Assisted Anterior Cruciate Ligament Reconstruction Research Articles

A STUDY OF FUNCTIONAL OUTCOME OF ACL RECONSTRUCTION WITH ANATOMICAL HAMSTRING TENDON AUTOGRAFT

Background: The Anterior Cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting rotational and valgus stress. Anterior Cruciate Ligament (ACL) reconstruction is an established and widely practiced surgical procedure with proven efcacy and a low morbidity prole. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. The advantages with anatomical hamstring grafts are availability of a greater sectional area and unaffected integrity of the extensor mechanism. Moreover tensile strength of quadrupled anatomical hamstring is found to be even better than a normal ACL. The rate of complications like extension loss, anterior knee pain and surgical site infections was also lower than other procedures. Cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for initial xation of soft tissue in the femoral tunnel for ACL reconstruction. The aperture xation methods like the interference screws allows for early rm xation and heal with tight bone-tendon interface. To evalua Objectives: te functional outcome of arthroscopy assisted ACL reconstruction with anatomical hamstring tendon graft using Endobutton and Bioabsorbable interference screw and tibial disc. The Methodology: study results included 30 patients admitted with clinical and radiological deciency of ACL during October 2021 to December 2022, in Department of Orthopaedics, SMIMER Hospital, Surat. Study aims to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction with anatomical hamstring tendon graft using Endobutton and Bioabsorbable interference screw and tibial disc in terms of range of motion, postoperative knee stability, graft site morbidity, subjective knee functions and prospective assessment of functional outcome using Tegner Lysholm knee scoring system. All the patients included in the s Results: tudy were 23 male and 2 female patient. The analysis of the studied cases revealed that the most common affected age group was between 18 to 24 years .. Majority of patients were operated more than 6 months after injury. Sports/BPET (Battle Physical Efciency Test) injuries was the most common mode of injury. The mean size of graft used was 8.2±0.39.Post-operatively at 3, 6, 12month follow up,1 case (4%) had a positive Pivot shift test with a "Glide" (Grade-I), whereas remaining 24 cases (96%) had a negative Pivot shift test. None of the patients had grade III laxity. The mean postoperative Lysholm score improved from preoperative score of 66±5.2 to 88.70±5.54. The overall satisfactory result (excellent + good) at follow up was 95%. All the patients had returned to preinjury level of activity. ACL injuries are common in younger age group individuals. S Conclusion: ports related injury and RTA are the most common modes of injury. Arthroscopy assisted ACL reconstruction using Anatomical hamstring tendon autograft provides a stable knee, reduces postoperative morbidity and enables early rehabilitation. Graft xation using endobutton and and Bioabsorbable interference screw will help the graft to facilitate graft tunnel healing and also maintain its strength until there is a good graft to bone healing occurs. It allows the patients to return to preinjury level of activity, allows the patient to squat, sit crossed leg and climb stairs without difculty. Degeneration of the articular surfaces rarely occurs and the re-operation rates are minimal.

The tibial insertion of the hamstring can be considered to be preserved during anterior cruciate ligament reconstruction.

BackgroundHamstring as a graft was very common in anterior cruciate ligament reconstruction surgery. Usually the hamstring muscles needed to be taken out and then woven to be used.AimIn order to investigate whether it was beneficial for patients to preserve the transpedicular insertion of hamstring when using the hamstring as a graft for anterior cruciate ligament reconstruction.MethodsThis was a retrospective study. Patients with anterior cruciate ligament injury who underwent surgery in a large hospital from January 2015 to May 2021 were included in the study. These patients underwent anterior cruciate ligament reconstruction assisted by arthroscopic. Autologous hamstring muscles were used as grafts. The tibial insertion of the hamstring were preserved during the operation were included in the observation group. The remaining patients were included in the control group. The knee joint function and operation of the two groups were compared.ResultsA total of 97 patients were included in the study. There was no statistical difference between the two groups in general data including gender, age and surgical side. All the patients’ operations were successfully completed there was no significant difference in the operation time between the two groups. All patients were followed up for at least 1 year. No patients had complications such as wound infection and graft failure at the last follow-up. There was no significant difference between the two groups in Lysholm score and IKDC score before operation. Similarly, there was no significant difference between the two groups in Lysholm score and IKDC score 3 months after operation. However, the Lysholm score and IKDC score of the two groups 1 year after operation were statistically different, and the patients in the observation group had higher Lysholm score and IKDC score. After comparing the MRI images of the knee of the two groups 3 months after operation through the MRI evaluation system, compared with the patients in the control group, the patients in the observation group have higher scores, and the difference was statistically significant.ConclusionIn the knee arthroscopic assisted anterior cruciate ligament reconstruction using the hamstring as a graft, the tibial insertion of the hamstring can be preserved, which can make the patient have better function after the operation. This kind of operation leads to the increase of operation time and operation risk.

Impaction Of Rehabilitations And Strengthening Programs before And after Anterior Cruciate Ligament Reconstruction In Return to the Fitness Level.

