Short stay and less pain after ambulatory anterior cruciate ligament (ACL) repair: COX-2 inhibitor versus glucocorticoid versus both combined

2011 ◽  
Vol 56 (1) ◽  
pp. 95-101 ◽  
Author(s):  
V. DAHL ◽  
U. J. SPRENG ◽  
M. WAAGE ◽  
J.C. RAEDER
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Short Stay ◽  
Acl Repair ◽  
Cox 2 ◽  
Anterior Cruciate

scholarly journals Satisfactory patient-reported outcomes at 5 years following primary repair with suture tape augmentation for proximal anterior cruciate ligament tears

2021 ◽  
Author(s):  
Graeme P. Hopper ◽  
Joanna M. S. Aithie ◽  
Joanne M. Jenkins ◽  
William T. Wilson ◽  
Gordon M. Mackay
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Reported Outcomes ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Acl Repair ◽  
Patient Reported ◽  
Activity Scale ◽  
Anterior Cruciate ◽  
Suture Tape

Abstract Purpose An enhanced understanding of anterior cruciate ligament (ACL) healing and advancements in arthroscopic instrumentation has resulted in a renewed interest in ACL repair. Augmentation of a ligament repair with suture tape reinforces the ligament and acts as a secondary stabilizer. This study assesses the 5-year patient-reported outcomes of primary repair with suture tape augmentation for proximal ACL tears. Methods Thirty-seven consecutive patients undergoing ACL repair with suture tape augmentation for an acute proximal rupture were prospectively followed up for a minimum of 5 years. Patients with midsubstance and distal ruptures, poor ACL tissue quality, retracted ACL remnants and multiligament injuries were excluded. Patient-reported outcome measures were collated using the Knee Injury and Osteoarthritis Outcomes Score (KOOS), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12-Item Health Survey (VR-12) and the Marx Activity Scale. Patients with a re-rupture were identified. Results Three patients were lost to follow-up leaving 34 patients in the final analysis (91.9%). The mean KOOS at 5 years was 88.5 (SD 13.8) which improved significantly from 48.7 (SD 18.3) preoperatively (p < 0.01). The VAS score improved from 2.3 (SD 1.7) to 1.0 (SD 1.5) and the VR-12 score improved from 35.9 (SD 10.3) to 52.4 (SD 5.9) at 5 years (p < 0.01). However, the Marx activity scale decreased from 12.4 (SD 3.4) pre-injury to 7.3 (SD 5.2) at 5 years (p = 0.02). Six patients had a re-rupture (17.6%) and have since undergone a conventional ACL reconstruction for their revision surgery with no issues since then. These patients were found to be younger and have higher initial Marx activity scores than the rest of the cohort (p < 0.05). Conclusion Primary repair with suture tape augmentation for proximal ACL tears demonstrates satisfactory outcomes in 28 patients (82.4%) at 5-year follow-up. Six patients sustained a re-rupture and have no ongoing problems following treatment with a conventional ACL reconstruction. These patients were significantly younger and had higher initial Marx activity scores. Level of evidence Level IV.

scholarly journals Primary ACL Repair vs Reconstruction: Investigating the Current Conventional Wisdom

2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0004 ◽  
Author(s):  
Gabriella Bucci ◽  
Michael Begg ◽  
Kevin Pillifant ◽  
Steven B. Singleton
Keyword(s):  
Anterior Cruciate Ligament ◽  
Sports Medicine ◽  
Cruciate Ligament ◽  
Conventional Wisdom ◽  
Acl Repair ◽  
Arthroscopic Technique ◽  
Anterior Cruciate ◽  
Injured Knee

