Anterior Cruciate Ligament Allograft Reconstruction Research Articles

Anterior Cruciate Ligament Allograft Reconstruction Augmented With a Reinforced, Bioinductive Collagen Scaffold in the Setting of Multiligamentous Knee Injury

The gold standard for surgical treatment of anterior cruciate ligament (ACL) injuries is reconstruction. There are a variety of graft options, from autograft to allograft, using bone–patellar tendon–bone (BTB), hamstrings, quadriceps, or Achilles, and, in the case of a multiligamentous knee injury (MLKI), allograft may be preferred to decrease operative time and graft harvest morbidity. The BioBrace (ConMed, New Haven, CT) is a bioinductive collagen scaffold designed to provide an environment for soft tissue remodeling with time zero biomechanical support and can be used to augment graft reconstructions in the case of concerns for allograft strength, healing, or width. The purpose of this Technical Note is to describe the technique for performing an ACL reconstruction with BioBrace-augmented allograft in the setting of a MLKI, with special consideration for 2 methods of graft preparation (BTB and soft tissue).

A randomised controlled study for the comparison of functional outcome of femoral tunnel fixation devices, aperture fixation by screw vs suspensory fixation by endo-button in arthroscopic anterior cruciate ligament reconstruction

: The goal of this study was to compare suspensory and aperture fixation methods for restoring soft tissue allografts in the anterior cruciate ligament (ACL).: 30 patients were chosen and randomly allocated to one of two experimental groups, suspensory fixation or aperture fixation, following the completion of a prospective analysis, permission from the institutional review board, and patient agreement. All of the patients underwent ACL reconstruction surgery using soft tissue allografts made of hamstring tendon. The procedures were either (1) femoral and tibial fixation with a femoral cannulated interference screw and a tibial cannulated interference screw (aperture) or (2) femoral cortical buttons (suspensory) and a tibial cannulated interference screw. The subjective anterior drawer test analysis and changes in the International Knee Documentation Committee knee examination rating were employed as end measures.: All of the patients who had received treatment (100%) had successfully completed a clinical assessment at the 1-month, 4-month, 8-month, and 12-month follow-ups. Out of the 30 patients who were included, 15 (50%) underwent suspensory fixation treatment and the other 15 (50%) underwent aperture fixation treatment. The primary outcome measure—AP stability at 25 degrees of knee flexion—did not differ across groups at a 12-month follow-up. Also, at the 1-month and 4-month evaluations, secondary data revealed a statistically significant difference between the groups.: Our data showed no meaningful differences in knee AP stability or other outcomes between ACL allograft reconstruction using aperture fixation and ACL allograft reconstruction utilising suspensory fixation at the 12-month mark, while aperture fixation performed better at the first and fourth months. One of our main outcome measures was the grading of knee anteroposterior (AP) stability (clinical judgments).: Level II, lesser-quality randomised controlled trial with a follow-up of 1 year.

Cortical Suspensory Button Versus Aperture Interference Screw Fixation for Knee Anterior Cruciate Ligament Soft-Tissue Allograft: A Prospective, Randomized Controlled Trial

To compare anterior cruciate ligament (ACL) soft-tissue allograft reconstruction using suspensory versus aperture fixation. After we performed prospective power analysis and obtained institutional review board approval, as well as patient consent, 64 patients were block randomized among 3 study sites to the aperture fixation group or suspensory fixation group. All patients underwent all-inside ACL reconstruction with soft-tissue allograft using either (1) femoral and tibial joint-line fixation with a femoral cannulated interference screw and a tibial cannulated interference retrograde screw (aperture) or (2) femoral and tibial cortical buttons (suspensory). Our primary outcome measure was knee anteroposterior (AP) stability measured using the KT-1000 device (MEDmetric, San Diego, CA). Secondary outcome measures included change in pain score on a visual analog scale versus preoperatively, narcotic consumption, International Knee Documentation Committee knee examination rating, International Knee Documentation Committee subjective evaluation score, Knee Society Scores, Short Form 12 scores, and radiographic analysis for socket widening. Ultimately, 6 included patients (9%) were not treated (cancelled surgery), and at 2 years' follow-up, 43 treated patients (74%) completed clinical evaluation. The primary outcome measure, instrumented knee AP stability at 25° of knee flexion, showed no difference between groups (P = .61) at 24 months' follow-up. In addition, no statistically significant difference between groups was observed for secondary measures. Our results show no significant differences in knee AP stability or other outcomes comparing all-inside ACL allograft reconstruction using aperture fixation and all-inside ACL allograft reconstruction using suspensory fixation. Level II, lesser-quality randomized controlled trial with follow-up of less than 80% at 2 years.

