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Damayanthi ED, Kholinne E, Singjie LC, Sakti M, Anesstesia IJ. Combined Anterior Cruciate Ligament Reconstruction (ACLR) and Lateral Extra-articular Tenodesis through the Modified Lemaire Technique versus Isolated ACLR: A Meta-analysis of Clinical Outcomes. Rev Bras Ortop 2024; 59:e180-e188. [PMID: 38606123 PMCID: PMC11006520 DOI: 10.1055/s-0044-1785492] [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: 03/27/2023] [Accepted: 08/25/2023] [Indexed: 04/13/2024] Open
Abstract
Objective Lateral extra-articular tenodesis (LET) has been proposed to resolve rotatory instability following anterior cruciate ligament reconstruction (ACLR). The present meta-analysis aimed to compare the clinical outcomes of ACLR and ACLR with LET using the modified Lemaire technique. Materials and Methods We performed a meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) staement. The literature search was performed on the PubMed, EBSCOHost, Scopus, ScienceDirect, and WileyOnline databases. The data extracted from the studies included were the study characteristics, the failure rate (graft or clinical failure) as the primary outcome, and the functional score as the secondary outcome. Comparisons were made between the patients who underwent isolated ACLR (ACLR group) and those submitted to ACLR and LET through the modified Lemaire technique (ACLR + LET group). Results A total of 5 studies including 797 patients were evaluated. The ACLR + LET group presented a lower risk of failure and lower rate of rerupture than the ACLR group (risk ratio [RR] = 0.44; 95% confidence interval [95%CI]: 0.26 to 0.75; I 2 = 9%; p = 0.003). The ACLR + LET group presented higher scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) regarding the following outcomes: pain, activities of daily living (ADL), sports, and quality of life (QOL), with mean differences of 0.20 (95%CI: 0.10 to 0.30; I 2 = 0%; p < 0.0001), -0.20 (95%CI: -0.26 to -0.13; I 2 = 0%; p < 0.00001), 0.20 (95%CI: 0.02 to 0.38; I 2 = 0%; p = 0.03), and 0.50 (95%CI: 0.29 to 0.71; I 2 = 0%; p < 0.00001) respectively when compared with the ACLR group. Conclusion Adding LET through the modified Lemaire technique to ACLR may improve knee stability because of the lower rate of graft rerupture and the superiority in terms of clinical outcomes. Level of Evidence I.
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Affiliation(s)
- Essy Dwi Damayanthi
- Departamento de Ortopedia e Traumatologia, Ulin General Hospital, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, Indonésia
| | - Erica Kholinne
- Departamento de Cirurgia Ortopédica, St. Carolus Hospital, Faculty of Medicine, Universitas Trisakti, Jacarta, Indonésia
| | | | - Muhammad Sakti
- Departamento de Cirurgia Ortopédica, Faculty of Medicine, Hasanuddin University, Macáçar, Indonésia
| | - Ira Juliet Anesstesia
- Departamento de Cirurgia Ortopédica, St. Carolus Hospital, Faculty of Medicine, Universitas Trisakti, Jacarta, Indonésia
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Sonnery-Cottet B, Fabre C, Vieira TD, Saithna A. Editorial Commentary: Knee Lateral Extra-articular Tenodesis Procedures: Appropriate Study Design Is Essential for Reducing Conflicting Findings and Unnecessary Controversy in the Orthopaedic Literature. Arthroscopy 2024:S0749-8063(24)00196-8. [PMID: 38490502 DOI: 10.1016/j.arthro.2024.02.041] [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] [Received: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
Knee lateral extra-articular tenodesis procedures (LEAPs) reduce graft rupture rates when performed at the time of anterior cruciate ligament (ACL) reconstruction. However, in the setting of revision ACL reconstruction, LEAPs are less studied and remain controversial. Many studies support combined procedures (ACL + LEAP), yet others do not. When the literature comprises small patient cohorts and short follow-up periods, conflicting results often arise. The controversy surrounding them may be unnecessarily generated by the publication of low-quality studies. Future studies should focus on adequate power; appropriate design and methodology, including matching or randomization to account for potential confounding factors; proper statistical analyses; and avoidance of spin bias.
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Grassi A, Olivieri Huerta RA, Lucidi GA, Agostinone P, Dal Fabbro G, Pagano A, Tischer T, Zaffagnini S. A Lateral Extra-articular Procedure Reduces the Failure Rate of Revision Anterior Cruciate Ligament Reconstruction Surgery Without Increasing Complications: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:1098-1108. [PMID: 38294248 PMCID: PMC10943615 DOI: 10.1177/03635465231173698] [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: 11/26/2022] [Accepted: 03/17/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Lateral extra-articular procedures are becoming increasingly popular in association with anterior cruciate ligament (ACL) reconstruction, especially in patients with persistent rotatory instability and in a high-risk population. However, few studies have investigated the outcomes of the lateral extra-articular procedure as an associated procedure in an ACL revision (R-ACLR) setting and its benefit with respect to isolated intra-articular reconstruction. HYPOTHESIS Lateral extra-articular procedures reduce the failure rate of revision ACL reconstruction (R-ACLR). PURPOSE To compare subjective outcomes, knee stability, and failure and complication rates between patients who underwent ACL revision with and without an associated lateral extra-articular procedure. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 3. METHODS A systematic search of the PubMed, Cochrane, and OVID databases was performed on September 2022 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eligible studies were trials directly comparing patients who had isolated ACL revision with patients who had ACL revision associated with lateral extra-articular procedures at a minimum follow-up of 2 years. A meta-analysis was performed, and bias and the quality of the evidence were rated according to the Newcastle-Ottawa Scale. The meta-analysis was conducted according to the PRISMA guidelines. RESULTS Eight studies were included: a total of 334 patients were treated with isolated revision (isolated (R-ACLR)) and 342 treated with combined revision and a lateral extra-articular procedure (combined (R-ACLR)). For the failure rate, the meta-analysis showed a significantly decreased relative risk reduction of 54% (P = .004) in patients with combined (R-ACLR) with respect to isolated R-ACL, whereas no difference in complication rate was observed. The combined (R-ACLR) group demonstrated a decreased risk ratio of 50% (P = .002) for having a positive pivot-shift test result and a relative risk reduction of 68% (P = .003) for having a grade 2-3 pivot shift when compared with the isolated (R-ACLR) group. Finally, no significant differences were observed among the lateral extra-articular procedures. CONCLUSION The addition of a lateral extra-articular procedure to revision ACL significantly reduced the failure rate and postoperative pivot shift without increasing the complication rate. Anterolateral ligament reconstruction and a lateral extra-articular procedure with iliotibial band were effective in improving the outcomes of revision ACL reconstruction. Further high-level studies could help to clarify which subgroup of patients could particularly benefit from an anterolateral procedure in the context of ACL revision.
