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Das U, Patra G, Das B, Pradhan S. Double-Versus Single-Bundle Anterior Cruciate Ligament Reconstructive Surgery: A Prospective Study With >1 Year Follow-Up. Cureus 2023; 15:e42829. [PMID: 37664285 PMCID: PMC10471894 DOI: 10.7759/cureus.42829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Background The increased prevalence of knee trauma predominantly adds to the anterior cruciate ligament (ACL) tear frequencies that require single- or double-bundle reconstructive surgeries. Few studies have demonstrated the superior results of double-bundle reconstruction compared to single-bundle approaches. This study investigated the knee function improvement capacity of both reconstruction techniques in patients with ACL tears. Methods Thirty cases with ACL tears have been enrolled and segregated equally in distinct (single-bundle versus double-bundle) batches. The diagnostic assessments were undertaken through comprehensive clinical history, knee radiographs, Lysholm scoring, the International Knee Documentation Committee (IKDC) scale, the Lachman analysis, the International Knee Documentation Committee (IKDC) scale, and the pivot shift method. Results After one year, there was a significant enhancement in the postoperative versus preoperative Lysholm scores in the single-bundle (58.5 ± 21.2 vs. 82.4 ± 26.2, p<0.001) and double-bundle (86.4 ± 22.8 vs 60.3 ± 19.2, p<0.001) groups. There was a significant improvement in the IKDC scores after a follow-up period of one year (p-value: 0.012 and p-value: 0.002, respectively) in both of the study batches. After a year of follow-up, Lysholm scores (p=0.352) and IKDC scores (p=0.574) between the study groups (82.4 ± 26.2 vs. 86.4 ± 22.8) were comparable. Conclusion The clinical outcomes remained comparable between subjects with single-bundle reconstruction versus double-bundle reconstruction subjects with ACL injuries. Findings were similar between the groups after one year and two years of surgical interventions.
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Affiliation(s)
- Udayan Das
- Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Gopabandhu Patra
- Department of Orthopaedics, Bhima Bhoi Medical College, Balangir, IND
| | - Biswajit Das
- Department of Orthopaedics, Fakir Mohan Medical College, Balasore, IND
| | - Sandeep Pradhan
- Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Yela-Verdú C, Ares O, Albareda D, Oller B, Sallent A, Jornet-Gibert M, Amillo JR. Anterior Cruciate Ligament Reconstruction with Autologous Hamstring Single- versus Double-Bundle Graft: A Prospective Study with 10-Year Follow-up. J Knee Surg 2022. [PMID: 35820434 DOI: 10.1055/s-0042-1748898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of the present study was to compare the clinical and subjective outcomes of anterior cruciate ligament (ACL) reconstruction using an autologous hamstring double bundle (DB) with a single bundle (SB) after a 10-year follow-up. A prospective comparative cohort study was performed of 47 consecutive patients with ACL rupture included between May 2006 and March 2008. Inclusion criteria were less than 2 years since the injury date, no previous surgery on the affected knee, and having closed growth plates. Patients were divided into two groups: (1) SB group (n = 25) and (2) DB group (n = 22). Patients underwent evaluation before surgery and at 1 and 10 years postoperatively. The clinical evaluation included the International Knee Documentation Committee (IKDC) Questionnaire, pivot shift test, and single hop test, as well as X-rays (anterior drawer X-rays on a Telos stress radiography). Range of motion (ROM) was assessed at 10-year follow-up. Both groups were similar in terms of baseline characteristics. Post hoc power analysis showed that among 30 and 226 patients would be needed for statistical significance, depending on the outcome. With the numbers available, no significant differences were observed in subjective IKDC, anterior stability (measured with Telos), and functional test outcomes (single hop test) between both groups at 1 and 10 years postoperatively. Regarding rotational instability (pivot-shift test), DB group was significantly superior (p = 0.002). Regarding ROM, no significant differences were observed between groups. No failure was registered in any of the groups. ACL reconstruction (ACLR) with an autologous hamstring, both with bundles and DB, shows overall better outcomes compared with the status before surgery. DB ACLR provides better rotational control of the knee, an outcome that is maintained after 10 years.
