Occurrence of inadequate ACL healing after Dynamic Intraligamentary Stabilization and functional outcome—a multicentre case series

Abstract Introduction Dynamic Intraligamentary Stabilization (DIS) is a technique for preservation, anatomical repair and stabilization of a freshly injured anterior cruciate ligament (ACL). The main purpose of this study was to evaluate the short-term re-operation rate when compared to traditional autograft reconstruction. Methods Four, from the developer independent, centres enrolled patients that underwent ACL repair by DIS, according to the specific indications given by MRI imaging at a minimum follow-up of 12 months. The re-operation rate was recorded as primary outcome. Secondary outcome measures were the postoperative antero-posterior knee laxity (using a portable Rolimeter®), as well as the Tegner, Lysholm and IKDC Scores. Results A total of 105 patients were investigated with a median follow-up of 21 months. Thirteen patients were lost to follow-up. Of the remaining 92 patients 15 (16.3%) had insufficient functional stability and required subsequent ACL reconstruction. These patients were excluded from further analysis, leaving 77 consecutive patients for a 12 months follow-up. The median age at time of surgery was 30 years for that group. At time of follow-up a median antero-posterior translation difference of 2 mm was measured. None of these patients reported subjective insufficiency (giving way), but in 14 patients (18.2%), the difference of antero-posterior translation was more than 3 mm. We found a median Tegner Score of 5.5, a median Lysholm Score of 95.0 and a median IKDC Score of 89.4. Conclusion The main finding of this multicentre study is a relevant re-operation rate of 16.3%. Another 18.2% showed objective antero-posterior laxity (≥ 3 mm) during testing raising the suspicion of postoperative non-healing. The failure rate of DIS in this study is higher than for reconstruction with an autologous tendon graft. However, our successfully treated patients had a good clinical and functional outcome based on antero-posterior knee laxity and clinical scores, comparable to patients treated by autograft reconstruction.

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THE LARS AUGMENTED 4-TUNNEL HAMSTRING “HYBRID” ACLR GRAFT CONSTRUCTION ALLOWS ACCELERATED REHABILITATION WITHOUT KNEE LAXITY — CASE SERIES OF 111 PATIENTS AFTER 2 YEARS

Journal of Musculoskeletal Research ◽

10.1142/s0218957715500207 ◽

2015 ◽

Vol 18 (04) ◽

pp. 1550020 ◽

Cited By ~ 2

Author(s):

Travis M. Falconer ◽

Louise Tusak ◽

William H. Breidahl ◽

Peter T. Annear

Keyword(s):

Graft Failure ◽

Cruciate Ligament ◽

Case Series ◽

Knee Laxity ◽

Future Research ◽

X Rays ◽

Sports Activity ◽

Accelerated Rehabilitation ◽

Operation Rate ◽

Kt 1000

Purpose: This prospective case series is designed to determine the 2-year clinical and radiological outcomes of patients undergoing an ACL reconstruction using the ligament augmentation reconstruction system (LARS) 133 prosthesis as an augmentation device for a 4-tunnel autologous hamstrings graft, in the context of accelerated rehabilitation. Methods: A total of 91 patients were assessed at 2 years post-operatively after undergoing an anterior cruciate ligament reconstruction (ACLR) with a doubled semitendinosis and LARS 133 prosthesis for the anteromedial bundle (AMB) and gracilis for the posterolateral bundle. Assessment included clinical review, KT-1000 arthrometry, IKDC, Tegner, Lysholm, Cincinnati and ACL QOL knee scoring, graft failure and re-operation rates. Tunnel positions and synovitis were assessed using gadolinium magnetic resonance imaging (MRI) scans and X-rays. Results: This technique in the context of accelerated rehabilitation is not associated with increased knee laxity and failure. There was no increase in knee laxity, with a mean side-to-side difference in KT-1000 arthrometer testing of 0.5[Formula: see text]mm ([Formula: see text]/[Formula: see text] 1.7). Two-year outcomes were satisfactory with 98% of all patients having an IKDC rating of A or B, and mean values of IKDC subjective 86.5 ([Formula: see text]/[Formula: see text] 11.6), Tegner 6.5 ([Formula: see text]/[Formula: see text] 2.0), Lysholm 87.1 ([Formula: see text]/[Formula: see text] 8.9), Cincinnati 378.8 ([Formula: see text]/[Formula: see text] 41.5) and ACL Quality of Life 81.5 ([Formula: see text]/[Formula: see text] 19.3). There was no evidence of synovitis and all tunnels were positioned satisfactorily. The graft failure rate was 1.1% and there was a re-operation rate of 15.4%. Conclusion: We conclude that LARS 133 augmentation of autologous hamstrings ACLR provides a graft construct allowing accelerated rehabilitation without increased knee laxity. It is not associated with significant synovitis within the first two years. Re-operation rates however are higher. The rates at which patients recover and return to life and sports activity following different ACLR graft types appears as a topic of future research interest.

