu, Daejeon, South Korea
| | - Sung Taek Chung
- Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, South Korea
| | - Byung Hoon Lee
- Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, South Korea.
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11
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Schreiber VM, Jordan SS, Bonci GA, Irrgang JJ, Fu FH. The evolution of primary double-bundle ACL reconstruction and recovery of early post-operative range of motion. Knee Surg Sports Traumatol Arthrosc 2017; 25:1475-1481. [PMID: 27743079 DOI: 10.1007/s00167-016-4347-z] [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: 04/18/2016] [Accepted: 09/27/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to analyse early post-operative range of motion (ROM) as our anatomic double-bundle (DB) anterior cruciate (ACL) reconstruction technique with respect to tunnel placement evolved. It is the hypothesis of this study that more anatomic placement of the femoral insertion site of the anteromedial (AM) bundle of the ACL results in better restoration of early post-operative knee range of motion. METHODS Two methods of DB ACL reconstruction regarding more accurate placement of the femoral AM tunnel in relation to its anatomic origin were compared. Patients presenting for 1- and 3-month post-operative clinical visits were examined for passive extension and active flexion by members of the clinical staff. Only patients undergoing primary DB reconstruction with allograft were included in the analyses. To determine the effects of the modified AM bundle placement on recovery of post-operative ROM, patients undergoing surgery in the 6 months before July 2006 (Group A, n = 50) were compared to patients undergoing surgery in the 6 months after July 2006 (Group B, n = 49). RESULTS A total of 99 patients met the inclusion criteria. More accurate placement of the AM bundle of the ACL was associated with a smaller side-to-side difference in flexion at 1 month (n.s.) and at 3 months (3° reduction, p < 0.03) after surgery. There was no effect on extension (n.s.) CONCLUSION: More anatomic placement of the femoral insertion of the AM bundle was associated with improved knee flexion. The study translates the findings of previous anatomic basic science research to demonstrate improved restoration of normal joint motion. This ideally leads to improved long-term clinical outcomes and maintenance of joint and cartilage health. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Verena M Schreiber
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 5th Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | | | - Gregory A Bonci
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 5th Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 5th Avenue, Suite 1011, Pittsburgh, PA, 15213, USA.
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Nakamura K, Koga H, Sekiya I, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Muneta T. Dynamic Evaluation of Pivot-Shift Phenomenon in Double-Bundle Anterior Cruciate Ligament Reconstruction Using Triaxial Accelerometer. Arthroscopy 2016; 32:2532-2538. [PMID: 27296869 DOI: 10.1016/j.arthro.2016.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/12/2016] [Accepted: 04/19/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of initial graft tension on rotational stability and to determine the minimum required tension (MRT) based on the pivot-shift phenomenon in isolated anteromedial bundle (AMB), isolated posteromedial bundle (PLB), and double-bundle anterior cruciate ligament (ACL) reconstructions using a triaxial accelerometer during surgery. METHODS Primary double-bundle ACL reconstructions were included. The pivot-shift test and N-test were performed before and during surgery with the acceleration measurements using a triaxial accelerometer. The pivot-shift test was also manually graded. The AMB and PLB were fixed to a graft tensioning system during surgery with the following settings: (1) AMB only (AMB), (2) PLB only (PLB), and (3) AMB and PLB (A+P). The total graft tension was first set at 20 N and then was increased in increments of 10 N until the pivot-shift test became negative, which was defined as the MRT in each setting. RESULTS Twenty-five patients were evaluated. The MRT in the AMB setting averaged 26 N (range, 20 to 40 N); in the PLB setting, 28 N (range, 20 to 40 N); and in the A+P setting, 24 N (range, 20 to 40 N). The MRT in the A+P setting was significantly smaller than that in the PLB setting (P = .008). The acceleration in the A+P setting was significantly smaller than that in the AMB and PLB settings both in the pivot-shift test (vs AMB: P = .007, vs PLB: P = .011) and in the N-test (vs AMB: P < .001, vs PLB: P < .001). CONCLUSIONS Double-bundle ACL reconstruction better controlled rotational stability with smaller MRT than isolated PLB reconstruction at the time of surgery. In double-bundle reconstruction, the MRT based on the pivot-shift phenomenon could be larger than previously reported MRT based on anteroposterior laxity. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Kaori Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Toshifumi Watanabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Tomoyuki Mochizuki
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Masafumi Horie
