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Truong PN, Toan NV, Nam VH, Fang WH, Vangsness CT, Han B, Hoang BX. Preoperative Determination of the Size of the Semitendinosus and Gracilis Tendon by Multidetector Row CT Scanner for Anterior Cruciate Ligament Reconstruction. J Knee Surg 2022; 35:1556-1562. [PMID: 33853156 DOI: 10.1055/s-0041-1727112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accurately measuring the length and diameter of the hamstring tendon autograft preoperatively is important for planning anterior cruciate ligament (ACL) reconstructive surgery. The purpose of this study was to assess the reliability of three-dimensional computed tomography (3D CT) scanning technique to produce the actual measurement of the gracilis and semitendinosus (GT and ST, respectively) tendon grafts' length and diameter for surgery. Ninety patients were scheduled for ACL reconstruction with hamstring autograft. Before the surgery, patients were examined under the multidetector row CT scanner and the ST and GT tendons were qualitatively measured by a volume-rendering technique. The length of ST and GT was measured with 3D CT compared with the length of the harvested ST and GT. The cross-sectional area (CSA) of ST and GT measured with 3D CT compared with the ST and GT graft diameter. Tendon size measured preoperatively and during surgery were statistically compared and correlated. The GT tendons length and cross-sectional area measured during surgery was both shorter and smaller compared with the ST tendon. GT and ST tendon length were correlated to patients' body index such as the height and weight (p < 0.05). However, the correlation levels were low to medium (r = 0.23-0.49). There was strong correlation between the lengths of GT (r = 0.76; p < 0.001) and ST (r = 0.87; p < 0.001) measured with the 3D CT and tendon length at surgery. There was a moderate correlation between graft diameter measured at surgery and 3D CT cross-sectional area (r = 0.31; p < 0.05). A multidetector row CT scanner can determine the ST and GT tendons' length and diameter. These measurements can be used for preoperative planning to help determine the surgical method and counsel patients on appropriate graft choices prior to surgery.
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Affiliation(s)
- Pham N Truong
- Department of Trauma and Orthopeadic, 198 Hospital, Hanoi, Vietnam
| | - Ngo V Toan
- Department of Trauma and Orthopeadic 1, VietDuc Hospital, Hanoi, Vietnam
| | - Vũ H Nam
- Department of Trauma and Orthopeadic, 198 Hospital, Hanoi, Vietnam
| | - William H Fang
- Department of Translational Research, Western University of Health Sciences, Pomona, California
| | - C Thomas Vangsness
- Department of Orthopaedics, Keck School of Medicine, USC, Los Angeles, California
| | - Bo Han
- Department of Surgery, Keck School of Medicine USC, Los Angeles, California
| | - Ba X Hoang
- Department of Surgery, Keck School of Medicine USC, Los Angeles, California
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Huang W, Ong TY, Fu SC, Yung SH. Prevalence of patellofemoral joint osteoarthritis after anterior cruciate ligament injury and associated risk factors: A systematic review. J Orthop Translat 2019; 22:14-25. [PMID: 32440495 PMCID: PMC7231960 DOI: 10.1016/j.jot.2019.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/23/2019] [Accepted: 07/09/2019] [Indexed: 01/17/2023] Open
Abstract
Background The prevalence of patellofemoral joint (PFJ) osteoarthritis (OA) after anterior cruciate ligament (ACL) injury was inconsistently reported in the literature. This review summarises the reported prevalence of PFJ OA and risk factors of PFJ OA after ACL injury. Methods PubMed, Embase, WoS, and MEDLINE (OVID) were searched up to 1 March 2019. A modified version of the Coleman methodology score was used to assess the methodological quality of the included studies. Prevalence of PFJ OA was pooled depended on different interventions in ACL injured populations. Results Thirty-eight studies were included. Five different radiographic classification methods were used: the Kellgren and Lawrence Grade 2, IKDC Grade B, Fairbank Grade 1, joint space narrowing of Grade 2 based on OARSI, and Ahlbäck Grade 1. One included study used MRI Osteoarthritis Knee Score to evaluate PFJ degenerative changes. The overall prevalence of PFJ OA after ACL injury in included studies varied between 4.5% and 80%. The large variation of PFJ OA prevalence is mainly because of different follow-up period and surgical techniques. The pooled data showed that bone-patellar tendon-bone graft, single-bundle ACL reconstruction (ACLR), and delayed ACLR are likely associated with PFJ degenerative changes after ACL injury. ACLR, delayed ACLR, body mass index (BMI), meniscectomy, patellofemoral chondral lesions, age at surgery, and TFJ OA were identified in the literature inducing PFJ OA after ACL injury. Conclusions Large variations of PFJ OA after ACL injury are associated with different follow-up period and surgical techniques. ACL reconstructed population with bone-patellar tendon-bone graft, single-bundle reconstruction, and delayed operation time has a high prevalence of PFJ OA. The translational potential of this article This review focuses more on the effect of surgical technique factors on the degenerative changes on PFJ. The results reveal that BPTB, single-bundle reconstruction, and delayed ACLR are more likely associated with PFJ degenerative changes after ACL injury. These findings imply that awareness of PFJ problems after surgical intervention will remind of surgeons taking PFJ into consideration in operations, which is likely to reduce the incidences of anterior knee pain, patellar maltracking, and over-constrained patella in the early stage after surgery.
