Comparison of clinical results, second look arthroscopic findings, and magnetic resonance imaging findings, between the transportal and outside-in techniques after double bundle anatomic anterior cruciate ligament reconstruction: A prospective randomized controlled trial with a minimum 2-year follow-up

2018 ◽  
Vol 104 (8) ◽  
pp. S93
Author(s):  
Jae Gyoon Kim ◽  
Seung Hoon Kang ◽  
Jun Ho Kim ◽  
Chae Wook Lim ◽  
Joon Ho Wang
Keyword(s):  
Ligament Reconstruction ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Double Bundle ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Arthroscopic Findings ◽  
Anterior Cruciate

Bioabsorbable Versus Titanium Screws in Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft: A Prospective, Randomized Controlled Trial With 13-Year Follow-up

2020 ◽  
Vol 48 (6) ◽  
pp. 1316-1326
Author(s):  
Keran Sundaraj ◽  
Lucy J. Salmon ◽  
Emma L. Heath ◽  
Carl S. Winalski ◽  
Ceylan Colak ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Hamstring Autograft ◽  
Cruciate Ligament Reconstruction ◽  
Titanium Screw ◽  
Randomized Controlled ◽  
Titanium Screws ◽  
Anterior Cruciate

Background: Bioabsorbable screws for anterior cruciate ligament reconstruction (ACLR) have been a popular choice, with theoretical advantages in imaging and surgery. Titanium and poly-L-lactic acid with hydroxyapatite (PLLA-HA) screws have been compared, but with less than a decade of follow-up. Purpose/Hypothesis: The purpose was to compare long-term outcomes of hamstring autograft ACLR using either PLLA-HA screws or titanium screws. We hypothesized there would be no difference at 13 years in clinical scores or tunnel widening between PLLA-HA and titanium screw types, along with high-grade resorption and ossification of PLLA-HA screws. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Forty patients undergoing ACLR were randomized to receive either a PLLA-HA screw or a titanium screw for ACL hamstring autograft fixation. Blinded evaluation was performed at 2, 5, and 13 years using the International Knee Documentation Committee score, Lysholm knee score, and KT-1000 arthrometer. Magnetic resonance imaging (MRI) was performed at 2 or 5 years and 13 years to evaluate tunnel volumes, ossification around the screw, graft integration, and cyst formation. Computed tomography (CT) of patients with PLLA-HA was performed at 13 years to evaluate tunnel volumes and intratunnel ossification. Results: No differences were seen in clinical outcomes at 2, 5, or 13 years between the 2 groups. At 13 years, tibial tunnel volumes were smaller for the PLLA-HA group (2.17 cm3) compared with the titanium group (3.33 cm3; P = .004). By 13 years, the PLLA-HA group had complete or nearly complete resorption on MRI or CT scan. Conclusion: Equivalent clinical results were found between PLLA-HA and titanium groups at 2, 5, and 13 years. Although PLLA-HA screws had complete or nearly complete resorption by 13 years, tunnel volumes remained largely unchanged, with minimal ossification.

scholarly journals Quadriceps and hamstring tendon autografts in ACL reconstruction yield comparably good results in a prospective, randomized controlled trial

2021 ◽  
Author(s):  
Hauke Horstmann ◽  
Maximilian Petri ◽  
Uwe Tegtbur ◽  
Gernot Felmet ◽  
Christian Krettek ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Tendon Reconstruction ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Anterior Cruciate

Abstract Introduction Comparable data of functional outcomes of anterior cruciate ligament reconstruction using either hamstring- or quadriceps tendon grafts is controversial. This prospective, randomized controlled trial aims to provide data comparing both grafts regarding the functional outcome. Materials and methods A two centre trial involving symptomatic patients 18 years of age or older with an anterior cruciate ligament tear was conducted. We randomly assigned 27 patients to quadruple hamstring tendon reconstruction and 24 to quadriceps tendon reconstruction. The patients were evaluated preoperatively, at 3, 6, 12 and 24 months post-surgery. The primary outcome parameter was the side-to-side knee laxity measured with an arthrometer. Secondary outcomes included results in the International Knee Documentation Committee (IKDC) and Lysholm Scores and isokinetic testing of strength in knee extension and flexion. Results Forty-four patients (86%) completed the 2-year follow-up. There was significantly improved knee stability at all time intervals with no difference between the two study groups. The manual side-to-side displacement improved by 4.7 ± 3.0 mm in patients with hamstring tendon reconstruction and 5.5 ± 2.9 mm in patients with quadriceps tendon reconstruction. In addition, muscle strength and outcome scores (IKDC and Lysholm Score) did not show any differences between the hamstring tendon group and the quadriceps tendon group. Patients in the hamstring tendon group returned to their pre-injury activity level after 95.2 ± 45.5 days while patients in the quadriceps tendon group needed 82.1 ± 45.6 days. Conclusion Quadriceps and hamstring tendon autografts yield comparably good results in primary anterior cruciate ligament reconstruction.

