Anatomical reconstruction of the anterior cruciate ligament: a logical approach

Introduction: Over the last years, the incidence of multiple ligament injuries has increased significantly due to the rising number of traffic accidents in relation to their kinetics and due to higher sports demands. Among their various combinations, one of them is the lesion of anterior cruciate ligament (ACL) which is associated to medial collateral ligament responsible for them in a 13 %. Nowadays several techniques to the reconstruction of Anterior Cruciate Ligament (ACL) and Medial Collateral Ligament (MCL) are applied. Therefore, for the last three years, we have carried out the simultaneous reconstruction of ACL with autologous graft and of MCL with allograft. Benefits include avoidance of morbidity in multiple donor areas, a safe bone-to-bone fixation in the case of Achilles tendon grafting; tiny incisions in the skin , and anatomical reconstruction. Throughout the years, the use of allografts has been very frequent. This is due to their safety factors, accessibility and their functional outcomes in the long term. Objectives: Show our surgical technique and experience in the combined reconstruction of anterior cruciate ligament with autologous graft and of medial collateral ligament with allograft. Methods: Fourteen (14) patients, with an average age of 29, were evaluated after they had undergone a reconstruction of ACL and MCL with autologous graft and allograft respectively. Average follow-up was 19.6 months. With respect to the surgical technique, it comprises two small incisions placing the anatomical femoral and tibial insertion for the MCL, and arthroscopically the anatomical location of the LCA. Later, some corresponding holes are made to be fixed with blunt Titanium screws following the same procedure. Mobility, joint laxity and subjective functionality were evaluated by means of Lysholm scores and International Knee Documentation Committee (IKDC). Results: The Average Lysholm knee score was 93, while all the patients were classified A/B according to the IKDC and were able to return to their normal sport and daily activity. Their range of motion remained stable. Conclusion: In multiple ligament knee injury, the use of allografts or in combination with autologous graft has become a valid resource. The lower risk of morbidity from the donor zone, the lower exposure of tissues, the lower postoperative pain with the MCL allograft at a low cost and greater security with ACL autologous graft have turned this surgical technique in a viable option for multi-ligament injured knee reconstruction.

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The use of a 3D-printed individualized navigation template to assist in the anatomical reconstruction surgery of the anterior cruciate ligament

Annals of Translational Medicine ◽

10.21037/atm-20-7515 ◽

2020 ◽

Vol 8 (24) ◽

pp. 1656-1656

Author(s):

Dejian Liu ◽

Yanlin Li ◽

Tao Li ◽

Yang Yu ◽

Guofeng Cai ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Anatomical Reconstruction ◽

Reconstruction Surgery ◽

3D Printed ◽

Anterior Cruciate ◽

Navigation Template

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A study on functional outcome of arthroscopic anatomical reconstruction of anterior cruciate ligament using quadrupled hamstring graft

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172886 ◽

2017 ◽

Vol 3 (4) ◽

pp. 854

Author(s):

Jagdeesh P. C. ◽

Suhail R. Shaikh

Keyword(s):

Anterior Cruciate Ligament ◽

Functional Outcome ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Scoring Systems ◽

Activity Level ◽

Anatomical Reconstruction ◽

Proper Patient Selection ◽

Anterior Cruciate ◽

Hamstrings Tendon

Background: Various techniques and graft types are now available for the reconstruction of ACL. Opinions differ among experts with regard to the ideal technique and graft type to be used. Arthroscopic anatomical ACL reconstruction using quadrupled hamstring autograft with fixation in the femoral tunnel using tightrope and in the tibial tunnel with interference screw is a relatively new technique. Purpose of this study is to analyze the postoperative outcome in our experience with this procedure.Methods: This was a prospective study of patients with ACL injury who underwent Arthroscopic anatomical ACL reconstruction using quadrupled hamstrings autograft. All patients were operated upon by the same surgeon and had the same rehabilitation protocol. They were followed up for six months at regular intervals using IKDC, LGS scoring systems, tegner activity scale and a subjective questionnaire.Results: About 95% of the patients had a favorable outcome as per three scoring systems. (IKDC, Lysholm score, subjective questionnaire) all three scoring system had a very high correlation around 90% of individuals were able to return to their pre injury activity level.Conclusions: We conclude that the functional outcome of arthroscopic anatomical anterior cruciate ligament reconstruction using quadrupled hamstrings tendon autograft is excellent to good (95%). With proper patient selection and rehabilitation full occupational and recreational activities can be expected for most of the patients within four to six months of the procedure.