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Meniscal Repairs in the Adolescent Knee: Can the Number of Fixation Sites Improve Outcomes?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119881963 ◽

2019 ◽

Vol 7 (11) ◽

pp. 232596711988196 ◽

Cited By ~ 1

Author(s):

John A. Schlechter ◽

Shawn V. Nguyen ◽

Katie L. Fletcher

Keyword(s):

Children And Adolescents ◽

Functional Outcome ◽

Failure Rate ◽

Cruciate Ligament ◽

Case Series ◽

Meniscal Repair ◽

Study Cohort ◽

Outcome Score ◽

The Mean

Background: Meniscal pathology in children and adolescents is now a common occurrence because of their ever-increasing participation in youth sports. Purpose: To investigate the outcomes of arthroscopic meniscal repair in an adolescent cohort and analyze the variables that may affect outcomes, specifically the number of fixation sites utilized during repair. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all children and adolescents younger than 18 years who underwent arthroscopic meniscal repair at a single institution was performed. Patient characteristics, operative details (eg, tear pattern, tear location, method of repair, and number of fixation sites [determined based on the number of sutures used for repair]), and concomitant procedures were recorded. Results: A total of 175 primary meniscal repairs met inclusion criteria and were analyzed. Of this cohort, 115 were able to be contacted and were included in the final study cohort. The mean follow-up was 41 months. The mean age of the children was 14.9 years, and 91 (79%) had concomitant anterior cruciate ligament reconstructions with their meniscal repair. The mean Pediatric International Knee Documentation Committee functional outcome score was 91 (range, 43-100), and the mean Lysholm functional outcome score was 91 (range, 47-100). Of the 115 meniscal repairs, there were a total of 19 reoperations (17%); 15 (13%) were because of meniscal repair failures. The only variable that statistically increased the risk of meniscal repair failure was low number of fixation sites, with the failure group having a mean of 1.79 sutures and the nonfailure group having a mean of 2.97 sutures ( P = .03). Conclusion: Successful meniscal repairs and a lower failure rate may be achieved with a greater number of fixation sites with promising results at a minimum 2-year follow-up. Validated functional outcome scores were good, with a 13% failure rate. Larger cohort, longer term, multicenter multisurgeon data are still needed to further elucidate the number of fixation sites needed when performing a meniscal repair in the pediatric and adolescent knee.

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Femoral and Tibial Tunnel Diameter and Bioabsorbable Screw Findings After Double-Bundle ACL Reconstruction in 5-Year Clinical and MRI Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967116685525 ◽

2017 ◽

Vol 5 (2) ◽

pp. 232596711668552 ◽

Cited By ~ 3

Author(s):

Tommi Kiekara ◽

Antti Paakkala ◽

Piia Suomalainen ◽

Heini Huhtala ◽

Timo Järvelä

Keyword(s):

Clinical Evaluation ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Case Series ◽

