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Zhang H, Xu M, Zhao Y, Li Z, Han B, Wang S, Zhang J, Zhang J, Hu Y. Can the Sterilization Protocol Be Improved to Enhance the Healing of Allograft Tendons? An In Vivo Study in Rabbit Tendons. Clin Orthop Relat Res 2024; 482:1074-1086. [PMID: 38427791 PMCID: PMC11124595 DOI: 10.1097/corr.0000000000003017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/31/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Peracetic acid and irradiation are common sterilization methods for allograft tendons; however, under some conditions, both methods adversely affect the fiber arrangement and ultimate load of the tendon. An in vitro study showed that low-dose peracetic acid combined with irradiation may be less detrimental to allograft tendon structure and properties, possibly because the breakdown of peracetic acid can lead to an enlargement of the interstitial spaces and an increase in porosity. QUESTIONS/PURPOSES Using a rabbit Achilles tendon model, we asked: What is the effect of peracetic acid-ethanol combined irradiation on (1) the histopathology and fiber diameter of the allograft tendon, (2) tensile creep and load-to-failure biomechanical properties of allograft tendons, and (3) healing of the treated tendon in vivo compared with fresh-frozen allograft and peracetic acid-ethanol sterilization at 4 and 8 weeks? METHODS The Achilles tendons used in this study were sourced from euthanized 10-week-old male New Zealand White rabbits previously used for ophthalmic experiments. All allografts were divided into three groups: fresh-frozen group (control group, n = 20), peracetic acid-ethanol sterilization group (n =20), and peracetic acid-ethanol combined irradiation group (n = 20). The sterilization protocols were performed per a predetermined plan. In the peracetic acid-ethanol sterilization group, the tendon tissues were covered with the peracetic acid-ethanol sterilization solution (1% peracetic acid for 30 minutes). In the peracetic acid-ethanol combined irradiation group, the tendon tissues were covered with the peracetic acid-ethanol sterilization solution (0.2% peracetic acid for 30 minutes) and were subjected to 15 kGy gamma irradiation. Thirty 10-week-old male New Zealand White rabbits received bilateral Achilles tendon allografts surgically. Tendon samples from each group were harvested at 4 weeks (n = 30) and 8 weeks (n = 30) postoperatively. For each timepoint, eight tissues were used for histologic staining and electron microscopy, 15 tissues were used for biomechanical testing, and seven tissues were used for hydroxyproline assay and quantitative polymerase chain reaction. Histopathology was determined qualitatively by hematoxylin and eosin and Masson staining, while fiber diameter was measured quantitatively by transmission electron microscopy. Biomechanical properties were measured using cyclic loading tests and load-to-failure tests. The healing outcome was quantitatively judged through healing-related genes and proteins. RESULTS At 4 weeks and 8 weeks postoperatively, the peracetic acid-ethanol combined irradiation group visually demonstrated the best continuity and minimal peripheral adhesions. Histologic staining showed that tendon fibers in the peracetic acid-ethanol combined irradiation group maintained consistent alignment without notable disruptions or discontinuities, and there was a qualitatively observed increase in the number of infiltrating cells compared with the control group at the 4-week timepoint (444 ± 49 /mm 2 versus 256 ± 43 /mm 2 , mean difference 188 /mm 2 [95% confidence interval 96 to 281]; p < 0.001). At 8 weeks postoperatively, the tendon fiber diameter in the peracetic acid-ethanol combined irradiation groups was similar to that of the control group (0.23 ± 0.04 µm versus 0.21 ± 0.03 µm, mean difference 0.02 µm [95% CI -0.04 to 0.08]; p = 0.56). At 8 weeks postoperatively, the peracetic acid-ethanol combined irradiation group exhibited better properties in terms of both ultimate load (129 ± 15 N versus 89 ± 20 N, mean difference 40 N [95% CI 7 to 73]; p = 0.02) and energy absorption density (17 ± 6 kJ/m 2 versus 8 ± 4 kJ/m 2 , mean difference 8 kJ/m 2 [95% CI 0.7 to 16]; p = 0.004) compared with the control group. Gene expression analysis revealed higher expression levels of COL1A1 (2.1 ± 0.8 versus 1.0 ± 0, mean difference 1.1 [95% CI 0.1 to 2.1]; p = 0.003) and MMP13 (2.0 ± 0.8 versus 1.0 ± 0, mean difference 1.0 [95% CI 0.4 to 1.6]; p = 0.03) in the peracetic acid-ethanol combined irradiation group than in the control group. There was a higher amount of collagen Type I in tendons treated with peracetic acid-ethanol combined irradiation than in the control group (0.36 ± 0.03 versus 0.31 ± 0.04, mean difference 0.05 [95% CI 0.01 to 0.09]; p = 0.02). CONCLUSION Treatment with peracetic acid-ethanol combined irradiation did not have any discernible adverse effect on the histology, fiber diameter, enzymatic resistance, collagen content, or biomechanical strength of the allograft tendons compared with the control group. Peracetic acid-ethanol combined irradiation treatment had a positive impact on remodeling of the extracellular matrix and realignment of collagen fibers. CLINICAL RELEVANCE This sterilization method could be helpful to expand the scope and frequency with which allogeneic materials are applied. The long-term healing effect and strength of allograft tendons must be tested before clinical use, and it is necessary to conduct comparative studies on autografts and synthetic materials that are currently widely used clinically.
