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Chen Y, Hao M, Bousso I, Thomopoulos S, Xia Y. Reliable Fabrication of Mineral-Graded Scaffolds by Spin-Coating and Laser Machining for Use in Tendon-to-Bone Insertion Repair. Adv Healthc Mater 2024; 13:e2402531. [PMID: 39104021 PMCID: PMC11650398 DOI: 10.1002/adhm.202402531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/28/2024] [Indexed: 08/07/2024]
Abstract
A reliable method for fabricating biomimetic scaffolds with a controllable mineral gradient to facilitate the surgical repair of tendon-to-bone injuries and the regeneration of the enthesis is reported. The gradient in mineral content is created by sequentially spin-coating with hydroxyapatite/poly(ε-caprolactone) suspensions containing hydroxyapatite nanoparticles in decreasing concentrations. To produce pores and facilitate cell infiltration, the spin-coated film is released and patterned with an array of funnel-shaped microchannels by laser machining. The unique design provided both mechanical (i.e., substrate stiffness) and biochemical (e.g., hydroxyapatite content) cues to spatially control the graded differentiation of mesenchymal stem cells. Immunocytochemical analysis of human mesenchymal stem cell-seeded scaffolds after 14 days of culture demonstrated the formation of a spatial phenotypic cell gradient from osteoblasts to mineralized chondrocytes based on the level of mineralization in the scaffold. By successfully recreating compositional and cellular features of the native tendon enthesis, the biomimetic scaffolds offer a promising avenue for improved tendon-to-bone repair.
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Affiliation(s)
- Yidan Chen
- School of Materials Science and EngineeringGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Min Hao
- The Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGA30332USA
| | - Ismael Bousso
- Department of Orthopedic SurgeryDepartment of Biomedical EngineeringColumbia UniversityNew YorkNY10032USA
| | - Stavros Thomopoulos
- Department of Orthopedic SurgeryDepartment of Biomedical EngineeringColumbia UniversityNew YorkNY10032USA
| | - Younan Xia
- The Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGA30332USA
- School of Chemistry and BiochemistryGeorgia Institute of TechnologyAtlantaGA30332USA
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Vasavada K, Vasavada V, Moran J, Devana S, Lee C, Hame SL, Jazrawi LM, Sherman OH, Huston LJ, Haas AK, Allen CR, Cooper DE, DeBerardino TM, Spindler KP, Stuart MJ, (Ned) Amendola A, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, David TS, Dunn WR, Flanigan DC, Frederick RW, Ganley TJ, Gatt CJ, Gecha SR, Giffin JR, Hannafin JA, Lindsay Harris N, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, Wright RW, York JJ. A Novel Machine Learning Model to Predict Revision ACL Reconstruction Failure in the MARS Cohort. Orthop J Sports Med 2024; 12:23259671241291920. [PMID: 39555321 PMCID: PMC11565622 DOI: 10.1177/23259671241291920] [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: 03/09/2024] [Accepted: 04/03/2024] [Indexed: 11/19/2024] Open
Abstract
Background As machine learning becomes increasingly utilized in orthopaedic clinical research, the application of machine learning methodology to cohort data from the Multicenter ACL Revision Study (MARS) presents a valuable opportunity to translate data into patient-specific insights. Purpose To apply novel machine learning methodology to MARS cohort data to determine a predictive model of revision anterior cruciate ligament reconstruction (rACLR) graft failure and features most predictive of failure. Study Design Cohort study; Level of evidence, 3. Methods The authors prospectively recruited patients undergoing rACLR from the MARS cohort and obtained preoperative radiographs, surgeon-reported intraoperative findings, and 2- and 6-year follow-up data on patient-reported outcomes, additional surgeries, and graft failure. Machine learning models including logistic regression (LR), XGBoost, gradient boosting (GB), random forest (RF), and a validated ensemble algorithm (AutoPrognosis) were built to predict graft failure by 6 years postoperatively. Validated performance metrics and feature importance measures were used to evaluate model performance. Results The cohort included 960 patients who completed 6-year follow-up, with 5.7% (n = 55) experiencing graft failure. AutoPrognosis demonstrated the highest discriminative power (model area under the receiver operating characteristic curve: AutoPrognosis, 0.703; RF, 0.618; GB, 0.660; XGBoost, 0.680; LR, 0.592), with well-calibrated scores (model Brier score: AutoPrognosis, 0.053; RF, 0.054; GB, 0.057; XGBoost, 0.058; LR, 0.111). The most important features for AutoPrognosis model performance were prior compromised femoral and tibial tunnels (placement and size) and allograft graft type used in current rACLR. Conclusion The present study demonstrated the ability of the novel AutoPrognosis machine learning model to best predict the risk of graft failure in patients undergoing rACLR at 6 years postoperatively with moderate predictive ability. Femoral and tibial tunnel size and position in prior ACLR and allograft use in current rACLR were all risk factors for rACLR failure in the context of the AutoPrognosis model. This study describes a unique model that can be externally validated with larger data sets and contribute toward the creation of a robust rACLR bedside risk calculator in future studies. Registration NCT00625885 (ClinicalTrials.gov identifier).
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Affiliation(s)
- MARS Group
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Kinjal Vasavada
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Vrinda Vasavada
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Jay Moran
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Sai Devana
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Changhee Lee
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Sharon L. Hame
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Laith M. Jazrawi
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Orrin H. Sherman
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Laura J. Huston
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Amanda K. Haas
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Christina R. Allen
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Daniel E. Cooper
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Thomas M. DeBerardino
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Kurt P. Spindler
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Michael J. Stuart
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Annunziato (Ned) Amendola
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Christopher C. Annunziata
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Robert A. Arciero
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Bernard R. Bach
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Champ L. Baker
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Arthur R. Bartolozzi
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Keith M. Baumgarten
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Jeffrey H. Berg
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Geoffrey A. Bernas
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Stephen F. Brockmeier
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Robert H. Brophy
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Charles A. Bush-Joseph
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - J. Brad Butler V
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - James L. Carey
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - James E. Carpenter
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Brian J. Cole
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Jonathan M. Cooper
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Charles L. Cox
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - R. Alexander Creighton
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Tal S. David
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Warren R. Dunn
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - David C. Flanigan
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Robert W. Frederick
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Theodore J. Ganley
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Charles J. Gatt
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Steven R. Gecha
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - James Robert Giffin
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Jo A. Hannafin
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Norman Lindsay Harris
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Keith S. Hechtman
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Elliott B. Hershman
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Rudolf G. Hoellrich
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - David C. Johnson
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Timothy S. Johnson
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Morgan H. Jones
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Christopher C. Kaeding
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Ganesh V. Kamath
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Thomas E. Klootwyk
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Bruce A. Levy
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - C. Benjamin Ma
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - G. Peter Maiers
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Robert G. Marx
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Matthew J. Matava
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Gregory M. Mathien
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - David R. McAllister
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Eric C. McCarty
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Robert G. McCormack
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Bruce S. Miller
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Carl W. Nissen
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Daniel F. O’Neill
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Brett D. Owens
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Richard D. Parker
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Mark L. Purnell
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Arun J. Ramappa
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Michael A. Rauh
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Arthur C. Rettig
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Jon K. Sekiya
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Kevin G. Shea
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - James R. Slauterbeck
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Matthew V. Smith
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Jeffrey T. Spang
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Steven J. Svoboda
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Timothy N. Taft
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Joachim J. Tenuta
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Edwin M. Tingstad
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Armando F. Vidal
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Darius G. Viskontas
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Richard A. White
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - James S. Williams
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Michelle L. Wolcott
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Brian R. Wolf
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - Rick W. Wright
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
| | - James J. York
- Investigation performed at NYU Langone Health, New York, New York, USA, and University of California at Los Angeles, Los Angeles, California, USA
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Avasthi S, Aggarwal P, Mahapatra S, Nishat N, Mishra M, Aslam A. Diagnostic accuracy of lever sign test in acute and chronic ACL injuries. J Clin Orthop Trauma 2024; 52:102427. [PMID: 38799022 PMCID: PMC11126818 DOI: 10.1016/j.jcot.2024.102427] [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: 07/18/2023] [Revised: 01/16/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The anterior cruciate ligament (ACL) is a commonly affected knee ligament prone to frequent injuries. Henceforth, we aimed to determine the diagnostic accuracy of lever sign test in Acute and chronic ACL injuries. Method At the institution's initial outpatient visit, 150 consecutive patients (92 males and 58 females) were evaluated. Total 108 patients had injury in their right leg, whereas 42 had injury in their left leg. Based on time since injury, the patients were divided into Acute and chronic groups. Clinical examinations (lachman's test and lelli's test) of all patients were confirmed with arthroscopic findings and compared between the two groups. Results In the acute ACL injury, the lever test had a kappa value 0.704. The accuracy and sensitivity of the Lachman, anterior drawer, pivot shift, and lever tests were calculated. We found that the lever test had the highest accuracy and sensitivity (85.48 %, 91.18 %) than the rest. In the chronic ACL injury, the kappa value for the results of the Lachman test evaluation was 0.723. The chronic ACL injuries accuracy and sensitivity values for the Lachman (86.36 %, 91.67 %), anterior drawer (76.14 %, 81.25 %), pivot shift (55.68 %, 58.49 %), and lever tests were determined. Conclusion The lever sign test is more accurate and reliable in the acute ACL injuries, while the Lachman test is more accurate and reliable in the chronic ACL injuries.
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Affiliation(s)
| | | | | | | | | | - Ammar Aslam
- Department of Orthopaedics, Dr RMLIMS, Lucknow, India
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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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Jildeh TR, Bowen E, Bedi A. Revision Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients. J Am Acad Orthop Surg 2023; 31:e920-e929. [PMID: 37364250 DOI: 10.5435/jaaos-d-23-00288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/27/2023] [Indexed: 06/28/2023] Open
Abstract
Revision anterior cruciate ligament (ACL) reconstruction in the skeletally immature patient is a challenging procedure for pediatric patients with recurrent instability after primary ACL reconstruction. The pediatric population presents unique technical challenges and complications secondary to open physes compared with the adult population. Complications can include growth disturbances, recurrent graft failure, instability, and secondary chondral and/or meniscal injury. Moreover, identifying the etiology of graft failure is critical for a successful revision. Patients should undergo a complete history and physical examination with a focus on patient physiologic age, physeal status, mechanical axis, tibial slope, collagen status, injury mechanism, concomitant injuries, and previous surgical procedures. The surgeon must be adept at reconstruction with various grafts as well as socket or tunnel preparation and fixation, including over-the-top, all-epiphyseal, transphyseal, extra-articular augmentation, and staging approaches. Reported rates of return to sport are lower than those of primary reconstruction, with higher rates of cartilage and meniscal degeneration. Future research should focus on optimizing surgical outcomes and graft survivorship after primary ACL reconstruction with minimized trauma to the physis.
