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Meena A, Das S, Runer A, Tapasvi K, Hegde P, D'Ambrosi R, Hiemstra L, Tapasvi S. Revision ACL reconstruction in female athletes: current concepts. J ISAKOS 2024:S2059-7754(24)00035-X. [PMID: 38403190 DOI: 10.1016/j.jisako.2024.02.007] [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: 09/28/2023] [Revised: 01/07/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
The challenge of revision anterior cruciate ligament (ACL) reconstruction lies in its complexity, varied presentation, and technical intricacies. A successful ACL reconstruction should allow patients to safely return to preinjury activities. However, it is only sometimes simple, and many risk factors and concurrent pathologies come into play. Evaluating and analysing the cause of failure and associated conditions is paramount to addressing them effectively. Despite a plethora of research and improvements in knowledge and technology, e gaps exist in issues such as optimal techniques of revision surgery, graft options, fixation, concurrent procedures, rehabilitation and protocol for return to sports of high-level athletes. Female athletes need additional focus since they are at higher risk of re-injury, suboptimal clinical outcomes, and lower rates of return to sport following revision reconstruction. Our understanding about injury prevention and the protection of ACL grafts in female athletes needs to be improved. This review focuses on the current state of revision ACL surgery in female athletes and provides recommendations and future directions for optimising outcomes in this high-risk group.
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Affiliation(s)
- Amit Meena
- Division of Orthopedics, Shalby Multi-Specialty Hospital, Jaipur, 302021, India; Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria.
| | - Saubhik Das
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria
| | - Armin Runer
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Komal Tapasvi
- The Orthopaedic Speciality Clinic, Pune, 411004, India
| | - Prathik Hegde
- The Orthopaedic Speciality Clinic, Pune, 411004, India
| | - Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, 20161, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milan, 20133, Italy
| | - Laurie Hiemstra
- Banff Sport Medicine, University of Calgary, T1W 0L5, Canada
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Yuan W, Qi W, Hu T, Zhang J, An MY, Zhao G, Wang XP, Li C, Liu Y. Outcomes of RigidFix Cross Pin Fixation in Femoral and Tibial Tunnel for Anterior Cruciate Ligament Reconstruction. Orthop Surg 2024; 16:337-345. [PMID: 38088239 PMCID: PMC10834228 DOI: 10.1111/os.13934] [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: 08/29/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES There is no clear consensus so far on which fixation method is most favorable for the tibial tunnel in anterior cruciate ligament reconstruction (ACLR). The purpose of this paper is to investigate the outcome of RigidFix cross pins fixation in the tibial tunnel and to explore the advantages of RigidFix applied both in the femoral and tibial tunnel with hamstring tendon graft in anterior cruciate ligament reconstruction. METHODS This retrospective study included 53 patients (male/female, 45/8) who underwent anterior cruciate ligament reconstruction using autologous hamstring tendons between January 2013 and December 2017 at our institute. The participants in group A (n = 36) received anterior cruciate ligament reconstruction with RigidFix cross pins fixation in both femoral and tibial tunnels, while those in group B (n = 17) with RigidFix cross pins fixation in the femoral tunnel and Interference screw fixation in the tibial tunnel. The visual analogue scale (VAS) score, International Knee Documentation Committee subjective knee form 2000 (IKDC2000) score, Lysholm knee scoring scale, Tegner activity score and the side-to-side difference were compared at 2 and 5 years postoperatively. The graft diameter, number of strands in graft and the average diameter of each strand were also compared between the two groups. The categorical parameters were analyzed by chi-square test and the continuous variables conforming to a normal distribution were analyzed by Student's t-test. RESULTS At 2 years postoperation, the VAS score (1.61 ± 0.55), side-to-side difference (1.50 ± 0.58) in group A were significantly lower than that in group B, and the IKDC2000 score (88.81 ± 3.88), Tegner activity score (6.14 ± 0.60) in group A were significantly higher than that in group B. At 5 years postoperation, the VAS score (1.64 ± 0.68), side-to-side difference (1.73 ± 0.63) in group A were significantly lower than that in group B, and the IKDC2000 score (89.09 ± 3.85), Tegner activity score (6.58 ± 0.94) in group A were slso significantly higher than that in group B. There was statistical difference in the change of the side-to-side difference between the two groups (group A vs. B, 0.22 ± 0.08 vs. 0.34 ± 0.11, p < 0.001). There were also statistical differences in the graft diameter (group A vs. B, 7.83 ± 0.74 vs. 7.41 ± 0.51, p = 0,038), number of strands in graft (5.67 ± 0.72 vs. 4.00 ± 0.00, p < 0.001) and the average diameter of each strand (1.41 ± 0.22 vs. 1.85 ± 0.13, p < 0.001) between the two groups. CONCLUSION RigidFix cross pins fixation in the tibial tunnel for anterior cruciate ligament reconstruction can achieve better 5-year results when compared with the interference screw, and the hamstring tendon can be folded into a thicker graft when RigidFix cross pins were applied in both femoral and tibial tunnels.