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Affiliation(s)
- Haoran Zhang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Mingyou Xu
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yiwei Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiyi Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bingtai Han
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jingyu Zhang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yongcheng Hu
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
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Selcuk H, Baz AB, Egerci OF, Kose O. Peroneus longus tendon autograft versus allograft in revision ACLR: A retrospective comparison. Orthop Traumatol Surg Res 2024; 110:103775. [PMID: 38013008 DOI: 10.1016/j.otsr.2023.103775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE The use of peroneus longus tendon (PLT) autografts in primary anterior cruciate ligament reconstruction (ACLR) has increased recently, but there is a lack of research on its use in revision ACLR. This study aimed to compare the clinical outcomes and complications between revision ACLR using allografts and PLT autografts. MATERIALS AND METHODS Fifty-nine patients who underwent arthroscopic revision of ACLR with complete clinical follow-ups between 2012 and 2021 were retrospectively reviewed. Allograft was used in 44 of these patients, and PLT autograft was used in 15 of them. Lysholm knee score, Tegner activity score, Lachman, and anterior drawer tests were performed after a mean follow-up of 60months (range: 19-116). The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to evaluate the donor ankle functions. Clinical outcomes and complications were compared between groups. RESULTS Both groups showed significantly improved functional outcomes compared to their preoperative assessments. However, both groups had similar clinical results at the final follow-up, including Lysholm knee score, Tegner activity scale, knee range of motion, return to sports, time to return to daily activities, and rate of re-rupture. No major complications were seen in any of the patients. The AOFAS score was 99.13±2.64 in the PLT autograft group without loss of ankle muscle strength, deformity, instability, and permanent iatrogenic neurovascular injuries. The cumulative cost of the allograft group was significantly higher than the PLT autograft group. CONCLUSIONS The PLT autograft might be an alternative autograft option to allografts due to similar clinical outcomes, low donor site morbidity, and reduced cost in ACLR revisions, especially if the primary ACLR was performed using grafts harvested around the knee. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Huseyin Selcuk
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey
| | - Ali Bulent Baz
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey.
| | - Omer Faruk Egerci
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey
| | - Ozkan Kose
- University of Health Sciences, Antalya Education and Research Hospital, Department of Orthopedics and Traumatology, Antalya, Turkey
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Krumbach B, Meretsky C, Schiuma AT, Ajebli M. A Comparative Analysis of Quadriceps Tendon, Patellar Tendon Bone Allograft, and Cadaver Graft in Anterior Cruciate Ligament (ACL) Repair and Reconstructive Surgery. Cureus 2024; 16:e59836. [PMID: 38846230 PMCID: PMC11156480 DOI: 10.7759/cureus.59836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries are a common occurrence among athletes and active individuals, often necessitating surgical intervention for optimal recovery. The choice of graft material for ACL reconstruction remains a topic of debate, with various options available, including quadriceps tendon (QT), patellar tendon bone allograft (PTBA), and cadaver graft (CG). This paper aims to provide an extensive review and comparison of the efficacy, outcomes, and complications associated with these graft types based on recent research. A systematic literature search following PRISMA guidelines was conducted to identify relevant studies published in the past six years. The findings suggest that while each graft type has its advantages and limitations, there is no definitive superior choice. Factors such as patient age, activity level, comorbidities, and surgeon preference should be considered when selecting the most appropriate graft for ACL repair surgery. QT grafts are associated with lower donor-site morbidity compared to patellar tendon grafts. However, QT grafts may have a higher risk of graft rupture and decreased knee flexion strength. PTBA grafts, compared to QT grafts, have a higher risk of donor-site morbidity but a lower risk of graft rupture and improved knee stability. CG grafts have lower donor-site morbidity compared to PTBA grafts but may have a higher risk of graft rupture and decreased knee flexion strength compared to PTBA grafts. In conclusion, the choice of graft material for ACL reconstruction is a complex decision that requires careful consideration of various factors, including patient age, activity level, comorbidities, and surgeon preference. While each graft type has its advantages and limitations, there is no definitive superior choice. Therefore, it is essential to carefully weigh the risks and benefits of each graft type to ensure optimal outcomes for patients undergoing ACL repair surgery.
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Affiliation(s)
| | | | | | - Mohammed Ajebli
- Biology Sciences, Faculty of Sciences and Technology, Moulay Ismail University, Errachidia, MAR
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Gabr A, Mancino F, Robinson J, Hage W, O'Leary S, Spalding T, Haddad FS. Satisfactory 5-year functional outcomes following primary ACL reconstructions from the UK National Ligament Registry. Knee Surg Sports Traumatol Arthrosc 2024; 32:798-810. [PMID: 38426562 DOI: 10.1002/ksa.12071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The aim of this study was to describe the 10-year findings from the UK National Ligament Registry (NLR). METHODS A retrospective review was performed for prospectively collected data on the NLR between January 2013 and December 2022. All patients who underwent primary ACL reconstruction (ACLR) on the registry were included. Surgical characteristics were analysed, including surgeon grade and case volume, concomitant knee procedures, venous thromboembolic prophylaxis, graft characteristics, femoral and tibial tunnel drilling, and fixation methods. Clinical outcomes were collected preoperatively and at 6 months, 1 year, 2 years and 5 years following the index procedure. RESULTS During the study period, 17,492 unilateral ACLR procedures were recorded. Autograft was used in 98%, most commonly a combined semitendinosus and gracilis graft (77%) or patella tendon graft (31%). Allograft was used in only 1% of the patients. In 52% of cases, ACLR was associated with an additional procedure, with isolated medial meniscal surgery being the most common (21%). Femoral tunnel drilling was mostly performed through an anteromedial portal (73%) and tibial tunnel drilling using an outside-in technique (92%). The most common method of femoral graft fixation was with an Endobutton fixed loop suspensory device (77%), while interference screws predominated for tibial tunnel fixation (86%). Patients who underwent ACLR surgery showed significant improvement in their functional outcome scores at six months, 1 year, 2 years and 5 years postoperatively. CONCLUSION Data from the NLR shows a detailed description of the current trends and evolution of ACLR in the United Kingdom over the last 10 years. Satisfactory functional outcomes were observed 5 years postoperatively. This study provides useful information on the prevalence of ACL-associated injuries and current surgical techniques with the aim of improving the quality of clinical care and patients' outcomes. Moreover, it provides surgeons with a benchmark against which to compare current practices and functional outcomes following ACLR across the United Kingdom. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ayman Gabr