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A Single Cycle Study of Screw Fixation in Anterior Cruciate Ligament Reconstruction

ASME 2008 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2008-191567 ◽

2008 ◽

Author(s):

M. Chizari ◽

B. Wang ◽

M. Snow

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Screw Fixation ◽

Cruciate Ligament ◽

Bone Tunnel ◽

Anatomical Reconstruction ◽

Initial Stability ◽

History Of ◽

Post Traumatic ◽

Anterior Cruciate

The natural history of Anterior Cruciate rupture is one of progressive deterioration of knee function, with the development of instability, meniscal tears and post traumatic osteoarthritis. The current surgical approach is for anatomical reconstruction using a biological tissue autograft. It is well understood that the initial stability is dependent on the strength of the fixation rather than the strength of the graft, until the graft becomes biologically incorporated in the bone tunnel. A study was carried out to better understand postoperative internal bone stresses in anterior cruciate ligament (ACL) reconstruction surgery. The mechanical aspects of an interface screw fixation were examined both experimentally and numerically, with the aim to minimize deleterious effects in ACL reconstruction. The tibial cortical/cancellous bony tunnel and the stress pattern resulting from the screw fixation in the tunnel are investigated.

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Anatomical Reconstruction of the Anterior Cruciate Ligament in Goats

Journal of Investigative Surgery ◽

10.3109/08941939109140779 ◽

1991 ◽

Vol 4 (2) ◽

pp. 191-202 ◽

Cited By ~ 7

Author(s):

Dennis L. Powers ◽

Pamela A. Jacob ◽

Michael J. Drews

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Anatomical Reconstruction ◽

Anterior Cruciate

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Tunnel Position for Anatomical Reconstruction of the Anterior Cruciate Ligament

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2020.55.4.305 ◽

2020 ◽

Vol 55 (4) ◽

pp. 305

Author(s):

Jin Kyu Lee ◽

Jae-Hyuk Yang

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Anatomical Reconstruction ◽

Tunnel Position ◽

Anterior Cruciate

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Simultaneous Double-boundle “All Inside” Posterior Cruciate Ligament and Anterior Cruciate Ligament Reconstruction: 2 Years Follow Up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00185 ◽

2018 ◽

Vol 6 (12_suppl5) ◽

pp. 2325967118S0018

Author(s):

Franco Farina ◽

Matías Orlando ◽

Ma. Florencia Weisburd ◽

Francisco Vega ◽

Emilio Morales ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Posterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Anatomical Reconstruction ◽

Pcl Reconstruction ◽

Kt 1000 ◽

Anterior Cruciate ◽

Anterior Posterior

The purpose of this study was to evaluate the clinical results of simultaneuos Double-boundle “All Inside” posterior Cruciate Ligament (PCL) and Anterior Cruciate Ligament (ACL) Reconstruction. Methods: this study population included 31 men and 2 women with 26 acute and 7 chronic knee injuries. Ligament injuries included 21 ACL / PCL / Posterolateral instability, 9 ACL / PCL / Medial Cruciate Ligament (MCL), 3 ACL / PCL instability. Artroscopically assited combined ACL/PCL. Reconstruction were performed using the All Inside PCL reconstruction and ACL anatomical Reconstruction. The patients were followed up for a minimum of 2 years and evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm Rating scale. The anterior-posterior knee laxity was assessed by KT-1000 examination. Results: At the last Follow Up, all patients showed normal knee extension. Two patients had 10 grades flexion limitation, and five had a 5 grades flexion limitation. The Lysholm scores was 90,4 +/- 4,6. According to the last IKDC evaluation, the results were graded as normal in 21 patients (63,6%), nearly normal in 11 patients (33,3%), and abnormal in 1 patient (3,1%). The KT-1000 examination showed that de side to side difference in overall anterior-posterior laxity at 70 grades flexion was 0 to 2 mm in 24 patients, 3 to 5 mm in 8 patients, and 6 to 10 mm in 1 patient; the side to side difference in overall anterior-posterior laxity at 20 grades flexion was 0 to 2 mm in 23 patients, 3 to 5 mm in 9 patients and 6 to 10 mm in 1 patient. Conclusion: simultaneuos Double-Boundle “All Inside” PCL and ACL reconstruction can effectively and safely restore knee stability, and can yield normal results in 62,5% of patients and nearly normal in 33,3% at minimum 2 years.