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Affiliation(s)
- Wei Yuan
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Wei Qi
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tingting Hu
- The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jia Zhang
- Medical School of Chinese PLA, Beijing, China
| | | | - Gang Zhao
- Medical School of Chinese PLA, Beijing, China
| | - Xiao-Ping Wang
- Department of Orthopedics, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Chunbao Li
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yujie Liu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Liang J, Wu S, Shen M, Lu A, Tan L, Luo J, Feng J, Cao Y, Wang J, He J. Application of multiplanar reconstruction and 3D printing in anterior cruciate ligament revision. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2024; 49:95-112. [PMID: 38615171 PMCID: PMC11017017 DOI: 10.11817/j.issn.1672-7347.2024.230081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 04/15/2024]
Abstract
OBJECTIVES Anterior cruciate ligament injury is the most common type of knee joint ligament injury. Anterior cruciate ligament reconstruction has a high failure rate, with bone tunnel abnormalities as the most significant factor in these failures. Digital orthopedic technology can effectively develop implementation plans for the revision, thus increasing the success rate. This study aims to develop a surgical plan for anterior cruciate ligament revision by employing multiplanar reconstruction (MPR) for measuring bone tunnel position and diameter, and simulating bone tunnel creation via 3D printing preoperatively. METHODS A total of 12 patients who underwent anterior cruciate ligament revision at the Third Xiangya Hospital of Central South University between 2014 and 2021 were retrospectively studied. The data included patient demographics, preoperative formulated knee joint 3D printing models, and preoperative knee CT scans. The study measured the bone tunnel's diameter and position to guide the establishment of revision bone tunnels during surgery, reassessed the postoperative bone tunnels, and evaluated knee joint functional scores [including International Knee Documentation Committee Knee Evaluation Form (IKDC) score, Lysholm score, and Tegner exercise level score]. RESULTS Preoperative measurements revealed suboptimal femoral tunnels positions in 4 patients and tibial tunnels positions in 2 patients. MPR and 3D printing technology were used to guide the establishment of a new bone canal during surgery, and postoperative measurements were satisfactory for all patients. Preoperative measurements demonstrated the interclass correlation coefficient for femoral tunnels and tibial tunnels diameters were 0.843 (P<0.05) and 0.889 (P<0.001), respectively. Meanwhile, the intraclass correlation coefficient were 0.811 (P<0.05) and 0.784 (P<0.05), respectively. The intraoperative diameter of femoral and tibial tunnels showed excellent correlation with postoperative CT measurements, with intraclass correlation coefficient values of 0.995 (P<0.001) and 0.987 (P<0.001), respectively. All bone tunnel positions were within the normal range. At the final follow-up, knee joint function scores in all 12 patients improved significantly compared to pre-surgery (P<0.001), and the reoperation rate was zero. CONCLUSIONS MPR and 3D printing technology can accurately measure the parameters of reconstructed anterior cruciate ligament bone tunnels. Personalized revision plans for patients with reconstruction failure enhances the success rate of revision surgery and improves patient prognosis.
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Affiliation(s)
- Jiehui Liang
- Department of Orthopedics, Third Xiangya Hospital, Central South University, Changsha 410013.
- Department of Orthopedics, Xiangtan Central Hospital, Xiangtan Hunan 411100.
| | - Song Wu
- Department of Orthopedics, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Minren Shen
- Department of Orthopedics, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Anjie Lu
- Department of Orthopedics, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Lingjie Tan
- Department of Orthopedics, Hunan Provincial People's Hospital, Changsha 410012
| | - Jiewen Luo
- Department of Clinical Medicine, Xiangya School of Medicine, Central South University, Changsha 410013
| | - Jing Feng
- Department of Orthopedics, Changsha Central Hospital, Changsha 410028
| | - Yangbo Cao
- Department of Clinical Medicine, Xiangya School of Medicine, Central South University, Changsha 410013
| | - Jiaoju Wang
- School of Mathematics and Statistics, Central South University, Changsha 410083, China
| | - Jinshen He
- Department of Orthopedics, Third Xiangya Hospital, Central South University, Changsha 410013
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Tabatabaei Irani P, Ayati Firoozabadi M, Toofan H, Seyedtabaei SMM, Poursalehian M, Ghasemian M, Mortazavi SMJ. Simultaneous Tunnel Grafting and Anterior Cruciate Ligament Reconstructions Revision Using Double Suspensory Fixation: A Single-Stage Solution. Arthrosc Tech 2024; 13:102806. [PMID: 38312866 PMCID: PMC10837771 DOI: 10.1016/j.eats.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/20/2023] [Indexed: 02/06/2024] Open
Abstract
The anterior cruciate ligament (ACL) is often vulnerable to sports-related injuries, leading to numerous ACL reconstructions (ACLRs) annually in the United States. Although largely successful, these procedures face the risk of recurrent instability due to graft failure. ACLR failures are typically attributed to technical errors and patient-related factors, with improper positioning of the tibial and femoral tunnels as the most common technical mistake. Current 2-stage revision techniques involve primary bone grafting followed by secondary tendon graft placement, resulting in increased costs and extended rehabilitation times. This article proposes a single-stage revision strategy involving simultaneous tunnel grafting and ACLR revision. The method employs double suspensory fixation by adjustable loop buttons, thereby eliminating the dependence on metaphyseal bone stock for stable graft fixation. This new procedure may offer a more efficient and cost-effective approach, reducing the need for a second surgery and potentially allowing patients to return to normal activities more quickly.
