Knee Ligament Reconstruction Surgery Research Articles

The Importance of Preoperative Rehabilitation in Knee Ligament Reconstruction Surgery

The Importance of Preoperative Rehabilitation in Knee Ligament Reconstruction Surgery

Does The Peroneus Longus Tendon Autograft Affect The Ankle Function? A Case Series

Introduction: The peroneus longus (PL) tendon is one of the autograft choices for knee ligament injury because of its safety, length, and strength. However, studies that evaluated donor site morbidity after PL tendon graft are still limited. This case series aims to evaluate the functional outcomes of donor site morbidity after full-thickness PL tendon harvesting for knee ligament reconstruction.Presentation of Case:This study evaluated four patients who had a revision of knee ligament reconstruction surgery using PL tendon autograft from August until September 2018. The functional outcome of the donor site was evaluated before surgery, two weeks, and three months after surgery by using functional scores assessment of foot and ankle.Discussion:There are some donor sites of autograft, but several studies show that the PL tendon autograft has proven to be more favorable methods for knee ligament reconstruction based on the accessibility, safety, and strength of the harvested tendon. The studies also found that using PL tendon as an autograft, has a good result in donor site morbidity evaluation compared to others. This study provides a satisfying result on the functional outcome of the donor site morbidity evaluation.Conclusion:This study showed satisfactory functional outcomes of the foot and ankle after harvesting full-thickness PL tendon. All functional score assessment provides an excellent result in three months after surgery, although lateral ankle bulging has occurred in all patients. However, gait analysis and isokinetic test with a more significant number of patients and longer follow up periods are necessary for further study.

Interpretations of the dial test should be reconsidered. A diagnostic accuracy study reporting sensitivity, specificity, predictive values and likelihood ratios

ObjectivesTo determine the accuracy of the dial test, used alone and in combination with additional clinical tests, in the diagnosis of an isolated posterolateral corner (PLC) injury, combined PLC-posterior cruciate ligament (PCL) injury or medial knee injury.MethodsA retrospective analysis of consecutive patients who underwent arthroscopic and/or open knee ligament reconstruction surgery was conducted. The dial test was performed in an outpatient’s clinic as part of a routine knee examination. Examination under anaesthetic and intraoperative findings were used as the reference standard test to determine the diagnostic accuracy of the dial test used alone and in combination with other PCL and medial knee tests. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−) were calculated with corresponding 95% CI.ResultsData from 87 patients were available and included in the data analysis. For an isolated PLC injury, the dial test sensitivity and specificity were 0.20 (95% CI 0.08 to 0.39) and 1.00 (95% CI 0.92 to 1.00). The PPV and NPV were 1.00 (95% CI 0.52 to 1.00) and 0.70 (95% CI 0.59 to 0.80). LR+ and LR− of the dial test detecting isolated PLC injury were infinity (95% CI calculation not possible, infinity) and 0.80 (95% CI 0.41 to 1.57). The diagnostic accuracy of the dial test, when used alone and in combination with other PCL and medial knee tests, was also calculated for combined PLC-PCL and medial knee injuries.ConclusionA negative dial test at 30° of knee flexion can rule out a PLC injury, while a test that is positive at 30° and negative at 90° indicates a PLC injury, without concomitant injury to the PCL or medial knee ligaments. A positive test at both 30° and 90° can indicate isolated PLC, combined PLC-PCL or medial ligament injuries, and other knee examination findings are required to differentially diagnose these injury patterns.Level of evidenceII.

The Supine Internal Rotation Test: A Pilot Study Evaluating Tibial Internal Rotation in Grade III Posterior Cruciate Ligament Tears.

Background:Biomechanical studies have reported that the posterior cruciate ligament (PCL) functions as a restraint against excessive tibial internal rotation at higher degrees of knee flexion.Purpose:To investigate the use of a supine internal rotation (IR) test for the diagnosis of grade III PCL injuries. The hypothesis was that internal rotation would be greater in patients with grade III PCL injuries compared with other knee injuries and that the supine IR test would demonstrate excellent diagnostic accuracy.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:A consecutive series of 309 patients underwent arthroscopic and/or open knee ligament reconstruction surgery. Seven patients were excluded based on the inability to perform a side-to-side comparison of internal rotation. Tibial internal rotation was assessed bilaterally on 302 patients during examination under anesthesia by a single orthopaedic surgeon measuring tibial tubercle excursion (mm) while applying internal rotation torque. Internal rotation was graded from 0 to 4 at 60°, 75°, 90°, 105°, and 120° of knee flexion. Data were collected and stored prospectively. The optimal threshold for the supine IR test was chosen based on maximization of the Youden index. Diagnostic accuracy parameters were calculated. Multiple logistic regression models were constructed to assess the influence of other knee pathologies on diagnostic accuracy.Results:Examination of the 22 PCL-deficient knees demonstrated an increase in tibial internal rotation at 60°, 75°, 90°, 105°, and 120° of knee flexion. The supine IR test had a sensitivity of 95.5%, a specificity of 97.1%, a positive predictive value of 72.4%, and a negative predictive value of 99.6% for the diagnosis of grade III PCL injuries. Posterolateral corner injury had a significant interaction with the supine IR test, increasing its sensitivity and decreasing its specificity.Conclusion:PCL-deficient knees demonstrated an increase in the side-to-side difference in tibial internal rotation compared with other knee pathologies. The supine IR test offers high sensitivity and specificity for grade III PCL injuries and may represent a useful adjunct for diagnosing PCL injuries.

