Standard Anterior Cruciate Ligament Research Articles

Biomechanical and Histological Study of Retrieved LARS Synthetic Ligaments

Background: Synthetic grafts have been used for a number of years in anterior cruciate ligament (ACL) reconstruction surgery. One of the more recent additions to the stable of synthetic ligaments is the Ligament Augmentation and Reconstruction System (LARS) ligament. Purpose: To analyze the biomechanics and histology of LARS grafts retrieved due to failure of the device. Study Design: Descriptive laboratory study. Methods: A total of 22 LARS ligament grafts that were explanted from patients were sent for analysis. Five new, unused samples of the standard LARS ACL graft were also analyzed. Biomechanical testing was performed: ultimate tensile force, force versus displacement, and stress versus strain were recorded. Histopathological examination was performed looking for degree of fibrous tissue ingrowth as well as the presence of a foreign body reaction. Results: Of the 22 grafts retrieved, 14 were used for ACL grafts, 1 for a lateral collateral ligament graft, 2 for medial collateral ligament grafts, 4 for gluteal tendon augmentation, and 1 for a supraspinatus augmentation. A severe foreign body reaction was found in 86% of the grafts (18/22) and a mild foreign body reaction in the remaining 14% (4/22). Tissue ingrowth was minimal in the majority of ACL grafts; the other grafts showed moderate tissue ingrowth. Maximal tensile force was significantly higher for the new ACL grafts (mean ± SD, 1667 ± 845 N) compared with the retrieved grafts (897 ± 395 N; P < .05). Conclusion: This study demonstrated that the vast majority of retrieved LARS artificial ligaments had a florid foreign body reaction. There was minimal tissue ingrowth in ACL grafts and moderate ingrowth in other grafts. Retrieved grafts had a decreased ultimate tensile force, which increased their risk of rupture. Clinical Relevance: Surgeons should be cautious in choosing to use these grafts in reconstructive surgery for patients.

Comparison of the Clinical Outcomes between All-inside and Standard Technique in Anterior Cruciate Ligament Reconstruction with 6-strand Hamstring Tendon Autograft.

All-inside and standard techniques with 4-strand hamstrings graft have been widely used in anterior cruciate ligament (ACL) reconstruction. However, the graft diameter of less than 8 mm will significantly increase the rate of surgical failure, and the 6-strand graft can solve this problem. The purpose of this study is to compare all-inside ACL reconstruction using suspensory cortical button fixation on both tibia and femur with standard ACL reconstruction using suspensory femoral fixation and a bioabsorbable tibial interference screw with a 6-strand hamstring tendon autograft in postoperative clinical outcomes. From January 2020 to December 2020, 48 patients performed ACL reconstruction were divided into the all-side group and the standard group according to the different surgical techniques. Magnetic resonance imaging (MRI) and subjective function scores was used to assess clinical outcomes at least 24 months following ACL reconstruction. MRI was used to measure the value of bone tunnel widening in articular and middle portions. Subjective function scores included the Lysholm knee score, the International Knee Documentation Committee (IKDC) score, the Knee Society Score (KSS) for pain and function, and KT-1000. The t-test was used assuming the distribution of the patients which follows the normal distribution and we used non-parametric tests if these two conditions were not satisfied. At the final follow-up, there were 22 patients in the all-inside group and 24 patients in the standard group. No significant differences were found with respect to femoral tunnel widening and subjective function scores. However, a significant increase in tibial tunnel widening was found in the middle portion of the standard group (2.25 ± 0.74) compared to the all-inside group (0.76 ± 0.24) (p < 0.01) and also in the articular portion of the standard group (2.07 ± 0.77) compared to the all-inside group (1.52 ± 0.54) (p = 0.02). In addition, the value of the KT-1000 was 1.81 ± 0.45 for the all-inside group and 2.12 ± 0.44 in the standard group (p = 0.016). The objective stability of the knee was relatively better in the all-inside group than in the standard group. And tunnel widening after ACL reconstruction was significantly greater in the standard technique when compared to the all-inside technique on the tibia side.