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Affiliation(s)
- Toufic R Jildeh
- From the Department of Orthopaedics, Michigan State University, East Lansing, MI (Jildeh), the Weill Cornell Medical College, New York, NY (Bowen), and the NorthShore Medical Group, Skokie, IL (Bedi)
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Nakasa T, Hayashi S, Nakamae A, Ishikawa M, Ochi M, Adachi N. Human Trials on the Prevention of Tunnel Widening by the Emdogain in Anterior Cruciate Ligament Reconstruction. Cureus 2023; 15:e35960. [PMID: 37050981 PMCID: PMC10085527 DOI: 10.7759/cureus.35960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Background Although anterior cruciate ligament reconstruction (ACLR) is an established procedure, some problems remain, such as bone tunnel widening after ACLR. In animal studies, Emdogain (EMD) prevented tunnel widening by promoting tendon-bone healing. This study aimed to evaluate the effects of EMD on the prevention of tunnel widening after anterior cruciate ligament (ACL) injury in humans. Methods Nineteen patients who underwent ACLR were included. Seven patients in the EMD group were administered EMDs into the femoral tunnel during ACLR, while 12 patients in the control group were not administered EMDs. After surgery, at two and four weeks and three, six, and 12 months, femoral and tibial tunnel widening were evaluated on computed tomography images. Anteroposterior laxity and clinical scores such as the Lysholm score, the International Knee Documentation Committee (IKDC) subjective form, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were assessed before surgery and 12 months postoperatively. Results Tunnel widening on the femoral side was significantly smaller in the EMD group than in the control group at two weeks. However, there was no significant difference between the two groups at 12 months. There were no significant differences in anteroposterior laxity and clinical scores between the groups before and 12 months after surgery. Conclusion EMD administration into the bone tunnel did not prevent tunnel widening at 12 months after ACLR, although tunnel widening of the femoral tunnel was reduced by EMD administration in the early phase.
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7
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Modular Bioreactor Design for Directed Tendon/Ligament Tissue Engineering. Bioengineering (Basel) 2022; 9:bioengineering9030127. [PMID: 35324816 PMCID: PMC8945228 DOI: 10.3390/bioengineering9030127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Functional tissue-engineered tendons and ligaments remain to be prepared in a reproducible and scalable manner. This study evaluates an acellular 3D extracellular matrix (ECM) scaffold for tendon/ligament tissue engineering and their ability to support strain-induced gene regulation associated with the tenogenesis of cultured mesenchymal stromal cells. Preliminary data demonstrate unique gene regulation patterns compared to other scaffold forms, in particular in Wnt signaling. However, the need for a robust bioreactor system that minimizes process variation was also evident. A design control process was used to design and verify the functionality of a novel bioreactor. The system accommodates 3D scaffolds with clinically-relevant sizes, is capable of long-term culture with customizable mechanical strain regimens, incorporates in-line load measurement for continuous monitoring and feedback control, and allows a variety of scaffold configurations through a unique modular grip system. All critical functional specifications were met, including verification of physiological strain levels from 1–10%, frequency levels from 0.2–0.5 Hz, and accurate load measurement up to 50 N, which can be expanded on the basis of load cell capability. The design process serves as a model for establishing statistical functionality and reliability of investigative systems. This work sets the stage for detailed analyses of ECM scaffolds to identify critical differentiation signaling responses and essential matrix composition and cell–matrix interactions.
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8
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Midttun E, Andersen MT, Engebretsen L, Visnes H, Fenstad AM, Gjertsen JE, Persson A. Good validity in the Norwegian Knee Ligament Register: assessment of data quality for key variables in primary and revision cruciate ligament reconstructions from 2004 to 2013. BMC Musculoskelet Disord 2022; 23:231. [PMID: 35264137 PMCID: PMC8908681 DOI: 10.1186/s12891-022-05183-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Norwegian Knee Ligament Register was founded in 2004 to provide representative and reliable data on cruciate ligament surgery. The aim of this study was to evaluate the validity of key variables in the Norwegian Knee Ligament Register to reveal and prevent systematic errors or incompleteness, which can lead to biased reports and study conclusions. Method We included a stratified cluster sample of 83 patients that had undergone both primary and revision anterior cruciate ligament surgery. A total of 166 medical records were reviewed and compared with their corresponding data in the database of the Norwegian Knee Ligament Register. We assessed the validity of a selection of key variables using medical records as a reference standard to compute the positive predictive values of the register data for the variables. Results The positive predictive values for the variables of primary and revision surgery ranged from 92 to 100% and from 39 to 100% with a mean positive predictive value of 99% and 88% respectively. Data on intraoperative findings and surgical details had high positive predictive values, ranging from 91 to 100% for both primary and revision surgery. The positive predictive value for the variable “date of injury” was 92% for primary surgeries but only 39% for revision surgeries. The positive predictive value for “activity at the time of injury” was 99% for primary surgeries and 52% for revisions. Conclusion Overall, the data quality of the key variables examined in the Norwegian Knee Ligament Register was high, making the register a valid source for research. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05183-2.
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Affiliation(s)
- Espen Midttun
- Department of Neurology, Førde Central Hospital, Svanehaugvegen 2, 6812, Førde, Norway.
| | | | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Håvard Visnes
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Orthopaedic Surgery, The Norwegian Knee Ligament Register, Haukeland University Hospital, Bergen, Norway.,Department of Orthopaedics, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Anne Marie Fenstad
- Department of Orthopaedic Surgery, The Norwegian Knee Ligament Register, Haukeland University Hospital, Bergen, Norway.,The Norwegian National Advisory Unit On Arthroplasty and Hip Fractures, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jan-Erik Gjertsen
- The Norwegian National Advisory Unit On Arthroplasty and Hip Fractures, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Andreas Persson
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Orthopaedic Surgery, The Norwegian Knee Ligament Register, Haukeland University Hospital, Bergen, Norway
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9
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Ennis HE, Bondar K, McCormick J, Chen CJL, Donnally CJ, Kaplan L. The 50 Most Cited Articles in the Indications, Risk Factors, Techniques, and Outcomes of ACL Revision Surgery. J Knee Surg 2021; 34:1170-1181. [PMID: 32369839 DOI: 10.1055/s-0040-1702182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The rate of anterior cruciate ligament (ACL) retear remains high and revision ACL reconstruction has worse outcomes compared with primaries. To make advances in this area, a strong understanding of influential research is necessary. One method for systematically evaluating the literature is by citation analysis. This article aims to establish and evaluate "classic" articles. With consideration of these articles, this article also aims to evaluate gaps in the field and determine where future research should be directed. The general approach for data collection and analysis consisted of planning objectives, employing a defined strategy, reviewing search results using a multistep and multiauthor approach with specific screening criteria, and analyzing data. The collective number of citations for all publications within the list was 5,203 with an average of 104 citations per publication. "Biomechanical Measures during Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport" by Paterno et al contained both the highest number of total citations and the highest number of citations per year, with 403 total citations and 43.9 citations per year. The most recurring level of evidence were level II (n = 18) and level III (n = 17). "Clinical Outcomes" was the most common article type (n = 20) followed by "Risk Factors" (n = 10). The American Journal of Sports Medicine had the highest recorded Cite Factor with over 50% of the articles (n = 27) published. The most productive authors included R.W. Wright (n = 6), S.D. Barber-Westin (n = 5), F.R. Noyes (n = 5), and K.P. Spindler (n = 5). Historically, influential studies have been published in the realms of clinical outcome and risk factor identification. It has been established that revision ACL reconstruction has worse outcomes and more high-level studies are needed. Additionally, prospective studies that apply the knowledge for current known risk factor mitigation are needed to determine if graft tear rates can be lowered.
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Affiliation(s)
- Hayley E Ennis
- Department of Orthopedic Surgery, Jackson Memorial Hospital, Miami, Florida.,Department of Orthopedic Surgery-Sports Medicine, University of Miami Health System, Miami, Florida
| | - Kevin Bondar
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Johnathon McCormick
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Clark Jia-Long Chen
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Chester J Donnally
- Department of Orthopedic Surgery, Jackson Memorial Hospital, Miami, Florida
| | - Lee Kaplan
- Department of Orthopedic Surgery-Sports Medicine, University of Miami Health System, Miami, Florida
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Büyükdoğan K, Laidlaw MS, Kew ME, Miller MD. Allograft Bone Dowels Show Better Incorporation in Femoral Versus Tibial Tunnels in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Computed Tomography-Based Analysis. Arthroscopy 2021; 37:1920-1928. [PMID: 33581298 DOI: 10.1016/j.arthro.2021.01.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to quantitatively evaluate the radiographic outcomes of allograft dowels used in 2-stage revision anterior cruciate ligament reconstruction (ACLR) and to compare the incorporation rates of dowels placed in tibial and femoral tunnels. METHODS Prospective review of patients who underwent 2-stage revision ACLR with allograft bone dowels. Inclusion criteria were tibial/femoral tunnel diameter of ≥14 mm on preoperative computed tomography (CT) or overlapping of prior tunnels with planned tunnels. Second-stage timing was determined based on qualitative dowel integration on CT obtained at ∼3 months after the first stage. Quantitative analysis of incorporation rates was performed with the union ratio (UR) and occupying ratio (OR) on postoperative CT scans. RESULTS Twenty-one patients, with a mean (SD) age of 32.1 (11.4; range, 18-50) years, were included. Second-stage procedures were performed at a mean (SD) of 6.5 (2.1; range, 2.4-11.5) months after first-stage revision. All dowels showed no signs of degradation at the host bone/graft junction at the second-stage procedure. The mean (SD) diameter of the dowels placed in tibial tunnels was greater than those placed in femoral tunnels (16.1 [2.3] mm vs 12.4 [1.6] mm; P < .05). CT was obtained at a mean (SD) of 121 (28; range, 59-192) days after the first-stage surgery. There was no difference between the OR of femoral and tibial tunnels (mean [SD], 87.6% [4.8%] vs 85.7% [10.1%]; P = .484), but the UR was significantly higher in femoral tunnels (mean [SD], 83% [6.2%] vs 74% [10.5%], P = .005). The intraclass correlation coefficients of OR and UR measurements indicated good reliability. CONCLUSIONS Allograft bone dowels are a viable graft choice to replenish bone stock in the setting of a staged revision ACL reconstruction. Allograft dowels placed in femoral tunnels had a higher healing union ratio than tibial tunnel allografts and no evidence of degradation at the bone/graft junction, with no difference seen in occupying ratio. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kadir Büyükdoğan
- Department of Orthopaedic Surgery, Koc University Hospital, Zeytinburnu/Istanbul, Turkey
| | | | - Michelle E Kew
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
| | - Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, U.S.A..