Computer-assisted surgery for knee ligament reconstruction.

Anterior cruciate ligament (ACL) reconstruction is one of the most frequently performed orthopaedic procedures. The most common technical cause of reconstruction failure is graft malpositioning. Computer-assisted surgery (CAS) aims to improve the accuracy of graft placement. Although posterior cruciate ligament (PCL) injury and reconstruction are far less common, PCL reconstruction has comparable difficulties relating to graft placement. This is an update of a Cochrane review first published in 2011. To assess the effects of computer-assisted reconstruction surgery versus conventional operating techniques for ACL or PCL injuries in adults. For this update, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (from 2010 to July 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 5, 2013), MEDLINE (from 2010 to July 2013), EMBASE (from 2010 to July 2013), CINAHL (from 2010 to July 2013), article references and prospective trial registers. We included randomized controlled trials (RCTs) and quasi-randomized controlled trials that compared CAS for ACL or PCL reconstruction versus conventional operating techniques not involving CAS. Two authors independently screened search results, assessed the risk of bias in the studies and extracted data. Where appropriate, we pooled data using risk ratios (RR) or mean differences (MD), both with 95% confidence intervals (CI). The updated search resulted in the inclusion of one new study. This review now includes five RCTs with 366 participants. There were more female than male participants (70% were female); their ages ranged from 14 to 53 years. All trials involved ACL reconstructions performed by experienced surgeons.Assessing the studies' risk of bias was hampered by poor reporting of trial methods, and consequently several studies were judged to be 'unclear' for several types of bias. One trial presenting primary outcome data was at high risk of detection bias from lack of clinician blinding and attrition bias from an unaccounted loss to follow-up at two years.We found moderate quality evidence (three trials, 193 participants) of no clinically relevant difference between CAS and conventional surgery in International Knee Documentation Committee (IKDC) subjective scores (self-reported measure of knee function; scale of 0 to 100 where 100 was best function). Pooled data from two of these trials (120 participants) showed a small, but clinically irrelevant difference favouring CAS (MD 2.05, 95% CI -2.16 to 6.25). A third trial (73 participants) also found minimal difference in IKDC subjective scores (reported MD 0.2).We found low quality evidence (two trials, 120 participants) showing no difference between the two groups in Lysholm scores, also measured on a scale 0 to 100 where 100 is best function (MD 0.25, 95% CI -3.75 to 4.25). We found very low quality evidence (one trial, 40 participants) showing no difference between the two groups in Tegner scores. We found low quality evidence (three trials, 173 participants) showing the majority of participants in both groups were assessed as having normal or nearly normal knee function (86/87 with CAS versus 84/86 with no CAS; RR 1.01, 95% CI 0.96 to 1.06).Similarly, no differences were found for our secondary outcome measures of knee stability, loss in range of motion and tunnel placement. None of the trials reported on re-operation.No adverse post-surgical events were reported in two trials (133 participants); this outcome was not reported by the other three trials.CAS use was associated with longer operating times compared with conventional operating techniques: the mean difference in operating times reported in the studies ranged between 9 and 27 minutes. From the available evidence, we are unable to demonstrate or refute a favourable effect of CAS for cruciate ligament reconstructions of the knee compared with conventional reconstructions. However, the currently available evidence does not indicate that CAS in knee ligament reconstruction improves outcome. There is a need for improved reporting of future studies of this technology.

Computer-assisted surgery for knee ligament reconstruction.