Knee Laxity ◽

Double Bundle ◽

Tunnel Enlargement ◽

Patient Reported ◽

Double Bundle Acl Reconstruction

Background: Tunnel enlargement is frequently seen in short-term follow-up after anterior cruciate ligament reconstruction (ACLR). According to new evidence, tunnel enlargement may be followed by tunnel narrowing, but the long-term evolution of the tunnels is currently unknown. Hypothesis/Purpose: The hypothesis was that tunnel enlargement is followed by tunnel narrowing caused by ossification as seen in follow-up using magnetic resonance imaging (MRI). The purpose of this study was to evaluate the ossification pattern of the tunnels, the communication of the 2 femoral and 2 tibial tunnels, and screw absorption findings in MRI. Study Design: Case series; Level of evidence, 4. Methods: Thirty-one patients underwent anatomic double-bundle ACLR with hamstring grafts and bioabsorbable interference screw fixation and were followed with MRI and clinical evaluation at 2 and 5 years postoperatively. Results: The mean tunnel enlargement at 2 years was 58% and reduced to 46% at 5 years. Tunnel ossification resulted in evenly narrowed tunnels in 44%, in conical tunnels in 48%, and fully ossified tunnels in 8%. Tunnel communication increased from 13% to 23% in the femur and from 19% to 23% in the tibia between 2 and 5 years and was not associated with knee laxity. At 5 years, 54% of the screws were not visible, with 35% of the screws replaced by a cyst and 19% fully ossified. Tunnel cysts were not associated with worse patient-reported outcomes or knee laxity. Patients with a tibial anteromedial tunnel cyst had higher Lysholm scores than patients without a cyst (93 and 84, P = .03). Conclusion: Tunnel enlargement was followed by tunnel narrowing in 5-year follow-up after double-bundle ACLR. Tunnel communication and tunnel cysts were frequent MRI findings and not associated with adverse clinical evaluation results.

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Dynamic intraligamentary stabilization of anterior cruciate ligament repair: hardware removal has no effect on knee laxity at 2-year follow-up

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-019-03113-x ◽

2019 ◽

Vol 139 (5) ◽

pp. 639-644 ◽

Cited By ~ 1

Author(s):

Janosch Häberli ◽

Kathrin Susan Bieri ◽

Emin Aghayev ◽

Stefan Eggli ◽

Philipp Henle

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Knee Laxity ◽

Hardware Removal ◽

Ligament Repair ◽

Dynamic Intraligamentary Stabilization ◽

Anterior Cruciate Ligament Repair ◽

Anterior Cruciate

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Cartilage Damage Determines Intermediate Outcome in the Late Multiple Ligament and Posterolateral Corner-Reconstructed Knee

The American Journal of Sports Medicine ◽

10.1177/0363546507311091 ◽

2008 ◽

Vol 36 (2) ◽

pp. 267-275 ◽

Cited By ~ 16

Author(s):

Kristoff Corten ◽

Johan Bellemans

Keyword(s):

Functional Outcome ◽

Cartilage Damage ◽

Case Series ◽

Posterolateral Corner ◽

Reliable Technique ◽

Sling Procedure ◽

Time Of Surgery ◽

Functional Scores ◽

Reconstructed Knee

Background Patients with chronic ruptures of 1 or both cruciate ligaments in combination with posterolateral rotatory instability of the knee often have some degree of cartilage damage at the time of surgery. Hypothesis Chondrosis at the time of reconstruction does not influence early and intermediate functional outcome of the multiple ligament reconstructed knee. Study Design Case series; Level of evidence, 4. Methods Twenty-one patients were available from an original 27 treated between 1995 and 2000. All patients were assessed preoperatively and postoperatively by physical examination and by applying 4 different knee rating scores. All patients were assessed at a mean follow-up of 39 months (range, 14–75 months) and 87 months (range, 62–123 months). Results At the first follow-up, all knee rating scores had improved significantly ( P < .0003) compared with preoperatively; 84% of the reconstructed knees had normal to nearly normal laxities according to the International Knee Documentation Committee 2000 score. At the second follow-up, the functional scores remained significantly ( P < .0089) better than preoperatively. Patients with chondrosis at the time of surgery did not have significantly different knee rating scores at the first follow-up compared with patients without cartilage damage. Four years later, the results in the chondrosis group were significantly worse ( P < .05) for all knee rating scores compared with the patients without chondrosis. The results in 3 of 4 knee rating scores declined significantly in the chondrosis group over the 48-month interval between follow-up sessions. In the Tegner and Lysholm score, the results deteriorated to the preoperative level. Patients with different cruciate ligament reconstructions did not have significantly different knee rating scores. Conclusion The posterolateral sling procedure is a stable and reliable technique for posterolateral corner reconstruction. The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up.

