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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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Lim S, Park KH, Park DY, Kim TH, Koh JH, Chung JY. Rotational stability can be enhanced in revision anterior cruciate ligament reconstruction using the over-the-top augmentation technique compared to single bundle technique. BMC Sports Sci Med Rehabil 2023; 15:111. [PMID: 37715268 PMCID: PMC10504798 DOI: 10.1186/s13102-023-00724-1] [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: 03/31/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE Revision anterior cruciate ligament (ACL) reconstruction is technically challenging due to mispositioned tunnels, bone loss, and tunnel enlargement, which may compromise graft fixation and result in failure. To obtain firm graft fixation and strength in one stage, we utilized an over-the-top augmentation technique using an Achilles tendon allograft in revision ACL reconstruction (OA-ACLR). This study compared OA-ACLR with single-bundle ACL reconstruction (SB-ACLR). We hypothesized that OA-ACLR would enhance the postoperative knee joint rotational stability. METHODS We retrospectively analyzed 47 patients who underwent revisional OA-ACLR and 48 who underwent primary SB-ACLR with minimum follow-up of 6 months. Knee instability was evaluated with the anterior drawer, Lachman, and pivot shift tests preoperatively and at the final follow-up. Side-to-side differences were compared with the non-affected side at the final follow-up. Function was evaluated using the IKDC subjective and Lysholm knee scores preoperatively and at the final follow-up. RESULTS The groups did not differ in terms of sex, age, BMI, and etiology. There were no significant differences in concomitant surgical procedures, such as meniscectomy and meniscus repair, between the two groups (p = 0.335, > 0.99). Both groups significantly improved in the anterior drawer, Lachman, pivot shift tests, and IKDC and Lysholm knee scores after surgery (all p < 0.001). The OA-ACLR group showed significantly higher rotational stability in the pivot shift test than the SB-ACLR group (p = 0.017). The postoperative side-to-side difference, the IKDC and Lysholm scores showed no significant differences between the groups (p = 0.34, 0.301, 0.438). CONCLUSIONS OA-ACLR showed enhanced rotational stability with pivot shift test compared to SB-ACLR. It may be considered a useful alternative for revision ACL reconstruction.
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Affiliation(s)
- Sumin Lim
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Ki-Hoon Park
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
- Daprtment of Orthopedic Surgery, Armed Forces Yangju Medical Center, Yangju-si, Korea
| | - Do Young Park
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Tae Hun Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Jeong-Hyun Koh
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499, Korea.
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Özbek EA, Winkler PW, Nazzal EM, Zsidai B, Drain NP, Kaarre J, Sprague A, Lesniak BP, Musahl V. Failure Rates and Complications After Multiple-Revision ACL Reconstruction: Comparison of the Over-the-Top and Transportal Drilling Techniques. Orthop J Sports Med 2023; 11:23259671231186972. [PMID: 37533497 PMCID: PMC10392383 DOI: 10.1177/23259671231186972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/14/2023] [Indexed: 08/04/2023] Open
Abstract
Background Multiple-revision anterior cruciate ligament reconstruction (ACLR) presents several technical challenges, often due to residual hardware, tunnel widening, malposition, or staged surgeries. Purpose To compare failure and complication rates between the over-the-top (OTT) and transportal drilling (TD) techniques in patients undergoing surgery for failed revision ACLR. Study Design Cohort study; Level of evidence, 3. Methods The medical records of patients with at least 2 revision ACLRs using either the OTT or TD technique were reviewed retrospectively. Data on patient demographics, graft characteristics, number of revisions, concomitant procedures, complications, and failures were collected. Between-group comparisons of continuous and categorical variables were conducted with the independent-samples t test and the Fisher exact or chi-square test, respectively. Results A total of 101 patients undergoing multiple-revision ACLR with OTT (n = 37, 37%) and TD (n = 64, 63%) techniques were included for analysis. The mean follow-up time was 60 months (range, 12-196 months). There were no significant differences in age, sex, body mass index, laterality, or follow-up length between groups (P > .05). Allograft was the graft used most frequently (n = 64; 67.3%) with no significant differences between groups in graft diameter (P > .05). There were no statistically significant differences between groups regarding rate of concurrent medial and lateral meniscus, cartilage, or lateral extra-articular procedures (P > .05). There was also no significant66 between-group difference in complication rate (OTT: n = 2 [5.4%]; TD: n = 8 [13%]) or graft failure rate (OTT: n = 4 [11%]; TD: n = 14 [22%]) (P > .05 for both). Conclusion The results of this study showed notably high failure and complication rates in challenging multiple-revision ACLR. Complication and failure rates were similar between techniques, demonstrating that the OTT technique is a valuable alternative that can be used in a revision ACLR, particularly as a single-stage approach when the single-stage TD technique is not possible.
