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Catma MF, Dulgeroglu D, Guroz AN, Kuzucu Y. Association Between Knee Flexor Strength and Preservation of the Tibial Attachment of the Sartorial Fascia During Hamstring Tendon Harvest. Orthop J Sports Med 2024; 12:23259671241248079. [PMID: 38827139 PMCID: PMC11143827 DOI: 10.1177/23259671241248079] [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: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 06/04/2024] Open
Abstract
Background During anterior cruciate ligament (ACL) reconstruction, there are various autograft options. Donor-site morbidity is an important consideration while deciding the type of the autograft. Gracilis and semitendinosus autografts are commonly used in ACL reconstruction, resulting in weakness of the hamstring muscle. Hypothesis We hypothesized that if we preserved the tibial insertion site of the sartorial fascia (SF) during hamstring tendon harvest, there would be better recovery of knee flexor strength. Study Design Case-control study; Level of evidence, 3. Methods In this retrospective study, 34 patients (aged 20-59 years) underwent ACL reconstruction using hamstring tendon autograft with 2 different incision techniques on the SF. The tibial attachment site of the SF was preserved in 17 patients. The insertion site of the muscle was incised transversely in 17 patients. The follow-up duration was ≥2 years. Patients were recalled to the institute for examination and muscle strength assessment. The results were compared between the groups in terms of flexor and extensor knee isokinetic muscle strength at 60 and 180 deg/s. Results There was no statistical difference between the groups in terms of age, sex, or body mass index. When compared with patients whose SF attachment site was incised, patients with a preserved SF tibial insertion were found to have a higher flexion peak torque at the angular speed of 180 deg/s (P < 002). No statistically significant difference was noted at 60 deg/s. Conclusion During collection of gracilis and semitendinosus autografts, preserving the SF tibial attachment site was associated with better knee flexion peak torque.
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Affiliation(s)
- Mehmet Faruk Catma
- Department of Orthopedics and Traumatology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Deniz Dulgeroglu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ali Nazmican Guroz
- Department of Orthopedics and Traumatology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Yakup Kuzucu
- Department of Orthopedics and Traumatology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Farshidfar SS, Cadman J, Neri T, Parker D, Appleyard R, Dabirrahmani D. Towards a validated musculoskeletal knee model to estimate tibiofemoral kinematics and ligament strains: comparison of different anterolateral augmentation procedures combined with isolated ACL reconstructions. Biomed Eng Online 2023; 22:31. [PMID: 36973768 PMCID: PMC10044816 DOI: 10.1186/s12938-023-01094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Isolated ACL reconstructions (ACLR) demonstrate limitations in restoring native knee kinematics. This study investigates the knee mechanics of ACLR plus various anterolateral augmentations using a patient-specific musculoskeletal knee model. MATERIALS AND METHODS A patient-specific knee model was developed in OpenSim using contact surfaces and ligament details derived from MRI and CT data. The contact geometry and ligament parameters were varied until the predicted knee angles for intact and ACL-sectioned models were validated against cadaveric test data for that same specimen. Musculoskeletal models of the ACLR combined with various anterolateral augmentations were then simulated. Knee angles were compared between these reconstruction models to determine which technique best matched the intact kinematics. Also, ligament strains calculated by the validated knee model were compared to those of the OpenSim model driven by experimental data. The accuracy of the results was assessed by calculating the normalised RMS error (NRMSE); an NRMSE < 30% was considered acceptable. RESULTS All rotations and translations predicted by the knee model were acceptable when compared to the cadaveric data (NRMSE < 30%), except for the anterior/posterior translation (NRMSE > 60%). Similar errors were observed between ACL strain results (NRMSE > 60%). Other ligament comparisons were acceptable. All ACLR plus anterolateral augmentation models restored kinematics toward the intact state, with ACLR plus anterolateral ligament reconstruction (ACLR + ALLR) achieving the best match and the greatest strain reduction in ACL, PCL, MCL, and DMCL. CONCLUSION The intact and ACL-sectioned models were validated against cadaveric experimental results for all rotations. It is acknowledged that the validation criteria are very lenient; further refinement is required for improved validation. The results indicate that anterolateral augmentation moves the kinematics closer to the intact knee state; combined ACLR and ALLR provide the best outcome for this specimen.