Objectives Sports injuries are one of the most common orthopedic injuries particularly in young and active populations. Football is the most popular sport among Saudis, and thus, anterior cruciate ligament (ACL) injuries are common in clinics and emergency rooms in Saudi Arabia. The aim of this study was to evaluate the outcomes of patients six months after ACL reconstruction in both hospitals and gym-based rehabilitation services and its impaction on the patients to return to sports and preinjury fitness levels. Methods This is a retrospective case series of patients who underwent arthroscopically assisted ACL reconstruction using a hamstring autograft at our center. Data were gathered from January 2020 to December 2020. Patients were given a questionnaire about their visits to the orthopedic clinic in the 6th month after surgery. Results Sixty patients with ACL reconstructions were studied. Noncontact sports were the leading cause of injuries (53.3%). The mean Lysholm score was 84.9 (SD 3.45) out of 100 after six months of follow-up, and the mean Tegner score was 4.77 (SD 1.06) out of 10 points. The Lysholm score was excellent (>90) among 5% (n= 3), good (84–90) among 60% (n= 36), and fair (65–83) among 35% (n= 21). As a result, we observed that the duration of postoperative rehabilitation has a significant relationship with the fitness level (X2= 18.711; p=0.001).Conclusion The Lysholm knee scoring scale and the Tegner activity scale showed that arthroscopically assisted ACL reconstruction using hamstring autograft has a successful and functional outcome after which the patient returns to sports or regains the preinjury level of fitness level depends on the rehabilitation.The period and types of preoperative and postoperative rehabilitation have a direct impact on the return to fitness levels and normal daily life activities.

Poster 256: The "N+10 Rule" to Avoid Graft Tunnel Mismatch in Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction Using Independent Femoral Tunnel Drilling

Objectives: To determine the amount of tibial graft tunnel mismatch during application of the “N+10” rule in arthroscopic assisted anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BTB) graft using independent femoral tunnel drilling.To compare actual (measured) tibial tunnel length and desired (calculated) tibial tunnel length when using the “N+10” rule for independent femoral tunnel drilling. Methods:Twenty paired knees from 10 fresh frozen cadaveric specimens (5 female and 5 male specimens) underwent arthroscopic assisted bone-patellar tendon-bone ACL reconstruction using independent femoral tunnel drilling with either a hyperflexion accessory anteromedial portal (n=10) or flexible reamer technique (n=10). The prepared patellar tendon graft bone blocks were trimmed to 10 x 20mm for all specimens and the intertendinous distance (N) between the bone blocks was measured. The “N+10 Rule” was used to set the angle of the ACL tibial tunnel guide to the appropriate degree setting for drilling. The amount of excursion or recession of the tibial bone plug in relation to the anterior tibial cortical aperture was measured in both flexion and extension. A +/-6mm threshold was used to assess this strategy based on prior biomechanical aperture fixation studies. As a secondary outcome, the intraarticular distance (IAD) and the actual tibial tunnel length (TTL) were measured and compared to the planned TTL based on the equation: IAD + TTL = N + 20 (size of bone plug in millimeters)Results:The average BTB ACL intertendinous distance (N) was 47.5mm (SD =5.5mm). The average measured IAD was 27.2mm (SD=3.0mm). Using the “N+10 Rule”, the average mismatch of the tibial tunnel was 4.9mm (SD=3.6mm) and 3.8mm (SD=3.5mm) in flexion and extension, respectively. Both values fall within the +/- 6mm threshold. When comparing the actual measured tibial tunnel length (TTL) to the desired TTL, there was an average difference of 5.4mm (SD=3.9mm)Conclusions:The “N+10” rule resulted in an acceptable average mismatch in both flexion and extension using the threshold of +/- 6mm for 20 cadaveric knees. Measured actual TTL compared to the desired calculated TTL were acceptable 61% of the time using the same threshold. The “N+10” is a simple and effective intraoperative strategy for achieving desired tibial tunnel length to avoid excessive graft tunnel mismatch.Figure 1:Derived formula for calculating ideal tibial tunnel length (TTL) using intraarticular distance (IAD), and the known values of the intertendinous distance (N) and lengths of the bone blocks (20mm).Figure 2:Intraoperative photo of BTB ACL graft measuring intertendinous distance between the bone plugs (N=55mm). Following the "N+10" ruleFigure 3:Intraoperative photo of tibial ACL guide measurement of tibial tunnel length at 50mm with guide set to 65 degrees.Figure 4:Intraoperative photo of the ACL tibial tunnel guide positioned on the anatomic tibial footprint set to 65 degrees (N=55mm). Using this setting for the guide, the tibial tunnel measured 50mm as seen in the zoomed in photo, as per the formula.