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Clinical evaluation of anatomical reconstruction of the anterior cruciate ligament

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-1-48-54 ◽

2021 ◽

Vol 27 (1) ◽

pp. 48-54

Author(s):

V.V. Zayats ◽

◽

A.K. Dulaev ◽

A.V. Dydykin ◽

I.N. Ulyanchenko ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Sport Performance ◽

Anatomical Reconstruction ◽

Anteromedial Portal ◽

Surgical Time ◽

Evaluation Form ◽

Group I ◽

Group Ii ◽

Anterior Cruciate

Purpose Evaluate clinical effectiveness of anatomical reconstruction of the anterior cruciate ligament (ACL) and determine the perspectives for practical health care. Material and methods The review included 706 patients who underwent arthroscopic reconstruction of the ACL and graft interference screw fixation between 2010 and 2018. ACL reconstruction was performed using either anteromedial portal (n = 396, Group I) or an isometric transtibial tunnel technique (n = 310, Group II). Outcomes were evaluated clinically and radiographically using the 2000 International Knee Documentation Committee (2000 IKDC) Subjective Knee Evaluation Form, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Lysholm scoring scale. Clinical and economic outcome measures included surgical time, rehabilitation and disability periods and period of recovery for sports performance. Results The knee anterior drawer test was equally negative and showed no significant differences in the groups. The Lachman test and the pivot shift test showed better results in Group I (p < 0.001). Contractures, atrophic femoral muscles (p < 0.05), synovitis (p < 0.01), vertical position of the femoral graft channels and pathologically extended bone channels with wind-wiper effect (p < 0.001) were more common among patients of Group II. Although knee function returned to normal, as rated with the 2000 IKDC Subjective Knee Evaluation Form, in 91.3 % of cases pathological changes in the knee (C) and severely impaired function (D) were 2.5 and 5 times less common in group I than in Group II (p < 0.05). Pain, symptoms and sport scores were significantly higher on the KOSS scale for Group I (p < 0.05). Surgical time was longer in patients of Group I (p < 0.05) who had shorter rehabilitation period (p < 0.05). Conclusion Anatomical reconstruction of ACL using anteromedial portal was shown to be a more reliable technique as compared to transtibial approach to ensure overall knee stability arranging adequate bone channels. The technique is capable to protect the graft from injury, reduce the likelihood of pain, synovitis, contractures, muscle atrophy, providing shorter rehabilitation, disability period and recovery for sport performance.

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Improving revision operations for restoration of the anterior cruciate ligament of the knee joint in military personnel

Vestnik of Russian military medical Academy ◽

10.17816/brmma62829 ◽

2020 ◽

Vol 22 (4) ◽

pp. 201-207

Author(s):

V. V. Khominets ◽

O. V. Rikun ◽

A. S. Grankin ◽

R. A. Fedorov ◽

A. O. Fedotov ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Joint ◽

Military Personnel ◽

Cruciate Ligament ◽

High Stress ◽

Main Trend ◽

Anatomical Reconstruction ◽

Rotational Instability ◽

Increased Risk ◽

Anterior Cruciate

The analysis of foreign and domestic scientific publications of recent years, devoted to the problem of revision reconstructions of the anterior cruciate ligament of the knee joint in young and middle-aged patients with high functional demands. The key directions for improving the treatment of this category of patients have been determined. It was found that the main trend in the improvement of revision reconstructions of the anterior cruciate ligament of the knee in patients with high functional demands, which primarily include professional athletes and military personnel, is the desire for enhanced stabilization of the joint by eliminating residual, primarily rotational instability and increasing protection the main graft from high stress overload. Of particular importance is a strictly individual approach to the choice of the method of revision reconstruction of the anterior cruciate ligament, which makes it possible to implement the principles underlying the primary plastic of the ligament. The solution of these two problems requires, firstly, a more detailed examination of patients in order to identify factors of increased risk for the development of recurrent joint instability, which must be eliminated during surgical treatment. Secondly, the strict anatomical nature of restoration, and more often reconstruction, of the main and auxiliary functionally incompetent stabilizing structures of the joint against an unfavorable anatomical background caused by previous operations in the form of bone defects and deformities of the condyles with destruction of hyaline cartilage and previously resected menisci. Third, the use of reinforced grafts of increased strength for the reconstruction of the anterior cruciate ligament, as the main structure that stabilizes the joint. Moreover, such reinforcement can be direct, by strengthening the cruciate ligament graft directly, or indirectly, by strengthening the anterolateral part of the joint. The most appropriate is a combination of these two directions in order to obtain the maximum positive effect. Promising options for extra-articular reinforcement today are anatomical reconstruction of the anterolateral ligament and lateral extra-articular tenodesis of the iliotibial tract as part of the anterolateral joint complex. This makes it possible to compensate for the forced resections of the menisci and, without correction, at least at the first revision, the increased posterior inclination of the articular surface of the tibial condyles. The main advantages of these operations in combination with the reconstruction of the anterior cruciate ligament are their proven efficiency, versatility, technical simplicity and availability, which are of particular importance for the introduction into wide clinical practice of trauma departments of military hospitals.

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