How To Avoid Suture Damage in Simultaneous Anterior Cruciate Ligament Reconstruction and Lateral Meniscal Posterior Root Reinsertion With the Transtibial Pullout Technique: A Technical Note

Lateral meniscus posterior root tears (LMPRTs) are estimated to occur in 7% to 12% of anterior cruciate ligament (ACL)-injured knees. This topic is of great interest because of their biomechanical consequences in terms of interruption of hoop stress distribution. If left unrepaired, the corresponding compartment is exposed to unfavorable contact dynamics, similar to those resulting from a total meniscectomy. This Technical Note describes a transtibial LMPRT repair using a Knee Scorpion and an 18-gauge spinal needle. It is a reproducible arthroscopic LMPR reinsertion technique combined with concomitant standard ACL + anterolateral ligament reconstruction with hamstring tendons and it describes how to safely avoid damage to root traction sutures during the ACL independent tibial tunnel drilling.

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Tibial graft fixation in anterior cruciate ligament reconstruction: multiple tibial tunnel technique (collateral tunnel technique).

This study aimed to compare the outcomes of patients with an anterior cruciate ligament (ACL) rupture who underwent tibial fixation using the multiple tibial tunnel fixation (MTTF) and standard tibial fixation methods. This retrospective study was conducted between January 1, 2020, and August 1, 2021. MTTT was applied to 43 patients diagnosed with ACL rupture. Of the 43 patients who met the study criteria, 38 were classified as Group 1. In the clinic where the study was conducted, 40 of 57 patients who underwent standard ACL reconstruction by opening a single tibial tunnel were assigned to Group 2. The Endobutton technique was used for fixation of the graft to the femur in both groups. Bioabsorbable and postfix screws were used for the tibial fixation of the patients in Group 2. For patients in Group 1, a bioabsorbable screw, a postfix screw, and an additional MTTT fixation were performed for tibial fixation. Lachman, anterior drawer, Pivot-Shift test results, Lysholm and IKDC knee evaluation scores of the patients in both groups were compared. In this study, there was no significant difference between the groups for the anterior drawer, Lachman, and Pivot-Shift test results at the final control (p > 0.05). There was a significant difference between the two groups for the Lysholm and IKDC scores at the final controls (p < 0.05). There was a significant difference in the Lysholm and IKDC scores between the groups (p < 0.05). In conclusion, ACL reconstruction was performed using the MTTF technique in this study. Due to the additional fixation, it was observed that the patients had a more successful knee function after the surgery.

Effects of remnant preservation in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

BackgroundCompared with standard anterior cruciate ligament (ACL) reconstruction, it is controversial whether anterior cruciate ligament reconstruction (ACLR) with remnant preservation can lead to better clinical outcomes. We conducted a systematic study and meta-analysis to assess the differences in clinical efficacy between the two.MethodWe searched for clinical randomized controlled studies and cohort studies included in the Cochrane library, PubMed, and Embase from March 2012 to March 2022 in English. The included studies were ACLR with or without remant preservation, and the data were extracted and the quality of the included studies was assessed by two authors, respectively. Revman 5.4 was used for statistical analysis and conclusions were presented.ResultTen articles containing a total of 777 patients were finally included. There was no significant difference in postoperative Lachman test [OR = 1.66, 95%CI (0.79, 3.49), P = 0.18 > 0.05], Tegner score [SMD = −0.13, 95%CI (−0.47, 0.22), P = 0.46 > 0.05], synovial coverage rate by second-look arthroscopy [OR = 1.55, 95%CI (0.66, 3.65), P = 0.32 > 0.05], the rate of cyclops lesion [OR = 3.92, 95%CI (0.53, 29.29), P = 0.18 > 0.05], joint range of motion [SMD = 0.27, 95%CI (−0.13, 0.68), P = 0.19 > 0.05] and re-injury rate [OR = 0.57, 95%CI (0.18, 1.74), P = 0.32 > 0.05] between the two groups. There were statistically significant differences in postoperative Lysholm score [SMD = 0.98, 95% CI (0.32, 1.64), P = 0.004 < 0.05], International Knee Documantation Committee grade (IKDC grade) [OR = 2.19, 95%CI (1.03, 4.65), P = 0.04 < 0.05], Pivot shift test [OR = 1.71, 95%CI (1.06, 2.77), P = 0.03 < 0.05], KT1000/2000 arthrometer side-to-side difference [SMD = −0.22, 95%CI (−0.42, −0.03), P = 0.02 < 0.05], operation time [SMD = 11.69, 95%CI (8.85, 14.54), P = 0.00001 < 0.05] and degree of tibial tunnel enlargement [SMD = −0.66, 95%CI (−1.08, −0.23), P = 0.002 < 0.05].ConclusionThis meta-analysis concluded that remnant preservation significantly had better results in terms of patient functional score (Lysholm, IKDC), knee stability (Pivot shift test, postoperative side-to-side anterior laxity) and tibial tunnel enlargement. In terms of complications (incidence of Cyclops lesions, range of motion, re-injury rate), no significant differences were seen between the two groups. Although many studies concluded that remnant preservation could bring better synovial coverage, this meta-analysis indicated that there is insufficient evidence to support it, possibly due to different remnant preservation procedures.The potential risks associated with longer operation times are also worth considering.