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Affiliation(s)
- Sara Sadat Farshidfar
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Joseph Cadman
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Thomas Neri
- Sydney Orthopaedic Research Institute, Sydney, Australia
- Department of Orthopaedic Surgery, University Hospital of Saint Etienne, Saint Etienne, France
- EA 7424-Inter-University Laboratory of Human Movement Science, University Lyon-University Jean Monnet Saint Etienne, Saint Etienne, France
| | - David Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Richard Appleyard
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Danè Dabirrahmani
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Devitt BM, Klemm HJ, Kirby J, Batty LM, Webster KE, Whitehead TS, Feller JA. Effect of Radiological Evidence of Kaplan Fiber Injury on the Clinical and Functional Outcomes After Acute Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2022; 50:3557-3564. [PMID: 36178144 DOI: 10.1177/03635465221124249] [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: 01/31/2023]
Abstract
BACKGROUND A paucity of information is available regarding the clinical outcomes of patients with radiological evidence of Kaplan fiber (KF) injury who undergo anterior cruciate ligament (ACL) reconstruction (ACLR). PURPOSE/HYPOTHESIS The purpose was to compare clinical and functional outcomes in patients undergoing acute primary ACLR with and without magnetic resonance imaging (MRI) evidence of KF injury. The hypothesis was that there would be no difference in clinical or functional outcomes in patients with versus those without radiological evidence of KF injury. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS MRI analysis was conducted on patients in a longitudinal prospective study of ACL injury. Only patients who had an MRI scan and had undergone isolated primary ACLR within 60 days of injury were included. MRI was performed using standard knee protocols, and diagnostic criteria were applied to identify KF injury. A total of 32 patients with KF injury (mean age, 24.2 years; 21 male, 11 female) were identified and matched for sex, age, graft type, and preinjury activity with 90 patients who had intact KF. Patients were followed up at 12 months with KT-1000 arthrometer measurements of side-to-side difference in anterior knee laxity, single- and triple-hop limb symmetry index (LSI), Marx activity and International Knee Documentation Committee (IKDC) scores, and return to sport (RTS) rates at 12 months and 24 months. RESULTS No differences were found in anterior knee laxity and single- and triple-hop LSI values between the KF-intact and KF-injured cohorts at 12 months. No differences in Marx and IKDC scores were found between the groups at 12 months and 2 years. The overall rate of RTS within 24 months was 75% (92/122), and 5 patients (2 KF-injured; 3 KF-intact) had a subsequent graft rupture. CONCLUSION We found no difference in clinical or functional outcomes in patients with and without radiological evidence of KF injury who underwent acute primary ACLR. Based on these findings, the radiological presence of KF injury at the time of acute ACL injury should not be regarded as a risk factor for a negative prognosis after ACLR.
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Affiliation(s)
- Brian M Devitt
- OrthoSport Victoria Research Unit, Richmond, Melbourne, Victoria, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Haydn J Klemm
- OrthoSport Victoria Research Unit, Richmond, Melbourne, Victoria, Australia
| | - Julia Kirby
- OrthoSport Victoria Research Unit, Richmond, Melbourne, Victoria, Australia
| | - Lachlan M Batty
- OrthoSport Victoria Research Unit, Richmond, Melbourne, Victoria, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | | | - Julian A Feller
- OrthoSport Victoria Research Unit, Richmond, Melbourne, Victoria, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
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Frisch NB, Keller RA, Mueller JKP, Bandi M, Snethen KG. Treatment of Medial Collateral Ligament Injury During Total Knee Arthroplasty With Internal Suture Brace Augmentation: A Cadaveric and Biomechanical Study. Orthopedics 2022; 45:e269-e275. [PMID: 35485886 DOI: 10.3928/01477447-20220425-05] [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] [Indexed: 02/03/2023]
Abstract
Intraoperative medial collateral ligament (MCL) injury during total knee arthroplasty (TKA) is a serious complication. External bracing and/or conversion to a constrained implant has previously been studied. The technique of using an internal high-strength suture brace to augment an MCL repair has been evaluated in the nonarthroplasty patient and could provide an alternate solution. The goal of this study was to determine whether MCL repair with internal suture bracing restores stability of the implanted knee joint. A robotic simulator completed laxity testing on 5 cadaveric knee specimens in 4 sequential phases: (1) intact knee, (2) after implantation with TKA, (3) after sectioning of the MCL, and (4) after MCL repair with suture brace augmentation. Laxity was compared between the different test phases throughout range of motion. Subsequently, the internal brace was tested to failure under valgus load. The MCL repair with internal bracing was effective at restoring laxity in varus-valgus, internal-external, and medial-lateral degrees of freedom through midflexion, with limited support at deeper flexion angles and in anterior-posterior laxity. Rotational laxity was not significantly different than intact knee laxity. Generally, medial-lateral translations were less and anterior-posterior translations were greater and were significantly different at 30° to 45° and 90°, respectively. The mean failure moment was 46.4±9.1 Nm, with the primary mode of failure being MCL repair. Primary MCL repair with internal bracing using a high-strength suture augment showed the potential to provide adequate stability and strength to correct MCL incompetence in TKA without the use of an external knee brace or constrained implants. [Orthopedics. 2022;45(5):e269-e275.].
