Anterior Open-Wedge Osteotomy in Posterior Cruciate Ligament Deficient Knees: From a Historical Perspective to First Clinical Results

2021 ◽  
Author(s):  
Andreas Weiler ◽  
Jörg Dickschas ◽  
Clemens Gwinner
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Tibial Slope ◽  
Clinical Results ◽  
Wedge Osteotomy ◽  
Open Wedge ◽  
Open Wedge Osteotomy ◽  
Early Failures ◽  
Anterior Cruciate

AbstractRecently, the bony anatomy of the proximal tibia has gained strong interest, particularly in the cruciate ligament deficient knee. Regarding the anterior cruciate ligament (ACL), several studies outlined that a steep tibial slope (≥12 degrees) contributes to early failures after ACL reconstruction. As a consequence, the first clinical reports are available on slope reducing osteotomies in revision ACL surgery. Vice versa, biomechanical as well as clinical reports suggest that a flat slope increases the load on the posterior cruciate ligament (PCL) and might contribute to a poor result after PCL reconstruction. Since many decades, slope increasing anterior open wedge osteotomies are used to treat a symptomatic genu recurvatum. The aim of the current report is to describe different surgical techniques and report our first clinical experience of an anterior open wedge osteotomy as a sole procedure in chronic PCL deficient knees with a flat tibial slope. In six cases, a mean preoperative slope of 3.7 degrees (range = 2–5 degrees) was increased to a mean of 11.5 degrees (range = 9–13 degrees). There was one case with a delayed bone healing, which was successfully treated without loss of correction by revision internal fixation and bone grafting.

scholarly journals The correlation between posterior tibial slope and dynamic anterior tibial translation and dynamic range of tibial rotation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
M.J.M Zee ◽  
M.N.J Keizer ◽  
L Dijkerman ◽  
J.J.A.M van Raaij ◽  
J.M. Hijmans ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Dynamic Range ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Wedge Osteotomy ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Before And After ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract Purpose The amount of passive anterior tibial translation (ATT) is known to be correlated to the amount of posterior tibial slope (PTS) in both anterior cruciate ligament-deficient and reconstructed knees. Slope-altering osteotomies are advised when graft failure after anterior cruciate ligament (ACL) reconstruction occurs in the presence of high PTS. This recommendation is based on studies neglecting the influence of muscle activation. On the other hand, if dynamic range of tibial rotation (rTR) is related to the amount of PTS, a “simple” anterior closing-wedge osteotomy might not be sufficient to control for tibial rotation. The purpose of this study was to evaluate the correlation between the amount of PTS and dynamic ATT and tibial rotation during high demanding activities, both before and after ACL reconstruction. We hypothesized that both ATT and rTR are strongly correlated to the amount of PTS. Methods Ten subjects were studied both within three months after ACL injury and one year after ACL reconstruction. Dynamic ATT and dynamic rTR were measured using a motion-capture system during level walking, during a single-leg hop for distance and during a side jump. Both medial and lateral PTS were measured on MRI. A difference between medial and lateral PTS was calculated and referred to as Δ PTS. Spearman’s correlation coefficients were calculated for the correlation between medial PTS, lateral PTS and Δ PTS and ATT and between medial PTS, lateral PTS and Δ PTS and rTR. Results Little (if any) to weak correlations were found between medial, lateral and Δ PTS and dynamic ATT both before and after ACL reconstruction. On the other hand, a moderate-to-strong correlation was found between medial PTS, lateral PTS and Δ PTS and dynamic rTR one year after ACL reconstruction. Conclusion During high-demand tasks, dynamic ATT is not correlated to PTS. A compensation mechanism may be responsible for the difference between passive and dynamic ATT in terms of the correlation to PTS. A moderate-to-strong correlation between amount of PTS and rTR indicates that such a compensation mechanism may fall short in correcting for rTR. These findings warrant prudence in the use of a pure anterior closing wedge osteotomy in ACL reconstruction. Trial registration Netherlands Trial Register, Trial 7686. Registered 16 April 2016—Retrospectively registered. Level of evidence Level 2, prospective cohort study

scholarly journals Developing Trends and Core Knowledge in Posterior Cruciate Ligament Research: A Bibliometric and Visualized Analysis

2021 ◽  
Author(s):  
Jinfei Li ◽  
Shuangyi Chen ◽  
Michael A. DiNenna ◽  
Shuyi Chen ◽  
Qi Chen ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Sports Medicine ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Tibial Slope ◽  
The United States ◽  
Postoperative Recovery ◽  
Research Trend ◽  
Future Research ◽  
Pcl Reconstruction

Abstract Background: The Posterior Cruciate Ligament (PCL) has important research value and broad application prospects in sports medicine. This study provides information on the present status, worldwide trends, evolutionary path and frontier research hotspots in this field. Methods: Publications from 1971 to 2021 were obtained from the Web of Science database and analyzed using VOSviewer and CiteSpace software. Results: there is an increasing trend in the relative research interests and the number of publications per year globally. The research institution with the highest documents and citations was the University of Pittsburgh. The United States showed a dominant position in publication outputs, followed by China and South Korea. Leading researchers, their cooperative relationships, and their scientific masterpieces have been identified. Arthroscopy has published the most papers in this field, followed by Knee Surgery Sports Traumatology Arthroscopy and American Journal of Sports Medicine. The publications can be divided into eight clusters: “Total knee arthroplasty”, “PCL reconstruction”, “Injury and rehabilitation”, “Anatomy and diagnosis” and “Functional assessment and etiology”. A cluster of citation keywords showed that “tibial slope” is the new research focus in the field. Conclusions: The publications about PCL research would remain in a high level of relevance for the future, based on the current global trends. Double bundle PCL reconstruction is the preferred surgical method for most PCL complex injuries. Its surgical techniques and postoperative management are making continuous progress, with doctors paying more attention to rapid postoperative recovery and improvement of patient satisfaction. Bibliometrics analysis enables us to accurately identify scholars, institutions, and journals with great academic influence in the vast and miscellaneous literature. This helps us quickly understand the current development and future research trend of the field.