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11
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Zhao GL, Lyu JY, Liu CQ, Wu JG, Xia J, Huang GY. A modified anterior drawer test for anterior cruciate ligament ruptures. J Orthop Surg Res 2021; 16:260. [PMID: 33853620 PMCID: PMC8045226 DOI: 10.1186/s13018-021-02381-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/23/2021] [Indexed: 11/12/2022] Open
Abstract
Objective This study was aimed to utilize a modified anterior drawer test (MADT) to detect the anterior cruciate ligament (ACL) ruptures and investigate its accuracy compares with three traditional tests. Methods Four hundred patients were prospectively enrolled between January 2015 and September 2017 preoperatively to undergo knee arthroscopic surgeries. The MADT, anterior drawer test, Lachman test, and pivot shift test were used in the outpatient clinical setting and were compared statistically for their accuracy in terms of ACL ruptures, with arthroscopic findings as the gold standard. Results The prevalence of ACL ruptures in this study was 37.0%. The MADT demonstrated the highest sensitivity (0.89) and accuracy (0.92) among the four tests and had comparable specificity (0.94) and a positive predictive value (0.90) compared with the anterior drawer test, Lachman test, and pivot shift test. The diagnostic odds ratio (DOR) of MADT was 122.92, with other test values of no more than 55.45. The area under the receiver operating characteristic curve (AUC) for the MADT was 0.92 ± 0.01, with a significant difference compared with that for the anterior drawer test (z = 17.00, p < 0.001), Lachman test (z = 9.66, p = 0.002), and pivot shift test (z = 16.39, p < 0.001). The interobserver reproducibility of the MADT was good, with a kappa coefficient of 0.86. When diagnosing partial tears of ACL, the MADT was significantly more sensitive than the anterior drawer test (p < 0.001), Lachman test (p = 0.026), and pivot shift test (p = 0.013). The MADT showed similar sensitivity in detecting anteromedial and posterolateral bundle tears (p = 0.113) and no difference in diagnosing acute and chronic ACL ruptures (χ2 = 1.682, p = 0.195). Conclusions The MADT is also an alternative diagnostic test to detect ACL tear, which is equally superior to the anterior drawer test, Lachman test, and pivot shifting test. It could improve the diagnosis of ACL ruptures combined with other clinical information including injury history, clinical examination, and radiological findings. Levels of evidence Level II/observational diagnostic studies Trial registration Chinese Clinical Trial Registry. ChiCTR1900022945 /retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02381-x.
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Affiliation(s)
- Guang-Lei Zhao
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China
| | - Jin-Yang Lyu
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China
| | - Chang-Quan Liu
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China
| | - Jian-Guo Wu
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China.,Department of Orthopaedic Surgery, North Branch of Huashan Hospital Fudan University, 518th Jingpohu Road, Bao'shan District, Shanghai, China
| | - Jun Xia
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China
| | - Gang-Yong Huang
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China. .,Department of Orthopaedic Surgery, North Branch of Huashan Hospital Fudan University, 518th Jingpohu Road, Bao'shan District, Shanghai, China.
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12
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Marín Fermín T, Hovsepian JM, Symeonidis PD, Terzidis I, Papakostas ET. Insufficient evidence to support peroneus longus tendon over other autografts for primary anterior cruciate ligament reconstruction: a systematic review. J ISAKOS 2020; 6:161-169. [PMID: 34006580 DOI: 10.1136/jisakos-2020-000501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/06/2020] [Accepted: 10/24/2020] [Indexed: 11/04/2022]
Abstract
IMPORTANCE Graft choice for anterior cruciate ligament reconstruction (ACLR) remains a subject of interest among orthopaedic surgeons because no ideal graft has yet been found. Peroneus longus tendon (PLT) has emerged as an alternative autograft for reconstruction in kneeling populations and in simultaneous anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries. OBJECTIVE To evaluate the current evidence on the outcome of primary ACLR with PLT autograft in adults and donor ankle morbidity, in addition to determining the average PLT graft dimensions from published studies. EVIDENCE REVIEW Two independent reviewers searched PubMed, CENTRAL, EMBASE, Scopus and Virtual Health Library databases using the terms "anterior cruciate ligament," "peroneus longus" and "fibularis longus" alone and in combination with Boolean operators AND/OR. Studies evaluating clinical and stability outcomes, graft-donor ankle morbidity and graft dimensions of PLT in ACLR were included. Methodological quality was assessed using the Modified Coleman Methodology Score (mCMS). A narrative analysis is presented using frequency-weighted means wherever feasible. Publication bias was assessed using the ROBIS tool. FINDINGS Twelve articles with intermediate-level methodological quality were included. Eight studies assessing the clinical and stability outcomes of reconstruction with PLT showed satisfactory outcomes, similar to those of hamstring tendons (HT). No studies assessed anterior knee pain as an outcome. Six studies evaluated the graft-donor ankle morbidity using general functional foot and ankle scores and non-validated tools, showing favourable outcomes. Nine studies assessed PLT graft diameter, revealing grafts consistently larger than 7 mm among the different preparation techniques, which is comparable with reports of HT grafts. CONCLUSIONS AND RELEVANCE The clinical and stability outcomes of ACLR with different PLT autograft preparation techniques are comparable with those of HT during short-term follow-up; however, there is insufficient evidence to support its use in the populations that motivated its implementation. Thus, stronger evidence obtained with the use of validated tools reporting negligible donor-graft ankle morbidity after PLT harvesting is required prior to recommending its routine use, despite the consistency of its dimensions. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Theodorakys Marín Fermín
- Orthopedics, Hospital Periferico de Coche, Caracas, Capital District, Venezuela, Bolivarian Republic of .,Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Central Macedonia, Greece
| | - Jean Michel Hovsepian
- Department of Orthopaedic Sports Medicine, Chirurgisches Klinikum München Süd, München, Bayern, Germany
| | | | - Ioannis Terzidis
- Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Central Macedonia, Greece.,St. Luke's Hospital, Thessaloniki, Central Macedonia, Greece
| | - Emmanouil Theodorus Papakostas
- Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Central Macedonia, Greece.,Sports Medicine Orthopaedics, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
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13
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Yari SS, El Naga AN, Patel A, Qadeer AA, Shah A. TightRope Versus Biocomposite Interference Screw for Fixation in Allograft ACL Reconstruction: Prospective Evaluation of Osseous Integration and Patient Outcomes. JB JS Open Access 2020; 5:e0057. [PMID: 33123662 PMCID: PMC7418916 DOI: 10.2106/jbjs.oa.19.00057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure with many options regarding graft choice and graft fixation. The purpose of this study was to compare suspensory and aperture fixation in terms of femoral osseous integration of the bone block after ACL reconstruction with an Achilles tendon allograft. Methods After institutional review board approval and patient consent were obtained, 37 patients underwent ACL reconstruction with an Achilles tendon allograft. The patients were randomized according to the graft femoral fixation technique, which was with either a suspensory device (Arthrex TightRope) or aperture fixation by a biocomposite interference screw (Arthrex BioComposite Interference Screw or DePuy Mitek MILAGRO Interference Screw). Tibial fixation, performed with a biocomposite screw and knotless anchor, was identical in all patients. All patients underwent a computed tomography (CT) scan at 6 months to evaluate bone block incorporation of the femoral graft within the femoral tunnel, which was the study's primary outcome. Secondary outcome measures included a postoperative visual analogue scale (VAS) pain score, range-of-motion measures, and International Knee Documentation Committee scores. Demographic data were collected. Results Thirty-three patients (89%) completed the study's 6-month follow-up, at which time the femoral ossification score was significantly greater in the aperture fixation group (p = 0.025). There was no substantial difference between the 2 groups with regard to any other outcome measure. Conclusions Performing Achilles tendon allograft ACL reconstruction with femoral aperture fixation results in greater femoral bone block incorporation at 6 months postoperatively compared with what is seen after suspensory fixation. Level of Evidence Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shahram Shawn Yari
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Ashraf N El Naga
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Amar Patel
- Departments of Radiology (A.P.) and Orthopedic Surgery (A.S.), Kelsey-Seybold Clinic, Houston, Texas
| | - Ali Asaf Qadeer
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Anup Shah
- Departments of Radiology (A.P.) and Orthopedic Surgery (A.S.), Kelsey-Seybold Clinic, Houston, Texas
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14
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Wang N, Zhu Z, Wu Z, He H, Wang H, Li W, Xie D, Wang Y. Comparative risk-benefit profiles of different femoral drilling techniques in anterior cruciate ligament reconstruction: A protocol for a systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e20544. [PMID: 32502016 PMCID: PMC7306331 DOI: 10.1097/md.0000000000020544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury experiences about 200,000 isolated cases annually, and ACL reconstruction has become the gold standard for the restoration of stability and functionality. In view of that incorrect graft placement is a common cause of ACL reconstruction failure, it is critically important to ensure that the tibial and femoral tunnels are properly placed during the operation. Therefore, we intend to conduct a network meta-analysis to comparatively evaluate the clinical outcomes among the different surgical techniques in ACL reconstruction. METHODS Embase, PubMed, and Cochrane Library will be searched through to retrieve the relevant literature up to April 2020. The outcomes include the International Knee Documentation Committee subjective/objective score, Lachman test, Lysholm score, laxity of knee joint, pivot-shift test, Tegner activity scale, and the number of adverse events. A Bayesian hierarchical framework will be used to evaluate the comparative efficacy among different fixation devices. Cochrane Q test and I statistics will be applied to evaluate the heterogeneity, and the Cochrane risk of bias assessment tool will be employed to evaluate the study quality and the risk of bias. RESULTS The comparative risk-benefit profiles of different femoral drilling techniques will be evaluated based on the existing evidence, in order to summarize a prioritization regimen. CONCLUSION Findings from this network meta-analysis will provide useful reference to patients, surgeons, and guideline makers in the related fields. REGISTRATION Open Science Framework (OSF) Preregistration. April 20, 2020. osf.io/uzahs.
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15
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Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. J Orthop Res 2020; 38:1191-1203. [PMID: 31840832 PMCID: PMC7225036 DOI: 10.1002/jor.24562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/25/2019] [Indexed: 02/04/2023]
Abstract
The underlying theme throughout this series of studies authored by the Multicenter anterior cruciate ligament (ACL) Revision Study consortium has been to determine the modifiable predictors or risk factors of long-term outcomes of revision ACL reconstruction. The observational studies described and summarized in the manuscript are both clinically relevant and of great interest in finding out the long-term consequences of the intervention and its relationship to the original injury. The successful completion of these studies has important implications for both therapy and future clinical trials. The identification of modifiable risk factors will play an important role in secondary prevention, while the identification of nonmodifiable risk factors will aid us in counseling our patients and making surgical decisions. Thus, we expect a profound clinical impact on patients' care. More importantly, this project represents an important step forward in bringing evidence to bear in clinical decision making in orthopedic surgery.