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Affiliation(s)
- Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Pagano
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Thomas Tischer
- Department of Orthopaedic and Trauma Surgery, Klinik Für Orthopädie und Unfallchirurgie, Malteser Waldkrankenhaus St Marien, Erlangen, Germany
- Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Murgier J, Duthon V, Deygas A, Ehkirch FP. Does an early post traumatic knee brace reduce the incidence of knee rotational instability? Arch Orthop Trauma Surg 2024; 144:1161-1169. [PMID: 38253710 DOI: 10.1007/s00402-024-05206-8] [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: 07/22/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE Several anterolateral stabilization procedures have been developed recently to address rotational instability of the knee. Currently, these procedures tend to be systematically used by some practitioners. However, antero-lateral structures of the knee (including the anterolateral ligament, ALL) have a self-healing potential which can reduce the need to perform an antero-lateral procedure. In this study, it was hypothesized that early post-traumatic immobilization of the knee with a knee brace would allow partial healing of antero-lateral structures and also allow control of the pivot shift, thus avoiding antero-lateral extra-articular stabilization. The objective of this study was to compare the severity of pivot shift between two groups of patients who all experienced anterior cruciate ligament (ACL) tear and respectively underwent post-traumatic immobilization of the knee versus no immobilization. METHODS This was a comparative, multicentric (three centers' study) retrospective, consecutive study including 168 patients who underwent ACL reconstruction between May and September 2022. The application or not of post-traumatic immobilization and its duration, the severity of pivot shift observed in the operating room under general anesthesia, the presence of anterolateral lesions as revealed by MRI and the patients' pre-injury sport activity were recorded. RESULTS A grade 3 pivot shift was found in 44 patients (27%). It was more frequently observed in the group without a brace compared to the group with a knee brace (18 patients out of 36: 50% versus 26 patients out of 132: 19.7%; p = 0.0012). Wearing a brace, whether hinged (OR = 0.221, [0.070-0.652]; p = 0.006) or not (OR = 0.232, [0.076-0.667]; p = 0.0064), was protective from the risk of developing a significant pivot shift. CONCLUSION This study demonstrated that the presence of pivot-shift was lower in the patients that had an early post-injury knee brace before their ACL reconstruction. Based on this result, systematic brace placement could be advocated for in patients after knee trauma. LEVEL OF EVIDENCE III, prognostic retrospective case-control study.
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Affiliation(s)
- Jérôme Murgier
- Orthopedics Department, Aguiléra Clinic, 21 Rue de L'Estagnas, 64200, Biarritz, France.
| | - Victoria Duthon
- Centre de Médecine du Sport et de L'Exercice, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Geneva, Switzerland
| | - Aymeric Deygas
- Orthopaedic Department, Clinique Maussins-Nollet, Paris, France
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Jones EN, Post HK, Stovall BA, Ierulli VK, Vopat BG, Mulcahey MK. Lateral Extra-articular Tenodesis Augmentation of Anterior Cruciate Ligament Reconstruction Is Most Commonly Indicated for Pivot Shift of Grade 2 or Greater and for Revision Anterior Cruciate Ligament Reconstruction. Arthroscopy 2024:S0749-8063(24)00085-9. [PMID: 38331370 DOI: 10.1016/j.arthro.2024.01.031] [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] [Received: 09/25/2023] [Revised: 01/14/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To determine the most common indications for lateral extra-articular tenodesis (LET) augmentation of anterior cruciate ligament reconstruction (ACLR). METHODS A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Embase, Web of Science, and Cochrane Database of Systematic Reviews from 2000 to the present (June 2022). Studies that met the following criteria were included: patients of any age who underwent LET in addition to ACLR, studies reporting at least 1 indication for LET, and observational/randomized controlled trial study designs including prevalence of indications. Publications had to be reported in English and peer reviewed and to have originated in the United States or countries offering identical protocols and procedures. RESULTS A total of 463 studies were identified from the initial search, 23 of which met inclusion criteria and were included in the review. Eight of the 23 studies (34.8%) used a modified Lemaire technique, seven (30.4%) used a MacIntosh modified by Arnold-Coker, and eight (34.8%) used other techniques to perform LET. A total of 2,125 patients (53% female, 47% male [3 studies did not report sex]) underwent ACLR augmented with LET. The indications along with prevalence were as follows: positive pivot shift test (grade ≥2) (19 of 23, 82.6%), revision ACLR (12 of 23, 52.2%), ligamentous laxity (11 of 23, 47.8%), general sports participation (11 of 23, 47.8%), age less than 25 years (8 of 23, 34.8%), high risk of graft failure (5 of 23, 21.7%), and positive Lachman test (4 of 23, 17.4%). CONCLUSIONS Pivot shift grade ≥2 was the most common reason orthopaedic surgeons chose to add LET to ACLR, with revision ACLR, patient age <25, and general sports participation following closely behind. LEVEL OF EVIDENCE Level I to IV, systematic review of studies.
