The Long-Term Effect of 2 Postoperative Rehabilitation Programs after Anterior Cruciate Ligament Reconstruction – A Randomized Controlled Clinical Trial with 2 Years of Follow-Up

2010 ◽  
Vol 13 (05) ◽  
pp. 201-201
Author(s):  
F. Diemer ◽  
V. Sutor
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Controlled Clinical Trial ◽  
Postoperative Rehabilitation ◽  
Randomized Controlled ◽  
Rehabilitation Programs ◽  
Long Term Effect ◽  
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.

The Effect of Postoperative KT-1000 Arthrometer Score on Long-Term Outcome After Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 45 (7) ◽  
pp. 1522-1528 ◽  
Author(s):  
Andrew D. Goodwillie ◽  
Sarav S. Shah ◽  
Malachy P. McHugh ◽  
Stephen J. Nicholas
Keyword(s):  
Postoperative Period ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Long Term Follow Up ◽  
Kt 1000 ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B

Background: Many long-term studies have looked at outcomes after anterior cruciate ligament reconstruction (ACLR), but none have correlated long-term outcomes with postoperative laxity greater than 5 mm. It has been stated previously that more than 5 mm of postoperative graft laxity constituted a procedural failure. Purpose: To directly compare tight grafts (<3 mm) and loose grafts (>5 mm) to determine the effect of graft laxity, as measured by KT-1000 arthrometer, after ACLR on long-term clinical outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: The study included 171 consecutive patients who had undergone transtibial bone–patellar tendon–bone ACLR between 1992 and 1998. At 6, 12, and 24 months postoperatively (the immediate postoperative period), patients were evaluated. Group A included patients with a maximal side-to-side (STS) difference in the immediate postoperative period of less than 3 mm (tight grafts), and group B included patients with a maximal STS difference of greater than 5 mm (loose grafts). Any patient with a history of ipsilateral or contralateral ACLR or ACL injury, meniscectomy, or cartilage restoration was excluded. Patients were prospectively followed to long-term follow-up, when a telephone interview was conducted regarding knee function and to document Lysholm, Tegner, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) subjective outcome scores. Results: Eighty-seven patients met inclusion criteria: 66 tight grafts (group A) and 21 loose grafts (group B). The mean ± SD time to follow-up was 16.3 ± 1.5 years in group A (n = 46) and 16.8 ± 1.3 years in group B (n = 15). Tegner ( P = .77), Lysholm ( P = .85), KOOS ( P = .96), and IKDC ( P = .42) were found to have no statistically significant difference between groups at long-term follow-up. Both Tegner and Lysholm scores significantly improved in tight and loose grafts in the immediate postoperative period as well as at long-term follow-up compared with preoperatively. There were 2 ACL revisions in group A and none in group B. Eleven of 46 patients (24%) in group A required subsequent procedures versus 1 of 15 patients (6.7%) in group B ( P = .146). Conclusion: Postoperative laxity of greater than 5 mm STS difference as measured by KT-1000 arthrometer does not appear to place patients at a worse clinical outcome at long-term follow-up, nor does it lead to significantly more subsequent procedures. In addition, transtibial ACLR can provide excellent clinical results at long-term follow-up.

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