scholarly journals Open approaches for cruciate ligament reconstruction in knee dislocations: A technical note and case series

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 17
Author(s):  
Michael Held ◽  
Martiz Laubscher ◽  
Richard von Bormann ◽  
Dustin L. Richter ◽  
Daniel C. Wascher ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Short Form ◽  
Cruciate Ligament ◽  
Arthroscopic Surgery ◽  
Knee Injuries ◽  
Case Series ◽  
Cruciate Ligaments ◽  
Cruciate Ligament Reconstruction ◽  
Patient Reported ◽  
Knee Dislocations

Introduction: Arthroscopic surgery is the gold standard for cruciate ligament reconstruction in multi-ligament knee injuries. However, hospitals in limited-resource settings often lack arthroscopic-trained surgeons or equipment. Open approaches for treating knee dislocations can overcome many of these limitations. Methodology: This study aims to describe techniques for open approaches in a supine patient to address the cruciate ligaments in multi-ligament knee injuries and to review associated complications and clinical outcomes in a retrospective case series. Results: Ten patients with multi-ligament knee injuries who had undergone open cruciate ligament reconstruction between July 2016 and November 2018 were retrospectively identified. Open approaches were performed owing to the extravasation of arthroscopy fluid into the posterior compartment (3) or a large traumatic arthrotomy (7). Complications and patient-reported outcomes were analysed. Eight of the 10 patients were followed up at 10 months postoperatively (range, 5–23 months). None had iatrogenic neurovascular damage. Median outcomes scores were: visual analogue scale, 45 (range, 0–100); Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form, 81.4 (range, 75–100); Lysholm, 85 (range, 67–92). Discussion: Open approaches were safe and useful in treating cruciate ligaments and should be considered in arthroscopy fluid extraversion and large traumatic arthrotomies.

Clinical Thresholds for Quadriceps Assessment After Anterior Cruciate Ligament Reconstruction

2015 ◽  
Vol 24 (1) ◽  
pp. 36-46 ◽  
Author(s):  
Christopher Kuenze ◽  
Jay Hertel ◽  
Susan Saliba ◽  
David R. Diduch ◽  
Arthur Weltman ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Roc Curves ◽  
Knee Extension ◽  
Related Function ◽  
Cruciate Ligament Reconstruction ◽  
Good Patient ◽  
Patient Reported ◽  
Anterior Cruciate ◽  
Return To Activity

Context:Normal, symmetrical quadriceps strength is a common clinical goal after anterior cruciate ligament reconstruction (ACLR). Currently, the clinical thresholds for acceptable unilateral quadriceps function and symmetry associated with positive outcomes after return to activity are unclear.Objective:To establish quadriceps-activation and knee-extension-torque cutoffs for clinical assessment after return to activity after ACLR.Design:Descriptive laboratory study.Setting:Laboratory.Patients:22 (10 female, 12 male; age = 22.5 ± 5.0 y, height = 172.9 ± 7.1 cm, mass = 74.1 ± 15.5 kg, months since surgery = 31.5 ± 23.5) recreationally active persons with a history of unilateral, primary ACLR at least 6 months prior and 24 (12 female/12 male, age = 21.7 ± 3.6 y, height = 168.0 ± 8.8 cm, mass = 69.3 ± 13.6 kg) recreationally active healthy participants.Main Outcome Measures:Patient-reported measures of pain, knee-related function, and physical activity level were recorded for all participants. Normalized knee-extension maximum-voluntary-isometric-contraction (MVIC) torque (Nm/kg) and quadriceps central-activation ratio (CAR, %) were measured bilaterally in all participants. Receiver-operator-characteristic (ROC) curves were used to establish thresholds for unilateral measures of normalized knee-extension MVIC torque and quadriceps CAR, as well as limb-symmetry indices (LSI). ROC curves then established clinical thresholds for normalized knee-extension MVIC torque and quadriceps CAR LSIs associated with healthy knee-related function.Results:Involved-quadriceps CAR above 89.3% was the strongest unilateral indicator of healthy-group membership, while quadriceps CAR LSI above 0.996 and knee-extension MVIC torque above 0.940 were the strongest overall indicators. Unilateral normalized knee-extension MVIC torque above 3.00 Nm/kg and quadriceps CAR LSI above 0.992 were the best indicators of good patient-reported knee-related outcomes.Conclusions:Threshold values established in this study may provide a guide for clinicians when making return-to-activity decisions after ACLR. Normalized knee-extension MVIC torque (>3.00 Nm/kg) and quadriceps CAR symmetry (>99.6%) are both strong indicators of good patient-reported outcomes after ACLR.