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Affiliation(s)
- Emily N Jones
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Hunter K Post
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
| | - Bailey A Stovall
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Victoria K Ierulli
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Bryan G Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, U.S.A..
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Eggeling L, Drenck TC, Breer S, Frosch KH, Akoto R. Association of Remaining Anterior Knee Laxity With Inferior Outcomes After Revision ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671231219695. [PMID: 38371998 PMCID: PMC10870811 DOI: 10.1177/23259671231219695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 02/20/2024] Open
Abstract
Background The relationship between remaining anterior knee laxity and poorer clinical outcomes after anterior cruciate ligament reconstruction (ACLR) may be underrated, and the criteria for failure of revision ACLR have not been defined. Purpose/Hypothesis To evaluate a possible association between remaining knee laxity and functional scores in patients after revision ACLR. We hypothesized that a postoperative side-to-side-difference (SSD) in knee laxity of ≥6 mm will be an objective parameter for failure. Study Design Cohort study; Level of evidence, 3. Methods A total of 200 patients (77 women and 123 men; mean age, 30.8 ± 11 years; range, 18-61 years) who underwent revision ACLR between 2016 and 2019 were evaluated; The mean follow-up period was 30.2 ± 9 months (range, 24-67 months). Patients were divided into 3 groups according to postoperative SSD (<3 mm, 3-5 mm, or ≥6 mm). Preoperative and postoperative outcome measures (Lachman, pivot shift, visual analog scale [VAS] for pain, Tegner, Lysholm, International Knee Documentation Committee, and Knee injury and Osteoarthritis Outcome Score) were compared between the groups. Results Of the 200 patients, 74% (n = 148) had a postoperative SSD of <3 mm at the latest follow-up, 19.5% (n = 39) had a postoperative SSD of 3 to 5 mm, and 6.5% (n = 13) had a postoperative SSD of ≥6 mm. Patients in all groups saw significant pre- to postoperative reductions in positive Lachman and pivot-shift tests as well as significant improvements in VAS pain, Lysholm, and Tegner scores (P < .001 for all). All postoperative functional scores of the patients with SSDs of <3 mm and 3-5 mm were significantly increased compared with those of patients with an SSD of ≥6 mm (P≤ .01 for all). Conclusion In patients following revision ACLR, anterior and rotational knee laxity were successfully reduced while increasing postoperative functional outcomes. A remaining postoperative SSD of ≥6 mm was associated with inferior patient outcomes compared with an SSD <6 mm. An SSD of ≥6 mm represents an objective parameter in the definition of failure of revision ACLR.
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Affiliation(s)
- Lena Eggeling
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
- Asklepios St. Georg Clinic, Hamburg, Germany
| | - Tobias Claus Drenck
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
| | - Stephan Breer
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
- Department of Trauma Surgery and Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Akoto
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
- Asklepios St. Georg Clinic, Hamburg, Germany
- Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
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Boksh K, Sheikh N, Chong HH, Ghosh A, Aujla R. The Role of Anterolateral Ligament Reconstruction or Lateral Extra-articular Tenodesis for Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Comparative Clinical Studies. Am J Sports Med 2024; 52:269-285. [PMID: 36960926 DOI: 10.1177/03635465231157377] [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] [Indexed: 03/25/2023]
Abstract
BACKGROUND After its success in restoring rotational stability and reducing failure rates in primary anterior cruciate ligament reconstruction (ACLR), lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALLR) has been endorsed for use in revision ACLR surgery, where failure rates are historically higher. PURPOSE To perform a systematic review and meta-analysis on whether the addition of a LET or ALLR results in superior clinical outcomes and stability compared with isolated revision ACLR (iACLR). STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis of comparative studies using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: ("extra-articular" OR "tenodesis" OR "anterolateral ligament" OR "iliotibial") AND ("anterior cruciate ligament") AND ("revision" OR "re-operation"). Data pertaining to all patient-reported outcome measures (PROMs), rotational stability, and postoperative complications were extracted from each study. RESULTS After abstract and full-text screening, 10 clinical comparative studies were included. There were 793 patients, of whom 390 had an iACLR while 403 had an ACLR augmented with a LET or an ALLR (augmented ACLR [aACLR]). The mean time for assessment of PROMs was 35 months. The aACLR group had superior International Knee Documentation Committee (IKDC) scores (standardized mean difference [SMD], 0.27; 95% CI, 0.01 to 0.54; P = .04), rotational stability (odds ratio [OR], 2.77; 95% CI, 1.91 to 4.01; P < .00001), and lower side-to-side difference (OR, -0.53; 95% CI, -0.81 to -0.24; P = .0003) than those without the augmentation. Furthermore, they were less likely to fail (OR, 0.44; 95% CI, 0.24 to 0.80; P = .007). Subgroup analysis in the higher-grade laxity cohort (grade ≥2) revealed an even greater IKDC score (SMD, 0.51; 95% CI, 0.16 to 0.86; P = .005) and an improved Lysholm score (SMD, 0.45; 95% CI, 0.24 to 0.67; P < .0001) in the aACLR group. CONCLUSION Revision aACLR with a LET or an ALLR can improve subjective IKDC scores, restore rotational stability, and reduce failure rates compared with iACLR. Although controversy remains on the necessity of augmenting all revision ACLRs, the present meta-analysis advocates adding a lateral procedure, particularly in those with a higher-grade pivot shift.