Anterolateral Extraarticular Stabilisation of the Knee: Modified Lemaire Procedure.

The anterolateral aspect of the knee is prone to laxity or symptomatic instability, if the anterior cruciate ligament (ACL) is torn. It is necessary to address this issue in patients with general joint hyperlaxity, overextension of the knee, massive anterolateral instability, or re-tear of the ACL with chronic instability. In these cases, and in addition to a preoperative bony workup and revision ACL reconstruction, anterolateral stabilisation should be considered to avoid persistent anterolateral rotation instability and failure of the ACL reconstruction.To stabilise the anterolateral corner of the knee, the modified Lemaire procedure as presented and illustrated here is a straight forward surgical technique that can be performed right after standard ACL reconstruction surgery, if indicated. It is independent from the graft choice for the ACL reconstruction, and the surgical setting in the operating room remains unchanged.

ACL Repair of Femoral Osseous Avulsion in a 13-Year-Old Using Suture Pullout Technique

Background: The incidence of pediatric anterior cruciate ligament (ACL) injuries has been increasing over the past 20 years, with the majority comprised of mid substance tears or tibial eminence avulsion fractures. Pediatric femoral sided osseous avulsion is rarely reported in orthopedic literature and specific surgical indications and contraindications, as well as recommended surgical techniques and postoperative rehabilitation protocols, are underdefined. Indications: The surgical indications for femoral-sided repair of ACL osseous avulsion includes a displaced osseous fragment and ligamentous laxity on physical examination. There was no concomitant midsubstance tear necessitating reconstruction. Technique Description: Two sutures piercing the proximal ligamentous bony junction of the ACL were fed through 2.4-mm transphyseal tunnels and secured with cortical button and backup fixation with a 3.9-mm swivel lock anchor in the proximal lateral femoral metaphysis. The patient was immobilized in a hinged-knee brace locked in extension during ambulation and limited to 90 degrees of flexion while nonweightbearing for the first 6 weeks after surgery. Standard ACL protocol was followed thereafter. Results: Successful fixation and restoration of ligamentous tension and impingement-free range of motion were achieved without complication. There was stable Lachman, negative pivot shift, 125 degrees of knee flexion, and evidence of early healing at 3 months follow-up. Discussion/Conclusion: This report demonstrates successful reduction and fixation of proximal bony avulsion of the ACL. Although this patient exhibits stable physical examination and undisturbed growth at early follow-up, more research is required to establish treatment and rehabilitation guidelines for this rare injury.

Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Incorporation.