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Salem HS, Axibal DP, Wolcott ML, Vidal AF, McCarty EC, Bravman JT, Frank RM. Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review of Bone Graft Options for Tunnel Augmentation. Am J Sports Med 2020; 48:767-777. [PMID: 31116949 DOI: 10.1177/0363546519841583] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. PURPOSE To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. STUDY DESIGN Systematic review. METHODS A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. PubMed, EMBASE, and the Cochrane Library were queried through use of the terms anterior cruciate ligament and revision to identify all studies reporting outcomes of bone tunnel grafting in 2-stage revision ACL reconstruction. Data extracted included indications for 2-stage surgery, surgical technique, graft material, time between surgeries, rehabilitation protocols, physical examination findings, patient-reported outcomes, and radiographic and histologic findings. RESULTS The analysis included 7 studies with a total of 234 patients. The primary outcome in 2 studies was graft incorporation (mean follow-up, 8.8 months), whereas the other 5 studies reported clinical outcomes with follow-up mean ± SD of 4.2 ± 2.1 years. The indication for bone grafting and between-stage protocol varied among studies. Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1). In 2 studies, the authors investigated the outcomes of allograft: allograft bone matrix (ABM) and allograft bone chips (AC). Finally, 1 study compared ICBG to a synthetic bone substitute. Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. In 4 studies, the authors reported the time interval between first and second surgeries, with an average of 6.1 months for ICBG compared with 8.7 months for allogenic and synthetic grafts. Revision ACL graft failure rates were reported by 5 studies, including 1 study with ABM (6.1%), 1 study with AC (8.3%), 1 study with TBA (0%), and 2 studies with ICBG (0% and 2%). CONCLUSION The indications for staged ACL reconstruction and the rehabilitation protocol between stages need to be clearly established. The available data indicate that autograft for bone tunnel grafting in 2-stage ACL revision may be associated with a lower risk of revision ACL reconstruction graft failure compared with allograft bone.
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Affiliation(s)
- Hytham S Salem
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Derek P Axibal
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Armando F Vidal
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric C McCarty
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Rachel M Frank
- University of Colorado School of Medicine, Aurora, Colorado, USA
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17
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So SY, Suh DW, Lee SS, Jung EY, Ye DH, Ryu D, Kwon KB, Wang JH. Revision Anterior Cruciate Ligament Reconstruction After Primary Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Case Series of 40 Patients. Arthroscopy 2020; 36:546-555. [PMID: 31901397 DOI: 10.1016/j.arthro.2019.08.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/09/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the surgical methods according to the status of tunnels at the time of revision anterior cruciate ligament reconstruction (ACLR) and to evaluate clinical outcomes of revision ACLR in patients who underwent primary ACLR with the anatomic 4-tunnel double-bundle (DB) technique. METHODS A total of 487 patients who underwent primary anatomic DB ACLR from April 2010 to July 2016 were retrospectively reviewed, and among those knees, the patients who underwent revision ACLR were included in the study. The patients with concomitant posterior cruciate ligament injuries were excluded. Forty patients (40 knees) were identified and enrolled. The surgical methods were reviewed. The range of motion, objective laxity using KT-2000, Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, and Tegner score after revision ACLR were compared with those after primary ACLR in the same patient using paired t-test with Bonferroni correction. RESULTS The timing of reinjury after primary ACLR and mean interval between primary and revision ACLR were 18 months (range 1.5-80 months) and 24 months (range 4-82 months), respectively. Among 40 patients, 38 patients (95%) underwent 1-stage revision with the DB technique using pre-existing tunnels without compromised positioning of the grafts, and the other 2 patients (5%) underwent 2-stage revision. The postrevision range of motion, KT-2000, Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, and Tegner score were 137 ± 7°, 2.4 ± 1.2 mm, 91.4 ± 5.8, 98.9 ± 2.2, 78.6 ± 11.5, and 5.5 ± 1.2, respectively, and did not show any differences from those after primary ACLR. CONCLUSIONS In the revision setting after primary anatomic DB ACLR, most of the cases could be managed with 1-stage revision with DB technique using pre-existing tunnels, and the objective laxity and clinical scores after revision DB ACLR were comparable with those after primary DB ACLR. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Sang-Yeon So
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Dong Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-si, Gyeonggi-do, Korea
| | - Eui Yub Jung
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea
| | - Dong-Hee Ye
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongjin Ryu
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeu-Back Kwon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
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Kim DH, Bae KC, Kim DW, Choi BC. Two-stage revision anterior cruciate ligament reconstruction. Knee Surg Relat Res 2019; 31:10. [PMID: 32660548 PMCID: PMC7219575 DOI: 10.1186/s43019-019-0010-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. When performing a revision reconstruction, the surgeon decides between a single-stage or a two-stage revision. Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active infection, and concomitant knee pathology (e.g., malalignment, other ligamentous injuries, meniscal or chondral lesions). Among these potential scenarios requiring a two-stage revision, tunnel-widening is the most common cause; the first stage involves graft removal, tunnel curettage, and bone grafting, followed by revision ACL reconstruction in the second stage. The purpose of this article is to review the preoperative planning, surgical considerations, rehabilitation, and outcomes of two-stage revision ACL reconstructions and summarize the recent literature outlining treatment results.
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Affiliation(s)
- Du-Han Kim
- Department of Orthopaedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 1035 Dalgubul-ro, Dalseo-gu, Daegu, 42601, South Korea
| | - Ki-Cheor Bae
- Department of Orthopaedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 1035 Dalgubul-ro, Dalseo-gu, Daegu, 42601, South Korea.
| | - Dong-Wan Kim
- Department of Orthopaedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 1035 Dalgubul-ro, Dalseo-gu, Daegu, 42601, South Korea
| | - Byung-Chan Choi
- Department of Orthopaedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 1035 Dalgubul-ro, Dalseo-gu, Daegu, 42601, South Korea
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19
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Lever sign test: is it sensitive for the diagnosis of anterior cruciate ligament disruption? CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Liu J, Wang J, Tao L, Liu C, Wang Y, Wei B, Li P, Bao H, Ma B, Qi Y, Xu Y. Comparison of Tibial Tuberosity-Trochlear Groove (TT-TG) distances between different anterior cruciate ligament reconstructions: A retrospective clinical and imaging study. Technol Health Care 2019; 27:229-238. [PMID: 31045542 PMCID: PMC6598009 DOI: 10.3233/thc-199022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND: Previous studies showed that compared with single-bundle (SB) precedures, double-bundle (DB) anterior cruciate ligament (ACL) reconstruction perform better. OBJECTIVE: To make assurance that distance of TT-TG may be altered along with ACL rupture and reconstruction. METHODS: Imaging study of 201 patients’s related cases by MRI and CT scans. RESULTS: Compared with the intact knee’s overall mean TT-TG value, the mean overall pre/postoperative TT-TG values showed a significant difference. For SB reconstruction, the mean pre/postoperative TT-TG values were 15.67± 2.46 mm and 14.72± 2.48 mm, respectively. Postoperative and intact knee TT-TG values were significantly different (p< 0.001). For DB reconstruction, the pre/postoperative mean TT-TG values were 15.11± 1.99 mm and 13.11± 1.71 mm. Postoperative and intact knee TT-TG values were not significantly different (p= 0.141). CONCLUSIONS: The increased TT-TG value from a ruptured ACL was significantly restored after ACL reconstruction. The TT-TG value after SB reconstruction was still obviously larger than that of the intact knee. It showed no significant difference between the postoperative TT-TG of the DB group and intact knees. The original TT-TG values of the knees were much closer to restoration after DB reconstruction.
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Affiliation(s)
- Jianfeng Liu
- Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China.,Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China
| | - Junchen Wang
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China.,Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.,Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China
| | - Chenlu Liu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yongxiang Wang
- Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China
| | - Baogang Wei
- Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China
| | - Pengfei Li
- Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China
| | - Huricha Bao
- Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China
| | - Bingxian Ma
- Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China
| | - Yansong Qi
- Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China
| | - Yongsheng Xu
- Department of Orthopaedics, Inner Mongolia People's Hospital, Hohhot, China
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22
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Chahla J, Cinque ME, Mandelbaum BR. Biologically Augmented Quadriceps Tendon Autograft With Platelet-Rich Plasma for Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2018; 7:e1063-e1069. [PMID: 30533350 PMCID: PMC6261920 DOI: 10.1016/j.eats.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/26/2018] [Indexed: 02/03/2023] Open
Abstract
Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures studied in the orthopaedic literature. In this regard, graft preparation is a key factor for successful outcomes. Although current methods to reconstruct the ACL are generally perceived to be successful, recent studies indicate that normal structure and function of the knee are fully restored in less than half of the patients. Therefore, biologically augmenting these scaffolds could provide a potential solution for improving healing times and biomechanical properties of the graft. The purpose of this Technical Note is to describe our preferred technique for an ACL graft preparation (quadriceps tendon) augmented with platelet-rich plasma.
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Affiliation(s)
- Jorge Chahla
- Cedars Sinai Kerlan Jobe Institute, Santa Monica, California, U.S.A.,Address correspondence to Jorge Chahla, M.D., Ph.D., 2020 Santa Monica Blvd, Ste 400, Santa Monica, CA 90404, U.S.A.
| | - Mark E. Cinque
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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23
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Ponzo A, Monaco E, Basiglini L, Iorio R, Caperna L, Drogo P, Conteduca F, Ferretti A. Long-Term Results of Anterior Cruciate Ligament Reconstruction Using Hamstring Grafts and the Outside-In Technique: A Comparison Between 5- and 15-Year Follow-up. Orthop J Sports Med 2018; 6:2325967118792263. [PMID: 31457062 PMCID: PMC6700944 DOI: 10.1177/2325967118792263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Increased femoral tunnel widening and weakness of the hamstring muscles postoperatively have been described as potential adverse events after anterior cruciate ligament (ACL) reconstruction (ACLR) with a hamstring graft. Meniscectomy and cartilage lesions are important factors for the development of degenerative osteoarthritis. Purpose: To compare 15-year follow-up data with 5-year follow-up data from the same cohort of patients after ACLR with a hamstring autograft using an outside-in technique. Study Design: Case series; Level of evidence, 4. Methods: A total of 72 patients who underwent anatomic ACLR with a quadruple hamstring graft and an outside-in technique were selected for this prospective study. Patients were reviewed at a minimum follow-up of 15 years. Results were compared with the same series of patients previously reviewed at 5 years after surgery. Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores as well as KT-1000 arthrometer measurements were obtained at final follow-up. Comparative weightbearing radiographs were obtained and analyzed according to the Fairbank, Kellgren-Lawrence, and IKDC classifications and used for the tunnel evaluation. Results: No significant difference was detected on the subjective evaluation. Objectively, patients categorized as A or B according to the IKDC score were not significantly different at 5 and 15 years (P < .01). A KT-1000 arthrometer side-to-side manual maximum difference >5 mm, a pivot shift >2+, any giving-way episode, and ACL revision surgery were considered as failures, and these were noted in 6 patients at 5 years and 6 patients at 15 years. The radiological evaluation at 15 years showed a higher rate of osteoarthritis in 2 of 3 radiological scales used in the study compared with results at 5-year follow-up (P < .01). At 15-year follow-up, there was a statistically significant reduction in the mean tibial tunnel diameter (P < .01). Conclusion: Endoscopic single-bundle ACLR using hamstring grafts and an outside-in technique demonstrated good results at 15-year follow-up in terms of subjective, objective, and radiographic evaluations. As compared with 5-year follow-up, clinical results remained stable both subjectively and objectively. However, a progression of osteoarthritis changes was observed, especially in patients in whom meniscectomy had been performed.
