SERIAL MAGNETIC RESONANCE IMAGING OF ANTERIOR CRUCIATE LIGAMENT GRAFTS AFTER RECONSTRUCTION

2000 ◽  
Vol 04 (01) ◽  
pp. 31-37 ◽  
Author(s):  
Yoshihito Nakayama ◽  
Yasumasa Shirai ◽  
Tetsuya Narita ◽  
Atsushi Mori ◽  
Kaoru Kobayashi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
High Signal ◽  
Intermediate Type ◽  
Signal Type ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B ◽  
Signal Band

We investigated the serial changes in MR appearance of anterior cruciate ligament (ACL) grafts after reconstruction, and looked for a correlation between MRI and clinical results. Fifty-four patients underwent serial MRI examinations at 5, 11 and 24 months after arthroscopically-assisted ACL reconstruction. The MR appearance of the graft was categorized into three types depending on the signal intensity and continuity of the ligament: low signal type, intermediate type and high signal type. For the low signal type, a homogeneous low signal band with continuity was visualized over the entire course; for the intermediate type, the signal intensity increased and low signal band was visualized only in part of the graft; and for the high signal type, the graft was not identified through the joint cavity due to markedly increased signal. Forty-three of the 54 patients retained normal low signal type during the first two years of reconstruction. They were classified as Group A. Four of the remaining 11 patients showed intermediate type at five months and altered to high signal type after 12 months. The remaining seven patients showed high signal type at five months and persisted with the same MR type until 24 months. These 11 patients with increased signal intensity were classified as Group B. The mean injured-to-uninjured differences of KT-2000 arthrometer measurements were significantly greater in Group B than that in Group A. Moreover, the percentage of cases with a difference of 5 mm or more was significantly higher in Group B (54.5%) than in Group A (9.3%). It is concluded that the majority of the grafts showed no changes in signal intensity during the first two years of reconstruction. The increase in signal intensity observed in some patients may be a reflection of a deterioration in graft integrity following reconstruction.

A Simple Method to Reduce the Incidence of Cyclops Lesion after Anterior Cruciate Ligament Reconstruction

2019 ◽  
Author(s):  
Keita Nagira ◽  
Makoto Enokida ◽  
Ikuta Hayashi ◽  
Koji Ishida ◽  
Haruhisa Kanaya ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Cruciate Ligament Reconstruction ◽  
Cyclops Lesion ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B ◽  
Bone Tunnels

AbstractThe purpose of this study is to determine the influence of debridement in and around the bone tunnels on the prevalence of cyclops lesion (CL), after anterior cruciate ligament reconstruction (ACLR) with hamstring grafts. Our hypothesis was that bone tunnel debridement during ACLR would reduce the prevalence of CL. Methods for debridement in and around the bone tunnels after tunnel drilling were standardized and applied to 38 knees undergoing double-bundle ACLR between 2011 and 2014, Group A (debridement group). Group B (nondebridement group) included 56 knees in which bone tunnel debridement was not performed. Postoperative MRI was performed to evaluate the presence of CL and the following three criteria: (1) the intercondylar site of CL (grade 1–3), depending on its anterior extent along the femoral condyle; (2) posterior bowing of the ACL graft; and (3) the positional relationship between the frontmost fiber of ACL graft and Blumensaat's line. If CL caused loss of extension or pain or discomfort during knee extension, it was defined as symptomatic CL (SCL). CL was detected in 8 cases (21.1%) in Group A and 26 cases (46.4%) in Group B. The prevalence of CL was significantly lower in Group A than in Group B (p = 0.010), and the risk ratio of CL was 0.31 (95% confidence interval: 0.12–0.79). Furthermore, 10 patients in Group B had SCL, compared with none in Group A (p = 0.004). In Group A, the intercondylar site of CL was grade 1 in all cases, while in Group B, the CL grades were 1 (n = 17), 2 (n = 7), 3 (n = 2) (p = 0.008). There were no cases of posterior bowing of the ACL in Group A, but six cases in Group B (p = 0.023). Debridement in and around the bone tunnel is a simple and effective method of preventing CL and SCL after ACLR. The level of evidence for the study is 3.

scholarly journals Poredjenje klinickih rezultata rekonstrukcije prednjeg ukrstenog ligamenta koriscenjem dvaju razlicitih postupaka

