In-vivo pivot-shift test measured with inertial sensors correlates with the IKDC grade

2018 ◽  
Vol 3 (2) ◽  
pp. 89-93 ◽  
Author(s):  
Giulio Maria Marcheggiani Muccioli ◽  
Cecilia Signorelli ◽  
Alberto Grassi ◽  
Tommaso Roberti di Sarsina ◽  
Federico Raggi ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Case Series ◽  
Pivot Shift Test ◽  
Female Ratio ◽  
The Mean ◽  
Over The Top ◽  
Clinical Grading

ObjectivesKinematic Rapid Assessment (KiRA) is a wireless, non-invasive, inertial system with a single tibial sensor developed to measure the pivot-shift (PS) test. The purpose of this study was to in-vivo compare acceleration values acquired by KiRA to the objective International Knee Documentation Committee (IKDC) clinical grading of PS. The comparison was performed in non-anaesthetised patients before and after anterior cruciate ligament (ACL) reconstruction. We hypothesised the existence of a correlation between the side-to-side difference in the measured acceleration range by KiRA and the objective IKDC clinical grading of the PS.MethodsBetween 2010 and 2014, 60 non-professional football players (male/female ratio: 42/18; mean age 34±15.4 years, range 14–51 years) with ACL lesion were enrolled. They underwent over-the-top ACL reconstruction plus lateral extra-articular plasty with autologous hamstrings. All the patients were evaluated before the reconstruction and re-evaluated at 12-month follow-up. Each patient underwent a clinical examination and then was subjected to the instrumental PS examination by KiRA. The difference in the acceleration range between injured/reconstructed and contralateral limb (Δarange) was used in the analysis. Correlations between Δarange values and objective IKDC clinical grades of PS were calculated using Spearman correlation analysis.ResultsAll subjective scores improved from preoperative to follow-up (P≤0.01). Objective IKDC clinical grading of the PS improved from 4B, 40C and 16D to 50A, 8B and 2C (P<0.0001). The mean Δarange measured by KiRA improved from 2.0±1.0 to 0.2±0.4 m/s2(P<0.0001). A very strong correlation was displayed between the overall Δarange measured by KiRA and overall objective IKDC clinical grading of the PS (r=0.86, P<0.0001); correlation was strong for preoperative data (r=0.71, P<0.0001) and moderate for postoperative data (r=0.53, P<0.0001). The mean Δarange resulted 0.3±0.3 m/s2for the IKDC A subgroup, 0.8±0.3 m/s2for the IKDC B subgroup, 1.7±0.8 m/s2for the IKDC C subgroup and 2.9±0.9 m/s2for the IKDC D subgroup.ConclusionThe side-to-side difference in the measured acceleration range by KiRA shows a correlation with objective IKDC clinical grading of PS.Study designCase series; level of evidence: 4.

scholarly journals Combined Intra- and Extra-Articular Technique in Revision Anterior Cruciate Ligament Reconstruction

Joints ◽  
2017 ◽  
Vol 05 (03) ◽  
pp. 156-163 ◽  
Author(s):  
Jessica Zanovello ◽  
Federica Rosso ◽  
Alessandro Bistolfi ◽  
Roberto Rossi ◽  
Filippo Castoldi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Return To Sport ◽  
Surgical Removal ◽  
Level Of Evidence ◽  
Anterior Cruciate ◽  
Over The Top

Purpose The aim of the study was to evaluate the “over the top” (OTT) nonanatomical technique for revision of anterior cruciate ligament (ACL) reconstruction. Methods Twenty-four patients with a mean age of 31.9 ± 11.2 years underwent revision of ACL reconstruction using OTT technique. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner score, Subjective Patient Outcome for Return to Sport (SPORTS) score, Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, and KT-1000 evaluation were recorded at a mean follow-up of 30.7 ± 18.9 months. Results Postoperatively, the IKDC objective total score significantly improved (p = 0.0046). The KOOS, Lysholm, and Tegner scores also improved, but the results were not statistically significant (62.4 vs. 72.6, 6.5 vs. 75.8, and 4.1 vs. 6.0, respectively). The subjective IKDC evaluation score improved from an average of 51.1 points to 63.7 points at the last follow-up (p = 0.0027). The RTP prevalence was 81.8%, with 44.4% of the patients returning to the same preinjury level. According to the SPORTS score, 16.6% of patients played sport without limitations in activity and performance. The average ACL-RSI score was 52.1 ± 27.0. No major complications were reported. A total of 21.5% of patients underwent surgical removal of staples. The failure prevalence was 14.3% and the cumulative survivorship, calculated using the Kaplan–Meier method, was equal to 70% at 60 months of follow-up. Conclusion The OTT technique in the revision ACL reconstruction provided improvement in objective and subjective scores, good RTP prevalence, and acceptable rate of complication and failure. One of the advantages was the possibility to avoid the femoral tunnel. Level of Evidence Level IV, therapeutic case series.