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Affiliation(s)
- Antonio Ponzo
- Kirk Kilgour Sports Traumatology Center, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | - Edoardo Monaco
- Kirk Kilgour Sports Traumatology Center, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | - Luca Basiglini
- Kirk Kilgour Sports Traumatology Center, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | - Raffaele Iorio
- Kirk Kilgour Sports Traumatology Center, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | - Ludovico Caperna
- Kirk Kilgour Sports Traumatology Center, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | - Piergiorgio Drogo
- Kirk Kilgour Sports Traumatology Center, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | - Fabio Conteduca
- Kirk Kilgour Sports Traumatology Center, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | - Andrea Ferretti
- Kirk Kilgour Sports Traumatology Center, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
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Bone-Patellar Tendon-Bone Graft Preparation for Fixation with Suspensory Method in Anterior Cruciate Reconstruction: A Biomechanical Study. Asian J Sports Med 2018. [DOI: 10.5812/asjsm.66378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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25
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Zhang Q, Kou Y, Yuan Z. A meta-analysis on anterior cruciate ligament reconstruction: Is modified transtibial technique inferior to independent drilling techniques? Exp Ther Med 2018; 16:1790-1799. [PMID: 30186403 PMCID: PMC6122342 DOI: 10.3892/etm.2018.6395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023] Open
Abstract
This report respectively compared the standard transtibial (sTT) technique to the independent drilling (ID) techniques applied to anterior cruciate ligament (ACL) reconstruction. It also made a comparison between the clinical results of the modified transtibial (mTT) technique and of the ID techniques. Prospective studies on transtibial (TT) and ID techniques for ACL reconstruction were retrieved from several databases and a subgroup analysis was performed to compare the sTT technique with the ID techniques and the mTT with the ID techniques. Furthermore, comparison of the Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC) subjective and objective evaluations, Lysholm score and Tegner activity scale were conducted. This report included 12 clinical studies that involved 681 patients having received ACL reconstruction. The study results indicated that in comparison between the sTT and ID techniques, the ID techniques outperformed the sTT technique in the IKDC subjective score (P=0.01) and laxity (P=0.0004). However, there was no significant difference in the IKDC objective score (P=0.34), pivot-shift test (P=0.24), Lachman test (P=0.21), Lysholm score (P=0.14) and Tegner activity scale (P=0.66). The comparison between the new mTT technique and the ID techniques suggested no significant difference in the IKDC objective and subjective scores (P=0.86), laxity (P=0.38), pivot-shift test (P=0.66), Lachman test (P=0.10), Lysholm score (P=0.10) and Tegner activity scale (P=0.55). Compared to the sTT technique, the mTT and ID techniques are more suitable for ACL reconstruction because they can present better subjective feelings. Moreover, considering that the TT technique is familiar to surgeons and the mTT technique can bring favorable subjective feelings and objective clinical outcomes, the mTT technique shows greater utilization potential.
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Affiliation(s)
- Qunhu Zhang
- Department of Orthopedics, Shuyang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suqian Jiangsu 223600, P.R. China
| | - Yu Kou
- Medical College of Soochow University, Suzhou Jiangsu 215123, P.R. China
| | - Zhen Yuan
- Center of Sports Medicine and Rehabilitation, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, P.R. China
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Comparison of Knee Stability, Strength Deficits, and Functional Score in Primary and Revision Anterior Cruciate Ligament Reconstructed Knees. Sci Rep 2018; 8:9186. [PMID: 29907841 PMCID: PMC6003945 DOI: 10.1038/s41598-018-27595-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/01/2018] [Indexed: 02/05/2023] Open
Abstract
Comparing to primary surgery, revision ACL reconstruction is more technically demanding and has a higher failure rate. Theoretically, rehabilitation can improve knee function after ACL reconstruction surgery. This study aimed to compare knee stability, strength, and function between primary and revision ACL reconstructed knees. 40 primary and 40 revision ACL reconstruction surgeries were included between April 2013 and May 2016. Patients with revision surgery had a higher anteroposterior translation comparing those with primary reconstruction (median laxity, 2.0 mm vs. 3.0 mm, p = 0.0022). No differences were noted in knee extensor at 60°/sec or 180°/sec (p = 0.308, p = 0.931, respectively) or in flexor muscle strength at 60°/sec or 180°/sec between primary and revision ACL reconstruction knees (p = 0.091, p = 0.343, respectively). There were also no significant differences between functional scores including IKDC score and Lysholm score in primary versus revision surgeries at 12th months after index operation (p = 0.154, p = 0.324, respectively). In conclusion, despite having higher anteroposterior instability, patients with revision ACL reconstruction can have non-inferior outcomes in isokinetic knee strength and function compared to those with primary ACL reconstruction after proper rehabilitation.
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27
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Buckle C, Wainwright AM. A systematic review of long-term patient reported outcomes for the treatment of anterior cruciate ligament injuries in the skeletally immature. J Child Orthop 2018; 12:251-261. [PMID: 29951125 PMCID: PMC6005221 DOI: 10.1302/1863-2548.12.170179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To systematically review the available literature regarding outcomes for the treatment of anterior cruciate ligament (ACL) injuries in the skeletally immature at skeletal maturity or more than five years after surgery. METHODS A systematic search was performed of seven online databases for literature reporting patient reported outcomes for the treatment of ACL injuries in the skeletally immature. A systematic review of this literature was performed examining the outcomes and their association with skeletal immaturity and treatment techniques. RESULTS A total of 18 articles reported the outcomes of 425 subjects. The mean age at surgery ranged from 10.3 to 15 years. Mean follow-up ranged from 36 to 163 months. Ten studies followed up subjects until skeletal maturity. Mean outcome scores were similar for extraphyseal (Lysholm 96.2 (95.7 to 97.4), Tegner 6.75, IKDC 95.4 (94 to 100)) and transphyseal surgery (Lysholm 94.3 (84.6-100), Tegner 7.6 (6 to 8.7), International Knee Documentation Committee (IKDC) 93.6 (84 to 99)). However, the lower range boundary for Lysholm and IKDC was worse for the transphyseal group. The results for non-surgical treatments were worse (Lysholm 63.2, Tegner 4.8, IKDC 87). No significant differences were found in the incidence of limb-length discrepancy (p = 0.32), coronal plane growth disturbance (p = 0.48), graft rupture (p = 0.88) and persistent symptomatic instability (p = 0.11) with transphyseal and extraphyseal surgical techniques. CONCLUSION Both transphyseal and extraphyseal reconstructive techniques produced good patient reported outcomes, with no significant differences in the incidence of limb-length discrepancy, coronal plane growth disturbance, graft rupture and persistent symptomatic instability. They compare favourably with the repair techniques reviewed and the natural history of the condition. Further high-quality studies comparing the transphyseal and extraphyseal techniques are required. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- C. Buckle
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK, Correspondence should be sent to C. Buckle, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. E-mail:
| | - A. M. Wainwright
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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29
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Forogh B, Aslanpour H, Fallah E, Babaei-Ghazani A, Ebadi S. Adding high-frequency transcutaneous electrical nerve stimulation to the first phase of post anterior cruciate ligament reconstruction rehabilitation does not improve pain and function in young male athletes more than exercise alone: a randomized single-blind clinical trial. Disabil Rehabil 2017; 41:514-522. [DOI: 10.1080/09638288.2017.1399294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bijan Forogh
- Neuromusculoskeletal Research center, Iran University of Medical Sciences, Tehran, Iran
- Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Aslanpour
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Fallah
- Department of Orthopedics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Arash Babaei-Ghazani
- Neuromusculoskeletal Research center, Iran University of Medical Sciences, Tehran, Iran
- Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Safoora Ebadi
- Neuromusculoskeletal Research center, Iran University of Medical Sciences, Tehran, Iran
- Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Jarbo KA, Hartigan DE, Scott KL, Patel KA, Chhabra A. Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2017; 5:2325967117729809. [PMID: 29051898 PMCID: PMC5639970 DOI: 10.1177/2325967117729809] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: The lever sign test is a new physical examination tool to diagnose anterior cruciate ligament (ACL) tears. Preliminary results suggest almost 100% sensitivity and specificity to diagnose acute and chronic complete ACL tears and clinically significant partial tears as compared with magnetic resonance imaging (MRI). Purpose: To assess the sensitivity and specificity of the lever sign test for the diagnosis of acute ACL injuries, as compared to MRI. We also aimed to determine the accuracy of the lever sign test compared with 3 other tests (anterior drawer, Lachman, and pivot shift) when performed by providers of various training levels, and with the patient awake or under anesthesia. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We evaluated patients with a chief concern of acute (≤4 weeks) knee pain seen between October 2014 and January 2015, with a thorough history, physical examination, and standard radiographs. MRI was the reference standard; patients without an MRI evaluation were excluded. The 4 physical examination maneuvers were performed on each symptomatic knee during the initial clinic visit (for nonsurgical patients) or under anesthesia in the operating room (for surgical patients) by a randomly assigned undergraduate student, medical student, orthopaedic resident, or orthopaedic fellow. The senior author trained all staff to perform the lever sign test. Statistical analyses were performed. Results: Of 102 patients, 54 were surgical (28 female, 26 male), and 48 were nonsurgical (16 female, 32 male); the mean patient age was 23 years (range, 15-66 years). The overall accuracy of the lever sign test was 77% (63% sensitivity, 90% specificity); the accuracy was similar between patients under anesthesia and awake (77% vs 76%, respectively). There were no significant differences when comparing the sensitivity and specificity of the lever sign test with patients under anesthesia and awake (sensitivity: under anesthesia, 86%, and awake, 68% [P = .40]; specificity: under anesthesia, 85%, and awake, 96% [P = .17]). Furthermore, the accuracy of the lever sign test was similar when performed on female versus male patients (75% vs 79%, respectively) or when performed by undergraduate students and medical students compared with orthopaedic residents and fellows (84% vs 88%, respectively). Conclusion: Our study results challenge the exceptional sensitivity and specificity values (both 100%) of the lever sign test, as reported by the original author of the test.