FUNCTIONAL OUTCOME OF ARTHROSCOPE ASSISTED RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT USING BONE-PATELLAR TENDON-BONE GRAFT

Objective: To evaluate arthroscopic assisted Anterior Cruciate Ligament (ACL) reconstruction using Bone-Patellar Tendon-Bone (BPTB) graft using anteromedial approach to drill the femoral tunnel followed by accelerated ACL rehabilitation protocol in terms of Lysholm score. Study Design: Prospective comparative study. Place And Duration Of Study: The study was conducted in Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar from May 2018 to April 2019. Methodology: This study was an analysis of prospectively collected data of patients who had undergone Anterior Cruciate Ligament reconstruction. All patients below the age of 35 years presenting with Anterior Cruciate Ligament Grade 3 tear were assessed objectively and subjectively using Lysholm score pre and post operatively. Manual laxity of knee was assessed with anterior drawer and Lachman test; and being compared with normal contralateral knee. Rotational instability was assessed by pivot shift test. Results: Nineteen patients, all males, were included in this study with the mean age of 26.7 ± 4.68 years. All patients underwent arthroscopic assisted Anterior Cruciate Ligament reconstruction with uneventful recovery. Every patient had his pre and post-operative Lysholm scoring done. Mean pre-operative Lysholm score was 53.89± 3.81. Patients were followed up at 5 months and at 9 months and their mean Lysholm scores were 84.74 ± 6.31 and 92.47 ± 3.04 respectively with the p-value of <0.001. Only 2 patients had residual Grade I Lachman laxity and none of the patients had any rotational instability. Conclusion: Arthroscopic assisted Anterior Cruciate Ligament reconstruction using Bone-Patellar Tendon-Bone graft followed by accelerated Anterior Cruciate Ligament rehabilitation protocol led to signicant improvement of Lysholm score.

Study of the effect of using antihemorrhagic drugs and the use of intraarticular drain after arthroscopic anterior cruciate ligament reconstruction on the outcome of the procedure

Background Reconstruction of the anterior cruciate ligament (ACL) is crucial for maintenance of the stability of the knee. ACL reconstruction is a bloody operation owing to the formation of transosseous tunnels. Blood might obscure the view during surgery and may collect postoperatively to impair the range of movement and slow down the rate of rehabilitation. The use of intraarticular (IA) drains might be helpful in that issue; however, the risk of introduction of infection to the joint might be increased. Hypothesis The purpose of this study was to determine whether the use of IA drains are necessary for improving outcomes after arthroscopic ACL reconstruction and also whether the use of preoperative antihemorrhagic drugs might preclude the use of IA drains. Patients and methods A total of 60 adult patients (60 knees) with documented ACL injury were eligible for arthroscopically assisted ACL reconstruction. The patients were randomly divided into two groups, each consisting of 30 patients. Both groups had anatomical single-bundle ACL reconstruction using the transaccessory femoral portal approach. The ACL graft substitute was hamstring tendon autograft in 25 cases and quadriceps tendon autograft in five cases. In the first group, an IA drain was fixed at the end of surgery, without preoperative antihemorrhagic drugs. The second group was given antihemorrhagic drugs IV (tranexamic acid 500 mg/5 ml, trade name Kapron) 1 h before surgery, and no drain was applied at the end of the operation. The patients were examined for the degree of knee swelling, pain as assessed by the visual analog scale, amount of blood collected, and range of movement. These parameters were reassessed after 2 weeks and at the end of the follow-up at 3 months postoperatively. Results Group 1 with the drain tended to have less pain and swelling in the immediate postoperative period, more wasting of the quadriceps at the end of follow-up, and comparatively lower mean range of motion (ROM) at the end of follow-up. On the contrary, group 2 without drain tended to have more swelling in the immediate postoperative period, which decreased dramatically over time to be significantly lower than that in patients in group 1 at a comparable stage of follow-up. Only four patients developed significant hemarthrosis that needed aspiration with a wide-bore needle in group 2. The final mean ROM is significantly better in this group. The rate of infection tended to be lower in group 2 without a drain, but with no statistically significant results. Conclusion The use of IA drain after arthroscopic ACL reconstruction decreases pain and swelling in the immediate postoperative period. However, patients among group 2 despite having more pain and swelling in the immediate postoperative period recovered more rapidly and more effectively, having a comparatively better ROM and less wasting of the quadriceps at the end of follow-up. The rate of infection tended to be lower in group 2 without a drain, but with no statistically significant results. The preoperative use of parenteral antihemorrhagic medication decreases the intraoperative bleeding and improves visualization during arthroscopic surgery; moreover, it may be beneficial in decreasing the postoperative hemarthrosis.

The incidence and risk factor of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction

PurposeTo retrospectively analyze the incidence and risk factors of deep venous thrombosis (DVT) detected by ultrasonography after arthroscopically assisted Anterior Cruciate Ligament Reconstruction (ACLR). MethodsWe retrospectively reviewed medical records of arthroscopically assisted ACLR surgery performed at our institution between 2012 and 2015. Revision ACLR, bone patella tendon bone (BTB) graft reconstruction, and concomitant multiple ligament reconstructions were excluded. We performed a standardized double-bundle reconstruction procedure using hamstrings graft for ACLR. All patients routinely received DVT screening by using venous ultrasonography on postoperative day 7 from 2012 to 2013, and postoperative days 7 and 14 from 2014 to 2015. The prevalence of DVT was calculated and clinical factors such as age, gender, Body Mass Index (BMI), operative time, and duration of tourniquet application were evaluated in relation to the risk factor of DVT. ResultsTwo hundred and fifty-six patients (129 men and 127 women) with a mean age of 28.9 were enrolled. Sixteen patients (6.6%) were detected with DVT on postoperative day 7. Among 146 patients who received venous ultrasonography on both postoperative days 7 and 14, DVT were detected in five additional patients on postoperative day 14. In a total of 21 patients who were diagnosed with DVT, two were proximal, the remaining 19 were distal, and no patient had progressed to pulmonary embolism (PE). In terms of predisposing factors for developing DVT on postoperative day 7, only age ≥30 showed a statistically significant higher risk of DVT (P = 0.03). ConclusionIncidence of DVT after ACLR detected by ultrasonography on postoperative day 7 was 6.6%. Patients aged ≥30 years have a potentially higher risk for developing DVT. Great care for DVT should be taken if prolonged immobilization is applied after ACLR surgery. Level of evidenceLevel Ⅳ

Comparison of efficacy and safety of different fixation devices for anterior cruciate ligament reconstruction: A Bayesian network meta-analysis protocol.

