No difference in postoperative rotational laxity after ACL reconstruction in patients with and without anterolateral capsule injury: quantitative evaluation of the pivot-shift test at 1-year follow-up

AbstractTechniques using the anteromedial portal (AMP) and accessory anteromedial portal (AAMP) are commonly used in anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate the radiological and clinical outcomes of arthroscopic single-bundle ACL reconstruction using the AMP or AAMP technique to drill the femoral tunnel. The records of 157 patients who underwent single-bundle ACL reconstruction using the AMP or AAMP technique between 2011 and 2015 were reviewed. The femoral tunnel clock-face position and femoral tunnel and tibial tunnel anterior–posterior (AP) inclination angles were assessed on axial or AP magnetic resonance images. At last follow-up, the Lachman test and pivot-shift test were used to evaluate AP and rotational stability, respectively. The Lysholm knee scoring scale and the International Knee Documentation Committee (IKDC) form were used to evaluate clinical and functional results. No statistically significant differences were found between the groups in patient age, sex, follow-up period, or affected side distribution. The mean femoral tunnel inclination angle was 31.13 ± 8.06 degrees in the AMP group and 30.17 ± 9.02 degrees in the AAMP group (p = 0.513). The tibial tunnel inclination angle in the AMP group (16.28 ± 7.89 degrees) was not different from that in the AAMP group (13.70 ± 6.08 degrees). No significant differences were observed between the two groups in the Lachman test, pivot-shift test, Lysholm knee scoring scale, or IKDC scores. The AAMP technique was not clinically superior to the AMP technique in ACL reconstruction. This is a retrospective comparative study and its level of evidence is III.

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Arthroscopic Reconstruction of Anterior Cruciate Ligaments With Allograft: Single-tunnel Double-bundle Versus Single-tunnel Single-bundle

10.21203/rs.3.rs-44919/v1 ◽

2020 ◽

Author(s):

Weimin Zhu ◽

Yuanhui Zhou ◽

Kang Chen ◽

Yizi Zheng ◽

Wei Lu ◽

...

Keyword(s):

Knee Joint ◽

Acl Reconstruction ◽

Pivot Shift ◽

Double Bundle ◽

Pivot Shift Test ◽

Single Bundle ◽

Arthroscopic Reconstruction ◽

Anterior Cruciate ◽

The Stability

Abstract Purpose Arthroscopic reconstruction of anterior cruciate ligament (ACL) commonly adopted single-tunnel single-bundle (STSB) or double-tunnel double-bundle (DTDB) methods. Though single-tunnel double-bundle (STDB) has been used in clinical practice, the efficacy remains unclear. The objective of this study is to compare the clinical results of ACL reconstruction using the STDB and STSB techniques. Methods Between March 2010 to June 2013, 78 patients with ACL rupture underwent arthroscopic STDB reconstruction (42 cases) or STSB reconstruction (36 cases) using anterior tibialis tendon allografts in our department. IKDC, Lysholm and Tegner scores were used to evaluate the subjective function of the knee joint during the postoperative follow-up. In addition, the Lachman test and pivot shift test were used to objectively assess the stability of the knee. Results The average follow-up time is 24.2 ± 5.7 months in the STDB group, and 24.8 ± 6.6 months in the STSB group. Patients in both groups recovered to preoperative sports level with few complications. The postoperative Lysholm, IKDC, Tegner scores, and knee joint stability were significantly improved compared to preoperative status in both groups (P < 0.05). However, no statistically significant difference was observed between the two groups at the final follow-up (P > 0.05), except for the improvement of pivot shift test positive rate in the STDB group compared with STSB group (P < 0.05). Conclusion Both techniques can be used to restore the stability and function of the knee joint with satisfactory short-term efficacy, and STDB showed better rotational stability than STSB technique, indicating the STDB technique may also considered a reliable method for ACL reconstruction.

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Arthroscopic reconstruction of anterior cruciate ligaments with allograft: Single-tunnel double-bundle versus single-tunnel single-bundle

10.21203/rs.3.rs-147572/v1 ◽

2021 ◽

Author(s):

Weimin Zhu ◽

Yizi Zheng ◽

Wei Lu ◽

Jianyi Xiong ◽

Daping Wang ◽

...