Background:It has been shown that adding lateral extra-articular tenodesis (LET) to standard anterior cruciate ligament (ACL) reconstruction significantly decreases the loads on the ACL composite graft. To date, the possible effect of LET on ACL graft incorporation is not known.Purpose:To compare the incorporation in tibial bone tunnels of a standard quadrupled semitendinosus (ST4) graft to an ST4 graft plus LET at 1 year postoperatively using magnetic resonance imaging (MRI).Study Design:Cohort study; Level of evidence, 3.Methods:A total of 62 patients who underwent ACL reconstruction were enrolled prospectively: 31 received an ST4 graft, and 31 received an ST4 graft plus LET. Graft incorporation was evaluated with MRI at the 1-year follow-up visit. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel widening, graft healing, and graft maturity according to the Howell scale. The primary endpoint was the SNQ of the ST4 graft at 1 year postoperatively; this parameter was adjusted because of unequal baseline characteristics between groups. Clinical and functional outcomes as well as incorporation of the graft were analyzed as secondary endpoints.Results:The mean adjusted SNQ was 0.5 ± 2.1 (95% CI, 0.4-4.6) in the ST4 + LET group and 5.9 ± 3.7 (95% CI, 4.7-7.0) in the ST4 group (P = .0297). The mean tibial tunnel widening was 73.7% ± 42.2% in the ST4 + LET group versus 77.5% ± 46.7% in the ST4 group (P = .5685). Howell grade I, indicative of better graft maturity, was statistically more frequent in the ST4 + LET group (P = .0379). No statistically significant difference was seen between groups in terms of graft healing (P = .1663). The Lysholm score was statistically higher in the ST4 + LET group (P = .0058). No significant differences were found between groups in terms of the International Knee Documentation Committee subjective score (P = .2683) or Tegner score (P = .7428). The mean SNQ of the LET graft at the 1-year follow-up visit was 2.6 ± 4.9.Conclusion:At 1 year postoperatively, the MRI appearance of ACL grafts showed generally better incorporation and maturation when combined with LET.

Suture Augmented Versus Standard Anterior Cruciate Ligament Reconstruction: A Matched Comparative Analysis

To compare outcomes between standard anterior cruciate ligament reconstruction (ACLR) using hamstring grafts with and without suture augmentation (SA). Patients who underwent ACLR with hamstring autografts or allografts with minimum 2-year follow-up were retrospectively reviewed. Patients undergoing ACLR with SA were matched 1:1 by age, gender, body mass index, graft type, and revision status to standard ACLR. Range of motion, pain, postoperative activity, patient-reported outcome measures (PROMs), and complications were collected. Paired 2-tailed Student's t-tests and Pearson's χ2-tests were used for continuous and categorical variables, respectively. A multivariate analysis of variance was conducted. Return to preinjury activity level was assessed using Spearman's rho and Pearson's χ2-tests. Sixty patients at a mean age of 29.50 ± 6.60years, 43.4% male, body mass index 26.27 ± 3.37, and follow-up of 29.54 ± 5.37months were included. Preoperative PROMs were not significantly different (P >. 05). Postoperative range of motion was similar between groups (P= .457). Postoperative average daily (0.60 ± 1.25 vs 1.66 ± 1.90) and maximum daily pain (1.57 ± 1.83 vs 3.35 ± 2.28) were significantly lower for SA (P < .014). SA predicted improvement in PROMs (P < .05) and maximum pain scores (P= .001). SA was significantly correlated with improved time to return to preinjury activity level (9.17 ± 2.06 vs 12.88 ± 3.94months; P= .002) and percentage of preinjury activity level (93.33% ± 13.22% vs 83.17% ± 17.69%; P= .010). There was a trend toward improved rate of return to preinjury activity level for SA (76.7% vs 56.7%; P=.100). Our study demonstrates that SA hamstring ACLRs were associated with improved PROMs, less pain, and a higher percentage of and earlier return to preinjury activity level when compared with standard hamstring ACLRs without evidence of overconstraint. Level III, retrospective comparative study.

Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Reconstruction

There has been a renewed interest in anterior cruciate ligament (ACL) repairs over the last decade with some early promising results in the right patient population. Additionally, the anterolateral ligament has been extensively studied and has recently been shown to have a protective effect on standard ACL reconstructions in a clinical trial. Given its protective effect on ACL reconstructions, we believe this phenomenon is also relevant to ACL repairs and can decrease rerupture rates. In this publication, we demonstrate a surgical technique for ACL repair using an internal brace combined with an anterolateral ligament reconstruction using a gracilis autograft.

