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Kraeutler MJ, McCulloch PC, Sherman SL, Vidal AF. The Principles of Knee Joint Preservation: Operative Treatment Strategies. J Bone Joint Surg Am 2023; 105:1638-1646. [PMID: 37616413 DOI: 10.2106/jbjs.23.00212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
➤ Joint alignment, meniscal status, and ligament stability are codependent factors involved in knee joint preservation, and any injury or imbalance can impact the knee articular cartilage status and can result in adverse clinical outcomes.➤ Cartilage preservation procedures in the knee will not result in optimal outcomes if there is joint malalignment, meniscal deficiency, or ligamentous instability.➤ Lower-extremity varus or valgus malalignment is a risk factor for the failure of an anterior cruciate ligament (ACL) reconstruction. It represents an indication for a high tibial osteotomy or distal femoral osteotomy in the setting of failed ACL reconstruction, and may even be considered in patients who have an initial ACL injury and severe malalignment.➤ An elevated posterior tibial slope increases the risk of failure of ACL reconstruction, whereas a decreased posterior tibial slope increases the risk of failure of posterior cruciate ligament reconstruction.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Seth L Sherman
- Department of Orthopedic Surgery, Stanford University, Redwood City, California
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TWO TO 14 YEAR OUTCOMES OF COMBINED MENISCAL ALLOGRAFT TRANSPLANTATION WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A SYSTEMATIC REVIEW. Arthroscopy 2022; 39:1584-1592.e1. [PMID: 36343764 DOI: 10.1016/j.arthro.2022.10.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with meniscal allograft transplantation (MAT) through systematic review of current available evidence. METHODS A systematic database search of PubMed, Embase, Web of Science and CINAHL was performed from inception up to 7 December 2021 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Follow-up studies (inception cohort studies/non-randomized controlled trials/retrospective cohort studies) and case series that had more than 10 people published in English, which involved patients who underwent a combination of ACLR and MAT were included. Quality of these studies were appraised using the Cochrane Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Systematic review of International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores were conducted. RESULTS Seven studies involving 363 patients were included. The average mean follow up time was 4.08 years, ranging from 1.75 to 14 years. All studies used the Lysholm Knee Scoring system to report clinical outcomes, while two studies and four studies used the IKDC Questionnaire and Tegner activity scale respectively to measure clinical outcomes post-operatively. Comparing postoperative to pre-operative scores, we found an improvement above the minimal clinically important difference (MCID) for the Lysholm (Mean Difference (MD) range= 16.00 to 26.10) and Tegner activity scores (MD range = 1.50 to 1.90). All but one study reported an increase above the MCID for IKDC scores post-op (MD range= 5.60 to 23.00). CONCLUSIONS Combined MAT and ACLR have good two to 14 year clinical outcomes post operatively and is an optimal procedure for patients with concurrent ACL injuries with irreparable meniscus injuries. More prospective studies and studies evaluating outcome differences between concurrent ACLR with MAT and staged ACLR with MAT should be conducted. LEVEL OF EVIDENCE IV, systematic review and/or meta-analysis of studies with Levels I to IV.
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Jackson GR, Meade J, Yu Z, Young B, Piasecki DP, Fleischli JE, Parisien RL, Trofa DP, Saltzman BM. Outcomes and failure rates after revision meniscal repair: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:1557-1562. [PMID: 35477793 DOI: 10.1007/s00264-022-05413-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this meta-analysis is to determine the outcomes and failure rates for revision meniscus repairs in patients with re-tears after primary repair failure. METHODS A literature search was conducted using PubMed and Embase with the terms "Meniscus," "Meniscal," "Revised," and "Revision." The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol and included four articles (79 patients). The search criteria were limited to studies reporting outcomes and failure rates. The exclusion criteria included languages other than English, biomechanical studies, letters to editors, non-full text, review articles, meta-analysis, and case reports. RESULTS Four comparative studies with 79 patients (53 males, 26 females) with a mean age of 23.9 ± 6.4 years treated with a revision meniscus repair were included in the final analysis. Within this analysis, we found a failure rate of 25.3% (20 of 79 patients). Of these failed repairs, 30.95% (13 of 42) were of the medial meniscus, and 18.9% (7 of 37) were of the lateral meniscus. In the four articles, the postoperative Tegner sports activity score was found to be 6.1 ± 1.6 (range, 2 to 10). The post-operative Lysholm score was reported in three articles (45 patients). At a mean follow-up of 58.3 ± 23.9 months, the mean post-operative Lysholm score was 89.1 ± 7.6 (range, 38 to 100). The Coleman score for the included articles ranged between 52 and 59. CONCLUSION This analysis found that revision meniscus repairs in patients with re-tears after primary repair failure result in clinical outcomes similar to that of primary repairs.