Comparison between two different platelet-rich plasma preparations and control applied during anterior cruciate ligament reconstruction. Is there any evidence to support their use?

To compare the clinical, analytical and graft maturation effects of two different platelet-rich plasma (PRP) preparations applied during anterior cruciate ligament (ACL) reconstruction. A total of 150 patients with ACL disruption were included in the study. Arthroscopic ACL reconstruction with patellar tendon allograft was conducted on all knees using the same protocol. One hundred patients were prospectively randomised to either a group to receive double-spinning platelet-enriched gel (PRP) with leukocytes (n=50) or to a non-gel group (n=50). Finally, we included 50 patients treated with a platelet-rich preparation from a single-spinning procedure (PRGF Endoret(®) Technology) without leukocytes. Inflammatory parameters, including C-reactive protein (CRP) and knee perimeters (PER), were measured 24 hours and 10 days after surgery. Postoperative pain score (visual analogue score [VAS]) was recorded the day after surgery. Follow-up visits occurred postoperatively at 3, 6, and 12 months. The International Knee Documentation Committee scale (IKDC) was included to compare functional state, and MRI was conducted 6 months after surgery. The PRGF group showed a statistically significant improvement in swelling and inflammatory parameters compared with the other two groups at 24 hours after surgery (p<0.05). The results did not show any significant differences between groups for MRI and clinical scores. PRGF used in ACL allograft reconstruction was associated with reduced swelling; however, the intensity and uniformity of the graft on MRI were similar in the three groups, and there was no clinical or pain improvement compared with the control group. II.

Arthroscopic Meniscus Allograft Transplantation in Male Professional Soccer Players

Background: Meniscus allograft transplantation (MAT) is an option for symptomatic patients who have undergone subtotal meniscectomy and can potentially result in pain relief and increased function. Hypothesis: Professional soccer players would benefit from arthroscopic MAT in terms of pain, knee function, and return to play at 36-month follow-up. Study Design: Case series; Level of evidence, 4. Methods: Twelve male patients who had undergone MAT (6 medial, 6 lateral) were prospectively evaluated at 12- and 36-month follow-up. The mean age at the time of surgery was 24.5 ± 3.6 years (range, 19-29 years), and the mean time from meniscectomy to surgery was 37 ± 31 months (range, 2-82 months). The transplantation was performed in patients who had undergone subtotal meniscectomy using an arthroscopic bone plug–free technique with a single tibial tunnel plus “all-inside” meniscus sutures. The anterior horn of the transplanted meniscus was sutured to the capsule and to the remnant of the anterior horn of the native meniscus. Seven patients (58%) underwent concurrent procedures. All patients were evaluated at follow-up by the Tegner, Lysholm, International Knee Documentation Committee (IKDC) subjective, IKDC objective, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale (VAS) for pain scores. Information regarding rehabilitation, return to play, and return to official competition was recorded. Results: Eleven of the 12 patients (92%) returned to play soccer. At 36-month follow-up, 9 patients (75%) were still playing as professionals (Tegner score of 10), whereas 2 patients (17%) were playing as semiprofessionals (Tegner score of 9). The mean time from surgery to the end of rehabilitation was 7.5 ± 2 months, whereas the mean time to official competition was 10.5 ± 2.6 months. Patients demonstrated significant improvements on the median Tegner score from 8 (interquartile range, 3-10) to 10 (interquartile range, 9-10) (P = .0391); the mean Lysholm score from 67 ± 14 to 92 ± 10 (P = .0021); the mean IKDC subjective score from 61.8 ± 16.3 to 85.3 ± 9.8 (P = .0026); the mean IKDC objective score from 1 A, 8 B, 1 C, and 2 D to 7 A and 5 B (P = .0077); the mean WOMAC score from 77.1 ± 15.9 to 92.2 ± 9.1 (P = .0242); and the mean VAS score from 61 ± 16 to 29 ± 32 (P = .0029) at 12-month follow-up. There were no significant improvements in these outcomes at 36-month follow-up. One patient developed a knee infection after MAT plus anterior cruciate ligament allograft reconstruction. This complication was successfully treated, but the patient stopped playing soccer (Tegner score of 3 at 36-month follow-up), and this was considered a failure (8%). Conclusion: Arthroscopic MAT in professional soccer players allowed a return to play at the same level (Tegner score of 10) in 75% of the cases at 36-month follow-up.

