Arthrometer Testing Research Articles

5-years outcomes following arthroscopic anterior cruciate ligament reconstruction comparing quadruple hamstring and peroneus longus tendon autografts: a randomized control trial.

This study presents clinical outcomes, functional results, and return to sports after anterior cruciate ligament (ACL) reconstruction using quadruple hamstring tendon autograft or peroneus longus tendon autograft in a randomized controlled trial. Between February 2018 and July 2019, patients who underwent ACL reconstruction were randomly assigned to two groups: hamstring and peroneus longus. Patient related outcome measurements and pain intensity were evaluated using IKDC, Lysholm, and visual analog scores at 3 and 6months, 1, 2, and 5years after the surgery. At the 5year follow-up, anterior stability was tested using the 3D printable Knee Arthrometer. In addition, in the peroneus longus group, ankle functional assessment was performed using the American foot and ankle score. Additionally, data on the return to sports/activities was collected for both groups at the last follow-up. Sixty patients, with 30 in the hamstring group and 30 in the peroneus group, were included in the study. Patients were predominately male and with low activity demands. After five years of follow-up, there was no significant difference in functional assessment scores (IKDC and Lysholm) between the two groups (P n.s). The median graft diameter was 7.9 ± 0.4mm in the hamstring tendon group and 8.9 ± 0.2mm in the PL group (P < 0.001). The improvement in Arthrometer testing measurements (AMT) for the operated knees in the hamstring and peroneus longus groups were similar. In the peroneus longus group, the mean postoperative foot and ankle score was 98.6 ± 3.9 (range = 85-100). Using Peroneus longus tendon autograft for arthroscopic ACL reconstruction is a feasible alternative as studied in this cohort of predominately male patients with low activity demands. The graft diameter in this study was sufficient, and the results regarding laxity and patient related outcome measurements were similar to those achieved with hamstring tendon autografts. Level I TRIAL REGISTRATION: ChiCTR2000036989.

Concomitant Popliteomeniscal Fascicles Tears Are Found in 21% of Professional Soccer Players With Acute Anterior Cruciate Ligament Injuries

PurposeTo investigate the incidence of popliteomeniscal fascicles (PMF) tears in anterior cruciate ligament (ACL) rupture in professional soccer players, to describe arthroscopic and MRI findings and treatment of these lesions with clinical outcomes, and to evaluate the incidence of subsequent lateral meniscus tears and ACL reinjury. MethodsACL reconstructions on soccer players were retrospectively analyzed, and among them, a cohort of patients with PMFs tears was reviewed. The cohort was assessed with magnetic resonance imaging (MRI) examination, arthrometric testing, Lysholm score and IKDC score. The occurrence of subsequent lateral meniscus tears and ACL reinjury were evaluated. ResultsA total of 208 ACL reconstructions were identified. From these, 43 males and 3 females with a mean age of 24 ± 4.2 years were included. Median time from injury to surgery was 5 days. Pre-operative MRI showed a tear of posterior PMFs in 24 out of 47 knees (51.1%). The mean pre-op arthrometric measured laxity was 4.3 ± 1.65 mm, and post-op 0.1 ± 1.1 mm. Pre-op Lysholm score and IKDC score were respectively 50.4 ± 25.4 and 39.6 ± 5, post-op was 98 ± 2.4 and 73.6 ± 1.2. Mean time to return to play, at the same pr-op level for all patients, was 184 ± 41.7 days. One patient underwent ACL revision due to a reinjury 9 months after surgery, while no lateral meniscus tears occurred in the follow-up period. ConclusionsPopliteomeniscal fascicles tears are found in approximately 20% of professional soccer players with acute ACL injuries. After ACL reconstruction and PFT repair, outcomes including return to play are good, ACL retear is low, and recurrent lateral meniscus tears were not observed. Level of EvidenceLevel IV, Therapeutic case series.

Objective Clinical Measurement Tools for Functional Evaluation of the Surgical Patient.

Following knee surgery, clinicians have traditionally used visually rated or time-based assessments of lower extremity movement quality to measure surgical outcomes, plan rehabilitation interventions, and measure success. These methods of assessment are prone to error and do not fully capture a patient's inefficient movement patterns post surgery. Further, currently available systems which objectively measure kinematics during these tasks are expensive and unidimensional. For these reasons, recent research has called for the development of objective and low-cost precision rehabilitation tools to improve clinical measurement of movement tasks. The purpose of this article is to highlight two such tools and their applications to knee surgery. The systems highlighted within this article are the Mizzou Point-of-Care Assessment System (MPASS) and the Mizzou Knee Arthrometer Testing System (MKATS). MPASS has demonstrated high levels of agreement with the gold-standard Vicon system in measuring kinematics during sit-to-stand (R > 0.71), lateral step-down (intraclass correlation coefficient [ICC] > 0.55, apart from ankle flexion), and drop vertical jump tasks (ICC > 0.62), as well as gait (R > 0.87). MKATS has been used to quantify differences in tibiofemoral motion between groups during lateral step-down, step-up-and-over, and step-up/step-down tasks. Objective measurement of clinical tasks using portable and inexpensive instruments, such as the MPASS and MKATS, can help clinicians identify inefficient movement patterns and asymmetries which may damage and wear down supporting structures within the knee and throughout the kinetic chain causing pain and discomfort. Identifying these issues can help clinicians to plan interventions and measure their progress at a lower cost than currently available systems. The MPASS and MKATS are useful tools which have many applications to knee surgery.