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Least possible fixation techniques of 4-part valgus impacted fractures of the proximal humerus: a systematic review

Orthopedic Reviews ◽

10.4081/or.2016.6211 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 5

Author(s):

Andreas Panagopoulos ◽

Irini Tatani ◽

Dimitrios Ntourantonis ◽

Ioannis Seferlis ◽

Antonis Kouzelis ◽

...

Keyword(s):

Systematic Review ◽

Avascular Necrosis ◽

Proximal Humerus ◽

Constant Score ◽

Surgical Techniques ◽

Case Series ◽

Cochrane Library ◽

Operation Rate ◽

Fixation Techniques

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV.

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Preliminary Results in Anatomic All-inside Anterior Cruciate Ligament Reconstruction

Journal of Interdisciplinary Medicine ◽

10.1515/jim-2016-0050 ◽

2016 ◽

Vol 1 (s2) ◽

pp. 23-26

Author(s):

Octav Russu ◽

Tiberiu Bățagă ◽

Andrei-Marian Feier ◽

Radu Prejbeanu ◽

Radu Fleaca ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Knee Laxity ◽

Clinical Results ◽

Lysholm Score ◽

X Rays ◽

The Mean ◽

Anterior Cruciate

Abstract Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common lesions in knee traumatology; therefore the number of ACL reconstructions is increasing worldwide. Usually, an anteromedial (AM) accessory portal is required in anatomical positioning of the femoral tunnel, which is not absolutely necessary in this technique. Aim: Assessment of all-inside ACL reconstruction preliminary clinical results with adjustable loops and buttons on both femoral and tibial surfaces. Method: Our prospective study included 28 subjects (19 male, 9 female) with chronic ACL ruptures. The mean age of the study population was 27.72 ± 8.23 years. In all cases ACL reconstruction was carried out with the use of quadrupled semitendinosus auto-grafts with adjustable loops and buttons on the femoral and tibial surfaces and anatomic placement of both tunnels, using an outside-in technique, with flipcutters (Arthrex®). Clinical and radiological evaluations were carried out before surgery and at 3 and 6 months postoperatively, with the Lysholm scoring system, the Tegner activity scale and anterior-posterior and latero-lateral X-rays. Anterior knee laxity was measured in 25° of flexion using a portable arthrometer (RolimeterTM, Aircast®) and maximum manual force. Results: During the final follow-up, the Lysholm score was good and excellent in 27 cases, with a mean Lysholm score of 95.55 ± 4.63; all results were classified as good. The mean preoperative Tegner activity score was 3.46 ± 1.71 (range: 1-7), and the post-operative mean score was 5.75 ± 2.24 (range: 2-10). We found no graft ruptures. Preoperative knee laxity measurements showed a mean displacement of 11.5 ± 3.1 mm and side-to-side differences of 5.6 ± 3.5 mm, while the postoperative measurements at the last follow-up were 6.3 ± 1.54 mm and 2.65 ± 1.86 mm, respectively. Conclusion: Short-term clinical outcomes of all-inside ACL restoration with anatomic placement femoral and tibial tunnels seem to recommend this surgical option, with good subjective and objective results. Additional research will have to prove the long-term success.

