ACL Reconstruction in the Multiple Ligament Injured Knee

2019 ◽  
Vol 33 (05) ◽  
pp. 418-420
Author(s):  
Robert G. Marx ◽  
Isabel A. Wolfe
Keyword(s):  
Acl Reconstruction ◽  
Sports Injuries ◽  
Current Knowledge ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
High Energy ◽  
Acl Injuries ◽  
Proper Diagnosis ◽  
Anterior Cruciate ◽  
Injured Knee

AbstractMultiple ligament knee injuries are complex and can result from sports injuries or high energy trauma. The proper diagnosis and treatment of multiple ligament knee injuries are essential, and careful evaluation and planning are required to achieve successful outcomes. Anterior cruciate ligament (ACL) reconstruction in the multiple ligament injured knee is complicated by several factors, necessitating additional technical considerations. Patient selection, surgical timing, graft selection, and surgical technique require consideration specific to the ACL component of these injuries. We present a summary of the current knowledge with respect to the treatment of ACL injuries in the context of the multiple ligament injured knee.

scholarly journals Epidemiology of surgically managed anterior cruciate ligament ruptures in a sports surgery practice

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668428 ◽  
Author(s):  
Andrew Arjun Sayampanathan ◽  
Bryan Koh Thean Howe ◽  
Hamid Rahmatullah Bin Abd Razak ◽  
Chong Hwei Chi ◽  
Andrew Hwee Chye Tan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Road Traffic ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Knee Injuries ◽  
Treatment Strategies ◽  
Senior Author ◽  
Acl Injuries ◽  
Anterior Cruciate

Introduction: Anterior cruciate ligament (ACL) tears are common knee injuries, especially among sportsmen and sportswomen. The aim of this study is to better understand the epidemiology of surgically managed ACL tears sustained in our institution. Methods: All patients who underwent arthroscopic ACL reconstruction by the senior author of this article in Singapore from 2008 to 2013 were studied. Patients who were diagnosed clinically and/or radiologically to have a complete tear of the ACL and subsequently underwent arthroscopic ACL reconstruction were included. Patients who suffered from traumatic knee dislocation were excluded. Two hundred and ninety-two patients were available for analysis. All patients were operated on by the senior author. Results: 83.9% of patients were male. 60.5, 23.0, 8.46, and 8.11% were of Chinese, Malay, Indian and other origins, respectively. 69.6 and 28.7% were in white-collared and blue-collared jobs, respectively, while 1.69% were unemployed. Mean age at operation was 29.4 years. Mean body mass index was 25.3 kg/m2. 82.4 and 17.6% of ACL tears were sports (contact—27.5%; non-contact—72.5%) and non-sports injuries (activities of daily living—94.2%, road traffic accidents—5.77%), respectively. The top four sporting activities causing ACL tears were soccer, basketball, racquet games and volleyball. 56.2% of ACL tears presented with concomitant knee injuries (medial meniscus—63.4%; lateral meniscus—31.1%; posterior cruciate ligament—5.49%). 84.5% were primary tears. Conclusions: In this epidemiological review of ACL injuries, we found that ACL injuries tend to cluster within certain population subgroups. Patterns of mechanisms of injuries have been observed. These findings may lead to better preventive and treatment strategies in the management of ACL tears.

Which Outcome Measures Should Be Used to Determine Readiness to Play After ACL Reconstruction?