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Affiliation(s)
| | - David E Hartigan
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Kelly L Scott
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Karan A Patel
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA.,Arizona State University, Phoenix, Arizona, USA
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31
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Kraeutler MJ, Welton KL, McCarty EC, Bravman JT. Revision Anterior Cruciate Ligament Reconstruction. J Bone Joint Surg Am 2017; 99:1689-1696. [PMID: 28976434 DOI: 10.2106/jbjs.17.00412] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Matthew J Kraeutler
- 1Department of Orthopaedics, Seton Hall-Hackensack Meridian School of Medicine, South Orange, New Jersey 2Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
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32
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Noailles T, Boisrenoult P, Sanchez M, Beaufils P, Pujol N. Torsional Appearance of the Anterior Cruciate Ligament Explaining "Ribbon" and Double-Bundle Concepts: A Cadaver-based Study. Arthroscopy 2017; 33:1703-1709. [PMID: 28865572 DOI: 10.1016/j.arthro.2017.03.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/27/2017] [Accepted: 03/14/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of the anterior cruciate ligament (ACL) torsion in 90° knee flexion on the morphological appearance of the ACL. METHODS Sixty knees from fresh frozen anatomical specimens were dissected. Eighteen knees were excluded according to selection criteria (torn ACL, mucoid degeneration of the ACL, arthritic lesions of the notch, or knees harboring synovial inflammatory pathologies). After the removal of the synovial membrane, the morphology of the ligamentous fibers of the ACL and the twist were analyzed. Twisting of the ACL was measured using a goniometer in 90° knee flexion and defined by the angle of external rotation of the femur on the axis of the tibia required to visualize a flat ACL. The orientation of tibial and femoral footprint was described in a coronal plane for the tibia and a sagittal plane for the femur. RESULTS In the 42 knees that were finally included, the ACL was always displayed as a single ribbon-like structure. The torsion of the fibers was on average 83.6° (± 9.4°) in 90° knee flexion. The twisting could be explained by the different orientations of the femoral (vertical in a sagittal plane) and tibial (horizontal in a coronal plane) footprints. An intraligamentous proximal cleavage area was encountered in 11 cases (i.e., 26%). CONCLUSIONS The ACL is a twisted structure with 83.6° of external torsion of fibers in 90° knee flexion. It is the torsion in the fibers, due to the relative position of bone insertions, which gives the ACL the appearance of being double bundle. CLINICAL RELEVANCE The concept of the torsional flat structure of the native ACL may be of importance during ACL reconstruction, both in terms of graft choice (flat rather than cylindrical) and of technical positioning (torsion).
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Affiliation(s)
- Thibaut Noailles
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France.
| | - Philippe Boisrenoult
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France
| | - Matthieu Sanchez
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France
| | - Philippe Beaufils
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France
| | - Nicolas Pujol
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France
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Fan J, Sun L, Chen X, Qu L, Li H, Liu X, Zhang Y, Cheng P, Fan H. Implementation of a stratified approach and gene immobilization to enhance the osseointegration of a silk-based ligament graft. J Mater Chem B 2017; 5:7035-7050. [PMID: 32263895 DOI: 10.1039/c7tb01579h] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A silk scaffold exhibits high potential for the human anterior cruciate ligament (ACL) reconstruction due to its exceptional mechanics as well as biocompatibility. Inefficient ACL interface restoration is thought to be a major hurdle for the common implementation of a silk-based ligament graft. By integrating a stratified approach and gene immobilization, here we developed a gene-immobilized triphasic silk scaffold to enhance ACL osseointegration. Isotropic silk was divided into three regions (respectively corresponding to a ligament, fibrocartilage and the bone region of the native ACL interface) using a custom-made divider, and the lentiviral vector-encoded transforming growth factor beta-3 (TGF-β3) and bone morphogenetic protein-2 (BMP2) was further, respectively, immobilized to phosphatidylserine (PS)-coated fibrocartilage and the bone region of the triphasic silk scaffold. The in vitro assessments displayed that this gene-immobilized triphasic silk scaffold significantly promotes bone marrow mesenchymal stem cell (BMSC) proliferation and differentiation into corresponding cell lineage. Moreover, the gene-modified triphasic silk scaffold combined with BMSCs alone, which was rolled into a compact shaft to be implanted onto rabbit ACL-defect models, revealed roughly complete osseointegration restoration as a result of apparent three-layered tissue formation and robust mechanical ability as early as 12 weeks postoperatively. These outcomes demonstrated that employing the stratified approach and gene immobilization efficiently expedites silk-mediated ACL interface formation, expanding the therapeutic potential of the silk-based ligament graft for ACL reconstruction.
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Affiliation(s)
- Jiabing Fan
- Division of Advanced Prosthodontics, School of Dentistry, University of California, Los Angeles, California 90095, USA
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LaPrade RF, Venderley MB, Dahl KD, Dornan GJ, Turnbull TL. Functional Brace in ACL Surgery: Force Quantification in an In Vivo Study. Orthop J Sports Med 2017; 5:2325967117714242. [PMID: 28748195 PMCID: PMC5507383 DOI: 10.1177/2325967117714242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: A need exists for a functional anterior cruciate ligament (ACL) brace that dynamically supports the knee joint to match the angle-dependent forces of a native ACL, especially in the early postoperative period. Purpose/Hypothesis: The purpose of this study was to quantify the posteriorly directed external forces applied to the anterior proximal tibia by both a static and a dynamic force ACL brace. The proximal strap forces applied by the static force brace were hypothesized to remain relatively constant regardless of knee flexion angle compared with those of the dynamic force brace. Study Design: Controlled laboratory study. Methods: Seven healthy adult males (mean age, 27.4 ± 3.4 years; mean height, 1.8 ± 0.1 m; mean body mass, 84.1 ± 11.3 kg) were fitted with both a static and a dynamic force ACL brace. Participants completed 3 functional activities: unloaded extension, sit-to-stand, and stair ascent. Kinematic data were collected using traditional motion-capture techniques while posteriorly directed forces applied to the anterior aspect of both the proximal and distal tibia were simultaneously collected using a customized pressure-mapping technique. Results: The mean posteriorly directed forces applied to the proximal tibia at 30° of flexion by the dynamic force brace during unloaded extension (80.2 N), sit-to-stand (57.5 N), and stair ascent (56.3 N) activities were significantly larger, regardless of force setting, than those applied by the static force brace (10.1 N, 9.5 N, and 11.9 N, respectively; P < .001). Conclusion: The dynamic force ACL brace, compared with the static force brace, applied significantly larger posteriorly directed forces to the anterior proximal tibia in extension, where the ACL is known to experience larger in vivo forces. Further studies are required to determine whether the physiological behavior of the brace will reduce anterior knee laxity and improve long-term patient outcomes. Clinical Relevance: ACL braces that dynamically restrain the proximal tibia in a manner similar to physiological ACL function may improve pre- and postoperative treatment.
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Affiliation(s)
- Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | - Kimi D Dahl
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
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Pullout strength of a novel hybrid fixation technique (Tape Locking Screw™) in soft-tissue ACL reconstruction: A biomechanical study in human and porcine bone. Orthop Traumatol Surg Res 2017; 103:591-595. [PMID: 28238964 DOI: 10.1016/j.otsr.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A novel hybrid anterior cruciate ligament (ACL) reconstruction technique known as Tape Locking Screw™ (TLS) is gaining popularity. Utilizing a suspension-type construct in conjunction with an interference screw, this technique has demonstrated successful initial clinical results with the use of quadruple hamstring graft. However, there is currently limited data available on the biomechanical strength of this fixation. This study investigates the pullout strength of the construct in human distal femora as well as in a porcine model. The construct is tested in isolation, without the use of any graft. We hypothesized that the pullout strength of this construct would be similar to or better than current fixation systems available. MATERIALS AND METHODS The Tape Locking Screw hybrid fixation system was implanted into twenty-two fresh frozen human distal femora (50-89 years old) randomized to 10×20mm titanium or polyether ether ketone (PEEK) screws by a single sports fellowship trained orthopedic surgeon. Given that the graft is secured to polyethylene terephthalate tape within the construct, the construct was implanted without any graft in order to isolate the device for biomechanical testing. After implantation, a tensile force was applied directly to the loop of tape at a loading rate of 5mm/min using an electromechanical testing system. The failure load was calculated from the resultant load-displacement curve. Specimens were then visually examined for mode of failure. Similar biomechanical tests were performed on sixteen porcine femora. RESULTS In the human model, the mean pullout strength was 523±269N with the PEEK screw and 578±245N with the titanium screw. In the porcine femur model, mean strength was 616±177N with PEEK, 584±245N with titanium. There was no statistically significant difference in failure loads between these four groups. Tape slippage at the screw bone interface was the primary mode of failure in all the groups tested. DISCUSSION Our results demonstrate that the hybrid technique provides excellent pullout strength in comparison to other soft-tissue ACL fixation methods, with tape slippage being the mode of failure in all specimens tested. This data, in addition to the advantages of the TLS system, support its consideration in the armamentarium of constructs available for soft-tissue ACL reconstruction. LEVEL OF EVIDENCE Laboratory controlled study level 2.
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Post-Traumatic Osteoarthritis in Mice Following Mechanical Injury to the Synovial Joint. Sci Rep 2017; 7:45223. [PMID: 28345597 PMCID: PMC5366938 DOI: 10.1038/srep45223] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/20/2017] [Indexed: 01/14/2023] Open
Abstract
We investigated the spectrum of lesions characteristic of post-traumatic osteoarthritis (PTOA) across the knee joint in response to mechanical injury. We hypothesized that alteration in knee joint stability in mice reproduces molecular and structural features of PTOA that would suggest potential therapeutic targets in humans. The right knees of eight-week old male mice from two recombinant inbred lines (LGXSM-6 and LGXSM-33) were subjected to axial tibial compression. Three separate loading magnitudes were applied: 6N, 9N, and 12N. Left knees served as non-loaded controls. Mice were sacrificed at 5, 9, 14, 28, and 56 days post-loading and whole knee joint changes were assessed by histology, immunostaining, micro-CT, and magnetic resonance imaging. We observed that tibial compression disrupted joint stability by rupturing the anterior cruciate ligament (except for 6N) and instigated a cascade of temporal and topographical features of PTOA. These features included cartilage extracellular matrix loss without proteoglycan replacement, chondrocyte apoptosis at day 5, synovitis present at day 14, osteophytes, ectopic calcification, and meniscus pathology. These findings provide a plausible model and a whole-joint approach for how joint injury in humans leads to PTOA. Chondrocyte apoptosis, synovitis, and ectopic calcification appear to be targets for potential therapeutic intervention.