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Key Words
- ACL, Anterior Cruciate Ligament
- ACLR, Anterior Cruciate Ligament Reconstruction
- Anterior cruciate ligament injury
- BPTB, Bone-Patellar Tendon-Bone
- CI, Confidence Interval
- CMS, Coleman methodology score
- HS, Hamstring
- IKDC, International Knee Documentation Committee
- JSN, Joint Space Narrowing
- KL, Kellgren and Lawrence
- MOAKS, MRI Osteoarthritis Knee Score
- OA, Osteoarthritis
- OARSI, Osteoarthritis Research Society International
- ORs, odd ratios
- PFJ, Patellofemoral Joint
- Patellofemoral joint osteoarthritis
- Prevalence
- Risk factors
- TFJ, Tibiofemoral Joint
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Affiliation(s)
- Wenhan Huang
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Tim-Yun Ong
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Sai-Chuen Fu
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Shu-Hang Yung
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Kim JG, Kang SH, Kim JH, Lim CO, Wang JH. Comparison of Clinical Results, Second-Look Arthroscopic Findings, and MRI Findings Between the Transportal and Outside-In Techniques for Double-Bundle Anatomic Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Trial With a Minimum 2-Year Follow-up. Am J Sports Med 2018; 46:544-556. [PMID: 29293362 DOI: 10.1177/0363546517744535] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although image analysis has shown that the outside-in (OI) technique is associated with different femoral tunnel geometry than the transportal (TP) technique in anatomic anterior cruciate ligament (ACL) reconstruction, it is not known whether clinical results differ between the 2 techniques. PURPOSE To compare clinical results, second-look arthroscopic findings, and magnetic resonance imaging (MRI) findings between the TP and OI techniques in anatomic double-bundle (DB) ACL reconstruction. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS From November 2010 to March 2013, 128 patients were enrolled in this study and were randomly assigned to either the TP group (64 patients) or the OI group (64 patients), and DB ACL reconstructions were performed. At the minimum 2-year follow-up (34.9 ± 10.9 months), 111 patients (86.7%) were evaluated with multiple clinical scores and stability tests (KT-2000 arthrometer, Lachman test, and pivot-shift test). Ninety-three knees were evaluated for graft continuity, graft tension, and synovialization by use of second-look arthroscopy. Seventy-eight knees were evaluated on MRI for graft continuity, femoral graft tunnel healing, and graft signal/noise quotient (SNQ). The primary outcome was KT-2000 arthrometer results. Results were compared between the TP and OI groups. RESULTS No significant differences were found between the 2 groups in terms of KT-2000 arthrometer results, which was the primary outcome, and other clinical results, with the exception of the postoperative functional test of International Knee Documentation Committee (IKDC) objective score. The ratio of grade A and B on the postoperative functional test of IKDC objective score was significantly larger for the OI group (51/58) than the TP group (36/53) ( P = .005). The second-look arthroscopic findings were not significantly different between the 2 groups in either bundle ( P > .05). In addition, MRI findings did not differ significantly between the 2 groups ( P > .05). CONCLUSION With the exception of the functional test of IKDC objective score, we found that clinical results, second-look arthroscopic findings, and MRI findings did not differ significantly between the OI and TP techniques for anatomic ACL reconstruction, although femoral tunnel geometries differed significantly between the 2 techniques.
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Affiliation(s)
- Jae Gyoon Kim
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Seung Hoon Kang
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Chae Ouk Lim
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
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Lee BH, Jangir R, Kim HY, Shin JM, Chang M, Kim K, Wang JH. Comparison of anterior cruciate ligament volume after anatomic double-bundle anterior cruciate ligament reconstruction. Knee 2017; 24:580-587. [PMID: 28408164 DOI: 10.1016/j.knee.2017.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 01/31/2017] [Accepted: 02/24/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUD To determine whether anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) can restore the native ACL volume, and whether the volume change after reconstruction affects clinical outcomes and re-rupture rates following the contemporary techniques. METHODS Eighty patients undergoing anatomic DB-ACLR using transportal or outside-in technique were prospectively evaluated with magnetic resonance imaging (MRI) before and after surgery. The ACL volumes were determined from 3-D models constructed by applying reverse engineering software. In all participants, measured reconstructed ACL volume were compared with the ACL on the opposite uninjured side. Participants were divided into two groups according to the volume of reconstructed graft; larger volume than native ACL of contra-lateral side (Group 1) or smaller (Group 2). RESULTS The mean ACL volume on the reconstructed side (1726.5mm3, 982.1 - 2733.8) was significantly smaller than that on the uninjured opposite side (1857.6mm3, 958.2 - 2871.5) (P<0.001). A total of 31 patients in Group 1 and 49 in Group 2 showed no significant difference of improvement in the clinical outcome scales at the postoperative two-year follow-up (Lysholm knee score, P=0.830, Tegner activity score, P=0.848). Four patients with ACL re-rupture during the two-year follow-up after reconstruction had smaller reconstructed ACL volumes than native ligament on the opposite site. CONCLUSION Anatomic DB-ACLR technique restored the graft volume rather smaller than the volume of the native ACL. Based on the volumetric consideration, graft reconstructed by anatomic DB-ACLR might have increased probability of re-rupture due to its smaller volume related to native ACL on the contralateral side.