Both Adjustable and Fixed Loop Hamstring Tendon Graft Fixation Have Similar Clinical and Patient-Reported Outcomes in Anterior Cruciate Ligament Reconstruction

PurposeThis study aims to compare the outcomes of fixed-loop device (FLD) vs adjustable-loop device (ALD) graft fixation with up to 2-year follow-up in patients undergoing primary anterior cruciate ligament reconstruction (ACLR) in a predominantly Asian setting. MethodsProspectively collected outcome measures as well as clinical records of patients who underwent primary ACLR using either FLD or ALD fixation of hamstring tendon autograft performed by a single surgeon were reviewed. The surgeon in this study used a fixed-loop device from 2018 to 2019 and then changed to adjustable loop from 2019 to 2020. Suspensory fixation was performed on the femoral side, and aperture (interference screw) fixation was performed on the tibial side. Outcome measures included knee range of motion, KT-1000 arthrometer testing, Lysholm knee score, and Tegner activity scale. Patients were assessed preoperatively and postoperatively at regular intervals of 6, 12, and 24 months. ResultsA total of 105 patients were identified. Forty-six were excluded due to incomplete follow-up data, so 59 patients with full 2-year follow-up were included in the final study group. Both groups (FLD vs ALD) were similar in demographics except for age (P = .042). Out of 105, there were 59 patients remaining in the study group with 2-year follow-up data. No significant differences were observed between the 2 groups at all respective testing intervals. ConclusionsFLDs and ALDs for suspensory fixation of hamstring tendon autograft in ACLR had similar clinical outcomes with a minimum of 2-year follow up. There is no evidence of graft loosening from loop lengthening. Level of EvidenceLevel III, retrospective comparative trial.

Regeneration of Partial Anterior Cruciate Ligament Tears Using the Technique of Biologic Augmentation with Bone Marrow Concentrate and Platelet-Rich Plasma Under Arthroscopic Visualization

To present clinical outcomes in a preliminary patient cohort using a biologic augmentation technique consisting of intra-ligamentous and intra-articular infiltration of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) under arthroscopic visualization for treatment of isolated and acute partial anterior cruciate ligament (ACL) tears. Athletes with an acute symptomatic partial ACL injury with clinical examination findings of increased anterior tibial translation without rotational instability were treated with the biologic augmentation technique. Patients were followed for 2 years postoperatively. The Lysholm Knee Questionnaire, IKDC Objective score, physical examination findings, MRI, and the KT-1000 arthrometer were used to assess clinical outcomes. Five patients were included in the analysis with a median age of 22. All patients were determined to have a healed ACL on MRI 8 months postoperatively. The median Lysholm Score at the final follow-up of 99 was significantly increased from the median pre-operative score (p = 0.042). In addition, the objective IKDC score improved in all patients postoperatively, and no clinical examination findings of knee instability were identified at the final follow-up. The median side-to-side difference in KT-1000 arthrometer testing was 3 mm pre-operatively and 0 mm at the last follow-up (p = 0.038). The treatment of appropriately indicated partial ACL injuries in this study has demonstrated that restoration of ligamentous structure and function may be achieved by a biologic augmentation technique using intra-ligamentous and intra-articular infiltration of BMAC and PRP. This technique is performed with minimal technical difficulty, leading to excellent 2-year clinical outcomes in this preliminary series of patients.

One-stage revision reconstruction of the anterior cruciate ligament using autograft: retrospective cohort study

