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Delcogliano M, Sangiorgio A, Bensa A, Andriolo L, Boffa A, Filardo G. Platelet-rich plasma augmentation in anterior cruciate ligament reconstruction: Evidence is still too scattered. A scoping review of randomised controlled trials. Knee Surg Sports Traumatol Arthrosc 2024; 32:1143-1159. [PMID: 38488226 DOI: 10.1002/ksa.12127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE Platelet-rich plasma (PRP) augmentation has been proposed to improve the results of anterior cruciate ligament reconstruction (ACLR). The present study aims to quantify the available evidence to support the use of PRP as biological augmentation in ACLR surgery. METHODS A systematic literature search was conducted on the PubMed, Cochrane, Web of Science and Embase databases on 10 March 2023. Inclusion criteria were randomised controlled trials (RCTs), written in English, addressing PRP augmentation in ACLR surgery, with no time limitation. A scoping review was performed to map the body of literature by examining the evidence related to specific aspects of patients' treatment and evaluation. Risk of bias evaluation was performed with the Cochrane risk-of-bias tool for randomised trials Version 2 (RoB 2), while the quality assessment was performed with the use of the Coleman Score. RESULTS Out of 983 articles retrieved, 23 RCTs on 943 knees were included in this scoping review. PRP was administered in a liquid form in nine studies and clotted in 11 studies, while in three studies both liquid and clotted PRP were used. Hamstring auto/allografts were used in 14 studies, patellar tendon auto/allografts were used in eight studies and one study described ACLR with peroneus longus allografts. The map of the evidence documented high heterogeneity also in terms of surgical technique, objective and subjective outcome measures and radiological assessment, as well as follow-up times ranging from 1 day to 2 years, with virtually no overlapping data among studies neither in terms of treatments nor evaluations. Risk of bias evaluation showed an overall low quality of the included studies. CONCLUSIONS The available literature addressing PRP augmentation in ACLR is largely scattered. PRP was produced and applied following different procedures, and high variability was detected across the included studies for every aspect of ACLR surgery and evaluation. Currently, a meaningful comparison of the available studies is not possible as the quantification of the literature results is biased by their heterogeneity. Future studies should provide more standardisation to investigate the benefits of biological augmentation in ACL surgery and confirm the promising yet weak evidence of PRP potential as well as the most suitable application modality, before routine use in clinical practice. LEVEL OF EVIDENCE Levels I and II, scoping review.
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Affiliation(s)
- Marco Delcogliano
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Alessandro Bensa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Angelo Boffa
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Siboni R, Pioger C, Mouton C, Seil R. Presentation of an intraosseous suspensory fixation technique for pediatric and adult ACL reconstruction. Orthop Traumatol Surg Res 2024; 110:103633. [PMID: 37121431 DOI: 10.1016/j.otsr.2023.103633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/24/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023]
Abstract
The aim is to present a technique for pediatric and adult ACL reconstruction using an intraosseous suspensory fixation. This technique uses a 4-strands hamstring graft fixed in the femoral tunnel, with a loop locked in a polyetheretherketone (PEEK) cage. The ACLip® device offers an inside-out drilling system and a closer fixation to the joint than an extracortical button fixation. The technique can be easily used both in adults and in skeletally immature patients. The first practical experience shows promising results regarding the safety and the effectiveness of the technique. Level of evidence: IV.
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Affiliation(s)
- Renaud Siboni
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Department of Orthopaedic Surgery, Reims teaching Hospital, hôpital Maison Blanche, 45, rue Cognacq-Jay, 51092 Reims, France
| | - Charles Pioger
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Department of Orthopaedic Surgery, Ambroise-Paré Hospital, Paris Saclay University, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Caroline Mouton
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg; Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg, Luxembourg.