Keyword(s):

Knee Joint ◽

Acl Reconstruction ◽

Pivot Shift ◽

Double Bundle ◽

Pivot Shift Test ◽

Single Bundle ◽

Arthroscopic Reconstruction ◽

Anterior Cruciate ◽

The Stability

Abstract Background: Arthroscopic reconstruction of anterior cruciate ligament (ACL) commonly adopted single-tunnel single-bundle (STSB) or double-tunnel double-bundle (DTDB) methods. Though single-tunnel double-bundle (STDB) has been used in clinical practice, the efficacy remains unclear. The objective of this study is to compare the clinical results of ACL reconstruction using the STDB and STSB techniques.Methods: Between March 2010 to June 2013, 78 patients with ACL rupture underwent arthroscopic STDB reconstruction (42 cases) or STSB reconstruction (36 cases) using anterior tibialis tendon allografts in our department. IKDC, Lysholm and Tegner scores were used to evaluate the subjective function of the knee joint during the postoperative follow-up. In addition, the Lachman test and pivot shift test were used to objectively assess the stability of the knee.Results: The average follow-up time is 24.2±5.7 months in the STDB group, and 24.8±6.6 months in the STSB group. Patients in both groups recovered to preoperative sports level with few complications. The postoperative Lysholm, IKDC, Tegner scores, and knee joint stability were significantly improved compared to preoperative status in both groups (P<0.05). However, no statistically significant difference was observed between the two groups at the final follow-up (P>0.05), except for the improvement of pivot shift test positive rate in the STDB group compared with STSB group (P<0.05).Conclusion: Both techniques can be used to restore the stability and function of the knee joint with satisfactory short-term efficacy, and STDB showed better rotational stability than STSB technique, indicating the STDB technique may also considered a reliable method for ACL reconstruction.

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In-vivo pivot-shift test measured with inertial sensors correlates with the IKDC grade

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2017-000167 ◽

2018 ◽

Vol 3 (2) ◽

pp. 89-93 ◽

Cited By ~ 2

Author(s):

Giulio Maria Marcheggiani Muccioli ◽

Cecilia Signorelli ◽

Alberto Grassi ◽

Tommaso Roberti di Sarsina ◽

Federico Raggi ◽

...

Keyword(s):

Acl Reconstruction ◽

Pivot Shift ◽

Case Series ◽

Pivot Shift Test ◽

Female Ratio ◽

The Mean ◽

Over The Top ◽

Clinical Grading

ObjectivesKinematic Rapid Assessment (KiRA) is a wireless, non-invasive, inertial system with a single tibial sensor developed to measure the pivot-shift (PS) test. The purpose of this study was to in-vivo compare acceleration values acquired by KiRA to the objective International Knee Documentation Committee (IKDC) clinical grading of PS. The comparison was performed in non-anaesthetised patients before and after anterior cruciate ligament (ACL) reconstruction. We hypothesised the existence of a correlation between the side-to-side difference in the measured acceleration range by KiRA and the objective IKDC clinical grading of the PS.MethodsBetween 2010 and 2014, 60 non-professional football players (male/female ratio: 42/18; mean age 34±15.4 years, range 14–51 years) with ACL lesion were enrolled. They underwent over-the-top ACL reconstruction plus lateral extra-articular plasty with autologous hamstrings. All the patients were evaluated before the reconstruction and re-evaluated at 12-month follow-up. Each patient underwent a clinical examination and then was subjected to the instrumental PS examination by KiRA. The difference in the acceleration range between injured/reconstructed and contralateral limb (Δarange) was used in the analysis. Correlations between Δarange values and objective IKDC clinical grades of PS were calculated using Spearman correlation analysis.ResultsAll subjective scores improved from preoperative to follow-up (P≤0.01). Objective IKDC clinical grading of the PS improved from 4B, 40C and 16D to 50A, 8B and 2C (P<0.0001). The mean Δarange measured by KiRA improved from 2.0±1.0 to 0.2±0.4 m/s2(P<0.0001). A very strong correlation was displayed between the overall Δarange measured by KiRA and overall objective IKDC clinical grading of the PS (r=0.86, P<0.0001); correlation was strong for preoperative data (r=0.71, P<0.0001) and moderate for postoperative data (r=0.53, P<0.0001). The mean Δarange resulted 0.3±0.3 m/s2for the IKDC A subgroup, 0.8±0.3 m/s2for the IKDC B subgroup, 1.7±0.8 m/s2for the IKDC C subgroup and 2.9±0.9 m/s2for the IKDC D subgroup.ConclusionThe side-to-side difference in the measured acceleration range by KiRA shows a correlation with objective IKDC clinical grading of PS.Study designCase series; level of evidence: 4.

