Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction

Aims

To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction.

Patients and Methods

A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage.

Results

In the medial compartment, multivariable logistic regression analysis indicated that partial medial meniscectomy (odds ratio (OR) 6.82, 95% confidence interval (CI) 2.11 to 22.04, p = 0.001), pivot-shift test grade at the final follow-up (OR 3.53, CI 1.39 to 8.96, p = 0.008), BMI (OR 1.15, CI 1.03 to 1.28, p = 0.015) and medial meniscal repair (OR 3.19, CI 1.24 to 8.21, p = 0.016) were significant risk factors for progression of cartilage damage. In the lateral compartment, partial lateral meniscectomy (OR 10.94, CI 4.14 to 28.92, p < 0.001) and side-to-side differences in anterior knee laxity at follow-up (OR 0.63, p = 0.001) were significant risk factors.

Conclusion

Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite r anatomical ACL reconstruction. Cite this article: Bone Joint J 2018;100-B:285–93.

Revision single-bundle anterior cruciate ligament reconstruction with over-the-top route procedure

PURPOSE

In revision anterior cruciate ligament reconstruction (ACLR), the single-stage technique and the over-the-top route (OTTR) procedure were usually selected for cases where the bone tunnel cannot be created at an anatomical position due to tunnel enlargement and overlap with the mal-positioned tunnel of primary reconstruction. The purpose of this study was to evaluate the clinical results of revision single-bundle ACL reconstruction using OTTR procedure and to compare the clinical results of OTTR procedure with those of anatomical single-bundle revision reconstruction (SBR).

HYPOTHESIS

The results of OTTR procedure are equivalent to that of SBR.

METHODS

Seventy-six revision ACL reconstruction knees from April 2002 to December 2012 were involved in our study. We focused on 21 knees which underwent surgery with SBR and 22 knees with OTTR using hamstring tendon. The clinical results were evaluated by means of the Lysholm score and the knee stability was assessed by the Lachman test, pivot-shift test and side-to-side difference by KT-2000 pre-operatively and after 1 year post-operatively. AP translation and rotational laxity using a navigation system were evaluated before and after revision ACL reconstruction under anesthesia in 8 cases of OTTR and in 6 cases of SBR.

RESULTS

There was no statistically significant difference between the OTTR and SBR regarding Lysholm score, Lachman test, pivot-shift test, ATT by KT-2000, and AP translation and rotational laxity with a navigation system.

CONCLUSIONS

The clinical results of OTTR are almost equivalent to those of SBR. For the cases in which it is impossible to create the femoral tunnel in an anatomical position, OTTR is a valuable revision ACL reconstruction method.

LEVEL OF EVIDENCE

Case-control study. Level III.

Clinical outcomes of second-look arthroscopic evaluation after anterior cruciate ligament augmentation

We report the clinical outcome and findings at second-look arthroscopy of 216 patients (mean age 25 years (11 to 58)) who underwent anterior cruciate ligament (ACL) reconstruction or augmentation. There were 73 single-bundle ACL augmentations (44 female, 29 male), 82 double-bundle ACL reconstructions (35 female, 47 male), and 61 single-bundle ACL reconstructions (34 female, 27 male).

In 94 of the 216 patients, proprioceptive function of the knee was evaluated before and 12 months after surgery using the threshold to detect passive motion test.

Second-look arthroscopy showed significantly better synovial coverage of the graft in the augmentation group (good: 60 (82%), fair: 10 (14%), poor: 3 (4%)) than in the other groups (p = 0.039). The mean side-to-side difference measured with a KT-2000 arthrometer was 0.4 mm (-3.3 to 2.9) in the augmentation group, 0.9 mm (-3.2 to 3.5) in the double-bundle group, and 1.3 mm (-2.7 to 3.9) in the single-bundle group: the result differed significantly between the augmentation and single-bundle groups (p = 0 .013). No significant difference in the Lysholm score or pivot-shift test was seen between the three groups (p = 0.09 and 0.65, respectively). In patients with good synovial coverage, three of the four measurements used revealed significant improvement in proprioceptive function (p = 0.177, 0.020, 0.034, and 0.026).

We conclude that ACL augmentation is a reasonable treatment option for patients with favourable ACL remnants.

Cite this article: Bone Joint J 2014;96-B:1325–32

Proprioceptive function after isolated single-bundle posterior cruciate ligament reconstruction with remnant preservation for chronic posterior cruciate ligament injuries

INTRODUCTION

Posterior cruciate ligament (PCL) reconstruction using the remnant preserving technique may contribute to improved postoperative posterior stability, graft healing, and proprioception recovery. Although there have been several reports on remnant preserving PCL reconstruction, no study has yet evaluated the proprioceptive functions before and after PCL reconstruction with remnant preservation. The purpose of this study is to retrospectively evaluate the clinical outcomes and proprioceptive function after isolated single-bundle PCL reconstruction with remnant preservation for chronic PCL injuries.

HYPOTHESIS

Isolated single-bundle PCL reconstruction with remnant preservation surgery for chronic PCL injuries provides satisfactory clinical outcomes and good recovery of the proprioceptive function.

METHODS

Nineteen patients who had undergone isolated single-bundle PCL reconstruction with remnant preservation for chronic PCL injuries were followed up for more than 2 years. The posterior laxity was measured by the gravity sag view, stress radiography and the KT-2000 knee arthrometer. The proprioceptive function was defined as the threshold to detect passive motion (TTDPM).

RESULTS

The average Lysholm score significantly improved from 63.7±13.2 preoperatively to 94.4±4.6 at final follow-up. The postoperative posterior laxity significantly improved. Regarding TTDPM, there were no significant differences between the preoperative score and the score at every given time point, regardless of the starting angles and the moving directions of the knees.

CONCLUSIONS

The proprioceptive function, defined as TTDPM, is maintained after single-bundle PCL reconstruction with remnant preservation, and the postoperative clinical scores and posterior laxity significantly improve.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Unsuccessful regeneration of the semitendinosus tendon harvested for anterior cruciate ligament reconstruction: report of two cases

Recent magnetic resonance imaging (MRI) and three-dimensional (3D) computed tomography (CT) analyses have demonstrated that semitendinosus tendon can regenerate at a high rate following harvesting the tendon for anterior cruciate ligament (ACL) reconstruction. Although it is known that the regeneration of the semitendinosus tendon does not occur in all the patients, the reason for this unsuccessful regeneration of the tendon in certain patients remains unknown. We recently encountered two cases in which regeneration of the semitendinosus tendon was unsuccessful because of apparent reasons. These patients experienced a sudden sharp pain in the posterior aspect of their thighs when their hamstring muscles were subjected to aggressive load at 3 and 4 weeks after surgery. At the follow-up examination conducted after 12 months, 3D CT imaging revealed unsuccessful regeneration of the semitendinosus tendons in both cases. Severe proximal retraction of the semitendinosus muscle belly was also confirmed.