2014 ◽  
Vol 23 (2) ◽  
pp. 158-164 ◽  
Author(s):  
Luke M. Mueller ◽  
Ben A. Bloomer ◽  
Chris J. Durall
Keyword(s):  
Acl Reconstruction ◽  
Outcome Measures ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Surgical Reconstruction ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Injured Knee

Clinical Scenario:Anterior cruciate ligament (ACL) injuries are associated with a lengthy recovery time, decreased performance, and an increased rate of reinjury. To improve performance of the injured knee, affected athletes often undergo surgical reconstruction and rehabilitation. Determining when an athlete is ready to safely return to play (RTP), however, can be challenging for clinicians. Although various outcome measures have been recommended, their ability to predict a safe RTP is questionable.Focused Clinical Question:Which outcome measures should be used to determine readiness to return to play after ACL reconstruction?

scholarly journals Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls

2018 ◽  
Vol 47 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Anne Fältström ◽  
Joanna Kvist ◽  
Håkan Gauffin ◽  
Martin Hägglund
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Activity Level ◽  
Soccer Players ◽  
Healthy Controls ◽  
Acl Injuries ◽  
Activity Scale ◽  
Anterior Cruciate ◽  
Tegner Activity Scale

Background: Many patients with anterior cruciate ligament (ACL) reconstruction who return to sport suffer new ACL injuries or quit sports soon after returning. Purpose: To prospectively follow a cohort of female soccer players with primary unilateral ACL reconstruction and matched knee-healthy controls from the same soccer teams to compare (1) the rate of new traumatic and nontraumatic knee injuries and other injuries, (2) the proportion of players who quit soccer, and (3) player-reported activity level and satisfaction with activity level and knee function. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 117 active female soccer players (mean ± SD age, 19.9 ± 2.5 years) 18.9 ± 8.7 months after ACL reconstruction and 119 knee-healthy female soccer players (19.5 ± 2.5 years) matched from the same teams were prospectively followed for 2 years for new knee injuries, other injuries, soccer playing level, activity level according to the Tegner Activity Scale, and satisfaction with activity level and knee function. Results: Players with ACL reconstruction had a higher rate of new ACL injuries (n = 29 vs 8; 19 vs 4 per 100 player years; rate ratio [RR], 4.82; 95% CI, 2.20-10.54; P < .001), other traumatic knee injuries (29 vs 16 per 100 player years; RR, 1.84; 95% CI, 1.16-2.93; P < .01), and nontraumatic knee injuries (33 vs 9 per 100 player years; RR, 3.62; 95% CI, 2.11-6.21; P < .001) as compared with controls. There was no difference in the rate of other (not knee) injuries (43 vs 48 per 100 player years; RR, 0.90; 95% CI, 0.65-1.23; P = .494). During the 2-year follow-up, 72 (62%) players with ACL reconstruction quit soccer, as opposed to 43 (36%) controls ( P = .001). The median Tegner Activity Scale score decreased in both groups ( P < .001) but more for the ACL-reconstructed group ( P < .015). Conclusion: Female soccer players with ACL reconstruction had nearly a 5-fold-higher rate of new ACL injuries and a 2- to 4-fold-higher rate of other new knee injuries, quit soccer to a higher degree, and reduced their activity level to a greater extent as compared with knee-healthy controls.

scholarly journals Concomitantly combined ACL and PLC reconstruction: Case report and literature review

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Van Hoc Nguyen ◽  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Knee Injuries ◽  
Posterolateral Corner ◽  
Ligament Injury ◽  
Knee Ligament ◽  
Anterior Cruciate ◽  
Injured Knee

Abstract Introduction: : Injuries involving the posterolateral ligamentous system occur in approximately 7 - 16% of knee ligament injuries. However, only 28% of all posterolateral corner (PLC) injuries are alone and usually combined with cruciate ligament injury (posterior cruciate ligament-PCL > anterior cruciate ligament-ACL). Combined ACL and PLC tears account for 10% of complex knee injuries. An unaddressed posterolateral corner injury may be a leading cause of ACL reconstruction failure. Case presentation: A 26 year old male patient with combined ACL and PLC injury. He was concurrently reconstructed by both ACL and PLC. We used 2 semitendinosi (1 in each knee) and 1 gracilis tendon (in the injured knee). The ACL was reconstructed by one stranded semitendinosus with all-inside technique and Tightrops fixation. The PLC reconstruction utilized one femoral tunnel at the isometric point, graft fixation at the femoral tunnel by tightrope, and at the tibial tunnel by absorbable screw. At the 9 months follow-up, the Cincinnati score was 70/100 and the IKDC score was B type. Conclusions: Concomitantly combined ACL and PLC reconstruction has good results in remaining knee functions and decreasing ACL reconstruction failure. However, femoral tunnel creation needs to avoid femoral tunnel intersection.

