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Kern K, Sanii R, Peterson JC, Menge T. Autograft Versus Allograft in Posterolateral Corner Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671241247542. [PMID: 38840793 PMCID: PMC11151772 DOI: 10.1177/23259671241247542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/30/2023] [Indexed: 06/07/2024] Open
Abstract
Background Several approaches to surgical techniques and graft types exist in posterolateral corner (PLC) reconstruction. The literature lacks knowledge regarding outcomes after autograft versus allograft reconstruction for PLC injuries. Purpose To comprehensively review the current literature on PLC reconstruction and compare outcomes between autograft and allograft tissues. Study Design Systematic review; Level of evidence, 4. Methods The PubMed and Scopus online databases were searched with the terms "PLC,""posterolateral knee,""posterolateral corner," and "reconstruction" in varying combinations. Patient characteristics, graft type, graft failure, surgical techniques, functional outcome scores, and varus laxity on stress radiographs were reviewed and compared between PLC reconstruction with autografts versus allografts. Results Included were 22 studies comprising 33 cohorts: 16 autografts (n = 280 knees) and 17 allografts (336 knees). There were 69 isolated PLC reconstructions (58 allografts and 11 autografts) and 493 multiligament reconstructions (269 autografts and 224 allografts). There was no difference in the mean patient age (30.5 vs 33.5 years, respectively; P = .11) or mean follow-up (39.5 vs 37.7 months, respectively; P = .68) between the autograft and allograft groups. There was no evidence to suggest a difference in graft failures between graft types (pooled mean autograft vs allograft: 0.44 vs 0.41 failures; P = .95). There was a significant difference in the mean postoperative Lysholm scores for autografts versus allografts (89.6 vs 85.5, respectively; P = .04). There was no difference between the cohorts in preoperative or postoperative International Knee Documentation Committee (IKDC) scores or postoperative varus laxity. Conclusion Our review and meta-analysis indicated no significant differences in graft failure rates or objective outcomes after PLC reconstruction based on graft type alone. There was a significant difference in postoperative Lysholm scores in favor of the autograft group and no significant difference in IKDC subjective scores.
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Affiliation(s)
- Kent Kern
- Corewell Health/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Ryan Sanii
- Corewell Health/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - James C Peterson
- Corewell Health/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Travis Menge
- Corewell Health/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
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Keoliya A, Ramteke SU. A Case Report on Medial Patellofemoral Ligament Reconstruction Rehabilitation in a Cricket Player Through Targeted Agility Training. Cureus 2024; 16:e56002. [PMID: 38606268 PMCID: PMC11007486 DOI: 10.7759/cureus.56002] [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: 02/12/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
The medial patellofemoral ligament (MPFL) serves as a crucial stabilizer, preventing lateral dislocation of the patella. Surgery is usually advised after a second dislocation, with MPFL reconstruction being a common procedure. The primary objective of rehabilitation post-surgery is not just to relieve pain and restore range of motion (ROM), but also to combine proprioceptive neuromuscular training to help patients return to their prior functional level. Agility training is a crucial component in accomplishing this goal. The current case is of a 19-year-old male cricket player with a history of recurrent patellar dislocation who underwent surgery after the latest incident rendered him unable to bear weight. His rehabilitation program included standard protocols alongside the early implementation of agility drills, such as ladder exercises. Compared to traditional approaches, this case demonstrates significant improvement in the patient's functional ability following surgery. This report highlights the importance of comprehensive rehabilitation for patients undergoing MPFL reconstruction. It not only underscores the rationale behind the surgery but also lays the groundwork for comparing recovery times. Notably, this program incorporated early agility exercises from the very beginning, suggesting that such an approach might accelerate recovery compared to standard protocols. Further investigation is warranted to explore the potential benefits of early agility training in this patient population.
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Affiliation(s)
- Ashish Keoliya
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapnil U Ramteke
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Screpis D, Santamaria F, Magnanelli S, De Berardinis L, Natali S, Gigante AP, Zorzi C. Double Vector: A Combined Biomechanical and Anatomical Posterolateral Corner Reconstruction Technique. Arthrosc Tech 2024; 13:102870. [PMID: 38435272 PMCID: PMC10907964 DOI: 10.1016/j.eats.2023.10.012] [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: 08/22/2023] [Accepted: 10/23/2023] [Indexed: 03/05/2024] Open
Abstract
Posterolateral corner (PLC) injuries are complex knee injuries that are becoming increasingly frequent. Often undiagnosed and underestimated, a systematic diagnostic workup is necessary to assess the severity of PLC injury in order to then be able to select the proper surgery approach. Anatomical and nonanatomical PLC-reconstruction techniques have been described. In this Technical Note, we describe our technique of biomechanical reconstruction of PLC in case of severe posterolateral rotational instability.