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Affiliation(s)
- Christian Yela-Verdú
- Department of Orthopedic Surgery and Traumatology, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Oscar Ares
- Department of Orthopedic Surgery and Traumatology, Hospital Clínic, Barcelona, Spain.,School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Albareda
- Department of Orthopedic Surgery and Traumatology, Clínica Albareda, Barcelona, Spain
| | - Bárbara Oller
- Department of Orthopedic Surgery and Traumatology, Hospital de Viladecans, Viladecans, Spain
| | - Andrea Sallent
- Department of Orthopedic Surgery and Traumatology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Juan R Amillo
- Department of Orthopedic Surgery and Traumatology, Hospital de Viladecans, Viladecans, Spain
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The Effect of Tibial Insertion Site in Single-Bundle ACL Reconstruction during Gait Based on Motion Capture and Musculoskeletal Model. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7596995. [PMID: 35281547 PMCID: PMC8913050 DOI: 10.1155/2022/7596995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate the effect of tibial insertion site (TIS) of the anterior cruciate ligament (ACL) in single-bundle ACL reconstruction on ligament force during gait. A musculoskeletal model with an ACL ligament was created, and gait data were collected based on the motion capture system from seven female patients with single-bundle ACL reconstruction. The TIS was simulated in OpenSim and systematically changed in 2.5 mm intervals (2.5 mm, 5.0 mm, and 7.5 mm) in the anteroposterior and mediolateral directions from the center. The changes of the ACL force overtime and peak force were compared using the Pearson correlation and paired t-test separately for all simulated TISs. The results indicated that anterior movement of the TIS would significantly increase the loading of reconstructed ACL and the risk of secondary injury, but the posterior TIS would keep the ACL loose during gait. The mediolateral change of the TIS also affected the ligament force during gait, which increased in the medial direction and decreased in lateral direction, but the magnitude of the change is relatively small compared with those measured in the anteroposterior direction. Therefore, during preoperative surgery planning, defining the outline of the ACL attachment site during surgery can help to guide the decision for the TIS and can significantly affect the reconstructed ACL force during gait, especially if the TIS is moved in the anteroposterior direction.
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Yazdi H, Kwon JY, Ghorbanhoseini M, Gomrokchi AY, Motaghi P. Anatomic reconstruction of the medial collateral ligament in multi-ligaments knee injury using achilles allograft : a modification of Marx’s technique. Acta Orthop Belg 2021. [DOI: 10.52628/87.2.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Medial Collateral Ligament (MCL) injury may require operative treatment. Marx et al. described the latest technique for reconstruction of MCL. While good results have been reported using the Marx technique, some issues have been observed. To address the mentioned issues, a modification to the Marx technique has been devised.
Eleven patients were enrolled and their ligaments were repaired by the fixation of allograft on the proximal and distal attachment footprints of the superficial MCL. For preventing loss of knee ROM, MCL and other ligaments were reconstructed in 2 separate stages. At the last follow up the ROM, knee ligament laxity and functional outcome scores, subjective (IKDC) and Lysholm score were evaluated and recorded.
Knee motion was maintained in all cases. Two cases demonstrated 1+ valgus instability at 30 degrees of knee flexion. Both were treated for combined MCL and PCL tear, the rest were stable. The average IKDC-subjective score was 93 ± 4 and the average Lysholm score was 92 ± 3. All patients were satisfied and returned to their previous level of activity.
In this technique, the superficial MCL was recon- structed closer to its anatomical construct. Patients didn’t have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Patients didn’t have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Also reconstructing the ligaments in 2 stages helped to preserve the knee motion.