Background:Anterior cruciate ligament (ACL) injury is a common ligament injury to the knee joint, and often lead to limited function, osteoarthritis after knee trauma, secondary damage to meniscus and cartilage, and impaired quality of life. ACL reconstruction is the gold standard surgical treatment for ACL injury, and ligament fixation after reconstruction is the key factor of ACL reconstruction success. However, the optimal fixation device for ACL reconstruction remains unclear. This study aims to evaluate the efficacy and safety of different fixation devices and to find the best fixation device for ACL reconstruction.Methods:The PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Chinese Biomedicine Literature will be searched to identify relevant studies from inception to December 2018. We will include randomized controlled trials (RCTs) comparing the effects of different fixation devices fixed on the femoral side in arthroscopically assisted ACL reconstruction. Risk of bias assessment of the included RCTs will be conducted according to the Cochrane Handbook 5.1.0. A Bayesian network meta-analysis (NMA) will be performed using R software.Results:The results of this NMA will be submitted to a peer-reviewed journal for publication.Conclusion:This NMA will summarize the direct and indirect evidence to evaluate the effect of different fixation devices for ACL reconstruction.

Contrast-Enhanced MRI Evaluation of Bone-Patellar Tendon-Bone and Hamstring ACL Autograft Healing in Humans: A Prospective Randomized Study.

Background:Gadopentetate dimeglumine–enhanced magnetic resonance imaging (MRI), or gadolinium-enhanced MRI, was used to prospectively study the postoperative course of bone–patellar tendon–bone (BPTB) and combined semitendinosus and gracilis (STG) tendon autografts following arthroscopically assisted reconstruction of the anterior cruciate ligament (ACL) in humans. Gadopentetate dimeglumine is a contrast agent that has been shown to enhance the signal of vascularized tissue when examined by MRI.Purpose:To prospectively determine and compare the pattern and timing of autograft revascularization following arthroscopically assisted ACL reconstruction by BPTB or STG autografts.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 73 patients (63 males, 10 females) with ACL tears who were scheduled to undergo reconstruction consented to participate in this study. The patients were randomized to receive arthroscopically assisted reconstruction of the ACL employing either BPTB or STG autografts. Gadolinium-enhanced MRI scans were scheduled at 3-month intervals during the first postoperative year to assess the integrity, timing, and pattern of enhancement of the ACL graft. The temporal sequence and morphologic characteristics of imaged signals were compared for both types of ACL reconstructions.Results:Based on all knees with 1 exception, there were no statistically significant differences in gadopentetate dimeglumine–mediated graft enhancement grade observed between BPTB and STG autografts.Conclusion:The results suggest that autograft revascularization probably varies in intensity and location during the time course of graft healing. The interval signal changes observed 3 to 9 months, but especially 6 to 9 months, postoperatively are due to increased contrast uptake as a reflection of ongoing neovascularization during the process of ligamentization.

Arthroscopically assisted anterior cruciate ligament reconstruction: Comparison of bone-patellar tendon-bone versus semitendinosus gracilis autograft

Anterior cruciate ligament (ACL) tear is the most common serious ligamentous injury to the knee joint. The ACL is the primary stabilizer against anterior translation of the tibia on the femur and is important in counteracting rotation and valgus stress. Anterior cruciate ligament deficiency leads to knee instability. This results in recurrent injuries and increased risk of intra-articular damage, especially the meniscus. The goals of the ACL reconstruction are to restore stability to the knee: allow the patient to return to normal activities, including sports; and to delay the onset of osteoarthritis with associated recurrent injuries to the articular cartilage and loss of meniscal functions. The bone-patellar tendon-bone graft and the hamstring tendon graft are the two commonly used auto grafts for reconstruction. This study is to compare the results of arthroscopically assisted ACL Reconstruction using Bone-Patellar Tendon-Bone (PTB) and Semitendinosus-Gracilis (STG) grafts. This study was conducted in Govt. Medical College Kozhikode from March 2014 to October 2015. During this period 40 cases of adult patients with ACL deficient knees were selected according to the inclusion criteria. This study aims to compare the results of Arthoscopically assisted ACL Reconstruction using Bone –Patellar – Bone and STG tendon grafts in terms of Post operative knee stability, Subjective knee functions, Patient satisfaction, Graft site morbidity and Range of motion. Results of our study clearly showed that both bone patellar tendon bone and hamstring tendon grafts could effectively improve knee stability and functions after Anterior Cruciate Ligament reconstruction. At follow up evaluation, both groups had similar subjectives outcomes. The outcome for patients in this study undergoing ACL reconstruction with a Hamstring tendon graft did not differ from that of patients with a Patellar tendon graft in term of clinical stability, range of motion and general symptoms. The hamstring tendon group also had lower graft harvest site morbidly, as demonstrated by less kneeling pain at 6 months and 1 year.