BACKGROUND: “Why try to convert other collagen substitutes into ligament if the original can be preserved?” said Sherman1. Nowadays, reconstruction became the gold standard treatment for ACL injuries. Despite current treatment, secondary knee osteoarthritis has been described in more than 70% of the injured patients after 10 years follow up.2 Recent studies have reported that tears involving the proximal ACL have an intrinsic healing response. This response has been compared to the one observed in MCL injuries.3, 4. OBJECTIVE: The aim of this study is to initiate a scientific analysis of our experience in patients diagnosed with an acute, proximal ACL tear treated with a primary repair arthroscopic technique. We suggest the creation of a symposium that reconsiders the ACL repair as a tool for treatment, on a selected subset of patients. METHODS: We analyzed retrospectively the data of 12 consecutive patients diagnosed clinically and radiologically (MRI) with proximal ACL tears in our clinic. The inclusion criteria were: proximal ACL tear (type 1 tear in Sherman´s classification), good remaining ACL quality tissue and less than 3 months from injury. The mean age at time of surgery was 33 years (16 to 55). Patients included in this study are athletes either at an amateur or professional level. The technique consists of an anatomical reinsertion of native ACL by reinforcing the anteromedial and posterolateral bundles of the ACL with a series of high strength locking Bunnell-type sutures, moving up the ligament from distal to proximal with an arthroscopic suture passer. The normal ACL insertional footprint within the notch is then debrided to provide a bleeding surface for healing. Finally, the torn ligament is opposed to the native footprint using 1-2 absorbable anchors that recreate the anatomic bundle insertional sites of the native ACL. RESULTS: Associated injuries were found in 7 of the 12 patients, these included 4 knees with lateral and 1 with medial meniscal tear which were repaired in the same procedure. Also, one knee had a medial bucket handle tear, partial meniscectomy was performed, and one knee with a combined ACL/MCL injury in which the MCL was simultaneously repaired. In our ongoing series, were excluded patients that had sustained complex knee injuries with multi-ligament damage (except ACL/MCL injuries), those with ACL re-ruptures, and previous knee surgery with cartilage repair procedures. Validated functional outcomes scores were collected after a mean follow up of 20 months (14-26). For the IKDC subjective score 11 of 12 patients rated their knees as normal or nearly normal. Lachman and Pivot Shift was negative in all patients. Lysholm score postoperatively averaged 93.5 ± 7; preoperatively 48 ± 7. Tegner preinjury 7.5 ± 1.2 postinjury: 7 ± 1.4. The KT-1000 knee arthrometer, objectively measured < 3 mm of anterior tibial motion relative to the femur in the injured knee compared to the non-injured knee at all levels of force, including manual max tests, in all patients included in the study. No complications or further surgeries are reported up to date. CONCLUSION: The keys to success include: Proper patient selection, early intervention, all arthroscopic technique, appropriate suture control of the torn ACL fibers, and stable opposition to a bleeding bone surface at the native attachment site within the femoral notch. Long-term data is pending. However, basic science and early clinical studies are promising. REFERENCES Mark F. Sherman, MD, Lawernce Lieber, MD, Joel R. Bonamo, MD, Luga Podesta, MD, Ira Reiter, RPT., The long-term followup of primary anterior cruciate ligament repair, 1991, The American Journal of Sports Medicine, Vol. 19, No 3. Martha M. Murray, MD. Current Status and Potential for Primary ACL Repair. 2009. Clin Ssports Med. Duy Tan Nguyen, Tamara H. Ramwadhdoebe, Cor P. van der Hart, Leendert Blankervoort, Paul Peter Tak, Cornelis Niek van Dijk., Intrinsic Healing Response of the Human Anterior Cruciate Ligament: An Histological Study of Reattached ACL Remnants, 2014, Journal of Orthopaedic Research. Martha M. Murray, MD, Braden C. Fleming, Ph.D., Use of a Bioactive Scaffold to Stimulate ACL Healing Also Minimizes Post-traumatic Osteoarthritis after Surgery, 2014, American Journal of Sports Medicine. Primary ACL Repair vs Reconstruction: Investigating the Current Conventional Wisdom

scholarly journals Predictors of Healing Ligament Size and Magnetic Resonance Signal Intensity at 6 Months After Bridge-Enhanced Anterior Cruciate Ligament Repair

2019 ◽  
Vol 47 (6) ◽  
pp. 1361-1369 ◽  
Author(s):  
Martha M. Murray ◽  
Ata M. Kiapour ◽  
Leslie A. Kalish ◽  
Kirsten Ecklund ◽  
Christina Freiberger ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Acl Repair ◽  
Cross Sectional ◽  
Anterior Cruciate