scholarly journals Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee

2021 ◽  
Author(s):  
Xuelei Wei ◽  
Zengliang Wang ◽  
Yandong Lu ◽  
Jie Sun ◽  
John Riehl
Keyword(s):  
Avulsion Fracture ◽  
Pivot Shift ◽  
Anterolateral Ligament ◽  
Lysholm Score ◽  
Pivot Shift Test ◽  
X Rays ◽  
Avulsion Fractures ◽  
Ikdc Score ◽  
The Mean

AbstractThe existence and anatomy of the anterolateral ligament (ALL) of the knee are a somewhat controversial topic in orthopaedic surgery. The fixation of the avulsion fracture of the ALL (Segond fracture), associated with periarticular knee fractures, is rarely given much consideration while the major fracture fragments are reconstructed. This study aims to confirm the existence of ALL and evaluate the clinical outcomes of surgical management for avulsion fractures, involving its insertion, when associated with periarticular knee fractures. Twenty-three patients (16 males and 7 females) with avulsion fractures of the ALL associated with periarticular knee fractures were fixed with a spider plate, cannulated screw, or suture anchor. Eight patients were diagnosed with distal femoral fracture, 10 with tibial plateau fracture, and 5 with tibial eminence avulsion fracture. All patients underwent X-rays at follow-up. Clinical and functional outcomes were assessed with the pivot-shift test, objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale. The ALL was found and identified as a distinct ligamentous structure in all patients. Prior to Segond repair, patients had significantly more instability, as determined by pivot-shift test, than seen postoperatively (p < 0.0001). At final follow-up, the mean subjective IKDC score was 83.2 ± 10.3. Fourteen patients were graded A, 6 were graded B, and 3 was graded C on the IKDC objective score. The mean Lysholm score was 85.4 ± 12.2. The mean Tegner score was 7.5 ± 1.2. This study confirmed that the ALL is a distinct structure in the anterolateral portion of the knee. The fixation of the avulsion fracture of the ALL associated with periarticular knee fractures can be an effective procedure without specific complications. Long-term and comparative follow-up studies are necessary to confirm the effects.

scholarly journals Arthroscopic Reduction and Fixation by Cerclage Wire Loop for Tibial Spine Avulsion in Adults: Short-term Results

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096311
Author(s):  
Maysara Abdelhalim Bayoumy ◽  
Mohamed M. Abdelhamid ◽  
Hesham A. Elkady ◽  
Mohamed Mosa Mohamed
Keyword(s):  
Pivot Shift ◽  
Case Series ◽  
Pivot Shift Test ◽  
Stable Fixation ◽  
Cerclage Wire ◽  
Lachman Test ◽  
Tibial Spine ◽  
Arthroscopic Reduction ◽  
Ikdc Score ◽  
The Mean

Background: Several arthroscopic techniques for the treatment of avulsion tibial spine fractures have been described in the literature. Purpose: To evaluate the outcomes of the arthroscopically assisted stainless steel wiring technique in the treatment of avulsed tibial spine in adults. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study involved 28 patients (28 knees), 16 to 42 years of age, with tibial spine avulsion fracture that was treated using arthroscopic reduction and cerclage wire fixation by a single surgeon between March 2015 and August 2018. The degrees of avulsion in these patients were type II (n = 12), type III (n = 10), and type IV fractures (n = 6). Clinical assessment included International Knee Documentation Committee (IKDC) objective score (which noted swelling), range of knee movement, Tegner activity scale, Lachman test, and pivot-shift test compared with the normal opposite knee. Results: The mean follow-up period was 24.1 months (range, 18-30 months). The mean IKDC score was 93.7 (range, 88.5-98.9); the IKDC score was normal in 22 patients and nearly normal in 6 patients. The Lachman test was grade 1 in 25 patients and grade 2 in 3 patients, whereas the pivot-shift test was grade 0 in 26 patients and grade 1 in 2 patients. All patients achieved their preinjury Tegner activity levels. Radiological assessment showed healing in all patients within a mean of 12 weeks after surgery. Conclusion: The outcomes of all patients were satisfactory; fixation by cerclage wiring permitted reduction of tibial spine fragment anatomically to its fracture bed, provided stable fixation in displaced tibial spine avulsion, and allowed for early rehabilitation and weightbearing because of stable fixation.