BACKGROUND: Revision reconstruction of the anterior cruciate ligament (ACL) is a technically more complex procedure than primary reconstruction. Recurrence of anterior instability is most often associated with a technical error during the primary operation. The primary task of revision reconstruction is to identify the cause of recurrence of anterior instability and careful preoperative planning. Thus, the principles of ACL anatomical location to be essential restore stability. This paper discusses options for revision anatomical reconstruction of the ACL, including surgical technique, preoperative preparation, and choice of autograft material.&#x0D; AIM: This study aimed to evaluate the results of a one-stage revision reconstruction of the ACL and show that this method can be performed in one stage, rather than in two stages, which will lead to a reduction in the patients recovery time and return to usual physical activity.&#x0D; MATERIALS AND METHODS: To monitor the long-term treatment results, 50 of 92 patients with revision through one-stage ACL reconstruction, who were examined 9, and 12 months after surgery, were enrolled. All patients were young, who were working from age 18 to 42 years. The mean age was 29 years. This group included only male patients. As a graft material, all patients underwent sampling of the tendons of the fine and semitendinous muscles from the diseased or the contralateral limb. To assess the treatment results, the IKDC scale, Lysholm scale, arthrometric testing on KT-1000, and functional tests were conducted.&#x0D; RESULTS: The use of developed surgical approaches made it possible to obtain good treatment results in patients with recurrences of anterior instability according to the Lysholm score of 82 points. Grade II residual lateral instability was observed in two (4%) patients in the observed group and in seven (14%) patients in the control group. According to the subjective assessment of treatment outcomes, 19 patients (38%) remained satisfied with them.&#x0D; CONCLUSION: The practical application of the proposed options for the location of the channels and methods for fixing the autograft in the intraosseous channels make it possible to perform revision arthroscopic reconstruction of the ACL in one stage, without additional bone grafting of the channels, which in turn reduces the treatment and recovery time of patients, as evidenced by the results.

Revision anterior cruciate ligament reconstruction: Return to sports at a minimum 5-year follow-up.

BACKGROUNDBetween 43% and 75% of patients who undergo primary anterior cruciate ligament (ACL) surgery return to sport activity. However, after a revision ACL reconstruction (ACLR) the rate of return to sports is variable. A few publications have reported returns to sports incidence between 56% to 100% after revision ACLR.AIMTo determine return to sports and functional outcomes after a single-stage revision ACLR with a 5-year minimum follow-up at a single institution.METHODSAll patients operated between 2010 and 2016 with a minimum 5 years of follow-up were included. Type of sport, intensity, frequency, expectation, time to return to sport and failure rate were recorded. Lysholm, Tegner and International Knee Documentation Committee forms were evaluated prior to the first ACLR surgery, at 6 mo after primary surgery and after revision ACLR at 5 years minimum of follow-up. Objective stability was tested with the knee arthrometer test (KT-1000 knee arthrometer, Medmetric Corp).RESULTSA total of 41 patients who underwent revision ACLR during that period of time were contacted and available for follow-up. Median patient age at time of revision was 29 years old [interquartile range (IQR): 24.0-36.0], and 39 (95.0%) were male. The median time from revision procedure to follow-up was 70 mo (IQR: 58.0-81.0). Regarding return to sports, 16 (39.0%) were at the same level compared to preinjury period, and 25 patients (61.0%) returned at a lower level. Sixty-three percent categorized the sport as very important and 37.0% as important. One patient (2.4%) failed with a recurrent ACL torn. Mean preoperative Lysholm and subjective International Knee Documentation Committee scores were 58.8 [standard deviation (SD) 16] and 50 (SD 11), respectively. At follow-up, mean Lysholm and subjective International Knee Documentation Committee scores were 89 (SD 8) and 82 (SD 9) (P = 0.0001). Mean Tegner score prior to primary ACLR was 6.7 (SD 1.3), 5.1 (1.5 SD) prior to revision ACLR and 5.6 (1.6 SD) at follow-up (P = 0.0002). Overall, knee arthrometer test measurement showed an average of 6 mm (IQR: 4.0-6.0) side-to-side difference of displacement prior to revision ACLR and 3mm (IQR: 1.5-4.0) after revision.CONCLUSIONAlmost 40.0% of patients returned to preinjury sports level and 60.0% to a lower level. These may be useful when counseling a patient regarding sports expectations after a revision ACLR.

ACL Reconstruction Combined With the Arnold-Coker Modification of the MacIntosh Lateral Extra-articular Tenodesis: Long-term Clinical and Radiological Outcomes

