Tibial slope, remnant preservation, and graft size are the most important factors affecting graft healing after ACL reconstruction

2021 ◽  
Author(s):  
Ahmet Emin Okutan ◽  
Muhammet Kalkışım ◽  
Enes Gürün ◽  
Muhammet Salih Ayas ◽  
Osman Aynacı
Keyword(s):  
Acl Reconstruction ◽  
Tibial Slope ◽  
Graft Size ◽  
Factors Affecting ◽  
Graft Healing ◽  
Remnant Preservation

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 48 (1) ◽  
pp. 99-108 ◽  
Author(s):  
Takeshi Oshima ◽  
Sven Putnis ◽  
Samuel Grasso ◽  
Antonio Klasan ◽  
David Anthony Parker
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Volume Ratio ◽  
Single Bundle ◽  
Graft Size ◽  
Graft Healing ◽  
High Resolution Mri ◽  
Anterior Cruciate ◽  
Femoral Notch

Background: The combined influence of anatomic and operative factors affecting graft healing after anterior cruciate ligament (ACL) reconstruction within the femoral notch is not well understood. Purpose: To determine the influence of graft size and orientation in relation to femoral notch anatomy, with the signal/noise quotient (SNQ) of the graft used as a measure of graft healing after primary single-bundle ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: A total of 98 patients with a minimum 2-year follow-up after primary single-bundle ACL reconstruction with hamstring tendon autografts were included. Graft healing was evaluated at 1 year on magnetic resonance imaging (MRI) scan as the mean SNQ measured from 3 regions situated at sites at the proximal, middle, and distal graft. Patient characteristics, chondropenia severity score, tunnel sizes, tunnel locations, graft bending angle (GBA), graft sagittal angle, posterior tibial slope (PTS), graft length, graft volume, femoral notch volume, and graft-notch volume ratio (measured using postoperative 3-T high-resolution MRI) were evaluated to determine any association with 1-year graft healing. The correlation between 1-year graft healing and clinical outcome at minimum 2 years was also assessed. Results: There was no significant difference in mean SNQ between male and female patients ( P > .05). Univariate regression analysis showed that a low femoral tunnel ( P = .005), lateral tibial tunnel ( P = .009), large femoral tunnel ( P = .011), large tibial tunnel ( P < .001), steep lateral PTS ( P = .010), steep medial PTS ( P = .004), acute graft sagittal angle ( P < .001), acute GBA ( P < .001), large graft volume ( P = .003), and high graft-notch volume ratio ( P < .001) were all associated with higher graft SNQ values. A multivariate regression analysis showed 2 significant factors: a large graft-notch volume ratio ( P = .001) and an acute GBA ( P = .004). The 1-year SNQ had a weak correlation with 2-year Tegner Activity Scale score ( r = 0.227; P = .026) but no other clinical findings, such as International Knee Documentation Committee subjective and Lysholm scores and anterior tibial translation side-to-side difference. Conclusion: The 1-year SNQ value had a significant positive association with graft-notch volume ratio and GBA. Both graft size and graft orientation appeared to have a significant influence on graft healing as assessed on 1-year high-resolution MRI scan.

Effect of Remnant-Preserving Reconstruction of Acute Anterior Cruciate Ligament Injuries in a Rabbit Model: Histological and Biomechanical Analysis

2022 ◽  
Vol 12 (5) ◽  
pp. 897-906
Author(s):  
XiaoChen Ju ◽  
Hao Chai ◽  
Sasirekha Krishnan ◽  
Abinaya Jaisankar ◽  
Murugan Ramalingam ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Articular Cartilage ◽  
Acl Reconstruction ◽  
Bone Healing ◽  
Cruciate Ligament ◽  
Cartilage Degeneration ◽  
Remnant Preservation ◽  
Model Animal ◽  
Anterior Cruciate ◽  
Articular Cartilage Degeneration