Application of a Beta-Tricalcium Phosphate Graft to Minimize Bony Defect in Bone–Patella Tendon–Bone Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone autograft yields good clinical outcomes. Despite appropriate clinical outcomes, the most common complaint after reconstruction with a bone–patellar tendon–bone autograft is anterior knee pain at the donor graft sites. Synthetic bone grafts, such as beta-tricalcium phosphate (β-TCP), have been previously used to fill the bony defect in fractures as well as removal of bony tumors, and have shown positive utility in improving anterior knee pain after ACL reconstruction. In this Technical Note, we describe the technique of placing a β-TCP graft in the donor graft site after bone–patellar tendon–bone ACL reconstruction. After standard arthroscopic ACL reconstruction, the β-TCP is appropriately sized with an osteotome and sagital saw before being placed into the patellar and tibial donor sites. A 0-Vicryl suture is used to suture the periosteum to secure the β-TCP graft at the donor sites. This described technique allows for appropriate sizing and secure placement of the graft to maximize bone regeneration at the donor site.

Comparison of patellar tendon versus hamstrings autografts for anterior cruciate ligament reconstruction in Indian population: A randomised control trial study

Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The best choice of graft for reconstruction remains undecided. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (QHT) grafts for ACL reconstruction over a 1-year follow-up interval in Indian population. Methods42 consecutive patients with ACL injury were recruited, by pick and draw method and allotted into two groups with 21 patients in each group. Group A patients underwent arthroscopic ACL reconstruction using BPTB graft while QHT autograft was used for patients in Group B. All the patients underwent standard ipsilateral arthroscopic ACL reconstruction procedure using a single incision, antero-medial (AM) portal technique for BPTB or the QHT autograft by a same surgeon. Patients were followed up regularly for a minimum period of 1 year. ResultsAfter one year, the Cincinnati score was 91 ± 4.117 in BPTB group and 89.29 ± 5.371 in QHT group (P = 0.282). There was no significant difference between the two groups in the mean scores with respect to pain, overall activity level and running in the Cincinnati score. None of the patients complained of the knee giving way. Similarly, at 1 year, the Lysholm score was 92.84 ± 2.630 and 90.55 ± 2.395 in the two groups respectively (P = 0.842). There were no episodes of locking or instability and there was no significant difference in the mean Lysholm scores regarding pain and squatting. ConclusionThere was no significant functional difference between the two grafts in terms of Lysholm and the Cincinnati score, anterior knee laxity and altered sensation over proximal leg. The patients with QHT groups performed better than BPTB functionally at 6 month so early return to sport is possible even with QHT autograft.

Effect of Core Stability Training on Knee Proprioception after Anterior Cruciate Ligament Reconstruction

AbstractBackground: Decreased core stability reduce activity participation of athlete. Deficits of core stability is neuromus-cular risk factor for anterior cruciate ligament (ACL) injury.Purpose: This study was conducted to study the effect of core stability training (CST) on knee proprioception and function after ACL reconstruction.Methods: Thirty patients of both gender after ACL reconstruction. Their age ranged from 20-30 years. All patients were referred by the orthopedic surgeon who was responsible for diagnosis and surgery based on clinical and radiological examination. They were randomly assigned into 2 groups group A included 15 patients received standard ACL rehabil-itation protocol and group B included 15 patients received CST in conjugation with standard ACL rehabilitation protocol. Three sessions per week for 8 weeks. The study was conducted in the duration from August 2016 till August 2017 at a private orthopedic and arthroscopic center.Evaluation: The digital inclinometer has been used to assess knee proprioception (joint position sense) after ACL reconstruction.Results: Showed that both standard ACL rehabilitation protocol (group A) and CST in conjugation with standard ACL rehabilitation protocol (group B) were effective in improving the knee proprioception.Conclusion: There was no significant difference in knee proprioception between standard rehabilitation protocol with or without CST, however there was clinical difference and high percent of improvement in adding CST to standard rehabilitation protocol.

Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients.