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Affiliation(s)
- Pouya Tabatabaei Irani
- Joint Reconstruction Research Center, Orthopedic Surgery Department, Imam Khomeini Hospital, Tehran, Iran
| | - Mohammad Ayati Firoozabadi
- Joint Reconstruction Research Center, Orthopedic Surgery Department, Imam Khomeini Hospital, Tehran, Iran
| | - Hesam Toofan
- Joint Reconstruction Research Center, Orthopedic Surgery Department, Imam Khomeini Hospital, Tehran, Iran
| | | | - Mohammad Poursalehian
- Joint Reconstruction Research Center, Orthopedic Surgery Department, Imam Khomeini Hospital, Tehran, Iran
| | - Mohammadmahdi Ghasemian
- Joint Reconstruction Research Center, Orthopedic Surgery Department, Imam Khomeini Hospital, Tehran, Iran
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Okimura S, Suzuki T, Ikeda Y, Shiwaku K, Teramoto A. Satisfactory outcomes after one-stage revision anterior cruciate ligament reconstruction using rectangular tunnel technique. Knee Surg Sports Traumatol Arthrosc 2023; 31:5690-5697. [PMID: 37898566 DOI: 10.1007/s00167-023-07627-1] [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: 06/11/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE One-stage revision anterior cruciate ligament reconstruction (ACLR) with the anatomic rectangular tunnel (RT) technique using bone-patellar tendon-bone (BTB) grafts results in anatomically precise tunnel placement and secure graft fixation. This study evaluated knee joint laxity and clinical outcomes in terms of femoral tunnel overlap. It was hypothesised that there would be no significant differences in knee joint laxity or clinical outcomes regardless of femoral tunnel overlap. METHODS Between 2012 and 2021, a single surgeon conducted 196 one-stage revision ACLRs with the RT technique using BTB grafts. Patients were divided based on the presence of femoral tunnel overlap. Knee joint laxity was evaluated using the Lachman test, pivot shift test, and side-to-side difference measured with a KT-1000 arthrometer. Clinical outcomes were assessed using the Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Knee Examination Form 2000. Knee joint laxity and clinical outcomes were compared between groups after a median follow-up of 2.5 years (range 2.0-8.0). RESULTS The study included 30 and 73 patients in the overlap and non-overlap groups, respectively. No significant differences were observed in the results of the Lachman test, pivot shift test, or KT-1000 arthrometer as well as in the Lysholm, KOOS, or IKDC scores between the two groups. Based on the IKDC scores, all patients were graded as normal or nearly normal. CONCLUSION One-stage revision ACLR with the RT technique using BTB grafts improved knee joint laxity and had favourable clinical outcomes regardless of femoral tunnel overlap. To achieve optimal results in one-stage revision ACLR, it is crucial to create a tunnel within the anatomical attachment area and ensure proper graft fixation and tensioning. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shinichiro Okimura
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, North-7, West-27-1-3, Chuo-ku, Sapporo, Hokkaido, 060-0007, Japan.