scholarly journals Patient and Surgeon Expectations Prior to Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 14 (3) ◽  
pp. 282-285 ◽  
Author(s):  
Mahmoud Michael Khair ◽  
Hassan Ghomrawi ◽  
Sean Wilson ◽  
Robert G. Marx
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Patient Expectations ◽  
Activity Level ◽  
Cruciate Ligament Reconstruction ◽  
Special Surgery ◽  
Anterior Cruciate

Abstract Background When discussing potential treatment with patients choosing to undergo surgery for disruption of the anterior cruciate ligament (ACL) and their families, surgeons spend considerable time discussing expectations of the short- and long-term health of the knee. Most of the research examining patient expectations in orthopedic surgery has focused largely on arthroplasty. Questions/Purposes The purpose of this study was to quantitatively assess the differences between the patient’s and the surgeon’s expectations before primary anterior cruciate ligament reconstruction (ACLR). Methods In this case series, we prospectively enrolled 93 patients scheduled for primary ACLR between 2011 and 2014. Expectations were measured using the Hospital for Special Surgery 23-item Knee Expectations Survey; scores were calculated for each subject. Results In all but six categories, patients had expectations that either aligned with their surgeons’ or were lower. The largest discordance between surgeon and patient expectations in which the patient had lower expectations was employment; 75% of patients had similar expectations to the surgeon when asked if the knee would be “back to the way it was before the problem started,” less than 1% had higher expectations, and 17% had lower expectations. Conclusion In general, patient expectations align well with surgeon expectations. Patients who are older, have a lower activity level, and who have selected allograft over autograft for ACLR could also be at risk for greater discordance. Understanding these differences, and their predictors, will help guide physicians when they are counseling patients about ACLR and also help them interact with patients after surgery as they assess outcomes.

scholarly journals Septic arthritis of the knee following anterior cruciate ligament reconstruction

2009 ◽  
Vol 1 (1) ◽  
pp. 3 ◽  
Author(s):  
Matjaz Sajovic ◽  
Gorazd Lesnicar ◽  
Mojca Z. Dernovsek
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Septic Arthritis ◽  
Range Of Motion ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Activity Level ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Septic arthritis of the knee is a rare complication after arthroscopic anterior cruciate ligament reconstruction, and the most appropriate treatment is unclear. All case series reported so far have been retrospective, and case numbers of septic arthritis have ranged from 4 to 11. From a consecutive case series of 1,283 patients who underwent arthroscopic anterior cruciate ligament reconstruction between January 1997 and May 2008, we report on 3 patients (0.23%) with post-operative septic arthritis. All patients had acute infection (≤ 2 weeks), bacterial cultures showed Staphylococcus species in 2 patients, while the bacterial culture was negative in the third. All of them underwent immediate arthroscopic debridement and lavage with continuous irrigation, as well as antibiotic treatment. The results were evaluated with physical and radiographic examination, functional testing, KT-2000, Lysholm and Tegner scales. The infection was successfully eradicated without further surgical treatment and the ligament graft was retained in all patients. Follow-up, at an average of 33 months, revealed that the patients had full symmetric knee range of motion and no effusion. The average Lysholm score was 91 points. In the patient with a lower subjective score, radiographs demonstrated patellofemoral joint-space narrowing, which is most probably in correlation with his anterior knee pain problems and lower activity level. The 134 N KT-2000 arthrometer side-to-side differences averaged 13 mm. Their performance in the single-legged hop test gave excellent results. The goals of treatment for septic arthritis after anterior cruciate ligament reconstruction are, primarily, to protect the articular cartilage and, secondly, to protect the graft. Through early diagnosis and prompt treatment, the infection can be successfully eradicated, with stability of the knee and full range of motion achieved.

scholarly journals Influence of graft diameter on patient reported outcomes after hamstring autograft anterior cruciate ligament reconstruction

2019 ◽  
Author(s):  
Robert A. Duerr ◽  
Kirsten D. Garvey ◽  
Jakob Ackermann ◽  
Elizabeth G. Matzkin
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Autograft ◽  
Cruciate Ligament Reconstruction ◽  
Point Increase ◽  
Patient Reported ◽  
Anterior Cruciate ◽  
Graft Diameter

Several studies have identified graft diameter as a risk factor for failure following anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to evaluate the effect of graft diameter on patient reported outcome measures (PROMS) following ACLR. We performed a retrospective review of prospectively collected data using a global surgical registry. 153 of 287 patients (53.3%) had complete data for each timepoint. Effect of graft diameter, graft type, femoral tunnel drilling technique, patient age, sex, and body mass index were evaluated. At 1-year post-operatively, a 1-mm increase in graft diameter was found to correlate with a 5.7-point increase in the Knee Injury and Osteoarthritis Outcome Score (KOOS) activity of daily living score (p = 0.01), a 10.3-point increase in the sport score (p=0.003), and a 9.8-point increase in the quality of life score (p=0.013). At 2-years post-operatively, a 1-mm increase in graft size was found to be marginally correlated with KOOS symptoms and sport scores. Patients undergoing hamstring autograft ACLR, increasing graft diameter can result in improved PROMS, specifically improved KOOS subscale scores at 1 and 2-years post-operative.