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3
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Runer A, Hax J, Gelber P, Stadelmann VA, Preiss S, Salzmann G. Triple Hybrid Tibial Anterior Cruciate Ligament Graft Fixation. Arthrosc Tech 2023; 12:e2375-e2379. [PMID: 38196858 PMCID: PMC10773257 DOI: 10.1016/j.eats.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/13/2023] [Indexed: 01/11/2024] Open
Abstract
Optimal graft fixation in anterior cruciate ligament reconstruction is critical. Several direct and indirect methods of graft fixation exist, each with advantages and disadvantages. This Technical Note describes a tibial hybrid anterior cruciate ligament graft fixation technique combining direct and indirect fixation methods, including autologous bone augmentation of the drill tunnel using cancellous bone fragments.
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Affiliation(s)
- Armin Runer
- Department of Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jakob Hax
- Departments of Hip and Knee Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Pablo Gelber
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Stefan Preiss
- Departments of Hip and Knee Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Gian Salzmann
- Departments of Hip and Knee Surgery, Schulthess Klinik, Zürich, Switzerland
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4
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Runer A, Keeling L, Wagala N, Nugraha H, Özbek EA, Hughes JD, Musahl V. Current trends in graft choice for anterior cruciate ligament reconstruction - part I: anatomy, biomechanics, graft incorporation and fixation. J Exp Orthop 2023; 10:37. [PMID: 37005974 PMCID: PMC10067784 DOI: 10.1186/s40634-023-00600-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023] Open
Abstract
Graft selection in anterior cruciate ligament (ACL) reconstruction is critical, as it remains one of the most easily adjustable factors affecting graft rupture and reoperation rates. Commonly used autografts, including hamstring tendon, quadriceps tendon and bone-patellar-tendon-bone, are reported to be biomechanically equivalent or superior compared to the native ACL. Despite this, such grafts are unable to perfectly replicate the complex anatomical and histological characteristics of the native ACL. While there remains inconclusive evidence as to the superiority of one autograft in terms of graft incorporation and maturity, allografts appear to demonstrate slower incorporation and maturity compared to autografts. Graft fixation also affects graft properties and subsequent outcomes, with each technique having unique advantages and disadvantages that should be carefully considered during graft selection.
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Affiliation(s)
- Armin Runer
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.
- Department for Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Laura Keeling
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nyaluma Wagala
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hans Nugraha
- Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Udayana, / Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Emre Anil Özbek
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Muacevic A, Adler JR, Moros G, Mylonas D, Kouzelis A, Gliatis J. Isokinetic Muscle Strength and Knee Function in Anatomical Anterior Cruciate Ligament Reconstruction With Hamstring Autografts: A Prospective Randomized Comparative Study Between Suspensory and Expandable Femoral Fixation in Male Patients. Cureus 2022; 14:e32482. [PMID: 36644094 PMCID: PMC9836015 DOI: 10.7759/cureus.32482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Background Clinical performance, anterior knee stability, and isokinetic strength after anterior cruciate ligament (ACL) reconstruction with hamstring autografts are mainly influenced by graft selection, femoral tunnel preparation, and type of femoral fixation. Expandable femoral fixation devices are expected to provide a stronger initial fixation with circular graft compression, a blind-ended tunnel in the femur with less enlargement, and a theoretical double-band ACL equivalent through graft rotation. This study aimed to evaluate isokinetic strength and functional capacity after ACL reconstruction with hamstring tendons using