Quadrupled Semitendinosus Anterior Cruciate Ligament Reconstruction Without the Use of Tourniquet and Minimal Instrumentation: The "Double D" Technique

Use of tourniquet in anterior cruciate ligament reconstruction: Is it truly necessary? A prospective randomized clinical trial

PURPOSE

To examine the effects of tourniquet use in arthroscopic anterior cruciate ligament reconstruction in terms of (1) intraoperative visualization, (2) surgical time, (3) consumption of sterile saline, and (4) postoperative pain.

METHODS

In this prospective randomized clinical trial, patients were assigned to Tourniquet Group or No Tourniquet treatment groups. The primary outcomes were intraoperative visualization, with scores ranging from 0 to 10 (0 = no visibility; 10 = clear and perfect display), surgical time, and the consumption of sterile saline. The secondary aim was to measure postoperative pain (24 h after surgery) with the visual analog scale (VAS) for pain.

RESULTS

A total of 71 patients were included in the No Tourniquet group, and 75 were included in the Tourniquet group, with mean ages of 26.73 ± 8.05 years and 26.95 ± 10.11 years, respectively (p = .88). In the No Tourniquet group, 37 concomitant meniscal lesions were treated, whereas in the Tourniquet group, 38 (p = .99) were treated. The mean surgical times were 51.07 ± 6.90 and 50.03 ± 7.62 (p = .325), respectively, while the mean amount of saline consumed was 6.17 ± 1.18 L versus 5.89 ± 1.23 L (p = .217). Both groups achieved optimal visualization, with a sum of all surgical steps of 65.49 ± 1.86 for the no tourniquet group and 65.39 ± 1.88 for the Tourniquet group (p = .732). Postoperative pain was significantly lower in the No Tourniquet group (VAS score: 2.82 ± 1.33 vs 5.80 ± 1.22).

CONCLUSIONS

Tourniquet use during ACL reconstruction does not improve intraoperative visualization and does not reduce surgical time but leads to greater postoperative pain with a risk of well-known tourniquet-related complications.

LEVEL OF EVIDENCE

Level I - Randomized clinical trial.

Anterior cruciate ligament injury should not be considered a contraindication for medial unicompartmental knee arthroplasty: Finite element analysis

PURPOSE

The research objective of this study is to use finite element analysis to investigate the impact of anterior cruciate ligament (ACL) injury on medial unicompartmental knee arthroplasty (UKA) and explore whether patients with ACL injuries can undergo UKA.

METHODS

Based on the morphology of the ACL, models of ACL with diameters ranging from 1 to 10mm are created. Finite element models of UKA include ACL absence and ACLs with different diameters. After creating a complete finite element model and validating it, four different types of loads are applied to the knee joint. Statistical analysis is conducted to assess the stress variations in the knee joint structure.

RESULTS

A total of 11 finite element models of UKA were established. Regarding the stress on the ACL, as the diameter of the ACL increased, when a vertical load of 750N was applied to the femur, combined with an anterior tibial load of 105N, the stress on the ACL increased from 2.61 MPa to 4.62 MPa, representing a 77.05% increase. Regarding the equivalent stress on the polyethylene gasket, a notable high stress change was observed. The stress on the gasket remained between 12.68 MPa and 14.33 MPa in all models. the stress on the gasket demonstrated a decreasing trend. The equivalent stress in the lateral meniscus and lateral femoral cartilage decreases, reducing from the maximum stress of 4.71 MPa to 2.61 MPa, with a mean value of 3.73 MPa. This represents a reduction of 44.72%, and the statistical significance is (P < 0.05). However, under the other three loads, there was no significant statistical significance (P > 0.05).

CONCLUSION

This study suggests that the integrity of the ACL plays a protective role in performing medial UKA. However, this protective effect is limited when performing medial UKA. When the knee joint only has varying degrees of ACL injury, even ACL rupture, and the remaining structures of the knee joint are intact with anterior-posterior stability in the knee joint, it should not be considered a contraindication for medial UKA.