| | - Yasutoshi Ikeda
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Yavari E, Moosa S, Cohen D, Cantu-Morales D, Nagai K, Hoshino Y, de Sa D. Technology-assisted anterior cruciate ligament reconstruction improves tunnel placement but leads to no change in clinical outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:4299-4311. [PMID: 37329370 DOI: 10.1007/s00167-023-07481-1] [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: 03/04/2023] [Accepted: 06/02/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To investigate the effect of technology-assisted Anterior Cruciate Ligament Reconstruction (ACLR) on post-operative clinical outcomes and tunnel placement compared to conventional arthroscopic ACLR. METHODS CENTRAL, MEDLINE, and Embase were searched from January 2000 to November 17, 2022. Articles were included if there was intraoperative use of computer-assisted navigation, robotics, diagnostic imaging, computer simulations, or 3D printing (3DP). Two reviewers searched, screened, and evaluated the included studies for data quality. Data were abstracted using descriptive statistics and pooled using relative risk ratios (RR) or mean differences (MD), both with 95% confidence intervals (CI), where appropriate. RESULTS Eleven studies were included with total 775 patients and majority male participants (70.7%). Ages ranged from 14 to 54 years (391 patients) and follow-up ranged from 12 to 60 months (775 patients). Subjective International Knee Documentation Committee (IKDC) scores increased in the technology-assisted surgery group (473 patients; P = 0.02; MD 1.97, 95% CI 0.27 to 3.66). There was no difference in objective IKDC scores (447 patients; RR 1.02, 95% CI 0.98 to 1.06), Lysholm scores (199 patients; MD 1.14, 95% CI - 1.03 to 3.30) or negative pivot-shift tests (278 patients; RR 1.07, 95% CI 0.97 to 1.18) between the two groups. When using technology-assisted surgery, 6 (351 patients) of 8 (451 patients) studies reported more accurate femoral tunnel placement and 6 (321 patients) of 10 (561 patients) studies reported more accurate tibial tunnel placement in at least one measure. One study (209 patients) demonstrated a significant increase in cost associated with use of computer-assisted navigation (mean 1158€) versus conventional surgery (mean 704€). Of the two studies using 3DP templates, production costs ranging from $10 to $42 USD were cited. There was no difference in adverse events between the two groups. CONCLUSION Clinical outcomes do not differ between technology-assisted surgery and conventional surgery. Computer-assisted navigation is more expensive and time consuming while 3DP is inexpensive and does not lead to greater operating times. ACLR tunnels can be more accurately located in radiologically ideal places by using technology, but anatomic placement is still undetermined because of variability and inaccuracy of the evaluation systems utilized. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ehsan Yavari
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, ON, N2G 1C5, Canada.
| | - Sabreena Moosa
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, ON, N2G 1C5, Canada
| | - Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, MUMC 4E14, Hamilton, ON, L8S 4L8, Canada
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Gopinatth V, Casanova FJ, Knapik DM, Mameri ES, Jackson GR, Khan ZA, McCormick JR, Yanke AB, Cole BJ, Chahla J. Consistent Indications and Good Outcomes Despite High Variability in Techniques for Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2023; 39:2098-2111. [PMID: 36863622 DOI: 10.1016/j.arthro.2023.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/12/2022] [Accepted: 02/03/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE To systematically review the current literature regarding the indications, techniques, and outcomes after 2-stage revision anterior cruciate ligament reconstruction (ACLR). METHODS A literature search was performed using SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. Inclusion criteria was limited to Level I-IV human studies reporting on indications, surgical techniques, imaging, and/or clinical outcomes of 2-stage revision ACLR. RESULTS Thirteen studies with 355 patients treated with 2-stage revision ACLR were identified. The most commonly reported indications were tunnel malposition and tunnel widening, with knee instability being the most common symptomatic indication. Tunnel diameter threshold for 2-stage reconstruction ranged from 10 to 14 mm. The most common grafts used for primary ACLR were bone-patellar tendon-bone (BPTB) autograft, hamstring graft, and LARS (polyethylene terephthalate) synthetic graft. The time elapsed from primary ACLR to the first stage surgery ranged from 1.7 years to 9.7 years, whereas the time elapsed between the first and second stage ranged from 21 weeks to 13.6 months. Six different bone grafting options were reported, with the most common being iliac crest autograft, allograft bone dowels, and allograft bone chips. During definitive reconstruction, hamstring autograft and BPTB autograft were the most commonly used grafts. Studies reporting patient-reported outcome measures showed improvement from preoperative to postoperative levels in Lysholm, Tegner, and objective International Knee and Documentation Committee scores. CONCLUSIONS Tunnel malpositioning and widening remain the most common indications for 2-stage revision ACLR. Bone grafting is commonly reported using iliac crest autograft and allograft bone chips and dowels, whereas hamstring autograft and BPTB autograft were the most used grafts during the second-stage definitive reconstruction. Studies showed improvements from preoperative to postoperative levels in commonly used patient reported outcomes measures. LEVEL OF EVIDENCE Level IV, systematic review of Level I, III, and IV studies.
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Affiliation(s)
- Varun Gopinatth
- Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A.; Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Felipe J Casanova
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Enzo S Mameri
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Garrett R Jackson
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zeeshan A Khan
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - Adam B Yanke
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A..
