Single-bundle Anterior Cruciate Ligament Research Articles

Higher Rates of Anatomical Insertion of Medial Hamstring Tendon Regeneration Post-Anterior Cruciate Ligament Reconstruction with Stump Preservation Graft Harvesting Technique: A Prospective, Randomized, Double-Blinded Clinical Trial with Magnetic Resonance Imaging Evaluation

Objective(s): The purpose of this study was to compare the regeneration of semitendinosus and gracilis tendons from two different graft harvesting techniques which are the stump preservation and conventional graft harvesting technique. We hypothesised that the stump preservation graft harvesting technique which preserved the distal attachment of tendons at their insertion would facilitate anatomical regeneration to the pes anserinus. MethodsThis is a prospective, randomised double-blinded study whereby thirty consecutive patients who underwent single bundle anterior cruciate ligament reconstruction with ipsilateral semitendinosus and gracilis autografts were recruited. The patients were randomly assigned to the stump preservation group (14 patients) or conventional group (16 patients). magnetic resonance imaging (MRI) evaluation was performed preoperatively and at 6-months postoperatively. ResultsAt 6-months follow-up, MRI evaluations showed a higher percentage of insertion of regenerated semitendinosus and gracilis at the pes anserinus in the stump preservation group (75.0%) than that in the conventional group (68.8%). There was significantly higher proximal shift of musculotendinous junction of semitendinosus (5.70 cm versus 3.36 cm, p = 0.029) and gracilis (5.28 cm versus 3.16 cm, p = 0.045) in the conventional group postoperatively. ConclusionThe stump preservation technique yields higher percentage of anatomical insertion of regenerated tendons and lesser amount of proximal shift of musculotendinous junction. Level of EvidenceIII – Prospective study with up to two negative criteria

Remnant-Sparing Anterior Cruciate Ligament Reconstruction Results in Similar Clinical, Functional, and Quality-of-Life Outcomes to Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

To compare a large cohort of patients who underwent remnant-sparing anterior cruciate ligament reconstruction (rACLR) with a matched group of patients who underwent anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) with respect to clinical laxity, patient-reported outcomes, and functional testing. Patients who underwent rACLR between January 2010 and December 2015 were matched according to age, sex, body mass index, and graft type to patients who underwent ACLR. The primary outcome measure was the ACL Quality of Life (ACL-QOL) score at final follow-up of 24 months. Secondary outcomes included functional tests and clinical laxity measurements at 6, 12, and 24 months postoperatively. Concurrent intra-articular pathology at the time of surgery and postoperative complications were also recorded. Statistical analyses included the dependent t test and the Wilcoxon signed rank test. A total of 210 rACLR patients were successfully matched to a corresponding cohort of 210 ACLR patients. There were no statistically significant differences in ACL Quality of Life (ACL-QOL) or functional testing results between the groups; however, scores in both groups showed a steady and statistically significant improvement over time. A statistically significant difference was noted with respect to the Lachman test findings, favoring the rACLR cohort (Z= -2.79, P= .005); no between-group difference was seen for the pivot-shift test (Z= -0.36, P= .72). The rACLR group had a significantly lower rate of concurrent meniscal and chondral injury. There was no difference in complications between the groups (Z= -0.49, P= .63). There was no difference in patient-reported or functional testing outcomes in patients undergoing remnant-sparing compared with anatomic single-bundle ACLR. There was, however, a significantly lower rate of positive Lachman test findings after rACLR. Furthermore, the rate of concurrent meniscal and chondral pathology was lower in the rACLR group. Level III, retrospective cohort study.

Double and Single Bundle in Athletes: A Comparison in Medium and Long-Term Rates to Return to Sport and Re-Injury.

Compare, retrospectively, the medium- and long-term of return to sport rates and re-injury of the anterior cruciate ligament (ACL) in patients submitted to single-bundle (SB) compared to double-bundle (DB) technique reconstruction. Athletes operated by SB or DB ACL reconstruction, with at least five years of follow-up at a single center, were included. The following data were collected: demographic data; competitive sports practice before the injury; previous surgery; injury/surgery to the contralateral knee; return to sports and level of the return; re-injury (time of the re-injury after the first surgery; mechanism of trauma for the re-injury; necessity of operative treatment); signs and complaints related to the knee the last clinical consultation. Seventy-six athletes (27 SB and 49 DB) were included. The return to sport rate (98%) was the same for both groups, and the return to the previous level rate showed an improvement in the DB group but without statistical significance (63% vs. 79%; P = 0.173). However, other outcomes showed higher results for the DB group: lower re-injury rate throughout the follow-up period (41% vs. 18%; P = 0.034) and during the first year of follow-up (22% vs. 4%; P = 0.021), and less stiffness (0% vs. 22%, P = 0.001). While in primary reconstruction cases, there was not a higher re-injury rate using SB (P = 0.744), in the revision cases, SB was correlated with more re-injuries than DB (P = 0.002). The overall re-injury in the medium- and long-term and the return to practice sports at the same level as before surgery in athletes submitted to DB reconstruction were slightly better than those submitted to SB reconstruction, especially in the cases that were asecond time lesion ( revisioned knees).

