Arthroscopic Reconstruction Research Articles

Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction using Hamstring Graft in Police personnel in a tertiary care center - A retrospective study

Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction using Hamstring Graft in Police personnel in a tertiary care center - A retrospective study

A Study to Determine the Clinical and Functional Outcomes Following Anatomical Arthroscopic Anterior Cruciate Ligament Reconstruction by Hamstring Graft with Adjustable Loop Using Graft Retensioning Technique

Abstract Background: The anterior cruciate ligament (ACL) plays an important role in stabilising the knee joint. ACL injuries can lead to substantial functional limitations, necessitating surgical intervention for most patients experiencing knee instability and pain. Objectives: To assess the clinical and functional outcomes of anatomical arthroscopic ACL reconstruction using a hamstring graft with an adjustable loop and graft retensioning technique. Materials and Methods: The present prospective clinical study was carried out on patients, with ACL tears confirmed clinically or radiologically. Following the anatomical arthroscopic ACL reconstruction using a hamstring graft with an adjustable loop and graft retensioning technique, a radiograph was obtained to confirm graft placement. Patients then underwent physiotherapy of the affected knee to restore range of motion, strength, and proprioception. Regular follow-ups were conducted at 1, 3, and 6 months postoperatively, with specific evaluations focussing on active knee flexion of the operated knee. Results: In our study, a total of 30 patients were included with the mean age of 36.60 ± 7.58 years. Postoperatively, 43.3% of patients achieved excellent functional outcomes, while 56.7% achieved good outcomes. The Lysholm knee score showed significant improvement from preoperative to postoperative levels (P < 0.05). The range of motion measurements at each follow-up (1, 3, and 6 months) demonstrated significant improvement compared to baseline values (P < 0.05). Conclusion: Our study showed that patients who underwent anatomical arthroscopic ACL reconstruction using a hamstring graft achieved good to excellent clinical and functional outcomes. This was accomplished using an adjustable loop fixation technique combined with graft retensioning.

All-inside arthroscopic procedures for chronic lateral ankle instability: evidence-based clinical practice guidelines

Abstract Background All-inside arthroscopic procedures are now frequently employed to manage chronic lateral ankle instability (CLAI) with satisfactory functional outcomes. Currently, no evidence-based guidelines exist for all-inside arthroscopic procedures for CLAI. Many surgical decisions remain uncertain and challenging. Sources of data Published scientific literature in PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane databases. Areas of agreement All-inside arthroscopic repair and reconstruction procedures are reliable treatments for CLAI. Areas of controversy The all-inside arthroscopic procedures for CLAI present significant challenges, particularly in the following aspects: Growing points Given the lack of guidelines for the all-inside arthroscopic procedures for CLAI, this evidence-based clinical practice guideline provides 11 recommendations to address the controversy. Areas timely for developing research In patients with CLAI undergoing all-inside arthroscopic procedures, comparative studies are urgently needed to establish the optimal timing for weight-bearing, as well as return to work and sports.

Efficacy of complex decongestive therapy in managing limb swelling, pain, and enhancing functional recovery after arthroscopic reconstruction of anterior cruciate ligament.

Efficacy of complex decongestive therapy in managing limb swelling, pain, and enhancing functional recovery after arthroscopic reconstruction of anterior cruciate ligament.

Allograft Resorption Following Arthroscopic Anatomic Glenoid Reconstruction is part of Remodeling to Restore the Native Glenoid Size and Shape 6.9 Months Postoperatively.

Allograft Resorption Following Arthroscopic Anatomic Glenoid Reconstruction is part of Remodeling to Restore the Native Glenoid Size and Shape 6.9 Months Postoperatively.