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Mhaskar VA, Jain Y, Soni P, Fiske R, Maheshwari J. How Important is the Tunnel Position in Outcomes Post-ACL Reconstruction: A 3D CT-Based Study. Indian J Orthop 2021; 56:312-318. [PMID: 35140863 PMCID: PMC8789976 DOI: 10.1007/s43465-021-00485-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Drilling the femoral and tibial tunnels at their anatomical locations are critical for good outcomes and involve seeing the footprints well. We intended to compare two techniques of drilling the tunnels and the patient-reported outcomes and knee stability of patients undergoing single bundle ACL reconstruction using 3D CT to evaluate if the tunnels were anatomical or not. MATERIALS AND METHODS Sixty single bundle ACL reconstructions were analyzed, 30 each with Technique A and B. Pre-operative and after a minimum 27 month follow-up Lysholm, IKDC, Tegner score, hop test, and Lachman test were noted. 3D CT was done to classify femoral tunnels positions as being well placed, slightly or grossly misplaced and tibial tunnels as optimal or suboptimal and compared. RESULTS Sixty ACL reconstructions had full follow-up with a mean follow-up of 34 months. There was no significant difference between tunnel positions between the two techniques. Well-placed femoral tunnel had better Lysholm score (62.2 ± 16.2 v/s 48.5 ± 17.2, p 0.002) and IKDC score (62.5 ± 14.3 v/s 52.7 ± 15.1, p 0.012).). Those who had their surgeries within 3 months of their injury had better hop test (4.4 ± 0.9 v/s 3.9 ± 1, p 0.034) and IKDC scores (62.5 ± 15.8 v/s 33.2 ± 13.8, p 0.026) as compared to those that had surgery done after 3 months. CONCLUSION Tibial tunnel positions were optimal in most cases and did not differ between the two techniques. Well-placed femoral tunnels and surgeries done within 3 months of the injury produced best results.
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Affiliation(s)
- Vikram A. Mhaskar
- Department of Orthopaedics, Max Smart Hospital Saket, New Delhi, 110017 India ,Knee & Shoulder Clinic, F7 East Of Kailash, New Delhi, 110017 India
| | - Yogesh Jain
- Department of Orthopaedics, Max Smart Hospital Saket, New Delhi, 110017 India
| | - Pankaj Soni
- Department of Orthopaedics, Max Smart Hospital Saket, New Delhi, 110017 India
| | - Rajendra Fiske
- Department of Orthopaedics, Max Smart Hospital Saket, New Delhi, 110017 India
| | - Jitendra Maheshwari
- Department of Orthopaedics, Max Smart Hospital Saket, New Delhi, 110017 India ,Knee & Shoulder Clinic, F7 East Of Kailash, New Delhi, 110017 India
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Pontoh LAP, Ismail HD, Fiolin J, Yausep OE. Pain Following Single-bundle versus Double-bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) has been known to result in better functional outcomes, joint stability, and lower revision rates compared to single-bundle (SB) ACLR. However, given the increased invasiveness and damage to the surrounding tissue area, it is proposed that it may be associated with increased pain.
AIM: This review aims to gather all studies and literature that reported pain as an outcome when comparing SB versus DB ACLR.
METHODS: Literature searching was conducted across seven search engines for studies reporting pain as an outcome and comparing SB versus DB ACLR.
RESULTS: Eight studies met the eligibility criteria and were included in the study. Overall, the studies show variable findings regarding pain in DB compared to SB ACLR, with the only statistically significant results from two studies indicating that DB ACLR is associated with more pain than SB ACLR.
CONCLUSION: Based on the limited evidence available, no conclusions can be made regarding the pain experienced between people receiving either procedure. This constitutes a need for additional studies with increased follow-up time periods, larger sample size, and better study design.