Accessory Anteromedial Portal may not Provide Clinically Superior Results Compared with the Anteromedial Portal in Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 31 (08) ◽  
pp. 716-722
Author(s):  
Shu-Ming Ye ◽  
Jue-Hua Jing ◽  
Hao Lv ◽  
Ji-Sen Zhang ◽  
Xin-Zhong Xu ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Pivot Shift Test ◽  
Single Bundle ◽  
Anteromedial Portal ◽  
Anterior Cruciate

AbstractTechniques using the anteromedial portal (AMP) and accessory anteromedial portal (AAMP) are commonly used in anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate the radiological and clinical outcomes of arthroscopic single-bundle ACL reconstruction using the AMP or AAMP technique to drill the femoral tunnel. The records of 157 patients who underwent single-bundle ACL reconstruction using the AMP or AAMP technique between 2011 and 2015 were reviewed. The femoral tunnel clock-face position and femoral tunnel and tibial tunnel anterior–posterior (AP) inclination angles were assessed on axial or AP magnetic resonance images. At last follow-up, the Lachman test and pivot-shift test were used to evaluate AP and rotational stability, respectively. The Lysholm knee scoring scale and the International Knee Documentation Committee (IKDC) form were used to evaluate clinical and functional results. No statistically significant differences were found between the groups in patient age, sex, follow-up period, or affected side distribution. The mean femoral tunnel inclination angle was 31.13 ± 8.06 degrees in the AMP group and 30.17 ± 9.02 degrees in the AAMP group (p = 0.513). The tibial tunnel inclination angle in the AMP group (16.28 ± 7.89 degrees) was not different from that in the AAMP group (13.70 ± 6.08 degrees). No significant differences were observed between the two groups in the Lachman test, pivot-shift test, Lysholm knee scoring scale, or IKDC scores. The AAMP technique was not clinically superior to the AMP technique in ACL reconstruction. This is a retrospective comparative study and its level of evidence is III.

Over-the-top ACL Reconstruction Plus Extra-articular Lateral Tenodesis With Hamstring Tendon Grafts: Prospective Evaluation With 20-Year Minimum Follow-up

2017 ◽  
Vol 45 (14) ◽  
pp. 3233-3242 ◽  
Author(s):  
Stefano Zaffagnini ◽  
Giulio Maria Marcheggiani Muccioli ◽  
Alberto Grassi ◽  
Tommaso Roberti di Sarsina ◽  
Federico Raggi ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Joint Space ◽  
Hamstring Tendon ◽  
Lysholm Score ◽  
Significant Difference ◽  
Lateral Tenodesis ◽  
Tegner Score ◽  
Over The Top