Background: Primary repair of the anterior cruciate ligament (ACL) augmented with a tissue engineered scaffold to facilitate ligament healing is a technique under development for patients with ACL injuries. The size (the amount of tissue) and signal intensity (the quality of tissue) of the healing ligament as visualized on magnetic resonance imaging (MRI) have been shown to be related to its strength in large animal models. Hypothesis: Both modifiable and nonmodifiable risk factors could influence the size and signal intensity of the repaired ligament in patients at 6 months after surgery. Study Design: Case series; Level of evidence, 4. Methods: 62 patients (mean age, 19.4 years; range, 14-35 years) underwent MRI of the knee 6 months after ACL repair augmented with an extracellular matrix scaffold. The signal intensity (normalized to cortical bone) and average cross-sectional area of the healing ligament were measured from the MRI stack obtained by use of a gradient echo sequence. Associations between these 2 measures and patient characteristics, which included demographic, clinical, and anatomic features, were determined by use of multivariable regression analysis. Results: A larger cross-sectional area of the repaired ligament at 6 months was associated with male sex, older age, and the performance of a larger notchplasty ( P < .05 for all associations). A lower signal intensity at 6 months, indicating greater similarity to normal ligament, was associated with a smaller tibial slope and greater side-to-side difference in quadriceps strength 3 months after surgery. Other factors, including preoperative body mass index, mechanism of injury, tibial stump length, and Marx activity score, were not significantly associated with either MRI parameter at 6 months. Conclusion: Modifiable factors, including surgical notchplasty and slower recovery of quadriceps strength at 3 months, were associated with a larger cross-sectional area and improved signal intensity of the healing ACL after bridge-enhanced ACL repair in this preliminary study. Further studies to determine the optimal size of the notchplasty and the most effective postoperative rehabilitation strategy after ACL repair augmented by a scaffold are justified. Registration: NCT02664545 (ClinicalTrials.gov identifier).

scholarly journals Method for Determining the Isometricity of the Location of the Femoral and Tibial Tunnels Before Their Formation in The Anterior Cruciate Ligament Plasty

2021 ◽  
Vol 9 (4) ◽  
pp. 580-585
Author(s):  
V. V. Slastinin ◽  
N. V. Yarygin ◽  
M. V. Parshikov ◽  
A. M. Fain ◽  
M. V. Sychevsky
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Original Method ◽  
Acl Repair ◽  
Key Points ◽  
Anterior Cruciate ◽  
Fixation Points ◽  
Flexion And Extension

Relevance. One of the key points in plasty of the anterior cruciate ligament (ACL) is the isometric position of the graft, in which its tension remains the same during flexion and extension of the knee joint. However, no method has been described today for the intraoperative determination of the isometricity of the location of the femoral and tibial tunnels (for placing the graft) before their formation.Purpose of the study. To develop a method for intraoperative determination of the isometricity of the location of the femoral and tibial tunnels before their formation during ACL plasty and to study its effectiveness.Material and methods. The study included 30 patients who underwent ACL repair. For a preliminary intraoperative assessment of the isometric areas of graft fixation on the femur and tibia, the proposed original method with the use of two knot pushers and a thread passing through them. Isometry was assessed by the degree of displacement of this thread. After determining the isometric areas of fixation, the femoral and tibial tunnels were formed, and the isometric position of the graft before its fixation in the tibia was checked by the degree of displacement of the threads with which the graft was sutured relative to the aperture of the tibial tunnel.Results. The average displacement of the thread relative to the pusher of the knot in the preliminary determination of the isometric areas of fixation according to the proposed method corresponded to the displacement of the threads with which the distal end of the graft was sewn relative to the outer aperture of the tibial tunnel (this value did not exceed 2 mm on average) until the final fixation of the graft in the tibial tunnel.Conclusion. The developed method makes it possible to determine the isometric location of the femoral and tibial tunnels during arthroscopic plasty of the anterior cruciate ligament before their formation. If the location of the fixation points on the femur and tibia is determined non-isometric, it is possible to correct their position.

Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair

2021 ◽  
pp. 194173812110329
Author(s):  
Jocelyn Wu ◽  
Jamie L. Kator ◽  
Michael Zarro ◽  
Natalie L. Leong
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Ligament Repair ◽  
Acl Repair ◽  
Pubmed Database ◽  
Anterior Cruciate Ligament Repair ◽  
Ligament Augmentation ◽  
Internal Bracing ◽  
Anterior Cruciate ◽  
Repair Techniques