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A Rare Case of Bilateral Spaghetti Injuries in Children due to Assault by Mother and Analysis of Functional Outcome at Three Years

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1735346 ◽

2021 ◽

Author(s):

Parag B. Lad ◽

N. Venkateshwaran ◽

M. R. Thatte ◽

Sanket Tanpure

Keyword(s):

Functional Outcome ◽

Case Series ◽

Sensory Loss ◽

Nerve Reconstruction ◽

Range Of Movement ◽

Flexor Tendons ◽

Tendon Lengthening ◽

Flexor Tendon Injuries ◽

Life Threatening

AbstractManagement of child abuse with flexor tendons, neurovascular injuries, and life-threatening conditions is challenging. It needs a multisectoral coordinated and synchronized team effort for successful outcomes. We present a case series of children abused by a parent with a sharp object. The children sustained multiple flexor tendon injuries, neurovascular injuries in upper limbs, and tracheal injury compromising respiration. We performed a tracheostomy to save a child and subsequently repaired numerous flexor tendons, nerves, and arteries. During follow-up, these children required secondary reconstruction (tenolysis, tendon lengthening, nerve reconstruction) for flexor contractures, stiffness, and sensory loss in distal forearms. We measured the range of movements and assessed the children’s functional outcome using the Strickland score at 3-year follow-up. The range of movement and functional outcome was excellent in both children in our series. A timely performance of surgery, aided with efficient intensive care, therapy, and consistent posttraumatic psychosocial rehabilitation, produced excellent results in our series.

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FUNCTIONAL OUTCOME OF ARTHROSCOPIC ACL RECONSTRUCTION WITH HAMSTRING GRAFT

10.36106/ijar/6501202 ◽

2021 ◽

pp. 36-37

Author(s):

Sai Bharath Kanugula ◽

Atchuta Rao Ampolu ◽

Ashok Kumar Patnala

Keyword(s):

Anterior Cruciate Ligament ◽

Functional Outcome ◽

Cruciate Ligament ◽

Common Mechanism ◽

Associated Injuries ◽

Hamstring Graft ◽

Sports Activity ◽

Anterior Drawer Test ◽

Anterior Cruciate

Background: The most common joint to be injured in our body is knee joint, and the commonest ligament to be injured is anterior cruciate ligament in the knee.Etiology includes road trafc accidents and sport injuries. The ACL, along with other ligaments, the capsule are the stabilizers of the knee and prevents anterior translation, and limits valgus and rotational stress. The articular cartilage injuries in acute ACL tears constitutes from 16 – 46%, and in chronic tears, the incidence increases further2. For prevention of further worsening of the existing lesions and also to prevent formation of new lesions, stablity of the knee should be achieved.The present study is to assess the functional outcome of arthroscopic anterior cruciate ligament reconstruction using hamstring tendon (gracilis and semitendinosus) autograft in patients with ACL tears. Methods: Study design: Hospital Based Observational study. Study period: September 2019 to August 2021. Sample size: 30 30 consecutive patients who underwent arthroscopic ACL reconstructions with hamstring graft were taken for this study. Results: Out of these, 27 patients were male and 3 were female. Right side affected in 18 patients and left side in 12 patients. The most common mechanism of the injury was sports activity in 17 patients, RTA injuries in 10 patients and other job related injuries in 3 patients. Isolated ACL tears in thirteen patients in our study and rest had associated injuries to menisci in same knee.Better postoperative functional scores are seen with patients with isolated ACL injuries compared to those patients with associated injuries of the knee like meniscal tears. Observations include anterior drawer test was negative in 83.33% of patients at 3 months, 86.67% of patients at 6 months and at 1 year 96.15% of patients had a negative anterior drawer test. Full range of motion attained in 86.67% of patients at 3 months, 93.33% of patients at 6 months and at 1 year 96.15% of patients.Pivot shift test was negative postoperatively for all the patients at any follow-up. Postoperatively at 3 months 25 (83.33%) patients had 5/5 quadriceps power (MRC grading) 92.3% of them had 5/5 power at latest follow up. Complications include Supercial infection and Deep infection in our study. Conclusion: Anterior cruciate ligament tears are most common at a mean age of 28 years with preponderance to male gender. The most common mechanism of the injury was sports activity. Isolated ACL injury is more common than along with associated meniscal injuries.Anatomic single bundle reconstruction with quadrupled hamstring graft gives good functional results.Hamstring graft xation with endobutton and interference screw gives better functional outcome.

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