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Williams AA, Erhart-Hledik JC, Asay JL, Mahtani GB, Titchenal MR, Lutz AM, Andriacchi TP, Chu CR. Patient-Reported Outcomes and Knee Mechanics Correlate With Patellofemoral Deep Cartilage UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:675-683. [PMID: 33507800 DOI: 10.1177/0363546520982608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral joint degeneration and dysfunction after anterior cruciate ligament reconstruction (ACLR) are increasingly recognized as contributors to poor clinical outcomes. PURPOSE To determine if greater deep cartilage matrix disruption at 2 years after ACLR, as assessed by elevated patellofemoral magnetic resonance imaging (MRI) ultrashort echo time-enhanced T2* (UTE-T2*), is correlated with (1) worse patient-reported knee function and pain and (2) gait metrics related to patellofemoral tracking and loading, such as greater external rotation of the tibia at heel strike, reduced knee flexion moment (as a surrogate of quadriceps function), and greater knee flexion angle at heel strike. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS MRI UTE-T2* relaxation times in patellar and trochlear deep cartilage were compared with patient-reported outcomes and ambulatory gait metrics in 60 patients with ACLR at 2 years after reconstruction. ACLR gait metrics were compared with those of 60 uninjured reference patients matched by age, body mass index, and sex. ACLR UTE-T2* values were compared with those of 20 uninjured reference patients. RESULTS Higher trochlear UTE-T2* values were associated with worse Knee injury and Osteoarthritis Outcome Scores (KOOS) Sport/Recreation subscale scores (rho = -0.32; P = .015), and showed a trend for association with worse KOOS Pain subscale scores (rho = -0.26; P = .045). At 2 years after ACLR, greater external rotation of the tibia at heel strike was associated with higher patellar UTE-T2* values (R = 0.40; P = .002); greater knee flexion angle at heel strike was associated with higher trochlear UTE-T2* values (rho = 0.39; P = .002); and greater knee flexion moment showed a trend for association with higher trochlear UTE-T2* values (rho = 0.30; P = .019). Patellar cartilage UTE-T2* values, knee flexion angle at heel strike, and external rotation of the tibia at heel strike were all elevated in ACLR knees as compared with reference knees (P = .029, .001, and .044, respectively). CONCLUSION Patellofemoral deep cartilage matrix disruption, as assessed by MRI UTE-T2*, was associated with reduced sports and recreational function and with gait metrics reflective of altered patellofemoral loading. As such, the findings provide new mechanistic information important to improving clinical outcomes related to patellofemoral dysfunction after ACLR.
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Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Jennifer C Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Jessica L Asay
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Gordhan B Mahtani
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Amelie M Lutz
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Thomas P Andriacchi
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
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Masic I, Jankovic SM. Comparative Analysis of Web of Science and Pubmed Indexed Medical Journals Published in Former Yugoslav Countries. Med Arch 2020; 74:252-264. [PMID: 33041441 PMCID: PMC7520058 DOI: 10.5455/medarh.2020.74.252-264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The source of scientific information, methods for their evaluation, and methodology of their use are critical for serious scientific research and publishing of the scientific research results. Certain methodological principles should be inexcusably followed when designing clinical or observational research to avoid bias and presentation of results that do not reflect the truth about the phenomenon that is the object of the study. AIM The aim of this study was to compare the methodological quality of clinical trials and observational studies published in medical journals from ex-Yugoslav countries indexed in Web of Science (WoS) and Pubmed/MEDLINE. METHODS Clinical studies published in medical journals of ex-Yugoslav countries were retrieved from the WoS and Pubmed database, and the sample for analysis was randomly chosen from the retrieved publications. The rate of the most common errors in the design of clinical/observational studies was established by a careful reading of the sampled publications and their checking against predefined criteria. RESULTS Number and percent of the evaluated studies that failed to meet each of the methodological criteria tested, number of the evaluated criteria not satisfied per database and number of studies that satisfied more than 4 criteria were analyzed per database. When explanatory potential of journal impact factor, number of citations, time elapsed from publication and a database where a journal is referred were tested by linear regression in regard to the number of methodological criteria satisfied per study, the linear regression model was obtained by backward deletion method and achieved R2 adjusted of 0.166 (F=13.827, df1 = 2, df2 = 127, p=0.000). The methodological quality of studies was directly related to impact factor of the journals (B = 0.976, 95% confidence interval 0.539 - 1.413, p=0.000) and inversely with the database where a journal is referred (B =-0.444, 95% confidence interval-0.824 - -0.064, p = 0.022). Each additional unit of impact factor increased number of satisfied methodological criteria for about 1, while referring a journal only in WoS decreased number of satisfied criteria for 0.45 points in comparison with journals referred in both WoS and Pubmed/MEDLINE, and for 0.9 points in comparison to journals referred only in MEDLINE. CONCLUSION Methodological and scientometric quality of clinical studies published in medical journals from ex-Yugoslav region varies significantly, and the variations are higher in journals referenced only in WoS than in journals referenced in Pubmed/MEDLINE only, or in both Pubmed and Web of Science databases.
