scholarly journals Twin athlete brothers with open physes operated for ACL reconstruction on the same day, but with different elapsed times after injury: a 5-year follow-up

2014 ◽  
Vol 2014 (feb06 2) ◽  
pp. bcr2013202650-bcr2013202650 ◽  
Author(s):  
D. C. Astur ◽  
D. Lauxen ◽  
B. Ejnisman ◽  
M. Cohen
Keyword(s):  
Acl Reconstruction ◽  
Open Physes

scholarly journals Mid-Term Patient Reported Outcomes and Return to Sport for Physeal Sparing ACL Reconstruction in Skeletally Immature Patients

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0033
Author(s):  
Lauren K. Szolomayer ◽  
Carl W. Nissen ◽  
Christine Mary Kelly ◽  
Regina Kostyun
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Return To Sport ◽  
Chronological Age ◽  
Open Physes ◽  
Recreational Athletes ◽  
Patient Reported ◽  
Competitive Athletes ◽  
Physeal Sparing

Objectives: Physeal-sparing techniques for anterior cruciate ligament (ACL) reconstruction have previously been described as safe treatment for adolescent ACL tears in patients with open physes, however few studies to date have reported on return-to-sport or patient reported outcome scores for this specific patient population. This study examined patient reported outcomes in children who underwent a physeal-sparing ACL reconstruction with a minimum of two-year follow-up. Methods: Surgical logs of ACLR performed at a single pediatric/adolescent sports medicine center from 2011 to 2016 were reviewed. Patients with open physes who had ACLR with a hybrid physeal sparing or all-epiphyseal technique were identified. Patients were treated by one of two pediatric sports trained orthopedic surgeons. Their demographics, operative reports, rehabilitative course, time to return-to-play, and post-operative course were retrospectively reviewed. Prospective patient reported outcomes scores, ACL-Return to Sport after Injury (ACL-RSI) and International Knee Documentation Committee (IKDC) or Pediatric IKDC (Pedi-IKDC) and return to sport questionnaire including pre-injury primary sport and competition level, ability to return to pre-injury level of competition following ACLR and subsequent ACL injury were collected. Results: There were 49 patients who met inclusion criteria. Prospectively collected data was obtained for 25 patients at an average of 4.6 (range 2.1-8.0) years following surgery. The average chronological age of patients at time of surgery was 12.8 ± 1.4 years with an average bone age of 13.5 ± 1.3 years. At mid-term follow-up, the average chronological age was 17.2 ± 2.0 years. Average Pedi-IKDC or IKDC score was 94.2 ± 9.2 and ACL-RSI Score was 89.2 ± 18.3. There were 23 patients who considered themselves athletes prior to surgery, 8 patients identifying as recreational athletes competing in town or school leagues and 15 patients identifying as competitive athletes participating on youth travel or club leagues. All patients reported the ability to return to their primary sport following ACLR, with 74% returning to the same or higher level of competition, of which 6 were recreational athletes and 11 were competitive athletes. In addition, 6 patients did not complete outcomes data, but had suffered tear of their ipsilateral (3) or contralateral (3) side and were treated at the same facility. These patients were included in calculation of overall re-tear rate of 12.5% (5 patients) and contralateral tear of 25% (8 patients). Conclusion: Mid-term results of patients treated with a hybrid physeal-sparing or all-epiphyseal ACLR were favorable, with adolescents reporting a high level of functional ability and strong psychological readiness to engage in athletic activities. Re-tear and contralateral tear rates were equivalent to other reported studies. These physeal-sparing techniques demonstrate the ability for young athletes to successfully remain physically active and involved in their sports several years following surgery.

Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

2021 ◽  
pp. 036354652110273
Author(s):  
Joshua S. Everhart ◽  
Sercan Yalcin ◽  
Kurt P. Spindler
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Increased Risk ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

scholarly journals Long term results after transepiphysal ACL reconstruction in children and adolescent

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0001
Author(s):  
Christian Eberle ◽  
Wolfgang Schopf ◽  
Andree Ellermann
Keyword(s):  
Acl Reconstruction ◽  
Cartilage Damage ◽  
Long Term Results ◽  
Angular Deformity ◽  
Leg Length ◽  
Growth Disturbance ◽  
Children And Adolescent ◽  
The Mean

The aim of our study was to review the long term clinical and radiological (MRI) outcomes of adult patients who underwent ACL reconstruction as children or adolescent with emphasize to the features of growth disturbance, angular deformity, meniscal and cartilage damage and revision rate We retrospectively evaluated patient who underwent ACL reconstruction in our clinic with arthroscopic transepiphyseal technique using hamstrings graft in childhood or adolescence between the years 1997 and 2009. A total of 43 Patients were assessed. 25 male and 18 female. The average age at time of surgery was 13,5 years (8 - 16 y.), at time of assessement 22,4 years (18 - 30 y.) . The mean follow up was 10 years (4 - 16 years). The physical development of the patients was assessed with the Lysholm score and the Cincinnati Knee score scale, their satisfaction was recorded on the basis of the IKDC subjective knee evaluation form and the Tegner activity score . Leg deformity or leg length discrepancy was evaluated clinically by the observers. The instrumented Lachman test using KT1000 and manual Pivot shift test was performed to assess knee stability. MRI was used to detect graft integrity, cartilage and meniscal damages. No significant leg deformities or leg length discrepancy had been detected. The average Lysholm score was 91 points (83 - 100), the Cincinnati Knee Score was 90,4 (79 - 100) points on average . The mean IKDC score was 92 points (82 -100). The Tegner-Activity-Score changed from preop 6,8 (2-10) to post op 5,8 (2-9). 2 Patient underwent revision ACL reconstruction due to rerupture (3 and 9 years post op). 2 Patients underwent meniscal surgery during follow up (1 resection and one refixation). KT1000 evaluation showed 67% excellent, 21% good and in 12% bad results. The MRI scan showed 42 intact grafts and one unverifiable graft. One patient with cartilage damage up to 3° (ICRS), 3 patients with meniscal degeneration up to grade 2. Each patient showed a free range of motion Our data underlines that transepiphyseal ACL reconstruction in children and adolescent with hamstrings is a save procedure leading to good long term results without causing angular deformity or growth disturbance

scholarly journals GRAFT CHOICE FOR ADOLESCENT ATHLETES RETURNING TO HIGH-RISK SPORTS: A MATCHED COHORT ANALYSIS OF PATELLAR TENDON AND HAMSTRING AUTOGRAFTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0007
Author(s):  
Crystal Perkins ◽  
Michael Busch ◽  
Melissa Christino ◽  
Belinda Schaafsma ◽  
S. Clifton Willimon
Keyword(s):  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Graft Rupture ◽  
Graft Choice ◽  
Anterior Cruciate