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Koji Otabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
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13
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Debandi A, Maeyama A, Hoshino Y, Asai S, Goto B, Smolinski P, Fu FH. The Influence of Knee Flexion Angle for Graft Fixation on Rotational Knee Stability During Anterior Cruciate Ligament Reconstruction: A Biomechanical Study. Arthroscopy 2016; 32:2322-2328. [PMID: 27189870 DOI: 10.1016/j.arthro.2016.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 02/21/2016] [Accepted: 03/11/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the effect of knee flexion angle for hamstring graft fixation, full extension (FE), or 30°, on acceleration of the knee motion during pivot-shift testing after either anatomic or nonanatomic anterior cruciate ligament (ACL) reconstruction using triaxial accelerometry. METHODS Two types of ACL reconstructions (anatomic and nonanatomic) using 2 different angles of knee flexion during graft fixation (FE and 30°) were performed on 12 fresh-frozen human knees making 4 groups: anatomic-FE, anatomic-30°, nonanatomic-FE, and nonanatomic-30°. Manual pivot-shift testing was performed at ACL-intact, ACL-deficient, and ACL-reconstructed conditions. Three-dimensional acceleration of knee motion was recorded using a triaxial accelerometer. RESULTS The anatomic-30° group showed the smallest overall magnitude of acceleration among the ACL-reconstructed groups (P = .0039). There were no significant differences among the anatomic-FE group, the nonanatomic-FE group, and the nonantomic-30° group (anatomic-FE vs nonanatomic-FE, P = .1093; anatomic-FE vs nonanatomic-30°, P = .8728; and nonanatomic-FE vs nonanatomic-30°, P = .1093). After ACL transection, acceleration was reduced by ACL reconstruction with the exception of the nonanatomic-FE group that did not show a significant difference when compared with the ACL-deficient (P = .4537). CONCLUSIONS The anatomic ACL reconstruction with the graft fixed at 30° of knee flexion better restored rotational knee stability compared with FE. An ACL graft fixed with the knee at FE in anatomic position did not show a significant difference compared with the nonanatomic ACL reconstructions. CLINICAL RELEVANCE Knee flexion angle at the time of graft fixation for ACL reconstruction can be considered to maximize the rotational knee stability.
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Affiliation(s)
- Aníbal Debandi
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Akira Maeyama
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Shigehiro Asai
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Bunsei Goto
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A..
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14
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Clinical advantages of image-free navigation system using surface-based registration in anatomical anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:3556-3564. [PMID: 27761623 DOI: 10.1007/s00167-016-4332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/14/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the clinical advantages of a navigation system developed with an emphasis on attaining an appropriate femoral tunnel length and posterior wall margin with no posterior wall blowout, as well as having accurate tunnel positioning, in anatomical anterior cruciate ligament reconstruction (ACLR). METHODS Ten freshly frozen human knees were transected at mid-femur and mid-tibia. Each knee specimen underwent arthroscopic single-bundle anterior cruciate ligament reconstruction using the outside-in technique, with two knees by manual ACLR (control group) and another eight knees by only the navigational ACLR without arthroscopic assistance (experimental group). The position/orientation information of tunnel entry point, tunnel length, and posterior wall distance of pre-, intra-, and postoperative tunnel were recorded, and the reliability and errors among them were evaluated. RESULTS From comparison of the 3D models for preoperative planning and postoperative reconstruction, the mean differences for navigational femoral tunnelling and arthroscopic-assisted femoral tunnelling were recorded, respectively: (1) tunnel entry position, 1.4 mm (SD 0.3) versus 4.9 mm; (2) tunnel length, 0.7 mm (SD 0.2), similar to 0.6 mm in arthroscopic-assisted femoral tunnelling, and (3) posterior wall distance, 0.5 mm (SD 0.2), much smaller than 4.7 mm for arthroscopic-assisted femoral tunnelling. The intraclass correlation coefficients, calculated to determine the accuracy and reliability of navigational femoral tunnelling, showed excellent internal consistency that ranged from 0.965 to 0.989 for tunnel length and from 0.810 to 0.953 for posterior wall distance. CONCLUSION Navigation systems with enhancement of the registration accuracy by the developed system are feasible in anatomical ACLR, in reducing surgical failures such as short tunnel length or posterior wall breakage of distal femur. The present study revealed that computer navigation could aid in avoiding major mistakes in exact positioning and posterior wall blowout and help in attaining appropriate length for femoral tunnelling in anatomical ACLR.