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Affiliation(s)
- Izet Masic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Slobodan M Jankovic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
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9
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Yazdi H, Yousof Gomrokchi A, Nazarian A, Lechtig A, Hanna P, Ghorbanhoseini M. The Effect of Gentamycin in the Irrigating Solution to Prevent Joint Infection after Anterior Cruciate Ligament (ACL) Reconstruction. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:67-74. [PMID: 30805418 PMCID: PMC6372265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/21/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Arthroscopic reconstruction of ACL is an effective method to restore knee stability after ACL rupture. Postoperative septic arthritis (SA) is very uncommon while the incidence of serious complications range between 0.14% and 1.8%. Some of the devastating consequences of septic arthritis can encompass hyaline cartilage damage, arthrofibrosis, and in rare cases amputation. The purpose of this study was to evaluate the effect of gentamicin irrigation solutions as a process to restrain septic arthritis following arthroscopic ACL reconstruction. METHODS In this retrospective cohort study, 1464 patients who underwent ACL reconstruction with hamstring tendon autograft in our institution over 7 years (February 2008 to January 2015) were included. The patients were divided into two groups based on the type of intra-articular irrigation solution used during the surgery. Patients in Group 1 (Saline) received intra-articular irrigation with normal saline (0.9 % sodium chloride) solution, while those in Group 2 (Gentamycin) received intra-articular irrigation with gentamicin (80 mg/L) added to the normal saline solution. Data about postoperative infection, its course, management, and outcome were obtained from patients' records. RESULTS Seven patients developed SA, four of whom were from SALINE group (2.2%) and three from Gentamycin group (0.23%). The incidence rate of SA after arthroscopic ACL reconstruction was significantly lower (P <0.05) when irrigated with gentamicin solution than merely with saline solution. CONCLUSION Gentamicin irrigation solution has a preservative and protective effect against SA development following arthroscopic ACL reconstruction. We recommend evaluating this technique as a way in order to depreciate the prevalence of SA after ACL reconstruction.
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Affiliation(s)
- Hamidreza Yazdi
- Department of knee Surgery, bone and joint reconstruction research center, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC, Harvard Medical School, Boston, MA, USA
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, MA, USA
- Tufts Medical Center, Boston, USA
- Research performed at Orthopaedic Department of firoozgar hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Yousof Gomrokchi
- Department of knee Surgery, bone and joint reconstruction research center, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC, Harvard Medical School, Boston, MA, USA
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, MA, USA
- Tufts Medical Center, Boston, USA
- Research performed at Orthopaedic Department of firoozgar hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ara Nazarian
- Department of knee Surgery, bone and joint reconstruction research center, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC, Harvard Medical School, Boston, MA, USA
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, MA, USA
- Tufts Medical Center, Boston, USA
- Research performed at Orthopaedic Department of firoozgar hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Aron Lechtig
- Department of knee Surgery, bone and joint reconstruction research center, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC, Harvard Medical School, Boston, MA, USA
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, MA, USA
- Tufts Medical Center, Boston, USA
- Research performed at Orthopaedic Department of firoozgar hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Philip Hanna
- Department of knee Surgery, bone and joint reconstruction research center, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC, Harvard Medical School, Boston, MA, USA
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, MA, USA
- Tufts Medical Center, Boston, USA
- Research performed at Orthopaedic Department of firoozgar hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghorbanhoseini
- Department of knee Surgery, bone and joint reconstruction research center, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC, Harvard Medical School, Boston, MA, USA
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, MA, USA
- Tufts Medical Center, Boston, USA
- Research performed at Orthopaedic Department of firoozgar hospital, Iran University of Medical Sciences, Tehran, Iran