Background: There are few published studies with very long-term follow-up of combined intra- and extra-articular anterior cruciate ligament (ACL) reconstruction. Purpose: To analyze clinical and radiographic outcomes of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with autologous hamstrings at minimum 20-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Of 60 originally eligible patients who underwent over-the-top ACL reconstruction with double-stranded hamstring tendon (leaving intact graft tibial insertions) and extra-articular lateral plasty (performed with the remnant part of tendons), 52 were prospectively evaluated at a minimum 20-year follow-up (mean follow-up, 24 years; 41 men, 11 women; mean age at time of surgery, 25.5 ± 7.6 years). Twenty-nine patients were available for prospective evaluations: clinical (Lysholm, Tegner, and objective International Knee Documentation Committee [IKDC]), instrumented (KT-2000), and radiographic (standard, long-standing, and Merchant views). Subjective KOOS (Knee injury and Osteoarthritis Outcome Score) and objective inertial sensor pivot-shift analysis (KiRA) were carried out at final follow-up. Twenty-three patients were investigated by phone interview for subjective Tegner score and documented complications, rerupture, or revision surgery. Results: At final follow-up, mean Lysholm score was 85.7 ± 14.6; median Tegner score, 4 (range, 3-5); sport activity resumption, 86.2%; and objective IKDC score, good or excellent in 86% of patients (31%, A; 55%, B). Only 3 of 26 patients (12%) had >5-mm manual maximum KT-2000 side-to-side difference. KiRA system documented positive pivot-shift (>0.9-m/s2 tibial acceleration side-to-side difference) in these 3 of 26 patients (12%). Statistically significant changes were as follows: decrease in Tegner score from 7 (range, 6-8) at 5-year follow-up to 4 (range, 3-5) at 10 years ( P < .0001) and decrease in Lysholm score from 96.1 ± 7.3 at 10-year follow-up to 85.7 ± 14.6 at 20 years ( P = .0003). Radiographic evaluation demonstrated significant difference of medial joint space between injured and healthy knees in patients with concomitant medial meniscectomy (n = 8, 3.2 ± 0.6 vs 5.0 ± 1.8 mm, P = .0114). No significant differences were reported regarding lateral or patellofemoral joint space. One patient (2%) experienced rerupture, with 3 of 52 (5.8%) having a contralateral ACL injury (excluded from KT-2000 and radiographic evaluations). Overall, 4 of 29 clinical failures (objective IKDC, KT-2000) and 1 rerupture among 52 patients were registered at final follow-up. Conclusion: Studied surgical technique demonstrated good results in laxity control at 20-year minimum follow-up. The lateral extra-articular plasty associated with ACL reconstruction did not generate lateral knee or patellofemoral osteoarthritis. The factor increasing osteoarthritis was meniscectomy.

scholarly journals Clinical outcome after knee ligament reconstruction with tendon allografts

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Jon Olav Drogset ◽  
Kristina Hovde Størset ◽  
Thea Marie Nitteberg ◽  
Tone Gifstad
Keyword(s):  
Clinical Outcome ◽  
Pivot Shift ◽  
Activity Score ◽  
Pivot Shift Test ◽  
Postoperative Infections ◽  
Knee Ligament ◽  
Lachman Test ◽  
Patient Reported ◽  
The Mean

Abstract Purpose The purpose of this study is to investigate the clinical outcome for patients after knee ligament reconstructions with allografts at a university hospital. Methods A total of 33 patients received allografts for reconstructive knee surgery between 2007 and 2017. The follow up evaluation consisted of a clinical knee examination including evaluation of range of motion (ROM), lateral and medial laxity, the Lachman test, the Pivot shift test, the sag test, the posterior drawer test and checking for patellofemoral pain. The following patient-reported outcome measures (PROMs) were used; the Lysholm Function Score, the Tegner activity score, and the Knee injury and Osteoarthritis Outcome Score (KOOS). Results Twenty-one (64%) patients were available for the follow-up evaluation and the mean follow-up time was 4.8 years. A total of 16 out of 21 patients had multiligament injuries of which the ACL was the ligament most frequently ruptured. At the time of follow-up, 14 out of 16 patients (87%) with ACL injury had Lachman test grade 0 or grade 1 + , and 12 out of 13 (92%) had a pivot shift grade 0 or 1 + . The mean Lysholm Score was 74. All mean KOOS subscale values were ≥ 59 at the follow-up. The preoperative Tegner activity score was 3 (range, 1–6) and 4 (range, 2–6) at follow up. There were no deep postoperative infections. A total of 19 out of 21 patients (90%) reported that they would have undergone surgery again had they known the clinical outcome in advance. Conclusions The patients improved from the preoperative score to the follow-up score in the knee-related Quality of Life (QoL) KOOS subscale. None of the patients were diagnosed with deep postoperative infections.

scholarly journals Arthroscopic Reconstruction of Anterior Cruciate Ligaments With Allograft: Single-tunnel Double-bundle Versus Single-tunnel Single-bundle

2020 ◽  
Author(s):  
Weimin Zhu ◽  
Yuanhui Zhou ◽  
Kang Chen ◽  
Yizi Zheng ◽  
Wei Lu ◽  
...  
Keyword(s):  
Knee Joint ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Double Bundle ◽  
Pivot Shift Test ◽  
Single Bundle ◽  
Arthroscopic Reconstruction ◽  
Anterior Cruciate ◽  
The Stability