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Surgical intra- and extra-articular anterior cruciate ligament reconstruction: a meta-analysis

10.21203/rs.2.20069/v1 ◽

2020 ◽

Author(s):

Xiangyun Cheng ◽

Fanxiao Liu ◽

Dongsheng Zhou ◽

Alexander C. Paulus

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Pivot Shift ◽

Cruciate Ligament ◽

Meta Analysis ◽

Cochrane Library ◽

Pivot Shift Test ◽

Reconstruction Technique ◽

Anterior Cruciate

Abstract Background: It is still controversial whether the combination of anterior cruciate ligament (ACL) reconstruction and extra-articular reconstruction (EAR) have good clinical efficacy. This meta-analysis aims to compare the clinical effectiveness of ACL reconstruction and combined reconstruction. Methods: Electronic databases, including Medline/PubMed, Embase and the Cochrane Library, were systematically searched to identify targeted studies. A meta-analysis aims to pool the outcome estimates of interest, such as the Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores and the results from the KT-1000/2000 arthrometer test, the Lachman test and the pivot shift test. Results : Twelve studies involving 1146 knees were identified. Compared with single ACL reconstruction, combined reconstruction had better results for a pivot shift of grade 1 (relative ratio [RR] = 0.88, 95% CI: 0.83-0.94) and grade 2 (RR = 0.95, 95% CI: 0.91-0.99) rather than grade 3 (RR = 0.98, 95% CI: 0.90-1.06) and no statistically significant difference for both Lachman grade 1 (RR = 0.96, 95% CI: 0.89-1.05) and grade 2 (RR = 0.96, 95% CI: 0.90-1.03). Combined reconstruction resulted in significant improvements on the instrumented joint laxity test when considering a failure standard of more than 5 mm (a side-to-side arthrometric difference) (RR = 0.94, 95% CI: 0.89-0.98) rather than 3 mm (RR = 0.94, 95% CI: 0.86-1.03). Moreover, combined reconstruction increased the IKDC score at the 12-month (weighted mean difference [WMD] = -6.38, 95% CI: -9.66 to -3.10), 24-month (WMD = -5.60, 95% CI: -8.54 to -2.66) and 36-month follow-ups (WMD = -4.71, 95% CI: -7.59 to -1.83) and the Tegner score at the 36-month follow-up (WMD = -0.53, 95% CI: -0.97 to -0.09), but it did not increase the Lysholm score at the 36-month follow-up (WMD = -0.84, 95% CI: -2.02 to 0.34). Conclusion : With the advances in reconstruction techniques, combined reconstructions were found to be effective in improving rotational stability and to lead to good functional scores. However, obviously, the combined reconstruction technique is more time-consuming and requires an additional incision, which is not suitable for all ACL-deficient patients. Therefore, programs should be personalized and customized for the specific situation of each patient.

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Arthroscopic reconstruction of anterior cruciate ligaments with allograft: Single-tunnel double-bundle versus single-tunnel single-bundle

10.21203/rs.3.rs-44919/v2 ◽

2020 ◽

Author(s):

Weimin Zhu ◽

Yuanhui Zhou ◽

Kang Chen ◽

Yizi Zheng ◽

Wei Lu ◽

...

Keyword(s):

Knee Joint ◽

Acl Reconstruction ◽

Pivot Shift ◽

Double Bundle ◽

Pivot Shift Test ◽

Single Bundle ◽

Arthroscopic Reconstruction ◽

Anterior Cruciate ◽

The Stability

Abstract Purpose: Arthroscopic reconstruction of anterior cruciate ligament (ACL) commonly adopted single-tunnel single-bundle (STSB) or double-tunnel double-bundle (DTDB) methods. Though single-tunnel double-bundle (STDB) has been used in clinical practice, the efficacy remains unclear. The objective of this study is to compare the clinical results of ACL reconstruction using the STDB and STSB techniques.Methods: Between March 2010 to June 2013, 78 patients with ACL rupture underwent arthroscopic STDB reconstruction (42 cases) or STSB reconstruction (36 cases) using anterior tibialis tendon allografts in our department. IKDC, Lysholm and Tegner scores were used to evaluate the subjective function of the knee joint during the postoperative follow-up. In addition, the Lachman test and pivot shift test were used to objectively assess the stability of the knee.Results: The average follow-up time is 24.2±5.7 months in the STDB group, and 24.8±6.6 months in the STSB group. Patients in both groups recovered to preoperative sports level with few complications. The postoperative Lysholm, IKDC, Tegner scores, and knee joint stability were significantly improved compared to preoperative status in both groups (P<0.05). However, no statistically significant difference was observed between the two groups at the final follow-up (P>0.05), except for the improvement of pivot shift test positive rate in the STDB group compared with STSB group (P<0.05).Conclusion: Both techniques can be used to restore the stability and function of the knee joint with satisfactory short-term efficacy, and STDB showed better rotational stability than STSB technique, indicating the STDB technique may also considered a reliable method for ACL reconstruction.