2005 ◽  
Vol 52 (2) ◽  
pp. 89-94
Author(s):  
S. Ninkovic ◽  
D. Savic ◽  
M. Stankovic ◽  
S. Radic ◽  
A. Milicic ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Patella Tendon ◽  
Significant Difference ◽  
Golden Standard ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B ◽  
Hamstrings Tendon

During the last two decades the "golden standard" in reconstruction of anterior cruciate ligament knee was the middle third of patellar tendon, but now are more used hamstrings tendon autograft. The aim of this work was to compare our results of the artroscopic reconstruction ACL ( anterior cruciate ligament) of the knee using two different techniques. We were controling 60 patients within the period of two years after operation. Group A was composed of 39 patients which had reconstructed ACL done with bone-patella tendon-bone autografts, in the group B were 21 patients and at them as autographts have been used hamstring tendon. Difference between health and the ill knee by the Lachman?s test after operation, in the group A was 2,4mm , but in the group B was 2,2mm (p> 0,05 ). Postoperative middle value of the Lysholm and Gillquist score in the group A was 97,74, in the group B it was 96,67 (p>0,05). IKDC score results are following: Group A- mark A 32 patients (84,6%); mark B 5 (12,8%); mark C 1 (2,6%) and in the group B: mark A 17 patients (81%); mark B 3 (14,28%): mark C 1 (4,72%) (p> 0,05). Postoperative value for the Tegner and Lyscholm score activity in the A group was 8,23, in B group it was 8,81. The reconstruction of ACL with bone-patella tendon-bone grafts gave better results then the reconstruction with the hamstring tendon only according to Tegner score values. In other parameters between those two groups there was no statistically significant difference.

scholarly journals Substantive molecular and histological changes within the meniscus with tears

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yi Long ◽  
Jingping Xie ◽  
Zhi-Qi Zhang ◽  
Ziji Zhang ◽  
Fangang Meng ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
In Situ Hybridisation ◽  
International Knee Documentation Committee ◽  
Vital Role ◽  
Pathological Changes ◽  
Meniscus Degeneration ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B

Abstract Background The meniscus plays a vital role in the normal biomechanics of the knee. However, it is not well studied at the molecular level. The purpose of this study was to determine whether molecular and pathological changes in the meniscal tissue vary depending on the presence or absence of meniscal and/or anterior cruciate ligament tear (ACL). Methods Six normal menisci (group A), seven simple torn menisci (group B) and seven torn menisci with concomitant anterior cruciate ligament tears (group C) were collected. We observed the pathological changes in the menisci and used real-time polymerase chain reaction along with immunohistochemistry and in situ hybridisation to examine the levels of ACAN, ADAMTS5, COL10A1, CEBPβ, MMP13 and miR-381-3p, miR-455-3p, miR-193b-3p, miR-92a-3p, respectively. Patients were scored preoperatively and postoperatively using the Lysholm Knee Scoring Scale and International Knee Documentation Committee Subjective Knee Evaluation Form. Results Compared with group A, the expression levels of ADAMTS5, COL10A1, CEBPβ, and MMP13 and all the miRNAs were increased while ACAN was down-regulated in groups B and C. Additionally, the gene expression and miRNA levels were higher in group C than that in group B, except for ACAN, which was lower. Several fibrochondrocytes strongly expressed ADAMTS5, CEBPβ, and MMP13 in groups B and C and had high levels of miR-381-3p and miR-455-3p than that in group A. Postoperative Lysholm and IKDC scores were higher in group B than in group C. Conclusions Our findings suggest that the meniscus tended to degenerate after it was injured, especially when combined with a torn ACL. The miRNAs investigated in this study might also contribute to meniscus degeneration. Patients with a combined injury patterns might have relatively worse joint function.

scholarly journals Graft Survivorship After Anterior Cruciate Ligament Reconstruction Based on Tibial Slope

2021 ◽  
pp. 036354652110492
Author(s):  
Clemens Gwinner ◽  
Milan Janosec ◽  
Guido Wierer ◽  
Michael Wagner ◽  
Andreas Weiler
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Odds Ratio ◽  
Cox Regression ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Acl Graft ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B