two different anatomical femoral fixation techniques (expandable vs fixed-looped button). Methodology A total of 48 male patients with ACL deficient knees were randomized to two different femoral fixation groups, namely, the expandable (AperFix) and the standard cortical (Button) group. The primary outcome measures were isokinetic hamstrings and quadriceps strength capabilities and the hamstrings/quadriceps ratio at 60 degrees/second (°/s) and 180°/s using a Cybex before and at three, six, nine, 12, and 24 months after surgery. Secondary measurements were anteroposterior knee stability at two years (using KT-1000 arthrometer) and the functional outcome using the International Knee Documentation Committee (IKDC 2000) form, the Tegner activity scale, and the Lysholm knee score. Data were compared using a paired t-test and analysis of variance, with a p < 0.05 level of significance. Results Most patients regained the 60°/s quadriceps strength between three and 12 months (62.5% for the Button group vs. 50% for the AperFix group), as well as the 180°/s strength (79.17% vs 70.83%); however, at the 24-month evaluation, seven (29.17%) patients in the Button group and five (20.83%) in the AperFix group had significant deficits. The 60°/s flexor strength was regained in the first six months in 19 (79.17%) patients in the Button group and in 16 (66.7%) patients in the AperFix group, whereas the percentages for the 180°/s strength were 79.17% and 75%, respectively. Beyond the 24-month evaluation, only three (12.5%) patients in the Button group and four (16.67%) in the AperFix group had significant flexor deficits. Regarding the H/Q ratio, at 60°/s, the mean recovery time was six and 7.5 months for the Button and AperFix groups, respectively, whereas 15 and 12 patients, respectively, did not recover during the two-year duration. At 180°/s, a mean recovery time of six months was needed for the button group, and nine patients did not recover two years later. For the AperFix group, nine months were needed, and 12 patients did not recover in two years. Clinical performance and anterior knee stability showed no statistically significant differences between groups. Conclusions Although there were no significant differences in clinical performance, knee stability, and isokinetic strength testing between expandable and cortical button femoral fixation groups, return to play was doubtful at two years postoperatively.
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Nie S, Zhou S, Huang W. Femoral fixation methods for hamstring graft in anterior cruciate ligament reconstruction: A network meta-analysis of controlled clinical trials. PLoS One 2022; 17:e0275097. [PMID: 36137116 PMCID: PMC9499312 DOI: 10.1371/journal.pone.0275097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 09/11/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the clinical effectiveness of cortical button (CB), cross-pin (CP) and compression with interference screws (IS) fixation techniques in anterior cruciate ligament (ACL) reconstruction using hamstring graft. Methods Studies were systematically retrieved from PubMed, Embase, Cochrane Library and Web of Science up to May 20, 2021. Primary outcomes were KT-1000 assessment, International Knee Documentation Committee (IKDC) score A or B, Lachman’s test, pivot-shift test, visual analogue scale (VAS) score, Lysholm score, Tegner score, and Cincinnati Knee Score. Secondary outcomes included reconstruction failures and synovitis. League tables, rank probabilities and forest plots were drawn for efficacy comparison. Results Twenty-six controlled clinical trials (CCTs) with 1,824 patients undergoing ACL reconstruction with hamstring graft were included. No significant differences were found among CB, CP and IS fixation methods regarding the 10 outcomes. For KT-1000 assessment, IKDC score A or B, Lachman’s test, VAS score and pivot-shift test, CP had the greatest probability of becoming the best method, and IS may be the suboptimal method in 4 out of these 5 outcomes except pivot-shift test. Conclusions CP, CB and IS fixations have comparable clinical performance, while CP fixation is most likely to be the optimum fixation technique for hamstring graft in ACL reconstruction. Future larger-sample studies of high quality comparing these techniques in more clinical outcomes are required.