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
- University College London Hospitals NHS Trust, London, UK
| | - Fabio Mancino
- University College London Hospitals NHS Trust, London, UK
| | | | | | - Sean O'Leary
- The Royal Berkshire Hospital NHS Trust, Reading, UK
| | | | - Fares S Haddad
- University College London Hospitals NHS Trust, London, UK
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Li X, Cao W, Zhou H, Ji R, Xiao J, Zhao C. The healing effect of the all inside technique is superior to the traditional technique in the reconstruction of the anterior cruciate ligament. Eur J Transl Myol 2024; 34:11970. [PMID: 38351844 PMCID: PMC11017173 DOI: 10.4081/ejtm.2024.11970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 03/28/2024] Open
Abstract
Our main objective was to examine the curative effect of all inside technique and traditional technique in anterior cruciate ligament (ACL) reconstruction. In our retrospective study at the First People's Hospital of Jiashan County, we analyzed 88 participants with ACL injuries (50 males, 38 females, average age 27 years). They were randomly divided into two groups: traditional ACL reconstruction (42 participants) and all inside ACL reconstruction (46 participants). We measured and recorded the Visual Analog Scores (VAS), International Knee Documentation Committee (IKDC), Lysholm scores, operation time, graft diameter and length between the traditional technique group and all inside technique group. There were statistically significant differences in the Lysholm scores and IKDC scores between traditional and all inside technique groups. The all inside technique showed a higher efficacy and effective post-operative recovery with minimal pain and recurrent injuries. Our findings showed that the differences in gender, age, side of injury and operation time were not significant (p> 0.05). Follow-up was conducted at 6 months and 12 months post operations (mean, 7.5 ± 1.1 months). All inside technique minimizing tissue disruption, optimizing graft placement and facilitating early recovery have a significant impact on patient outcomes.
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Affiliation(s)
- Xiong Li
- Department of Orthopedics, Jiashan County First People's Hospital, Jiaxing, Zhejiang.
| | - Wu Cao
- Department of Orthopedics, Jiashan County First People's Hospital, Jiaxing, Zhejiang.
| | - Hongyu Zhou
- Department of Orthopedics, Jiashan County First People's Hospital, Jiaxing, Zhejiang.
| | - Ruida Ji
- Department of Orthopedics, Jiashan County First People's Hospital, Jiaxing, Zhejiang.
| | - Jian Xiao
- Department of Orthopedics, Jiashan County First People's Hospital, Jiaxing, Zhejiang.
| | - Chen Zhao
- Department of Orthopedics, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital(Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang.
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Thiel GE, Puga TB, Perleberg TD, Figuerres BF, Dennis JF. Achilles Allograft Fiber Track Graft Preparation Technique for Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2024; 13:102844. [PMID: 38435240 PMCID: PMC10907893 DOI: 10.1016/j.eats.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/20/2023] [Indexed: 03/05/2024] Open
Abstract
Anterior cruciate ligament rupture is a common orthopaedic injury, with reconstruction the treatment of choice for active individuals. Graft selection is an important consideration for surgical planning. Achilles tendon allograft is a graft choice most likely used in cases of revision anterior cruciate ligament reconstruction. This technical note discusses an approach to Achilles tendon allograft preparation that respects and follows the rotation of the fibers of the Achilles tendon. Key considerations in the use of this technique include (1) identifying the rotational fiber tracks, (2) performing careful dissection along the identified tracks of the fibers, and (3) ensuring an appropriate graft width based on patient size, all of which are crucial for the success of this unique technique. The preservation of the rotational fibers provided by this technique may have the potential to result in increased tensile strength and better clinical outcomes.
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Affiliation(s)
- Grace E. Thiel
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri, U.S.A
| | - Troy B. Puga
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri, U.S.A
| | - Tyler D. Perleberg
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri, U.S.A
| | - Benedict F. Figuerres
- Department of Orthopedics and Sports Medicine, The University of Kansas Health System St. Francis Campus, Topeka, Kansas, U.S.A
| | - Jennifer F. Dennis
- Department of Pathology and Anatomical Sciences, Kansas City University, Kansas City, Missouri, U.S.A
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Bourgeault-Gagnon Y, Leang AK, Bédard S, Lebel K, Balg F, Vézina F. Estimated diameter increase from a 4S to a 6S hamstring graft configuration - A cadaveric study. SICOT J 2023; 9:34. [PMID: 38032265 PMCID: PMC10688256 DOI: 10.1051/sicotj/2023033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE Graft diameter in anterior cruciate ligament reconstructions has been shown to influence the risk of failure. It is therefore important to be able to adjust the graft configuration to modify the diameter. To measure the impact of a 6-strand (6S) hamstring autograft configuration on graft diameter compared to the standard 4-strand (4S) configuration. METHODS Cadaveric study on 33 knees, using the usual hamstring graft harvesting technique. Semitendinosus and gracilis tendons were harvested and their length, width, and diameter were measured in 4S and 6S configurations separately by three evaluators. RESULTS 6S configuration leads to a median increase of 1.5 (range: 0.0-2.0) mm in diameter compared to 4S (p < 0.001). A graft diameter of more than 8 mm is attained in less than a third of 4S grafts within this population in comparison to 84% when the 6S configuration is used. DISCUSSION The 6S hamstring graft configuration increases the graft diameter by a median of 1.5 millimeters compared to the traditional 4S configuration. It can reliably be used to obtain an 8.5 mm graft diameter or more in cases where the semitendinosus measures at least 270.5 mm and the 4S configuration has a diameter of 7.5 mm or 8 mm. This information helps to better delineate the impact of a 6S configuration in a pre-operative or intra-operative setting to optimize the decisional process and surgical flow and to easily adapt the graft diameter. LEVEL OF EVIDENCE V (cadaveric study).