Background:The safest and most effective technique for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients is currently unknown.Purpose:To evaluate the functional and patient-reported outcomes of a specific all-epiphyseal ACL reconstruction technique in which the graft, bone tunnels, and fixation do not cross the knee growth plates.Study Design:Case series; Level of evidence, 4.Methods:Twenty-seven patients (23 boys, 4 girls; mean age, 11 years; range, 8-15 years) underwent an all-epiphyseal ACL reconstruction with a single femoral transverse epiphyseal tunnel and primarily split tibial epiphyseal tunnels. Outcomes were evaluated in terms of the manual Lachman test, range of motion, pain, return to activity, angular or leg-length deformity on imaging, and International Knee Documentation Committee (IKDC) or Pedi-IKDC score an average of 3.8 years postoperatively, with a minimum 2-year follow-up.Results:The mean IKDC score was 94 ± 11. There were no growth arrests, but 3 patients had knee overgrowth, and 2 required a subsequent guided growth procedure. The ACL graft failed in 4 patients (15%), and 2 patients had contralateral ACL tears (7%). There were 5 subsequent ipsilateral meniscal tears, 4 of which were retears of a repaired meniscus. Ipsilateral knee reinjury significantly correlated with the number of associated injuries at the time of index surgery (P = .040) and the number of sports played (P = .029).Conclusion:All-epiphyseal ACL reconstruction resulted in excellent long-term functional outcomes, despite a high rate of complications (48%) and secondary procedures (37%) in this highly active cohort. The incidence of graft failure was similar to other standard ACL reconstruction techniques for patients younger than 20 years.

No evidence that remnant-preserving anterior cruciate ligament reconstruction ensures better proprioceptive function than a standard single-bundle reconstruction: a systematic review of randomised controlled trials

ImportanceInjury to the anterior cruciate ligament (ACL) causes significant mechanical instability and unequal functional deficits in patients with similar injury due to loss of proprioception. Therefore, the importance of the ACL remnant has been emphasised; it has the perceived potential to improve postoperative proprioception in knees with ACL reconstruction. However, the current literature shows unproven benefits of doing so, and thus the need for a systematic review.ObjectiveThe purpose of this systematic review was to review published randomised control trials (RCTs) to determine whether a remnant-preserving ACL reconstruction offers any proprioceptive benefit over a standard single-bundle ACL reconstruction.Evidence reviewThe PRISMA checklist was used for all aspects of this systematic review. The PubMed, EMBASE, Cochrane and HuGE databases were searched from their inception until 15 June 15 2016 with specific keywords. Trial registry databases were also searched.FindingsThe initial search yielded 3081 articles. Out of these 2841 did not relate to the research question and were removed. The remaining 240 articles were screened for their abstracts. 178 articles which were either non-clinical studies or not related to ACL remnant preservation and proprioception were excluded. For the remaining 62 studies, full-text articles were studied and 57 were excluded from the study as they were not RCTs or dealt with remnant preservation techniques only in isolation or were non-comparative outcome studies or reviews. That left 5 RCTs. Out of these, 4 did not deal with proprioception as an outcome measure and were excluded. This left only 1 RCT by Hong et al available for the review.Conclusions and relevanceAt present there is no direct evidence to favour or refute ACL remnant preservation at the time of reconstruction.

Femoral-Side ACL Rupture: Arthroscopic Transosseous Refixation Technique and Early Outcomes

Background: Many different surgical techniques are nowadays performed in Anterior Cruciate Ligament (ACL) lesions. Several studies demonstrated that native ACL contains mechanoreceptors that are fundamentals for the proprioception of the knee, which are removed during the standard arthroscopic ACL reconstruction. Material and Methods: This article shows a new arthroscopic way to reinsert an ACL, through a Vycril® #2 wire using a modified Mason-Allen technique, combined with the “healing response technique”, described by Steadman. We recommend this technique for patients with an ACL lesion, detached from his femoral insertion, as suggested by MRI and confirmed by arthroscopic view. Postoperatively the patient must have a knee brace locked at 15-degrees of flexion for the first two weeks with partial weight bearing and prophylaxis of thrombosis with low-molecular-weight heparin until the complete weight bearing; then gradually the flexion will be increased during the next month. Discussion: This new technique permits to maintain the native ACL, reinserted into his anatomical insertion and the mechanoreceptors that are fundamentals for the proprioception, associated with the healing power of the bone marrow cells and blood.