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15
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Fu FH. CORR Insights(®): Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction? Clin Orthop Relat Res 2016; 474:1690-1. [PMID: 27164959 PMCID: PMC4887382 DOI: 10.1007/s11999-016-4878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Freddie H Fu
- University of Pittsburgh Medical Center, 3471 5th Avenue, Suite 1011 Kaufmann Building, Pittsburgh, PA, 15213, USA.
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16
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Bohn MB, Sørensen H, Petersen MK, Søballe K, Lind M. Rotational laxity after anatomical ACL reconstruction measured by 3-D motion analysis: a prospective randomized clinical trial comparing anatomic and nonanatomic ACL reconstruction techniques. Knee Surg Sports Traumatol Arthrosc 2015; 23:3473-81. [PMID: 24993569 DOI: 10.1007/s00167-014-3156-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 06/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the ability of three different anterior cruciate ligament (ACL) reconstruction techniques to normalize rotational knee stability 1 year after ACL reconstruction. Two of these techniques are so-called anatomic techniques. METHODS Three different ACL reconstruction techniques were tested for their ability to normalize rotational knee stability in a prospective randomized study. Forty-seven ACL-deficient (ACLD) patients were randomized to transtibial single-bundle (SB), anatomic SB, and double-bundle ACL reconstruction. Three-dimensional motion analysis was performed preoperatively and at 1-year follow-up to evaluate tibial rotation and rotational stiffness. Motion data were captured using an eight-camera motion analysis system. Tibial rotation was determined during walking, running, and a pivoting task. Other outcome parameters were KT-1000 knee laxity measurements and the subjective outcome scores KOOS and IKDC. RESULTS Three-dimensional motion analysis demonstrated that the tibial internal rotation and the rotational stiffness did not differ between the ACL reconstruction techniques during walking, running, and pivoting at 1-year follow-up. Objective knee stability and subjective outcome scores did not differ between the reconstruction groups. CONCLUSION No significant difference in rotational stability walking, running, and pivoting was seen between anatomic and nonanatomic ACL reconstruction techniques at 1-year follow-up. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Marie Bagger Bohn
- Division of Sportstrauma, Department of Orthopedics, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Henrik Sørensen
- Department of Public Health, Section of Sports Science, Aarhus University, Aarhus, Denmark
| | - Mette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital and Centre of Research in Rehabilitation, Institute of Clinical Medicine and Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kjeld Søballe
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Lind
- Division of Sportstrauma, Department of Orthopedics, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark.