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Affiliation(s)
- Khalis Boksh
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nomaan Sheikh
- Department of Trauma and Orthopaedics, Kettering General Hospital, Kettering, UK
| | - Han Hong Chong
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Arijit Ghosh
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Randeep Aujla
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
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Sørensen OG, Faunø P, Konradsen L, Nielsen T, Schaarup S, Mygind-Klavsen B, Krogsgaard M, Lind M. Combined anterior cruciate ligament revision with reconstruction of the antero-lateral ligament does not improve outcome at 2-year follow-up compared to isolated acl revision; a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:5077-5086. [PMID: 37733288 PMCID: PMC10598101 DOI: 10.1007/s00167-023-07558-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE It is essential to obtain rotational stability of the knee after anterior cruciate ligament reconstruction (ACL-R) and it is suggested that a supplementary reconstruction of the antero-lateral ligament (ALL-R) may supports this. Theoretically, ALL-R may be particularly advantageous to support revision of failed ACL-Rs. It was hypothesized that ACL revision combined with ALL-R will result in superior outcome compared to isolated ACL revision. METHODS The study was designed as a randomized controlled trial. Patients eligible for first time ACL revision were randomized to either isolated ACL revision (- ALL group) or ACL revision combined with a single-stranded allograft ALL-reconstruction (+ ALL group). Patient reported outcomes and function were evaluated at two-year follow-up by KNEES-ACL, KOOS, and Tegner activity scale. Objective knee laxity was evaluated at one-year follow-up using an instrumented Rolimeter test, the pivot shift test, and a manual Lachman test. RESULTS A total of 103 patients were enrolled with 49 patients randomized to the + ALL group and 54 patients in the - ALL group. There were no differences at baseline between groups regarding age, gender, body mass index, preoperative patient reported outcome scores and concomitant meniscus or cartilage injury. The ACL revision was performed with an allograft in 10 patients (20%) in the + ALL group and 8 patients (15%) in the -ALL group. At follow-up there was no significant difference between the groups in patient reported outcome scores and clinical knee laxity. CONCLUSION Supplementary ALL-R does not improve subjective outcome of first time ACL revision at two-years and clinical knee stability at one-year follow-up compared to isolated ACL revision. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Ole Gade Sørensen
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark.
| | - Peter Faunø
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark
| | - Lars Konradsen
- Section for Sports Traumatology, Bispebjerg, Frederiksberg University Hospital, Copenhagen, Denmark
| | - Torsten Nielsen
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark
| | - Susanne Schaarup
- Section for Sports Traumatology, Bispebjerg, Frederiksberg University Hospital, Copenhagen, Denmark
| | | | - Michael Krogsgaard
- Section for Sports Traumatology, Bispebjerg, Frederiksberg University Hospital, Copenhagen, Denmark
| | - Martin Lind
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark
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Borim FM, Jubert NJ, Vinaixa MMR, Portas-Torres I, Bueno JP, Mayayo RS, Peiró JVA, Feliu EC, Monyart JM. Good rates of return-to-sport in athletes after revision anterior cruciate ligament reconstruction using autologous patellar tendon and lateral extra-articular tenodesis: a 2-year follow-up prospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3125-3133. [PMID: 37039899 PMCID: PMC10504162 DOI: 10.1007/s00590-023-03544-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Most athletes who undergo revision of the anterior cruciate ligament reconstruction (ACLR) aim to return to their preinjury sport at a similar level of performance while minimizing the risk for reinjury. Additional lateral extra-articular tenodesis (LET) has recently been correlated with improved outcomes and low complication rate. Yet, there are few series evaluating return-to-sport (RTS) and clinical outcomes after revision ACLR using bone-patellar tendon-bone (BPTB) and LET in athletes. METHODS The study cohort consisted of 19 eligible athletes who had undergone their first revision ACLR using BPTB and LET (modified Lemaire) between January 2019 and 2020. Patients were prospectively followed and interviewed in a sports activity survey during a 2-year follow-up. RESULTS Despite all patients returning to sports after revision ACLR surgery, 52.6% resumed playing at their preinjury level. Furthermore, patient-reported functional outcomes improved significantly following revision surgery, as evidenced by improvements in IKDC [64.4 (± 12) to 87.8 (± 6)], Lysholm [71.27 (± 12) to 84.2 (± 9.7)], and SF-12 scales [Physical: 53.3 (± 3) 57 (± 1.2); Mental: 50.2 (± 3.3) to 52.7 (± 2.4)]. One case (5.3%) experienced persistent pain and underwent reoperation for a partial meniscectomy. CONCLUSION After revision ACLR using autologous BPTB and LET, all active individuals are expected to RTS, similar to primary ACLR. The difference comes down to returning to the preinjury level, where the levels are lower depending on the sport and initial level of play. Good mid-term functional outcomes with a low complication rate can be expected in most cases. STUDY DESIGN Case series; Level of evidence IV. ETHICAL COMMITTEE APPROVAL NUMBER PR(ATR)79/2021 and HCB/2023/0173.
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Affiliation(s)
- Felipe Moreira Borim
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain.
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Nayana Joshi Jubert
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Maria Mercedes Revertè Vinaixa
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Knee Surgery Unit, Clínica Corachan, Carrer de Buïgas, 19, 08017, Barcelona, Spain
| | - Irene Portas-Torres
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joan Pijoan Bueno
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Knee Surgery Unit, Clínica Corachan, Carrer de Buïgas, 19, 08017, Barcelona, Spain
| | - Raquel Sevil Mayayo
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Knee Surgery Unit, Clínica Corachan, Carrer de Buïgas, 19, 08017, Barcelona, Spain
| | - José Vicente Andrés Peiró
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Knee Surgery Unit, Clínica Corachan, Carrer de Buïgas, 19, 08017, Barcelona, Spain
| | - Enric Castellet Feliu
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joan Minguell Monyart
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain.
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Knee Surgery Unit, Clínica Corachan, Carrer de Buïgas, 19, 08017, Barcelona, Spain.