Background: Increased tibial slope (TS) is believed to be a risk factor for anterior cruciate ligament (ACL) tears. Increased TS may also promote graft insufficiency after ACL reconstruction. Purpose: To delineate the relationship between TS and single as well as multiple graft insufficiencies after ACL reconstruction. Study Design: Cohort study; Level of evidence 3. Methods: We retrospectively identified 519 patients who had sustained ACL graft insufficiency after primary or revision ACL reconstruction (1 graft insufficiency, group A; 2 graft insufficiencies, group B; and ≥3 graft insufficiencies, group C). In addition, a subgroup analysis was conducted in 63 patients who received all surgical interventions by 2 specialized high-volume, single-center ACL surgeons. TS was measured by an observer with >10 years of training using lateral knee radiographs, and intrarater reliability was performed. Multiple logistic and univariate Cox regression was used to assess the contribution of covariates (TS, age, sex, and bilateral ACL injury) on repeated graft insufficiency and graft survival. Results: The study included 347 patients, 119 female and 228 male, who were 24 ± 9 years of age at their first surgery (group A, n = 260; group B, n = 62; group C, n = 25). Mean TS was 9.8°± 2.7° (range, 3°-18°). TS produced the highest adjusted odds ratio (1.73) of all covariates for repeated graft insufficiency. A significant correlation was found between TS and the number of graft insufficiencies ( r = 0.48; P < .0001). TS was significantly lower in group A (9.0°± 2.3°) compared with group B (12.1°± 2.5°; P < .0001) and group C (12.0°± 2.6°; P < .0001). A significant correlation was seen between the TS and age at index ACL tear ( r = −0.12; P = .02) as well as time to graft insufficiency ( r = −0.12; P = .02). A TS ≥12° had an odds ratio of 11.6 for repeated ACL graft insufficiency. Conclusion: The current results indicate that patients with a markedly increased TS were at risk of early and repeated graft insufficiency after ACL reconstruction. Because the TS is rarely accounted for in primary and revision ACLR, isolated soft tissue procedures only incompletely address recurrent graft insufficiency in this subset of patients.

scholarly journals A short term study for core stabilization as post operative protocol in post operated anterior cruciate ligament and its outcome

2020 ◽  
Author(s):  
N. V. Siva Rama Krishna ◽  
Prathyush Chitithoti
Keyword(s):  
Anterior Cruciate Ligament ◽  
Functional Outcome ◽  
Cruciate Ligament ◽  
Core Stability ◽  
Core Stabilization ◽  
Kt 1000 ◽  
Hop Test ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B

<p class="abstract"><strong>Background:</strong> The aim of the study was to assess the role of core stability exercises post op protocol for anterior cruciate ligament (ACL) reconstructed cases.</p><p class="abstract"><strong>Methods:</strong> Out of 100 only selected were<strong> </strong>ninety-two male athletes who got ACL reconstruction with anatomical positioning of tunnels and adequate graft were enrolled in the study that was conducted between 2017 January to 2019 February. The enrolled were divided into two groups based on random number sequence i.e. group A (conventional rehabilitation; n=46) and group B (core stabilization and conventional rehabilitation; n=46). Assessment was done at 6 months, 9 months and 12 months for assessing the functional outcome by International Knee Documentation Committee (IKDC) score, triple hop test, single leg hop test and knee laxity (KT-1000) test.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of study it was observed that scores of IKDC was higher in group B as compared to group A (p&lt;0.005). Similarly, single and triple hop test jump distances were more in group B as compared to group A (p&lt;0.05). In group A, 24 out of 43 sports persons returned to sports as compared to group B, where 35 out of 45 patients returned to sports (p value=0.02). There was no difference in KT-1000 score between two groups.</p><p class="abstract"><strong>Conclusions:</strong> Addition of core stability exercises in the ACL rehabilitation program improves the functional outcome and incidence of return to sports. However, core stability exercises have no effect on knee stability.</p><p class="abstract"> </p>

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 Does the Application of Platelet-Rich Fibrin in Anterior Cruciate Ligament Reconstruction Enhance Graft Healing and Maturation? A Comparative MRI Study of 44 Cases

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090201 ◽  
Author(s):  
Tahsin Beyzadeoglu ◽  
Tuna Pehlivanoglu ◽  
Kerem Yildirim ◽  
Halil Buldu ◽  
Reha Tandogan ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Synovial Fluid ◽  
Acl Reconstruction ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Postoperative Blood Loss ◽  
Platelet Rich Fibrin ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