Knee joint accessory motion following anterior cruciate ligament allograft reconstruction: a preliminary report.

Early in the postoperative period, changes in tibial translation have been noted in patient populations following anterior cruciate ligament reconstructive surgery. Deformation due to a lengthening of the ligament graft has been the most widely accepted reason for the change in tibial translation. Treatment techniques have not been proven successful in the abatement or reversal of this graft lengthening. The purpose of this study was to investigate the effect of functional bracing on tibial translation during the first year postoperatively in a group of patients with early changes in tibial translation. Three consecutive patients with early increases in KT-2000 manual maximum total drawer following bone-patellar tendon-bone allograft reconstruction were identified as subjects in the control group. Five consecutive anterior cruciate ligament bone-patellar tendon-bone allografts with early increases in KT-2000 manual maximum total drawer were identified as subjects in the treatment group. These patients were followed monthly during the first year postoperatively by manual maximum total drawer KT-2000 testing. Criteria for inclusion in the treatment and control groups included KT-2000 testing, with an increase in translation of greater than or equal to 2 mm when compared with the uninvolved knee during the first year postoperatively. The treatment group was required to wear a functional knee brace during all weight-bearing activities until KT-2000 displacement measures were stabilized for 3 consecutive months. Treatment with the functional brace resulted in a mean 2.3-mm decrease in tibial translation in the manual maximum total drawer KT-2000 when comparing the involved and uninvolved knee prebracing with posttreatment. All five subjects in the treatment group had a decrease in tibial translation. A Median Test comparing the control and treatment group's KT-2000 scores was significant at the p < .05 level. Patients who experience early increases in tibial translation with anterior cruciate ligament reconstructions may be assisted in a reduction of the displacement by the use of a functional brace.

High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A two- to seven-year follow-up study.

We assessed short-term treatment results of younger patients with varus malalignment and chronic anterior cruciate ligament deficiency. Forty-one patients (mean, 32 years; range, 16 to 47) underwent a high tibial osteotomy. Because of giving way symptoms, 14 also had a lateral iliotibial band extraarticular procedure at the time of the osteotomy and 16 had an intraarticular anterior cruciate ligament allograft reconstruction after the osteotomy. All returned for followup (mean, 58 months; range, 23 to 86), which included KT-1000 arthrometer testing and evaluation by our knee rating system. Statistically significant (P < 0.05) improvements were found in the mean overall rating scores for pain, swelling, and giving way. Preoperatively, 30 (73%) had pain with activities of daily living or with any sports activity; 11 (27%) could perform only light sports activities without pain. At followup, 32 patients (78%) had no pain with activities of daily living or light sports. Ten of 15 patients with advanced medial tibiofemoral arthrosis (subchondral bone exposure) had significant improvements in symptoms. Patient satisfaction was high: 88% stated they would undergo the procedure again and 78% felt their knee condition was improved. Patients who had the allograft reconstruction had significantly lower (P < 0.05) anterior-posterior displacements at followup than those who had the extraarticular procedure. We concluded that osteotomy should be performed early in the disease process for younger athletes who experience symptoms with activity. It may be unrealistic, however, to expect continuation of sports beyond light recreational, given the joint arthrosis that is usually present and the high in vivo joint loadings with athletes. Anterior cruciate ligament reconstruction should be considered when giving way previously occurred and the patient plans to resume athletics. However, patients with advanced arthrosis can avoid anterior cruciate ligament surgery by reducing athletic activities.