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Dauty M, Louguet B, Menu P, Grondin J, Crenn V, Daley P, Fouasson-Chailloux A. Enlightenment on Knee Flexors Strength Loss in Cases of Posterior Knee Pain After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2024:1-8. [PMID: 38684207 DOI: 10.1123/jsr.2023-0346] [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: 10/10/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024]
Abstract
CONTEXT The persistence and the recurrence of posterior medial knee pain (PKP) after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon graft are often overlooked during rehabilitation. DESIGN Cross-sectional observational study. METHODS The study aimed (1) to evaluate the prevalence of these types of PKP before 4 months post-ACLR, (2) to measure their consequences on the knee flexors strength, and (3) to evaluate the role of the type of ACLR. From a cohort of patients operated on with hamstring tendon procedures, the persistent and the recurrent PKP were sought at 4 months post-ACLR. The evolution of isokinetic muscle strength recovery in PKP subjects was compared with those of nonpainful subjects. The functional deficit was measured at 6/7 months post-ACLR by a hop test. RESULTS Three hundred seventeen subjects (25.8 [6.0] y) were included. At 4 months post-ACLR, 2 populations were identified based on the recurrent onset of PKP (PKP+, n = 40) or the absence of knee pain (PKP-, n = 277). The prevalence of PKP was 8.3%. At the fourth month post-ACLR, the PKP+ group had a higher flexor strength deficit compared with the PKP- group (limb symmetry index at 60°/s: 67.2% [12.4%] vs 84.3% [12.6%]; P < .05). At 6/7 months, the loss of strength persisted (limb symmetry index at 60°/s: 82.3% [13.4%] vs 87.7% [12.8%]; P < .05). The hop test deficit was comparable, and no difference was shown according to the type of graft. CONCLUSIONS Persistent and recurrent PKP during the rehabilitation period were not uncommon and were associated with a worsening of flexors strength loss on the ACLR side.
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Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
| | - Bastien Louguet
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
| | - Jérôme Grondin
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Vincent Crenn
- Clinique Chirugicale Othopédique et Traumatiologique, CHU Nantes, Nantes Université, Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
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Vivekanantha P, Nedaie S, Hassan Z, Abdel Khalik H, Carsen S, Nagai K, Hoshino Y, de Sa D. Contralateral hamstring autografts do not provide benefit compared to ipsilateral hamstring autografts in primary or revision anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5641-5651. [PMID: 37864773 DOI: 10.1007/s00167-023-07597-4] [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: 07/31/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of primary or revision ACL reconstruction (ACLR) after contralateral hamstring autografts versus ipsilateral hamstring autograft harvest. METHODS Three databases (MEDLINE, PubMed and EMBASE) were searched from inception to April 27th, 2023 for studies investigating contralateral hamstring autografts in primary or revision ACLR. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, strength measures, patient-reported outcome measures (PROMs), and rates of positive Lachman test, positive pivot-shift test and graft rupture were extracted. PROMs included Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores. RESULTS Nine studies comprising 371 patients were included in this review. In primary ACLR, there were no significant differences between contralateral and ipsilateral groups in isokinetic hamstring torque in the non-ACLR limb or isokinetic quadriceps torque in both limbs when tested at 60, 90, 120 or 180 degrees/second. Isokinetic hamstring torque in the non-ACLR limb was significantly weaker in the contralateral group at six months for primary ACLR; however, these deficits did not persist. There were no significant differences in postoperative median Tegner scores and Lysholm scores between contralateral and ipsilateral groups in primary ACLR. There were no significant differences in postoperative median Tegner, mean Lysholm and IKDC scores between groups in revision ACLR. There were no significant differences in positive Lachman, positive pivot-shift and rupture rates in primary ACLR between groups. Rates of positive Lachman and pivot-shift were slightly higher in the contralateral than ipsilateral group for revision ACLR. CONCLUSION Contralateral hamstring autografts results in comparable muscle strength to ipsilateral hamstring autografts, with the exception of weaker hamstring strengths in the early postoperative period. Patient-reported outcome measures were similar between the two groups across both primary and revision ACLR, with rates of instability and failure being similar between groups for primary ACLR. Contralateral hamstring grafts do not provide additional benefit when compared to ipsilateral options for either primary or revision ACLR, and should be used only in select circumstances including insufficient ipsilateral hamstring grafts or situations where quadriceps or patella autografts are not optimal. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Soroush Nedaie
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Zackariyah Hassan
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St West, Hamilton, ON, L8S 4L8, Canada.