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Xenograft for anterior cruciate ligament reconstruction was associated with high graft processing infection

Journal of Experimental Orthopaedics ◽

10.1186/s40634-020-00292-0 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Willem Van Der Merwe ◽

Martin Lind ◽

Peter Faunø ◽

Kees Van Egmond ◽

Stefano Zaffagnini ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Infection Rate ◽

Pivot Shift ◽

Cruciate Ligament ◽

Pivot Shift Test ◽

Tunnel Widening ◽

Kt 1000 ◽

Anterior Cruciate

Abstract Purpose To evaluate clinical ad radiological outcomes of anterior cruciate ligament (ACL) reconstruction with an immunochemically modified porcine patellar tendon xenograft controlled against human Achilles tendon allograft at 24-month minimum follow-up. Methods 66 patients undergoing arthroscopic ACL reconstruction were randomized into 2 groups: 34 allografts and 32 xenografts treated to attenuate the host immune response. Follow-up was 24-month minimum. Anterior knee stability was measured as KT − 1000 side-to-side laxity difference (respect to the contralateral healthy knee). Functional performance was assessed by one-legged hop test. Objective manual pivot-shift test and subjective (IKDC, Tegner and SF-36) outcomes were collected. MRI and standard X-Ray were performed. Results 61 subjects (32 allograft, 29 xenograft) were evaluated at 12 and 24 months. Six of the subjects in xenograft group (20.6%) got an infection attributed to a water-based pathogen graft contamination in processing. Intention-to-treat analysis (using the last observation carried forward imputation method) revealed higher KT − 1000 laxity in xenograft group at 24-month follow-up (P = .042). Also pivot-shift was higher in xenograft group at 12-month (P = .015) and 24-month follow-up (P = .038). Per-protocol analysis (missing/contaminated subjects excluded) did not revealed clinical differences between groups. Tibial tunnel widening in the allograft group was low, whereas xenograft tunnel widening was within the expected range of 20–35% as reported in the literature. No immunological reactivity was associated to xenograft group. Conclusions High infection rate (20.6%) was reported in xenograft group. Both groups of patients achieved comparable clinical outcomes if missing/contaminated subjects are excluded. Improved harvesting/processing treatments in future studies using xenografts for ACL reconstruction are needed to reduce infection rate, otherwise xenograft should not be used in ACL reconstruction. Level of evidence Multicenter and double-blinded Randomized Controlled Clinical Trial, Level I.

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Excessive Preoperative Anterior Tibial Subluxation in Extension Is Associated With Inferior Knee Stability After Anatomic Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546519900158 ◽

2020 ◽

Vol 48 (3) ◽

pp. 573-580 ◽

Cited By ~ 1

Author(s):

Guan-yang Song ◽

Hui Zhang ◽

Jin Zhang ◽

Zhi-jun Zhang ◽

Tong Zheng ◽

...

Keyword(s):

