Primary Arthroscopic Anterior Cruciate Ligament Research Articles

Failure rate analysis and clinical outcomes of two different femoral tunnel positions using anteromedial portal technique in anterior cruciate ligament reconstruction

AimTo analyze two different femoral tunnel positions and to evaluate their correlation with clinical, functional outcomes and surgical revision rate in patients who underwent primary arthroscopic anterior cruciate ligament (ACL) reconstruction with anteromedial (AM) portal technique. MethodsFrom January 2015 to October 2018, we recruited 244 patients that underwent primary single-bundle ACL reconstruction, using four strand-semitendinosus graft and AM portal technique for femoral tunnel placement. Patients were divided into two groups based on the different femoral tunnel positions: 117 patients of group A had ACL footprint center femoral tunnel position compared with 127 patients of group B, with femoral tunnel placement close to the AM bundle footprint. Preoperatively and at last follow up, all patients were assessed subjectively by Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores, while Lachman, Pivot-shift, and KT-1000 tests were performed to evaluate knee joint stability. ResultsGroup B patients showed significantly better results in Lysholm, objective, and subjective IKDC scores compared with patients of group A (P < 0.001). A significantly higher surgical failure rate was found in group A than in group B (10.26% vs. 2.3%; P < 0.001). A higher anterior knee laxity was recorded in patients of group A than in patients of group B (1.9 ± 1.1 vs. 1.3 ± 1 mm; P < 0.001); a reduction in mean anterior tibial translation from preoperative to final follow up was found in group B compared with group A (3.5 ± 1.2 vs. 2.7 ± 1.1 mm; P < 0.001). No significant differences in the Tegner scale were found between the two groups. ConclusionACL reconstruction performed using the AM portal technique showed better and more satisfactory clinical and functional outcomes associated with a lower failure rate when the femoral tunnel had been placed more eccentrically in the footprint, in the AM bundle center position.

Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Knee Joint Using Hamstring Autograft

One of the most common injuries during sports is anterior cruciate ligament (ACL) injury. A number of surgical and rehabilitation techniques have been developed. ACL reconstruction is mainstay of treatment. Objective: In this study we are evaluating the outcome of ACL surgery. Design &amp; Setting: Retrospective study Methodology: Data collection of all cases that underwent primary arthroscopic anterior cruciate ligament reconstruction performed. All patients were operated with same surgical technique using quadrupled hamstring autograft. Results: There was an overall male predominance (95.3%). Medical meniscal injury was found in 05 (24%) patients. Lateral Meniscus injury was found in 04(19%) patients. Adjustable length CSF device was used in 12 (57%) patients and fixed-loop CSF device in 9 (43%) patients. Conclusion: At two years, outcome of ACL reconstruction performed by one surgeon using same surgical technique with adjustable CSF device and absorbable tibial screw granted satisfactory clinical results in all patients. Rehabilitation played an important role in return to activities of daily living in all patients at final follow up. Keywords: Anterior Cruciate Ligament, Arthroscopy, Rehabilitation

Communication of critical values in the clinical laboratory

To describe the clinical outcomes after primary arthroscopic anterior cruciate ligament (ACL) repair.A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to the PRISMA guidelines. All English-language literature published from 2000 to 2018 that reported the clinical outcomes after primary arthroscopic repair (AR) of complete tear of the ACL (without augmentation) with a minimum 2-year follow-up was reviewed by 2 independent reviewers. Outcomes included repair failure, reoperation, postoperative knee stability, and patient-reported outcomes. Descriptive statistics are presented. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Nonrandomized Studies (MINORS) score.Six studies (2 level III, 4 level IV) were included. The mean MCMS was 62.2. The mean MINORS score for noncomparative studies was 11.8, and for comparative studies, 18. Six studies reported outcomes of 89 patients who underwent AR of the ACL from 2007 to 2016 (age, 8 to 67 years; follow-up, 24 to 110 months). All 6 studies included exclusively proximal avulsion tears. Overall, 0% to 25.0% of patients experienced repair failure (I2 = 23.7%; 95% confidence interval, 0% to 67.6%), and 0% to 20.0% of patients had a subsequent reoperation (I2 = 12.1%; 95% confidence interval, 0% to 77.7%). Similar inconsistent results were shown for postoperative knee stability measures and patient-reported outcomes.The literature on clinical outcomes of primary arthroscopic ACL repair is limited. The reported rates of repair failure and reoperation are highly inconsistent. Most studies report relatively high failure rates.IV, systematic review of level III and IV studies.

Translation and validation of the simplified Chinese version of the anterior cruciate ligament-return to sport after injury (ACL-RSI).