Effect of Physical Therapy Visits on Clinical Outcomes Following Anterior Cruciate Ligament Reconstruction With and Without Concurrent Meniscal Repair

2019 ◽  
Vol 28 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Jesse C. Christensen ◽  
Caitlin J. Miller ◽  
Ryan D. Burns ◽  
Hugh S. West
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Reported Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Patient Reported Outcome ◽  
Younger Patients ◽  
Cruciate Ligament Reconstruction ◽  
Patient Reported ◽  
Anterior Cruciate

Background:Health care payment reform has increased employers and health insurance companies’ incentive to take measures to control the rising costs of medical care in the United States. To date, limited research has investigated the influence outpatient physical therapy (PT) visits have on clinical outcomes following anterior cruciate ligament reconstruction (ACLR) with and without a concurrent meniscal repair.Objective:To examine the relationship between the number of PT visits and patient-reported outcome scores following ACLR outpatient rehabilitation.Study Design:Retrospective cohort.Level of Evidence:2b.Methods:Patients following ACLR with (n = 62) and without (n = 328) meniscal repair were identified through an electronic medical record database.Results:Patients with more PT visits had higher knee outcome survey—activities of daily living (KOS-ADL) change scores (P = .01) following ACLR without meniscal repair. Younger patients yielded significantly higher KOS-ADL change scores (P = .05) in the same cohort. Patients in the semisupervised PT visit strata recorded an 11.1 higher KOS-ADL change score compared with patients within the unsupervised PT visit stratum (P = .02). Younger patients also yielded significantly larger reductions in numeric pain (P = .01) following ACLR without meniscal repair. No significant differences were found between PT visits and either patient-reported outcome following ACLR with meniscal repair.Conclusions:Our findings suggest that younger patients and those in a semisupervised PT visit model have superior patient-reported outcomes following ACLR without meniscal repair. Preliminary findings indicate no relationship with PT visits and patient-reported outcomes in patients after ACLR with meniscal repair surgery.Clinical Relevance:These findings promote an alternative model to outpatient PT following ACLR without meniscal repair that may be more clinically effective and value based. There appears to be a need for patients to undergo a balanced regimen of supervised PT and effective interventions that can be conducted independently.

Outcomes of 1- Versus 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

2020 ◽  
pp. 036354652092309
Author(s):  
Matthew Colatruglio ◽  
David C. Flanigan ◽  
Joseph Long ◽  
Alex C. DiBartola ◽  
Robert A. Magnussen
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Cruciate Ligament Reconstruction ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Cruciate

Background: Anterior cruciate ligament reconstruction (ACLR) is a common orthopaedic sports medicine procedure, but graft failure is not uncommon and often leads to revision ACLR. Revision surgery can be performed in a 1- or 2-stage fashion. Hypothesis: Graft failure risk, patient-reported outcomes, and anterior knee laxity are similar after 1- and 2-stage revision ACLR. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed to evaluate patient outcomes after 1- versus 2-stage revision ACLR. A search was performed with the phrase “revision anterior cruciate ligament reconstruction” across Embase, PubMed, Scopus, and SportDiscus from the beginning of their archives through July 12, 2019. Results: Thirteen studies met inclusion criteria and included 524 patients: 319 patients who underwent 1-stage revision ACLR and 205 patients who underwent 2-stage revision ACLR. Two studies compared outcomes of 1- versus 2-stage revision ACLR; 4 studies reported outcomes after 2-stage revision ACLR; and the remaining 7 studies documented outcomes after 1-stage ACLR. The mean follow-up was 4.1 years. The 2 studies that compared 1- versus 2-stage ACLR reported no differences in functional, radiologic, or patient-reported outcomes or failure risk. Overall, 9 studies reported subjective International Knee Documentation Committee (IKDC) scores; 4 studies, Knee injury and Osteoarthritis Outcome Score values; 8 studies, Lysholm scores; and 7 studies, Tegner scores; 8 studies measured anterior laxity with a KT-1000 arthrometer. The mean weighted subjective IKDC score for all studies including this outcome at final follow-up was 66.6 for 1-stage revisions and 65.9 for 2-stage revisions. Conclusion: The available evidence comparing 1- versus 2-stage revision ACLR is retrospective and limited. The results of each approach are similar in appropriately selected patients.

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