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Affiliation(s)
- Emre Anil Özbek
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
| | - Philipp W. Winkler
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Linz, Austria
| | - Ehab M. Nazzal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bálint Zsidai
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicholas P. Drain
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Janina Kaarre
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrew Sprague
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Shiwaku K, Suzuki T, Shino K, Yamakawa S, Otsubo H, Okimura S, Suzuki D, Nabeki S, Teramoto A, Ohnishi H, Fujie H, Yamashita T. A Biomechanical Comparison of 2 Over-the-Top Anterior Cruciate Ligament Reconstruction Techniques: A Cadaveric Study Using a Robotic Simulator. Orthop J Sports Med 2022; 10:23259671221139876. [PMID: 36545379 PMCID: PMC9761224 DOI: 10.1177/23259671221139876] [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: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
Background For skeletally immature patients, over-the-top (OTT) anterior cruciate ligament (ACL) reconstruction (ACLR) is preferred. However, increased anterior laxity at deep knee flexion angles remains concerning. We modified the procedure to proximally shift the graft fixation site on the femur to prevent graft loosening at higher knee flexion angles and named it the supra-OTT procedure. Purpose To compare anterior laxity and in situ forces of the ACL graft between conventional OTT and supra-OTT ACLR in a cadaveric model. Study Design Controlled laboratory study. Methods A total of 11 fresh-frozen cadaveric knee specimens underwent 4 robotic testing conditions: ACL intact, ACL resected, conventional OTT, and supra-OTT. For each condition, a 100-N load was applied at 0°, 15°, 30°, 60°, and 90° of knee flexion to simulate the Lachman test or anterior drawer test. In addition, a combined load of 5-N·m internal tibial torque and 10-N·m valgus torque was applied at 15° and 30° of knee flexion as a simulated pivot-shift test. Anterior tibial translation and in situ graft forces were recorded. The only difference between conventional OTT and supra-OTT ACLR was the graft fixation site on the femur. For conventional OTT ACLR, graft fixation was performed just on the proximal and lateral ends of the posterior condyle. For supra-OTT ACLR, the fixation point was around the proximal insertion of the lateral head of the gastrocnemius and the lateral edge of the posterior cortex, approximately 2 cm proximal to the conventional OTT position. Results On the simulated anterior drawer test at 60° and 90° of knee flexion, anterior tibial translation after supra-OTT ACLR was significantly smaller than after conventional OTT ACLR (P < .01). However, no significant differences were noted at other flexion angles or on the simulated pivot-shift test between the conventional OTT and supra-OTT procedures. Some overconstraint and higher graft forces were noted with both techniques, but the supra-OTT technique caused even more overconstraint at higher flexion angles. Conclusion Supra-OTT ACLR showed better biomechanical performance to control anterior laxity than conventional OTT ACLR at higher knee flexion angles. Clinical Relevance The supra-OTT procedure may improve anterior stability at deep knee flexion angles.