The aim of this study is to obtain a translation and adaptation of the anterior cruciate ligament-return to sport after injury (ACL-RSI) into simplified Chinese and validate the simplified Chinese version. Translation and adaptation were performed according to the guidelines of the American Academy of Orthopaedic Surgeons Outcome Committee. A total of 122 patients who were diagnosed with an ACL injury and underwent primary arthroscopic anterior cruciate ligament reconstruction (ACLR) between 2015 and 2016 were included in this study. The simplified Chinese version of the ACL-RSI (SC-ACL-RSI), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score and International Knee Documentation Committee (IKDC) subjective knee form were completed. Psychometric evaluations included score distribution, internal consistency, test-retest reliability, and construct and discriminant validity. SC-ACL-RSI scores exhibited a normal distribution without ceiling and floor effects. Internal consistency was high (Cronbach's alpha = 0.94). The intraclass correlation coefficient was 0.98, indicating excellent test-retest reliability. SC-ACL-RSI scores were correlated with all KOOS subscales (r = 0.30 to 0.69, p < 0.001), the IKDC subjective knee form (r = 0.46, p < 0.001) and the Lysholm score (r = 0.56, p < 0.001). The mean scores between patients who returned to the same preinjury level of sport (65.1 ± 14.3) and those who could not return to the same level (51.0 ± 15.0) were significantly different (p < 0.001). The SC-ACL-RSI is a reliable and valid instrument to evaluate the psychological impact of a patient returning to sport after ACLR. It is important to evaluate patients' ability to return to sport after an ACL injury. The information provided by the SC-ACL-RSI will affect decisions regarding treatment and rehabilitation plans, which are more likely to influence clinical outcomes. II.

Post-operative complications following primary ACL reconstruction using allogenic and autogenic soft tissue grafts: Increased relative morbidity risk is associated with increased graft diameter

BackgroundThe purpose of this study is to compare the risk of peri-operative complication events associated with allogenic and autogenic grafts during routine follow-up for six months after primary arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. MethodsA retrospective cohort study identified patients that underwent ACL reconstruction via an arthroscopically assisted single tunnel technique. Fixation was primarily cortical suspension (endobutton) from the femora and bicortical fixation (Washer-loc) in the tibia. Patients were monitored for six months following surgery. Morbidity was defined as complications during this period requiring medical or surgical intervention. Risk of complications was compared according to tissue type and patient characteristics. The Cochran–Mantel–Haenszel method was applied to estimate risk ratios (RR) and confidence intervals (CI) as the measure of association between graft type and morbidity risk. ResultsThe cohort included 413 eligible patients. Sixty six percent received allograft tissue, while the remainder received autograft tissue. Morbidity risk was 7.0% among patients receiving allograft tissue and 2.8% among patients receiving autograft tissue. Allograft demonstrated elevated risk of complication versus autograft (RR=2.3 (95% CI: 0.9–7.2)), though the data are of borderline significance (p=0.11). Complications were associated with larger graft diameter in comparison to patients who experienced no complication (9.0+/−1.2 mm v. 8.4+/−1.0mm, p=0.005). ConclusionThe relative morbidity risk was about two-fold greater among patients receiving allograft tissue. Regardless of tissue type, graft size was larger among patients who experienced a complication. Level of evidenceLevel III.

Intraoperative Incidents and Complications in Primary Arthroscopic Anterior Cruciate Ligament Reconstruction

To analyze intraoperative incidents and complications in primary arthroscopic anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) and quadruple hamstring semitendinosus and gracilis (STG) grafts. From January 1999 to June 2004, we performed 330 BPTB and 96 STG procedures. Intraoperative incidents and complications were recorded for each case. Our overall intraoperative incident and complication rate was 9.6% and was higher in the STG group (13.5%) than in the BPTB group (8.7%). In the BPTB group, combined incidents and complications according to stage of the procedure consisted of graft harvesting, 4 cases (1.21%); tunnel placement, 9 cases (2.7%); and graft fixation, 15 cases (4.5%). In the STG group, combined incidents and complications included graft harvesting, 8 cases (8.3%); tunnel placement, 1 case (1%); graft fixation, 3 cases (3.1%); and others, 1 case (1%). In 4 patients (0.9%), we had to change the technique from BPTB to STG and vice versa. In 2 STG cases, conversion of the technique was required because of graft-related problems; in the third case, it was necessary because of fixation. One BPTB was converted to STG because the graft was completely transected as a result of improper screw fixation technique. None of the encountered incidents and complications had an adverse effect on final stability or on range of motion in operated knees. All incidents and complications were due to technical errors that occurred during graft harvesting, tunnel placement, or graft fixation. It is known that technical errors are preventable if careful surgical technique is followed. The surgeon must be well versed in various reconstruction techniques to be able to detect and resolve forthcoming incidents or complications. Backup implants are mandatory. IV, therapeutic case series.

Financial Analysis of Anterior Cruciate Ligament Reconstruction at Baylor University Medical Center

Five hundred and twenty-five primary arthroscopic anterior cruciate ligament (ACL) reconstruction cases were retrospectively evaluated at our hospital with respect to operating room time, operating room cost, and hospital charges. Three main areas were financially analyzed: outpatient vs inpatient surgery, meniscus tears, and ACL grafting techniques. Patients who had their surgery done as an outpatient had, on average, a 21-minute faster operating room time, a $477 lower operating room cost, and an $840 lower hospital charge per case compared with patients who were admitted overnight (P = 0.001). Surprisingly, no statistically significant difference in operating room time or operating room cost was detected in ACL surgeries involving partial meniscectomy or meniscus repair compared with ACL surgeries without meniscus tears. When examining the 2 most popular ACL grafting techniques, 4-strand hamstring graft cases were, on average, 23 minutes faster, had $565 lower operating room costs, and had $1015 lower hospital charges compared with bone–patella tendon–bone cases (P = 0.001). Operating room time is a significant component of the overall cost of and charges for ACL surgery, and the 23-minute faster hamstring technique produced more savings than outpatient surgery.