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10
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Behrendt P, Fahlbusch H, Akoto R, Thürig G, Frings J, Herbst E, Raschke MJ, Frosch KH, Kittl C, Krause M. Comparison of Onlay Anchor Fixation Versus Transosseous Fixation for Lateral Extra-articular Tenodesis During Revision ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231166380. [PMID: 37213658 PMCID: PMC10196542 DOI: 10.1177/23259671231166380] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 05/23/2023] Open
Abstract
Background There is evidence on the clinical effectiveness of the Lemaire technique for lateral extra-articular tenodesis (LET) in patients undergoing revision anterior cruciate ligament reconstruction (ACLR), but the best fixation technique is unknown. Purpose To compare the clinical outcomes of 2 fixation techniques after revision ACLR: (1) onlay anchor fixation, which would avoid tunnel conflict and physis injury, and (2) transosseous tightening and interference screw fixation. Pain at the area of LET fixation was also assessed. Study Design Cohort study; Level of evidence, 3. Methods This was a retrospective 2-center study of patients with first-time revision ACLR and either LET with anchor fixation (aLET) with a 2.4-mm suture anchor or LET with transosseous fixation (tLET). Outcomes at minimum 12-month follow-up were assessed with the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, visual analog scale for pain at the LET fixation area, Tegner score, and anterior tibial translation (ATT). A subgroup analysis within the aLET group investigated passing the graft over or under the lateral collateral ligament (LCL). Results In total, 52 patients were included (26 patients in each group); the mean ± SD follow-up was 13.7 ± 3.4 months. No statistically significant differences were detected between the groups with respect to patient-reported outcome scores, clinical examination, or instrumented testing (side-to-side difference in ATT at 30° of flexion; aLET, 1.5 ± 2.5 mm; tLET, 1.6 ± 1.7 mm). Clinical failure was detected in 1 patient with aLET and none with tLET. Subgroup analysis revealed a small, nonsignificant flexion deficit in knees in which the iliotibial band strand was passed under (n = 42) or over (n = 10) the LCL. No clinically relevant tenderness was detected at the area of LET fixation in any group (aLET, 0.6 ± 1.3; tLET, 0.9 ± 1.7; over the LCL, 0.2 ± 0.6; under the LCL, 0.9 ± 1.6). Conclusion Onlay anchor fixation and transosseous fixation of the LET were equivalent with respect to outcome scores and instrumented ATT testing. Clinically, there were minor differences in passage of the LET graft over or under the LCL.
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Affiliation(s)
- Peter Behrendt
- Department of Trauma Surgery,
Orthopedics and Sportsorthopedics, Asklepios St Georg, Hamburg, Germany
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Anatomy,
Christian-Albrechts-University, Kiel, Germany
| | - Hendrik Fahlbusch
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Akoto
- Department of Trauma Surgery,
Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Grégoire Thürig
- Department of Orthopedics and
Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Jannik Frings
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and
Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and
Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery,
Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and
Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Matthias Krause, Priv-Doz,
Dr med, Department of Trauma and Orthopaedic Surgery, University Medical Center
Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany (
)
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11
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Saithna A, Monaco E, Carrozzo A, Marzilli F, Cardarelli S, Lagusis B, Rossi G, Vieira TD, Ferretti A, Sonnery-Cottet B. Anterior Cruciate Ligament Revision Plus Lateral Extra-Articular Procedure Results in Superior Stability and Lower Failure Rates Than Does Isolated Anterior Cruciate Ligament Revision but Shows No Difference in Patient-Reported Outcomes or Return to Sports. Arthroscopy 2023; 39:1088-1098. [PMID: 36592698 DOI: 10.1016/j.arthro.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine whether comparative clinical studies demonstrate significant advantages of revision anterior cruciate ligament reconstruction (RACLR) combined with a lateral extra-articular procedure (LEAP), with respect to graft rupture rates, knee stability, return to sport rates, and patient-reported outcome measures, compared with isolated RACLR. METHODS A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews & Meta-Analyses Guidelines. A PubMed search was conducted using the key words "revision anterior cruciate ligament reconstruction" combined with any of the following additional terms, "lateral extra-articular tenodesis" OR "anterolateral ligament reconstruction" OR "Lemaire." All relevant comparative clinical studies were included. Key clinical data were extracted and evaluated. RESULTS Eight comparative studies (seven Level III studies and a one Level IV study) were identified and included. Most studies reported more favorable outcomes with combined procedures with respect to failure rates (0%-13% following RACLR+LEAP, and 4.4%-21.4% following isolated RACLR), postoperative side-to-side anteroposterior laxity difference (1.3-3.9 mm following RACLR+LEAP and 1.8-5.9 mm following isolated RACLR), and high-grade pivot shift (0%-11.1% following RACLR+LEAP and 10.2%-23.8% in patients following isolated RACLR). There were no consistent differences between isolated and combined procedures with respect to return to sport or patient-reported outcome measures. CONCLUSIONS This systematic review demonstrates that the addition of a LEAP to RACLR was associated with an advantage with respect to ACL graft failure rates and avoidance of high-grade postoperative knee laxity across almost all included studies. LEVEL OF EVIDENCE IV, Systematic review of level III to IV studies.