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Saithna A. Editorial Commentary: Nonanatomic Lateral Extra-Articular Procedures Performed at the Time of Anterior Cruciate Ligament Reconstruction Risk Overconstraint: Anatomic Anterolateral Ligament Reconstruction Does Not. Arthroscopy 2022; 38:2697-2701. [PMID: 36064280 DOI: 10.1016/j.arthro.2022.05.015] [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: 05/04/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 02/02/2023]
Abstract
Isolated anterior cruciate ligament reconstruction is associated with a risk of graft rupture that is more than 5-fold higher than that of combined anterior cruciate ligament-anterolateral ligament (ALL) reconstruction at a mean follow-up of greater than 100 months. However, biomechanical and clinical studies report that overconstraint is a concern with nonanatomic lateral-sided reconstruction. In fact, the normal biomechanics of the native ALL are anisometric. The ligament is tight in extension (providing rotational control) and slack in flexion (allowing physiological internal rotation). The ALL femoral attachment is proximal and posterior to the lateral epicondyle. The tibial tunnel or tunnels are located anterior to the fibular head and posterior to the Gerdy tubercle. An ALL graft must lie deep to the iliotibial band and superficial to the lateral collateral ligament. Fixation is performed in extension and neutral rotation. A single- or double-strand technique may be used. Surgeons performing lateral extra-articular procedures must understand the technical pitfalls that can lead to overconstraint and must seek to avoid them. Overconstraint can occur for a number of reasons, including the use of nonanatomic reconstruction and technical errors in tensioning, fixation angle, and tunnel positioning.
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Neri T, Cadman J, Beach A, Grasso S, Dabirrahmani D, Putnis S, Oshima T, Devitt B, Coolican M, Fritsch B, Appleyard R, Parker D. Lateral tenodesis procedures increase lateral compartment pressures more than anterolateral ligament reconstruction, when performed in combination with ACL reconstruction: a pilot biomechanical study. J ISAKOS 2020; 6:66-73. [PMID: 33832979 DOI: 10.1136/jisakos-2019-000368] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Given the common occurrence of residual laxity and re-injury post anterior cruciate ligament reconstruction (ACLR), additional anterolateral procedures are increasingly used in combination with an ACLR. Despite the perception that there is a risk of over-constraining the lateral tibiofemoral (LTF) compartment, potentially leading to osteoarthritis, assessment on their effect on intra-articular compartment pressures is still lacking. Our objective was therefore, through a pilot biomechanical study, to compare LTF contact pressures after the most commonly used anterolateral procedures. METHODS A controlled laboratory pilot study was performed using 4 fresh-frozen cadaveric whole lower limbs. Through 0° to 90° of flexion, LTF contact pressures were measured with a Tekscan sensor, located under the lateral meniscus. Knee kinematics were obtained in 3 conditions of rotation (NR: neutral, ER: external and IR: internal rotation) to record the position of the knees for each loading condition. A Motion Analysis system with a coordinate system based on CT scans 3D bone modelling was used. After an ACLR, defined as the reference baseline, 5 anterolateral procedures were compared: anterolateral ligament reconstruction (ALLR), modified Ellison, deep Lemaire, superficial Lemaire and modified MacIntosh procedures. The last 3 procedures were randomised. For each procedure, the graft was fixed in NR at 30° of flexion and with a tension of 20 N. RESULTS Compared with isolated ACLR, addition of either ALLR or modified Ellison procedure did not increased the overall LTF contact pressure (all p>0.05) through the full range of flexion for the IR condition. Conversely, deep Lemaire, superficial Lemaire and modified MacIntosh procedure (all p<0.05) did increase the overall LTF contact pressure compared with ACLR in IR. No significant difference was observed in ER and NR conditions. CONCLUSION This pilot study, comparing the main anterolateral procedures, revealed that addition of either ALLR or modified Ellison procedure did not change the overall contact pressure in the LTF compartment through 0° to 90° of knee flexion. In contrast, the deep and superficial Lemaire, and modified MacIntosh procedures significantly increased overall LTF contact pressures when the knee was internally rotated.