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Affiliation(s)
| | - Alexandre Keith Leang
- Sherbrooke University 3001 12th Avenue North Sherbooke QC J1H 5H4 Canada
- Centre Hospitalier Hôtel-Dieu-de-Sorel 400 Av. de l’Hôtel-Dieu Sorel-Tracy QC J3P 1N4 Canada
| | - Sonia Bédard
- Center for Research at the CHUS (CIUSSS de l’Estrie CHUS) 3001 12th Avenue North Sherbooke QC J1H 5H4 Canada
| | - Karina Lebel
- Research center on aging (CIUSSS de l’Estrie CHUS), 1036, rue Belvédère Sud Sherbooke QC J1H 4C4 Canada
- Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke 2500, boulevard de l’Université, bureau C1-3050 Sherbrooke QC J1K 2R1 Canada
| | - Frédéric Balg
- Sherbrooke University 3001 12th Avenue North Sherbooke QC J1H 5H4 Canada
- Center for Research at the CHUS (CIUSSS de l’Estrie CHUS) 3001 12th Avenue North Sherbooke QC J1H 5H4 Canada
| | - François Vézina
- Sherbrooke University 3001 12th Avenue North Sherbooke QC J1H 5H4 Canada
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Cakar A, Kose O, Selcuk H, Egerci OF, Tasatan E, Dogruoz F. Complications of peroneus longus tendon harvesting: a retrospective review of 82 cases. Arch Orthop Trauma Surg 2023; 143:6675-6684. [PMID: 37453933 DOI: 10.1007/s00402-023-04988-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Peroneus longus tendon (PLT) has become a reliable autologous graft option for various ligament reconstructions. But there are potential risks and complications associated with its use as a graft. This retrospective study aimed to examine the complications and donor site morbidity following PLT harvesting. PATIENTS AND METHODS A retrospective review was performed on an institutional digital patient database, and all patients who underwent ligament reconstruction using PLT autograft were identified. Intraoperative, early, and late complications were reviewed using digital patient notes and patients underwent a complete physical examination during their final follow-up. Ankle function was assessed using the AOFAS score, and manual ankle muscle testing was performed on both sides. Sural nerve iatrogenic injury was evaluated with a dermatomal light touch examination. Cosmetic satisfaction due to incision scar and footwear complaints were also assessed. RESULTS 82 patients (74 male, eight female) with a mean age of 31.9 ± 10.4 years (range, 16-66) were included in the final analysis. The mean follow-up time was 46.6 ± 30.3 months (range, 6-109). The mean AOFAS score for the donor side was 98.7 ± 3.3 (range, 87-100), and the contralateral side score was 100, with manual muscle testing graded as 5 in all movements and similar to the contralateral side. Fifteen patients (18.3%) had hypoesthesia over the dorsolateral aspect of the foot distal to the incision scar, two patients (2.4%) had hyperalgesia over the distal incision scar, and one patient (1.2%) had mild ankle instability. There were two cases (2.4%) of compartment syndrome, both of which were treated with fasciotomy and had complete regression of symptoms after 5 days. One patient (1.2%) had a transient peroneal nerve injury and foot drop that resolved in the sixth month. CONCLUSIONS The results of this retrospective study suggest that harvesting the PLT is associated with a high rate of complications and donor site morbidity. The most common complication was hypoesthesia around the lateral side of the foot, although the ankle functions were not affected significantly. Two cases of compartment syndrome and one transient peroneal nerve injury were observed. Care should be taken while harvesting PLT autograft, and it should be kept in mind that peroneal nerve injury might occur. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Albert Cakar
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık Mah., Kazım Karabekir cd., Antalya, 07100, Muratpasa, Turkey.