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Monllau JC, Perelli S, Costa GG. Anterior cruciate ligament failure and management. EFORT Open Rev 2023; 8:231-244. [PMID: 37158400 PMCID: PMC10233803 DOI: 10.1530/eor-23-0037] [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: 05/10/2023] Open
Abstract
Anterior cruciate ligament (ACL) reconstruction failure can be defined as abnormal knee function due to graft insufficiency with abnormal laxity or failure to recreate a functional knee according to the expected outcome. Traumatic ruptures have been reported as the most common reason for failure. They are followed by technical errors, missed concomitant knee injuries, and biological failures. An in-depth preoperative examination that includes a medical history, clinical examinations, advanced imaging, and other appropriate methods is of utmost importance. There is still no consensus as to the ideal graft, but autografts are the favorite choice even in ACL revision. Concomitant meniscal treatment, ligamentous reconstruction, and osteotomies can be performed in the same surgical session to remove anatomical or biomechanical risk factors for the failure. Patient expectations should be managed since outcomes after ACL revision are not as good as those following primary ACL reconstruction.
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Affiliation(s)
- Juan Carlos Monllau
- Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- ICATKnee, Institut Catalá de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain
| | - Simone Perelli
- Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- ICATKnee, Institut Catalá de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain
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Multiple revision anterior cruciate ligament reconstruction: not the best but still good. Knee Surg Sports Traumatol Arthrosc 2023; 31:559-571. [PMID: 36224291 PMCID: PMC9898374 DOI: 10.1007/s00167-022-07197-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Given the paucity of literature on the re-revision of ACL, the current study was undertaken. The purpose of this systematic review was to synthesise and qualitatively assess the currently available evidence in the literature regarding the re-revision of ACL reconstruction (rrACLR). METHODS A systematic review was conducted based on the PRISMA guidelines. The following search terms were used in the title, abstract and keywords fields: "ACL" or "anterior cruciate ligament" AND "revision" or "multiple" or "repeat". The outcome data extracted from the studies were the Lysholm score, Subjective IKDC, Marx Score, Tegner, Marx Score, KOOS score, radiological changes and the rate of return to sports. Complications, failures and/or revision surgery were also analysed. RESULTS The cohort consisted of 295 patients [191 (64.7%) men and 104 (35.3%) women] with a mean age of 29.9 ± 2.8 years (range 14-58 years) from 10 studies. The mean postoperative follow-up (reported in all studies except one) was 66.9 ± 44.7 months (range 13-230.4 months). Associated injuries were 103 (34.9%) medial meniscus tears, 57 (19.3%) lateral meniscus tears, 14 (4.7%) combined medial plus lateral meniscus tears, 11 (3.7%) meniscal tears (not specified), 252 (85.4%) cartilage lesions, 6 (2.0%) medial collateral ligament injury and 2 (0.7%) lateral collateral ligament injuries. In 47 (15.9%) patients an extra-articular plasty was performed for the anterolateral ligament. In all studies that reported pre- and post-operative IKDC (subjective and objective) and Lysholm score, there was a significant improvement compared to the pre-operative value (p < 0.05). At the final follow-up, laxity measured with KT-1000 was found to be 2.2 ± 0.6 mm. 31 (10.5%) out of 295 patients returned to their pre-injury activity level. A total of 19 (6.4%) re-ruptures were found, while only 4 (1.4%) complications (all minors) were reported, out of which 2 (0.7%) were superficial infections, 1 (0.3%) cyclops lesion and 1 (0.3%) flexion loss. CONCLUSION Multiple revisions of anterior cruciate ligament reconstruction allow acceptable clinical results and a good degree of knee stability with a low rate of subsequent new re-ruptures but the possibility of regaining pre-injury sports activity is poor; whenever possible, it is preferred to revise the ligament in one stage. This surgery remains a challenge for orthopaedic surgeons and many doubts persist regarding the ideal grafts, additional extra-articular procedures and techniques to use. LEVEL OF EVIDENCE IV. STUDY REGISTRATION PROSPERO-CRD42022352164 ( https://www.crd.york.ac.uk/prospero/ ).
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Macchiarola L, Pizza N, Patania V, Grassi A, Dal Fabbro G, Marcacci M, Zaffagnini S. Double-bundle non-anatomic ACL revision reconstruction with allograft resulted in a low revision rate at 10 years. Knee Surg Sports Traumatol Arthrosc 2023; 31:340-348. [PMID: 36070000 DOI: 10.1007/s00167-022-07151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE This study aimed at reporting the long-term second revision rate and subjective clinical outcomes from a cohort of patients who underwent a double-bundle (DB) ACLR first revision with allograft at a single institution. METHODS The Institutional database was searched according to the following inclusion criteria: (1) patients that underwent DB-ACL first revision with Achilles tendon allograft, (2) surgery performed between January 2000 and December 2012, (3) age at revision ≥ 18 y/o. Patients' general information, history, surgical data, and personal contacts were extracted from charts. An online survey platform was implemented to collect responses via email. The survey questions included: date of surgeries, surgical data, date of graft failure and subsequent second ACL revision surgery, any other surgery of the index knee, contralateral ACLR, KOOS score, and Tegner scores. RESULTS Eighty-one patients were included in the survival analysis, mean age at revision 32 ± 9.2 y/o, 71 males, mean BMI 24.7 ± 2.7, mean time from ACL to revision 6.8 ± 5.4 years, mean follow-up time 10.7 ± 1.4 years. There were 12 (15%) second ACL revisions during the follow-up period, three females and nine males, at a mean of 4.5 ± 3 years after the index surgery. The overall survival rates were 85% from a second ACL revision and 68% from all reoperations of the index knee. Considering only the successful procedures (61 patients), at final follow-up, the mean values for the KOOS subscales were 84 ± 15.5 for Pain, 88.1 ± 13.6 for Symptoms, 93 ± 11.6 for ADL, 75 ± 24.5 for Sport, and 71 ± 19.6 for Qol. Twenty-nine (48%) patients performed sports activity at the same level as before ACLR failure. CONCLUSIONS Double-bundle ACL revision with fresh-frozen Achilles allograft yields satisfactory results at long-term follow-up, with an 85% survival rate from a second ACL revision at mean 10 years' follow-up and good patient-reported clinical scores. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Luca Macchiarola
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy. .,Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Foggia (FG), Viale Luigi Pinto, 1, 71122, Foggia, Italy.