scholarly journals Anterolateral ligament of the knee: back to the future in anterior cruciate ligament reconstruction

2015 ◽  
Vol 7 (2) ◽  
Author(s):  
Davide Edoardo Bonasia ◽  
Andrea D'Amelio ◽  
Pietro Pellegrino ◽  
Federica Rosso ◽  
Roberto Rossi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Anterolateral Ligament ◽  
Rotational Instability ◽  
Small Subset ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes.

scholarly journals Effects of a Prophylactic Knee Sleeve on Anterior Cruciate Ligament Loading During Sport-Specific Movements

2019 ◽  
Vol 28 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Jonathan Sinclair ◽  
Paul J. Taylor
Keyword(s):  
Anterior Cruciate Ligament ◽  
Repeated Measures ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Musculoskeletal Modeling ◽  
Acl Injuries ◽  
Recreational Athletes ◽  
Load Rate ◽  
Anterior Cruciate ◽  
3D Motion Capture

Context: Prophylactic knee bracing is extensively utilized in athletic populations to reduce the high risk from knee injuries, but its role in the attenuation of anterior cruciate ligament (ACL) pathologies is not well understood. Objective: The aim of this investigation was to explore the effects of a prophylactic knee sleeve on ACL loading parameters linked to the etiology of injury in recreational athletes. Setting: Laboratory. Design: Repeated measures. Participants: Thirteen healthy male recreational athletes. Intervention: Participants performed run, cut, and single-leg hop movements under 2 conditions; prophylactic knee sleeve and no sleeve. Main Outcome Measures: Biomechanical data were captured using an 8-camera 3D motion capture system and a force platform. Peak ACL force, average ACL load rate, and instantaneous ACL load rate were quantified using a musculoskeletal modeling approach. Results: The results showed that both average and instantaneous ACL load rates were significantly reduced when wearing the knee sleeve in the hop (sleeve = 612.45/1286.39 N/kg/s and no sleeve = 743.91/1471.42 N/kg/s) and cut (sleeve = 222.55/1058.02 N/kg/s and no sleeve = 377.38/1183.01 N/kg/s) movements. Conclusions: Given the biomechanical association between ACL loading and the etiology of ACL injuries, it is proposed that athletes may be able to attenuate their risk from injury during cut and hop movements through utilization of a prophylactic knee sleeve.

Low Rates of Return to Preinjury Sport After Bilateral Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 47 (2) ◽  
pp. 334-338 ◽  
Author(s):  
Kate E. Webster ◽  
Julian A. Feller ◽  
Alexander J. Kimp ◽  
Timothy S. Whitehead
Keyword(s):  
Quality Of Life ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Rates Of Return ◽  
Acl Injuries ◽  
Reconstruction Surgery ◽  
Anterior Cruciate