| | - Huseyin Selcuk
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık Mah., Kazım Karabekir cd., Antalya, 07100, Muratpasa, Turkey
| | - Omer Faruk Egerci
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık Mah., Kazım Karabekir cd., Antalya, 07100, Muratpasa, Turkey
| | - Ersin Tasatan
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Fırat Dogruoz
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık Mah., Kazım Karabekir cd., Antalya, 07100, Muratpasa, Turkey
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D’Ambrosi R, Kambhampati SBS, Vishwanathan K, Vaish A, Vaishya R. Trends of Publications on Single- and Double-Bundle ACL Reconstructions over the Last 20 Years: A Bibliometric Analysis of the PubMed Literature. Indian J Orthop 2023; 57:1623-1632. [PMID: 37766958 PMCID: PMC10519918 DOI: 10.1007/s43465-023-00977-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/11/2023] [Indexed: 09/29/2023]
Abstract
Purpose To improve the clinical outcomes of anterior cruciate ligament reconstruction (ACLR), there have been attempts to reproduce anatomic reconstruction by modifying the single-bundle (SB) and double-bundle (DB) techniques. Although DB ACLR restores better rotational control compared to SB ACLR, it is still debatable whether there are higher clinical outcomes in favor of DB ACLR. We aimed to study the trends of publications on SB and DB ACLR techniques over the last 20 years. Methods For this bibliometric study, we performed a PubMed search on 31/05/2022 with a well-defined search strategy. The articles were downloaded into Excel software, and citations were determined from the iCite website for PubMed. The analysis was performed using SPSS software version 28.0.1. Data mining was performed using Orange software, Mac version 3.32.0, from the titles of all articles and each group of SB and DB ACLR. The output is presented as word clouds. Results A total of 10,530 publications were identified, of which 9699 publications (92.1%) pertained to SB-ACLR and 831 publications (7.9%) to DB-ACLR. There was a steady increase in the publications on SB-ACLR until 2012, followed by a steep increase that peaked in 2021. The highest number of publications on DB-ACLR was in 2012 (n = 76; 9.1%). The mean citations per year for SB-ACLR and DB-ACLR were 2.87 ± 4.31 and 2.74 ± 3.17, respectively. The most prolific journals publishing on this topic were Knee Surgery Sports Traumatology Arthroscopy, American Journal of Sports Medicine, and Arthroscopy. The top three articles that received the maximum number of citations were from Japanese authors. Conclusion The number of publications related to SB-ACLR was significantly higher than that related to DB-ACLR in the last 20 years. The publications related to DB-ACLR have decreased in the recent past, after reaching a peak in 2012. The citations per year of SB-ACLR and DB-ACLR were similar.
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Affiliation(s)
- Riccardo D’Ambrosi
- IRCCS Ospedale Galeazzi – Sant’Ambrogio, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Karthik Vishwanathan
- Parul Institute of Medical Sciences and Research, Parul University, Limda, Waghodia, Vadodara, Gujarat India
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Wang L, Wan F, Xu Y, Xie S, Zhao T, Zhang F, Yang H, Zhu J, Gao J, Shi X, Wang C, Lu L, Yang Y, Yu X, Chen S, Sun X, Ding J, Chen P, Ding C, Xu F, Yu H, Peng H. Hierarchical helical carbon nanotube fibre as a bone-integrating anterior cruciate ligament replacement. NATURE NANOTECHNOLOGY 2023; 18:1085-1093. [PMID: 37142709 DOI: 10.1038/s41565-023-01394-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023]
Abstract
High rates of ligament damage require replacements; however, current synthetic materials have issues with bone integration leading to implant failure. Here we introduce an artificial ligament that has the required mechanical properties and can integrate with the host bone and restore movement in animals. The ligament is assembled from aligned carbon nanotubes formed into hierarchical helical fibres bearing nanometre and micrometre channels. Osseointegration of the artificial ligament is observed in an anterior cruciate ligament replacement model where clinical polymer controls showed bone resorption. A higher pull-out force is found after a 13-week implantation in rabbit and ovine models, and animals can run and jump normally. The long-term safety of the artificial ligament is demonstrated, and the pathways involved in integration are studied.
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Affiliation(s)
- Liyuan Wang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Fang Wan
- Department of Orthopedic Sports Medicine, Huashan Hospital, The Sports Medicine Institute, Fudan University, Shanghai, China
| | - Yifan Xu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Songlin Xie
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Tiancheng Zhao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Fan Zhang
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Han Yang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Jiajun Zhu
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingming Gao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Xiang Shi
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Chuang Wang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Linwei Lu
- Department of Integrative Medicine, Huashan Hospital, The Academy of Integrative Medicine, Fudan University, Shanghai, China
| | - Yifan Yang
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Xiaoye Yu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Orthopedic Sports Medicine, Huashan Hospital, The Sports Medicine Institute, Fudan University, Shanghai, China.
| | - Xuemei Sun
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China.
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Peining Chen
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China.
| | - Chen Ding
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Fan Xu
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Hongbo Yu
- Vision Research Laboratory, School of Life Sciences, State Key Laboratory of Medical Neurobiology, Collaborative Innovation Centre for Brain Science, Fudan University, Shanghai, China
| | - Huisheng Peng
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China.
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11
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Fan D, Ma J, Zhang L. Contralateral grafts have comparable efficacy to ipsilateral grafts in anterior cruciate ligament reconstructions: a systematic review. J Orthop Surg Res 2023; 18:596. [PMID: 37568165 PMCID: PMC10422826 DOI: 10.1186/s13018-023-04082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/06/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE To perform a systematic review of the clinical outcomes of anterior cruciate ligament reconstruction using either contralateral or ipsilateral tendon autografts. METHODS A systematic review of literature published from inception to December 9, 2022, in multiple databases (PubMed, Embase, Scopus, and the Cochrane Library) was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews) guidelines. Two reviewers independently screened the literature, extracted the data, performed the risk of bias assessment and assessed the study quality. At least one of the following outcomes was evaluated for each study: muscle strength (isometric strength of the quadriceps or hamstring muscles, isokinetic peak flexion torque of the hamstring, or isokinetic peak extension torque of the hamstring), knee laxity examination, Lysholm score, pivot shift, International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lachman test result, return to sports time, or incidence of complications. A random effects model was used for all analyses. RESULTS Four hundred scientific manuscripts were recovered in the initial search. After screening, 12 studies (2 randomized controlled trials, 9 cohort studies, and 1 case- control study) met the search criteria for the qualitative analysis. Among them, 9 cohort studies were used for the quantitative analysis. The results showed few statistically significant differences in terms of muscle strength (contralateral group versus ipsilateral group or donor site group versus ipsilateral group or donor site group versus nonoperative group), Lysholm score, and return to sports time. A comparison showed no significant differences in knee laxity, IKDC score, Tegner activity score, Lachman test score, or incidence of complication, or contralateral rupture. CONCLUSIONS In anterior cruciate ligament reconstruction, the contralateral autologous tendon has a similar effect as the ipsilateral autologous tendon.