Small Intercondylar Notch Size Is Not Associated with Poor Surgical Outcomes of Anatomical Single-Bundle Anterior Cruciate Ligament Reconstructions.

Although many studies have been conducted on the association between the intercondylar notch size and the risk of anterior cruciate ligament (ACL) injury, few studies have examined its relationship with the condition after surgical treatment. Therefore, this study aimed to investigate the surgical outcomes of anatomical single-bundle ACL reconstruction according to intercondylar notch volumes. Medical records of patients who underwent anatomical single-bundle ACL reconstruction using a tibialis anterior allograft between 2015 and 2019 were retrospectively reviewed. For each sex, eligible patients were classified into two groups based on their percentile of intercondylar notch volumes, which were measured using postoperative three-dimensional computed tomography images (group S, ≤ 50th percentile of included patients; group L, > 50th percentile of included patients). Additional grouping was performed based on the group's percentiles of normalized values of intercondylar notch volumes to body heights. Between-group comparative analyses were performed on the perioperative data and surgical outcomes in both objective and subjective aspects. One hundred patients were included in the study. For male patients, there were no differences in the overall surgical outcomes between groups, whereas group L showed a significantly greater knee anteroposterior (AP) laxity than group S at the final follow-up (p = 0.042 for the side-to-side differences [SSD] at the maximum manual force). Similarly, there were no differences in the female patients in the overall surgical results between the groups, whereas group L showed a significantly greater knee AP laxity at the final follow-up (p = 0.020 for the SSD at 134 N; p = 0.011 for the SSD at the maximum manual force). Additional analyses based on the normalized values of the intercondylar notch volume showed consistent results for male patients, and additional grouping for female patients was identical to the existing grouping. The surgical outcomes of anatomical single-bundle ACL reconstruction in patients with relatively small intercondylar notch volumes were comparable to those with large notch volumes, but rather showed favorable outcomes in postoperative knee AP laxity.

Effect of anteromedial portal location on femoral tunnel inclination, length, and location in hamstring autograft-based single-bundle anterior cruciate ligament reconstruction: a prospective study

BackgroundPortal positioning in arthroscopic anterior cruciate ligament reconstruction is critical in facilitating the drilling of the femoral tunnel. However, the traditional approach has limitations. A modified inferior anteromedial portal was developed. Therefore, this study aims to compare the modified and conventional far anteromedial portals for femoral tunnel drilling, assessing factors such as tunnel length, inclination, iatrogenic chondral injury risk, and blowout.Material and methodsPatients scheduled for hamstring autograft-based anatomical single-bundle arthroscopic anterior cruciate ligament reconstruction were divided into two groups: modified and far anteromedial groups. Primary outcomes include differences in femoral tunnel length intraoperatively, tunnel inclination on anteroposterior radiographs, and exit location on lateral radiographs. Secondary outcomes encompass tunnel-related complications and reconstruction failures. To identify potential risk factors for shorter tunnel lengths and posterior exits, regression analysis was conducted.ResultsTunnel parameters of 234 patients were analyzed. In the modified portal group, femoral tunnel length and inclination were significantly higher, with tunnels exhibiting a more anterior exit position (p < 0.05). A higher body mass index exerted a negative influence on tunnel length and inclination. However, obese patients in the modified portal group had longer tunnels, increased inclination, and a lower risk of posterior exit. Only a few tunnel-related complications were observed in the far anteromedial group.ConclusionThe modified portal allowed better control of tunnel length and inclination, ensuring a nonposterior femoral tunnel exit, making it beneficial for obese patients.

Race and Gender Differences in Anterior Cruciate Ligament Femoral Footprint Location and Orientation: A 3D-MRI Study.