Background: Patients with bilateral anterior cruciate ligament (ACL) injuries tend to report worse results in terms of knee function and quality of life as compared with those with unilateral injury. There are limited data regarding return to preinjury sport in this group. Purpose: To report return-to-sport rates for patients who had bilateral ACL reconstruction and to compare outcomes according to age and sex. Study Design: Case series; Level of evidence, 4. Methods: A total of 107 patients (62 male, 45 female) who underwent primary ACL reconstruction surgery to both knees completed a detailed sports activity survey at a mean 5-year follow-up (range, 2.5-10 years). Follow-up also included the International Knee Documentation Committee subjective form, Marx Activity Scale, and Knee injury and Osteoarthritis Outcome Score–Quality of Life subscale. Rates of return to preinjury levels of sport were calculated for the whole cohort, and for further analysis, the group was divided according to age (<25 vs ≥25 years), sex, and time between the reconstruction procedures (<3 vs ≥3 years). Results: The rate of return to preinjury sport after bilateral ACL reconstruction was 40% (95% CI, 31%-50%), as compared with an 83% (95% CI, 74%-88%) return rate after the first reconstruction procedure. Although not statistically significant, return rates were higher for male versus female patients (47% vs 31%) and older versus younger patients (45% vs 31%). Of those who returned to their preinjury levels of sport after the second reconstruction, 72% thought that they could perform as well as before their ACL injuries. In contrast, only 20% thought that they could perform as well if they returned to a lower level. Fear of reinjury was the most common reason cited for failure to return to sport after the second reconstruction. Patient-reported outcome scores were higher for those who returned to their preinjury levels of sport but did not differ for sex and age. Conclusion: Return-to-sport rates drop markedly after a second (contralateral) ACL reconstruction, with less than half of the investigated cohort returning to its preinjury level of sport. Return-to-sport outcomes are less than ideal for patients who have ACL reconstruction surgery to both knees.

Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up

2019 ◽  
Vol 48 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Alexia G. Gagliardi ◽  
Patrick M. Carry ◽  
Harin B. Parikh ◽  
Jay C. Albright
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Acl Injuries ◽  
Patient Reported ◽  
Adolescent Patients ◽  
Anterior Cruciate

Background: The incidence of anterior cruciate ligament (ACL) injury in the adolescent population is increasing. The quadriceps tendon–patellar bone autograft (QPA) has been established as a reliable graft choice for ACL reconstruction in the adult population. Purpose: To investigate graft failure, ability to return to sport, patient-reported functional outcomes, joint laxity, and subsequent injury among adolescent patients >2 years after primary ACL reconstruction with the QPA. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent QPA ACL reconstruction performed by a single surgeon were identified from an existing database. Information available in the database included demographics, concomitant/subsequent injuries, surgical procedures, graft failure, return to sport, and Lachman examination collected by medical record review. Pediatric International Knee Documentation Committee (Pedi-IKDC) and Lysholm scores were collected by telephone or during a clinic visit >2 years postoperatively. Results: The final cohort included 81 of 104 consecutive adolescent patients aged 10 to 18 years (mean ± SD, 15.9 ± 1.7 years at the time of surgery) for whom follow-up information was collected at >2 years after surgery. The cumulative incidence of graft failure within the 36-month follow-up period was 1.2% (95% CI, 0.1%-11.4%). The rate of ipsilateral non-ACL injuries was similar (1.2%; 95% CI, 0.2%-7.6%). Contralateral ACL and non-ACL injuries requiring surgical intervention were documented in 9.8% (95% CI, 4.9%-19.5%). The median Pedi-IKDC score was 94 (interquartile range, 89-98). The median Lysholm score was 99.5 (interquartile range, 89.0-100.0). At 36 months after surgery, 87.9% (95% CI, 81.4%-94.9%) of individuals had returned to play. Conclusion: The quadriceps tendon–patellar autograft is a novel graft that demonstrates excellent stability and favorable patient-reported outcomes. Based on these results, the QPA is a reliable choice for primary ACL reconstruction in adolescent patients.

Social Sources of Research Interest in Women’s Sport Related Injuries: A Case Study of ACL Injuries

2015 ◽  
Vol 32 (3) ◽  
pp. 229-247 ◽  
Author(s):  
Nancy Theberge
Keyword(s):  
Sports Injuries ◽  
Cruciate Ligament ◽  
Research Interest ◽  
Women's Sport ◽  
Acl Injuries ◽  
The Social ◽  
Il Y A ◽  
Anterior Cruciate ◽  
Biomedical Interest