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Affiliation(s)
- Kousuke Shiwaku
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Tomoyuki Suzuki
- Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan.,Tomoyuki Suzuki, MD, PhD, Sapporo Maruyama Orthopedic Hospital,
North 7 West 27, Chuo-Ku, Sapporo, 060-0007 Japan (
)
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Osaka University Graduate
School of Medicine, Suita, Japan
| | | | - Shinichiro Okimura
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Health Science, Hokkaido Chitose College of
Rehabilitation, Chitose, Japan
| | - Shogo Nabeki
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of
Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Department of Mechanical Engineering, Tokyo Metropolitan University
Graduate School of Science, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
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Kamei G, Nakamae A, Ishikawa M, Nakata K, Nekomoto A, Tsuji S, Hashiguchi N, Adachi N. Equivalent outcomes of ACL revision with over-the-top single and double-bundle reconstruction using hamstring tendon compared to anatomical single and double-bundle reconstruction. J Exp Orthop 2022; 9:33. [PMID: 35416542 PMCID: PMC9008081 DOI: 10.1186/s40634-022-00472-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/02/2022] [Indexed: 01/26/2023] Open
Abstract
Purpose In revision anterior cruciate ligament reconstruction (ACLR), our procedure of choice is the over-the-top route (OTTR) for cases where it is difficult to use a primary bone tunnel or to create a new bone tunnel due to the enlargement or malposition of the bone tunnel. Depending on the condition of the primary bone tunnel, we choose single (bone tunnel or OTTR) or double (bone tunnel or anteromedial (AM) bundle: OTTR /posterolateral (PL) bundle: bone tunnel) for femoral fixation. This study showed the results of single and double OTTR revision ACLR using the hamstring tendon. Methods Seventy-eight patients, who underwent revision ACLR using the hamstring tendon and who could be followed up for more than 2 year, were included in this study. The methods of revision ACLR were single in 54 cases (bone tunnel: 24 cases; OTTR method: 30 cases) and double in 24 cases (bone tunnel: 16 cases; OTTR for AM bundle and bone tunnel for PL bundle: eight cases). The cause of re-injury, the meniscus and cartilage injury, the reconstruction method, and the Lysholm score, Lachman test, Pivot-shift test, and the side-to-side difference in the tibial anterior translation were evaluated before and after surgery. Results There was no statistically significant difference in the Lyshom score, Lachman / Pivotshift test and side-to-side difference anterior translation of the tibia between the four groups. Conclusions The clinical results of single and double OTTR revision ACLR are equivalent to those of anatomic single and double bone tunnel procedures.
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Affiliation(s)
- Goki Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan.
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kyohei Nakata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Shunya Tsuji
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Naofumi Hashiguchi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
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Min BH, Song HK, Park KH, Kim TH, Park DY, Chung JY. Biomechanical Evaluation of Modified ACL Reconstruction with Over-the-Top Augmentation Technique. Indian J Orthop 2022; 56:812-820. [PMID: 35547346 PMCID: PMC9043071 DOI: 10.1007/s43465-021-00597-x] [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: 08/02/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Modified ACL reconstruction with over-the-top augmentation technique (OA-ACLR) was designed to allow one-stage revision regardless of tunnel conditions as well as to offer firm stability by hybrid double-fixation. Thus, the purpose of the study is to biomechanically evaluate its effect on knee stability by comparing it with single-bundle ACL reconstruction (SB-ACLR). METHODS Ten porcine knees were sequentially tested using a custom testing system for intact ACL, ACL deficiency, SB-ACLR and OA-ACLR. First, 134-N anterior tibial load was applied, and anterior tibial translation was measured at 30°, 60°, and 90°. Then, anterior tibial translation and relative tibial rotation were measured in a combined rotatory load of 5-Nm of internal tibial torque and 10-Nm of valgus torque. RESULTS Under anterior tibial load or combined anterior and rotatory loads, SB-ACLR and OA-ACLR resulted in no significant increase in anterior tibial translation at all flexion angles compared with an intact ACL group, and no significant difference was noted in anterior tibial translation between the two ACL reconstruction groups. In combined rotatory load, OA-ACLR resulted in enhanced rotational stability compared with SB-ACLR, and it more closely restored relative tibial internal rotation to the intact ACL group. CONCLUSIONS Our study showed that modified ACL reconstruction with over-the-top augmentation technique resulted in enhanced rotational stability compared to the conventional single-bundle ACL reconstruction, especially at lower flexion angle in a porcine model. Therefore, with several potential advantages as well as biomechanical superiority, our new technique could be clinically applicable in primary and revision ACL reconstruction. LEVEL OF EVIDENCE Experimental.