The femoral tunnel position is crucial to anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, but the ideal femoral footprint position are mostly based on small-sized cadaveric studies and elderly patients with a single ethnic background. This study aimed to identify potential race- or gender-specific differences in the ACL femoral footprint location and ACL orientation, determine the correlation between the ACL orientation and the femoral footprint location. Magnetic resonance images (MRIs) of 90 Caucasian participants and 90 matched Chinese subjects were used for reconstruction of three-dimensional (3D) femur and tibial models. ACL footprints were sketched by several experienced orthopedic surgeons on the MRI photographs. The anatomical coordinate system was applied to reflect the ACL footprint location and orientation of scanned samples. The femoral ACL footprint locations were represented by their distance from the origin in the anteroposterior (A/P) and distal-proximal (D/P) directions. The orientation of the ACL was described with the sagittal, coronal and transverse deviation angles. The ACL orientation and femoral footprint position were compared by the two-sided t-test. Multiple regression analysis was used to study the correlation between the orientation and femoral footprint position. The average femur footprint A/P position was -6.6 ± 1.6 mm in the Chinese group and -5.1 ± 2.3 mm in the Caucasian group, (p < 0.001). The average femur footprint D/P position was -2.8 ± 2.4 mm in Chinese and - 3.9 ± 2.0 mm in Caucasians, (p = 0.001). The Chinese group had a mean difference of a 1.5 mm (6.1%) more posterior and 1.1 mm (5.3%) more proximal in the position from the flexion-extension axis (FEA). And the males have a sagittal plane elevation about 4-5° higher than females in both racial groups. Furthermore, for every 1% (0.40 mm) increase in A/P and D/P values, the sagittal angle decreased by about 0.12° and 0.24°, respectively; the coronal angle decreased by about 0.10° and 0.30°, respectively. For every 1% (0.40 mm) increase in D/P value, the transverse angle increased by about 0.14°. The significant race- and gender-specific differences in the femoral footprint and orientation of the ACL should be taken in consideration during anatomic single-bundle ACL reconstruction. Furthermore, the quantitative relationship between the ACL orientation and the footprint location might provide some reference for surgeons to develop a surgical strategy in ACL single-bundle reconstruction and revision.

Application of femoral I.D.E.A.L localization in anterior cruciate ligament reconstruction with single bundle anterior cruciate ligament

To evaluate the effect of femoral I.D.E.A.L localization in single bundle anterior cruciate ligament reconstruction (ACLR). From January 2019 to October 2022, 122 patients with anterior cruciate ligament injury were treated with ACLR, including 83 males and 39 females. The age ranged from 23 to 43 years old, with an average of (32.19 ±8.55) years old. The course of disease ranged from 1 week to 6 months. According to the different surgical schemes, the patients were divided into two groups, namely the traditional group, which adopted the over-the-top femoral lateral positioning scheme, including 64 patients. The I.D.E.A.L group adopted the I.D.E.A.L femoral lateral positioning scheme, including 58 patients. The patient has pain and dysfunction of knee joint before operation. MRI of knee joint indicates anterior cruciate ligament injury. The visual analogue scale(VAS), International Knee Documentation Committee(IKDC) scoring system and Lysholm scoring system were used to evaluate the knee joint function of the patient. KT-2000 was used to detect the recovery of knee joint after operation and to count the postoperative complications. The wounds healed well after operation. One hundred and twenty-tow patients were followed up for 15 to 46 months, with an average of (25.45±9.22) months. The knee joint stability of patients after operation was significantly increased. The VAS at 1 day and 1 week after operation of patients in the I.D.E.A.L group was significantly lower than that in the traditional group(P<0.05). The IKDC score and Lysholm score of patients in the I.D.E.A.L group were significantly higher than those in the traditional group(P<0.05). In the traditional group, there were 6 cases of short-term (<1 month) complications and 19 cases of long-term (≥1 month)complicatios. In the I.D.E.A.L group, there were 3 cases of short-term complications and 7cases of long-term complications(P<0.05). The single bundle anterior cruciate ligament reconstruction and femoral I.D.E.A.L positioning can achieve better early postoperative effect and reduce early postoperative pain.

The effects of remnant-preserving anterior cruciate ligament reconstruction on proprioception: A prospective comparative study.

The aim of this study was to investigate the effects of anterior cruciate ligament reconstruction performed by preserving remnant tissue on proprioception and to assess the effects it has on isokinetic quadriceps and hamstring muscle strength, as well as on range of motion and functional scores. A prospective study was conducted with 44 patients who underwent either anterior cruciate ligament reconstruction with remnant preservation (study group, n=22) or with remnant excision (control group, n=22) with the use of a 4-strand hamstring allograft. The mean follow-up time was 20.2 ± 1.4 months after surgery. Using an isokinetic dynamometer, proprioception was evaluated with passive joint position perception at 150, 450, and 600, and quadriceps femoris, and hamstring muscle strength were evaluated at speeds of 900, 1800, and 2400 per second. Range of motion was measured using a goniometer. Functional outcomes were assessed using International Knee Documentation Committee subjective knee evaluation score and Lysholm knee scoring questionnaires. It was only at 15° of knee flexion that there was a statistically significant difference in proprioception; the median of the difference in the amount of deviation from the target angle between the healthy knee and the operated side was 1.7 (range, 0.7-20.7) in those with remnant preserved, and 2.7 (range, 1-26) in those with remnant excised (P=.016). At 2400/s speed, the mean quadriceps femoris strength was 77.2 ± 24.3 Nm in those with remnant preserved and 67.6 ± 24.2 Nm in those with remnant excised. (P=.048) There was no difference between the 2 groups in terms of range of motion, International Knee Documentation Committee, and Lysholm knee scoring. (P > .05) Conclusion: The present study has demonstrated that better proprioception and higher quadriceps femoris muscle strength can be obtained by remnant-preserving anatomical single-bundle anterior cruciate ligament reconstruction using a hamstring autograft. Level II, Therapeutic study.