Acute anterior cruciate ligament (ACL) is a key structure that stabilizes knee joints. The objective of this research is to investigate the influence of ligament remnants preserved on the tendon-bone healing following ACL reconstruction and to examine postoperative articular cartilage degeneration in rabbit as a model animal. Sixty New Zealand rabbits are randomly divided into an ACL reconstruction without remnant preservation group (Group A; n = 30) or ACL reconstruction with remnant preservation group (Group B; n = 30). The expression of HIF-1α, VEGF, and micro vessel density (MVD) in the transplanted tendon was detected by immunohistochemical staining at week 6 and 12 after the operation. The signal intensity of the transplanted tendon was observed by MRI scanning, and the width of the bone tunnel was measured by CT scanning at week 6 and 12 after the operation. The graft biomechanics was tested 12 weeks after the operation. The JNK and MMP-13 expression levels were compared to analyze the cartilage degeneration of the knee at week 12 after the operation. The experimental results were analyzed and showed that the remnant-preserving ACL reconstruction is beneficial for bone healing of the tendon in rabbits, but ACL reconstruction with or without ligament remnants preserved will not affect knee articular cartilage degeneration post-surgery.

The Effect of Remnant Preservation on Tibial Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction with Polyethylene Terephthalate Artificial Ligament in a Large Animal Model

2018 ◽  
Vol 32 (11) ◽  
pp. 1094-1101
Author(s):  
Jiangyu Cai ◽  
Fang Wan ◽  
Chengchong Ai ◽  
Wenhe Jin ◽  
Dandan Sheng ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Bone Tunnel ◽  
Control Group ◽  
Micro Ct ◽  
Tunnel Enlargement ◽  
Artificial Ligament ◽  
Remnant Preservation ◽  
Anterior Cruciate

AbstractAn enlarged bone tunnel may affect the graft–bone integration and pose a problem for revision anterior cruciate ligament (ACL) surgery. The purpose of this study was to evaluate the effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with polyethylene terephthalate (PET) artificial ligament. Twenty-four skeletally mature male beagles underwent ACL reconstruction with PET artificial ligament for both knees. One knee was reconstructed with remnant preservation using sleeve technique (remnant group), while the contralateral was reconstructed without remnant preservation (control group). The animals were sacrificed at 1 day, 6 weeks, and 12 weeks after surgery for further evaluation including macroscopic observation, microcomputed tomography (micro-CT), histological assessment, and biomechanical testing. The remnant group had better synovial coverage than the control group at 6 and 12 weeks after surgery. The micro-CT analysis showed the tibial tunnel area (TTA) of the remnant group was significantly smaller and the bone volume/total volume fraction (BV/TV) value was higher than those of the control group at 6 and 12 weeks. Moreover, TTA and BV/TV at each time point were divided into three groups according to the different grade of synovial coverage. Significant association was observed between the synovial coverage degree and the TTA and BV/TV values. The histological assessment revealed that the interface width between the graft and host bone in the remnant group was smaller than that in the control group in the tibial tunnels at 6 and 12 weeks. Moreover, the remnant group had better failure load and stiffness than the control group at 12 weeks. The remnant preservation using sleeve technique could effectively promote the synovial coverage of the graft, decrease the risk of tibial tunnel enlargement by sealing the bone tunnel entrance, and enhance the biological environment for graft–bone healing after ACL reconstruction using PET artificial ligament. This technique provides a potential solution for bone tunnel enlargement following artificial ligament surgery for the acute ACL rupture in the clinical practice.

scholarly journals Hamstring Autograft in ACL Reconstruction: A 13-Year Predictive Analysis of Anthropometric Factors and Surgeon Trends Relating to Graft Size

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711877978 ◽  
Author(s):  
Prem N. Ramkumar ◽  
Michael D. Hadley ◽  
Morgan H. Jones ◽  
Lutul D. Farrow
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Small Diameter ◽  
Large Cohort ◽  
Predictive Equation ◽  
Hamstring Autograft ◽  
Graft Size ◽  
Patient Demographics ◽  
The Mean