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Affiliation(s)
- DingYuan Fan
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
- Beijing University of Chinese Medicine, Beijing, China
- University College London, London, UK
| | - Jia Ma
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
| | - Lei Zhang
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China.
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China.
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12
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Chalatsis G, Mitrousias V, Siouras A, Panteliadou F, Tziolas I, Solomou C, Hantes M. Long-term Quality of Life in Patients After ACL Reconstruction With Concomitant Meniscal Injury Treatment: Patient-Reported Outcomes at Minimum 10-Year Follow-up. Orthop J Sports Med 2023; 11:23259671231177279. [PMID: 37347018 PMCID: PMC10280537 DOI: 10.1177/23259671231177279] [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: 02/07/2023] [Accepted: 03/09/2023] [Indexed: 06/23/2023] Open
Abstract
Background Long-term studies of patients after anterior cruciate ligament (ACL) reconstruction with or without concomitant meniscal tear treatment are limited. Purposes To (1) report postoperative outcomes after anatomic ACL reconstruction with a hamstring autograft, (2) investigate how concomitant treatment of meniscal injury could affect these outcomes, and (3) evaluate the association between quality of life and activity levels at a minimum 10-year follow-up. Study Design Cohort study; Level of evidence, 3. Methods Patients treated with a unilateral, anatomic ACL reconstruction between 2005 and 2011 were investigated. The following patient-reported outcome measures (PROMs) were reported for the overall sample as well as a subsample of patients with meniscal injury: International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, Tegner activity scale, 5-level EQ-5D (EQ-5D-5L), and patient satisfaction. Sex, age, body mass index (BMI), and meniscal injury treatment (meniscectomy vs meniscal repair) were examined as patient-specific risk factors regarding long-term activity and quality of life. Results Overall, 106 patients, 90 men (85%) and 16 women (15%), were enrolled in the study, with a mean follow-up of 13.2 years. The ACL retear rate was 2.8%. The mean scores were 80.6 ± 16.7 (IKDC-SKF), 87.4 ± 15.0 (KOOS), 90.5 ± 11.5 (Lysholm), 5.6 ± 1.9 (Tegner), and 91.8 ± 14.5 (EQ-5D-5L). The majority (90.6%) of patients considered their knee state satisfactory during follow-up. When compared with patients who underwent meniscal repair, patients who underwent meniscectomy had statistically significantly lower scores on all PROMs except for the Tegner and EQ-5D-5L (P < .05 for all). The mean difference between the 2 groups was ≥7 points on all PROM scores. Patient sex, age, and BMI did not affect PROM scores. There was a statistically significant, strong positive correlation between quality of life and activity. Conclusion Patients had few or no symptoms and considered their knee state satisfactory 13.2 years after anatomic ACL reconstruction. Patients with concomitant meniscal tears having undergone meniscal repair had improved PROMs compared with those treated with meniscectomy. Finally, participation in activities of daily living and sports was interrelated with quality of life and was not affected by patient age, sex, or BMI.
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Affiliation(s)
- Georgios Chalatsis
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Vasileios Mitrousias
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Athanasios Siouras
- Department of Computer Science and
Biomedical Informatics, School of Science, University of Thessaly, Lamia,
Greece
- AIDEAS OÜ, Tallinn, Estonia
| | - Freideriki Panteliadou
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Ioannis Tziolas
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Chrysovalantis Solomou
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Michael Hantes
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
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13
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Banovetz MT, Kennedy NI, LaPrade RF, Engebretsen L, Moatshe G. Biomechanical considerations for graft choice in anterior cruciate ligament reconstruction. ANNALS OF JOINT 2023; 8:17. [PMID: 38529237 PMCID: PMC10929340 DOI: 10.21037/aoj-22-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/30/2023] [Indexed: 03/27/2024]
Abstract
Injury to the anterior cruciate ligament (ACL) of the knee is common and often requires surgical reconstruction. There are numerous graft options available to the operating surgeon, to each of which a growing body of dedicated literature exists. Each of these potential choices of ACL graft specimen has a distinctive set of biomechanical properties, clinical outcome profiles, and other special considerations (e.g., autograft versus allograft, harvest site factors, and operating time). The purpose of this review is to discuss the biomechanical characteristics of the native ACL alongside those of several of the most commonly used ACL graft specimens based on a current review of the biomechanical literature. In doing so, this review will also briefly discuss the biomechanical implications for allograft versus autograft usage and single-bundle versus double-bundle repair techniques. This review lists and discusses the stress, strain, stiffness, Young's modulus, and ultimate load to failure of the native ACL, several common autografts [patellar bone-tendon-bone (BTB), hamstring tendon (HT), and quadriceps tendon (QT)], and several common allografts. Given the important biomechanical role of the ACL in stabilizing the knee to translational and rotational forces, it is crucial that the operating surgeon make a decision on graft choice that is informed in the biomechanical implications of ACL graft selection.