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Affiliation(s)
- Garrett R Jackson
- School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten
| | - Joshua Meade
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina, Charlotte, NC, USA
| | - Ziqing Yu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina, Charlotte, NC, USA
| | - Bradley Young
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina, Charlotte, NC, USA
| | - Dana P Piasecki
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina, Charlotte, NC, USA
| | - James E Fleischli
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina, Charlotte, NC, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Queens, NY, USA
| | - David P Trofa
- Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Bryan M Saltzman
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA. .,OrthoCarolina, Charlotte, NC, USA.
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Suh D, Chang MJ, Park HJ, Chang CB, Kang SB. Assessment of Anterolateral Ligament of the Knee After Primary Versus Revision Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:23259671211026237. [PMID: 34676268 PMCID: PMC8524717 DOI: 10.1177/23259671211026237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/28/2021] [Indexed: 01/26/2023] Open
Abstract
Background: The anterolateral ligament of the knee (ALL) is a component of the lateral
complex that stabilizes the structure against rotational force and may be
associated with the outcome of anterior cruciate ligament (ACL)
reconstruction (ACLR). Purpose: To (1) find whether the visibility of the structure of the ALL is different
in primary and revision ACLR groups, (2) determine whether the abnormal
findings of the ALL structure on magnetic resonance imaging (MRI) scans are
associated with type of trauma in ACL injury and mode of graft failure, and
(3) determine whether there are differences in knee functional scores
between patients with or without abnormal findings of the ALL structure on
MRI scans in primary and revision ACLR groups. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 40 patients who underwent primary ACLR and
39 patients who underwent revision ACLR. Conventional MRI (1.5-T) scans
taken before primary or revision ACLR were obtained and analyzed for
visibility of the ALL, frequency and degree of injury of the ALL, and ALL
signal anomalies. We also evaluated 1-year postoperative functional knee
scores using the subjective International Knee Documentation Committee and
Lysholm scores. Results: Visibility of the ALL was better in the primary ACLR group than the revision
ACLR group (38% vs 14%; P = .041). The primary ACLR group
showed a lower degree of injury across the femoral, meniscal, and tibial
attachment sites than did the revision ACLR group (30% vs 13%, 41% vs 8%,
and 62% vs 26%, respectively). Relative signal anomaly of the ALL was more
frequent in the case of contact versus noncontact trauma of the ACL (85% vs
15%; P = .035), while absolute signal anomaly was equally
observed between cases of contact and noncontact trauma in the primary ACLR
group (50% vs 50%). No association was observed between ALL signal anomalies
and 1-year postoperative functional knee scores. Conclusion: The revision ACLR group offered less visibility and showed a tendency for
more frequent, higher degree of injury to the structure of the ALL.
Regardless of observational differences between the 2 groups, no definite
relevance was observed between the image and the functional outcome. For the
assessment of the ALL, routinely performed conventional MRI alone is
insufficient to make a clinical decision.