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Affiliation(s)
- Byoung-Hyun Min
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
| | - Hyung Keun Song
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
| | - Ki Hoon Park
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
| | - Tae Hun Kim
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
| | - Do Young Park
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
| | - Jun Young Chung
- grid.251916.80000 0004 0532 3933Department of Orthopedic Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon, 16499 Korea
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Nakamura S, Tanaka Y, Kuriyama S, Nishitani K, Watanabe M, Yamauchi K, Song YD, Matsuda S. Anteromedial Tibial Attachment in Single-Bundle Anterior Cruciate Ligament Reconstruction Can Represent Normal Kinematics in Computer Simulation. J Knee Surg 2022; 36:731-737. [PMID: 34991175 DOI: 10.1055/s-0041-1741390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tunnel position during anterior cruciate ligament (ACL) reconstruction is considered as an important factor to restore normal knee kinematics and to gain better clinical outcomes. It is still unknown where the optimal femoral and tibial tunnel position is located in single-bundle (SB) ACL reconstruction. The purposes of this study were to analyze the knee kinematics with various graft positions and to propose the optimal graft position during SB ACL reconstruction. A musculoskeletal computer simulation was used to analyze knee kinematics. Four attachments on the femoral side (anteromedial [AM], mid, posterolateral [PL], and over-the-top positions) and three attachments on the tibial side (AM, middle, and PL positions) were determined. The middle-bundle attachment was placed at the midpoint of the AM and PL bundle attachments for the femoral and tibial attachments. SB ACL reconstruction models were constructed to combine each of the four femoral attachments with each of three tibial attachments. Kinematic comparison was made among a double-bundle (DB) model and 12 SB reconstruction models during deep knee bend and stair descent activity. The tunnel position of the tibia had greater effect of knee kinematics than that of the femur. AM tibial attachment models showed similar medial and lateral anteroposterior positions to the DB model for both activities. Axial rotation in the AM tibial attachment models was similar to the DB model regardless of the femoral attachment, whereas greater maximum axial rotation was exhibited in the PL tibial attachment models, especially during stair descent activity. AM tibial attachment can represent normal knee kinematics, whereas the PL tibial attachment can induce residual rotational instability during high-demand activities. The AM tibial tunnel is recommended for SB ACL reconstruction.
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Affiliation(s)
- Shinichiro Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Yoshihisa Tanaka
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Shinichi Kuriyama
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Kohei Nishitani
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Mutsumi Watanabe
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Kenshiro Yamauchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Young D Song
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Japan
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Moon DK, Jo HS, Lee DY, Kang DG, Won HC, Seo MS, Hwang SC. Anterior cruciate ligament femoral-tunnel drilling through an anteromedial portal: 3-dimensional plane drilling angle affects tunnel length relative to notchplasty. Knee Surg Relat Res 2021; 33:13. [PMID: 33853676 PMCID: PMC8048303 DOI: 10.1186/s43019-021-00092-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Notchplasty is a surgical technique often performed during anterior cruciate ligament reconstruction (ACLR) with widening of the intercondylar notch of the lateral distal femur to avoid graft impingement. The purpose of this study was to correlate femoral-tunnel length with 3-dimensional (3D) drilling angle through the anteromedial (AM) portal with and without notchplasty. Materials and methods Computer data were collected from an anatomical study using 16 cadaveric knees. The anterior cruciate ligament (ACL) femoral insertion was dissected and outlined for gross anatomical observation. The dissected cadaveric knees were scanned by computed tomography (CT). Three-dimensional measurements were calculated using software (Geomagic, Inc., Research Triangle Park, NC, USA) and included the center of the ACL footprint and the size of the ACL femoral footprint. The femoral-tunnel aperture centers were measured in the anatomical posterior-to-anterior and proximal-to-distal directions using Bernard’s quadrant method. The ACL tunnel was created 3-demensionally in the anatomical center of femoral foot print of ACL using software (SolidWorks®, Corp., Waltham, MA, USA). The 8-mm cylinder shaped ACL tunnel was rested upon the anatomical center of the ACL footprint and placed in three different positions: the coronal plane, the sagittal plane, and the axial plane. Finally, the effect of notchplasty on the femoral-tunnel length and center of the ACL footprint were measured. All the above-mentioned studies performed ACLR using the AM portal. Results The length of the femoral tunnels produced using the low coronal and high axial angles with 5-mm notchplasty became significantly shorter as the femoral starting position became more horizontal. The result was 30.38 ± 2.11 mm on average at 20° in the coronal plane/70° in the axial plane/45° in the sagittal plane and 31.26 ± 2.08 mm at 30° in the coronal plane/60° in the axial plane/45° in the sagittal plane, respectively, comparing the standard technique of 45° in the coronal/45° in the axial/45° in the sagittal plane of 32.98 ± 3.04 mm (P < 0.001). The tunnels made using the high coronal and low axial angles with notchplasty became longer than those made using the standard technique: 40.31 ± 3.36 mm at 60° in the coronal plane/30° in the axial plane/45° in the sagittal plane and 50.46 ± 3.13 mm at 75° in the coronal plane/15° in the axial plane/45° in the sagittal plane (P < 0.001). Conclusions Our results show that excessive notchplasty causes the femoral tunnel to be located in the non-anatomical center of the ACL footprint and reduces the femoral-tunnel length. Therefore, care should be taken to avoid excessive notchplasty when performing this operation.