A descriptive study of arthroscopy assisted anterior cruciate ligament reconstruction and evaluation of its functional outcome using Lysholm score

With the new advancements in the technology being used in orthopedic surgeries like arthroscopic reconstruction of joint injuries, the surgical outcome has improved a lot over the period of time. Arthroscopic reconstruction of the ACL ligament is one of the most commonly performed knee surgeries nowadays. The first arthroscopically assisted ACL reconstruction was performed in 1980 using an artificial ligament made out of carbon fiber supplemented with an extra-articular lateral substitution. Later in the first decade of twenty first century, anterior cruciate ligament reconstruction using Hamstring tendon autograft showed excellent self-reported and objective results. It was proved further that the outcome measures which favored Semitendinosus and Gracilis autografts included anterior knee pain, kneeling pain and extension loss. Long term studies have shown to have equal success rates with quadrupled Hamstring tendon graft or bone patellar tendon bone graft. We conducted this study to evaluate the anterior cruciate ligament injuries, their arthroscopic surgical reconstruction and their functional outcome using Lysholm score over a period of 6 months follow up. 52 Patients admitted in the Orthopedic department of the hospital with ACL injuries were included in the study. 36% of the population had ACL injury due to RTA, 33% of the population had ACL injury due to fall and 31% of the population had ACL injury due to sports injury. 55.8% of the patients underwent surgery within 4 months of the injury. 29% of the patients had associated injuries, while 6% had complications post-op. Mean Lysholm score showed significant improvement post-operatively on evaluation at 6 weeks, 3 months and 6 months. 73.1% patients underwent ACL reconstruction, 15.4% had ACL reconstruction with Meniscal Debridement while rest 11.5% underwent ACL reconstruction with Meniscal Repair.

One-incision versus two-incision techniques for arthroscopically assisted anterior cruciate ligament reconstruction in adults.

Anterior cruciate ligament (ACL) tears are serious knee injuries that are frequently treated surgically in the form of arthroscopically assisted reconstruction with grafts from the patella or hamstrings tendons. We reviewed the evidence for the choice of arthroscopically assisted ACL reconstruction technique in terms of whether it should involve one incision (femoral tunnel drilled from inside the knee joint under arthroscopic visualisation) or two incisions (femoral tunnel drilled from outside to inside the knee joint). To assess the effects (benefits and harms) of one-incision versus two-incision techniques for arthroscopically assisted ACL reconstruction in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Latin American and Caribbean Health Sciences (LILACS), the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, reference lists, and conference abstracts. The date of the search was 16 August 2017. Randomised and quasi-randomised controlled clinical trials evaluating one-incision versus two-incision techniques for arthroscopically assisted ACL reconstruction in adults. Two review authors independently searched and selected studies, and extracted data and assessed the risk of bias of the eligible studies. We undertook limited pooling of data using the fixed-effect model. We included five trials (four randomised and one quasi-randomised) evaluating a total of 320 participants who were mainly in their 20s. All participants underwent ACL reconstruction with patella tendon grafts. All five included trials were at a high risk of bias, particularly performance bias. Based on these limitations and the insufficiency of the available data resulting in imprecision of effect estimates, we judged the quality of the evidence as very low for all outcomes. This means that we are uncertain of the findings of the review.We found very low-quality evidence of no clinically important differences between the two techniques in self reported knee function, measured using the Lysholm knee score (scale 0 to 100: best outcome), at short-term (3 months) (mean difference (MD) 2.73 favours one-incision technique, 95% confidence interval (CI) -2.70 to 8.15; 79 participants, 2 studies), intermediate-term (12 months) (MD -3.68 favours two-incision technique, 95% CI -6.61 to -0.75; 79 participants, 2 studies), and long-term follow-up. The data available for long-term follow-up (2 to 5 years) was expressed in terms of the numbers of participants with excellent Lysholm scores (90 points or more); we found no difference between the two groups (42/45 versus 36/40; risk ratio (RR) 1.04, 95% CI 0.91 to 1.18; 1 study). There were no data for quality of life measures or for overall numbers of participants incurring an adverse event. We found very low-quality evidence of little between-group differences in individual adverse events such as infection, knee stiffness, reoperation, and graft failure.We found very low-quality evidence from one study (59 participants) of little difference between the two groups in activity levels measured using Tegner scores (scale 0 to 10: highest sport activity) at two years (MD -0.80 favours two-incision technique, 95% CI -1.90 to 0.30). There was very low-quality evidence from four studies of minimal between-group difference in the number of participants with normal or nearly normal objectively measured knee function (International Knee Documentation Committee objective assessment grading) at intermediate follow-up (means 12 to 28 months): 56/78 versus 63/89; RR 1.01, 95% CI 0.85 to 1.21; 167 participants). The very low-quality and often absent evidence means that we are uncertain whether one-incision arthroscopically assisted ACL reconstruction techniques yield better, worse, or equivalent results compared with two-incision techniques in terms of short-, intermediate-, or long-term subjective function, quality of life, adverse outcomes, activity levels, and objectively rated knee function. The evidence was available only for single-bundle ACL reconstruction using patella tendon grafts.When considering priorities for high-quality randomised trials on techniques for ACL reconstruction, it is important to note the insufficiency of the evidence available to inform this key comparison.