This article offers an analysis of the social sources of biomedical interest in women’s sports injuries through a case study of anterior cruciate ligament (ACL) injuries. Although both men and women incur them, there is extensive research interest in women’s ACL injuries. Drawing on interviews with researchers who have contributed to this research, the investigation examines the social sources of this interest. Explanations lie largely in the evolution of the agenda in sport medicine to a concern with injury prevention, which coincides with a movement toward the inclusion of women in health research. The article concludes with a consideration of the political and ideological implications of the interaction of the prevention and inclusion agendas in research on women’s sport injuries.Cet article propose une analyse des sources sociales de l’intérêt biomédical pour les blessures dans les sports féminins à travers l’étude du cas des blessures au ligament croisé antérieur (LCA). Bien que les hommes et les femmes en soient tous deux victimes, il y a énormément d’intérêt en recherche pour les blessures au LCA chez les femmes. S’appuyant sur des entrevues avec des chercheurs qui ont contribué à ce projet, l’étude examine les sources sociales de cet intérêt. Les explications reposent grandement sur l’évolution de l’agenda en médecine du sport vers un souci de prévention des blessures, ce qui coïncide avec un mouvement vers l’inclusion des femmes dans la recherche sur la santé. L’article conclut par une considération des implications politiques et idéologiques de l’interaction des agendas de prévention et d’inclusion en recherche sur les blessures sportives chez les femmes.

The Role of Patient Characteristics in the Success of Nonoperative Treatment of Anterior Cruciate Ligament Injuries

2020 ◽  
Vol 48 (7) ◽  
pp. 1657-1664 ◽  
Author(s):  
Jelle P. van der List ◽  
Frans J.A. Hagemans ◽  
Dirk Jan Hofstee ◽  
Freerk J. Jonkers
Keyword(s):  
Anterior Cruciate Ligament ◽  
Multivariate Analysis ◽  
Physical Therapy ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Patient Characteristics ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Acl Injuries ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears can either be treated nonoperatively with physical therapy and then treated operatively if persistent instability is present, or be directly treated operatively. Advantages of early ACL reconstruction surgery include shorter time from injury to surgery and potentially fewer meniscal injuries, but performing early ACL reconstruction in all patients results in surgery in patients who might not need ACL reconstruction. It is important to assess in which patients nonoperative treatment is successful and which patients will require ACL reconstruction and thus might be better treated surgically in an earlier phase. Purpose: To identify patient characteristics that predict the success of nonoperative treatment. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: All patients with complete ACL injuries who were evaluated between 2014 and 2017 at our clinic were included. The minimum follow-up was 2 years. The initial treatment and ultimate ACL reconstruction were reviewed. Univariate analysis was performed using Mann-Whitney U tests and chi-square tests and multivariate analysis using binary logistic regression. Results: A total of 448 patients were included with a median age of 26 years and median Tegner level of 7 and mean Tegner level of 6.4. At initial consultation, 210 patients (47%) were treated nonoperatively with physical therapy and 126 of these patients (60%) ultimately required ACL reconstruction. Nonoperative treatment failed in 88.9% of patients <25 years of age, 56.0% of patients 25 to 40 years, and 32.9% of patients >40 years ( P < .001); and 41.9% of patients with Tegner level 3 to 6, and 82.8% of patients with Tegner level 7 to 10. Age <25 years (odds ratio [OR], 7.4; P < .001) and higher Tegner levels (OR, 4.2; P < .001) were predictive of failing nonoperative treatment in multivariate analysis. Patients in the failed nonoperative group had longer time from diagnosis to surgery than the direct reconstruction group (6.2 vs 2.2 months; P < .001), and more frequently had new meniscal injuries (17.4% vs 3.1%; P < .001) at surgery. Conclusion: Nonoperative treatment of ACL injuries failed in 60% of patients and was highly correlated with age and activity level. In patients aged 25 years or younger or participating in higher-impact sports, early ACL reconstruction should be considered to prevent longer delay between injury and surgery, as well as new meniscal injuries.

Sign in / Sign up

Export Citation Format

Share Document