Background: Interest in the role of lateral extra-articular tenodesis (LET) in preventing rotatory instability and the pivot-shift phenomenon after anterior cruciate ligament reconstruction (ACLR) has been recently renewed. Nevertheless, there is still concern about overconstraint of the lateral compartment of the knee and the risk of subsequent osteoarthritis (OA). Purpose: The purpose of this retrospective study was to compare long-term subjective and objective outcomes and the rate of OA development between patients undergoing isolated ACLR (iACLR) with a hamstring tendon autograft and those with a combined Arnold-Coker modification of the McIntosh extra-articular procedure. Risk factors for long-term OA were evaluated. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 165 consecutive patients treated at a single center by ACLR. A total of 86 patients underwent iACLR (iACLR group) and 79 received combined intra- and extra-articular reconstruction (ACLR+LET). The International Knee Documentation Committee (IKDC), Lysholm, and Tegner activity scores were administered. Knee stability was tested through the Lachman test, the pivot-shift test, and the KT-1000 knee arthrometer test. A positive pivot-shift test (++/+++), laxity on the KT-1000, and referred giving-way episodes or revision ACLR were considered failures. Radiographic results were assessed according to the Fairbank, IKDC, and Kellgren-Lawrence scales. Radiographic evaluation included both the overall tibiofemoral joint and the medial and lateral compartment separately. A univariate and a multivariate logistic regression with penalized maximum likelihood was used to identify risks factors associated with long-term OA. Results: The mean follow-up was 15.7 years. There were no statistically significant differences in subjective scores between the 2 groups. A side-to-side difference >5 mm on the KT-1000 arthrometer evaluation was found in 8 patients in the iACLR group and in 1 patient in the ACLR+LET group (P = .01). Nine cases of failure were found in the iACLR group and only 1 case was found in the ACLR+LET group (P = .0093). Patients in the iACLR group had a significantly higher OA grades than those in the ACLR+LET group for the overall tibiofemoral joint and the lateral compartment of the knee. No differences were found in the medial compartment. A higher level of lateral compartment OA was found in patients who received partial lateral meniscectomy in the iACLR group compared with those in the ACLR+LET group. Univariate and multivariate analysis results demonstrated that meniscectomy was the most significant factor for long-term OA development. Conclusion: A significantly higher risk of long-term OA was found with iACLR than with ACLR combined with the Arnold-Coker modification of the McIntosh extra-articular procedure. Knees with combined ACLR also had a significantly lower OA grade after partial lateral meniscectomy. Additionally, those undergoing combined ACLR had better knee stability and lower graft rupture rates at the long-term follow-up. Partial meniscectomy was the main risk factor negatively associated with OA changes.

Comparing Knee Laxity After Anatomic Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Versus Semitendinosus Tendon Graft.

Background:The choice of graft in anterior cruciate ligament (ACL) reconstruction is still under discussion. The hamstrings are currently the most used grafts for primary ACL reconstruction in Europe. However, increased interest has arisen in the quadriceps tendon (QT) as an alternative autologous graft option for primary ACL reconstruction.Purpose:To evaluate knee stability and the subjective outcome after ACL reconstruction using either autologous QT graft in implant-free femoral press-fit fixation technique or semitendinosus tendon (ST) graft.Study Design:Cohort study; Level of evidence, 2.Methods:We evaluated 50 patients who underwent ACL reconstruction, including 25 patients who received autologous ipsilateral QT graft (QT group) and 25 patients who received the ipsilateral ST graft (ST group). The follow-up for this prospective comparative study was at least 2 years after surgery, comprising KT-1000 arthrometer testing, pivot-shift test, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and rerupture rate.Results:The mean patient age was 31.72 years (9 women, 16 men) in the QT group and 32.08 years (13 women, 12 men) in the ST group. The mean ± standard deviation postoperative side-to-side difference assessed using KT-1000 arthrometer was 1.56 ± 1.56 mm for the QT group and 1.64 ± 1.41 mm for the ST group, with no significant difference. No significant difference was found on any of the KOOS subscale scores (P = .694) or the Lysholm score (P = .682). No rerupture or positive pivot-shift test occurred during follow-up. No difference was found in donor-site morbidity between the study groups.Conclusion:Clinical outcomes were not significantly different between QT and ST grafts in the current study. Thus, the QT may serve as a good alternative graft for primary ACL reconstruction.

Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis.

Background:There have been conflicting results about the theoretical advantages of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction.Purpose:To evaluate the clinical and functional outcomes comparing anatomic single- versus double-bundle techniques, anatomic versus nonanatomic techniques, and transportal versus outside-in tunnel drilling for ACL reconstruction.Study Design:Systematic review; Level of evidence, 3.Methods:A search was performed in the MEDLINE and EMBASE databases up to August 2018 for clinical trials comparing anatomic ACL reconstruction (with tunnel positioning demonstrated using gold standard radiologic techniques) with another technique, with a minimum functional and biomechanical follow-up of 6 months. A meta-analysis was performed to compare clinical and functional outcomes between anatomic single- versus double-bundle reconstruction and between anatomic versus nonanatomic techniques, using the risk difference or the mean difference. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies and the Cochrane Risk of Bias tool and Jadad Score for randomized controlled trials.Results:Included were 15 studies comprising 1290 patients (follow-up, 12-36 months). No significant differences favoring anatomic double-bundle over anatomic single-bundle reconstruction or outside-in over transportal techniques were found. The meta-analyses showed significant differences in the International Knee Documentation Committee (IKDC) objective score (risk difference, –0.14; 95% confidence interval, –0.27 to –0.01) favoring anatomic over nonanatomic reconstruction. No statistically significant differences were found between anatomic and nonanatomic surgical techniques on other functional scores or clinical examination outcomes, including the IKDC subjective score, Lysholm score, Tegner score, KT-1000 arthrometer test, or pivot-shift test.Conclusion:Double-bundle reconstruction was not superior to the single-bundle technique in clinical and functional outcomes. Anatomic ACL reconstruction shows significantly superior results over nonanatomic ACL reconstruction, reinforcing the anatomic technique as the gold standard choice for clinical practice.