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Affiliation(s)
- Shixin Nie
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
| | - Shuqing Zhou
- Department of Orthopedics, The Centre Hospital of Jiangjin, Chongqing, China
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
- * E-mail:
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Affiliation(s)
| | - Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal, London, UK
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8
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Panagopoulos A, Mylonas D, Kouzelis A, Zampakis P, Kraniotis P, Lakoumentas J, Gliatis J. No Difference in Outcomes Between Suspensory (Fixed-Loop Cortical Button) Versus Expandable Anteromedial Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Autologous Hamstring Tendons: A Prospective, Randomized, Controlled Study in Male Patients. Arthrosc Sports Med Rehabil 2021; 3:e1155-e1163. [PMID: 34430896 PMCID: PMC8365223 DOI: 10.1016/j.asmr.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To compare anterior cruciate ligament (ACL) autograft reconstruction using fixed-looped suspensory versus expandable femoral fixation through the anteromedial portal. Methods After we performed prospective power analysis and obtained institutional review board, 70 patients with ACL rupture were block randomized to the expandable or suspensory femoral fixation group (35 in each group). All patients received autologous hamstring autograft through the anteromedial portal and fixed with a sheath-screw system in the tibia. The primary outcome measures were anteroposterior knee stability at 2 years’ follow-up measured using the KT-1000 arthrometer and the degree of femoral and tibial tunnels’ widening measured by the use of computed tomography imaging performed immediately postoperative and 12 months postsurgery. Secondary outcome measures included pain score on a visual analog scale, the subjective International Knee Documentation Committee 2000 assessment form, the Lysholm score, and the Tegner activity scale at 3, 6, 12, and 24 months. Results Twenty-four patients were excluded from further analysis, leaving a total of 48 patients (24 in each group) for the final evaluation. The anteroposterior knee stability (KT-1000) showed no difference between groups at 24 months’ follow-up (P = .31). The percentile widening (%) of femoral and tibial tunnel at 1-year follow-up showed no difference also, except for greater values at the tibial coronal point T2 (P = .065) and tibial sagittal point T1 (P = .033) in the group of cortical buttons. Secondary clinical outcomes showed no statistical differences between groups at 3, 6, 12, and 24 months’ postoperatively. Numerical pain scale (visual analog scale) was similar in both groups except for postoperative day 7, where the AperFix group showed better results (P = .014). There were no major intraoperative and late postoperative complications in any of the groups. Conclusions Our results showed no significant differences in knee anteroposterior stability, tunnel enlargement or other clinical outcomes comparing expandable versus cortical button fixation in anteromedial hamstrings ACL reconstruction. Level of Evidence Level II, randomized controlled trial.
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Affiliation(s)
- Andreas Panagopoulos
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Dimitris Mylonas
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Antonis Kouzelis
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Petros Zampakis
- Department of Radiology, Patras University Hospital Greece, Patras, Greece
| | - Pantelis Kraniotis
- Department of Radiology, Patras University Hospital Greece, Patras, Greece
| | - John Lakoumentas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - John Gliatis
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
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9
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Shanmugaraj A, Mahendralingam M, Gohal C, Horner N, Simunovic N, Musahl V, Samuelsson K, Ayeni OR. Press-fit fixation in anterior cruciate ligament reconstruction yields low graft failure and revision rates: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:1750-1759. [PMID: 32785757 DOI: 10.1007/s00167-020-06173-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/16/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Press-fit fixation is a hardware-free technique in anterior cruciate ligament reconstruction (ACLR). The purpose of this review was to quantitatively assess the risk profile and outcomes of press-fit fixation and provide an update on its effectiveness compared to more standard fixation techniques of ACLR. METHODS The electronic databases PUBMED, MEDLINE, and EMBASE were searched on March 26, 2020 for therapeutic randomized controlled trials (RCT) addressing press-fit fixation for primary ACLR. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the quality for randomized studies. A meta-analysis with a random-effects model was used to pool applicable outcomes data. RESULTS A total of six eligible RCTs were included in this review. There were 292 patients (72.9% male) with a mean age of 28.8 ± 3.8 years and a mean follow-up of 81.3 ± 88.3 months that underwent press-fit ACLR on the femoral, tibial or both tunnels. Femoral fixation techniques included press-fit fixation (96.6%) and cross-pin fixation (3.4%). Tibial fixation techniques included press-fit (37.0%), staples (28.1%), interference screws (21.2%) and abarticular post-screws (13.7%). Graft options included bone-patellar tend--bone autografts (73.6%) and semitendinosus and gracilis tendon autograft (26.4%). Significant improvements (p < 0.05) from baseline to follow-up were found for clinical outcomes. Significantly less postoperative bone tunnel enlargement (p < 0.05) was found with tibial press-fit fixation when compared to biodegradable screws. The overall complication rate was 13.3%. There were no significant differences in complication rates [odds ratio = 0.84 (95%CI 0.43-1.66); p = n.s.] (I2 = 0%) between patients undergoing femoral press-fit fixation and femoral metal interference screw fixation. CONCLUSION The overall graft failure and revision rates with press-fit ACLR were low. There were no significant differences in complication rates between patients undergoing femoral press-fit and femoral metal interference screw fixation. Included studies found that patients undergoing press-fit fixation for ACLR had significant improvements in functional outcome scores postoperatively and had significantly reduced postoperative bone tunnel enlargement compared to patients undergoing bioabsorbable fixation. Thus, early evidence suggests that press-fit fixation appears to be a good option for patients undergoing ACLR. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Ajaykumar Shanmugaraj
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| | | | - Chetan Gohal
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Nolan Horner
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Nicole Simunovic
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamitlon, ON, Canada.