EP1.12 Revision Arthroscopic Labral Reconstruction: Pushing the Science of Hip Preservation Surgery

Abstract Purpose: Patients who have experienced failure of arthroscopic labral reconstruction of the hip have traditionally been left with limited options, such as living with pain and dysfunction, or undergoing hip arthroplasty. The purpose of our study was to evaluate the outcomes of revision arthroscopic circumferential allograft labral reconstruction (CLR) in nonarthritic hips which had previously undergone labral reconstruction by the same surgeon. Method: Data from 24 hips (∼ 1% of the lead author’s surgical panel during a 4-year collection period) were evaluated to determine the efficacy of revision CLR based on validated patient-reported outcomes. Results: The success rate of the operation was 96%. PROs demonstrated statistically significant improvement with strong measures of effect. Modified Hip Harris Scores (mHHS) improved by a mean of 26.68 points. 88% of patients met the minimal clinically important difference (MCID) for mHHS (+6.49, p < .001, d = 1.32), and the majority of these patients met the patient acceptable symptom state (PASS) threshold. Lower Extremity Functional Scale (LEFS) scores improved by a mean of 21.88 points. 78% of patients met the MCID (+7.79, p < .001, d = 1.32) for LEFS. Conclusion: While labral reconstruction has broadly been shown to result in highly favorable outcomes, our study demonstrated that in the rare case of failure, revision CLR is not only feasible, but results in improved pain and functionality.

EP1.14 Arthroscopic Primary Labral Reconstruction in the Hip: Minimum 10-Year Outcomes with a Nested Propensity-Matched Control

Abstract Background: While labral reconstruction has shown promising short- and mid-term benefits in addressing irreparable labral tears, there remains a notable lack of evidence regarding its long-term-outcomes. Purpose/Hypothesis: To present minimum 10-year patient reported outcomes (PROs) of primary arthroscopic reconstruction in the setting of irreparable labral tears in comparison to a matched labral repair group. Primary labral reconstruction is anticipated to demonstrate comparable improvement in PROs when contrasted with the control group. Study Design: Retrospective Cohort Methods: Data from February 2008 to December 2013 was retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoroacetabular impingement, with minimum 10-year follow-up for modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, patient satisfaction, and visual analog scale for pain. Exclusion criteria were Tonnis osteoarthritis grade >1, prior hip conditions, or workers’ compensation claims. Cases were matched in a 1:3 ratio with a greedy nearest neighbor algorithm with a caliper of 0.2. Patient-reported outcomes and rates of achieving clinically relevant thresholds were compared between the two groups. Results: 22 Hip (22 patients) who underwent primary labral reconstruction were 1:3 matched to 66 hips (63 patients) who underwent primary repair. At minimum 10-year follow-up both groups showed significant improvement in all PROs and VAS with comparable rates of improvement. Both cohorts achieved MCID and PASS at similar rates for mHHS, NAHS, and HOS-SSS. Patients who underwent primary repair achieved SCB for NAHS at a significantly higher rate. Conclusions: Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 10-year follow-up and reaches comparable functional outcomes when compared with a benchmark labral repair control group.

EP1.22 Labral Revision Reconstruction in the Hip: Minimum 2-Year Outcomes with a Nested Propensity-Matched Control

Abstract Background: Although existing literature suggests poorer outcomes for patients undergoing revision hip arthroscopy compared to those undergoing a primary procedure, there is a lack of evidence demonstrating exactly how revision reconstructions compare to primary reconstructions. Purpose/Hypothesis: To present minimum 2-year patient reported outcomes (PROs) of revision arthroscopic labral reconstruction in the setting of a failed primary hip arthroscopy in comparison to a matched primary reconstruction group. We anticipate that revision labral reconstruction will show significant improvement in PROs, albeit potentially inferior when compared to the control group. Study Design: Retrospective Cohort. Methods: Data from April 2010 to November 2021 were retrospectively reviewed. Patients were included if they underwent a revision hip arthroscopy for labral reconstruction in the setting of irreparable labral tear and femoroacetabular impingement, with minimum 2-year follow-up for modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT), patient satisfaction, and visual analog scale for pain. Exclusion criteria were Tonnis osteoarthritis grade >1, hip conditions prior to the primary surgery, or workers’ compensation claims. Cases were matched with a benchmark control group of primary labral reconstruction. Patient-reported outcomes and rates of achieving clinically relevant thresholds were compared between the two groups. Results: 92 hips who underwent revision labral reconstruction were 1:1 matched to 92 hips who underwent primary labral reconstruction. At minimum 2-year follow-up both groups showed significant improvement in all PRO (p<0.001) with comparable rates of improvement in mHHS, NAHS and VAS (p>0.05). Revision reconstruction exhibit inferior 2-year outcomes in all PROs when compared to the control group (p<0.001). Conclusions: Both primary and revision labral reconstruction exhibit significant clinical improvement. However, primary reconstruction yields superior outcomes, with a higher percentage of patients achieving clinically significant thresholds.