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Affiliation(s)
| | - Edoardo Monaco
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | | | | | | | - Benson Lagusis
- University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
| | - Giorgio Rossi
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hopital Mermoz, Groupe Ramsay, Lyon, France
| | - Andrea Ferretti
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hopital Mermoz, Groupe Ramsay, Lyon, France
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12
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Green DW, Hidalgo Perea S, Brusalis CM, Chipman DE, Asaro LA, Cordasco FA. A Modified Lemaire Lateral Extra-articular Tenodesis in High-Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft: 2-Year Clinical Outcomes. Am J Sports Med 2023; 51:1441-1446. [PMID: 36917840 DOI: 10.1177/03635465231160681] [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: 03/16/2023]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) reconstruction (ACLR) in children and adolescents has increased significantly, and many such patients are at increased risk for ACL retear. Lateral extra-articular tenodesis (LET) may be performed in conjunction with ACLR to reduce the risk of ACL retear. PURPOSE To evaluate the 2-year clinical outcomes of ACLR with soft tissue quadriceps tendon (QUAD) autograft performed with a concomitant LET using a modified Lemaire technique in skeletally immature patients. STUDY DESIGN Case series; Level of evidence, 4. METHODS A consecutive series of adolescent patients who underwent QUAD autograft ACLR and LET with a minimum of 2 years of follow-up data were analyzed retrospectively. ACLR techniques, including all-epiphyseal and complete transphyseal, were indicated based on skeletal age. Outcome measures included return to sports, concomitant or subsequent surgical procedures, and multiple patient-reported outcome measures, including Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) scores. RESULTS The final cohort included 49 consecutive adolescent patients aged 11 to 16 years (mean, 14.2 ± 1 years) with a minimum follow-up of 2 years. One patient was lost to follow-up. Of the patients included in the study (N = 48; 27 male, 21 female), 98% participated in high-risk competitive sports. Two (4%) patients were undergoing revision ACLR. Thirty-eight (79%) patients underwent complete transphyseal, and 10 (21%) patients underwent all-epiphyseal ACLR. Sixteen (33%) patients had subsequent surgical procedures, including 5 contralateral ACLR, 4 meniscal surgery, 4 QUAD autograft scar revision, 4 irrigation and debridement (2 patients, 2 each), and 3 hardware removal (2 for hemi-epiphysiodesis and 1 tibial socket button removal) procedures. The rate of graft rupture was 0%. At a mean follow-up of 3.4 ± 1.2 years (range, 2-7 range), the mean SANE score was 93, the mean Pedi-IKDC score was 89, and the mean HSS Pedi-FABS score was 23. The return-to-sports rate was 100%. CONCLUSION An LET performed concomitantly with an ACLR is safe and should be considered as a concomitant procedure for adolescent patients with nonmodifiable risk factors who are at high risk of retear.
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Affiliation(s)
- Daniel W Green
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Sofia Hidalgo Perea
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
| | - Christopher M Brusalis
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Danielle E Chipman
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
| | - Lori A Asaro
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Frank A Cordasco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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13
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Servant C. Editorial Commentary: During Anterior Cruciate Ligament Reconstruction, Lateral Extra-Articular Procedures Have Risks and Should be Reserved for Proper Indications: Do Not LET ALL Revision Anterior Cruciate Ligament Reconstructions Be the Same. Arthroscopy 2023; 39:320-323. [PMID: 36603999 DOI: 10.1016/j.arthro.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 01/04/2023]
Abstract
Recently, there has been renewed interest in performing a lateral extra-articular procedure (LEAP), either an anterolateral ligament (ALL) reconstruction or a LET (lateral extra-articular tenodesis) to address a deficiency of the anterolateral complex (ALC) of the knee during anterior cruciate ligament (ACL) reconstruction. The ALC consists of the superficial and deep aspects of the iliotibial band with its Kaplan fiber attachments on the distal femur, along with the ALL, a structure within the anterolateral capsule. The ALC functions to provide anterolateral rotatory stability as a secondary stabilizer of the ACL. The evidence to date is that the addition of a LEAP to a revision ACL reconstruction may reduce the risk of repeat graft failure and rotatory laxity. However, in some cases, performing a LEAP may not confer any additional benefit and add unwarranted risk including lateral pain, reduced quadriceps strength, longer time to recovery, and overconstraint of the lateral compartment with associated cartilage damage. Perhaps LEAP is best indicated for high-risk patients (young, active in pivoting sports, high-grade pivot-shift, generalized ligamentous laxity or knee hyperextension, Segond fracture, chronic ACL lesion, lateral femoral notch sign, lateral coronal plane laxity, concurrent meniscus repair, or ALC injury on magnetic resonance imaging). Other modifiable risk factors should not be ignored (graft choice, graft size, tunnel position, graft fixation, associated injuries such as a lateral meniscal root tear, or anatomic factors such as an increased posterior tibial slope). Do not LET ALL revision anterior cruciate ligament reconstructions be the same! A lateral extra-articular procedure may sometimes, but not always, reduce the risk of further failure.
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14
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Helito CP, Sobrado MF, Moreira da Silva AG, Castro de Pádua VB, Guimarães TM, Bonadio MB, Pécora JR, Gobbi RG, Camanho GL. The Addition of Either an Anterolateral Ligament Reconstruction or an Iliotibial Band Tenodesis Is Associated With a Lower Failure Rate After Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Trial. Arthroscopy 2023; 39:308-319. [PMID: 35840071 DOI: 10.1016/j.arthro.2022.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the failure rate in patients who underwent revision anterior cruciate ligament (ACL) reconstruction alone or associated with an extra-articular procedure. Secondary objectives were to compare ACL laxity, patient-reported outcome measures, and complication rates in these patients and, subsequently, to compare the outcomes of patients who underwent revision ACL reconstruction associated with anatomical anterolateral ligament (ALL) reconstruction or lateral extra-articular tenodesis (LET). METHODS This was a retrospective comparative study. Patients were classified into 2 groups, according to whether (group 2) or not (group 1) an extra-articular reconstruction was performed. Patients who underwent an extra-articular procedure were further divided into ALL reconstruction (group 2A) and LET (group 2B). Baseline demographic variables, operative data and postoperative data were evaluated. RESULTS The groups with (86 patients) and without (88 patients) an associated extra-articular reconstruction had similar preoperative data. Group 2 had a lower failure rate (4.6% vs 14.7%; P = .038), better KT-1000, better pivot-shift, and better Lysholm. There was no difference regarding complications, except more lateral pain in group 2. Regarding the groups who underwent ALL reconstruction (41 patients) and LET (46 patients), group 2A showed better Lysholm scores. Both groups had similar failure rates and complications. CONCLUSIONS Patients who underwent revision ACL reconstruction with a laterally based augmentation procedure had a lower failure rate than patients who underwent isolated revision ACL reconstruction. KT-1000 and pivot-shift examination were also significantly better when a lateral augmentation was performed. Complications were similar except for an increase in lateral pain in the augmented group. No clinically important differences were found when comparing the LET group to the ALL group other than a statistical improvement in the Lysholm functional scale, likely not clinically meaningful, favoring the ALL group and an increased duration of post-operative lateral pain in the LET group. LEVEL OF EVIDENCE III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP; Hospital Sírio Libanês, São Paulo - SP
| | - Marcel Faraco Sobrado
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP; Hospital Sírio Libanês, São Paulo - SP
| | - Andre Giardino Moreira da Silva
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP.