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Fan D, Ma J, Zhang L. Contralateral grafts have comparable efficacy to ipsilateral grafts in anterior cruciate ligament reconstructions: a systematic review. J Orthop Surg Res 2023; 18:596. [PMID: 37568165 PMCID: PMC10422826 DOI: 10.1186/s13018-023-04082-z] [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: 06/29/2023] [Accepted: 08/06/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE To perform a systematic review of the clinical outcomes of anterior cruciate ligament reconstruction using either contralateral or ipsilateral tendon autografts. METHODS A systematic review of literature published from inception to December 9, 2022, in multiple databases (PubMed, Embase, Scopus, and the Cochrane Library) was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews) guidelines. Two reviewers independently screened the literature, extracted the data, performed the risk of bias assessment and assessed the study quality. At least one of the following outcomes was evaluated for each study: muscle strength (isometric strength of the quadriceps or hamstring muscles, isokinetic peak flexion torque of the hamstring, or isokinetic peak extension torque of the hamstring), knee laxity examination, Lysholm score, pivot shift, International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lachman test result, return to sports time, or incidence of complications. A random effects model was used for all analyses. RESULTS Four hundred scientific manuscripts were recovered in the initial search. After screening, 12 studies (2 randomized controlled trials, 9 cohort studies, and 1 case- control study) met the search criteria for the qualitative analysis. Among them, 9 cohort studies were used for the quantitative analysis. The results showed few statistically significant differences in terms of muscle strength (contralateral group versus ipsilateral group or donor site group versus ipsilateral group or donor site group versus nonoperative group), Lysholm score, and return to sports time. A comparison showed no significant differences in knee laxity, IKDC score, Tegner activity score, Lachman test score, or incidence of complication, or contralateral rupture. CONCLUSIONS In anterior cruciate ligament reconstruction, the contralateral autologous tendon has a similar effect as the ipsilateral autologous tendon.
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Affiliation(s)
- DingYuan Fan
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
- Beijing University of Chinese Medicine, Beijing, China
- University College London, London, UK
| | - Jia Ma
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
| | - Lei Zhang
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China.
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China.
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Kuliński K, Waśko MK, Tramś E, Malesa K, Pomianowski S, Kamiński R. Anterior Cruciate Ligament Reconstruction Using a 4-Strand Semitendinosus Tendon Graft or a Doubled Semitendinosus and Gracilis Tendon Graft: A 4.5-Year Prospective, Randomized, Double-Blind, Parallel-Group Study. Am J Sports Med 2023; 51:615-626. [PMID: 36856280 DOI: 10.1177/03635465221149738] [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] [Indexed: 03/02/2023]
Abstract
BACKGROUND Hamstring tendon grafts are the most common choice for anterior cruciate ligament (ACL) reconstruction (ACLR). Previous studies have provided evidence that offers conflicting opinions concerning the most favorable graft choice. PURPOSE To identify whether the use of a quadrupled semitendinosus tendon (ST) or doubled semitendinosus tendon and gracilis tendon (ST/G) graft provides comparable anterior tibial translation (ATT) with similar functional results and similar donor site morbidity. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This was a prospective, patient- and surgeon-blinded, randomized trial set in a busy orthopaedic and traumatology department at a university hospital. Between 2015 and 2017, a total of 162 patients with ACL lesions were randomized to undergo ACLR with either a quadrupled ST or doubled ST/G graft. The primary endpoint was ATT assessed with the KT-1000 arthrometer. Clinical outcomes were assessed using the patient-reported outcome measures (PROMs) of the visual analog scale (VAS), International Knee Documentation Committee (IKDC) subjective evaluation form, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, and Lysholm knee scoring scale. RESULTS Preoperative demographic data, ATT, and PROM scores showed no significant differences. At 4.5 years, no significant differences were found between the ST and ST/G groups with respect to PROM scores and KT-1000 arthrometer, Lachman test, and pivot-shift test findings. Differences in functional results between groups were significant (muscle strength). Subgroup analysis revealed significantly increased ATT in female patients undergoing ACLR with a quadrupled ST graft during the 4.5-year observation period, as assessed by the KT-1000 arthrometer, as well as inferior KOOS, IKDC, Lysholm, and VAS scores. CONCLUSION This study showed a significant increase in ATT as well as inferior results on PROMs during a 4.5-year observation period in female patients undergoing ACLR with a quadrupled ST graft. In male patients, the study provided evidence of the noninferiority of ACLR with an ST graft, with no influence on donor site morbidity. TRIAL REGISTRATION clinicaltrials.gov: NCT03626883.