Clinical outcomes of three different techniques using adjustable-loop fixation in arthroscopic single-bundle anterior cruciate ligament reconstruction: A prospective randomized clinical trial

BackgroundAdjustable femoral suspensory fixation for anterior cruciate ligament reconstruction (ACLR) become popular in recent years. The purpose of this study is to evaluate and compare the clinical outcomes of three different techniques using an adjustable-loop fixation in ACRL. MethodsThis study included 38 patients who underwent ACLR using the adjustable-loop device for femoral fixation between January 2018 and November 2021. All the participants were randomly assigned to a standard (group 1), retensioning (group 2), retensioning and knot tying (group 3). Clinical outcome parametres included Tegner – Lysholm Score, IKDC score, KT-1000 displacement and isokinetic muscle function tests. ResultsOverall, 38 patients (group 1: n = 13 [mean ± SD age, 30.1 ± 9.40 years]; group 2: n = 12 [mean ± SD age, 24.5 ± 7.79 years]; group 3 = 13 [mean ± SD age, 27.8 ± 6.59 years]) were included in the final analysis. The follow-up period was 9.7 ± 1.2; 9.5 ± 1.7 and 10 ± 1.5 months for groups 1, 2 and 3 respectively. From preoperatively to postoperatively, the mean Tegner-Lysholm scores improved significantly in all three groups (group 1: from 63.5 to 95.6; group 2: from 61.58 to 98.5; group 3: from 66.6 to 95.9, P < 0.0001 for all), as did the mean IKDC score (group 1: 53.9–88.8; group 2: 61.3–94.9; group 3: 60.7–94.6 (P < 0.0001 for all). ConclusionThe retensioning with or without knot-tying method is believed to increase stability in graft fixation. However, there were no significant differences in clinical outcomes in each technique.

Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Using a Calcium Phosphate-Hybridized Tendon Graft with More than an Average of 5 Years of Follow-Up: A Follow-Up Study of a Randomized Controlled Trial.

Calcium phosphate (CaP)-hybridized tendon grafting using an alternate soaking process improves tendon-to-bone healing in anterior cruciate ligament (ACL) reconstructions. This study aimed to compare bone tunnel enlargement, knee osteoarthritis, and clinical results between CaP-hybridized tendon grafting and conventional grafting in anatomical single-bundle ACL reconstruction. This study was a follow-up of a randomized controlled trial. Between July 2011 and December 2015, 90 patients underwent unilateral anatomical single-bundle ACL reconstructions and were randomly assigned to the CaP-hybridized tendon grafting (CaP group, n = 45; age, 27.1 [14-54] years; sex, 21 males and 24 females) or conventional grafting (control group, n = 45; age, 22.9 [13-58] years; sex, 26 males and 19 females). The randomization was performed according to the days of the week when the patients first visited the outpatient. The CaP-hybridized tendon grafting was created intraoperatively. The tendon grafts were soaked in a calcium solution for 30 s. After that, the tendon grafts were soaked in a NaHPO4 solution for 30 s. This soaking cycle between the calcium solution and the NaHPO4 solution was repeated 10 times. The bone tunnel enlargement, osteoarthritis grade, clinical score, and sports level were evaluated in patients who could be followed up for >3 years (CaP group, n = 20, average follow-up period 6.0 [5.1-6.9] years; control group, n = 15, average follow-up period 5.6 [4.3-6.9] years). Clinical scores, sports levels, and osteoarthritis grades were analyzed using a generalized linear mixed model (GLMM) based on repeated measurement data from preoperative and final observations, with time, group, sex, age, and BMI as fixed effects and the effect of individual differences as variable effects. In addition, bone-tunnel enlargements were analyzed using generalized linear models (GLM) with group, sex, age, and BMI as the main effects. Compared with the control group, the CaP group exhibited significantly reduced bone-tunnel enlargement on the femoral side (anteroposterior diameter; CaP group, 7.9% [-1.1-16.8] vs. control group, 29.2% [17.9-40.5], p = 0.004, MCID 16.05, proximal-distal diameter; CaP group, 7.9% [-1.9-17.8] vs. control group, 22.8% [10.9-34.7], p = 0.062, MCID 15.00). The osteoarthritis grades progressed in both groups (p < 0.001). The clinical scores and sports levels were not significantly different between the groups. This study suggests that the calcium phosphate-hybridized tendon graft reduces femoral bone-tunnel enlargement after anatomical single-bundle anterior cruciate ligament reconstruction in an average >5-year follow-up period. A longer follow-up period is necessary to reveal the clinical effects of the calcium phosphate-hybridized tendon grafts in anterior cruciate ligament reconstruction.