Pivot Shift ◽

Cruciate Ligament ◽

Pivot Shift Test ◽

Control Group ◽

Study Group ◽

Knee Stability ◽

Anterior Tibial ◽

Kt 1000 ◽

Anterior Cruciate

Background: Anterior tibial subluxation (ATS) in extension after anterior cruciate ligament (ACL) injury highlights an increased anterior position of the tibia relative to the femur. Recent studies demonstrated that subluxation is sometimes irreducible and the normal tibiofemoral relationship is not restored by ACL reconstruction (ACLR), which raises concerns regarding clinical outcomes after ACLR. Hypothesis: Excessive preoperative ATS in extension is associated with inferior knee stability after anatomic ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: From March 2016 to January 2017, a total of 487 consecutive patients with clinically diagnosed noncontact ACL injuries who underwent primary anatomic ACLR were retrospectively analyzed. Of these patients, 430 met the criteria for inclusion in this study. Anterior subluxation of the lateral and medial compartments (ASLC and ASMC) in extension relative to the femoral condyles was measured on preoperative magnetic resonance imaging. Twenty patients (study group) who demonstrated excessive (>10 mm) ASLC and ASMC in extension were matched 1:2 to 40 participants (control group) who showed minimal or no (<3 mm) ASLC and ASMC in extension. The amount of ASLC and ASMC in extension relative to the femoral condyles at 2 years postoperatively was the primary outcome. Moreover, the Lysholm score, IKDC grade (International Knee Documentation Committee), and stability assessments (pivot-shift test and KT-1000 arthrometer side-to-side difference) were evaluated preoperatively and at the last follow-up visit. Results: The preoperative mean ASLC and ASMC in extension of the study group were both significantly larger than those of the control group (study group vs control group: ASLC, 13.5 mm vs 1.2 mm; ASMC, 12.4 mm vs 1.0 mm; P < .05). Moreover, patients in the study group showed significantly larger posterior tibial slope than the patients in the control group (17.8°± 2.5° vs 9.5°± 1.5°; P < .05). At the final follow-up visit, the mean ASLC and ASMC of the study group were 8.1 mm and 7.3 mm, which were significantly larger than those of the control group (ASLC, 0.9 mm; ASMC, 0.7 mm; P < .05). In addition, the study group showed inferior knee stability when compared with the control group in terms of both the pivot-shift test (study group vs control group: 2 grade 2, 10 grade 1, and 8 grade 0 vs 1 grade 1 and 39 grade 0; P < .05) and the KT-1000 arthrometer side-to-side difference (study group vs control group: 4.4 ± 1.2 mm vs 1.5 ± 0.6 mm; P < .05). Furthermore, the study group showed significantly lower mean Lysholm score (study group vs control group: 80.3 ± 6.3 vs 93.3 ± 4.3, P < .05) and IKDC grading results (study group vs control group: 3 grade C, 16 grade B, and 1 grade A vs 3 grade B and 37 grade A; P < .05) as compared with the control group. Conclusion: In this short-term study, the excessive (>10 mm) preoperative ATS in extension after ACL injury was associated with inferior knee stability after anatomic ACLR.

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Preoperative Knee Instability Affects Residual Instability as Evaluated by Quantitative Pivot-Shift Measurements During Double-Bundle ACL Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120959020 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095902

Author(s):

Yusuke Kawanishi ◽

Masahiro Nozaki ◽

Makoto Kobayashi ◽

Sanshiro Yasuma ◽

Hiroaki Fukushima ◽

...

Keyword(s):

Angular Velocity ◽

General Anesthesia ◽

Acl Reconstruction ◽

Pivot Shift ◽

Cruciate Ligament ◽

Double Bundle ◽

Pivot Shift Test ◽

Important Indicator ◽

Quantitative Measurements ◽

Double Bundle Acl Reconstruction

Background: The pivot-shift test is an important indicator of functional outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR). Preoperative instability as indicated by the pivot-shift test is associated with residual instability after ACLR. Few studies have used quantitative means to evaluate the pivot shift after ACLR. Purpose: To investigate the relationship between preoperative and residual instability and to identify the risk factors for residual instability by using quantitative measurements of the pivot shift. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 91 patients undergoing primary double-bundle ACLR were retrospectively enrolled. Quantitative measurements of instability for ACL-deficient knees (ACLD) and uninjured contralateral knees (intact) preoperatively, as well as ACLR knees intraoperatively, were performed under general anesthesia using the pivot-shift test, with inertial sensors to measure acceleration and external rotational (ER) angular velocity. The ratios of intact to ACLD (ACLD/I) and intact to ACLR (ACLR/I) were measured. Patients who showed an ACLR/I of >1 were classified into the residual instability group, and those with an ACLR/I of ≤1 were classified into the noninstability group. Regarding demographic, surgical, and quantitative measurement factors, between-group comparisons and multivariate logistic regression were conducted for predictors of residual instability. Receiver operating characteristic curves were used to evaluate the correlations between ACLD/I and ACLR/I and the cutoff value of ACLD/I in predicting residual instability. Results: The predictive factors for intraoperative residual instability included female sex (odds ratio [OR], 0.3 [95% CI, 0.1-0.9]; P = .034) and ACLD/I for acceleration (OR, 1.6 [95% CI, 1.2-2.1]; P < .001), and ACLD/I for ER angular velocity (OR, 1.9 [95% CI, 1.2-3.1]; P = .013). Correlations between ACLD/I and ACLR/I were moderate with respect to both acceleration ( r = 0.435; P < .001) and ER angular velocity ( r = 0.533; P < .001). The cutoff points for ACLD/I were 4.9 for acceleration (sensitivity, 65.1%; specificity, 85.7%; area under the curve [AUC], 0.76) and 2.4 for ER angular velocity (sensitivity, 80.0%; specificity, 50.0%; AUC, 0.74). Conclusion: Greater preoperative instability was a risk factor for residual instability as measured intraoperatively by a quantitatively evaluation in the pivot shift during ACL reconstruction. Quantitative measurements of instability during the pivot shift mechanism under general anesthesia may enable surgeons to predict postoperative residual instability.

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