EP1.3 Preoperative Quantitative Imaging Use in Predicting Intraoperative Decision for Hip Labral Repair Versus Reconstruction

Abstract Introduction: Intraoperative assessment of labral quality determines arthroscopic repair versus reconstruction for hip labral tear treatment. T2 mapping technology discriminates between healthy and damaged cartilage. This study investigated if T2 mapping magnetic resonance imaging (MRI) can preoperatively predict labral repair versus reconstruction. Methods: This retrospective case-control study included patients with a preoperative T2 mapping MRI who underwent hip labral repair or reconstruction at a single institution between 3/2021-2/2023. Three reviewers blinded to patient information used Syngo.via software to each provide three separate sequencing analyses on each patient’s optimal T2 sagittal cut. The average T2 mapping value was recorded for the labrum and anterior, superior, and posterior acetabular and femoral head zones. Statistical analysis was stratified by age and sex, Bayseian generalized linear mixed models were constructed using the Beta coefficient to represent how the odds of needing a reconstruction change when the predictor variable is altered by 1-unit, and 95% credible intervals determined significance of regression coefficients. Results: 63 operations were included: 14 reconstructions and 49 repairs. Participants were 14-50 years-old with 35 females and 28 males. When controlling for age and sex, the odds of having a labral reconstruction were negatively associated with mapping values across all locations in a statistically significant manner (Labrum: β = -0.075, 95% CI [-0.116, -0.04]; Acetabulum: β = -0.101, 95% CI [-0.132, -0.073]; Femur: β = -0.060, 95% CI [-0.081, -0.041]). Additionally, there was a statistically significant positive association of age and the odds of needing reconstruction when controlling for the labral mapping value (β = 0.353, 95% CI [0.118, 0.635]) but not when controlling for acetabular or femoral measurements. There were no sex differences in the odds of needing reconstruction. Conclusions: T2 mapping with preoperative MRI is statistically significantly negatively associated with the odds of needing a labral reconstruction. The data revealed an additional statistically positive association between age and odds of needing a labral reconstruction when controlling for the T2 labral value. This study will allow further evaluation into anatomic and other variables that predict labral repair versus reconstruction.

EP1.9 Secondary Hip Labral Reconstruction Yields Inferior Minimum 2-Year Functional Outcomes to Primary Reconstruction Despite Comparable Intraoperative Labral Characteristics

Abstract Purpose: To compare intraoperative labral characteristics and minimum 2-year functional outcomes of allograft labral reconstruction in primary versus revision hip arthroscopy across multiple orthopedic centers. Method: A retrospective multicenter hip arthroscopy registry was queried for patients with completed labral reconstruction surgeries from January 2014 to March 2023 with completed 2-year international Hip Outcome Tool-12 (iHOT-12) reports. Age, sex, and major intraoperative variables were also collected. Patients were placed in cohorts based on whether their arthroscopic allograft labral reconstruction was a primary procedure or secondary procedure (reconstruction following failed hip arthroscopy). One-way ANOVA was performed on continuous variables. Chi-squared test was performed on categorical variables. Achievement of minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and Substantial Clinical Benefit (SCB) was also assessed. Results: In total, 77 patients met the inclusion and exclusion criteria and had complete information. The primary reconstruction group (n=50) was significantly older than the secondary reconstruction group (n=27) (47.5 ± 10.5 vs 39.1 ± 8.8 years; P = 0.001). In both cohorts, most patients had labral bruising, advanced labral degeneration, and/or grade III complexity of labral tearing. There was no difference in any recorded intraoperative findings (P = 0.160, P = 0.783, P = 0.357, respectively). Each cohort experienced significant improvement in iHOT-12 scores (P < .0001). However, patients undergoing secondary labral reconstruction reported inferior iHOT-12 scores (60.1 ± 29.2 vs 74.8 ± 27.0; P = 0.030). Patients undergoing primary reconstruction were more likely to reach MCID, PASS, and nearly normal SCB (92 vs 66.7%, P = 0.024; 68.0 vs. 40.7%, P = 0.021; 76.0 vs 48.1%, P = 0.014, respectively). Conclusions: Based on this small, non-randomized, non-matched, retrospective study, allograft labral reconstruction may be considered in the primary as well as revision settings. Level of Evidence: III, retrospective comparative prognostic case-control study.