Comparative analysis of the functional outcome of arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft fixed with bio absorbable interference screw against titanium interference screw

INTRODUCTION: Knee injuries are more common in the modern era due to increase in road traffic accidents and more involvement in sports related activities by common people. Anterior cruciate ligament is the most commonly injured ligament around knee joint. Anterior cruciate ligament has a pivot role in function and stability of the knee joint, being the primary stabilizer preventing the anterior translation of tibia over femur. Arthroscopic anterior cruciate ligament reconstruction has become the gold standard in the management of these injuries. AIM OF THE STUDY: To do comparative analysis of the functional outcome of Arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft with endobutton as femoral fixation device and bioabsorbable interference screw against titanium interference screw as tibial fixation devices respectively. MATERIALS & METHODS: This study is a retrospective and prospective study of 60 patients treated with arthroscopic anterior cruciate ligament reconstruction with quadrupled hamstring graft with endobutton as the femoral fixation device and titanium interference screw (no=30) and bioabsorbable interference screw (no=30) as tibial fixation device respectively between May 2012 and November 2013 at Institute of orthopaedics and traumatology, Rajiv Gandhi Government General Hospital, Chennai. Minimum age of the patient was 20 years and maximum age was 55 years with mean age of 31. Study group included 51 male patients and 9 female patients. Minimum duration after injury was 5 weeks and maximum duration since injury was 15 months. Minimum period of follow up was 6 months and maximum was 1.5 years. Of the 60 patients, 30 patients underwent arthroscopic assisted anterior cruciate ligament reconstruction with quadrupled hamstring graft with endobutton as femoral fixation device and tiatanium interference screw as tibial fixation device. Remaining 30 patients underwent arthroscopic assisted anterior cruciate ligament reconstruction with quadrupled hamstring graft with endobutton as femoral fixation device and bioabsorbable interference screw as tibial fixation device. All patients were operated under spinal aneasthesia. Except for 2 patients, postopearative period was uneventful for others. RESULTS: All patients are evaluated with Lysholm and Gillquist scoring at the end of 6 months. The maximum score achieved was 100 and minimum score was 56. Two patients in titanium interference group and one patient in bioabsorbable interference screw group lost to followup. Statistical analysis was studied using Yate’s corrected Chi-Square test. No significant differences were identified between the two screw typeswith respect to Lysholm and Gillquist scoring. The complication rates were also similar in the two groups. CONCLUSION: The clinical results associated with titanium interference screw and bioabsorbable interference screw are statistically similar. The complication rates associated with the two screws were also similar. The results of this comparative analysis support the hypothesis that there are no significant differences in the outcomes associated with tiaanium screws compared with bioabsorbable screws for ACL reconstruction.

Assessment of foot print of femoral tunnel placement with commercially available off set guide in arthroscopic ACL reconstruction

<p class="abstract"><strong>Background:</strong> <span>Accurate placement of the femoral tunnel is critical for long-term clinical success following anterior cruciate ligament (ACL) reconstruction.</span> <span> Current trends in ACL reconstruction favor anatomic positioning of ACL attachment sites. Surgical inaccuracy in femoral tunnel positioning can lead to potential early graft failure and early-onset osteoarthritis. The purpose of this study was to evaluate</span> the functional outcome in patients who underwent arthroscopic anatomic ACL reconstruction using hamstring tendon graft<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> The<strong> </strong>study was conducted in the Orthopedics Department of IIMCHRC, Indore the placement of femoral tunnel, using femoral off set guide with other techniques. All the patients who were diagnosed clinically and radiologically with ACL tear and all who gave the consent were included in the study. All patients were enrolled to undergo primary arthroscopically assisted ACL reconstruction.<strong></strong></p><p class="abstract"><strong>Results:</strong> In the present study out of 42 patients; 23 patients (55%) had right sided ACL injury and remaining 19 patients (45%) had left sided ACL injury. We assessed functional outcome of the patients through pre-operative and post-operative IKDC scoring. The mean of the pre-op IKDC scoring was 33.61 with SD of 9.67 and the mean of the post-operative IKDC scoring was 77.95 with SD of 15.15<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The commercially available off set guide technique of the femoral tunnel placement in arthroscopic ACL reconstruction is easy, reliable and reproducible with the foot print at anatomical place on the femoral site<span lang="EN-IN">.</span></p>

Sports-specific differences in postsurgical infections after arthroscopically assisted anterior cruciate ligament reconstruction.