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Affiliation(s)
| | | | | | - Lars Engebretsen
- Department of Orthopedic Surgery, University of Oslo Hospital, Oslo, Norway
| | - Gilbert Moatshe
- Department of Orthopedic Surgery, University of Oslo Hospital, Oslo, Norway
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14
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Kunze KN, Moran J, Polce EM, Pareek A, Strickland SM, Williams RJ. Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: a systematic review and network meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07402-2. [PMID: 37000243 DOI: 10.1007/s00167-023-07402-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE To perform a meta-analysis of RCTs evaluating donor site morbidity after bone-patellar tendon-bone (BTB), hamstring tendon (HT) and quadriceps tendon (QT) autograft harvest for anterior cruciate ligament reconstruction (ACLR). METHODS PubMed, OVID/Medline and Cochrane databases were queried in July 2022. All level one articles reporting the frequency of specific donor-site morbidity were included. Frequentist model network meta-analyses with P-scores were conducted to compare the prevalence of donor-site morbidity, complications, all-cause reoperations and revision ACLR among the three treatment groups. RESULTS Twenty-one RCTs comprising the outcomes of 1726 patients were included. The overall pooled rate of donor-site morbidity (defined as anterior knee pain, difficulty/impossibility kneeling, or combination) was 47.3% (range, 3.8-86.7%). A 69% (95% confidence interval [95% CI]: 0.18-0.56) and 88% (95% CI: 0.04-0.33) lower odds of incurring donor-site morbidity was observed with HT and QT autografts, respectively (p < 0.0001, both), when compared to BTB autograft. QT autograft was associated with a non-statistically significant reduction in donor-site morbidity compared with HT autograft (OR: 0.37, 95% CI: 0.14-1.03, n.s.). Treatment rankings (ordered from best-to-worst autograft choice with respect to donor-site morbidity) were as follows: (1) QT (P-score = 0.99), (2) HT (P-score = 0.51) and (3) BTB (P-score = 0.00). No statistically significant associations were observed between autograft and complications (n.s.), reoperations (n.s.) or revision ACLR (n.s.). CONCLUSION ACLR using HT and QT autograft tissue was associated with a significant reduction in donor-site morbidity compared to BTB autograft. Autograft selection was not associated with complications, all-cause reoperations, or revision ACLR. Based on the current data, there is sufficient evidence to recommend that autograft selection should be personalized through considering differential rates of donor-site morbidity in the context of patient expectations and activity level without concern for a clinically important change in the rate of adverse events. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, East 70th Street, New York, NY, 53510021, USA.
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA.
| | - Jay Moran
- Yale School of Medicine, New Haven, CT, USA
| | - Evan M Polce
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ayoosh Pareek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, East 70th Street, New York, NY, 53510021, USA
| | - Sabrina M Strickland
- Department of Orthopaedic Surgery, Hospital for Special Surgery, East 70th Street, New York, NY, 53510021, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA
| | - Riley J Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, East 70th Street, New York, NY, 53510021, USA
- Sports Medicine and Shoulder Institute, Hospital for Special Surgery, New York, NY, USA
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15
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Yañez-Diaz R, Roby M, Silvestre R, Zamorano H, Vergara F, Sandoval C, Neira A, Yañez-Rojo C, De la Fuente C. Multiclass Support Vector Machine improves the Pivot-shift grading from Gerdy's acceleration resultant prior to the acute Anterior Cruciate Ligament surgery. Injury 2023:S0020-1383(23)00271-1. [PMID: 37003872 DOI: 10.1016/j.injury.2023.03.020] [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: 12/23/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Rotatory laxity acceleration still lacks objective classification due to interval grading superposition, resulting in a biased pivot shift grading prior to the Anterior Cruciate Ligament (ACL) reconstruction. However, data analysis might help improve data grading in the operative room. Therefore, we described the improvement of the pivot-shift categorization in Gerdy's acceleration under anesthesia prior to ACL surgery using a support vector machine (SVM) classification, surgeon, and literature reference. METHODS Seventy-five patients (aged 30.3 ± 10.2 years, and IKDC 52.0 ± 16.5 points) with acute ACL rupture under anesthesia prior to ACL surgery were analyzed. Patients were graded with pivot-shift sign glide (+), clunk (++), and (+++) gross by senior orthopedic surgeons. At the same time, the tri-axial tibial plateau acceleration was measured. Categorical data were statistically described, and the accelerometry and categorical data were associated (α = 5%). A multiclass SVM kernel with the best accuracy trained by orthopedic surgeons and assisted from literature for missing data was compared with experienced surgeons and literature interval grading. The cubic SVM classifier achieved the best grading. RESULTS The intra-group proportions were different for each grading in the three compared strategies (p < 0.001). The inter-group proportions were different for all comparisons (p < 0.001). There were significant (p < 0.001) associations (Tau: 0.69, -0.28, and -0.50) between the surgeon and SVM, the surgeon and interval grading, and the interval and SVM, respectively. CONCLUSION The multiclass SVM classifier improves the acceleration categorization of the (+), (++), and (+++) pivot shift sign prior to the ACL surgery in agreement with surgeon criteria.
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Affiliation(s)
- Roberto Yañez-Diaz
- Traumatologia, Clinica MEDS, Santiago, Chile; Centro de Innovación, Clinica MEDS, Santiago Chile
| | - Matías Roby
- Traumatologia, Clinica MEDS, Santiago, Chile; Centro de Innovación, Clinica MEDS, Santiago Chile
| | - Rony Silvestre
- Centro de Innovación, Clinica MEDS, Santiago Chile; Carrera de Kinesiologia, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | | | - Alejandro Neira
- Escuela de Kinesiologia, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
| | | | - Carlos De la Fuente
- Centro de Innovación, Clinica MEDS, Santiago Chile; Carrera de Kinesiologia, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Applied Neuromechanics Research Group, Universidade Federal do Pampa, Uruguaiana, RS, Brazil.