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Affiliation(s)
- Daniele Screpis
- IRCCS Ospedale Sacro Cuore – Don Calabria, Via Luigi Rizzardi, 4 Negrar di Valpolicella (VR), Italia
| | - Fabio Santamaria
- Clinica Ortopedica dell'Adulto e Pediatrica, Università Politecnica delle Marche, Via Tronto 10/A, Ancona (AN), Italia
| | - Stefano Magnanelli
- IRCCS Ospedale Sacro Cuore – Don Calabria, Via Luigi Rizzardi, 4 Negrar di Valpolicella (VR), Italia
| | - Luca De Berardinis
- Clinica Ortopedica dell'Adulto e Pediatrica, Università Politecnica delle Marche, Via Tronto 10/A, Ancona (AN), Italia
| | - Simone Natali
- IRCCS Ospedale Sacro Cuore – Don Calabria, Via Luigi Rizzardi, 4 Negrar di Valpolicella (VR), Italia
| | - Antonio Pompilio Gigante
- Clinica Ortopedica dell'Adulto e Pediatrica, Università Politecnica delle Marche, Via Tronto 10/A, Ancona (AN), Italia
| | - Claudio Zorzi
- IRCCS Ospedale Sacro Cuore – Don Calabria, Via Luigi Rizzardi, 4 Negrar di Valpolicella (VR), Italia
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4
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Fortier LM, Knapik DM, Condon JJ, DeWald D, Khan Z, Kerzner B, Matava MJ, LaPrade R, Chahla J. Higher success rate observed in reconstruction techniques of acute posterolateral corner knee injuries as compared to repair: an updated systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5565-5578. [PMID: 37848567 DOI: 10.1007/s00167-023-07582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE There remains controversy regarding the optimal surgical treatment for acute complete (grade III) posterolateral corner (PLC) injuries. The purpose of this article is to systematically review the contemporary literature regarding surgical options and subsequent outcomes of acute grade III PLC injuries. METHODS A systematic review was performed using the following search terms: posterolateral corner knee, posterolateral knee, posterolateral instability, multi-ligament knee, and knee dislocation. Inclusion criteria consisted of studies with level I-IV evidence, reporting on human patients with acute grade III PLC injuries undergoing operative management within 4 weeks from injury, with subjective and/or objective outcomes (including varus stress examinations or varus stress radiographs) reported at a minimum 2-year follow-up. Two investigators independently performed the search by sequentially screening articles. Accepted definitions of varus stability on examination or stress radiographs and revision surgery were used to determine success and failure of treatment. RESULTS A total of 12 studies, consisting of 288 patients were included. Ten studies reported primary repair, while reconstruction techniques were reported in seven studies. Overall, 43% (n = 125/288) of injuries involved the PLC, ACL and PCL. Staged reconstruction was reported in 25% (n = 3/12) of studies. The Lysholm score was the most commonly reported outcome measure. An overall failure rate of 12.4% (n = 35/282) was observed. Surgical failure was significantly higher in patients undergoing repair (21.9%; n = 21/96) compared to reconstruction (7.1%; n = 6/84) (p = 0.0058). Return to sport was greater in patients undergoing reconstruction (100%; n = 22/22) compared to repair (94%; n = 48/51) (n.s). The most common post-operative complication was arthrofibrosis requiring manipulation under anesthesia (8.7%; n = 25/288). A total of 3.8% (n = 11/288) of patients underwent revision PLC reconstruction. CONCLUSION There remains substantial heterogeneity in the surgical techniques of acute, grade III PLC injuries with an overall failure rate of 12.4%. Failure rates were significantly lower, and return to sport rates higher in patients undergoing PLC reconstruction compared to repair. The most common postoperative complication was arthrofibrosis requiring manipulation under anesthesia. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Luc M Fortier
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, 14532 South Outer Forty Drive, Chesterfield, MO, 63017, USA
| | - Josh J Condon
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St. Suite 300, Chicago, IL, 60612, USA
| | - Daniel DeWald
- Midwest Orthopaedics at Rush, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Zeeshan Khan
- Midwest Orthopaedics at Rush, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St. Suite 300, Chicago, IL, 60612, USA
| | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, 14532 South Outer Forty Drive, Chesterfield, MO, 63017, USA
| | - Robert LaPrade
- Twin Cities Orthopaedics, 4010 W 65th St., Edina, MN, 55435, USA
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, 1611 W Harrison St., Chicago, IL, 60612, USA.