| | | | - Tales Mollica Guimarães
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP
| | - Marcelo Batista Bonadio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP
| | - José Ricardo Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP
| | - Riccardo Gomes Gobbi
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP
| | - Gilberto Luis Camanho
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP
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15
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Clinical results after arthroscopic reconstruction of the posterolateral corner of the knee: A prospective randomized trial comparing two different surgical techniques. Arch Orthop Trauma Surg 2023; 143:967-975. [PMID: 35344064 PMCID: PMC9925553 DOI: 10.1007/s00402-022-04403-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/18/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Arthroscopic reconstruction techniques of the posterolateral corner (PLC) of the knee have been developed in recent years. Reconstruction techniques for higher-grade PLC injuries have not yet been validated in clinical studies. This study aimed to compare clinical outcomes of two different techniques and to present results of the first prospective randomized clinical trial of patients to undergo these novel procedures. MATERIALS AND METHODS 19 patients with Fanelli Type B posterolateral corner injuries and additional posterior cruciate ligament ruptures were included in this prospective study. They were randomly assigned to one of two novel arthroscopic reconstruction techniques, based on open surgeries developed by Arciero (group A) and LaPrade (group B). Follow-up was conducted at 6 and 12 months postoperatively and included clinical examinations for lateral, rotational and posterior stability, range of motion and subjective clinical outcome scores (IKDC Subjective Score, Lysholm Score, Tegner Activity Scale and Numeric Rating Scale for pain). RESULTS At 6 and 12 months postoperative, all patients in both groups presented stable to varus, external rotational and posterior forces, there were no significant differences between the two groups. At 12-month follow-up, group A patients showed significantly higher maximum flexion angles (134.17° ± 3.76° vs. 126.60° ± 4.22°; p = 0.021) compared to patients of group B. Duration of surgery was significantly longer in Group B patients than in group A (121.88 ± 11.63 vs. 165.00 ± 35.65 min; p = 0.003). Posterior drawer (side-to-side difference) remained more reduced in group A (2.50 ± 0.69 mm vs. 3.27 ± 0.92 mm; p = 0.184). Subjective patient outcome scores showed no significant differences between groups (Lysholm Score 83.33 ± 7.79 vs. 86.40 ± 9.21; p = 0.621). CONCLUSIONS This study indicates sufficient restoration of posterolateral rotational instability, varus instability and posterior drawer after arthroscopic posterolateral corner reconstruction without neurovascular complications. Increased postoperative range of motion and a shorter and less invasive surgical procedure could favor the arthroscopic reconstruction technique according to Arciero over LaPrade's technique in future treatment considerations.
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Meyer P, Reiter A, Akoto R, Steadman J, Pagenstert G, Frosch KH, Krause M. Imaging of the medial collateral ligament of the knee: a systematic review. Arch Orthop Trauma Surg 2022; 142:3721-3736. [PMID: 34628563 PMCID: PMC9596543 DOI: 10.1007/s00402-021-04200-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The primary aim of this investigation was to systematically review relevant literature of various imaging modalities (magnetic resonance imaging (MRI), stress radiography and ultrasonography) in the assessment of patients with a medial collateral ligament (MCL) injury. MATERIALS AND METHODS A systematic literature review of articles indexed in PubMed and Cochrane library was performed. Original research reporting data associated with medial gapping, surgical, and clinical findings associated with MCL injuries were considered for inclusion. The methodological quality of each inclusion was also assessed using a verified tool. RESULTS Twenty-three imaging studies (magnetic resonance imaging (MRI) n = 14; ultrasonography n = 6; radiography n = 3) were ultimately included into the review. A total of 808 injured, and 294 control, knees were assessed. Interobserver reliabilities were reported in radiographic and ultrasonographic investigations with almost perfect agreement. MRI studies demonstrated agreement ranging between substantial to almost perfect. Intraobserver reliability was only reported in radiographic studies pertinent to medial gapping and was found to be almost perfect. Correlation of MRI with clinical findings was moderate to strong (65-92%). Additionally, MRI imaging was more sensitive in the detection of MCL lesions when compared to clinical examination. However, when compared to surgical findings, MRI underestimated the grade of instability in up to 21% of cases. Furthermore, MRI showed relatively inferior performance in the identification of the exact MCL-lesion location when compared to surgical findings. Interestingly, preoperative clinical examination was slightly inferior to stress radiography in the detection of MCL lesions. However, clinical testing under general anaesthesia performed similar to stress radiography. The methodological quality analysis showed a low risk of bias regarding patient selection and index testing in each imaging modality. CONCLUSION MRI can reliably diagnose an MCL lesion but demonstrates limitations in its ability to predict the specific lesion location or grade of MCL instability. Ultrasonography is a widely available, radiation free modality, but is rarely used in clinical practice for detecting MCL lesions and clinical or surgical correlates are scarce. Stress radiography findings correlate with surgical findings but clinical correlations are missing in the literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- P Meyer
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - A Reiter
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - R Akoto
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - J Steadman
- Department of Orthopaedics, University of Utah, Salt Lake City, USA
| | - G Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland
- Knee Institute Basel, Basel, Switzerland