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Affiliation(s)
- Dong-Kyu Moon
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ho-Seung Jo
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Dong-Yeong Lee
- Department of Orthopaedic Surgery, Barun Hospital, Jinju, Republic of Korea
| | - Dong-Geun Kang
- Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hee-Chan Won
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Min-Seok Seo
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
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Anterolateral ligament reconstruction as an augmented procedure for double-bundle anterior cruciate ligament reconstruction restores rotational stability: Quantitative evaluation of the pivot shift test using an inertial sensor. Knee 2020; 27:397-405. [PMID: 32178972 DOI: 10.1016/j.knee.2020.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/01/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the biomechanical function of the anterolateral structures (ALS) of the knee regarding rotational stability, and to attempt to verify the effectiveness of anterolateral ligament (ALL) reconstruction concomitant with double-bundle anterior cruciate ligament (ACL) reconstruction by quantifying the pivot shift test (PST) using an inertial sensor. METHODS Six knees of the fresh-frozen cadavers were evaluated during the following phases: (1) [Intact]; (2) ACL-deficient [ACL-D]; (3) ACL-reconstructed [ACL-R]; (4) ACL-reconstructed + ALS-deficient [ACL-R + ALS-D]; and (5) combined ACL and ALL reconstructed [ACL-R + ALL-R]. We evaluated knee rotational instability during each phase using the PST. We used an inertial sensor to calculate tibial external rotational angular velocity (ERAV) and tibial acceleration. Data were analyzed using repeated-measures analysis of variance; statistical significance was accepted as P < 0.05. RESULTS Relative to [Intact], [ACL-D] caused a significant increase in ERAV and acceleration. However, there was no difference in these parameters between [ACL-R] and [Intact]. [ACL-R + ALS-D] increased ERAV significantly compared with [ACL-R], and there was a significant difference between ERAV during [ACL-R + ALS-D] and [Intact]. However, ERAV was significantly reduced during [ACL-R + ALL-R] compared with [ACL-R + ALS-D], and there was no significant difference in ERAV or acceleration between [ACL-R + ALL-R] and [Intact]. CONCLUSIONS ALS controlled rotational instability in cooperation with the ACL in a cadaveric model. In cases of combined injury of ACL and ALS, concomitant ACL and ALL reconstruction may restore knee stability comparable with the intact state.
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Nagai K, Rothrauff BB, Li RT, Fu FH. Over-the-top ACL reconstruction restores anterior and rotatory knee laxity in skeletally immature individuals and revision settings. Knee Surg Sports Traumatol Arthrosc 2020; 28:538-543. [PMID: 31549207 DOI: 10.1007/s00167-019-05719-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/11/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the objective outcomes following anterior cruciate ligament reconstruction (ACLR) with the over-the-top (OTT) technique. METHODS Thirty-five ACL-deficient patients with mean follow-up of 2.2 years were retrospectively reviewed. This included 14 skeletally immature individuals (age: 14 ± 1 years) who underwent primary OTT ACLR (adolescent group) and 21 skeletally mature individuals (age: 25 ± 8 years) who underwent OTT revision ACLR (revision group). The tibial tunnel was created at the anatomic position for all cases. No lateral extra-articular tenodesis was performed. Before and after surgery, the side-to-side difference (SSD) in anterior laxity was measured using KT-1000 arthrometer. Lachman and pivot-shift tests were assessed according to IKDC grade. The graft failure rate was assessed. RESULTS The post-operative SSD in anterior laxity was significantly reduced in the adolescent (pre-op, 3.9 ± 1.8 mm; post-op, 1.2 ± 0.8 mm; p = 0.040) and revision groups (pre-op, 4.2 ± 1.7 mm; post-op, 1.2 ± 1.4 mm; p < 0.001). Postoperative knee laxity measured by Lachman and pivot-shift tests were also significantly improved in both groups. Graft rupture occurred in two patients in the adolescent group (14.3%), and one patient in the revision group (4.8%). CONCLUSION ACLR with the OTT technique restored anterior and rotatory knee laxity in skeletally immature individuals and in revision settings. This one-step procedure may be a good option for skeletally immature individuals and revision settings. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kanto Nagai
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Ryan T Li