Background: Small-diameter autograft hamstring grafts have been linked to graft failure after anterior cruciate ligament (ACL) reconstruction. The frequency of hamstring autografts that actually meet ideal size criteria remains unknown. Purpose: To examine a large cohort of patients to (1) evaluate sizing variability among a large cohort of surgeons and (2) identify patient factors most predictive of hamstring autograft size. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 1681 ACL reconstructions with hamstring autograft were analyzed as completed by 11 surgeons over a 13-year period. Patient demographics (age, height, weight, body mass index, sex) and intraoperative details (including graft diameter and strands) were extracted. Univariate and multivariate regression analyses were performed to correlate patient demographics with graft size and to develop a predictive model for hamstring graft size. Results: The mean height and weight of patients included in this study were 172.7 cm and 80.1 kg, respectively; 59% of patients were male. The mean diameters of hamstring autografts were 8.4 mm and 8.2 mm for the tibial and femoral ends of the graft, respectively. A total of 55.1% of grafts were ≤8 mm. Mixed-effects linear modeling revealed that height, weight, sex, and use of ≥5 strands correlated with graft size ( P < .001), while age did not. The predictive multivariate model based on the statistically relevant factors demonstrated a moderate correlation ( r = 0.39, R2 = 0.150), illustrated a predictive equation, and proved height to be the greatest determinant of graft size. Conclusion: Marked variability in graft size distribution was found among surgeons, and more than half of all grafts did not reach the ideal size for hamstring autograft ACL reconstruction. A predictive equation including anthropometric factors may be able to provide the expected graft size. The risk of early graft failure may be mitigated with preoperative consideration of anthropometric factors—most importantly, height—in preparation for possible augmentation, additional strands, or alternative graft sources.

scholarly journals Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110566
Author(s):  
Soroush Baghdadi ◽  
David P. VanEenenaam ◽  
Brendan A. Williams ◽  
J. Todd R. Lawrence ◽  
Kathleen J. Maguire ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Quadriceps Tendon ◽  
Graft Size ◽  
Operative Notes ◽  
Tendon Autograft ◽  
Graft Diameter ◽  
Mri Measurements

Background: There is increased interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population. Purpose: To evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and magnetic resonance imaging (MRI) measurements in predicting the graft size preoperatively. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded, and graft measurements were abstracted from the operative notes. Knee MRI scans were reviewed to measure the quadriceps tendon thickness on sagittal cuts. Graft length and diameter were then correlated with anthropometric and radiographic data. Results: A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17 years). A tendon length ≥65 mm was harvested in 159 (94%) patients. The final graft diameter was 8.4 ± 0.7 mm (mean ± SD; range, 7-11 mm). All patients had a graft diameter ≥7 mm, and 139 (82%) had a diameter ≥8 mm. Preconditioning decreased the graft diameter by a mean 0.67 ± 0.23 mm. Age ( P = .04) and quadriceps thickness on MRI ( P = .003) were significant predictors of the final graft diameter. An MRI sagittal thickness >6.7 mm was 97.4% sensitive for obtaining a graft ≥8 mm in diameter. Conclusion: Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in pediatric ACL reconstruction, yielding a graft diameter ≥8 mm in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness >6.7 mm being highly predictive of a final graft size ≥8 mm.

scholarly journals The difference between the medial and lateral posterior tibial slope is associated with greater internal tibial rotation

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0003
Author(s):  
Elmar Herbst ◽  
Andreas Imhoff ◽  
James Irrgang ◽  
William Anderst ◽  
Freddie Fu
Keyword(s):  
Acl Reconstruction ◽  
Tibial Slope ◽  
Tibial Rotation ◽  
Tibial Shaft ◽  
Posterior Tibial ◽  
Downhill Running ◽  
Lateral Posterior ◽  
Internal Tibial Rotation ◽  
The Difference