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17
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Middleton KK, Muller B, Araujo PH, Fujimaki Y, Rabuck SJ, Irrgang JJ, Tashman S, Fu FH. Is the native ACL insertion site "completely restored" using an individualized approach to single-bundle ACL-R? Knee Surg Sports Traumatol Arthrosc 2015; 23:2145-2150. [PMID: 24825174 DOI: 10.1007/s00167-014-3043-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/25/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The goal of individualized anatomic anterior cruciate ligament reconstruction (ACL-R) is to reproduce each patient's native insertion site as closely as possible. The amount of the native insertion site that is recreated by the tunnel aperture area is currently unknown, as are the implications of the degree of coverage. As such, the goals of this study are to determine whether individualized anatomic ACL-R techniques can maximally fill the native insertion site and to attempt to establish a crude measure to evaluate the percentage of reconstructed area as a first step towards elucidating the implications of complete footprint restoration. METHODS This is a prospective pilot study of 45 patients who underwent primary single-bundle anatomic ACL-R from May 2011 to April 2012. Length and width of the native insertion site were measured intraoperatively. Using published guidelines, reconstruction technique and graft choice were determined to maximize the percentage of reconstructed area. Native femoral and tibial insertion site area and femoral tunnel aperture area were calculated using the formula for area of an ellipse. On the tibial side, tunnel aperture area was calculated with respect to drill diameter and drill guide angle. Percentage of reconstructed area was calculated by dividing total tunnel aperture area by the native insertion site area. RESULTS The mean areas for the native femoral and tibial insertion sites were 83 ± 20 and 125 ± 20 mm(2), respectively. The mean tunnel aperture area for the femoral side was 65 ± 17, and 86 ± 17 mm(2) for the tibial tunnel aperture area. On average, percentage of reconstructed area was 79 ± 13 % for the femoral side, and 70 ± 12 % for the tibial side. CONCLUSION Anatomic ACL-R does not restore the native insertion site in its entirety. Percentage of reconstructed area serves as a rudimentary tool for evaluating the degree of native insertion site coverage using current individualized anatomic techniques and provides a starting point from which to evaluate the clinical significance of complete footprint restoration. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- K K Middleton
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA
| | - B Muller
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA.,Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, AZ, 1105, The Netherlands
| | - P H Araujo
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA.,Department of Biomechanics, Medicine and Rehabilitation of Locomotor System - Ribeirao Preto Medical School, São Paulo University, Av. Bandeirantes, 3900 - Monte Alegre, 14049-900, Ribeirão Prêto, SP, Brazil
| | - Y Fujimaki
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA.,Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Japan
| | - S J Rabuck
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA
| | - J J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA
| | - S Tashman
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA
| | - F H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA.
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18
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Labbé DR, Li D, Grimard G, de Guise JA, Hagemeister N. Quantitative pivot shift assessment using combined inertial and magnetic sensing. Knee Surg Sports Traumatol Arthrosc 2015; 23:2330-2338. [PMID: 24832695 DOI: 10.1007/s00167-014-3056-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the study was to demonstrate the feasibility of a new measurement system using micro-electromechanical systems (MEMS)-based sensors for quantifying the pivot shift phenomenon. METHODS The pivot shift test was performed on 13 consecutive anterior cruciate ligament-deficient subjects by an experienced examiner while femur and tibia kinematics were recorded using two inertial sensors each composed of an accelerometer, gyroscope and magnetometer. The gravitational component of the acquired data was removed using a novel method for estimating sensor orientations. Correlation between the clinical pivot shift grade and acceleration and velocity parameters was measured using Spearman's rank correlation coefficients. RESULTS The pivot shift phenomenon was best characterized as a drop in femoral acceleration observed at the time of reduction. The correlation between the femoral acceleration drop and the clinical grade was shown to be very strong (r = 0.84, p < 0.0001). CONCLUSIONS The present study demonstrates the feasibility of quantifying the pivot shift using MEMS-based sensors and removing the gravitational component of acceleration using an estimation of sensor orientation for improved correlation to the clinical grade.