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Affiliation(s)
- Dongwhan Suh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Daejeon, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung Jun Park
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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Zhang K. RESEARCH ON STABILITY OF ATHLETE KNEE QULUS LIGTE RECONSTRUCTION. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127082021_0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction: ACL injury of the knee joint is common in sports. Due to the special characteristics of strong physical confrontation and high speed, basketball has a high risk of ACL injury. Objective: To investigate the stability of anterior cruciate ligament (ACL) reconstruction on knee injury in athletes. Methods: In the south, medical research selected 3 cases of unilateral injuries in men's basketball athletes with arthroscopic anterior cruciate ligament autogenous tendon revascularization. We started collecting and recording data of three players three days after rehabilitation training, at various stages in the process Results: At the end of rehabilitation training, 10 weeks after operation, the pain disappeared, the range of motion of the knee joint increased significantly, muscle atrophy of bilateral lower limbs diminished, knee joint stability improved, knee joint muscle strength of the affected leg strengthened, and the rehabilitation goal was basically accomplished. Conclusions: Early rehabilitation training can effectively restore the movement function of the patient's knee joint, improve the efficiency of rehabilitation and shorten the rehabilitation period, thus helping the injured individual recover from the injury and return to the game rapidly. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Young EP, Chan PH, Prentice HA, Amar K, Hurvitz AP, Khan NA. Aseptic Revision and Reoperation Risks After Meniscectomy at the Time of Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:1296-1304. [PMID: 33667127 DOI: 10.1177/0363546521997101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An intact meniscus is considered a secondary stabilizer of the knee after anterior cruciate ligament reconstruction (ACLR). While loss of the meniscus can increase forces on the anterior cruciate ligament graft after reconstruction, it is unclear whether this increased loading affects the success of the graft after ACLR. PURPOSE To identify the risk of subsequent knee surgery when meniscectomy, either partial or total, is performed at the time of index ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We conducted a matched cohort study using data from the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry. Patients were identified who had a primary ACLR performed between January 1, 2005 and December 31, 2016, with up to 12 years of follow-up. The study sample comprised patients with ACLR who had a lateral meniscectomy (n = 2581), medial meniscectomy (n = 1802), or lateral and medial meniscectomies (n = 666). For each meniscectomy subgroup, patients with ACLR alone were matched to patients with a meniscectomy on a number of patient and procedure characteristics. After the application of matching, Cox proportional hazards regression was used to evaluate the risk of aseptic revision, while competing risks regression was used to evaluate the risk of cause-specific ipsilateral reoperation between meniscectomy and ACLR alone. Analysis was performed for each meniscectomy subgroup. RESULTS After the application of matching, we failed to observe a difference in aseptic revision risk for patients with ACLR and a meniscectomy-lateral (hazard ratio [HR], 0.80; 95% CI, 0.63-1.02), medial (HR, 0.95; 95% CI, 0.70-1.29), or both (HR, 1.25; 95% CI, 0.77-2.04)-as compared with ACLR alone. When compared with patients who had ACLR alone, patients with a lateral meniscectomy had a higher risk for subsequent lateral meniscectomy (HR, 1.89; 95% CI, 1.18-3.02; P = .008), and those with a medial meniscectomy had a lower risk for manipulation under anesthesia (HR, 0.13; 95% CI, 0.02-0.92; P = .041). CONCLUSION No difference in aseptic revision risk was observed for patients undergoing primary ACLR between groups with and without meniscectomy at the time of index surgery. Partial lateral meniscectomy at the time of index ACLR did associate with a higher risk of subsequent lateral meniscectomy.
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Affiliation(s)
- Edmond P Young
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, California, USA
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Heather A Prentice
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Karun Amar
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, California, USA
| | - Andrew P Hurvitz
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, California, USA
| | - Najeeb A Khan
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, California, USA
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Rhim HC, Lee JH, Han SB, Shin KH, Suh DW, Jang KM. Role of the Triceps Surae Muscles in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Matched Case-Control Study. J Clin Med 2020; 9:jcm9103215. [PMID: 33036346 PMCID: PMC7600692 DOI: 10.3390/jcm9103215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/23/2022] Open
Abstract
A limited number of studies has investigated the gastrocnemius and soleus in patients undergoing anterior cruciate ligament reconstruction (ACLR). This study investigated the muscle strength (Nm kg−1 × 100) and reaction time (acceleration time (AT), milliseconds) of thigh and calf muscles in patients undergoing ACLR. Thirty-two patients with ACLR and 32 normal control subjects were included. One year postoperatively, the strength of thigh muscles was significantly reduced after ACLR compared with that of controls (hamstring: 80 ± 31.3 vs. 142 ± 26.4, p < 0.001, quadriceps: 159 ± 63.7 vs. 238 ± 35.3, p < 0.001). However, the strength of calf muscles was not significantly different compared with that of controls (gastrocnemius: 77 ± 22.9 vs. 81 ± 22.5, p = 0.425, soleus: 54 ± 15.9 vs. 47 ± 16.1, p = 0.109). The AT of calf muscles was significantly faster after ACLR than that of controls (gastrocnemius: 26 ± 9.8 vs. 31 ± 9, p = 0.030, soleus: 18 ± 6.7 vs. 22 ± 8.5, p = 0.026). The AT of thigh muscles was significantly elongated after ACLR than that of controls (hamstring: 72 ± 18 vs. 55 ± 12.4, p < 0.001, quadriceps: 63 ± 17.6 vs. 47 ± 17, p < 0.000). The strength of thigh muscles was reduced, and the ATs of thigh muscles were slower one year after ACLR. However, the AT of the triceps surae was faster than that of controls. This may implicate a compensatory mechanism of the triceps surae for the weakness and delayed activation in hamstring and quadriceps muscles.