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10
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Yan L, Li JJ, Zhu Y, Liu H, Liu R, Zhao B, Wang B. Interference screws are more likely to perform better than cortical button and cross-pin fixation for hamstring autograft in ACL reconstruction: a Bayesian network meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:1850-1861. [PMID: 32813044 DOI: 10.1007/s00167-020-06231-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/10/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) reconstruction is widely accepted as the first choice of treatment for ACL injury, but there is disagreement in the literature regarding the optimal femoral fixation method. This meta-analysis assesses the evidence surrounding three common femoral fixation methods: cortical button (CB), cross-pin (CP) and interference screws (IS). METHODS A systematic search was conducted in Medline, EMBASE and the Cochrane Library to identify studies with evidence level I or II that compared at least two femoral fixation methods with hamstring autograft for ACL reconstruction. Ten primary outcomes were collected. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMD) were estimated using random-effects network meta-analysis in a Bayesian framework. Probability of ranking best (ProBest) and surface under the cumulative ranking curve (SUCRA) were used to rank all treatments. Funnel plots were used to identify publication bias and small-study effects. RESULTS Sixteen clinical trials were included for analysis out of 2536 retrieved studies. Bayesian network meta-analysis showed no significant differences among the three fixation methods for the ten primary outcome measures. Based on the 10 outcome measures, the IS, CB and CP had the highest ProBest in 5, 5 and 0 outcomes, and the highest SUCRA values in 5, 4 and 1 outcomes, respectively. No substantial inconsistency between direct and indirect evidence, or publication bias was detected in the outcomes. CONCLUSION There were no statistical differences in performance among the CP, CB and IS femoral fixation methods with hamstring autograft in ACL reconstruction, although the IS was more likely to perform better than CB and CP based on the analysis of outcome measures from the included studies. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Lei Yan
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China.,Shanxi Medical University, Taiyuan, China
| | - Jiao Jiao Li
- Kolling Institute, University of Sydney, Sydney, NSW, Australia.,School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| | - Yuanyuan Zhu
- Department of Pharmacy, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Haifeng Liu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Ruxing Liu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Bin Zhao
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China.
| | - Bin Wang
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China. .,Department of Sports Medicine and Adult Reconstruction Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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11
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Zhou H, Zhang C, Lin C, Jin G, Chen L, Chen C. Diffuse-Type Giant Cell Tumor of the Paratenon of Achilles Tendon Requiring Reconstruction Using Bilateral Autografts: A Case Report. J Foot Ankle Surg 2021; 59:388-393. [PMID: 32131008 DOI: 10.1053/j.jfas.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 02/03/2023]
Abstract
Although a diffuse-type giant cell tumor is a rare benign lesion, when it develops it tends to localize to the tendons of the hand and foot. In this study, we report the case of a 41-year-old male patient who was diagnosed with diffuse-type paratenon giant cell tumor involving the Achilles tendon. The duration of the bilateral tumors was 8 years. He visited first affiliated Hospital of Wenzhou Medical University for medical attention. Both his Achilles tendons required removal. The reconstructed Achilles tendon was replaced using tissue derived from the knee and foot. Postoperatively, the patient recovered well and regained full range of motion in the ankle. The use of autografts may shorten patients' recovery period.