Abstract Purpose Arthroscopic reconstruction of anterior cruciate ligament (ACL) commonly adopted single-tunnel single-bundle (STSB) or double-tunnel double-bundle (DTDB) methods. Though single-tunnel double-bundle (STDB) has been used in clinical practice, the efficacy remains unclear. The objective of this study is to compare the clinical results of ACL reconstruction using the STDB and STSB techniques. Methods Between March 2010 to June 2013, 78 patients with ACL rupture underwent arthroscopic STDB reconstruction (42 cases) or STSB reconstruction (36 cases) using anterior tibialis tendon allografts in our department. IKDC, Lysholm and Tegner scores were used to evaluate the subjective function of the knee joint during the postoperative follow-up. In addition, the Lachman test and pivot shift test were used to objectively assess the stability of the knee. Results The average follow-up time is 24.2 ± 5.7 months in the STDB group, and 24.8 ± 6.6 months in the STSB group. Patients in both groups recovered to preoperative sports level with few complications. The postoperative Lysholm, IKDC, Tegner scores, and knee joint stability were significantly improved compared to preoperative status in both groups (P < 0.05). However, no statistically significant difference was observed between the two groups at the final follow-up (P > 0.05), except for the improvement of pivot shift test positive rate in the STDB group compared with STSB group (P < 0.05). Conclusion Both techniques can be used to restore the stability and function of the knee joint with satisfactory short-term efficacy, and STDB showed better rotational stability than STSB technique, indicating the STDB technique may also considered a reliable method for ACL reconstruction.

scholarly journals Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction

2020 ◽  
Vol 8 (5) ◽  
pp. 232596712091767 ◽  
Author(s):  
Kazuhisa Hatayama ◽  
Masanori Terauchi ◽  
Kenichi Saito ◽  
Ryota Takase ◽  
Hiroshi Higuchi
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Pivot Shift Test ◽  
Knee Stability ◽  
Ramp Lesion ◽  
Significant Difference ◽  
Mri Scans ◽  
The Mean ◽  
Postoperative Knee

Background: Although the biomechanical importance of the ramp lesion in the anterior cruciate ligament (ACL)–deficient knee has been demonstrated, there is no clear consensus on the appropriate treatment for ramp lesions during ACL reconstruction. Purpose: To compare the postoperative outcomes for ramp lesions between patients treated with all-inside repair through the posteromedial portal and those whose ramp lesions were left in situ without repair during ACL reconstruction. We also determined whether ramp lesion healing status affected postoperative knee stability. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 57 patients who underwent anatomic double-bundle ACL reconstruction between August 2011 and December 2017 had attendant ramp lesions. Of these, 25 ramp lesions that were considered stable were left in situ without repair (Nonrepaired group), and 25 ramp lesions, including 21 stable and 4 unstable lesions, were treated using all-inside repair through the posteromedial portal (Repaired group). We evaluated the side-to-side difference (SSD) in anterior tibial translation on stress radiographs and rotational stability by using the pivot-shift test 2 years after surgery, and healing status of the ramp lesions was evaluated on 3.0-T magnetic resonance imaging (MRI) scans 1 year after surgery. Results: The mean SSDs in anterior translation were 2.4 ± 1.6 mm for the Nonrepaired group and 1.9 ± 1.6 mm for the Repaired group, with no significant differences. The positive ratios on the pivot-shift test were not significantly different between groups. Healing rates of ramp lesions on MRI scans showed a significant difference between the Nonrepaired group (60%) and the Repaired group (100%) ( P = .001). The mean SSDs for knees in which the ramp lesion had healed as shown on MRI scans and those in which it had not healed were 1.9 ± 1.6 mm and 3.2 ± 1.1 mm, respectively, which was a significant difference ( P = .02). Conclusion: Healing rates of ramp lesions were significantly better in the Repaired group than in the Nonrepaired group, although postoperative knee stability was not significantly different between groups. Anterior laxity in the knees in which the ramp lesion was unhealed was significantly greater compared with the knees in which the ramp lesion healed. All-inside repair through the posteromedial portal was a reliable surgical procedure to heal ramp lesions.

scholarly journals Arthroscopic reconstruction of anterior cruciate ligaments with allograft: Single-tunnel double-bundle versus single-tunnel single-bundle