Osteoconductive Scaffold Placed at the Femoral Tunnel Aperture in Hamstring Tendon ACL Reconstruction: A Randomized Controlled Trial.

Bone tunnel enlargement after single-bundle anterior cruciate ligament reconstruction remains an unsolved problem that complicates revision surgery. Positioning of an osteoconductive scaffold at the femoral tunnel aperture improves graft-to-bone incorporation and thereby decreases bone tunnel widening. Randomized controlled trial; Level of evidence, 1. In a 1:1 ratio, 56 patients undergoing primary anterior cruciate ligament reconstruction were randomized to receive femoral fixation with cortical suspension fixation and secondary press-fit fixation at the tunnel aperture of the tendon graft only (control) or with augmentation by an osteoconductive scaffold (intervention). Adverse events, patient-reported outcomes, and passive knee stability were recorded over 2 years after the index surgery. Three-dimensional bone tunnel widening was assessed using computed tomography at the time of surgery and 4.5 months and 1 year postoperatively. The intervention group exhibited a similar number of adverse events as the control group (8 vs 10; P = .775) including 2 partial reruptures in both groups. The approach was feasible, although 1 case was encountered where the osteoconductive scaffold was malpositioned without adversely affecting the patient's recovery. There was no difference between the intervention and control groups in femoral bone tunnel enlargement, as expressed by the relative change in tunnel volume from surgery to 4.5 months (mean ± SD, 36% ± 25% vs 40% ± 25%; P = .644) and 1 year (19% ± 20% vs 17% ± 25%; P =.698). Press-fit graft fixation with an osteoconductive scaffold positioned at the femoral tunnel aperture is safe but does not decrease femoral bone tunnel enlargement at postoperative 1 year. NCT03462823 (ClinicalTrials.gov identifier).

Single Bundle Anterior Cruciate Ligament With Anterolateral Ligament Reconstruction Yields Similar Clinical and Radiographic Results at Minimum 2-Year Follow-Up Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Trial

To compare the clinical, radiographic, and second-look arthroscopic outcomes between double-bundle (DB) anterior cruciate ligament (ACL) reconstruction (DB group) and combined single-bundle (SB) ACL and anterolateral ligament (ALL) reconstruction (SB+ ALL group) by a prospective randomized controlled trial. From May 2019 to June 2020, 84 patients were enrolled in this study. Among them, 10 were lost to follow-up. Thirty-six and 38 patients were successfully allocated to the DB (mean follow up 27.3 ± 4.2 months) and SB+ ALL groups (27.2 ± 4.5 months), respectively. The preoperative and postoperative Lachman test, pivot shift test, anterior translation on stress radiographs, KT-2000 arthrometer, Lysholm score, International Knee Documentation Committee score, and Tegner activity score were evaluated and compared. Graft continuity was evaluated using postoperative magnetic resonance imaging (MRI) (32 and 36 patients underwent MRI in the DB and SB+ ALL groups at 7.4 ± 3.2 and 7.5 ± 2.9 months after surgery, respectively), and second-look examinations (second-look examination and tibial screw removal were performed concomitantly when patients (1) had tibial screw-related irritation or (2) needed the screws removed, 28 and 23 patients underwent examinations in the DB and SB+ ALL groups at 24.0 ± 6.8 and 24.9 ± 8.1 months after surgery, respectively). All measurements were compared between the groups. Postoperative clinical outcomes significantly improved in both groups. (All variables showed P < .001) No statistically different outcomes were found between the 2 groups. Additionally, postoperative graft continuity on MRI and second-look examinations were not different between the 2 groups. The DB and SB+ ALL groups showed similar postoperative clinical, radiographic, and second-look arthroscopic outcomes. Both groups showed excellent postoperative stability and clinical outcomes compared with the preoperative measurements. Level II, randomized controlled trial.

Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study

Background and Objectives: Tunnel enlargement (TE) is a widely reported phenomenon after anterior cruciate ligament reconstruction (ACLR). Given the paucity of knowledge in the literature, it remains unclear whether screw position in the tunnel affects TE. This retrospective cohort study evaluated differences in postoperative tunnel enlargement rates (TER) and clinical results between anterior and posterior tibial interference screw insertion during single-bundle ACLR using autologous hamstring grafts. Materials and Methods: A group of consecutive patients that underwent primary arthroscopic single-bundle ACLR in our hospital were screened and divided into two groups based on the position of the tibial interference screw (determined by Computer Tomography within 3 days after surgery): anterior screw position group (A) and posterior screw position group (B). The bone tunnel size was measured using magnetic resonance imaging (MRI) performed 1 year after surgery. International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used for clinical results 1 year postoperatively. Results: 87 patients were included. The TER of Group A is higher than that of Group B (43.17% vs. 33.80%, p = 0.024). Group A showed a significant increase (12.1%) in enlargement rates at the joint line level than group B (43.77% vs. 31.67%, p = 0.004). Moreover, KOOS and IKDC scores improved in both groups. There were no significant differences in clinical outcomes between the two groups. Conclusions: One year after ACLR, patients with posterior screw showed significantly lower TE than patients with anterior screw. However, the position of screw did not lead to differences in clinical results over our follow-up period. Posterior screw position in the tibial tunnel maybe a better choice in terms of reducing TE. Whether the different screw positions affect the long-term TE and long-term clinical outcomes needs to be confirmed by further studies.

Outcome Analysis of Arthroscopic Single Bundle Anterior Cruciate Ligament Reconstruction Using Semitendinosus and Gracilis as Quadrupled Graft in Adults – A Case Series Study

Anterior cruciate ligament (ACL) injury is the common knee injury consequent to contact sports. There are different techniques recommended for the ACL reconstruction, with different graft materials. The aim of this study is to evaluate the functional outcome of arthroscopic single bundle ACL reconstruction using hamstring tendon graft in ACL deficient knees in adults. Between 2014 and 2017, a prospective study was conducted in Thanjavur Medical College on 10 ACL deficient patients. All patients were evaluated preoperatively using the Lysholm and Gillquist score and IKDC - 2000 score. All patients underwent arthroscopic single bundle ACL reconstruction with hamstring tendon graft, which was fixed with an endo-button CL fixation system on the femoral side and an interference screw on tibial side. They were advised a regular rehabilitation protocol. All patients were evaluated post-operatively at 6 weeks, 3 months, 6 months, and a year by same assessment scores. Ten patients were available for follow up for a period of 6 months to 2 years. The mean follow-up period was 10.5 months. When compared with their respective pre-operative knee assessment scores, it was found that a definite improvement was there in their knee function. The results were good to excellent in 80% patients, fair in 10%, and poor in 10% cases. For young active adults, single bundle reconstruction by arthroscopic methods gives acceptable results. The problems which are faced post-operatively can be again settled arthroscopically. A long-term follow-up of these cases is a must to analyze if there is degeneration that happened in the time between injury and ligament reconstruction.

Outcome analysis of arthroscopic reconstruction of anterior cruciate ligament in adults

Background: Anterior cruciate ligament injury is the common knee injury consequent to contact sports. There are different techniques recommended for the ACL reconstruction, with different graft materials. The aim of this study is to evaluate the functional outcome of arthroscopic single bundle ACL reconstruction using hamstring tendon graft in ACL deficient knees in adults. AIM: To evaluate the functional outcome of arthroscopic single bundle anterior cruciate ligament reconstruction using quadrupled hamstring tendon (Gracilis and semitendinosus) autograft with endobutton as femoral fixation device and interference screw as tibial fixation device in ACL deficient knees in adults. Methodology: Between December 2020 to December 2022, a prospective study was conducted in Government Medical College, Kota on 21 ACL deficient patients (M =19, F = 2] but 1 male patient was lost to follow-up. All patients were evaluated pre-operatively using the Lysholm & Gillquist score and IKDC – 2000 score. All patients underwent arthroscopic single bundle ACL reconstruction with hamstring tendon graft, which was fixed with an endobutton fixation system on the femoral side and an interference screw on tibial side. They were advised a regular rehabilitation protocol. All patients were evaluated post-operatively at 6 weeks, 3 months, 6 months and a year by same assessment scores. Results: 20 patients were available for follow up for a period of 6 months to 2 years. The mean follow-up period was 10.5 months. When compared with their respective pre-operative knee assessment scores, it was found that a definite improvement was there in their knee function. The results were good to excellent in 80% patients and fair in 20%. Conclusion: For young active adults, single bundle reconstruction by arthroscopic methods gives acceptable results. The problems which are faced post-operatively can be again settled arthroscopically. A long term follow-up of these cases is a must to analyze if there is degeneration that happened in the time between injury and ligament reconstruction.