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Affiliation(s)
- Haibo Zhou
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chao Zhang
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chuicong Lin
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Guangjian Jin
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lei Chen
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chun Chen
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; Surgeon, Engineering Research Center of Clinical Functional Materials and Diagnosis and Treatment Devices of Zhejiang Province, Wenzhou Institute of Biomaterials and Engineering, Wenzhou, China.
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Attia AK, Nasef H, ElSweify KH, Adam MA, AbuShaaban F, Arun K. Failure Rates of 5-Strand and 6-Strand vs Quadrupled Hamstring Autograft ACL Reconstruction: A Comparative Study of 413 Patients With a Minimum 2-Year Follow-up. Orthop J Sports Med 2020; 8:2325967120946326. [PMID: 32923507 PMCID: PMC7453462 DOI: 10.1177/2325967120946326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/14/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Anterior cruciate ligament reconstruction (ACLR) with hamstring autograft has gained popularity. However, an unpredictably small graft diameter has been a drawback of this technique. Smaller graft diameter has been associated with increased risk of revision, and increasing the number of strands has been reported as a successful technique to increase the graft diameter. Purpose: To compare failure rates of 5-strand (5HS) and 6-strand (6HS) hamstring autograft compared with conventional 4-strand (4HS) hamstring autograft. We describe the technique in detail, supplemented by photographs and illustrations, to provide a reproducible technique to avoid the variable and often insufficient 4HS graft diameter reported in the literature. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed prospectively collected data of all primary hamstring autograft ACLRs performed at our institution with a minimum 2-year follow-up and 8.0-mm graft diameter. A total of 413 consecutive knees met the study inclusion and exclusion criteria. The study population was divided into 5HS and 6HS groups as well as a 4HS control group. The primary outcome was failure of ACLR, defined as persistent or recurrent instability and/or revision ACLR. Results: The analysis included 224, 156, and 33 knees in the 5HS, 6HS, and 4HS groups, respectively. The overall ACLR failure rate in this study was 11 cases (8%): 5 cases for 5HS, 3 cases for 6HS, and 3 cases for 4HS. No statistically significant differences were found among groups (P = .06). The mean graft diameter was 9 mm, and the mean follow-up was 44.27 months. Conclusion: The 5HS and 6HS constructs have similar failure rates to the conventional 4HS construct of 8.0-mm diameter and are therefore safe and reliable to increase the diameter of relatively smaller hamstring autografts. We strongly recommend using this technique when the length of the tendons permits to avoid failures reportedly associated with inadequate graft size.
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Affiliation(s)
| | - Hazem Nasef
- Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Mohammed A Adam
- Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
| | - Faris AbuShaaban
- Department of Orthopedic Surgery, AlKhor Hospital, AlKhor, Qatar
| | - Kariyal Arun
- Department of Orthopedic Surgery, AlKhor Hospital, AlKhor, Qatar
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Wang Y, Lei G, Zeng C, Wei J, He H, Li X, Zhu Z, Wang H, Wu Z, Wang N, Ding X, Li H. Comparative Risk-Benefit Profiles of Individual Devices for Graft Fixation in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Network Meta-analysis. Arthroscopy 2020; 36:1953-1972. [PMID: 32360701 DOI: 10.1016/j.arthro.2020.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare the efficacy and safety of individual devices for femoral and/or tibial graft fixation in anterior cruciate ligament (ACL) reconstruction. METHODS The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception to December 12, 2018. Randomized controlled trials comparing individual devices for ACL graft fixation were included. Bayesian network meta-analysis was performed to assess the efficacy profile using the following outcomes: Lysholm score, International Knee Documentation Committee (IKDC) category, laxity, range of motion, and Tegner score. The incidence of infection, effusion, and graft rupture for each device was reported. RESULTS We included 57 randomized controlled trials involving 4,304 patients aged 23.8 to 40.9 years. The female proportion ranged from 0% to 100%. The length of follow-up ranged from 6 to 144 months. Of the 13 studied femoral fixation devices, none was significantly different from the others regarding the Lysholm score, IKDC category, range of motion, and Tegner score. Bioabsorbable interference screws (standardized mean difference, 1.3; 95% credible interval, 0.0-2.5) showed higher laxity than the EndoPearl at a borderline level of statistical significance, but the difference varied substantially within multiple sensitivity analyses. Infection (2.0%) was most commonly seen with the EndoPearl, whereas the bone mulch screw had the highest incidence of effusion (5.5%) and graft rupture (5.5%). For the 9 studied tibial fixation devices, no significant difference was observed in the aforementioned efficacy measurements. Bioabsorbable interference screws with staples had the highest incidence of infection (11.1%) and effusion (15.6%), whereas graft rupture was most commonly seen with the bone plug (4.0%). CONCLUSIONS Graft fixation devices in ACL reconstruction share a similar efficacy profile in terms of the Lysholm score, IKDC category, range of motion, and Tegner score but not laxity. On the other hand, safety profiles seem to vary among different devices. These findings can support surgeons, alongside their experience and preference, as well as the relative cost of each device, in delivering an individualized plan for an optimal operation. LEVEL OF EVIDENCE Level II, meta-analysis of Level I and II studies.