Positive impact of patient participation in arthroscopic anterior cruciate ligament reconstruction surgery on clinical and functional outcomes, rehabilitation and patient satisfaction

BackgroundThis study aimed to evaluate the effect of patient participation on clinical and functional outcomes, satisfaction, and compliance with postoperative rehabilitation in patients undergoing surgery for anterior cruciate ligament (ACL) injury.MethodsSixty-one patients who underwent isolated ACL reconstruction (ACLR) were included. Thirty patients in the participation group were shown the arthroscopy screen and allowed to communicate with the surgeon during surgery. For clinical and functional evaluation, knee joint range of motion (ROM), International Knee Documentation Committee Subjective Knee Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale (LKSS), Short Form-36 (SF-36) score, and Tegner Activity Scale (TAS), were used. The Pain Quality Assessment Scale was used to assess pain. Additionally, the patient’s satisfaction and exercise compliance were evaluated using a 5-point Likert scale and percentage of exercise participation, respectively.ResultsAt 3rd week, the ROM, SF-36, LKSS values, and pain scores were better in the participation group compared to the control group(p <.05). At 6th month, the IKDC, KOOS, SF-36 values and pain scores were also better in the participation group compared to the control group (p <.05). However, the ROM, LKSS, and TAS values were similar between groups at the 6th month(p >.05). Postop satisfaction at 3rd week and 6th month and exercise compliance postoperatively were significantly better in the participation group compared to the control group(p <.05).ConclusionPatient participation during ACLR surgery by communicating with the surgeon positively affects clinical and functional outcomes. It also contributes to patient satisfaction and compliance with the rehabilitation program postoperatively.Clinical trial numberNot Applicable.

Intraoperative periarticular injection may improve postoperative pain scores and reduce opioid consumption in arthroscopic anterior cruciate ligament reconstruction surgery.

Intraoperative periarticular injection may improve postoperative pain scores and reduce opioid consumption in arthroscopic anterior cruciate ligament reconstruction surgery.

Return to sport and satisfaction after arthroscopic anatomic reconstruction of the lateral ligaments of the ankle in athletes.

Return to sport and satisfaction after arthroscopic anatomic reconstruction of the lateral ligaments of the ankle in athletes.

Use of Ankle-GO to Assess and Predict Return to Sport After Lateral Ankle Reconstruction for Chronic Ankle Instability.