Background: Anterior cruciate ligament (ACL) reconstruction performed with growth factors and activated platelets has been suggested to accelerate tendon ligamentization, leading to earlier return to daily activities and sports. Hypotheses: Platelet-rich fibrin (PRF) will result in improved graft maturation and healing as evaluated by magnetic resonance imaging (MRI) in patients undergoing hamstring ACL reconstruction. Hemostatic and analgesic properties of PRF will lead to less postoperative blood loss and pain. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 44 patients with isolated ACL injuries who underwent arthroscopic all-inside anatomic single-bundle ACL reconstruction with semitendinosus tendon graft were enrolled. Group 1 included 23 patients who had PRF sprayed to the surface of the graft; group 2 included 21 patients for whom no PRF was used. Patients were discharged after 24 hours and examined for hemarthrosis that needed to be aspirated. MRI was performed at the fifth postoperative month. A blinded radiologist evaluated graft maturation according to its signal intensity and the presence of synovial fluid at the tunnel-graft interface. Results: PRF-treated grafts demonstrated lower MRI signal intensity and less fluid in the graft-tunnel interface as compared with controls for the entire length of the graft. The mean full-length MRI signal intensities were 9.19 versus 16.59 ( P = .047) for groups 1 and 2, respectively. Subgroup analysis of the semitendinosus grafts demonstrated a signal intensity of 11.57 versus 23.98 ( P = .044) for the proximal third, 9.53 versus 13.83 ( P = .237) for the midbody, and 6.48 versus 11.98 ( P = .087) for the distal third. Synovial fluid at the graft-tunnel interface was detected in 1 patient in group 1 (4.3%) and 3 patients in group 2 (14.3%; P < .001). Patients in group 1 had significantly less hemarthrosis that needed to be aspirated ( P = .003), while postoperative analgesia requirements were similar in both groups ( P = .08). No clinical benefit of PRF could be demonstrated in clinical outcomes. Conclusion: Application of PRF led to superior graft integration and maturation in the proximal third of the ACL graft. There was no significant difference in MRI signal intensity in the midbody or distal tibial graft. Application of PRF also resulted in significantly lower rates of postoperative hemarthrosis that needed to be aspirated.

Is Intraoperative Fluoroscopy Necessary to Confirm Device Position for Femoral-Sided Cortical Suspensory Fixation during Anterior Cruciate Ligament Reconstruction?

2019 ◽  
Vol 33 (03) ◽  
pp. 265-269
Author(s):  
B. Christian Balldin ◽  
Clayton W. Nuelle ◽  
Thomas M. DeBerardino
Keyword(s):  
Acl Reconstruction ◽  
Intraoperative Imaging ◽  
Cruciate Ligament ◽  
Intraoperative Fluoroscopy ◽  
Suspensory Fixation ◽  
Fluoroscopic Imaging ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B ◽  
Device Location

AbstractIncreased laxity within the graft construct system can lead to graft failure after anterior cruciate ligament (ACL) reconstruction. Suboptimal cortical device positioning could lead to increased laxity within the system, which could influence the mechanics and function of the graft reconstruction. This study evaluates the benefit of intraoperative fluoroscopy to confirm device position on the femur during ACL reconstruction using cortical suspensory fixation. One hundred consecutive patients who underwent soft tissue ACL reconstruction using a suspensory cortical device for femoral fixation were retrospectively evaluated. Patients were split into two groups: Group A utilized anteromedial portal visualization and had intraoperative fluoroscopic imaging performed at the time of ACL graft fixation to confirm femoral device placement on the lateral femoral metaphyseal cortex. Group B utilized anteromedial portal visualization alone. Both groups had radiographic X-rays performed at the first postoperative visit to evaluate device location and all images were independently evaluated by three fellowship trained orthopaedic surgeons. Device position was classified as optimal if there was complete apposition of the entire device against the femoral cortex and suboptimal if it was > 2 mm off the cortex. Fisher's exact test, analysis of variance, and 95% confidence intervals were calculated to compare the groups for statistical significance. The results showed 0/60 (0%) patients in group A had suboptimal device position at postoperative follow-up, while 4/40 (10%) patients in group B had suboptimal device position (p = 0.013). There were no graft failures in group A and one graft failure in group B. There was a significant difference in cortical device position in patients who had intraoperative fluoroscopic imaging versus patients who had no intraoperative imaging. The use of confirmatory intraoperative imaging may be beneficial to confirm appropriate device location when using a femoral cortical suspensory fixation technique for ACL reconstruction.

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