| | - K H Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - M Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Korthaus A, Krause M, Pagenstert G, Warncke M, Brembach F, Frosch KH, Kolb JP. Tibial slope in the posterolateral quadrant with and without ACL injury. Arch Orthop Trauma Surg 2022; 142:3917-3925. [PMID: 34964068 PMCID: PMC9596559 DOI: 10.1007/s00402-021-04298-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/30/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION An increased tibial slope is a risk factor for rupture of the anterior cruciate ligament. In addition, a tibial bone bruise or posterior lateral impression associated with slope changes also poses chronic ligamentous instability of the knee joint associated with an anterior cruciate ligament (ACL) injury. In the majority of cases, the slope is measured in one plane X-ray in the lateral view. However, this does not sufficient represent the complex anatomy of the tibial plateau and especially for the posterolateral quadrant. Normal values from a "healthy" population are necessary to understand if stability of the knee joint is negatively affected by an increasing slope in the posterolateral area. Until now there are no data about the physiological slope in the posterolateral quadrant of the tibial plateau. MATERIALS AND METHODS In 116 MRI scans of patients without ligamentous lesions and 116 MRI scans with an ACL rupture, tibial slope was retrospectively determined using the method described by Hudek et al. Measurements were made in the postero-latero-lateral (PLL) and postero-latero-central (PLC) segments using the 10-segment classification. In both segments, the osseous as well as the cartilaginous slope was measured. Measurements were performed by two independent surgeons. RESULTS In the group without ligamentous injury the mean bony PLL slope was 5.8° ± 4.8° and the cartilaginous PLL slope was 6.7° ± 4.8°. In the PLC segment the mean bony slope was 6.6° ± 5.0° and the cartilaginous slope was 9.4° ± 5.7°. In the cohort with ACL rupture, the bony and cartilaginous slope in both PLL and PCL were significantly higher (P < 0.001) than in the group without ACL injury (bony PLL 9.8° ± 4.8°, cartilage PLL 10.4° ± 4.7°, bony PLC 10.3° ± 4.8°, cartilage PLL 12.8° ± 4.3°). Measurements were performed independently by two experienced surgeons. There were good inter- (CI 87-98.7%) and good intraobserver (CI 85.8-99.6%) reliability. CONCLUSION The bony and the cartilaginous slope in the posterolateral quadrant of the tibial plateau are different but not independent. Patients with an anterior cruciate ligament injury have a significantly steeper slope in the posterolateral quadrant compared to a healthy group. Our data indicate that this anatomic feature might be a risk factor for a primary ACL injury which has not been described yet. LEVEL OF EVIDENCE III.
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Affiliation(s)
- A Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - M Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - G Pagenstert
- CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Basel, Switzerland
| | - M Warncke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Brembach
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany.
| | - J P Kolb
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Matassi F, Giabbani N, Arnaldi E, Tripodo A, Bonaspetti G, Bait C, Ronga M, Di Benedetto P, Zaffagnini S, Jannelli E, Schiavone Panni A, Berruto M. Controversies in ACL revision surgery: Italian expert group consensus and state of the art. J Orthop Traumatol 2022; 23:32. [PMID: 35840726 PMCID: PMC9287504 DOI: 10.1186/s10195-022-00652-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022] Open
Abstract
Background Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors’ aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction. Methods A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants’ answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience. Conclusions The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case. Level of evidence V (Expert opinion).
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Affiliation(s)
| | - Niccolò Giabbani
- Orthopaedic Clinic CTO, University of Florence, Florence, Italy.
| | | | | | - Giovanni Bonaspetti
- U.O. Ortopedia e Traumatologia 2, Istituto Clinico Sant'Anna, Brescia, Italy
| | | | - Mario Ronga
- Orthopaedic and Trauma Operative Unit, Department of BIOMORF, University Hospital G. Martino, University of Messina, Messina, Italy
| | | | | | - Eugenio Jannelli
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Berruto
- UOS Knee SURGERY-1st University Clinic of Orthopaedics, ASST Pini-CTO, Milan, Italy
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Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture. Arch Orthop Trauma Surg 2022; 142:2839-2847. [PMID: 34870728 PMCID: PMC9474331 DOI: 10.1007/s00402-021-04269-1] [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: 08/02/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of the current study was to objectify the rotational laxity after primary anterior cruciate ligament (ACL) rupture and rerupture after ACL reconstruction by instrumented measurement. It was hypothesized that knees with recurrent instability feature a higher internal rotation laxity as compared to knees with a primary rupture of the native ACL. STUDY DESIGN Cross-sectional study, Level of evidence III. METHODS In a clinical cross-sectional study successive patients with primary ACL rupture and rerupture after ACL reconstruction were evaluated clinically and by instrumented measurement of the rotational and antero-posterior laxity with a validated instrument and the KT1000®, respectively. Clinical examination comprised IKDC 2000 forms, Lysholm Score, and Tegner Activity Scale. Power calculation and statistical analysis were performed (p value < 0.05). RESULTS 24 patients with primary ACL rupture and 23 patients with ACL rerupture were included. There was no significant side-to-side difference in anterior translation. A side-to side difference of internal rotational laxity ≥ 10° was found significantly more frequent in reruptures (53.6%) compared to primary ruptures (19.4%; p < 0.001). A highly significant relationship between the extent of the pivot-shift phenomenon and side-to-side difference of internal rotation laxity could be demonstrated (p < 0.001). IKDC 2000 subjective revealed significantly better scores in patients with primary ACL tear compared to patients with ACL rerupture (56.4 ± 7.8 vs. 50.8 ± 6.2; p = 0.01). Patients with primary ACL tears scored significantly better on the Tegner Activity Scale (p = 0.02). No significant differences were seen in the Lysholm Score (p = 0.78). CONCLUSION Patients with ACL rerupture feature significantly higher internal rotation laxity of the knee compared to primary ACL rupture. The extend of rotational laxity can be quantified by instrumented measurements. This can be valuable data for the indication of an anterolateral ligament reconstruction in ACL revision surgery.
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