Early Operative Versus Delayed Operative Versus Nonoperative Treatment of Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis

Background: Treatment options for pediatric and adolescent anterior cruciate ligament (ACL) injuries include early operative, delayed operative, and nonoperative management. Currently, there is a lack of consensus regarding the optimal treatment for these injuries. Purpose/Hypothesis: The purpose was to determine the optimal treatment strategy for ACL injuries in pediatric and adolescent patients. We hypothesized that (1) early ACL reconstruction results in fewer meniscal tears than delayed reconstruction but yields no difference in knee stability and (2) when compared with nonoperative management, any operative management results in fewer meniscal tears and cartilage injuries, greater knee stability, and higher return-to-sport rates. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic search of databases was performed including PubMed, Embase, and Cochrane Library using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were a pediatric and adolescent patient population (≤19 years old at surgery), the reporting of clinical outcomes after treatment of primary ACL injury, and original scientific research article. Exclusion criteria were revision ACL reconstruction, tibial spine avulsion fracture, case report or small case series (<5 patients), non–English language manuscripts, multiligamentous injuries, and nonclinical studies. Results: A total of 30 studies containing 50 cohorts and representing 1176 patients met our criteria. With respect to nonoperative treatment, knee instability was observed in 20% to 100%, and return to preinjury level of sports ranged from 6% to 50% at final follow-up. Regarding operative treatment, meta-analysis results favored early ACL reconstruction over delayed reconstruction (>12 weeks) for the presence of any meniscal tear (odds ratio, 0.23; P = .006) and irreparable meniscal tear (odds ratio, 0.31; P = .001). Comparison of any side-to-side differences in KT-1000 arthrometer testing did not favor early or delayed ACL reconstruction in either continuous mean differences (P = .413) or proportion with difference ≥3 mm (P = .181). Return to preinjury level of competition rates for early and delayed ACL reconstruction ranged from 57% to 100%. Conclusion: Delaying ACL reconstruction in pediatric or adolescent patients for >12 weeks significantly increased the risk of meniscal injuries and irreparable meniscal tears; however, early and delayed operative treatment achieved satisfactory knee stability. Nonoperative management resulted in high rates of residual knee instability, increased risk of meniscal tears, and comparatively low rates of return to sports.

Anatomic Anterior Cruciate Ligament Reconstruction Using Rectangular Bone–Tendon– Bone Autograft Versus Double-Bundle Hamstring Tendon Autograft in Young Female Athletes

PurposeTo assess the clinical outcomes comparing rectangular bone–tendon–bone (BTB) grafts and double-bundle hamstring tendon (HM) grafts used for anatomic anterior cruciate ligament (ACL) reconstruction in young female athletes.MethodsFrom January 2014 to November 2017, young female athletes 20 years or younger who underwent primary ACL reconstructions by a single surgeon were identified. Patients with concomitant injuries, not being a regular sports participant, the existence of contralateral ACL reconstruction, and who did not have a minimum of 1-year follow-up were excluded. We searched the rate and time for return-to-play, clinical outcomes including chronological instrumental side-to-side tibial translation difference, and muscle strength. Second ACL injury rates between the 2 groups during follow-up period were evaluated.ResultsTwenty-seven BTB ACL reconstructions and 29 HM ACL reconstructions were performed. The mean follow-up periods were 35.2 months in the BTB group and 33.8 months in the HM group. The BTB group showed better knee stability in mean side-to-side translational difference via arthrometric testing of 0.6 mm in the BTB versus 1.7 mm in the HM group at 5 months (P = .01) and 1.1 mm and 2.0 mm at 12 months, respectively (P = .02). There was no significant side-by-side difference in quadriceps muscle strength ratio, but the hamstring muscle strength was significantly better in the BTB group. The graft reinjury rate in the BTB group and the HM group was 0% (0/27) and 10.3% (3/29) (P = .09), respectively. In contrast, contralateral ACL injuries occurred in 17.3% (4/27) of the BTB group and 3.5% (1/29) of the HM group (P = .12).ConclusionsFor young female athletes aged 20 years or younger, the BTB group had better knee instrumental stability than the HM group without range of motion loss or knee extensor muscle strength deficit. Although there was no statistical significance in terms of second ACL injury, we observed fewer graft rerupture and an increasing rate of contralateral ACL injuries in the BTB group.Level of EvidenceLevel III, retrospective comparative study.

Combined ACL-PCL-Medial and Lateral Side Injuries (Global Laxity).