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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Over-the-top ACL reconstruction yields comparable outcomes to traditional ACL reconstruction in primary and revision settings: a systematic review. Knee Surg Sports Traumatol Arthrosc 2019; 27:427-444. [PMID: 30078121 DOI: 10.1007/s00167-018-5084-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/27/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess clinical outcomes of over-the-top (OTT) ACL reconstruction (ACLR) in skeletally mature patients, where physeal sparing is not a consideration. The hypothesis is that OTT will produce successful yet inferior outcomes compared to anatomic ACL approaches in both primary and revision settings. METHODS Two reviewers searched two online databases (EMBASE and MEDLINE) from inception to October 2017 for literature on OTT ACLR in skeletally mature patients. The systematic screening process was completed in duplicate, independently, and based on predetermined criteria. An expert in the field was consulted to resolve disagreements for full-text screening. Quality assessment of included papers was performed independently and in duplicate. RESULTS From 3148 initial studies, 16 eligible studies (three RCTs and 13 case series) satisfied inclusion criteria. Three focused on the revision setting. The mean age of patients undergoing primary reconstruction was 26.9 ± 3.6, with 21.3% female patients and 31.4 ± 1.2 (26.1% female) in revision settings. Of primary studies reporting return to sport (n = 151), 69% of patients returned to pre-injury sports participation, with a total 94% returning to any sports activity. In revision settings (n = 48), 52.1% of patients returned to pre-injury sports participation, 25.2% returned to a lower level and 12.5% ceased sporting activity. Primary reconstruction studies reported a mean post-operative Tegner score of 6.5 ± 0.5 (n = 181) and mean KOOS of 82.8 ± 8.1 (n = 96). Primary studies reported a total 13 graft failures (3.7%), seven of which were re-ruptures (2.0%). The revision failure rate was 8.4% (four patients). CONCLUSION Clinically important outcomes for OTT ACLR are comparable to literature figures for traditional all-inside, transtibial and/or anteromedial portal drilling techniques. This holds true in revision settings. LEVEL OF EVIDENCE IV.
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Liu C, Wang Y, Li Z, Li J, Zhang H, Fu Y, Zhang K. Tibiofemoral joint contact area and stress after single-bundle anterior cruciate ligament reconstruction with transtibial versus anteromedial portal drilling techniques. J Orthop Surg Res 2018; 13:247. [PMID: 30286774 PMCID: PMC6172839 DOI: 10.1186/s13018-018-0956-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023] Open
Abstract
Background During single-bundle ACLR, femoral tunnel location plays an important role in restoring the intact knee mechanisms, whereas malplacement of the tunnel was cited as the most common cause of knee instability. The objective of this study is to evaluate, objectively, the tibiofemoral contact area and stress after single-bundle (SB) anterior cruciate ligament reconstruction (ACLR) with femoral tunnel positions drilled by transtibial (TT) or anteromedial (AM) portal techniques. Methods Seven fresh human cadaveric knees underwent ACLR by the use of TT or AM portal techniques in a randomized order. These specimens were reused for ACL-R (TT and AM). The tibiofemoral contact area and stresses were gauged by an electronic stress-sensitive film inserted into the joint space. The knee was under the femoral axial compressive load of 1000 N using a biomechanics testing machine at 0°, 10°, 20°, and 30° of flexion. Three conditions were compared: (1) intact ACL, (2) ACLR by the use of the TT method, and (3) ACLR by the use of the AM portal method. Results Compared with AM portal ACL-reconstructed knees, a significantly decreased tibiofemoral contact area on the medial compartment was detected in the TT ACL-reconstructed knees at 20°of knee flexion (P = .047). Compared with the intact group, the TT ACLR group showed a higher mean stress at 20° and 30° of flexion on the medial compartments (P = .001, P = .003, respectively), while the AM portal ACLR group showed no significant differences at 30° of flexion (P = .073). The TT ACLR group also showed a higher mean maximum stress at 20° of flexion on the medial compartments (P = .047), while the AM portal ACLR group showed no significant differences at this angle(P = .319). Discussion The alternation of the tibiofemoral joint contact area and stress in reconstructed knees may be caused by the mismatch of the tibiofemoral joint during knee movement procedures compared with intact knees. Conclusions SB ACLR by the use of the AM portal method and TT method both alter the tibiofemoral contact area and stress when compared with the intact knee. When compared with the TT technique, ACLR by the AM portal technique more closely restores the intact tibiofemoral contact area and stress at low flexion angles.