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Mayr HO, Bruder S, Hube R, Bernstein A, Suedkamp NP, Stoehr A. Single-Bundle Versus Double-Bundle Anterior Cruciate Ligament Reconstruction-5-Year Results. Arthroscopy 2018; 34:2647-2653. [PMID: 29937346 DOI: 10.1016/j.arthro.2018.03.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare anatomic single-bundle (SB) with double-bundle (DB) anterior cruciate ligament reconstruction (ACL-R) and to evaluate the respective clinical outcome results. METHODS In a prospective randomized study, 64 patients were included and separated into 2 groups. Anatomic SB and DB ACL-Rs were performed with hamstring tendons. Five years after surgery, the follow-up (FU) examination comprised International Knee Documentation Committee (IKDC) 2000, Laxitester (ORTEMA Sport Protection, Markgroeningen, Germany) measurement, and radiograph evaluation. Power calculation was performed to achieve a 95% confidence interval and 80% power on the base of 7-point IKDC subjective difference between the groups. RESULTS A total of 53 patients (83% FU) were examined at 63.2 ± 4.7 months after surgery: 28 patients in the DB group and 25 patients in the SB group. IKDC subjective (SB: 92.8 ± 6.2, DB: 91.6 ± 7.1; P = .55) and objective scores (grade A SB/DB 20%/25%, B SB/DB 72%/57%, C SB/DB 8%/18%, D SB/DB 4%/0%; P = .45) showed no differences comparing both groups. The Laxitester measurements showed no significant difference in regard to anterior-posterior translation in neutral, internal, and external rotation or to rotation angles (P = .79). No difference was seen between the groups regarding osteoarthritic changes and tunnel widening. CONCLUSIONS At the 5-year FU, no advantage for either the DB or SB technique in ACL-R can be seen with regard to patient-related and objective outcome measures. LEVEL OF EVIDENCE Level I, prospective randomized controlled clinical trial.
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Affiliation(s)
- Hermann O Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; Department of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Munich, Germany.
| | - Silvia Bruder
- Department of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Munich, Germany
| | - Robert Hube
- Department of Orthopedic Surgery, OCM-Clinic, Munich, Germany
| | - Anke Bernstein
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Norbert P Suedkamp
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Amelie Stoehr
- Department of Orthopedic Surgery, OCM-Clinic, Munich, Germany
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11
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El-Sherief FAH, Aldahshan WA, Wahd YE, Abdelaziz AM, Soliman HAG, Hassan TG, Elbehairy HF, Awadallah AH. Double-bundle anterior cruciate ligament reconstruction is better than single-bundle reconstruction in terms of objective assessment but not in terms of subjective score. Knee Surg Sports Traumatol Arthrosc 2018; 26:2395-2400. [PMID: 29159673 DOI: 10.1007/s00167-017-4804-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 11/10/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE A comparison of clinical outcomes between double-bundle (DB) and single-bundle (SB) anterior cruciate ligament (ACL) reconstruction for patients with ACL injury. METHODS Sixty patients were treated with either SB (n = 30) or DB (n = 30) ACL reconstruction between 2011 and 2012. The hamstring tendons were autografted with suspensory fixation on the femoral side, while a bio-absorbable interference screw was used for fixation on the tibial side. These patients were evaluated using Lysholm score, International Knee Documentation Committee (IKDC) forms (both objective and subjective), Lachman test, pivot shift test, and KT 1000 arthrometer. RESULTS After a median follow-up duration of 35.5 months (ranging between 30 and 42 months), the frequency of patients who had high objective IKDC scores was significantly higher in the DB group than those in the SB group. In terms of DB, the Lachman test was normal in 26 patients (86.7%), nearly normal in three patients (10%), and abnormal in one patient (3.3%); comparatively, in terms of SB, the Lachman test was normal in 20 patients (66.7%), nearly normal in eight patients (26.7%) and abnormal in two patients (6.6%). The pivot shift test was negative in 29 patients (96.7%) and 21 patients (70%) for DB and SB, respectively. The average KT-1000 side-to-side difference was 1.0 mm for DB and 1.5 mm for SB. The subjective IKDC and Lysholm score showed non-significant differences between both techniques. CONCLUSION Double-bundle ACL reconstruction was found to have a significant advantage in anterior and rotational stability as well as objective IKDC than that of SB reconstruction. However, subjective measurements showed no statistical differences between the techniques. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Faisal Ahmed Hashem El-Sherief
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt.
| | - Wael Abdelkarim Aldahshan
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Yaser Elsayed Wahd
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Ashraf Mohamed Abdelaziz
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Hany Abdel Gawwad Soliman
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Tohamy Goda Hassan
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Hassan Fathy Elbehairy
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Adel Hamed Awadallah
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt
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