Chronic ankle instability (CAI) develops in 20% to 40% of patients after ankle sprains because of inappropriate management or a premature return to sports (RTS). Patients become candidates for surgery when nonoperative treatment fails. The results of arthroscopic lateral ligament reconstruction have been shown to be excellent. However, there is no consensus on the RTS criteria in these cases. The Ankle-GO score, which has been validated in lateral ankle sprains, is an evidence-based protocol for RTS. To evaluate the discriminant and predictive capacity of the Ankle-GO score for RTS after arthroscopic lateral ankle reconstruction. Cohort study. Level of evidence, 2. This prospective multicenter cohort study, conducted between January 2022 and January 2023, evaluated patients with CAI who underwent arthroscopic anatomic lateral ankle ligament reconstruction using gracilis tendon autografts or allografts. The RTS rates at 4 and 6 months postoperatively were the primary and secondary outcomes, respectively. The evaluated variable at both timelines was the Ankle-GO score-a composite of 4 functional tests and 3 questionnaires. The study determined the discriminant validity of the Ankle-GO score for RTS at each timeline-Ankle-GO scores at 4 months for RTS at 4 months; Ankle-GO scores at 6 months for RTS at 6 months. The predictive capacity of the Ankle-GO score at 4 months for RTS at 6 months was also evaluated. A total of 51 patients, with a mean age of 32.8 years, were included, of whom 23 (45%) had returned to sports at 4 months and 39 (76.5%) at 6 months. The mean Ankle-GO score was significantly higher in the group that returned to sports than in the group that did not (12 ± 4.7 vs 8.8 ± 4.7 at 4 months, respectively, P = .003; 16.8 ± 3.6 vs 11.3 ± 4.8 at 6 months, respectively, P = .002).The predictive capacity of the Ankle-GO score at 4 months for RTS at 6 months was good, with an area under the curve of 0.74 (95% CI, 0.58-0.90; P = .005). The optimal threshold was 6 (sensitivity, 95%; specificity, 50%). The odds ratio of RTS when surpassing the Ankle-GO cutoff score was 18.5 (95% CI, 3-113.95; P = .002). The Ankle-GO score is effective in discriminating the RTS status at 4 and 6 months after lateral ligament reconstruction of the ankle. In addition, the Ankle-GO score at 4 months was also moderately predictive of RTS at 6 months after surgery.

Screw Fixation Has Better Outcomes, Lower Incidence of Redislocation, and Lower Bone Resorption Than Button Fixation for Arthroscopic Anatomic Glenoid Reconstruction With Distal Tibia Allograft: A Matched Cohort Analysis.

Screw Fixation Has Better Outcomes, Lower Incidence of Redislocation, and Lower Bone Resorption Than Button Fixation for Arthroscopic Anatomic Glenoid Reconstruction With Distal Tibia Allograft: A Matched Cohort Analysis.

Comparison of the effects of endobutton continuous loop and adjustable zip loop devices on bone tunnel enlargement and clinical results in arthroscopic anterior cruciate ligament reconstruction: A retrospective observational study.

It was aimed to reveal the effects of 2 different techniques [Endobutton Continuous Loop (CL), ZipLoop technique] used for graft fixation in anterior cruciate ligament (ACL) reconstruction on bone tunnel enlargement and clinical results. Patients who underwent arthroscopic ACL reconstruction using hamstring tendon graft due to ACL rupture between January 2016 and December 2020 were retrospectively analyzed. The study included 80 patients who were operated on by the same surgical team in the same clinic. Forty patients who underwent repair using the suspension system ZipLoop technique were classified as Group 1, and 40 patients who underwent repair using the Endobutton CL technique were classified as Group 2. Plain radiography and MRI were used to evaluate bone tunnel widening. Visual analog scale (VAS), International Knee Documentation Committee (IKDC) knee assessment score, and Lysholm scores were evaluated at the last follow-up to evaluate clinical outcomes. When bone tunnel enlargement was evaluated between the groups, femoral and tibial tunnel enlargement was found to be greater and statistically significant in Group 2 patients in direct radiography measurements. No statistically significant difference was found in tunnel enlargement in MRI measurements (P > .05). However, in MRI measurements, the graft apex-tunnel apex distance was found to be greater and statistically significant in Group 2 patients (P < .05). When the clinical results of both groups were compared, no statistically significant difference was found in VAS, IKDC and Lsyholm scores (P > .05). The graft fixation method affects bone tunnel enlargement. However, it was observed that this had no effect on clinical results.

Comparative Study of Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction with and without Lateral Extra-Articular Tenodesis (Modified Lemaire Technique)

Background: Anterior Cruciate Ligament (ACL) injuries commonly result in knee instability. This study compares functional outcomes between isolated ACL Reconstruction (ACLR) and ACLR combined with Lateral Extra-articular Tenodesis (LET) using the modified Lemaire technique. Methods: This prospective study involved 60 patients divided equally into two groups: ACLR alone and ACLR with LET. Functional outcomes were evaluated using LEFS, Tegner Lysholm, IKDC scores, and hop tests at 3, 6, 9, and 12-months follow-ups. Results: Patients undergoing ACLR with LET showed significantly better LEFS (73.10 vs 68.57), Tegner Lysholm (92.77 vs 84.03), and IKDC (79.03 vs 72.37) scores at 12 months (p&lt;0.001). Hop test scores indicated superior limb symmetry index and functional recovery in the ACLR with LET group. Conclusion: ACLR combined with LET significantly improves knee stability, functional recovery, and patient satisfaction compared to isolated ACLR. Augmentation with LET is recommended for younger patients involved in pivoting sports, although further long-term studies are needed. Keywords: ACL Reconstruction, Lateral Extra-articular Tenodesis, Knee Stability, Functional Outcomes