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Affiliation(s)
- Chunhui Liu
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yingpeng Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Ji Li
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hao Zhang
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yangmu Fu
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
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Comparison of quantitative evaluation between cutaneous and transosseous inertial sensors in anterior cruciate ligament deficient knee: A cadaveric study. J Orthop Sci 2017; 22:874-879. [PMID: 28559103 DOI: 10.1016/j.jos.2017.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/31/2017] [Accepted: 04/26/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recently several authors have reported on the quantitative evaluation of the pivot-shift test using cutaneous fixation of inertial sensors. Before utilizing this sensor for clinical studies, it is necessary to evaluate the accuracy of cutaneous sensor in assessing rotational knee instability. To evaluate the accuracy of inertial sensors, we compared cutaneous and transosseous sensors in the quantitative assessment of rotational knee instability in a cadaveric setting, in order to demonstrate their clinical applicability. METHODS Eight freshly frozen human cadaveric knees were used in this study. Inertial sensors were fixed on the tibial tuberosity and directly fixed to the distal tibia bone. A single examiner performed the pivot shift test from flexion to extension on the intact knees and ACL deficient knees. The peak overall magnitude of acceleration and the maximum rotational angular velocity in the tibial superoinferior axis was repeatedly measured with the inertial sensor during the pivot shift test. Correlations between cutaneous and transosseous inertial sensors were evaluated, as well as statistical analysis for differences between ACL intact and ACL deficient knees. RESULTS Acceleration and angular velocity measured with the cutaneous sensor demonstrated a strong positive correlation with the transosseous sensor (r = 0.86 and r = 0.83). Comparison between cutaneous and transosseous sensor indicated significant difference for the peak overall magnitude of acceleration (cutaneous: 10.3 ± 5.2 m/s2, transosseous: 14.3 ± 7.6 m/s2, P < 0.01) and for the maximum internal rotation angular velocity (cutaneous: 189.5 ± 99.6 deg/s, transosseous: 225.1 ± 103.3 deg/s, P < 0.05), but no significant difference for the maximum external rotation angular velocity (cutaneous: 176.1 ± 87.3 deg/s, transosseous: 195.9 ± 106.2 deg/s, N.S). CONCLUSIONS There is a positive correlation between cutaneous and transosseous inertial sensors. Therefore, this study indicated that the cutaneous inertial sensors could be used clinically for quantifying rotational knee instability, irrespective of the location of utilization.
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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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15
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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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16
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Quantitative comparison of the pivot shift test results before and after anterior cruciate ligament reconstruction by using the three-dimensional electromagnetic measurement system. Knee Surg Sports Traumatol Arthrosc 2015; 23:2876-81. [PMID: 26342695 DOI: 10.1007/s00167-015-3776-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/28/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE Tibial acceleration during the pivot shift test is a potential quantitative parameter to evaluate rotational laxity of anterior cruciate ligament (ACL) insufficiency. However, clinical application of this measurement has not been fully examined. This study aimed to measure and compare tibial acceleration before and after ACL reconstruction (ACLR) in ACL-injured patients. We hypothesized tibial acceleration would be reduced by ACLR and tibial acceleration would be consistent in the same knee at different time points. METHODS Seventy ACL-injured patients who underwent ACLR were enrolled. Tibial acceleration during the pivot shift test was measured using an electromagnetic measurement system before ALCR and at the second-look arthroscopy 1 year post-operatively. Tibial acceleration was compared to clinical grading and between ACL-injured/ACL-reconstructed and contralateral knees. RESULTS Pre-operative tibial acceleration was increased stepwise with the increase in clinical grading (P < 0.01). Tibial acceleration in ACL-injured knee (1.9 ± 1.2 m/s(2)) was larger than that in the contralateral knee (0.8 ± 0.3 m/s(2), P < 0.01), and reduced to 0.9 ± 0.3 m/s(2) post-operatively (P < 0.01). There was no difference between ACL-reconstructed and contralateral knee (n.s.). Tibial acceleration in contralateral knees was consistent pre- and post-operatively (n.s.). CONCLUSION Tibial acceleration measurement demonstrated increased rotational laxity in ACL-injured knees and its reduction by ALCR. Additionally, consistent measurements were obtained in ACL-intact knees at different time points. Therefore, tibial acceleration during the pivot shift test could provide quantitative evaluation of rotational stability before and after ACL reconstruction. LEVEL OF EVIDENCE III.