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Affiliation(s)
- David R Labbé
- Laboratoire de recherche en imagerie et orthopédie (LIO), Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Tour Viger, 900, rue Saint-Denis, Local R11.326, Montreal, QC, H2X 0A9, Canada. .,École de technologie supérieure, Montreal, Canada.
| | - Di Li
- Laboratoire de recherche en imagerie et orthopédie (LIO), Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Tour Viger, 900, rue Saint-Denis, Local R11.326, Montreal, QC, H2X 0A9, Canada.,École de technologie supérieure, Montreal, Canada
| | - Guy Grimard
- Centre hospitalier universitaire Ste-Justine, Montreal, Canada
| | - Jacques A de Guise
- Laboratoire de recherche en imagerie et orthopédie (LIO), Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Tour Viger, 900, rue Saint-Denis, Local R11.326, Montreal, QC, H2X 0A9, Canada.,École de technologie supérieure, Montreal, Canada
| | - Nicola Hagemeister
- Laboratoire de recherche en imagerie et orthopédie (LIO), Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Tour Viger, 900, rue Saint-Denis, Local R11.326, Montreal, QC, H2X 0A9, Canada.,École de technologie supérieure, Montreal, Canada
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19
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Lee BH, Bansal S, Park SH, Wang JH. Eccentric graft positioning within the femoral tunnel aperture in anatomic double-bundle anterior cruciate ligament reconstruction using the transportal and outside-in techniques. Am J Sports Med 2015; 43:1180-8. [PMID: 25670836 DOI: 10.1177/0363546514568278] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ellipticity of the femoral tunnel aperture, which is considered to better restore the native anterior cruciate ligament (ACL) footprint after ACL reconstruction, is different according to the femoral tunneling technique used. How much of the femoral tunnel aperture is filled with graft in different tunneling techniques has yet to be evaluated. PURPOSE The aim of this study was to evaluate and compare the graft filling area and graft position within the femoral tunnel aperture in ACL reconstruction using the transportal (TP) and outside-in (OI) techniques. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 70 patients were randomized to undergo double-bundle ACL reconstruction using either the TP (n=35) or OI (n=35) technique. The aperture filling was evaluated by calculating the ratio of the cross-sectional area of the graft to that of the femoral tunnel, and the graft center position within the tunnel was assessed using immediate postoperative magnetic resonance imaging. RESULTS The cross-sectional area of the femoral anteromedial (AM) tunnel aperture in the TP group (605.5±112.7 mm2) was larger than that in the OI group (537.9±126.8 mm2). The cross-sectional area of the femoral posterolateral (PL) tunnel aperture in the TP group (369.9±88.3 mm2) did not differ significantly from that of the OI group (387.9±87.0 mm2). The grafts filled only 52.0% of the AM tunnel and 55.3% of the PL tunnel in the TP group, compared with 54.9% of the AM tunnel and 54.4% of the PL tunnel in the OI group, but there was no statistically significant difference (P>.05). The AM graft center was positioned 1.7±0.6 mm from the center of the tunnel aperture in the TP group and 1.6±0.5 mm in the OI group, and the PL graft center was positioned 1.4±0.4 mm from the center in the TP group and 1.3±0.4 mm in the OI group, with no significant intergroup differences (P=.406 and P=.629, respectively). In the OI group, the PL graft center was positioned more perpendicular to the Blumensaat line in relation to the tunnel aperture center (-10.8°±7.6°) compared with the TP group (-4.0°±11.8°) (P=.04). CONCLUSION The grafts did not fill the tunnel aperture area in either group, and the centers of the grafts differed slightly from the centers of the tunnel apertures. The finding of eccentric graft positioning in the tunnel with condensation in a particular direction in each technique might suggest the necessity of an underreamed femoral tunnel for graft. In addition, it may be useful to standardize the starting position of the femoral tunnel according to anatomic landmarks.