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St. Suite 300, Chicago, IL, 60612, USA.
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Helal A, Marei AE, Shafik A, Elforse E. Clinical and radiological outcomes of a modified anatomic posterolateral corner reconstruction technique using a single semitendinosus autograft. Arch Orthop Trauma Surg 2023; 143:5767-5776. [PMID: 37140604 PMCID: PMC10449660 DOI: 10.1007/s00402-023-04862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/26/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE We aimed to assess the clinical and radiological outcomes of a modified anatomical posterolateral corner (PLC) reconstruction technique using a single autograft. METHODS This prospective case series included 19 patients with a posterolateral corner injury. The posterolateral corner was reconstructed using a modified anatomical technique that utilized adjustable suspensory fixation on the tibial side. Patients were evaluated subjectively using the international knee documentation form (IKDC), Lysholm, and Tegner activity scales and objectively by measuring the tibial external rotation angle, knee hyperextension, and lateral joint line opening on stress varus radiographs before and after surgery. The patients were followed-up for a minimum of 2 years. RESULTS Both IKDC and Lysholm knee scores significantly improved from 49 and 53 preoperatively to 77 and 81 postoperatively, respectively. The tibial external rotation angle and knee hyperextension showed significant reduction to normal values at the final follow-up. However, the lateral joint line opening measured on the varus stress radiograph remained larger than the contralateral normal knee. CONCLUSION Posterolateral corner reconstruction with a hamstring autograft using a modified anatomical reconstruction technique significantly improved both the subjective patient scores and objective knee stability. However, the varus stability was not completely restored compared with the uninjured knee. LEVEL OF EVIDENCE Prospective case series (Level of evidence IV).
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Affiliation(s)
- Ahmed Helal
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt.
| | - Abdelhakim E Marei
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt
| | - Ahmed Shafik
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt
| | - Elsayed Elforse
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt
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Low posterior tibial slope is associated with increased risk of PCL graft failure. Knee Surg Sports Traumatol Arthrosc 2022; 30:3277-3286. [PMID: 35028674 DOI: 10.1007/s00167-021-06760-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the effect of posterior tibial slope (PTS) on patient-reported outcomes (PROs) and posterior cruciate ligament (PCL) graft failure after PCL reconstruction. METHODS Patients undergoing PCL reconstruction with a minimum 2-year follow-up were included in this retrospective cohort study. A chart review was performed to collect patient-, injury-, and surgery-related data. Medial PTS was measured on preoperative lateral radiographs. Validated PROs, including the International Knee Documentation Committee Subjective Knee Form, Knee injury and Osteoarthritis Outcome Score, Lysholm Score, Tegner Activity Scale, and Visual Analogue Scale for pain, were collected at final follow-up. A correlation analysis was conducted to assess the relationship between PTS and PROs. A logistic regression model was performed to evaluate if PTS could predict PCL graft failure. RESULTS Overall, 79 patients with a mean age of 28.6 ± 11.7 years and a mean follow-up of 5.7 ± 3.3 years were included. After a median time from injury of 4.0 months, isolated and combined PCL reconstruction was performed in 22 (28%) and 57 (72%) patients, respectively. There were no statistically significant differences in PROs and PTS between patients undergoing isolated and combined PCL reconstruction (non-significant [n.s.]). There were no significant correlations between PTS and PROs (n.s.). In total, 14 (18%) patients experienced PCL graft failure after a median time of 17.5 months following PCL reconstruction. Patients with PCL graft failure were found to have statistically significantly lower PTS than patients without graft failure (7.0 ± 2.3° vs. 9.2 ± 3.3°, p < 0.05), while no differences were found in PROs (n.s.). PTS was shown to be a significant predictor of PCL graft failure, with a 1.3-fold increase in the odds of graft failure for each one-degree reduction in PTS (p < 0.05). CONCLUSIONS This study showed that PTS does not affect PROs after PCL reconstruction, but that PTS represents a surgically modifiable predictor of PCL graft failure. LEVEL OF EVIDENCE III.