| | - Nicola Pizza
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Vittorio Patania
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Alberto Grassi
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Giacomo Dal Fabbro
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Maurilio Marcacci
- Humanitas Clinical and Research Center, Rozzano (MI), Via Alessandro Manzoni, 56, 20089, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
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Wang H, Teng Y, Peng B, Jia G, Han H, Xia Y. Surgically adjust tibial tunnel in anatomical anterior cruciate ligament single-bundle reconstruction: A time-zero biomechanical study in vitro. J Orthop Surg (Hong Kong) 2023; 31:10225536221151131. [PMID: 36688346 DOI: 10.1177/10225536221151131] [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: 01/24/2023] Open
Abstract
BACKGROUND The anatomical positioning of the graft during anterior cruciate ligament reconstruction (ACLR) is of great significance for restoring normal knee kinematics and preventing early joint degeneration. Therefore, the adjustment of the mispositioned guide pin becomes extremely important. Our research aims to test the time-zero biomechanical properties in adjusting inaccurate guide pins to the center of the tibial footprint in anatomical anterior cruciate ligament single-bundle reconstruction. METHODS Porcine tibias and bovine extensor tendons were used to simulate a transtibial ACL reconstruction in vitro. Load-to failure testing was carried out in 4 groups: control group (n = 45): the guide pin was drilled at the center of the ACL footprint; group I, group II and group III (n = 45, respectively): the guide pin was respectively drilled 1 mm, 2 mm and 3 mm away from the center of the ACL footprint. In the experimental groups, a small tunnel with a 4.5 mm reamer is made and the guide pin is shifted to the center of the footprint. All the reamed tibias were scanned by CT to measure the area of the tunnel in the footprint, and time-zero biomechanical properties were recorded. RESULTS All graft-tibia complexes failed because the grafts slipped past the interference screws. Compare to control group, the ultimate load, yield load, and tunnel exit area in group III decreased significantly (p < 0.05). Regarding to the ultimate load, yield load, tensile stiffness, twisting force and tunnel exit area, t-test showed no significant differences between control group and group I, group II respectively (p > 0.05). Pearson test showed that tunnel exit area was negatively correlated with other characteristics (p < 0.05). CONCLUSIONS Surgical adjustment of the guide pin to the center of the tibial footprint may have significant influence in time-zero biomechanical properties in anatomical anterior cruciate ligament single-bundle reconstruction when the adjusted tibial tunnel was significantly enlarged compare to the standard tibial tunnel.
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Affiliation(s)
- Hong Wang
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| | - Yuanjun Teng
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| | - Bo Peng
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| | - Gengxin Jia
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| | - Hua Han
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
| | - Yayi Xia
- Department of Orthopaedics, 74713Lanzhou University Second Hospital, Lanzhou, China
- Orthopaedics Key Laboratory of Gansu Province, 74713Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Gansu Intelligent Orthopedics Industry Technology Center, Lanzhou, China
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12
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Helito CP, da Silva AGM, Guimarães TM, Sobrado MF, Pécora JR, Camanho GL. Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction. Knee Surg Relat Res 2022; 34:24. [PMID: 35527316 PMCID: PMC9082885 DOI: 10.1186/s43019-022-00153-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/20/2022] [Indexed: 01/24/2023] Open
Abstract
Abstract
Background
Revision anterior cruciate ligament (ACL) reconstructions are usually complex owing to previous tunnels. The objective of this study is to report the results of a revision ACL reconstruction technique with a tibial tunnel performed from the anterolateral plateau associated with an anterolateral ligament (ALL) reconstruction.