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Affiliation(s)
- Byung Hoon Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Samarjit Bansal
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sin Hyung Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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da Silveira Franciozi CE, Ingham SJM, Gracitelli GC, Luzo MVM, Fu FH, Abdalla RJ. Updates in biological therapies for knee injuries: anterior cruciate ligament. Curr Rev Musculoskelet Med 2014; 7:228-38. [PMID: 25070265 DOI: 10.1007/s12178-014-9228-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There have been many advances in anterior cruciate ligament reconstruction (ACLR) techniques incorporating biological treatment. The aim of this review is to discuss the recent contributions that may enlighten our understanding of biological therapies for anterior cruciate ligament (ACL) injuries and improve management decisions involving these enhancement options. Three main biological procedures will be analyzed: bio-enhanced ACL repair, bio-enhanced ACLR scrutinized under the four basic principles of tissue engineering (scaffolds, cell sources, growth factors/cytokines including platelet-rich plasma, and mechanical stimuli), and remnant-preserving ACLR. There is controversial information regarding remnant-preserving ACLR, since different procedures are grouped under the same designation. A new definition for remnant-preserving ACLR surgery is proposed, dividing it into its three major procedures (selective bundle augmentation, augmentation, and nonfunctional remnant preservation); also, an ACL lesion pattern classification and a treatment algorithm, which will hopefully standardize these terms and procedures for future studies, are presented.
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Affiliation(s)
- Carlos Eduardo da Silveira Franciozi
- Department of Orthopaedic Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Borges Lagoa, 783-5°Andar, Vila Clementino, 04038-032, São Paulo, SP, Brazil,
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21
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Asai S, Maeyama A, Hoshino Y, Goto B, Celentano U, Moriyama S, Smolinski P, Fu FH. A comparison of dynamic rotational knee instability between anatomic single-bundle and over-the-top anterior cruciate ligament reconstruction using triaxial accelerometry. Knee Surg Sports Traumatol Arthrosc 2014; 22:972-8. [PMID: 23568389 DOI: 10.1007/s00167-013-2499-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/02/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Recently, single-bundle (SB) anterior cruciate ligament (ACL) reconstruction has been advanced by the anatomic concept, but the biomechanical outcome of the anatomic method has not been fully investigated, especially for rotational instability. Anatomic SB and the single over-the-top procedures are the treatment of choice for primary cases and revision or skeletally immature cases, respectively. The purpose of this study was to investigate the dynamic rotational instability of anatomic SB and over-the-top reconstruction during a pivot shift test using triaxial accelerometry. METHODS Eight fresh frozen human cadaveric knees were used in this study. Rotational instability measurement was conducted during a pivot shift test by the use of a triaxial accelerometer attached to the tibia. The tests were performed in the ACL-intact, ACL-deficient and ACL-reconstructed knees with two different procedures (anatomic SB and over-the-top). The acceleration in three directions and the magnitude of acceleration were measured to evaluate rotational instability and compare between four different knee states. RESULTS The overall magnitude of acceleration was significantly different (P < 0.01) between the ACL-intact knees and the ACL-deficient knees. Both anatomic SB and over-the-top ACL reconstruction significantly reduced the overall magnitude of acceleration compared to the ACL-deficient knees, but still had larger accelerations compared to the ACL-intact knees. There was no significant difference for the overall magnitude of acceleration between anatomic SB and over-the-top reconstruction procedure. CONCLUSION Over-the-top reconstruction provides comparable result to anatomic SB reconstruction in terms of controlling the dynamic rotational stability. Over-the-top reconstruction might be one of the options for revision cases and in skeletally immature patients.
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Affiliation(s)
- Shigehiro Asai
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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22
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Innovative technology for knee laxity evaluation: clinical applicability and reliability of inertial sensors for quantitative analysis of the pivot-shift test. Clin Sports Med 2012. [PMID: 23177462 DOI: 10.1016/j.csm.2012.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There has been an increased interest in the quantification of the knee laxity secondary to anterior cruciate ligament (ACL) injury. In clinical practice, the diagnosis is performed by clinical examination and magnetic resonance imaging analysis and confirmed arthroscopically. The pivot shift phenomenon has been identified as one of the essential signs of functional ACL insufficiency. A reliable system to adequately assess patients with ACL injury, quantifying the pivot shift test outcome, is needed. Several studies have been conducted in this regard but the proposed methods remain confined to a research area. The goal of this article is to summarize the actual knowledge and current concepts.
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