The multiple ligament injured knee is a complex problem in orthopedic surgery. These injuries may or may not present as acute knee dislocations, and careful assessment of the extremity vascular and neurological status is essential because of the possibility of arterial and/or venous compromise, and nerve injury. These complex injuries require a systematic approach to evaluation and treatment. Physical examination and imaging studies enable the surgeon to make a correct diagnosis and formulate a treatment plan. Knee stability is improved postoperatively when evaluated with knee ligament rating scales, arthrometer testing, and stress radiographic analysis. Surgical timing depends upon the injured ligaments, vascular status of the extremity, reduction stability, and the overall health of the patient. The use of allograft tissue is preferred because of the strength of these large grafts, and the absence of donor site morbidity.

Surgical intra- and extra-articular anterior cruciate ligament reconstruction: a meta-analysis

BackgroundIt is still controversial whether the combination of anterior cruciate ligament (ACL) reconstruction and extra-articular reconstruction (EAR) have good clinical efficacy. This meta-analysis aims systematically to compare the clinical effectiveness of ACL reconstruction and combined reconstruction.MethodsElectronic databases, including Medline/PubMed, Embase and the Cochrane Library, were systematically searched to identify targeted studies. A meta-analysis were performed to pool the outcome estimates of interest, such as the Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores and the results from the KT-1000/2000 arthrometer test, the Lachman test and the pivot shift test.ResultsTwelve studies involving 1146 knees were identified. Compared with single ACL reconstruction, combined reconstruction had better results for a pivot shift of grade 1 (relative ratio [RR] = 0.88, 95% CI: 0.83–0.94) and grade 2 (RR = 0.95, 95% CI: 0.91–0.99) rather than grade 3 (RR = 0.98, 95% CI: 0.90–1.06) and no statistically significant difference for both Lachman grade 1 (RR = 0.96, 95% CI: 0.89–1.05) and grade 2 (RR = 0.96, 95% CI: 0.90–1.03). Combined reconstruction resulted in significant improvements on the instrumented joint laxity test when considering a failure standard of more than 5 mm (a side-to-side arthrometric difference) (RR = 0.94, 95% CI: 0.89–0.98) rather than 3 mm (RR = 0.94, 95% CI: 0.86–1.03). Moreover, combined reconstruction increased the IKDC score at the 12-month (weighted mean difference [WMD] = − 6.38, 95% CI: − 9.66 to − 3.10), 24-month (WMD = − 5.60, 95% CI: − 8.54 to − 2.66) and 36-month follow-ups (WMD = − 4.71, 95% CI: − 7.59 to − 1.83) and the Tegner score at the 36-month follow-up (WMD = − 0.53, 95% CI: − 0.97 to − 0.09), but it did not increase the Lysholm score at the 36-month follow-up (WMD = − 0.84, 95% CI: − 2.02 to 0.34).ConclusionWith the advances in reconstruction techniques, combined reconstructions were found to be effective in improving rotational stability and to lead to good functional scores. However, obviously, the combined reconstruction technique is more time-consuming and requires an additional incision, which is not suitable for all ACL-deficient patients. Therefore, programs should be personalized and customized for the specific situation of each patient.

Quadriceps- vs. semitendinosus tendon in ACL reconstruction - a prospective study comparing autologous transplants regarding their clinical outcome

Aims and Objectives:The purpose of this study was to evaluate the knee stability and subjective outcome after primary ACL reconstruction using either autologous semitendinosus or quadriceps tendon.Materials and Methods:We evaluated a total of 50 patients who underwent ACL reconstruction - including 25 using the ipsilateral semitendinosus tendon (group I) and 25 patients with autologous quadriceps tendon graft (group II). The follow-up of this prospective comparative study was at least two years after surgery, comprising clinical assessment according to the International Documantation Committee (IKDC), KT1000 arthrometer testing and an additional questionnaire including the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Lysholm score.Results:The mean postoperative side-to-side difference assessed by KT1000 arthrometer was 1.8mm for group I and 1.7mm for group II with no statistically significant difference. There was no statistically significant difference neither in the individual KOOS subscores nor the Lysholm score. No re-rupture or positive pivot-shift test occurred during follow-up for both groups.Conclusion:Semitendinosus- as well as quadriceps tendon are both equal regarding their clinical outcome. Thus, the quadriceps tendon may serve as a good alternative graft for primary ACL reconstruction.

Application of two types of suspensory fixation in reconstruction of anterior cruciate ligament with a semitendinosus-gracilis graft: A randomized prospective study