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Healing of tibial bone tunnels after bone grafting for staged revision anterior cruciate ligament surgery: A prospective computed tomography analysis. Knee 2016; 23:830-6. [PMID: 27189844 DOI: 10.1016/j.knee.2016.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/18/2016] [Accepted: 04/11/2016] [Indexed: 02/02/2023]
Abstract
AIM To quantify healing of tibial bone tunnels after bone grafting in two-stage ACL reconstruction revision. METHODS Ten consecutive patients underwent autogenous bone grafting prior to ACL reconstruction revision (four females and six males, average age 28years). The indications for two-stage surgery were as follows: (1) the enlargement of the tibial tunnel aperture was >20mm in diameter or, (2) the existing tunnel was overlapped with the optimal tunnel and positioned more than a half tunnel diameter posterior to the optimal position. An autogenous iliac bone block was driven into a new tunnel. CT examinations were performed at three, 12 and 24weeks after bone grafting. Evaluations were performed on 15 axial planes at one-millimeter intervals from the articular surface perpendicular to the long axis of the tibia using the following three parameters: occupying ratio (OR), union ratio (UR), and bone mineral density (BMD) of grafted bone. RESULTS The average ORs were 81, 85 and 94%, and the average URs were 49, 75 and 89% at three, 12 and 24weeks, respectively. Each parameter significantly increased over time. The average BMD was 510 and 571mg/cm(3) at 12 and 24weeks, respectively, with a significantly higher value at 24weeks. CONCLUSION The average ORs, URs and BMD at 24weeks after bone grafting were higher than those at 12weeks, which suggests that at 24weeks after bone grating, the condition of the patients' beds becomes favorable for safe implantation and fixation of ACL graft revision. LEVEL OF EVIDENCE Case series Level IV.
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Scillia AJ, Issa K, Boylan MR, McDermott JD, McInerney VK, Patel DV, Mont MA, Festa AN. Inpatient Cruciate Ligament Reconstruction in the United States: A Nationwide Database Study From 1998 to 2010. Orthopedics 2016; 39:e196-202. [PMID: 26726975 DOI: 10.3928/01477447-20151222-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/16/2015] [Indexed: 02/03/2023]
Abstract
This study evaluated inpatient cruciate ligament reconstruction in the United States during a 13-year period. The Nationwide Inpatient Sample database was used to identify inpatient cruciate ligament reconstructions performed from 1998 to 2010. National trends in incidence, patient demographics, perioperative complications, length of stay, and total admission costs were evaluated. The impact of various contributing factors on these outcomes was further evaluated using multivariable regression analyses. The rate of inpatient cruciate ligament reconstruction has decreased significantly in the United States during the past decade. The outcome data from this study can be used as a comparison cohort for future outpatient analyses of anterior cruciate ligament reconstruction in the United States.
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Brophy RH, Tycksen ED, Sandell LJ, Rai MF. Changes in Transcriptome-Wide Gene Expression of Anterior Cruciate Ligament Tears Based on Time From Injury. Am J Sports Med 2016; 44:2064-75. [PMID: 27159315 DOI: 10.1177/0363546516643810] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are a common injury. The healing potential of the injured ACL is poorly understood and is considered limited. Therefore, most ACL tears that are treated surgically undergo reconstruction rather than repair. However, there has been renewed interest recently in repairing ACL tears despite unanswered questions regarding the healing capacity of the ACL. HYPOTHESIS Gene expression in the injured ACL varies with time from injury. STUDY DESIGN Descriptive laboratory study. METHODS Transcriptome-wide expression profiles of 24 human ACL remnants recovered at the time of surgical reconstruction were analyzed using the Agilent human 8x60K microarray platform. Gene ontology was performed on differentially expressed transcripts based on time from injury (acute, <3 months; intermediate, 3-12 months; chronic, >12 months). A subset of transcripts with large fold changes in expression between any 2 categories was validated via microfluidic digital polymerase chain reaction. RESULTS Numerous transcripts representing important biological processes were differentially expressed by time from injury. The most significant changes were noted between the acute and chronic groups. Expression of several extracellular matrix genes- namely, POSTN, COL5A1, COL1A1, and COL12A1-was lower in the chronic tears compared with acute and intermediate tears. In acute tears, processes representing angiogenesis and stem cell differentiation were affected. In intermediate tears, processes representing stem cell proliferation concomitant with cellular component organization/cellular localization were altered. In ACL tears more than 12 months out from injury, processes denoting myosin filament organization, cellular component organization/cell localization, and extracellular matrix organization were affected. CONCLUSION These findings are consistent with initial repair activity in the injured ACL, which declines with time from injury. Individual genes identified in this study, such as periostin, deserve further investigation into their role in tissue repair. CLINICAL RELEVANCE The decreased healing capacity of ACL tears over time is relevant to the development of effective techniques for repairing ACL tears and may have some significance for ACL reconstruction techniques as well. The potential for healing appears to be greatest in acute ACL tears, suggesting this window should be the focus of research for ACL repair.
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Affiliation(s)
- Robert H Brophy
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Eric D Tycksen
- Genome Technology Access Center, Washington University in St Louis, St Louis, Missouri, USA
| | - Linda J Sandell
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, Missouri, USA Department of Biomedical Engineering, Washington University in St Louis at Engineering and Applied Sciences, St Louis, Missouri, USA Department of Cell Biology and Physiology, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Muhammad Farooq Rai
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, Missouri, USA
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Akkaya S, Akkaya N, Agladıoglu K, Gungor HR, Ok N, Özçakar L. Real-time elastography of patellar tendon in patients with auto-graft bone-tendon-bone anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 2016; 136:837-42. [PMID: 27146818 DOI: 10.1007/s00402-016-2459-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Patellar tendon donor site has been previously evaluated in patients with auto-graft bone-tendon-bone (BTB) anterior cruciate ligament (ACL) reconstruction using either magnetic resonance imaging or B mode ultrasound. However, donor site patellar tendon strain ratio-reflecting structural features-has not been studied with US elastography. Here, we ascertain real-time elastography properties of patellar tendon donor site and clinical relevance of these properties in patients with auto-graft BTB ACL reconstruction in the postoperative period. METHODS Patients who underwent ACL reconstruction using BTB autograft were evaluated. Demographic, operative and clinical data (severity of pain, Lysholm Knee score, sit to stand test, packages/year for smoking amount) were noted. Patellar tendons of the operated knees were evaluated by ultrasound (length and thickness) and sonoelastography (strain ratio). The healthy knees of the patients constituted the control group. RESULTS Eighteen patients (17 M, 1 F; mean age 30.9 ± 7 years) were evaluated. Mean postoperative follow-up period was 22.1 ± 2.6 (range 18-26) months. Patellar tendons were shorter and thicker on the operated side when compared with the contralateral side (both p = 0.001). Patellar tendon strain ratios of the operated side were lower than the contralateral side (harder tendon on operated side). While there was no correlation between strain ratios and clinical variables (age, BMI, postoperative time, severity of pain, Lysholm score, all p values > 0.05), significant negative correlations were detected between strain ratios of proximal, middle and distal thirds of operated side and amount of smoking (p = 0.008, r = -0.607, p = 0.009, r = -0.598, p = 0.023, r = -0.533, respectively). CONCLUSION Patellar tendons on the operated sides seemed to thicken and shorten with decreased strain ratios at the donor side compared to the healthy side at an average of 2-year follow-up in patients with ACL reconstruction using BTB autograft, and amount of smoking had negative relationship with strain ratio of donor patellar tendon.
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Affiliation(s)
- Semih Akkaya
- Department of Orthopedics and Traumatology, Pamukkale University, Denizli, Turkey
| | - Nuray Akkaya
- Department of Physical and Rehabilitation Medicine, Pamukkale University, Denizli, Turkey.
| | | | - Harun R Gungor
- Department of Orthopedics and Traumatology, Pamukkale University, Denizli, Turkey
| | - Nusret Ok
- Department of Orthopedics and Traumatology, Pamukkale University, Denizli, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University, Ankara, Turkey
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Erickson BJ, Cvetanovich G, Waliullah K, Khair M, Smith P, Bach B, Sherman S. Two-Stage Revision Anterior Cruciate Ligament Reconstruction. Orthopedics 2016; 39:e456-64. [PMID: 27045480 DOI: 10.3928/01477447-20160324-01] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/04/2015] [Indexed: 02/03/2023]
Abstract
The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [Orthopedics. 2016; 39(3):e456-e464.].
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Wasilko SM, Tourville TW, DeSarno MJ, Slauterbeck JR, Johnson RJ, Struglics A, Beynnon BD. Relationship between synovial fluid biomarkers of articular cartilage metabolism and the patient's perspective of outcome depends on the severity of articular cartilage damage following ACL trauma. J Orthop Res 2016; 34:820-7. [PMID: 26497486 PMCID: PMC6533635 DOI: 10.1002/jor.23084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 10/06/2015] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) trauma often occurs in combination with injury to the articular cartilage of the knee, this can result in earlier radiographic evidence of post traumatic osteoarthritis (OA) of the knee compared to the contralateral, ACL intact knee; however, the biomechanical and biological mechanisms associated with the onset and progression of this disease are not understood. We sought to gain insight into the mechanisms by determining the relationship between articular cartilage injury associated with ACL trauma and the expression of synovial fluid biomarkers of articular cartilage metabolism, and to evaluate the relationship between these biomarkers and the patient's perspective of the outcomes. Synovial fluid samples were acquired from 39 ACL injured subjects at an average of 10 weeks after injury, and 32 control subjects with normal knees (documented with clinical exam and MRI assessment). Subjects in the ACL-injured group were classified as low-risk for future OA if they displayed an International Cartilage Repair Society (ICRS) Grade 2 articular cartilage lesion or less and high-risk for future OA if they had an ICRS Grade 3A articular cartilage lesion. The patient's perspective of the injury was evaluated with the Knee Injury and Osteoarthritis Outcomes Score (KOOS). There were no significant differences in mean concentrations of the markers of type II collagen metabolism (CPII, C2C, and C1,2C) or the aggrecan breakdown Alanine-Arginine-Glycine-Serine (ARGS) -fragment between control subjects and the subjects in the low- and high-risk groups (p-value range: 0.80-0.43). Associations between ARGS-aggrecan concentration and KOOS subscales of symptoms and pain were significantly different between the low- and high-risk groups (p = 0.03 and p = 0.01, respectively). Likewise, there was strong evidence in support of an association between the markers of type II collagen metabolism (C1,2C and CPII concentrations) and the KOOS subscale of pain between the low- and high-risk groups (p = 0.051 and 0.077, correspondingly). In ACL injured subjects with concomitant Grade 3A articular cartilage injuries, concentrations of synovial fluid ARGS-aggrecan were directly associated with improvements in KOOS symptoms and pain. These findings suggest the possible involvement of ARGS-aggrecan in a localized tissue repair response involving an increase in aggrecan turnover following severe knee trauma. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:820-827, 2016.