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Affiliation(s)
- Byung Hoon Lee
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Rajat Jangir
- Department of Orthopedics, Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur, India
| | - Hun Yeong Kim
- Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Jung Min Shin
- Hanyang Medical Center, Hanyang University, Seoul, South Korea
| | - Minho Chang
- School of Mechanical Engineering, Korea University, Seoul, South Korea
| | - Kwon Kim
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University; Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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Torkaman A, Yazdi H, Hosseini MG. The Results of Single Bundle Versus Double Bundle ACL Reconstruction Surgery, a Retrospective Study and Review of Literature. Med Arch 2016; 70:351-353. [PMID: 27994295 PMCID: PMC5136424 DOI: 10.5455/medarh.2016.70.351-353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/29/2016] [Indexed: 11/16/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the results of single bundle and double bundle surgical techniques for anterior cruciate ligament (ACL) reconstruction. Methods: In this study, all single bundle and double bundle ACL reconstruction surgeries that were done in our university hospital from January 2008 to December 2012 were enrolled. All patients were followed at 2,6,12, 24 weeks and 1 a 2 years post operatively. On last follow up all patients were evaluated by clinical examination, KT-1000 and Lysholm questionnaire. Results: Seventy five patients were operated using single bundle and eighty five patients with double bundle technique. Fifty seven percent of patients in single bundle and 80% of patients in double bundle group had experienced pain during follow-up period. None of cases had knee extension or flexion loss. The average side to side differences using KT-1000 was 3.5 ± 0.38 (2.9-4.1) millimeters in single bundle group and 3.39 ± 0.39 (2.8-4) millimeters in double bundle group. These results showed no significant difference between two groups (P= 0.31). Lysholm score improved significantly in both groups, but there was no significant difference between them. Conclusion: According to this study the clinical results of single bundle ACL reconstruction was similar to double bundle reconstruction in short term follow up. Further studies are needed to evaluate the long term results.
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Affiliation(s)
- Ali Torkaman
- Department of Knee Surgery, Firoozgar Hospital, Iran University of Medical Science, Tehran, Iran
| | - Hamidreza Yazdi
- Department of Knee Surgery, Firoozgar Hospital, Iran University of Medical Science, Tehran, Iran
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Yoo YS, Song SY, Yang CJ, Ha JM, Kim YS, Seo YJ. A Comparison between Clinical Results of Selective Bundle and Double Bundle Anterior Cruciate Ligament Reconstruction. Yonsei Med J 2016; 57:1199-208. [PMID: 27401652 PMCID: PMC4960387 DOI: 10.3349/ymj.2016.57.5.1199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/12/2015] [Accepted: 02/17/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the clinical outcomes of arthroscopic anatomical double bundle (DB) anterior cruciate ligament (ACL) reconstruction with either selective anteromedial (AM) or posterolateral (PL) bundle reconstruction while preserving a relatively healthy ACL bundle. MATERIALS AND METHODS The authors evaluated 98 patients with a mean follow-up of 30.8±4.0 months who had undergone DB or selective bundle ACL reconstructions. Of these, 34 cases underwent DB ACL reconstruction (group A), 34 underwent selective AM bundle reconstruction (group B), and 30 underwent selective PL bundle reconstructions (group C). These groups were compared with respect to Lysholm and International Knee Documentation Committee (IKDC) score, side-to-side differences of anterior laxity measured by KT-2000 arthrometer at 30 lbs, and stress radiography and Lachman and pivot shift test results. Pre- and post-operative data were objectively evaluated using a statistical approach. RESULTS The preoperative anterior instability measured by manual stress radiography at 90° of knee flexion in group A was significantly greater than that in groups B and C (all p<0.001). At last follow-up, mean side-to-side instrumented laxities measured by the KT-2000 and manual stress radiography were significantly improved from preoperative data in all groups (all p<0.001). There were no significant differences between the three groups in anterior instability measured by KT-2000 arthrometer, pivot shift, or functional scores. CONCLUSION Selective bundle reconstruction in partial ACL tears offers comparable clinical results to DB reconstruction in complete ACL tears.
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Affiliation(s)
- Yon Sik Yoo
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Si Young Song
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Cheol Jung Yang
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jong Mun Ha
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Yoon Sang Kim
- HiLab, Korea University of Technology and Education, Cheonan, Korea
| | - Young Jin Seo
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
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