Background/Aim. Injury to the anterior cruciate ligament (ACL) of the knee is the most common ligament injury that requires operative treatment. So far, multiple ACL reconstruction (ACLR) techniques using a variety of graft types and implants that fixate the grafts have been described. The aim of the study was to compare two different ACLR techniques using two implant types for suspensory graft fixation in the femoral tunnel. Methods. This randomized-prospective study encompassed 60 patients/subjects who underwent ACLR in the period between January 2015 and December 2017 at the Department of Orthopaedics and Traumatology of Military Hospital ?Dr Vladan Djordjevic? Nis. The ACLR in all patients included in the study was per-formed using a quadruple semitendinosus-gracilis (STG) graft with two types of suspensory fixation on the lateral femoral cortex, whereas the graft fixation in the tibial tunnel was performed using an osteoconductive bioresorbable screw. The post-operative knee stability was assessed 24 months after surgery using the Lachman test and the lateral pivot shift test, as well as the KT-1000 arthrometer test. Results. In patients whose graft was fixated using a fixed-length loop implant, the mean post-surgery knee stability, measured with the KT-1000, was 1.167 ? 0.780; in patients whose graft was fixated using an adjustable-length loop implant, the mean value of the KT-1000 was 1.100 ? 0.894 (p = 0.605). The mean post-surgery International Knee Documentation Committee (IKDC) score for the fixed-length loop group was 84.887 ? 9.0207, while for the adjustable-length loop the score was 88.327 ? 7.302. The mean Lysholm score was 93.50 ? 6.872 for the fixed-length loop group of patients and 94.00 ? 5.527 for the adjustable-length loop group of patients. Conclusion. Both types of implants can be used with success during ACLR, because the functional results of operative treatment using both implants were identical after surgery.

Morphological Changes of the Femoral Tunnel and Their Correlation With Hamstring Tendon Autograft Maturation up to 2 Years After Anterior Cruciate Ligament Reconstruction Using Femoral Cortical Suspension

Background: Graft healing within the femoral tunnel after anterior cruciate ligament reconstruction (ACLR) using suspensory fixation could be reflected in graft maturation and tunnel morphological changes. However, the correlation between graft maturation and femoral tunnel changes remains unclear. Purpose: To quantitatively evaluate femoral tunnel morphological changes and graft maturation and to analyze their correlation after ACLR using femoral cortical suspension. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent single-bundle ACLR with a hamstring tendon autograft using femoral cortical suspension were included. Preoperative and postoperative (at 6, 12, and 24 months) knee function were evaluated using KT-1000 arthrometer testing, the Lysholm knee scoring scale, and the International Knee Documentation Committee (IKDC) questionnaire. At 1 day, 6 months, 12 months, and 24 months after ACLR, 3-dimensional magnetic resonance imaging was performed to observe the morphology of the femoral tunnel and to evaluate graft maturation using the graft signal/noise quotient (SNQ). The Pearson product moment correlation coefficients (r) of femoral tunnel radii versus clinical outcomes and graft SNQs at last follow-up were analyzed. Results: A total of 22 patients completed full follow-up. KT-1000 arthrometer, Lysholm, and IKDC scores improved over time postoperatively, but no significant improvement was seen after 12 months (P < .05). The radius of the tunnel containing the graft and the SNQs of the femoral intraosseous graft and intra-articular graft were the highest at 6 months, and they decreased by 24 months but remained higher than their 1-day postoperative values (P < .05). Expansion mainly occurred at the anteroinferior wall of the femoral tunnel. The tunnel aperture radius was positively correlated with SNQs of the intraosseous graft (r = 0.591; P < .05) and intra-articular graft (r = 0.359; P < .05) but not with clinical outcomes. Conclusion: After ACLR using suspensory fixation, morphological changes of the femoral tunnel were mainly observed in the part of the tunnel containing the graft, which expanded at 6 months and reduced by 24 months. Expansion mainly occurred at the anteroinferior wall of the femoral tunnel. Femoral tunnel expansion was correlated with inferior graft maturation but not with clinical outcomes.

ACL Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Provides Good Clinical Scores, High Levels of Satisfaction and Return to Sport, and a Low Retear Rate at 2 Years.

Background:There are a number of surgical methods for undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although relatively high rates of ipsilateral retears and contralateral tears exist, with only 65% of patients returning to their preinjury level of sport. ACLR techniques adopting synthetic augmentation have been proposed in an attempt to improve clinical outcomes and reduce reinjury rates.Purpose:To determine the efficacy of ACLR using autologous hamstrings augmented with the Ligament Augmentation and Reconstruction System (LARS).Study Design:Case series; Level of evidence, 4.Methods:A total of 65 patients were prospectively treated with arthroscopically assisted single-bundle ACLR using hamstrings augmented with the LARS, of whom 50 were available for 1- and 2-year reviews. Patient-reported outcome measures (PROMs), KT-1000 arthrometer testing, knee range of motion, peak isokinetic knee strength testing, and a battery of 4 hop tests were employed. Limb symmetry indices (LSIs) were calculated. Analysis of variance was used to evaluate differences over time and between limbs. Data on return to the preinjury level of sport, retears, and reoperations were collected.Results:High PROM scores were demonstrated at 1 and 2 years. Before the injury, 47 patients (94%) were actively participating in level 1 or 2 sports, with 38 (76%) and 43 (86%) patients having returned at 1 and 2 years, respectively. Normal (<3 mm; 90%) or nearly normal (3-5 mm; 10%) KT-1000 arthrometer side-to-side differences were observed at 2 years. Apart from knee flexion (P < .0001), extension (P = .001), and the 6-m timed hop (P = .039), there were no between-limb differences at 1 year, and there were no differences on any objective measures at 2 years (all P > .05). Mean LSIs across all measures were ≥90%. At 2 years, 84% to 90% of patients were ≥90% on the hop tests, with 72% and 76% of patients having ≥90% for extension and flexion strength, respectively. Two reoperations were undertaken for meniscal tears (7 and 8.5 months), 1 patient (2%) suffered a retear at 7 months, and 2 patients (3%) suffered a contralateral tear (8 and 12 months).Conclusion:This augmented ACLR technique demonstrated good clinical scores, a high rate of return to sport, and low rates of secondary ruptures and contralateral ACL tears at 2 years. Some caution should be noted in interpreting these results, as 15 of 65 patients (23%) were not included in the 2-year follow-up.