2021 ◽  
Author(s):  
Weimin Zhu ◽  
Yizi Zheng ◽  
Wei Lu ◽  
Jianyi Xiong ◽  
Daping Wang ◽  
...  
Keyword(s):  
Knee Joint ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Double Bundle ◽  
Pivot Shift Test ◽  
Single Bundle ◽  
Arthroscopic Reconstruction ◽  
Anterior Cruciate ◽  
The Stability

Abstract Background: Arthroscopic reconstruction of anterior cruciate ligament (ACL) commonly adopted single-tunnel single-bundle (STSB) or double-tunnel double-bundle (DTDB) methods. Though single-tunnel double-bundle (STDB) has been used in clinical practice, the efficacy remains unclear. The objective of this study is to compare the clinical results of ACL reconstruction using the STDB and STSB techniques.Methods: Between March 2010 to June 2013, 78 patients with ACL rupture underwent arthroscopic STDB reconstruction (42 cases) or STSB reconstruction (36 cases) using anterior tibialis tendon allografts in our department. IKDC, Lysholm and Tegner scores were used to evaluate the subjective function of the knee joint during the postoperative follow-up. In addition, the Lachman test and pivot shift test were used to objectively assess the stability of the knee.Results: The average follow-up time is 24.2±5.7 months in the STDB group, and 24.8±6.6 months in the STSB group. Patients in both groups recovered to preoperative sports level with few complications. The postoperative Lysholm, IKDC, Tegner scores, and knee joint stability were significantly improved compared to preoperative status in both groups (P<0.05). However, no statistically significant difference was observed between the two groups at the final follow-up (P>0.05), except for the improvement of pivot shift test positive rate in the STDB group compared with STSB group (P<0.05).Conclusion: Both techniques can be used to restore the stability and function of the knee joint with satisfactory short-term efficacy, and STDB showed better rotational stability than STSB technique, indicating the STDB technique may also considered a reliable method for ACL reconstruction.

scholarly journals Prospective Evaluation of Range of Motion in Acute ACL Reconstruction Using Patellar Tendon Autograft

2019 ◽  
Vol 7 (10) ◽  
pp. 232596711987541 ◽  
Author(s):  
Mitchell C. Harris ◽  
Connor Venrick ◽  
Adam C. Hines ◽  
Jay B. Cook ◽  
Douglas J. Rowles ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Case Series ◽  
Clinical Results ◽  
Contralateral Knee ◽  
Patellar Tendon Autograft ◽  
The Mean ◽  
Tendon Autograft

Background: Optimal timing of anterior cruciate ligament (ACL) reconstruction has been a topic of controversy. Reconstruction has historically been delayed for at least 3 weeks, given previous studies reporting a high risk of postoperative arthrofibrosis and suboptimal clinical results. Purpose: To prospectively evaluate postoperative range of motion following acutely reconstructed ACLs with patellar tendon autograft. Study Design: Case series; Level of evidence, 4. Methods: Patients (age >18 years) who had ACL reconstruction as soon as possible after injury, regardless of the condition or preoperative range of motion of the injured knee, underwent reconstruction with patellar tendon autograft. An identical standard surgical technique and postoperative rehabilitation were employed for all patients. Postoperative assessment included active range of motion measurements with a goniometer. Subjective outcomes were assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS). Results: A total of 25 consecutive patients who met the inclusion criteria were enrolled. The mean age was 27.9 years (range, 20-48 years), and 19 were men. The time from injury to surgery was a mean 4.5 days (range, 1-9 days). The mean objective follow-up was 10.9 months (range, 3 days–19.4 months), and range of motion was regained at a mean 4.4 months (range, 1-9 months). Three meniscal repairs and 3 microfractures were performed concomitantly. There was 1 graft failure at 3 years postoperatively, noted at 50 months of subjective follow-up. There was no loss of extension >3° as compared with the contralateral knee in any patient. There was no loss of flexion >5° as compared with the contralateral knee in any patient who completed objective follow-up. The mean KOOS at final subjective follow-up was 82.8 (range, 57.7-98.8) at a mean 56.6 months postoperative (n = 14/24; range, 48-58 months). Conclusion: Excellent clinical results can be achieved following ACL reconstruction performed ≤9 days after injury with patellar tendon autograft. The authors found that early ACL reconstructions do not result in loss of motion or suboptimal clinical results as long as a rehabilitation protocol emphasizing extension and early range of motion is employed.

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