Context: Injury to the anterior cruciate ligament (ACL) is among the most common orthopaedic injuries, and reconstruction of a ruptured ACL is a common orthopaedic procedure. In general, surgical intervention is necessary to restore stability to the injured knee, and to prevent meniscal damage. Along with surgery, intense postoperative physical therapy is needed to restore function to the injured extremity. ACL reconstruction (ACLR) has been the standard of care in recent decades, and advances in surgical technology have reintroduced the prospect of augmented primary repair of the native ACL via a variety of methods. Evidence Acquisition: A search of PubMed database of articles and reviews available in English was performed through 2020. The search terms ACLR, anterior cruciate ligament repair, bridge enhanced acl repair, suture anchor repair, dynamic intraligamentary stabilization, internal bracing, suture ligament augmentation, and internal brace ligament augmentation were used. Study Design: Clinical review. Level of Evidence: Level 5. Results: No exact consensus exists on effective rehabilitation protocols after ACL repair techniques, as the variation in published protocols seem even greater than the variation in those for ACLR. For some techniques such as internal bracing and dynamic interligamentary stabilization, it is likely permissible for the patients to progress to full weightbearing and discontinue bracing sooner. However, caution should be applied with regard to earlier return to sport than after ACLR as to minimize risk for retear. Conclusion: More research is needed to address how physical therapies must adapt to these innovative repair techniques. Until that is accomplished, we recommend that physical therapists understand the differences among the various ACL surgery techniques discussed here and work with the surgeons to develop a rehabilitation protocol for their mutual patients. Strength of Recommendation Taxonomy (SORT): C.

scholarly journals Postoperative Magnetic Resonance Imaging following Arthroscopic Primary Anterior Cruciate Ligament Repair

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Jelle P. van der List ◽  
Douglas N. Mintz ◽  
Gregory S. DiFelice
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Cruciate Ligament ◽  
First Year ◽  
Time Interval ◽  
Resonance Imaging ◽  
Acl Repair ◽  
Postoperative Magnetic Resonance Imaging ◽  
Anterior Cruciate

Introduction. Recently, there has been a resurgence of interest in arthroscopic primary anterior cruciate ligament (ACL) repair. To date, no studies have assessed the role of postoperative magnetic resonance imaging (MRI) on the status and maturation of the repaired ligament. The goal of this study was therefore to assess (I) the accuracy of MRI on rerupture of the repaired ligament and (II) the maturation of the repaired ACL. Methods. All postoperative MRIs of patients that underwent arthroscopic primary ACL repair were included. A musculoskeletal radiologist, blinded for MRI indication, surgery-MRI time interval, and clinical stability, retrospectively assessed the ligament continuity and graded ligament maturation as hypointense (similar to intact PCL), isointense (>50% similar to PCL), or hyperintense (<50% similar to PCL). Results. Thirty-seven MRIs were included from 36 patients. Mean age was 30 years (range: 14–57 years), and mean surgery-MRI interval was 1.5 years (range: 0.1–4.9 years). The radiologist recognized 6 out of 8 reruptures and 26 out of 29 intact ligaments (sensitivity 75%, specificity 90%, and accuracy 86%). Ligaments in the first year were more often hyperintense than after one year (60% vs. 11%, p=0.02), most often isointense (60%) between one and two years, and more often hypointense after two years than before two years (56% vs. 10%, p=0.03). Conclusion. Postoperative MRI was found to accurately predict the rerupture of the primarily repaired ACL. Furthermore, it can be expected that the repaired ligament is hyperintense within the first year, while the signal becomes similar to the intact PCL after two years.

Is There a Role for Internal Bracing and Repair of the Anterior Cruciate Ligament? A Systematic Literature Review

2017 ◽  
Vol 46 (9) ◽  
pp. 2291-2298 ◽  
Author(s):  
Carola F. van Eck ◽  
Orr Limpisvasti ◽  
Neal S. ElAttrache
Keyword(s):  
Anterior Cruciate Ligament ◽  
Success Rate ◽  
Platelet Rich Plasma ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Young Patients ◽  
Acl Repair ◽  
Internal Bracing ◽  
Electronic Database Search ◽  
Anterior Cruciate

Background: Renewed interest has arisen in arthroscopic anterior cruciate ligament (ACL) repair techniques. Hypothesis: ACL repair with or without some form of internal bracing could lead to good outcomes in a carefully selected subset of patients. Study Design: Systematic review. Methods: An electronic database search was performed to identify 89 papers describing preclinical and clinical studies on the outcome of ACL repair. Results: Proximal ACL tear patterns showed a better healing potential with primary repair than distal or midsubstance tears. Some form of internal bracing increased the success rate of ACL repair. Improvement in the biological characteristics of the repair was obtained by bone marrow access by drilling tunnels or microfracture. Augmentation with platelet-rich plasma was beneficial only in combination with a structural scaffold. Skeletally immature patients had the best outcomes. Acute repair offered improved outcomes with regard to load, stiffness, laxity, and rerupture. Conclusion: ACL repair may be a viable option in young patients with acute, proximal ACL tears. The use of internal bracing, biological augmentation, and scaffold tissue may increase the success rate of repair.

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