The objective of this study was to investigate the effect of lateral and medial posterior tibial slope (PTS) and meniscal slope (PMS) on in-vivo anterior tibial translation (ATT) and internal tibial rotation (IR) during downhill running on the healthy contralateral knee twenty-four months after ACL reconstruction. Forty-two individuals (twenty-six males; mean age 21.2 ± 6.9 years) who underwent unilateral ACL reconstruction were included in this study. Morphologic parameters were measured on 3 T magnetic resonance images (MRI) using the 3D DESS sequence on the ACL reconstructed and healthy contralateral knee. Lateral and medial PTS and PMS were measured according to the method described by Hudek et al. Briefly, the tibial shaft axis was determined by connecting the centroids of two circles fitting the tibial shaft on the central sagittal MRI slice. The PTS and PMS were determined by the angle between the tibial shaft axis and the line connecting the two most proximal anterior and posterior subchondral bone and meniscal points in the center of each joint compartment. Three-dimensional in-vivo kinematics data were acquired using dynamic stereo x-ray during downhill running (3.0 m/s, 10° slope) at 150 Hz twenty-four months after unilateral ACL reconstruction. A multiple regression analysis was performed (p < .05). The lateral and medial PTS and PMS as well as the differences between the medial and lateral compartment slopes were not significantly related to ATT in the healthy contralateral knees twenty-four months after ACL reconstruction (p > .05). The lateral and medial PTS and PMS were not significantly related to peak internal tibial rotation (p > .05). However, the difference between the medial and lateral PTS as well as PMS was associated with greater internal tibial rotation (PTS: b=1.55, p < .001; PMS: b = .71, p = .02). The most important finding of the present study is that the difference between the medial and lateral posterior tibial and meniscal slope are related to in-vivo internal tibial rotation during downhill running. ATT was not significantly influenced by the tibial bony and meniscal morphology. Taking into account the results of the present study, the difference between the medial and the lateral PTS and PMS may contribute to IR when an ACL injury occurs. However, the analyzed movement was a straight-ahead run without any cutting or pivoting maneuvers commonly related to ACL tears. In such motion patterns, the correlations may be even stronger compared to the results of this study.

No effect of graft size or body mass index on risk of revision after ACL reconstruction using hamstrings autograft

2019 ◽  
Vol 28 (3) ◽  
pp. 707-713 ◽  
Author(s):  
Eivind Inderhaug ◽  
Jon Olav Drogset ◽  
Stein Håkon Låstad Lygre ◽  
Tone Gifstad
Keyword(s):  
Body Mass Index ◽  
Acl Reconstruction ◽  
Body Mass ◽  
Graft Size

scholarly journals ACL rupture and posterior tibial slope - how do we handle this?

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0028
Author(s):  
Jörg Dickschas
Keyword(s):  
Range Of Motion ◽  
Acl Reconstruction ◽  
Plate Osteosynthesis ◽  
Critical Role ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Tibial Tubercle ◽  
Tibial Osteotomy ◽  
Posterior Tibial ◽  
Closed Wedge

Aims and Objectives: In recent publications on acl-ruptures and especially on failure of acl reconstruction there comes a strong focus on posterior tibial slope (PTS). ACL reconstructions with a PTS of >12° have an 8 times higher risk of recurrent instability and reconstruction failure. But many questions stay unclear so far-When do we have to correct the tibial slope? How do we correct it? What about simultaneous frontal axis deviations? In this publication a new algorhythm is presented. Materials and Methods: The following aspects have to be evaluated Is the PTS the only dimension of the deformity or do we have to correct the frontal axis simultaneuosly? Performing a anterior closed wedge extension osteotomy: when do we go distal the tuberosity and when do we perform a tuberosity osteotomy and use it as “bio plating”? Osteosynthesis only screws or always plate? Are there indications for a contineous correction, f.e. with a hexapod? Whats the role of preoperative range of motion of the knee (especially extension)? Always tunnel filling in the same surgery? What about PCL insufficiency and low PTS? Results: An algorhythm is presented giving a treatment path for the different questions mentioned. The procedures are shown step by step in clinical examples and surgery documentation for every pathway. Conclusion: Posterior tibial slope plays an critical role in ACl recontruction. In primary ACl tear a slope correction is probably not indicated. In ACL reconstruction failure a analysis of the PTS needs to be done and correction needs to be discussed. Simultaneuous varus deormities need to be corrected by openwedge valgisation - extension high tibial osteotomy (HTO), while as isolated PTS elevation is subject to an anterior closed wedge extension HTO. Preoperative range of motion needs to be respected not to create hyperextension. Osteosynthesis can be perormed with only screws using the tibial tubercle as “bio-plating”. In cases of former bone-tendeon-bone (BTB) ACL reconstruction a tibial tubercle osteotomy should be avoided and a infratuberositeal osteotomy should be performed and stabilized with plate osteosynthesis. In severe postraumatic cases contineous correction of the slope with fixateur externe, f.e. hexapodes, needs to be performed.

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