Combined Intra-articular and Extra-articular Reconstruction in Anterior Cruciate Ligament–Deficient Knee: 25 Years Later

To determine whether an anterior cruciate ligament (ACL)-reconstructed knee with hamstring autograft has a greater incidence of degenerative changes when an extra-articular reconstruction is added and to determine the effect of the combined reconstruction on knee stability and function at long-term follow-up. For this retrospective study, patients who underwent ACL reconstruction between January 2002 and December 2003 were selected and classified into 2 groups, I and II. Group I consisted of patients operated by a standard ACL reconstruction, and group II consisted of patients in whom, owing to the presence of risk factors (severe pivot shift graded+++ or high-risk sports), an extra-articular reconstruction performed with ileo-tibial tract according to McIntosh as modified by Cocker Arnold technique, was used in conjunction with intra-articular ACL reconstruction. At final follow-up, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores were used. An arthrometric KT-1000 evaluation was done. Comparative weight-bearing radiographs were taken, including a skyline view for the patellofemoral joint and analyzed according to Fairbank, Kellgren, and IKDC classification. Seventy-two of the 75 (96%) patients in group I and 68 of the 75 patients in group II were available at the final follow-up (minimum 10years). Subjective scores improved significantly in both groups, with no significant difference. Objectively, the number of patients receiving C and D IKDC objective activity scores in group I (7/56; 12.5%) was significantly higher than in group II (0/60) (P= .01). Considering as a failure a side-to-side arthrometric difference more than 5mm or a pivot shift test graded as++ or+++, or any giving way episode occurring postoperatively, we found 8 cases in group I and no cases in group II (P= .01) despite the presence of risk factors that group I did not include. Radiologic evaluation showed less arthritic changes in group II in both tibiofemoral and patellofemoral joints. On the basis of the results of this study, adding an extra-articular reconstruction to an anatomically placed intra-articular ACL reconstruction, followed by a modern rehabilitation protocol, does not increase the risk of osteoarthritis and may be able to reduce the rate of failure. Level III, retrospective comparative study.

Is anterior cruciate ligament preservation surgery better than reconstructing both bundles?

Rupture of the anterior cruciate ligament (ACL) is one of the most common ligamentous injuries of the knee, with an incidence of 35 out of 100,000. An ACL reconstruction is now a routine procedure. Generally, good outcomes are expected from the surgery, with return to preinjury level of sports activity in most patients. Debate, however, continues regarding the advantages of preserving the ACL remnant and augmenting it with a graft as opposed to debridement of the remnant in a standard ACL reconstruction. The purpose of this article is to consider the scientific basis of ACL preservation surgery (remnant preservation and selective bundle reconstruction) and to compare the outcomes between an ACL-preserving surgery and a double-bundle reconstruction. Both techniques provide anteroposterior laxity control and some degree of control on rotational laxity. Although superior Lysholm and subjective International Knee Documentation Committee (IKDC) scores have been documented with double-bundle reconstructions, remnant-preserving procedures have several advantages and seem to have a valuable contribution either on single-bundle, selective, and double-bundle reconstructions. Based on our experience, we recommend the remnant preserving technique. However, longer follow-up is necessary to ascertain which procedure could restore the normal knee kinematics, thus providing better clinical outcomes.

Comparison of Clinical Outcome of Autograft and Allograft Reconstruction for Anterior Cruciate Ligament Tears.

Background:Hamstring (HS) autograft and bone-patellar tendon-bone allograft are the most common choice for reconstruction of anterior cruciate ligament (ACL). There was a little report about the clinical outcome and difference of arthroscopic ACL reconstruction using allograft and autograft. This study aimed to compare the clinical outcome of autograft and allograft reconstruction for ACL tears.Methods:A total of 106 patients who underwent surgery because of ACL tear were included in this study. The patients were randomly divided into two groups, including 53 patients in each group. The patients in group I underwent standard ACL reconstruction with HS tendon autografts, while others in group II underwent reconstruction with bone-patellar tendon-bone allograft. All the patients were followed up and analyzed; the mean follow-up was 81 months (range: 28–86 months). Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC), Lysholm scores, physical instability tests, and patient satisfaction questionnaires. The complication rates of both groups were compared. Tibial and femoral tunnel widening were assessed using lateral and anteroposterior radiographs.Results:At the end of follow-up, no significant differences were found between the groups in terms of IKDC, Lysholm scores, physical instability tests, patient satisfaction questionnaires, and incidences of arthrofibrosis. Tibial and femoral tunnel widening was less in the HS tendon autografts. This difference was more significant on the tibial side.Conclusions:In the repair of ACL tears, allograft reconstruction is as effective as the autograft reconstruction, but the allograft can lead to more tunnel widening evidently in the tibial tunnel, particularly.