scholarly journals Age, time from injury to surgery and hop performance after primary ACLR affect the risk of contralateral ACLR

2021 ◽  
Author(s):  
Riccardo Cristiani ◽  
Magnus Forssblad ◽  
Gunnar Edman ◽  
Karl Eriksson ◽  
Anders Stålman
Keyword(s):  
Cruciate Ligament ◽  
Multivariable Analysis ◽  
Lateral Meniscus ◽  
Activity Level ◽  
Cartilage Injury ◽  
Factors Affecting ◽  
Hop Test ◽  
Tegner Activity Level ◽  
Single Leg Hop Test ◽  
Time From Injury

Abstract Purpose To evaluate factors affecting the risk of contralateral anterior cruciate ligament reconstruction (ACLR) within 5 years of primary ACLR. Methods Primary ACLRs performed at Capio Artro Clinic, Stockholm, Sweden, during the period 2005–2014, were reviewed. The outcome of the study was the occurrence of contralateral ACLR within 5 years of primary ACLR. Univariable and multivariable logistic regression analyses were employed to identify preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre-injury Tegner activity level], intraoperative [graft type, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [limb symmetry index (LSI) for quadriceps and hamstring strength and single-leg-hop test performance at 6 months] risk factors for contralateral ACLR. Results A total of 5393 patients who underwent primary ACLR were included. The incidence of contralateral ACLR within 5 years was 4.7%. Univariable analysis revealed that age ≥ 25 years, BMI ≥ 25 kg/m2, time from injury to surgery ≥ 12 months and the presence of a cartilage injury reduced the odds, whereas female gender, pre-injury Tegner activity level ≥ 6, quadriceps and hamstring strength and a single-leg-hop test LSI of ≥ 90% increased the odds of contralateral ACLR. Multivariable analysis showed that the risk of contralateral ACLR was significantly affected only from age ≥ 25 years (OR 0.40; 95% CI 0.28–0.58; P < 0.001), time from injury to surgery ≥ 12 months (OR 0.48; 95% CI 0.30–0.75; P = 0.001) and a single-leg-hop test LSI of ≥ 90% (OR 1.56; 95% CI 1.04–2.34; P = 0.03). Conclusion Older age (≥ 25 years) and delayed primary ACLR (≥ 12 months) reduced the odds, whereas a symmetrical (LSI ≥ 90%) 6-month single-leg-hop test increased the odds of contralateral ACLR within 5 years of primary ACLR. Knowledge of the factors affecting the risk of contralateral ACLR is important when it comes to the appropriate counselling for primary ACLR. Patients should be advised regarding factors affecting the risk of contralateral ACLR. Level of evidence Level III.

scholarly journals Age, time from injury to surgery and quadriceps strength affect the risk of revision surgery after primary ACL reconstruction

2021 ◽  
Author(s):  
Riccardo Cristiani ◽  
Magnus Forssblad ◽  
Gunnar Edman ◽  
Karl Eriksson ◽  
Anders Stålman
Keyword(s):  
Risk Factors ◽  
Potential Risk ◽  
Revision Surgery ◽  
Quadriceps Strength ◽  
Activity Level ◽  
Hop Test ◽  
Potential Risk Factors ◽  
Tegner Activity Level ◽  
Single Leg Hop Test ◽  
Time From Injury