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Affiliation(s)
- Krzysztof Kuliński
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Marcin K Waśko
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Tramś
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Kamila Malesa
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Stanisław Pomianowski
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Rafał Kamiński
- Department of Orthopaedics and Trauma Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Otwock, Poland
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Beaudoin A, Ogborn D, McRae S, Larose G, Brown H, McCormack R, MacDonald P. No differences found in long-term outcomes of a randomized controlled trial comparing ipsilateral versus contralateral hamstring graft in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:3718-3725. [PMID: 35507037 DOI: 10.1007/s00167-022-06980-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Contralateral graft harvest in primary ACL reconstruction is relatively uncommon and the long-term comparative of this approach relative to ipsilateral harvest has not been described. The purpose of this study was to evaluate ACL graft and contralateral rupture following ipsilateral or contralateral semitendinosus and gracilis (STG) graft harvest at follow-up of a minimum 10 years post-reconstruction in the treatment of a complete ACL tear. METHODS Patients from a previous randomized trial were evaluated. The primary outcome measures were ipsilateral and contralateral reinjury as well as the International Knee Documentation Committee (IKDC) knee assessment form, the ACL Quality of Life questionnaire (ACL-QoL) and the Tegner activity scale. Participants completed four different single-leg hop tests and concentric knee flexion and extension strength were assessed on an isokinetic dynamometer. RESULTS Of the original 100 patients, 50 patients (41.3 ± 9.5 years of age, 31 males, 19 females) reported on re-injury at 12.6 ± 1.4 years post-operative. Thirty-eight patients returned for full assessment and 12 responded by mail or phone survey. There were no differences between groups for graft rupture, contralateral injury, ACL-QoL score, IKDC categorization, or anterior tibial translation, though both groups experienced a reduction in the Tegner Activity Scale from their preinjury scores. There was no difference in knee flexor and extensor isokinetic concentric strength, or single leg hop test performance. Knee flexor strength limb symmetry index was reduced when measured in the supine relative to the seated position in both groups, indicating persistent deficits in knee flexor strength when measured in the supine position. CONCLUSION Contralateral hamstring harvest does not put patients at an increased risk of a contralateral ACL tear and long-term outcomes of ACL reconstruction do not differ based on the side of graft harvest. Contralateral STG harvest may provide a safe alternative surgical option for select patients. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Alisha Beaudoin
- Max Rady College of Medicine, University of Manitoba, 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada.
| | - Dan Ogborn
- Pan Am Clinic Foundation, Winnipeg, MB, Canada.,Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada.,Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Sheila McRae
- Pan Am Clinic Foundation, Winnipeg, MB, Canada.,Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada.,Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Gabriel Larose
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
| | - Holly Brown
- Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Robert McCormack
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Peter MacDonald
- Pan Am Clinic Foundation, Winnipeg, MB, Canada.,Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
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