What Is the Optimal Position of Low Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction? A Quantitative Analysis Based on 2D CT Images and 3D Knee Models.

There is currently no consensus on the optimal placement of the low tibial tunnel for posterior cruciate ligament (PCL) reconstruction. This study aimed to perform the quantitative measurements of the optimal tangential low tibial-tunnel (OTLT) parameters based on 2D CT images and 3D virtual knee models and expect to provide reference data for clinical creation of the OTLT during the arthroscopic transtibial PCL reconstruction. This was a retrospective CT image study. A total of 101 patients between January 2018 and December 2020 were included in our study for analysis. The CT image data of included patients were imported into Mimics software to create the 3D knee models, and the OTLT for PCL reconstruction was simulated on 2D CT images and 3D knee models, respectively. With that, the distances of the tunnel's entry (ADT) and exit points (BDT) to the tibial plateau, the length of the tunnel (LT), and the angle of the tunnel (AT) were measured. Variables were compared using the independent t-test or the Mann-Whitney u test. Correlation analyses between the data and patient demographic factors were performed using the Pearson or Spearman correlation analysis. One-way ANOVA was used to compare differences among height subgroups. The mean ADT, LT, and AT on 2D CT images were 57.96 ± 5.34 mm, 39.92 ± 5.49 mm, and 37.23° ± 4.57° respectively, smaller than the values on 3D knee models (61.86 ± 6.80 mm, 45.56 ± 4.27 mm, and 48.17° ± 6.12°, all p values < 0.001). While the mean BDT on 2D CT images was significantly larger than 3D knee models (35.28 ± 3.07 mm vs. 29.72 ± 3.00 mm, p < 0.001). The BDT showed larger in males than females, the LT showed larger in the taller group, and the AT seemed to be larger in females and shorter people (all p values < 0.05). The quantitative parameters of the OTLT based on 2D CT images and 3D knee models can be used as reference data for clinical surgeons to build an anteromedial OTLT during the arthroscopic transtibial PCL reconstruction.

Comparison of surgical and conservative treatment methods for cruciate ligament injury

Comparison of surgical and conservative treatment methods for cruciate ligament injury

Variations in functional outcome based on hamstring autograft thickness estimated using transportal technique in arthroscopic anterior cruciate ligament reconstruction

Objectives: We aimed to study the functional outcome difference in arthroscopic anterior cruciate ligament reconstruction (ACLR) using hamstring autograft thickness between more than 85% and ≤85%. Materials and Methods: In our study, 50 patients with anterior cruciate ligament (ACL) tears were operated with arthroscopic ACLR using an autologous hamstring graft. The anteroposterior diameter (APD) of the tibial footprint of ACL is measured using an arthroscopic ruler using a transportal and the graft thickness of more than 70% of the tibial footprint APD was used. The international knee documentation committee and knee society score (KSS) were compared between the groups in the 1st month, 6th month, and 12th month between autograft thickness of &gt;85% and ≤85%. Results: The mean IKDC scores of patients with graft thickness &gt;85% were higher compared to graft thickness ≤85% in the 6th and 12th post-operative months, with a statistically significant difference at the 12th post-operative month. The mean KSS scores of patients with graft thickness &gt;85% were higher compared to graft thickness ≤85% at the 3rd, 6th, and 12th post-operative months, with a statistically significant difference at the 12th post-operative month. Conclusion: The functional scores were better for autograft thickness of more than 85% compared to autograft thickness of ≤85% at short-term follow-up of the 3rd and 6th post-operative month with a statistical difference at long-term follow-up of the 12th month.