Abstract Purpose To identify preoperative, intraoperative and postoperative factors associated with revision anterior cruciate ligament reconstruction (ACLR) within 2 years of primary ACLR. Methods Patients who underwent primary ACLR at our institution, from January 2005 to March 2017, were identified. The primary outcome was the occurrence of revision ACLR within 2 years of primary ACLR. Univariate and multivariate logistic regression analyses were used to evaluate preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre-injury Tegner activity level], intraoperative [graft type, graft diameter, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [side-to-side (STS) anterior laxity, limb symmetry index (LSI) for quadriceps and hamstring strength and single-leg-hop test performance at 6 months] risk factors for revision ACLR. Results A total of 6,510 primary ACLRs were included. The overall incidence of revision ACLR within 2 years was 2.5%. Univariate analysis showed that age < 25 years, BMI < 25 kg/m2, time from injury to surgery < 12 months, pre-injury Tegner activity level ≥ 6, LM repair, STS laxity > 5 mm, quadriceps strength and single-leg-hop test LSI of ≥ 90% increased the odds; whereas, MM resection and the presence of a cartilage injury reduced the odds of revision ACLR. Multivariate analysis revealed that revision ACLR was significantly related only to age < 25 years (OR 6.25; 95% CI 3.57–11.11; P < 0.001), time from injury to surgery < 12 months (OR 2.27; 95% CI 1.25–4.17; P = 0.007) and quadriceps strength LSI of ≥ 90% (OR 1.70; 95% CI 1.16–2.49; P = 0.006). Conclusion Age < 25 years, time from injury to surgery < 12 months and 6-month quadriceps strength LSI of ≥ 90% increased the odds of revision ACLR within 2 years of primary ACLR. Understanding the risk factors for revision ACLR has important implications when it comes to the appropriate counseling for primary ACLR. In this study, a large spectrum of potential risk factors for revision ACLR was analyzed in a large cohort. Advising patients regarding the results of an ACLR should also include potential risk factors for revision surgery. Level of evidence III.

scholarly journals Eight-Months After Anterior Cruciate Ligament Reconstruction: Is It Time to Return to Physical Activity?

2021 ◽  
Vol 2 (121) ◽  
pp. 21-27
Author(s):  
Saulė Salatkaitė ◽  
Laimonas Šiupšinskas ◽  
Renata Žumbakytė-Šermukšnienė ◽  
Rimtautas Gudas
Keyword(s):  
Physical Activity ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Activity Level ◽  
Test Results ◽  
Hop Tests ◽  
Hop Test ◽  
Anterior Cruciate ◽  
Single Leg Hop Test

Background. Return to participation in sport is an important outcome when evaluating the success of anterior cruciate ligament (ACL) reconstruction surgery. A review by Arden et al. (2014) demonstrates that just because an athlete has surgery, it does not automatically mean that they will return to sport. So, the purpose of this study was to assess if patients could return to their pre-injury activity level 8 months after ACLR. Methods. Patients completed IKDC-2000, ACL-RSI questionnaires, underwent FMS, YBT, HOP test sets and drop jump tests, which were evaluated with the LESS. ACL laxity was measured by using a GNRB® device. Participants were 81 patients. They were divided into two groups based on single leg HOP test results. The first group included 30 persons who all had their four single leg HOP test scores above 90%. The second group consisted of 51 persons for whom at least one of the single leg HOP tests scored lower than 90%. Results. IKDC and HOP test results in the first group scored higher than in the second group. Psychological confidence was higher in the first group, who had better HOP test results. For the first group, FMS and LESS results were better than those for the second group. Moderate positive correlation was found between LESS scores and laxity results, FMS, three HOP sub-tests. IKDC had the biggest number of correlations with other tests. Results showed negative and weak correlation with laxity results using 134 N power, as well as positive and moderate correlation with HOP sub-tests, FMS, ACL-RSI. Single HOP for distance, triple HOP for distance, crossover HOP for distance and LESS increased the odds of achieving RTS criteria. No other factors were found to be associated with the accomplishment of reaching RTS criteria after ACLR. Conclusions. The main factor which can help decide if a person can return to their pre-injury level of physical activity are the single leg HOP test and LESS. The use of single leg HOP tests and LESS along with psychological and self-reported evaluations is the best test combination for assessment 8 months after ACLR. Keywords: ACL reconstruction, function tests, return to play, jump tests, psychological readiness.

scholarly journals DELAY TO ACL RECONSTRUCTION IN PEDIATRIC AND ADOLESCENT PATIENTS IS ASSOCIATED WITH A LINEAR INCREASE IN THE RISK OF MEDIAL MENISCAL TEARS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
David A. Kolin ◽  
Brody Dawkins ◽  
Joshua Park ◽  
Peter D. Fabricant ◽  
Allison Gilmore ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Linear Increase ◽  
Meniscal Injury ◽  
Meniscal Tears ◽  
Increased Risk ◽  
Text Figure ◽  
Time From Injury

Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal tears. Previous studies have shown that secondary meniscal tears—occurring after the initial ACL injury—are associated with greater delays from injury to ACL reconstruction (ACLR), but frequently use dichotomous categories of acute versus delayed ACLR. Purpose: As meniscal damage is likely accrued constantly over time, we investigated the variability of concurrent meniscal injuries as a function of time from injury to ACLR in a pediatric and adolescent population. Methods: We performed a retrospective review of all patients ≤18 years who underwent an ACLR between 2014 and 2018 at one of two tertiary academic hospitals. Outliers were excluded if time from injury to ACLR was greater than 78 weeks. Records were reviewed to assess patients’ dates of injury and surgery. The prevalence of concurrent medial and/or lateral meniscal injury was evaluated at the time of surgery for each patient. Adjusted relative risks (ARRs) of meniscal injury were calculated using Poisson regression models adjusted for age, sex, and body-mass index. Logistic regression was used to model the predicted probability of medial meniscal tears. Results: 546 patients met inclusion criteria. The mean age of participants was 15.3 years (S.D., 1.6), and 277 (50.7%) patients were male. Overall, 344 (63.0%) patients had a meniscal tear. 169 (49.1%) tears occurred at the medial meniscus, and 257 (74.7%) occurred at the lateral meniscus (Table 1). Compared to females, males had a greater risk of lateral meniscal injury (ARR, 1.46; 95% CI, 1.20-1.77) but not medial meniscal injury (ARR, 1.01; 95% CI, 0.77-1.31) (Figure 1). When considering all meniscal tears, time from injury to ACLR was not associated with increased risk of a tear (ARR, 1.01; 95% CI, 1.00-1.01). However, for medial meniscal tears, there was a significant association between time from injury to ACLR, in weeks, and meniscal tears (ARR, 1.02; 95% CI, 1.01-1.03, P = 0.003). A ten-week delay was associated with a 20% increased risk of medial meniscal injury (Figure 2). Conclusion: In pediatric and adolescent ACLR patients, the risk of any meniscal injury was not associated with delay from injury to surgery. However, the risk of medial meniscal injury increased by 2% each week from injury to surgery. [Table: see text][Figure: see text][Figure: see text]

Revision Single-Stage Anterior Cruciate Ligament Reconstruction Using an Anterolateral Tibial Tunnel

2019 ◽  
Vol 33 (04) ◽  
pp. 410-416
Author(s):  
Sohrab Keyhani ◽  
Behzad Hanafizadeh ◽  
René Verdonk ◽  
Mohammadreza Minator Sajjadi ◽  
Mehran Soleymanha
Keyword(s):  
Revision Surgery ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Clinical Results ◽  
Activity Level ◽  
Acl Revision ◽  
Anterior Cruciate ◽  
Level Scale ◽  
Tegner Activity Level ◽  
Acl Revision Surgery

AbstractRevision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24–51 months). The clinical results were evaluated by means of the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity level scale, and the knee stability was assessed by the Lachman test, pivot shift test, and anterior drawer test. Magnetic resonance imaging (MRI) of the index knee before the surgery and 2 years after revision surgery was assessed. The mean IKDC subjective score, mean Tegner activity level scale, and mean Lysholm score significantly improved in all study participants. This study showed that ACL revision surgery with ALTT can reliably restore stability and provide fair functional outcomes in patients with ACL retear. One could expect acceptable lateral tibial tunnel length compared with medial tibial tunnel in classic ACL revision, intact bony surround, and good graft fixation. This technique is clinically relevant in that making an anterolateral tunnel in one-stage ACL revision surgery had a good subjective result with low complication rate in midterm follow-up.

scholarly journals Surgical Technique for fixation of posterior root tears of the lateral meniscus and anterior cruciate ligament ruptures in acute lesions: Short-term clinical outcome