Increased ACL direct insertion coverage provided more positive biomechanical effects on graft and bone tunnel during knee flexion: a simulation study

PurposeFlattened femoral tunnels were recently applied in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Little is known about the biomechanical effect of such changes during knee flexion. The aim of the present simulation study was to assess the effect of altered ACL direct insertion coverage on the biomechanics of the graft and bone tunnel.MethodsFive finite element (FE) models, including a round femoral tunnel and four progressively flattened rounded rectangular femoral tunnels, were established to represent the ACL reconstructions. In vivo knee kinematics data obtained from the validated dual fluoroscopic imaging techniques controlled the FE models to simulate lunge motions. The maximal principal stress of the graft and the volume of equivalent strain within 1000–3000 microstrain (V1000-3000) of the cancellous bone were subsequently calculated at 0°, 30°, 60° and 90° of knee flexion.ResultsA lower stress state on the graft and a more beneficial strain state on the cancellous bone were observed when the femoral tunnel better covered the ACL direct insertion. The average maximal principal stress of each model were 3.93 ± 0.60 MPa, 3.82 ± 0.54 MPa, 3.43 ± 0.44 MPa, 3.45 ± 0.44 MPa and 3.05 ± 0.43 MPa, respectively. The average V1000-3000 of the cancellous bone of each model were 179.06 ± 89.62 mm3, 221.40 ± 129.83 mm3, 247.57 ± 157.78 mm3, 282.74 ± 178.51 mm3 and 295.71 ± 162.59 mm3, respectively. Both the stress and strain values exhibited two peaks during the flexion simulation. The highest value occurred at 30° of flexion, and the second highest value occurred at 90° of flexion.ConclusionsIncreased ACL direct insertion coverage provided more positive biomechanical effects after anatomical single-bundle ACL reconstruction during knee flexion.

A COMPARATIVE STUDY BETWEEN SUSPENSORY AND APERATURE FIXATION METHOD IN ARTHROSCOPIC SINGLE BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Purpose: To compare the functional outcome of suspensory and aperture fixation method in arthoscopic single bundle anterior cruciate ligament. Method: 30 patient (mean age grp ,35yr)underwent arthroscopic ACL repair with 15 got suspensory and another 15 got aperture fixation in random selection. Similar implant were use to nullify the error.We taken patient with MRI finding of isolated ACL (23)and ACL with medial meniscus tear(7) in our study. No multiligamentous injury were taken.The functional outcome measure with lachman test,Lysholm score ,IKDC score.Post op rehabilitation of early mobilization was done. Inclusion Criteria: Patient given their consent , Age 20-60 years ,Confirmed Complete ACL Tear in MRI Exclusion Criteria: Patients refusing for consent,Patient not ambulatory ,Multiligament knee injury ,Chronic ACL insufficiency with osteoarthritis ,Contradiction to Arthroscopy Result: Patient were followed up in 3week,6week,3month,6month and 1 year.Lysholm score of suspensory were 65.3%, 81.6%,84.5%, 85.1%,97.2%.Aperture fixation scores were 63.7%,76.8%,80.6%,82.13%,95.9%. The IKDC score is 57%, 62.1%,65%,66.6%,77.7% in suspensory fixation and 58.6%,61.6%,63.8%,65.4%,75.1% in aperture fixation. Conclusion: Lysholm score ad IKDC score show no much difference between these two after 3 week,6 week,3 months,6 months of post operation.But after 1 year somehow suspensory had a better result than aperture fixation method.

Double-bundle versus single-bundle anterior cruciate ligament reconstruction in preventing the progression of osteoarthritis: A protocol for systematic review and meta-analysis of randomized controlled trials.

The knee has a high incidence of osteoarthritis (OA) following the anterior cruciate ligament (ACL) injury, which was reduced by ACL reconstruction including double-bundle (DB) techniques and single-bundle (SB) techniques. However, the effectiveness of preventing the progression of OA after the ACL reconstruction using DB and SB techniques is controversial. This meta-analysis was performed following the preferred reporting items for systematic reviews and meta-analyses guidelines. The databases, including PubMed, Embase, and Cochrane Library, were searched. Randomized controlled trials comparing DB with SB ACL reconstruction and reporting clinical outcomes of radiological OA were included. Quality of the included studies was assessed using the Cochrane Collaboration's risk of bias tool. The outcome was analyzed using the risk ratio (RR) and its corresponding 95% confidence interval (CI). Ten Randomized controlled trials studies were included in this meta-analysis (accounting 1062 knees: 475 SB and 587 DB). The rate of radiological OA after the ACL reconstruction was 39% in SB group and 34% in DB group. The results of meta-analysis showed no difference in the occurrence of radiological OA between DB group and in SB group (RR, 1.05; 95% CI, 0.85-1.30, P = .63), including subgroup of radiological scores of OA (subgroup of Minimal OA: RR, 0.95; 95% CI, 0.61-1.48; P = .82; subgroup of Notable OA: RR, 1.16; 95% CI, 0.75-1.78; P = .51), subgroup of follow-up time in 5 years and more than 5 years (RR, 0.98; 95% CI, 0.80-1.20; P = .85), and subgroup of autograft graft for ACL (RR, 0.97; 95% CI, 0.79-1.19; P = .77). However, the DB group had less incidences of knee OA than the SB group in subgroup of less than 5 years (RR, 1.48; 95% CI, 1.13-1.92; P = .004) and subgroup of allograft type (RR, 1.42; 95% CI, 1.06-1.91; P = .02). Overall, this meta-analysis showed that the DB technique was no more effective in preventing the progression of OA than the SB technique in ACL reconstruction at midterm follow-up.