Post-operative infection after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a rare but severe complication, particularly for young and active patients. It is unclear whether the prevalence of knee infection is correlated with the type of sports or the level of performance. From 2008 to 2012, the internal single-centre ACL registry of the FIFA Medical Centre of Excellence Regensburg was retrospectively screened for sex, age, time between isolated primary ACL rupture and surgery, surgical technique, rate of infection after ACL reconstruction and the type of sports practised. In total, 4801 ACL reconstructions had been conducted over 5years, 4579 in amateur and 221 in professional athletes. After application of the exclusion criteria, 1809 athletes with ACL reconstruction were analysed regarding postsurgical infection and the type of sports practised. Professionals and amateurs did not significantly differ with regard to infection rates (n.s.) but in the timing of ACL repair (p<0.001). Eleven of 1130 football players had developed postsurgical infection after ACL reconstruction (1.0%) in contrast to 557 skiers and snowboarders without infection (p=0.02). The timing of ACL repair did not differ between the different types of sports (n.s.). Staphylococcus aureus and epidermidis were the predominant detected bacteria. All patients were hospitalised and successfully treated with arthroscopic lavage and antibiotic medication. ACL infections showed sports-related differences. Athletes practising summer outdoor sports such as football had a significantly higher risk of infection after ACL reconstruction than winter sports athletes. No difference was found between professional and amateur athletes. Relevant prevention strategies for postsurgical ACL infections should consider influencing patient factors such as the type of sports activity and attendant circumstances. III.

Effect of drains on dynamic proprioception after arthroscopically assisted anterior cruciate ligament reconstruction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Decrease in proprioception and kinesthesia occurs after ACL injury. Changes occurring within the joint following injury affect normal recruitment and firing patterns of the surrounding musculature. There are little data in the literature with reference to drain use after arthroscopic procedures on the knee or ACL reconstruction. The objective of the study was to determine the effect of postoperative drain use on proprioception after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring graft.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this study, 54 arthroscopic ACL reconstruction patients were randomized for either intra-articular suction drain group or non-drain group. Outcome Assessment was done at 1 month, 3, 6 and 12 months after the surgery in which patients were assessed using Star excursion balance test by measuring excursion distances in each of the 8 directions.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Excursion distances in eight directions showed more increment in drainage tube (DT) group compared to no DT group. However it was found to be statistically significant only for posteromedial (p =0.018) and medial directions (p &amp;lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Postoperative drain should be used after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring graft for improving the deficits in dynamic posture control.&lt;/p&gt;

Predictors of Revision Surgery After Anterior Cruciate Ligament Reconstruction

Background: Arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. Graft failure after reconstruction remains a devastating complication, often requiring revision surgery and less aggressive or modified rehabilitation. Worse functional and patient-reported outcomes are reported compared with primary reconstruction. Moreover, both rates and risk factors for revision are variable and inconsistent within the literature. Purpose: To determine the rate of revision surgery after ACL reconstruction in a large cohort of patients, to assess the influence of patient characteristics on the odds of revision, and to compare revision rates between active-duty military members and non–active-duty beneficiaries. Study Design: Descriptive epidemiology study. Methods: Using administrative data from the Military Health System, a retrospective study was designed to characterize the rate of ACL revision surgery among patients treated within a military facility. All patients ≥18 years at the time of ACL reconstruction were identified using the American Medical Association Current Procedural Terminology (CPT) for ACL reconstruction (CPT code 29888) over 7 years (2005-2011). Revision ACL reconstructions were identified as having ≥2 ACL reconstruction procedure codes on the ipsilateral knee at least 90 days apart. Univariate analysis was performed to calculate odds ratios (ORs) for demographic, perioperative medication use, and concomitant procedure–related risk factors. A multivariate logistic regression model determined risk covariates in the active-duty cohort. Results: The study population consisted of 17,164 ACL reconstructions performed among 16,336 patients, of whom 83.3% were male with a mean ± SD age of 28.9 ± 7.6 years for the nonrevision group, and was predominantly active duty (89.2%). Patients undergoing ACL reconstruction on both knees only contributed their index knee for analyses. There were 587 patients who underwent revision surgery, corresponding to an overall revision rate of 3.6%. The median time from the index surgery to revision surgery was 500 days (interquartile range, 102-2406 days). Revision rates were higher in the active-duty cohort as compared with non–active-duty beneficiaries (3.8% vs 1.8%, respectively; OR, 2.14; 95% CI, 1.49-3.07). Based on multivariate logistic regression in the active-duty cohort, age ≥35 years (OR, 0.44; 95% CI, 0.33-0.58) and concomitant meniscal repair (OR, 0.69; 95% CI, 0.53-0.91) were found to be protective with regard to the odds of revision surgery. Perioperative medication use of nonsteroidal anti-inflammatory drugs (NSAIDs) (OR, 1.33; 95% CI, 1.12-1.58; number needed to harm [NNH], 100) and COX-2 inhibitors (OR, 1.31; 95% CI, 1.04-1.66; NNH, 333) was associated with increased odds of revision surgery. No significant findings were detected among sex, race, nicotine use, body mass index, or other concomitant procedures of interest. Conclusion: In this large cohort study, the rate of revision ACL reconstruction was 3.6%, which is consistent with the existing literature. Increased odds of revision surgery among active-duty personnel were associated with the perioperative use of NSAIDs and COX-2 inhibitors. Age ≥35 years and concomitant meniscal repair were found to be protective against ACL revision.