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Affiliation(s)
- Hye Chang Rhim
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (H.C.R.); (S.-B.H.); (K.-H.S.)
| | - Jin Hyuck Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea;
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (H.C.R.); (S.-B.H.); (K.-H.S.)
| | - Kyun-Ho Shin
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (H.C.R.); (S.-B.H.); (K.-H.S.)
| | - Dong Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam 13497, Korea;
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (H.C.R.); (S.-B.H.); (K.-H.S.)
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea;
- Correspondence: ; Tel.: +82-292-06-406
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Seo SS, Kim CW, Lee CR, Park DH, Kwon YU, Kim OG, Kim CK. Second-look arthroscopic findings and clinical outcomes of meniscal repair with concomitant anterior cruciate ligament reconstruction: comparison of suture and meniscus fixation device. Arch Orthop Trauma Surg 2020; 140:365-372. [PMID: 31838547 DOI: 10.1007/s00402-019-03323-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the healing rate of repaired meniscus and functional outcomes of patients who received all-inside meniscal repair using sutures or devices with concomitant arthroscopic anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS Among the patients who have ACL tear and posterior horn tear of medial or lateral meniscus, 61 knees who received all-inside repair using sutures (suture group, n = 28) or meniscal fixation devices (device group, n = 33) with concomitant ACL reconstruction during the period from January 2012 to December 2015, followed by second-look arthroscopy, were retrospectively reviewed. Healing status of the repair site was assessed by second-look arthroscopy. Through the clinical assessment, clinical success (negative medial joint line tenderness, no history of locking or recurrent effusion, and negative McMurray test) rate of the repaired meniscus and functional outcomes (International Knee Documentation Committee subjective score and Lysholm knee score) was evaluated. RESULTS In a comparison of healing status of repaired meniscus evaluated by second-look arthroscopy, suture group had 23 cases of complete healing (82.1%), 4 cases of incomplete healing (14.3%), and 1 case of failure (3.6%). Device group had 18 cases of complete healing (54.5%), 4 cases of incomplete healing (24.2%), and 7 cases of failure (21.2%) (p = 0.048). Clinical success rate of the meniscal repair was 89.3% (25 cases) and 81.8% (27 cases) in suture group and device group, respectively (p = 0.488). No significant difference of functional outcomes was observed between the two groups (p > 0.05, both parameters). CONCLUSIONS Among the patients who received meniscal repair with concomitant ACL reconstruction, suture group showed better healing status of repaired meniscus based on the second-look arthroscopy than device group. However, no significant between-group difference of clinical success rate and functional outcomes was observed.
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Affiliation(s)
- Seung-Suk Seo
- Department of Orthopedic Surgery, Haeundae Bumin Hospital, 584, Haeundae-ro, Haeundae-gu, Busan, 48094, Republic of Korea
| | - Chang-Wan Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea.