Multi-planar instability, laxity and reduced knee flexion during the support phase of walking are determinants of return to sports.

Background: After anterior cruciate ligament reconstruction, some patients are not recommended to return to high-level physical activity because they fail to pass return-to-sports tests. The kinematic difference between these patients and those who pass the return-to-sports tests is unclear. Methods: Eighty-two patients who received anatomic single-bundle anterior cruciate ligament (ACL) reconstruction for unilateral ACL injury underwent return-to-sport tests during a hospital visit at a minimum of 9months (9-11 months) of follow-up. Fifteen patients who passed the return-to-sports tests (RTS group) and fifteen patients who did not (NRTS group) were randomly selected to perform a treadmill walk under dual-fluoroscopic imaging system surveillance for a 6 degrees of freedom kinematic evaluation. Results: Of the 82 patients, 53 passed the return-to-sports tests 9 months after surgery, with a return-to-sports rate of 64.6%. In the stance phase, the NRTS group had a larger anterior tibial translation (1.00 ± 0.03mm vs. 0.76 ± 0.03mm, p = 0.001), a larger lateral tibial movement (1.61 ± 0.05mm vs. 0.77 ± 0.05mm, p < 0.001), a larger distal tibial displacement (-3.09 ± 0.05mm vs. -2.69 ± 0.05mm, p < 0.001), a smaller knee flexion angle (6.72 ± 0.07° vs. 8.34 ± 0.07°, p < 0.001), a larger varus angle (-0.40 ± 0.03°VS. -0.01 ± 0.03°, p < 0.001) and a larger external rotation angle (1.80 ± 0.05° vs. 1.77 ± 0.05°, p < 0.001) than the RTS group. The maximum anterior tibial translation of the NRTS group is also larger than that of the RTS group (3.64 ± 0.42mm vs. 3.03 ± 0.59mm, p = 0.003). Conclusion: Compared with patients passing RTS tests, those who fail to pass show significant anterior, lateral, and rotational instability; knee laxity; and reduced flexion angle of the knee in the support phase during walking, which may be the possible factors hindering a return to sports.

Intra-Articular Biomechanical Changes of the Meniscus and Ligaments During Stance Phase of Gait Circle after Different Anterior Cruciate Ligament Reconstruction Surgical Procedures: A Finite Element Analysis.

The debate on the superiority of single- or double-bundle for anterior cruciate ligament reconstruction has not ceased. The comparative studies on intra-articular biomechanics after different surgical reconstructions are rare. This study is to evaluate the biomechanical stress distribution intra-knee after single- and double-bundle anterior cruciate ligament reconstruction by three-dimensional finite element analysis, and to observe the change of stress concentration under the condition of vertical gradient loads. In this study, magnetic resonance imaging data were extracted from patients and healthy controls for biomechanical analysis. Patients included in the three models were matched in age and sex. The strength and distribution of induced stresses were analyzed in two frequently used procedures, anatomical single-bundle anterior cruciate ligament reconstruction and anatomical double-bundle anterior cruciate ligament reconstruction, using femoral-graft-tibial system under different loads, to mimic a post-operation mechanical motion. The three-dimensional finite-element models for normal ligament and two surgical methods were applied. A vertical force simulating daily walking was performed on the models to assess the interfacial stresses and displacements of intra-articular tissues and ligaments. The evaluation results mainly included the stress of each part of ligament and meniscus. The stress values of different parts of three models were extracted and compared. The stress of ligament/graft at femoral side of three finite-element models was significantly higher than at tibial side, while the highest level was observed in single-bundle reconstruction finite-element model. With the increase of force, the maximum stress in the medial (7.1-7.1 MPa) and lateral (4.9-7.4 MPa) meniscus of single-bundle reconstruction finite-element model shifted from the anterior horn to the central area (p=0.0161, 0.0479, respectively). The stress was shown to be at a lower level at femoral side and posterior cruciate ligament of intra-knee in two reconstruction finite-element models than that in normal finite-element models, while presented higher level at the tibial side than normal knee (p=0.3528). The displacement of the femoral side and intra-knee areas in reconstruction finite-element models was greater than that in normal finite-element model (p=0.0855). Compared with the single-bundle technique, the graft of double-bundle anterior cruciate ligament reconstruction has better stress dissipation effect and can prevent postoperative meniscus tear more effectively.