Anterior cruciate ligament (ACL) reconstruction is one of the most frequently performed orthopaedic procedures. The most common technical cause of reconstruction failure is graft malpositioning. Computer-assisted surgery (CAS) aims to improve the accuracy of graft placement. Although posterior cruciate ligament (PCL) injury and reconstruction are far less common, PCL reconstruction has comparable difficulties relating to graft placement. This is an update of a Cochrane review first published in 2011. To assess the effects of computer-assisted reconstruction surgery versus conventional operating techniques for ACL or PCL injuries in adults. For this update, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (from 2010 to July 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 5, 2013), MEDLINE (from 2010 to July 2013), EMBASE (from 2010 to July 2013), CINAHL (from 2010 to July 2013), article references and prospective trial registers. We included randomized controlled trials (RCTs) and quasi-randomized controlled trials that compared CAS for ACL or PCL reconstruction versus conventional operating techniques not involving CAS. Two authors independently screened search results, assessed the risk of bias in the studies and extracted data. Where appropriate, we pooled data using risk ratios (RR) or mean differences (MD), both with 95% confidence intervals (CI). The updated search resulted in the inclusion of one new study. This review now includes five RCTs with 366 participants. There were more female than male participants (70% were female); their ages ranged from 14 to 53 years. All trials involved ACL reconstructions performed by experienced surgeons.Assessing the studies' risk of bias was hampered by poor reporting of trial methods, and consequently several studies were judged to be 'unclear' for several types of bias. One trial presenting primary outcome data was at high risk of detection bias from lack of clinician blinding and attrition bias from an unaccounted loss to follow-up at two years.We found moderate quality evidence (three trials, 193 participants) of no clinically relevant difference between CAS and conventional surgery in International Knee Documentation Committee (IKDC) subjective scores (self-reported measure of knee function; scale of 0 to 100 where 100 was best function). Pooled data from two of these trials (120 participants) showed a small, but clinically irrelevant difference favouring CAS (MD 2.05, 95% CI -2.16 to 6.25). A third trial (73 participants) also found minimal difference in IKDC subjective scores (reported MD 0.2).We found low quality evidence (two trials, 120 participants) showing no difference between the two groups in Lysholm scores, also measured on a scale 0 to 100 where 100 is best function (MD 0.25, 95% CI -3.75 to 4.25). We found very low quality evidence (one trial, 40 participants) showing no difference between the two groups in Tegner scores. We found low quality evidence (three trials, 173 participants) showing the majority of participants in both groups were assessed as having normal or nearly normal knee function (86/87 with CAS versus 84/86 with no CAS; RR 1.01, 95% CI 0.96 to 1.06).Similarly, no differences were found for our secondary outcome measures of knee stability, loss in range of motion and tunnel placement. None of the trials reported on re-operation.No adverse post-surgical events were reported in two trials (133 participants); this outcome was not reported by the other three trials.CAS use was associated with longer operating times compared with conventional operating techniques: the mean difference in operating times reported in the studies ranged between 9 and 27 minutes. From the available evidence, we are unable to demonstrate or refute a favourable effect of CAS for cruciate ligament reconstructions of the knee compared with conventional reconstructions. However, the currently available evidence does not indicate that CAS in knee ligament reconstruction improves outcome. There is a need for improved reporting of future studies of this technology.

Femoral fracture following knee ligament reconstruction surgery due to an unpredictable complication of bioabsorbable screw fixation: a case report and review of literature

We report an unusual case of femoral fracture from minimal trauma, due to the rapid disappearance of a bioabsorbable interference screw used for reconstruction of the posterolateral corner of the knee. The literature on bone tunnel fractures following knee ligament reconstruction surgery is also reviewed.

The unpredictable material properties of bioabsorbable PLC interference screws and their adverse effects in ACL reconstruction surgery

The aim of this study was to look at the clinical outcome of polylactide carbonate (PLC) interference screws in knee ligament reconstruction surgery. We prospectively followed up 59 patients who underwent primary hamstring anterior cruciate ligament (ACL) reconstructions using PLC (Calaxo screw; Smith and Nephew, Andover, MA) screws to secure the graft in the tibial tunnel. The average age was 34 years (range 17-55 years, SD 8.93). Twenty-three (39%) patients presented with complications [synovitis in 15% (nine) patients, prominent tibial swelling in 34% (20) patients and both in seven patients]. In comparison, similar complications were not seen in two groups of 59 age and sex matched patients in whom PLLA (Bio RCI; Smith and Nephew, Andover, MA) screws or Titanium (RCI; Smith and Nephew, Andover, MA) screws were used by the same surgeon. The problems encountered in the PLC screw group did not adversely affect knee stability. Six patients underwent exploration of the tibial tunnel site. A sterile white cheesy substance was removed, leaving an empty tibial tunnel. The ACL graft was found to be well attached to tibial tunnel in all cases. The PLC screw diameter, surface area or tibial tunnel diameter did not have any correlation to the occurrence of complications. Two patients required multiple washouts, one of whom developed a deep infection. The degradation of PLC screws does not follow the gradual and controlled pattern demonstrated in the ovine model. The unpredictable screw degradation, and the reaction to it can lead to serious clinical consequences.

S-017 Knee ligament reconstruction surgery using calcium phosphate-hybridized tendon : regeneration of bone-ligament insertion(Symposium 3 Novel treatments and their clinical application,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

S-017 Knee ligament reconstruction surgery using calcium phosphate-hybridized tendon : regeneration of bone-ligament insertion(Symposium 3 Novel treatments and their clinical application,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Oral tenoxicam for peripheral orthopaedic surgery: a pharmacokinetic study.

Non-steroidal anti-inflammatory drugs (NSAIDs) provide effective analgesia after orthopaedic surgery and reduce opioid requirements. The need for parenteral NSAIDs with peripheral surgery is controversial. In this study 10 patients were treated with oral tenoxicam 20 mg preoperatively, and at 4 hours and 28 hours after knee ligament reconstruction surgery. Plasma concentrations of tenoxicam, an NSAID with a long elimination half-life, were measured for 10 days. All patients received patient-controlled intravenous morphine postoperatively, which delayed absorption of the second and third tenoxicam doses. However, plasma concentrations of tenoxicam were achieved and maintained for the five-day surgical admission above the level considered to produce effective analgesia. Oral analgesic administration is a simple and feasible option in the perioperative period.