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16
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Xu C, Liu T, Wang M, Liu C, Li B, Lian Q, Chen T, Chen F, Qiao S, Wang Z. Comparison of proprioception recovery following anterior cruciate ligament reconstruction using an artificial graft versus an autograft. BMC Musculoskelet Disord 2022; 23:1056. [PMID: 36463165 PMCID: PMC9719127 DOI: 10.1186/s12891-022-06019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/23/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To compare proprioception recovery after anterior cruciate ligament reconstruction (ACLR) with a hamstring tendon autograft versus the artificial Ligament Advanced Reinforcement System (LARS). MATERIAL AND METHODS Forty patients (9 females, 31 males) with anterior cruciate ligament (ACL) rupture were enrolled in this prospective study. Patients were randomized to two groups, 1) ACLR using a hamstring tendon autograft (n = 20) or 2) ACLR using artificial LARS (n = 20). Proprioception was assessed with knee joint position sense (JPS) passive-passive test at 45° and 75° flexions, with the contralateral healthy knee as a control baseline to calculate the JPS error. Knee JPS absolute error was used as the main outcome variable and defined as the absolute difference between the reproduction and target angles. RESULTS JPS error in both groups at 3 months after ACLR was significantly higher than that at 12 months. However, no significant difference in JPS error was detected between the LARS and autograft groups at either 3 or 12 months after ACLR. Analyzing JPS data by grouping patients according to whether ACLR was performed more or less than 1 year following injury regardless of graft type showed a statistically significant difference between the groups at 3 months, but not at 12 months, after ACLR. Patients receiving the graft within 1 year of injury had a lower JPS error than those receiving the graft more than 1 year after injury at 3 months. No complications were associated with either ACLR method. CONCLUSION ACLR with a hamstring tendon autograft or LARS artificial graft is similarly safe and effective for recovering knee proprioception.
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Affiliation(s)
- Changli Xu
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China ,Department of Orthopedics, The Third Affiliated to the Naval Military Medical University, Shanghai, 201805 People’s Republic of China ,The fifth Outpatients Department, The 980th Hospital of Joint Logistic Support Force, Shijiazhuang, 050083 People’s Republic of China
| | - Tianze Liu
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China
| | - Miao Wang
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China ,Department of Orthopedics, The Third Affiliated to the Naval Military Medical University, Shanghai, 201805 People’s Republic of China
| | - Chang Liu
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China ,Department of Orthopedics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian Province 350025 People’s Republic of China
| | - Bo Li
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China
| | - Qiujian Lian
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China
| | - Tongjiang Chen
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China
| | - Fengmei Chen
- Department of Orthopedics, The Third Affiliated to the Naval Military Medical University, Shanghai, 201805 People’s Republic of China
| | - Suchi Qiao
- Department of Orthopedics, The Third Affiliated to the Naval Military Medical University, Shanghai, 201805 People’s Republic of China
| | - Zhiwei Wang
- grid.73113.370000 0004 0369 1660Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433 People’s Republic of China ,Department of Orthopedics, The Third Affiliated to the Naval Military Medical University, Shanghai, 201805 People’s Republic of China
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17
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Shichman I, Baruchi D, Rachevsky G, Amzallag N, Brandstetter AS, Vidra M, Morag G. Bone filling decreases donor site morbidity after anterior cruciate ligament reconstruction with bone-patellar tendon-bone autografts. Arch Orthop Trauma Surg 2022; 143:2565-2572. [PMID: 35916963 DOI: 10.1007/s00402-022-04572-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Bone-patellar tendon-bone (BTB) autograft remains the most widely used graft source for anterior cruciate ligament reconstruction (ACLR). The drawback associated with BTB is increased donor-site morbidity, such as anterior knee pain. The purpose of this study was to evaluate and compare anterior knee pain after refilling the patella bony defect with bone substitute. METHODS This is a retrospective analysis of consecutive patients who underwent BTB ACLR at a single institution between January 2015 and December 2020. The cohort was divided into two groups; one in which the patellar bony defect was refilled with bone substitute (Bone Graft group) and another in which this the bony defects were not treated (No Bone Graft group). Demographic variables, reported anterior knee pain, visual analog scale (VAS) score, complications, re-operation, and patient reported outcome measures, such as the IKDC, LYSHOLM and SF-12 scores, were compared between groups. RESULTS A total of 286 patients who underwent BTB ACLR were included. The No Bone Graft group included 88 (30.7%) patients and the Bone Graft group included 198 (69.3%) patients. The Bone Graft group had less anterior knee pain at last clinic follow up (33.3% vs. 51.1% p = 0.004) as well as lower VAS anterior knee pain scores (2.18 vs. 3.13, p = 0.004). The Bone Graft group had lower complications rates (21.7% vs 34.1, p = 0.027). No differences were found in the LYSHOLM, IKDC, and SF-12 scores. CONCLUSION Bone refilling in BTB ACLR significantly reduces prevalence and severity of anterior knee pain. Larger randomized trials are needed to confirm the benefits of bone refilling in ACLR patients. LEVEL OF EVIDENCE Retrospective study-III.
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Affiliation(s)
- Ittai Shichman
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, 6 Weizman Street, Tel-Aviv, Israel.
| | - David Baruchi
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, 6 Weizman Street, Tel-Aviv, Israel
| | - Gil Rachevsky
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, 6 Weizman Street, Tel-Aviv, Israel
| | - Nissan Amzallag
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, 6 Weizman Street, Tel-Aviv, Israel
| | - Addy S Brandstetter
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, 6 Weizman Street, Tel-Aviv, Israel
| | - Matias Vidra
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, 6 Weizman Street, Tel-Aviv, Israel
| | - Guy Morag
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, 6 Weizman Street, Tel-Aviv, Israel
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