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7
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Filbay SR, Skou ST, Bullock GS, Le CY, Räisänen AM, Toomey C, Ezzat AM, Hayden A, Culvenor AG, Whittaker JL, Roos EM, Crossley KM, Juhl CB, Emery C. Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus. Br J Sports Med 2022; 56:1465-1474. [PMID: 36171078 DOI: 10.1136/bjsports-2022-105626] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Determine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations. DESIGN Random-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed. DATA SOURCES MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021. ELIGIBILITY Studies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury. RESULTS Fifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2-14 years post-ACL injury. Pooled PCS scores were worse >10 years (50.8 (48.7 to 52.9)) compared with 2-5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (-1.5 (-2.9 to -0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some individuals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL). CONCLUSION There is a very-low certainty of evidence that PCS scores ≥2 years post-ACL injury are worse than uninjured controls and decline over time, whereas MCS scores remain high. ACL injury can result in prolonged work absenteeism and high health/economic costs. Further studies are needed to determine the long-term burden of traumatic meniscal injury.
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Affiliation(s)
- Stephanie Rose Filbay
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Christina Y Le
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Anu M Räisänen
- Department of Physical Therapy Education, Oregon, Western University of Health Sciences College of Health Sciences, Northwest, Lebanon, Oregon, USA.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Clodagh Toomey
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,School of Allied Health, University of Limerick, Limerick, Ireland
| | - Allison M Ezzat
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Jackie L Whittaker
- Arthritis Research Canada, Richmond, British Columbia, Canada.,Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Carolyn Emery
- Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Effect of modified Laprade technique on posterolateral ligament injury of knee. Eur J Med Res 2022; 27:171. [PMID: 36071511 PMCID: PMC9450289 DOI: 10.1186/s40001-022-00764-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/19/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To investigate the effect of modified Laprade technique on the reconstruction of posterolateral structure of knee and anterolateral ligament of knee in the treatment of posterolateral injury of knee. Methods From December 2013 to June 2020, multiple ligament injury patients who received surgery in our hospital were collected in this research. These patients underwent a modified Laprade technique for posterolateral structural reconstruction of the knee. Lysholm scores of patients pre- and post-operation were recorded. Result The operations of the observation group or the control group patients were completed. There were no significant differences in gender, age, preoperative knee range of motion and preoperative Lysholm score. At the time of follow-up 1 month after operation, there was no significant difference in knee range of motion, dial-up test angle and Lysholm score between the observation and the control group. When followed up 1 year after operation, the Lysholm score of the observation group was higher than that of the control group. The difference was statistically significant. The same situation occurred in the range of motion of the knee in both groups. However, there was still no significant difference between the two groups in the dial-up test 1 year after operation, whether the knee flexion was 30° or 90°. Conclusion For patients with posterolateral structure injury of knee, the modified Laprade technique is a feasible surgical technique.
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Sports activity and quality of life improve after isolated ACL, isolated PCL, and combined ACL/PCL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 31:1781-1789. [PMID: 35809104 PMCID: PMC10090003 DOI: 10.1007/s00167-022-07060-w] [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: 04/07/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare patient-reported outcomes following isolated anterior cruciate ligament reconstruction (ACL-R), isolated posterior cruciate ligament reconstruction (PCL-R), and combined ACL-R and PCL-R (ACL/PCL-R), at a minimum follow-up of 2 years. METHODS This was a prospective observational registry cohort study based on the Swedish National Knee Ligament Registry. Patients undergoing isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R between 2005 and 2019 were eligible for inclusion. Demographic characteristics as well as injury- and surgery-related data were queried from the SNKLR. To evaluate functional outcomes, the Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1- and 2-year follow-ups and compared between the treatment groups. RESULTS In total, 45,169 patients underwent isolated ACL-R, 192 patients isolated PCL-R, and 203 patients combined ACL/PCL-R. Preoperatively, and at the 1- and 2-year follow-ups, KOOS subscales were highest for the isolated ACL-R group, followed by the isolated PCL-R, and lowest for the combined ACL/PCL-R groups. Significant improvements were observed across all treatment groups in the majority of KOOS subscales between the preoperative, and 1- and 2-year follow-ups. All treatment groups showed the greatest improvements between the preoperative and 2-year follow-ups in the knee-related quality of life (mean improvement: isolated ACL-R, + 28 points; isolated PCL-R, + 23 points; combined ACL/PCL-R, + 21 points) and the function in sport and recreation (mean improvement: isolated ACL-R, + 26 points; isolated PCL-R, + 20 points; combined ACL/PCL-R, + 19 points) subscales. CONCLUSION Clinically relevant improvements in knee function can be expected after isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R. Functional improvements were particularly pronounced in the KOOS function in sport and recreation subscale, indicating the importance of knee stability for sports activity. This study facilitates more comprehensive patient education about functional expectations after surgical treatment of isolated and combined ACL and PCL injuries. LEVEL OF EVIDENCE Level 2.
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