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Affiliation(s)
- Thomas Neri
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia .,Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon - Jean Monnet, Saint Etienne, France
| | - Joseph Cadman
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Aaron Beach
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Samuel Grasso
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Danè Dabirrahmani
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sven Putnis
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Takeshi Oshima
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Brian Devitt
- OrthoSport Victoria, Richmond, Victoria, Australia
| | - Myles Coolican
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Brett Fritsch
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Richard Appleyard
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
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Neri T, Dabirrahmani D, Beach A, Grasso S, Putnis S, Oshima T, Cadman J, Devitt B, Coolican M, Fritsch B, Appleyard R, Parker D. Different anterolateral procedures have variable impact on knee kinematics and stability when performed in combination with anterior cruciate ligament reconstruction. J ISAKOS 2020; 6:74-81. [PMID: 33832980 DOI: 10.1136/jisakos-2019-000360] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The optimal anterolateral procedure to control anterolateral rotational laxity of the knee is still unknown. The objective was to compare the ability of five anterolateral procedures performed in combination with anterior cruciate ligament reconstruction (ACLR) to restore native knee kinematics in the setting of a deficient anterior cruciate ligament (ACL) and anterolateral structures. METHODS A controlled laboratory study was performed using 10 fresh-frozen cadaveric whole lower limbs with intact iliotibial band. Kinematics from 0° to 90° of flexion were recorded using a motion analysis three-dimensional (3D) optoelectronic system, allowing assessment of internal rotation (IR) and anteroposterior (AP) tibial translation at 30° and 90° of flexion. Joint centres and bony landmarks were calculated from 3D bone models obtained from CT scans. Intact knee kinematics were assessed initially, followed by sequential section of the ACL and anterolateral structures (anterolateral ligament, anterolateral capsule and Kaplan fibres). After ACLR, five anterolateral procedures were performed consecutively on the same knee: ALLR, modified Ellison, deep Lemaire, superficial Lemaire and modified MacIntosh. The last three procedures were randomised. For each procedure, the graft was fixed in neutral rotation at 30° of flexion and with a tension of 20 N. RESULTS Isolated ACLR did not restore normal overall knee kinematics in a combined ACL plus anterolateral-deficient knee, leaving a residual tibial rotational laxity (p=0.034). Only the ALLR (p=0.661) and modified Ellison procedure (p=0.641) restored overall IR kinematics to the normal intact state. Superficial and deep Lemaire and modified MacIntosh tenodeses overconstrained IR, leading to shifted and different kinematics compared with the intact condition (p=0.004, p=0.001 and p=0.045, respectively). Compared with ACLR state, addition of an anterolateral procedure did not induce any additional control on AP translation at 30° and 90° of flexion (all p>0.05), except for the superficial Lemaire procedure at 90° (p=0.032). CONCLUSION In biomechanical in vitro setting, a comparison of five anterolateral procedures revealed that addition of either ALLR or modified Ellison procedure restored overall native knee kinematics in a combined ACL plus anterolateral-deficient knee. Superficial and deep Lemaire and modified MacIntosh tenodeses achieved excellent rotational control but overconstrained IR, leading to a change from intact knee kinematics. LEVEL OF EVIDENCE The level-of-evidence statement does not apply for this laboratory experiments study.
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Affiliation(s)
- Thomas Neri
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia .,Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon-Jean Monnet, Saint Etienne, France
| | - Danè Dabirrahmani
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Aaron Beach
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Samuel Grasso
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Sven Putnis
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Takeshi Oshima
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Joseph Cadman
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Brian Devitt
- OrthoSport Victoria, Richmond, Victoria, Australia
| | - Myles Coolican
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Brett Fritsch
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
| | - Richard Appleyard
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
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