Background: Graft selection for skeletally mature adolescents undergoing anterior cruciate ligament (ACL) reconstruction is guided by surgeon and patient preference. In young patients returning to high-risk cutting and pivoting sports, graft rupture is the most feared complication of ACL reconstruction. Some studies have demonstrated slightly lower rates of graft failure and decreased laxity in the short term associated with patellar tendon (BTB) autografts as compared to hamstring (HS) autografts, but these studies are limited by their heterogeneity of ages and activity level1-3. The purpose of this study is to compare the rates of graft failure between BTB and HS ACL reconstruction cohorts matched by age, sex, and sport. Methods: A single-institution retrospective review was performed of consecutive patients less than 19 years of age treated with ACL reconstructions using either patellar tendon (BTB) or hamstring (HS) autograft performed by a single surgeon. Skeletally mature or nearly mature patients in “high-risk” ACL injury sports (basketball, football, soccer, lacrosse, and gymnastics) were initially treated with hamstring autografts but the graft preference transitioned to BTB autografts as the preferred graft choice during the study period. This transition in graft preference for adolescents participating in “high risk” sports allows for a comparison of outcomes based on graft types. Inclusion criteria were ages 13 – 18 years, participation in a “high risk” sport, and minimum 6-month follow-up. The two cohorts of patients were matched by age, gender, and sport. The primary outcome measure was graft rupture. Results: One hundred fifty-two patients with an average age of 16 years (range 13 – 18 years) underwent ACL reconstruction during the study period. There were 71 BTB reconstructions and 81 HS reconstructions. There were 64 females and 88 males. There was no difference in age, sex, BMI, or laterality between groups. There were more patients who played soccer in the BTB cohort (44%) vs HS cohort (20%) and fewer who played basketball in the BTB cohort (24%) vs HS cohort (41%), p = 0.005. There were no differences between the BTB and HS cohorts in terms of meniscus tears (61% v 72%, p = 0.15), meniscus repair (21% v 32%, p = 0.13), or partial meniscectomy (32% v 33%, p = 0.90). Mean duration of follow-up was 28 months (range 7-57 months). There was no difference in follow-up between cohorts (BTB 28 months and HS 29 months, p = 0.19). There were a total of 16 graft ruptures (10.5%). There was no difference in the rate of graft rupture between cohorts (BTB 8.5% vs HS 12.3%, p = 0.60). Mean time to graft rupture was 21 months (range 8 – 35 months) and Kaplan-Meier survival curves demonstrated no difference between cohorts. Conclusions: ACL reconstruction in adolescents returning to high-risk sports can be performed utilizing BTB or HS autografts with similar rates of graft rupture. There is a trend toward lower rates of graft rupture associated with BTB autografts, but additional patients will be necessary to determine if this trend will become a statistically significant difference. Beynnon BD, Johnson RJ, Fleming BC, et al. Anterior cruciate ligament replacement: comparison of bone-patellar tendon bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am 2002;84(9):1503-1513. Ho B, Edmonds EW, Chambers HG et al. Risk factors for early ACL reconstruction failure in pediatric and adolescent patients: a review of 561 cases. J Pediatr Orthop 2016. Samuelsen BT, Webster KE, Johnson NR, et al. Hamstring autograft versus patellar tendon autograft for ACL reconstruction: is there a difference in graft failure rate? A meta-analysis of 47,613 patients. Clin Orthop Relat Res 2017;475(10):2459-2468.

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.

scholarly journals One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0017
Author(s):  
Ritwik Kejriwal ◽  
Jens Buelow
Keyword(s):  
Acl Reconstruction ◽  
Single Bundle ◽  
Significant Heterogeneity ◽  
Hamstring Autograft ◽  
Rupture Rate ◽  
One Stage ◽  
Revision Acl Reconstruction ◽  
Satisfactory Outcome ◽  
Kt 1000

Objectives: Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option. Methods: Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases. Results: 66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up. Conclusion: Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.

scholarly journals Clinical Outcome, Return to Pre-injury Activities and Patients Satisfaction after Open ACL Reconstruction And Arthroscopic Reconstruction; An Experience From A Developing Country

2020 ◽  
pp. 13-17
Author(s):  
Prof. Shehzad Javed ◽  
Dr. Muhammad Farrukh Bashir ◽  
Dr. Zubair Khalid ◽  
Dr. Umair Ahmed ◽  
Prof Amer Aziz
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Outcome ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Open Technique ◽  
Arthroscopic Reconstruction ◽  
Open Procedure ◽  
Patients Satisfaction ◽  
Anterior Cruciate

Introduction: There are two techniques for reconstruction of anterior cruciate ligament (ACL), open technique and arthroscopic assisted technique. Arthroscopic assisted technique has many advantages over open procedure but it needs more expertise and cost comparatively.The objective of this study is to identify the clinical outcomes on basis of lyshlomknee score (LKS) system and find out patients satisfaction after performing both procedures in two groups separately. Material and Methods: Retrospective analysis of 600 patients undergoing open ACL reconstruction and arthroscopic reconstruction from 2005 to 2018 was done, at the Department of Orthopaedics, Ghurki Hospital, Lahore. We included all those patients who were 18 to 45 years of age and had at least 1 year follow up.

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