scholarly journals Role of constraining staple on tibial slope in open wedge osteotomy: A comparative study

2019 ◽  
Vol 105 (7) ◽  
pp. 1377-1381
Author(s):  
Frédéric Lavoie ◽  
Cynthia Gastineau ◽  
Antoine Denis ◽  
Fidaa Al-Shafka
Keyword(s):  
Comparative Study ◽  
Tibial Slope ◽  
Wedge Osteotomy ◽  
Open Wedge ◽  
Open Wedge Osteotomy

The Learning Curve in Arthroscopic ACL Reconstruction. The impact on the Surgical Time and Postoperative Clinical Results

2018 ◽  
Vol 69 (10) ◽  
pp. 2874-2876
Author(s):  
Teodor Negru ◽  
Stefan Mogos ◽  
Ioan Cristian Stoica
Keyword(s):  
Anterior Cruciate Ligament ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Positive Impact ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Single Bundle ◽  
Surgical Time ◽  
Anterior Cruciate ◽  
The Impact

Rupture of the anterior cruciate ligament (ACL) is a common injury. The objective of the current study was to evaluate if the learning curve has an impact on surgical time and postoperative clinical outcomes after anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) using an outside-in tunnel drilling hamstrings technique. The learning curve has a positive impact on surgical time but has no influence on postoperative clinical outcomes at short time follow-up.

scholarly journals Autologous conditioned plasma in anterior cruciate ligament reconstruction with hamstrings – short term clinical results

2012 ◽  
Vol 18 (3) ◽  
pp. 111-115
Author(s):  
O.M. Russu ◽  
I. Gergely ◽  
Ancuța Zazgyva ◽  
I. Moldovan ◽  
T.S. Pop
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Interference Screw ◽  
Lysholm Score ◽  
Cruciate Ligament Reconstruction ◽  
The Mean ◽  
Anterior Cruciate

Abstract Evaluating the early clinical results of anterior cruciate ligament reconstruction using hamstrings autograft, with interference screw on the tibial side (biocomposite interference screw, ConMed-Linvatec) and continuous closed loop fixation on the femoral side (XO-Button, ConMed-Linvatec), with and without intra-articular injection of autologous conditioned plasma (ACP). Our study included 21 patients with chronic anterior cruciate ligament (ACL) ruptures for whom we performed ACL reconstruction with a hamstrings autograft. The mean age was 34 years (range, 25 to 42), 16 patients were men and 5 were women. In 10 cases we performed an intraarticular infiltration of ACP at the end of the surgical intervention. Final evaluation was performed at the end of the 6th postoperative month using the Lysholm scoring system, Tegner activity scale and objective assessment with the RolimeterTM 50A. The Lysholm score was excellent in all cases at 6 months postoperatively, with a mean Lysholm score of 90 for patients without ACP and 91.09 for patients that received ACP; the mean Tegner activity score was also similar pre- and postoperatively for the two groups (from 3.5 and 3.63 for the group without ACP and the group with ACP to 5.6 and 5.72 respectively). Joint laxity measurement was similar for both groups. We found no graft ruptures. We found similar results after ACL reconstruction with and without intra-articular injection of PRP, but further studies are necessary to determine the exact role of these substances in speeding up the recovery process in these cases.

Anterior Cruciate Ligament Mechanoreceptors and their Potential Importance in Remnant-Preserving Reconstruction: A Review of Basic Science and Clinical Findings

2017 ◽  
Vol 31 (08) ◽  
pp. 736-746 ◽  
Author(s):  
Jonathan Kosy ◽  
Vipul Mandalia
Keyword(s):  
Anterior Cruciate Ligament ◽  
Posterior Cruciate Ligament ◽  
Clinical Studies ◽  
Basic Science ◽  
Animal Studies ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Future Research ◽  
Remnant Preservation ◽  
Anterior Cruciate

AbstractMechanoreceptors, within the anterior cruciate ligament (ACL), are believed to have importance in proprioception, contributing to dynamic knee stability. The potential for reinnervation of the ACL graft is one of the proposed advantages of remnant-preserving reconstruction. The aim of this review is to summarize advances in the basic science underpinning this function, alongside recent clinical studies, to define the current role for remnant-preservation.A comprehensive systematic review was performed using PubMed and Medline searches. Studies were analyzed with particular focus placed on the methodology used to either identify mechanoreceptors or test proprioception.Contemporary work, using immunohistological staining, has shown mechanoreceptors primarily within proximity to the bony attachments of the ACL (peripherally in the subsynovial layer). The number of these receptors has been shown to decrease rapidly, following rupture, with adhesion to the posterior cruciate ligament slowing this decline. Recent studies have shown proprioceptive deficits, in both the injured and contralateral knees, with the clinical relevance of findings limited by testing methodology and the small differences found. The advantages of remnant-preservation, seen primarily in animal studies, have not been shown in systematic reviews or meta-analysis of clinical studies.The potential for reinnervation of the graft is likely time-dependent and reliant on continued loading of the remnant. Therefore, current clinical use and future research should focus on preserving remnants within 6 months of injury that remain loaded by adherence to the posterior cruciate ligament. Subsequent testing should account for central neurological changes and focus on clinically relevant outcomes.

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