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Affiliation(s)
- Scott M. Wasilko
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont
| | - Timothy W. Tourville
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont
| | - Michael J. DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - James R. Slauterbeck
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont
| | - Robert J. Johnson
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont
| | - André Struglics
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Bruce D. Beynnon
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont
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Al-Bluwi MT, Azam MQ, Sadat-Ali M. The effect of bone growth factor in the tendon to bone healing in anterior cruciate ligament reconstruction: An experimental study in rabbits. Int J Appl Basic Med Res 2016; 6:23-7. [PMID: 26958518 PMCID: PMC4765269 DOI: 10.4103/2229-516x.174004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Reconstruction of the anterior cruciate ligament (ACL) involves use of semintendinosis and gracilis tendons graft that is transplanted into bone tunnels at the femoral and tibial insertion sites and the sites and the bone tendon interface is a weak link in the early healing period due to slow rate of healing. We hypothesized that an addition of bone growth factor like Sadat-Habdan mesenchymal stimulating peptide (SHMSP) could enhance bone tendon healing rate so that re-rupture of the tendon does not take place. METHODOLOGY Twenty skeletally mature rabbits underwent ACL reconstruction of the right knee. In 10 of the rabbits at the site of the tendon-graft 5 mg/kg body weight of SHMSP was put in the bone tunnel. In 10 other animals, nothing was added. At eight and 12 weeks 5 animals from each group were sacrificed. The tendon-graft site was harvested and sent for histopathological examination to assess the healing at the tendon-bone graft to the tibial tunnel. RESULTS There were no deaths in both the groups. One rabbit of the control group developed an infection. In all the animals of the study group from 4 weeks onward showed bone formation, wherein the control group only granulation tissue was observed. By 8 weeks in the study group, the canal was totally obliterated with the new bone formation which extended onto the periosteal area. In the control, there was minimal change in the formation of the new bone formation. CONCLUSION Addition of a growth factor like SHMSP would enhance the osteo-integration of the tendon-graft in the bony tunnel after ACL reconstruction in vivo.
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Affiliation(s)
- Mohammed T Al-Bluwi
- Department of Orthopedic Surgery, College of Medicine, University of Dammam, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Md Q Azam
- Department of Orthopedic Surgery, College of Medicine, University of Dammam, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Mir Sadat-Ali
- Department of Orthopedic Surgery, College of Medicine, University of Dammam, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
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Rybin AV, Kuznetsov IA, Rumakin VP, Netylko GI, Lomaya MP. EXPERIMENTAL AND MORPHOLOGICAL ASPECTS OF FAILED TENDON AUTO- AND ALLOGRAFTS AFTER ACL RECONSTRUCTION IN EARLY POSTOPERATIVE PERIOD. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2016. [DOI: 10.21823/2311-2905-2016-22-4-60-75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Han F, Banerjee A, Shen L, Krishna L. Increased Compliance With Supervised Rehabilitation Improves Functional Outcome and Return to Sport After Anterior Cruciate Ligament Reconstruction in Recreational Athletes. Orthop J Sports Med 2015; 3:2325967115620770. [PMID: 26740958 PMCID: PMC4687837 DOI: 10.1177/2325967115620770] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Successful return to sport is an important outcome measure after anterior cruciate ligament (ACL) reconstruction and a reason for patients’ decisions to elect surgery. Rehabilitation programs supervised by physical therapists are routinely prescribed after ACL reconstruction surgery. However, the added advantage of supervised physical therapy after ACL reconstruction is still debatable. Hypothesis: Attending more supervised physical therapy sessions after arthroscopic ACL reconstruction in recreational athletes increases their chance of successful return to sport. Study Design: Cohort study; Level of evidence, 3. Methods: The authors analyzed 93 recreational athletes who underwent arthroscopic ACL reconstruction. After arthroscopic single-bundle ACL reconstruction, patients were advised to attend 20 supervised physical therapy sessions. Patients’ demographics, surgical details, and outcome measures (Knee injury and Osteoarthritis Outcome Score [KOOS], Lysholm scale, and Short Form–36 Health Survey [SF-36]) were recorded presurgery and at 1-year follow-up. Ability to return to sports was documented through patients’ self-report. The attendance at physical therapy by each patient was obtained by examining database records and assessed as fully compliant (>15 sessions), moderately compliant (6-15 sessions), or noncompliant (<6 sessions). Results: Patients in the fully compliant group had significantly greater odds (odds ratio [OR], 18.5; 95% CI, 1.9-184.5; P = .013) of a successful return to sport as compared with the noncompliant group. Patients in the moderately compliant group also had greater odds of returning to sport as compared with the noncompliant group (OR, 4.2; 95% CI, 1.0-16.6; P = .043). Patients in the fully compliant group had significantly greater scores on the Lysholm (P < .001), KOOS Sports and Recreation subscale (P = .021), KOOS Symptoms subscale (P = .040), and SF-36 physical component summary (PCS) (P = .012) as compared with the noncompliant group. Moderately compliant patients had significantly greater scores on the Lysholm (P = .004), KOOS Sports and Recreation (P = .026), KOOS Symptoms (P = .041), KOOS Quality of Life (P = .022), and SF-36 PCS (P = .004) as compared with noncompliant patients. Conclusion: In recreational athletes, moderate to full compliance with a supervised physical therapy program predicts improved knee function and a greater chance of returning to sport 1 year after ACL reconstruction.
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Affiliation(s)
- Fucai Han
- National University Hospital Sports Centre, Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Anirban Banerjee
- Department of Rehabilitation, National University Hospital Sports Centre, National University Health System, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lingaraj Krishna
- National University Hospital Sports Centre, Department of Orthopaedic Surgery, National University Health System, Singapore
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Johnson WR, Makani A, Wall AJ, Hosseini A, Hampilos P, Li G, Gill TJ. Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2015; 3:2325967115611660. [PMID: 26779548 PMCID: PMC4714575 DOI: 10.1177/2325967115611660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. Purpose: To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed. Results: Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017). Conclusion: Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction had a statistically significantly, although not clinically significant, higher IKDC score after revision surgery compared with nontraumatic failures. These data may be useful when counseling a patient on whether to pursue revision ACL reconstruction surgery.
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Affiliation(s)
- William R Johnson
- Harvard Medical School, Boston, Massachusetts, USA.; Temple University Health System, Philadelphia, Pennsylvania, USA.; Tufts Medical Center, Boston, Massachusetts, USA
| | | | | | - Ali Hosseini
- Harvard Medical School, Boston, Massachusetts, USA.; Bioengineering Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Guoan Li
- Harvard Medical School, Boston, Massachusetts, USA.; Bioengineering Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas J Gill
- Orthopaedic Surgery, Tufts Medical School, Boston, Massachusetts, USA
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Stratified scaffold design for engineering composite tissues. Methods 2015; 84:99-102. [DOI: 10.1016/j.ymeth.2015.03.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 01/12/2023] Open
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Gali JC, Resina AF, Pedro G, Neto IAM, Almagro MAP, da Silva PAC, Caetano EB. Importance of anatomically locating the infrapatellar branch of the saphenous nerve in reconstructing the anterior cruciate ligament using flexor tendons. Rev Bras Ortop 2015; 49:625-9. [PMID: 26229872 PMCID: PMC4487444 DOI: 10.1016/j.rboe.2013.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/11/2013] [Indexed: 01/10/2023] Open
Abstract
Objective To describe the path of the infrapatellar branch of the saphenous nerve (IBSN) using the medial joint line, anterior tibial tuberosity (ATT), tibial collateral ligament and a horizontal line parallel to the medial joint line that passes over the ATT, as reference points, in order to help surgeons to diminish the likelihood of injuring this nerve branch during reconstruction of the anterior cruciate ligament (ACL) using flexor tendons. Methods Ten frozen knees that originated from amputations were examined. Through anatomical dissection performed with the specimens flexed, we sought to find the IBSN, from its most medial and proximal portion to its most lateral and distal portion. Following this, the anatomical specimens were photographed and, using the ImageJ software, we determined the distance from the IBSN to the medial joint line and to a lower horizontal line going through the ATT and parallel to the first line. We also measured the angle of the direction of the path of the nerve branch in relation to this lower line. Results The mean angle of the path of the nerve branch in relation to the lower horizontal line was 17.50 ± 6.17°. The mean distance from the IBSN to the medial joint line was 2.61 ± 0.59 cm and from the IBSN to the lower horizontal line, 1.44 ± 0.51 cm. Conclusion The IBSN was found in all the knees studied. In three knees, we found a second branch proximal to the first one. The direction of its path was always from proximal and medial to distal and lateral. The IBSN was always proximal and medial to the ATT and distal to the medial joint line. The medial angle between its direction and a horizontal line going through the ATT was 17.50 ± 6.17°.
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Affiliation(s)
- Julio Cesar Gali
- Orthopedics and Traumatology Service, School of Medical Sciences and Health of Sorocaba, Pontifical Catholic University of São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - André França Resina
- Orthopedics and Traumatology Service, School of Medical Sciences and Health of Sorocaba, Pontifical Catholic University of São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - Gabriel Pedro
- Orthopedics and Traumatology Service, School of Medical Sciences and Health of Sorocaba, Pontifical Catholic University of São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - Ildefonso Angelo Mora Neto
- Orthopedics and Traumatology Service, School of Medical Sciences and Health of Sorocaba, Pontifical Catholic University of São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - Marco Antonio Pires Almagro
- Orthopedics and Traumatology Service, School of Medical Sciences and Health of Sorocaba, Pontifical Catholic University of São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - Phelipe Augusto Cintra da Silva
- Orthopedics and Traumatology Service, School of Medical Sciences and Health of Sorocaba, Pontifical Catholic University of São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - Edie Benedito Caetano
- Orthopedics and Traumatology Service, School of Medical Sciences and Health of Sorocaba, Pontifical Catholic University of São Paulo (PUC-SP), Sorocaba, SP, Brazil
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Björkman P, Sandelin J, Harilainen A. A randomized prospective controlled study with 5-year follow-up of cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23:2353-2359. [PMID: 24832696 DOI: 10.1007/s00167-014-3063-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 05/02/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to determine and compare mid- to long-term results of cross-pin versus metal interference screw fixation of ACL graft. METHODS In a prospective trial, 62 patients were randomized into two groups based on method of fixation. Transtibial drilling technique was used in the cross-pin and outside-in femoral drilling in the interference screw fixation group. Clinical and radiographical outcomes were assessed 2 and 5 years postoperatively. RESULTS The study showed no clinically significant difference with respect to method of graft fixation. Mean anteroposterior side-to-side instrumented laxity difference was 2.4 mm in the cross-pin group and 2.5 mm in the screw group (n.s.). Median Tegner and mean Lysholm scores at 5 years were 6 (range 3-9) and 92.2 (range 69-100) in the screw group and 7 (3-10) and 93.3 (82-100), respectively, in the cross-pin group. Radiographical osteoarthritis increased in both groups from 2 to 5 years after reconstruction (p < 0.05), especially in the medial and patellofemoral joint spaces. Widening of the drill tunnels continued from 2 to 5 years without clinical significance. CONCLUSIONS AND CLINICAL RELEVANCE The method of graft fixation did not yield a difference in clinical or radiographical outcome at 5 years. Results were excellent in both groups. LEVEL OF EVIDENCE I.
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