Knee Stability and Functional Outcome Following Arthroscopic ACL Reconstruction: Comparison between Two Different Femoral Tunnel Positions

Background and purpose: Anterior cruciate ligament (ACL) reconstruction is one of the most commonly procedure which are done by orthopedic surgeon. The aim of this study was to compare knee stability and functional results in two different tunnel position groups. Materials and methods: In the current study, 472 patient s documents with ACL tear which were scheduled for reconstruction existed. By exclusion criteria, during the period January 2000 to July 2003, 159 total participants (147 men, 12women) were enrolled and were classified non-randomly in 2groups by the femoral tunnel position which all of them were operated arthroscopically assisted ACL reconstruction. Results: In our study 159 patients (147 male and 12 female) were participated. In the first group which femoral tunnel were placed at 11 o’clock position (right knee) and 1 o’clock (left knee), we found 28 cases with normal and 53 cases with varus and in the second group which femoral tunnel were placed at 10 o’clock position (right knee) and 2 o’clock position (left knee), we find 32 cases with normal and other 46 patients with varus mal alignment. Conclusion: We found no significant difference between the 10 and 11o’clock femoral tunnel placement position when compared by IKDC and Lysholm score. Other point that we should mention was that there was significant difference in anterior tibial translation between two groups at 25 degree flexion (P value 0.03). Finally, femoral tunnel placement change was not an accurate indicator of functional outcome and knee laxity in our study.

Effect of drainage tube on knee function after arthroscopically assisted anterior cruciate ligament reconstruction

Background: There is a paucity of literature evaluating the use of intra-articular drains after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction and their effects on knee function. Objective: The aim of this study is to determine the effect of postoperative drain use on knee function after ACL reconstruction with quadrupled hamstring graft. Materials and Methods: In this study, 44 arthroscopic ACL reconstruction patients were randomized for either intra-articular suction drain group or nondrain group. Outcome assessment was done on postoperative day 4, day 10, 1 month, 3, 6, and 12 months after the surgery in which patients were asked to complete a visual analog pain scale. They were assessed for a range of motion (ROM) in flexion and extension with a universal goniometer, knee effusion, and knee stability by Lachman's test. Results: Both treatment and control groups showed no statistical significant difference in flexion of the knee through the ROM (P = 0.116). The percentage reduction in knee effusion was found to be statistically significant at 4 th (P < 0.001), 10 th (P < 0.001) 16, and 1 month (P = 0.012) in between treatment and control group. The overall pain difference between the two groups was not found to be statistically significant (P = 0.198). Conclusion: Clinically, the drain group showed faster pain relief, lesser effusion, and early return to motion compared to the no-drain group but was not statistically significant.

The Prevalence of Symptomatic Deep Venous Thrombosis and Pulmonary Embolism After Anterior Cruciate Ligament Reconstruction

Background: Arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. The incidence and risk factors of venous thromboembolism (VTE) after ACL reconstruction remain unclear. Purpose: To define the incidence of VTE after ACL reconstruction and identify associated risk factors in a large cohort of patients. Study Design: Descriptive epidemiological study. Methods: All patients aged ≥18 years who underwent ACL reconstruction between 2005 and 2011 were identified from the Department of Defense Medical Data Repository. The prevalence of VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE), within 3 months of ACL reconstruction was queried. Univariate analyses were performed to define odds ratios (ORs) for demographic, medication use, and procedural-related risk factors. Results: A total of 87 VTE events (0.53% [95% CI, 0.42%-0.65%]) occurred after 16,558 ACL reconstructions performed on 15,767 patients. DVT was documented after 55 procedures and PE after 35 procedures. Three patients were documented to have both DVT and PE within the study period. The odds of VTE increased in patients aged ≥35 years (OR, 1.96 [95% CI, 1.27-3.04]; P = .003). Nicotine history increased the odds of DVT (OR, 1.99 [95% CI, 1.15-3.43]; P = .014). Concomitant high tibial osteotomy (HTO) increased the odds of PE (OR, 18.31 [95% CI, 2.4-139.6]; P = .005), whereas concomitant posterior cruciate ligament (PCL) reconstruction increased the odds of both VTE (OR, 3.43 [95% CI, 1.07-11.2]; P = .38) and DVT (OR, 5.57 [95% CI, 1.71-18.14]; P = .004). Nonsteroidal drug use was associated with decreased odds for VTE and DVT (OR, 0.44 [95% CI, 0.28-0.70]; P < .001 and OR, 0.38 [95% CI, 0.22-0.69]; P < .001, respectively). Anticoagulants were associated with increased odds for VTE, DVT, and PE (OR, 98.32 [95% CI, 61.63-156.86]; P < .001; OR, 111.93 [95% CI, 63.95-195.92]; P < .001; and OR, 47.84 [95% CI, 22.55-101.52]; P < .001, respectively). No detectible difference in odds was found for sex, body mass index, or aspirin or cyclooxygenase-2 inhibitor use. Conclusion: The incidence of VTE after ACL reconstruction in this large population was low. Increased odds of VTE was identified in patients aged ≥35 years with a history of nicotine use, anticoagulant use, concomitant HTO, or concomitant PCL reconstruction. Controlled studies are necessary to determine the efficacy of chemoprophylaxis and to develop evidence-based clinical practice guidelines to minimize VTE after ACL reconstruction.