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Affiliation(s)
- Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Osteoarthritis, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jie Wei
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyi He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
| | - Zhenglei Zhu
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
| | - Haochen Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ziying Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ning Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Ding
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
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14
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Svantesson E, Hamrin Senorski E, Danielsson A, Sundemo D, Westin O, Ayeni OR, Samuelsson K. Strength in numbers? The fragility index of studies from the Scandinavian knee ligament registries. Knee Surg Sports Traumatol Arthrosc 2020; 28:339-352. [PMID: 31190245 PMCID: PMC6995986 DOI: 10.1007/s00167-019-05551-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/31/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE The fragility index (FI) is a metric to evaluate the robustness of statistically significant results. It describes the number of patients who would need to change from a non-event to an event to change a result from significant to non-significant. This systematic survey aimed to evaluate the feasibility of applying the FI to findings related to anterior cruciate ligament (ACL) reconstruction in the Scandinavian knee ligament registries. METHODS The PubMed, EMBASE, Cochrane Library and AMED databases were searched. Studies from the Scandinavian knee ligament registers were eligible if they reported a statistically significant result (p < 0.05) for any of the following dichotomous outcomes; ACL revision, contralateral ACL reconstruction or the presence of postoperative knee laxity. Only studies with a two-arm comparative analysis were included. Eligibility assessment, data extraction and quality assessment were performed by two independent reviewers. The dichotomous analyses were stratified according to the grouping variable for the two comparative arms as follows; age, patient sex, activity at injury, graft choice, drilling technique, graft fixation, single- versus double-bundle, concomitant cartilage injury and country. The two-sided Fisher's exact test was used to calculate the FI of all statistically significant analyses. RESULTS From 158 identified studies, 13 studies were included. They reported statistical significance for a total of 56 dichotomous analyses, of which all but two had been determined by a time-to-event analysis. The median sample size for the arms was 5540 (range 92-38,666). The mean FI for all 56 dichotomous analyses was 80.6 (median 34.5), which means that a mean of 80.6 patients were needed to change outcome status to generate a non-significant result instead of a significant one. Seventeen analyses (30.4%) immediately became non-significant when performing the two-sided Fisher's exact test and, therefore, had an FI of 0. The analyses related to age were the most robust, with a mean FI of 178.5 (median 116, range 1-1089). The mean FI of the other grouping variables ranged from 0.5 to 48.0. CONCLUSION There was large variability in the FI in analyses from the Scandinavian knee ligament registries and almost one third of the analyses had an FI of zero. The FI is a rough measurement of robustness when applied to registry studies, however, future studies are needed to determine the most appropriate metric for robustness in registry studies. The use of the FI can provide clinicians with a deeper understanding of significant study results and promotes an evidence-based approach in the clinical care of patients. LEVEL OF EVIDENCE Systematic review of prospective cohort studies, Level II.
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Affiliation(s)
- Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Adam Danielsson
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Sundemo
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olof Westin
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Olufemi R. Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON Canada
| | - Kristian Samuelsson
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
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