Methods
Patients with at least two ACL reconstructions that failed and who had significant enlargement and confluence of tunnels in the medial tibial plateau and underwent revision ACL reconstruction associated with ALL reconstruction with the tibial tunnel for the ACL performed from the lateral plateau between 2017 and 2019 were evaluated. All patients were evaluated by physical examination, International Knee Documentation Committee (IKDC), and Lysholm functional scales.
Results
Six patients who underwent this surgical procedure were evaluated. All patients were sports practitioners and presented a grade 3 pivot shift. The mean age was 28.5 ± 8.2 years, and the mean follow-up time was 34.1 ± 12.8 months. No patient had a new graft rupture, but three (50%) had grade 1 pivot shift. Four patients had minor complications with no clinical impact on the final result. All except one patient were able to return to pre-injury type of sports, at a mean time of 14.6 ± 2.3 months after surgery.
Conclusion
The anterolateral tibial tunnel technique using an Achilles tendon allograft for revision ACL reconstruction after multiple failures associated with an ALL reconstruction showed good results and no major complications. The anterolateral tunnel can be considered a good alternative in cases of medial tibial confluence or significant enlargement of the medial tunnels in re-revision procedures.
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13
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Setliff JC, Gibbs CM, Musahl V, Lesniak BP, Hughes JD, Rabuck SJ. Harvesting a second graft from the extensor mechanism for revision ACL reconstruction does not delay return of quadriceps function. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07242-6. [PMID: 36434264 DOI: 10.1007/s00167-022-07242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether harvesting a second graft from the ipsilateral extensor mechanism adversely affects clinical outcomes in revision anterior cruciate ligament (ACL) reconstruction. METHODS A retrospective review of 34 patients undergoing revision anterior cruciate ligament (ACL) reconstruction with either quadriceps tendon (QT) autograft or bone-tendon-bone (BTB) autograft was conducted. Patients with two grafts (BTB+QT) from the extensor mechanism were matched based on age, laterality, and sex to patients who had primary reconstruction with hamstring (HS) autograft followed by revision with either BTB or QT autograft (HS+QT/BTB). Return of quadriceps function was assessed with time to return to jogging in a standardized rehab protocol or time to regain 80% quadriceps strength. Secondary outcomes included International Knee Documentation Committee (IKDC) and Marx scores at 12-month follow-up and return to sport. RESULTS There were no significant differences in return to jogging or 80% quadriceps strength (HS 149.5 ± 38.2 days, BTB+QT 131.7 ± 40.1 days, n.s.), number able to return to sport (HS 62%, BTB+QT 93%, n.s.), months to return to sport (HS 10.6 ± 1.4, BTB+QT 10.5 ± 2.3, n.s.), return to pre-injury level of competition (HS 62%, BTB+QT 73%, n.s.), or IKDC (HS 77.2 ± 16.4, BTB+QT 74.8 ± 23.9, n.s.) and Marx scores (HS 9.2 ± 5.3, BTB+QT 8.0 ± 3.7, n.s.) at one-year follow-up. CONCLUSION The main finding of the present study was that outcomes for patients who underwent revision ACL reconstruction with a second extensor mechanism autograft were comparable to those seen for patients who underwent revision ACL reconstruction with extensor mechanism autograft after primary ACL reconstruction with hamstring autograft. By better understanding the consequences of harvesting a second graft from the extensor mechanism, surgeons can better decide what graft to use in revision ACL reconstruction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Joshua C Setliff
- School of Medicine, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA.
| | - Christopher M Gibbs
- Department of Orthopaedic Surgery, UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stephen J Rabuck
- Department of Orthopaedic Surgery, UPMC, University of Pittsburgh, Pittsburgh, PA, USA
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Pandey V, Madi S, Thonse C, Joseph C, Rajan D, Varughese J, Thilak J, Jayaprasad PS, Acharya K, Ramamurthy KG, Reddy R, Amravathi R, Rao S, Gangavarapu S, Srinivas M, Jose S, Sundararjan SR. Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India. Indian J Orthop 2022; 56:1703-1716. [PMID: 36187588 PMCID: PMC9485326 DOI: 10.1007/s43465-022-00719-z] [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: 01/20/2022] [Accepted: 08/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although guidelines from multiple scientific studies decide the general trend in ACLR practice, there is often a variation between scientific guidelines and actual practice. METHODS A 17-member committee comprised of sports surgeons with experience of a minimum of 10 years of arthroscopy surgery finalized a survey questionnaire consisting of concepts in ACL tear management and perioperative trends, intraoperative and post-operative practices regarding single-bundle anatomic ACLR. The survey questionnaire was mailed to 584 registered sports surgeons in six states of south India. A single, non-modifiable response was collected from each member and analyzed. RESULTS 324 responses were received out of 584 members. A strong consensus was present regarding Hamstring tendons preference for ACLR, graft diameter ≥ 7.5 mm, viewing femoral footprint through the anterolateral portal, drilling femoral tunnel from anteromedial portal guided by ridges and remnants of femoral footprint using a freehand technique, suspensory devices to fix the graft in femur and interference screw in the tibia and post-operative bracing. A broad consensus was achieved in using a brace to minimize symptoms of instability of an ACL tear and antibiotic soaking of graft. There was no consensus regarding the timing of ACLR, preferred graft in athletes, pre-tensioning, extra-articular procedure, and return to sports. There was disagreement over hybrid tibial fixation and suture tapes to augment graft. CONCLUSION Diverse practices continue to prevail in the management of ACL injuries. However, some of the consensuses reached in this survey match global practices. Contrasting or inconclusive practices should be explored for potential future research.