Bridge-Enhanced Anterior Cruciate Ligament Repair: Two-Year Results of a First-in-Human Study.

Background:Bridge-enhanced anterior cruciate ligament repair (BEAR) combines suture repair of the anterior cruciate ligament (ACL) with a specific extracellular matrix scaffold (the BEAR scaffold) that is placed in the gap between the torn ends of the ACL to facilitate ligament healing.Purpose/Hypothesis:The purpose of this study was to report the 12- and 24-month outcomes of patients who underwent the BEAR procedure compared with a nonrandomized concurrent control group who underwent ACL reconstruction (ACLR) with an autograft. We hypothesized that the BEAR group would have physical examination findings, patient-reported outcomes, and adverse events that were similar to those of the ACLR group.Study Design:Cohort study; Level of evidence, 2.Methods:Ten patients underwent BEAR, and 10 underwent ACLR with a 4-stranded hamstring autograft. At 24 months, 9 of the 10 BEAR patients and 7 of the 10 ACLR patients completed a study visit. Outcomes reported included International Knee Documentation Committee (IKDC) subjective and objective results, knee anteroposterior (AP) laxity findings via an arthrometer, and functional outcomes.Results:There were no graft or repair failures in the first 24 months after surgery. The IKDC subjective scores in both groups improved significantly from baseline (P < .0001) at 12 and 24 months, to 84.6 ± 17.2 in the ACLR group and to 91.7 ± 11.7 in the BEAR group. An IKDC objective grade of A (normal) was found in 44% of patients in the BEAR group and in 29% of patients in the ACLR group at 24 months; no patients in either group had C (abnormal) or D (severely abnormal) grades. Arthrometer testing demonstrated mean side-to-side differences in AP laxity that were similar in the 2 groups at 24 months (BEAR, 1.94 ± 2.08 mm; ACLR, 3.14 ± 2.66 mm). Functional hop testing results were similar in the 2 groups at 12 and 24 months after surgery. Hamstring strength indices were significantly higher in the BEAR group compared with the ACLR group (P = .0001).Conclusion:In this small, first-in-human study, BEAR produced similar outcomes to ACLR with a hamstring autograft. BEAR may result in knee stability and patient-reported outcomes at 2 years sufficient to warrant longer term studies of efficacy in larger groups of patients.

Arthroscopic medial meniscal repair with or without concurrent anterior cruciate ligament reconstruction: A subgroup analysis

BackgroundThere are few large-scale, long-term studies comparing medial meniscal repairs with or without concurrent anterior cruciate ligament (ACL) reconstruction. MethodsA total of 140 patients who underwent arthroscopic medial meniscal repair were divided into two groups: Group A, meniscus repair only and Group B, meniscus repair with concurrent ACL reconstruction. Clinical assessments in- cluded physical examination findings, Lysholm score, and the International Knee Documentation Committee (IKDC) form. Barret criteria were used for the clinical assessment of healing status. Magnetic resonance imaging (MRI)was obtained to confirmhealing and failure. Subgroups of participants were compared in terms of suture technique, type of tear, and location of tear. KT-2000 arthrometer testing was used for objective evaluation of anterior–posterior knee movement. ResultsMean follow-up duration was 61 (34–85) months. Clinical outcomes in both groups were significantly improved compared to baseline (P=0.001 vs. P=0.001); however, there was no significant between-group difference in postoperative Lysholm and IKDC scores (P=0.830). The outcomes of three participants (seven percent) in Group A and 11 (11.3%) in Group B were considered as treatment failures (P=0.55). Red–red zone tears had higher scores. Mean postoperative KT2000 arthrometer values of failed participants in Groups A and B were 4.66mm (range, four to six) and 5.2mm (range, two to seven), respectively. ConclusionConcurrentmedialmeniscus repair and ACL reconstruction did not have clinical superiority over meniscus repair alone. Repairs in the red–red zone appeared to be associated with better outcomes.