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0019
Author(s):  
Germán A. Jaramillo ◽  
Rubén D. Arias ◽  
Esteban Arrubla ◽  
Natalia Valencia
Keyword(s):  
Anterior Cruciate Ligament ◽  
Surgical Treatment ◽  
Surgical Technique ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Surgical Techniques ◽  
Case Series ◽  
Activity Level ◽  
Acl Rupture ◽  
Anterior Cruciate

Background: Injuries of posterior lateral meniscus root (PLMR) are related to an acute trauma mechanism, which is commonly associated with anterior cruciate ligament (ACL) rupture. Many biomechanical studies have exposed the importance of the integrity of PLMR. There are several surgical techniques for its treatment, but is still controversial about which is the most appropriate, especially for combined injuries. Objective: To describe the clinical outcomes of patients with a surgical treatment of PLMR tear combined with ACL rupture Methods: Prospective case series. With patients who undergone repair of PLMR tears with ACL rupture, from 2016 to 2017 in a specialized hospital in Medellín city. Clinical evaluation it was determinate with Lysholm and IKDC (International Knee Documentation Committee) scores, before and one year after the surgical procedure. The paired sample t-test was applied to compare the results of the scores. Results: Six patients with acute lesion of PLMR tear combined with ACL rupture received treatment with a variation in the transtibial fixation of the PLMR surgical technique. Statistically significant differences were found when comparing the two scores before and after surgery (p=<0.05). In addition, no additional surgical interventions were performed in the follow-up time. Conclusion: The combined surgical treatment of PLMR and ACL injuries can be performed safely. This surgical technique provided an improvement in function, pain and activity level, which may help to delay the progression of osteoarthritis of the knee.

scholarly journals Clinical Results after Arthroscopic Meniscus Repair for Recurrent Subluxation of the Lateral Meniscus

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0009
Author(s):  
Sang Hak Lee ◽  
Jin Hwan Ahn ◽  
Kyung Ho Yoon ◽  
Chan Il Bae
Keyword(s):  
Full Range ◽  
Lateral Meniscus ◽  
Clinical Results ◽  
Suture Technique ◽  
Meniscus Repair ◽  
Activity Level ◽  
Discoid Lateral Meniscus ◽  
Limited Function ◽  
Tegner Activity Level

Purpose: This study was undertaken to diagnose and to document clinical results and the technical aspects of arthroscopic meniscus repair for treating the recurrent subluxation with peripheral tears around popoliteal hiatus of the LM. Methods: Twenty two patients (23 knees) with symptomatic recurrent subluxation of the LM treated by arthroscopic meniscus repair were included. The inclusion criteria were (1) patients with knee pain, locking or snapping symptoms despite 3 months of conservative treatment, (2) non-discoid lateral meniscus, (3) stable knee, and (4) tears involving the red-white or red–red zone. All tears were repaired with either the modified all-inside suture technique only or a combination of the modified all-inside and modified outside-in techniques. Clinical results were evaluated preoperatively and at final follow-up using Tegner activity level, Lysolm knee, and Hospital for Special Surgery (HSS) scores. Results: All patients returned to their prior life activities with little or no limitations, and no reoperation was required after an average follow-up of 52.3 months(range, 24–160). At the final follow-up, all knees achieved a full range of motion. Catching sensation was experienced in three knees, and limited function during squatting and jumping was complained in two knees. However no patient had recurrence of a locking episode. At the last follow-up, the mean Tegner activity level had improved significantly from 3.7 (range, 2–6) to 7.2 (range, 3–10, p<0.0001), mean Lysolm knee score improved from 75.1 92.0 (range, 76-100) preoperatively to 92.0 (range, 76-100) at final follow-up (p < 0.0001), and mean preoperative HSS score improved from 83.4 to 94.6 at final follow-up (p < 0.0001). Conclusion: Arthroscopic meniscus repair using the modified all-inside suture and outside-in techniques showed excellent clinical outcomes for treating symptomatic recurrent subluxation with peripheral tears around popoliteal hiatus of the LM without any complications or recurrence. [Figure: see text][Figure: see text]

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