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Affiliation(s)
- Vivek Pandey
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Sandesh Madi
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Chirag Thonse
- Vikram Hospital, Millers Road, Bangalore, 560052 India
| | - Clement Joseph
- Arthroscopy and Sports Medicine, SRM Institute for Medical Sciences, Vadapalani, Chennai, Tamil Nadu 600 026 India
| | - David Rajan
- Ortho-One Orthopaedic Speciality Centre, Trichy Road, Singanallur, Coimbatore, Tamil Nadu 641005 India
| | | | - Jai Thilak
- Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala 682 041 India
| | - P. S. Jayaprasad
- Kamineni Hospitals, L.B. Nagar, Bahadurguda, Hyderabad, Telangana 500068 India
| | - Kiran Acharya
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | | | - Raghuveer Reddy
- Krishna Institute of Medical Sciences Secunderabad, Hyderabad, India ,Care Hospitals in Banjara Hills, Hyderabad, India ,Sai Institute of Sports Injury and Arthroscopy in Banjara Hills, Hyderabad, 500 004 India
| | - Rajkumar Amravathi
- St John’s Medical College Hospital, Sarjapur Road, Bangalore, 560034 India
| | - Sharath Rao
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Sridhar Gangavarapu
- Department of Orthopaedics, Medicover Hospitals, Gokhale Rd, Krishna Nagar, Maharani Peta, Visakhapatnam, Andhra Pradesh 530002 India
| | - Moparthi Srinivas
- Nandan Hospital, Suryarao Pet, Vijayawada, Andhra Pradesh 520002 India
| | - Sujit Jose
- Institute of Advanced Orthopaedics at MOSC Hospital and Medical College, Kolenchery, Ernakulam, Kerala 682311 India
| | - S. R. Sundararjan
- Arthroscopy and Sports Medicine, Ganga Hospital, Coimbatore, 641 043 India
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15
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Shekhar A, Tapasvi S, Williams A. Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221083318. [PMID: 35299712 PMCID: PMC8921756 DOI: 10.1177/23259671221083318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Lateral meniscus posterior root tears (LMPRTs) almost always occur in association with anterior cruciate ligament (ACL) tears. Their repair is advocated to restore the stabilizing and load-sharing functions of the meniscus. Purpose: To study the functional outcomes of combined arthroscopic repair of LMPRTs and ACL reconstruction (ACLR). Study Design: Case series; Level of evidence, 4. Methods: The authors evaluated patients who underwent simultaneous arthroscopic ACLR and LMPRT repair. All patients had chronic injuries, with a mean time since ACL rupture of 7.9 months. Patient characteristics, Lachman and pivot-shift test results, type of LMPRT, associated injuries, and surgery details were documented. Pre- and postoperative functional status was assessed using the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. An independent single-tunnel transtibial repair using 2 SutureTapes was performed for Forkel type 1 and 3 tear root avulsions, while side-to-side suture repair was performed for type 2 radial/oblique tears. The Wilcoxon signed rank test and minimal clinically important difference (MCID) of the IKDC score were used for statistical analysis. Results: Included were 25 patients with a mean age of 29.6 ± 6.5 years. Of these, 22 patients (88%; 95% CI, 73.1%-100%) had a high-grade (grade 2 or 3) preoperative pivot shift. Diagnosis of the LMPRT on magnetic resonance imaging (MRI) scans was possible only in 5 patients (20%). At final evaluation, performed at 37.4 ± 7.1 months postoperatively, all functional scores had improved significantly from preoperatively: IKDC score, from 47.6 ± 9.5 to 81.8 ± 11.5; KOOS, from 45.5 ± 10.9 to 86.5 ± 10.3, and Lysholm score, from 49.0 ± 11.5 to 88.8 ± 7.6 (P < .001 for all). Twenty-four patients (96%) achieved the MCID for the IKDC score. All knees had a negative pivot shift at final analysis, and no patient underwent revision ACLR or LMPRT repair. Conclusion: LMPRT repair combined with ACLR led to good short-term clinical outcomes in this study. An LMPRT may frequently go undetected on preoperative MRI scans, but a high-grade pivot shift is present in a large majority of these patients.
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