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Ruffilli A, Buda R, Pagliazzi G, Baldassarri M, Cavallo M, Luciani D, Ferranti E, Giannini S. Over-the-Top Anterior Cruciate Ligament Reconstruction Using Single- or Double-Strand Hamstrings Autograft. Orthopedics 2015; 38:e635-43. [PMID: 26186328 DOI: 10.3928/01477447-20150701-64] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 08/27/2014] [Indexed: 02/03/2023]
Abstract
The purpose of this study is to (1) report the long-term clinical and radiographic outcomes of a nonanatomical anterior cruciate ligament (ACL) reconstruction using an over-the-top (OTT) femoral route and (2) compare single-strand (1SHG) and double-strand (2SHG) hamstrings graft reconstruction. Fifty-one consecutive patients (mean age, 29.2±3.8 years) underwent nonanatomical ACL reconstruction using OTT femoral passage. Twenty patients underwent 1SHG reconstruction and 31 underwent 2SHG reconstruction. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner score, and KT-1000 (Medmetric Corporation, San Diego, California) evaluation were recorded at a mean follow-up of 12.1±1.6 years. At final follow-up, radiographic evaluation was performed according to the IKDC grading system. Mean IKDC subjective score at follow-up was 76.6±21.9 in the 1SHG group and 88.9±10.0 in the 2SHG (P=.009). Average KOOS was 82.6±18.7 in the 1SHG group and 92.4±9.2 in the 2SHG group (P=.016). Objective IKDC evaluation showed a higher percentage of normal knees in the 2SHG group (P=.018). Pivot shift testing revealed a significantly higher number of normal knees in the 2SHG group (P=.001). Radiographs showed fewer degenerative changes in the 2SHG group at final follow-up in the medial (P=.01) and lateral (P=.037) compartments. Nonanatomical ACL reconstruction using the OTT technique provided satisfactory results in terms of control of both static and dynamic instability at long-term follow-up, thus preventing degenerative joint disease. The 2SHG group showed better subjective and functional outcomes with fewer degenerative changes compared with the 1SHG group at long-term follow-up.
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Usman MA, Kamei G, Adachi N, Deie M, Nakamae A, Ochi M. Revision single-bundle anterior cruciate ligament reconstruction with over-the-top route procedure. Orthop Traumatol Surg Res 2015; 101:71-5. [PMID: 25530482 DOI: 10.1016/j.otsr.2014.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/18/2014] [Accepted: 09/01/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE In revision anterior cruciate ligament reconstruction (ACLR), the single-stage technique and the over-the-top route (OTTR) procedure were usually selected for cases where the bone tunnel cannot be created at an anatomical position due to tunnel enlargement and overlap with the mal-positioned tunnel of primary reconstruction. The purpose of this study was to evaluate the clinical results of revision single-bundle ACL reconstruction using OTTR procedure and to compare the clinical results of OTTR procedure with those of anatomical single-bundle revision reconstruction (SBR). HYPOTHESIS The results of OTTR procedure are equivalent to that of SBR. METHODS Seventy-six revision ACL reconstruction knees from April 2002 to December 2012 were involved in our study. We focused on 21 knees which underwent surgery with SBR and 22 knees with OTTR using hamstring tendon. The clinical results were evaluated by means of the Lysholm score and the knee stability was assessed by the Lachman test, pivot-shift test and side-to-side difference by KT-2000 pre-operatively and after 1 year post-operatively. AP translation and rotational laxity using a navigation system were evaluated before and after revision ACL reconstruction under anesthesia in 8 cases of OTTR and in 6 cases of SBR. RESULTS There was no statistically significant difference between the OTTR and SBR regarding Lysholm score, Lachman test, pivot-shift test, ATT by KT-2000, and AP translation and rotational laxity with a navigation system. CONCLUSIONS The clinical results of OTTR are almost equivalent to those of SBR. For the cases in which it is impossible to create the femoral tunnel in an anatomical position, OTTR is a valuable revision ACL reconstruction method. LEVEL OF EVIDENCE Case-control study. Level III.
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Affiliation(s)
- M A Usman
- Department of Orthopaedic surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, 734-8551 Hiroshima, Japan; Department of Orthopaedic Traumatology, Faculty of Medicine, Hasanuddin University, Indonesia
| | - G Kamei
- Department of Orthopaedic surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, 734-8551 Hiroshima, Japan.
| | - N Adachi
- Department of Orthopaedic surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - M Deie
- Department of Physical therapy and Occupational therapy, Graduate School of Health Science, Hiroshima University, Hiroshima, Japan
| | - A Nakamae
- Department of Orthopaedic surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - M Ochi
- Department of Orthopaedic surgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
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