| | - Dae-Hyun Park
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Yong-Uk Kwon
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Ok-Gul Kim
- Department of Orthopedic Surgery, Bumin Hospital, 59, Mandeok-daero, Buk-gu, Busan, 46555, Republic of Korea
| | - Chang-Kyu Kim
- Department of Orthopedic Surgery, Haeundae Bumin Hospital, 584, Haeundae-ro, Haeundae-gu, Busan, 48094, Republic of Korea
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Lee JK, Seo YJ, Jeong SY, Yang JH. Biomechanical function of the anterolateral ligament of the knee: a systematic review. Knee Surg Relat Res 2020; 32:6. [PMID: 32660580 PMCID: PMC7219217 DOI: 10.1186/s43019-019-0021-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/21/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND It has been suggested that the anterolateral ligament (ALL) is an important anterolateral stabilizer of the knee joint which functions to prevent anterolateral subluxation and anterior subluxation at certain flexion angles in the knee. PURPOSE To analyze and systematically interpret the biomechanical function of the ALL. METHODS An online search was conducted for human cadaveric biomechanical studies that tested function of the ALL in resisting anterolateral subluxation and anterior subluxation of the knee. Two reviewers independently searched Medline, Embase, and the Cochrane Database of Systematic Reviews for studies up to 25 September 2018. Biomechanical studies not reporting the magnitude of anterior tibial translation or tibial internal rotation in relation to the function of the ALL were excluded. RESULTS Twelve biomechanical studies using human cadavers evaluating parameters including anterior tibial translation and/or internal tibial rotation in anterior cruciate ligament (ACL)-sectioned and ALL-sectioned knees were included in the review. Five studies reported a minor increase or no significant increase in anterior tibial translation and internal tibial rotation with further sectioning of the ALL in ACL-deficient knees. Five studies reported a significant increase in knee laxity in tibial internal rotation or pivot shift with addition of sectioning the ALL in ACL-deficient knees. Two studies reported a significant increase in both anterior tibial translation and internal tibial rotation during application of the anterior-drawer and pivot-shift tests after ALL sectioning. CONCLUSION There was inconsistency in the biomechanical characteristics of the ALL of the knee in resisting anterolateral and anterior subluxation of the tibia.
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Affiliation(s)
- Jin Kyu Lee
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Young Jin Seo
- Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Dongtan, Gyeonggi-do, South Korea
| | - Soo-Young Jeong
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Jae-Hyuk Yang
- Department of Orthopedic Surgery, Guri Hospital, Hanyang University Medical Center, 153, Gyeongchunro, Guri, Gyeonggi-Do, 11923, South Korea.
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Kim SG, Kim SH, Baek JH, Kim JG, Jang KM, Lim HC, Bae JH. High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study. Knee Surg Relat Res 2019; 31:11. [PMID: 32660645 PMCID: PMC7219574 DOI: 10.1186/s43019-019-0009-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Multicenter Orthopaedic Outcomes Network (MOON) group recently reported that medial meniscus (MM) repairs are associated with more frequent re-operations when compared to lateral meniscus (LM) repairs. The purpose of this study was to compare the meniscal healing and the incidence of subsequent re-operation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries. Methods We retrospectively reviewed patients who underwent second-look arthroscopy after primary ACL reconstruction (ACLR) between June 2005 to December 2016. The healing of meniscal tears following repair or left in situ, and re-tear following partial meniscectomy, were evaluated via second-look arthroscopy and compared between medial and lateral meniscus. Moreover, the incidence of subsequent meniscal re-operation after the index ACLR were investigated and compared between medial and lateral meniscus. Subsequent meniscal re-operation was performed in cases of the following three symptomatic meniscus tears: re-tears at the meniscectomy site; new tears; and failed healing of repaired or left in situ meniscus. Results There were 148 meniscal tears in 121 patients at index ACLR. There were 62 MM tears, 38 LM tears, and 24 bilateral meniscus tears. At second-look arthroscopy, the “successful healing” rate for tears following repair was higher in LM tears (91.2%) compared to MM tears (80.0%), although it was not statistically significant (p > 0.05). No significant differences were observed in the healing of left in situ tears or re-tear of meniscectomy site between medial and lateral meniscus. Patients with MM tears combined with ACL injuries had a higher incidence of subsequent meniscal re-operation compared to patients with LM tears (25.6% vs 16.1%, p = 0.025). Conclusions There was a trend for the successful healing rate to be higher in LM repairs than MM repairs. Subsequent meniscal re-operations after ACLR were more frequent in patients with medial meniscal tears concurrently with ACL injuries in comparison to patients with lateral meniscal tears. Level of study Level IV, retrospective case series.
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Affiliation(s)
- Sang-Gyun Kim
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan‑si, Gyeongki‑do, 15355, Republic of Korea
| | - Soo-Hyun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jung-Heum Baek
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan‑si, Gyeongki‑do, 15355, Republic of Korea
| | - Jae-Gyoon Kim
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan‑si, Gyeongki‑do, 15355, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hong-Chul Lim
- Department of Orthopaedic Surgery, Seoul Barunsesang Hospital, 421, Siheung-daero, Geumcheon-gu, Seoul, 08523, Republic of Korea
| | - Ji-Hoon Bae
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Abstract
Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears.
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Affiliation(s)
| | - Emily Naclerio
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA,Address for correspondence: Dr. Seth L Sherman, Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave., Columbia, MO 65212, USA. E-mail:
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