A Randomized Controlled Trial of Eccentric Versus Concentric Cycling for Anterior Cruciate Ligament Reconstruction Rehabilitation

2021 ◽  
Vol 49 (3) ◽  
pp. 626-636
Author(s):  
Giovanni Milandri ◽  
Sudesh Sivarasu
Keyword(s):  
Ligament Reconstruction ◽  
Perceived Exertion ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Eccentric Training ◽  
Randomized Controlled ◽  
Male Patients ◽  
Anterior Cruciate ◽  
Concentric Training

Background: Persistent strength and biomechanical deviations remain after anterior cruciate ligament reconstruction (ACLR). Eccentric training may reduce these and associated reinjury or osteoarthritis risks. Hypothesis: For male patients who have undergone ACLR, eccentric training is more effective than concentric training at improving knee flexion angle and other biomechanical deviations, as well as strength and patient-reported outcomes, using a matched perceived exertion dose. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 26 men, 10-16 weeks after hamstring tendon graft ACLR, were randomized to an eccentric training group or a concentric control group. Both groups trained 3 times a week for 8 weeks using the same isokinetic cycle ergometer in a matched studio environment. Exercise dose was matched in training frequency, time, progression, and intensity using a target rating of perceived exertion. Baseline and follow-up testing included questionnaires, dynamometer strength testing, and walk/run gait analysis. Results: Eccentric training increased knee (+2.1°; P = .022) and hip (+2.1°; P = .010) flexion angles more than concentric training but not more than the minimal clinically important difference of 3°. Very large asymmetries in baseline knee abduction moment (walk, −0.10 N·m/kg/m; run, −0.54 N·m/kg/m) had not changed in either group by follow-up. Knee valgus angle effects were mixed. Tibial rotation angle increased in both groups, but concentric training was more effective at promoting symmetry ( P < .001). Both groups had similar increases in affected limb quadriceps strength and knee flexion moments during walk/run gait (by 20% to 33%). Hamstring strength increased in the eccentric group (+15.4%) but not the concentric group. Eccentric group limb forces were 33% to 70% higher than those of the concentric group, with a lower heart rate. Both groups had low pain scores throughout. Conclusion: For rehabilitation after ACLR, progressive eccentric cycle training was not more clinically effective than concentric training at a matched perceived intensity dose in male patients. This can guide exercise prescription for reducing gait and strength deviations of these patients. Registration: PACTR201602001449365 (Pan African Clinical Trials Registry), NHREC 4344 (South African).

scholarly journals No Difference in the KOOS Quality of Life Subscore Between Anatomic Double-Bundle and Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction of the Knee: A Prospective Randomized Controlled Trial With 2 Years’ Follow-up

2018 ◽  
Vol 46 (10) ◽  
pp. 2341-2354 ◽  
Author(s):  
Cathrine Aga ◽  
May Arna Risberg ◽  
Morten Wang Fagerland ◽  
Steinar Johansen ◽  
Ingrid Trøan ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Double Bundle ◽  
Single Bundle ◽  
Activity Levels ◽  
Randomized Controlled ◽  
Anterior Cruciate

Background: The double-bundle reconstruction technique was developed to resemble the properties of the native anterior cruciate ligament (ACL) more closely than the conventional single-bundle technique. The clinical benefit of the operative procedure is controversial, and there is a need for studies with a focus on patient-reported outcomes (PROs). Study Design: Randomized controlled trial; Level of evidence, 1. Hypothesis: Anatomic double-bundle ACL reconstruction would be superior to anatomic single-bundle reconstruction regarding the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscore from baseline to 2-year follow-up. Methods: According to sample size calculations, 120 patients aged 18 to 40 years with a primary ACL injury of their knee were randomized to the anatomic double-bundle or anatomic single-bundle reconstruction groups. Patients with posterior cruciate ligament, posterolateral corner, or lateral collateral ligament injuries or with established osteoarthritis were excluded. Patients with residual laxity from a coexistent medial collateral ligament injury were excluded. Data were registered at baseline, 1 year, and 2 years. In 24 patients, postoperative 3-dimensional computed tomography was performed to verify the positioning of the bundles. The outcome measures were the change in KOOS subscores and the International Knee Documentation Committee 2000 subjective score, pivot-shift test result, Lachman test finding, KT-1000 arthrometer measurement, activity level, return-to-sports rate, and osteoarthritic changes on radiographs. A linear mixed model was used for the analysis of all the PROs, including the primary outcome. Results: The change in the KOOS QoL subscore from baseline to 2-year follow-up was not different between the double- and single-bundle groups (mean change, 29.2 points vs 28.7 points, respectively; –0.5-point difference; 95% CI, –8.4 to 7.4 points; P = .91). Neither were there any differences between the 2 groups in the remaining PROs, knee laxity measurements, or activity levels of the patients. Radiological signs of osteoarthritis were found in 2 patients. Eleven patients had a graft rupture: 8 in the single-bundle group and 3 in the double-bundle group ( P = .16). Three-dimensional computed tomography of the knees verified the positioning of the anteromedial bundle, posterolateral bundle, and single-bundle grafts to be within acceptable limits. Conclusion: There was no difference in the KOOS QoL subscore, the remaining PROs, knee laxity measurements, or activity levels comparing the double- and single-bundle ACL reconstruction techniques. The number of bundles does not seem to influence clinical and subjective outcomes, as long as the tunnels are adequately positioned. Registration: NCT01033188 ( ClinicalTrials.gov identifier).

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