Long-term Failure of Thermal Shrinkage for Laxity of the Anterior Cruciate Ligament

2005 ◽  
Vol 33 (7) ◽  
pp. 990-995 ◽  
Author(s):  
Jeffrey Halbrecht
Keyword(s):  
Anterior Cruciate Ligament ◽  
Thermal Energy ◽  
Cruciate Ligament ◽  
Thermal Shrinkage ◽  
Partial Tears ◽  
Kt 1000 ◽  
Ligament Laxity ◽  
Anterior Cruciate

Background Appropriate treatment for anterior cruciate ligament laxity, owing to partial tears of the native ligament or lax reconstruction, is unclear. Studies suggest that a significant percentage of these untreated tears may progress to complete tears or the patient may develop additional injuries to the meniscus or articular cartilage. Shrinkage of the ligament or graft using thermal energy has been proposed as a solution for this problem. Purpose To evaluate the long-term results using thermal energy to shrink laxity of the anterior cruciate ligament. Study Design Case series; Level of evidence, 4. Methods Nineteen patients with partial tears of the anterior cruciate ligament (n = 14) or stretched anterior cruciate ligament grafts (n = 5) underwent thermal shrinkage treatment. Fourteen were available for follow-up at 1 and 5 years. At 1 year, there were 12 partial tears and 2 grafts available for evaluation. At 5 years, there were 10 partial tears and 4 grafts. Preoperative, postoperative, and intraoperative stability testing was performed using the KT-1000 arthrometer. Clinical results were evaluated using the Cincinnati and Lysholm scoring systems. Results Intraoperative shrinkage averaged 2.12 mm (17%, P <. 0001). At 1 year, 12 of the 14 patients remained stable (86%) with a negative Lachman test result and mean KT-1000 arthrometer maximum side-to-side score of 1.29 mm (P <. 001). The 2 failed shrinkages were partial tears of the native anterior cruciate ligament. For these 12 patients, Cincinnati scores improved from 53 to 89 (P <. 0001), and Lysholm scores improved from 55 to 89 (P <. 0003). At 5-year follow-up, 11 of 13 patients had gone on to complete failure (85%, P <. 002; 8/9 partial tears and 3/4 grafts). Conclusion Thermal shrinkage provides short-term benefit in the treatment of anterior cruciate ligament laxity but leads to catastrophic failure in the majority of patients at long-term follow-up. We can no longer recommend this procedure for the treatment of anterior cruciate ligament laxity.

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

Septic Arthritis After Anterior Cruciate Ligament Reconstruction: How Important Is Graft Salvage?

2018 ◽  
Vol 46 (10) ◽  
pp. 2376-2383 ◽  
Author(s):  
Jonas Pogorzelski ◽  
Alexander Themessl ◽  
Andrea Achtnich ◽  
Erik M. Fritz ◽  
Klaus Wörtler ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Resonance Imaging ◽  
Kt 1000 ◽  
Graft Removal ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

Background: Septic arthritis (SA) of the knee after anterior cruciate ligament reconstruction (ACLR) is a rare but potentially devastating condition. In certain cases, graft removal becomes necessary. Purpose: To evaluate clinical, subjective, and radiologic outcomes of patients with SA after ACLR and assess whether graft retention has superior clinical results as compared with graft removal. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who were at least 12 months out from arthroscopic treatment of SA after isolated ACLR at our institution were eligible for inclusion. Patients were categorized into 2 groups: group 1, patients with initial graft retention; group 2, patients with initial graft removal. Group 2 was subdivided into 2 groups: group 2a, patients with graft reimplantation; group 2b, patients without graft reimplantation. Objective and subjective assessments were obtained at follow-up, including the International Knee Documentation Committee (IKDC) knee examination form, KT-1000 arthrometer measurements, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score, Lysholm score, and IKDC subjective evaluation. Radiologic assessment was performed with pre- and postoperative magnetic resonance imaging. Results: Of the 41 patients included, 33 (81%) were available for follow-up at a mean ± SD 54.7 ± 24.4 months at an age of 28.4 ± 9.3 years. When compared with patients from group 2 (n = 12), patients from group 1 (n = 21) obtained significantly better results on the objective IKDC score (normal or nearly normal: group 1, 66.6%; group 2, 36.4%; P = .047) and KT-1000 measurements (group 1, 1.3 ± 1.0 mm; group 2, 2.9 ± 1.5 mm; P = .005). Group 1 also scored better than group 2 on the Lysholm ( P = .007), IKDC subjective ( P = .011), and WOMAC ( P = .069) measures. Between groups 2a (n = 4) and 2b (n = 8), no significant differences in outcomes could be detected ( P values, .307-.705), although patients with anterior cruciate ligament graft reimplantation showed a clear tendency toward better results in objective and not subjective parameters. Magnetic resonance imaging evaluation showed higher rates of cartilage damage and meniscal tears among patients with graft resection versus graft retention. Conclusion: Patients with graft retention showed superior postoperative results when compared with patients who underwent initial graft resection, although subanalysis showed comparable outcomes between graft retention and reimplantation. Thus, while graft-retaining protocols should have the highest priority in the treatment of SA after ACLR, graft reimplantation should be performed in cases where graft resection becomes necessary, to avoid future cartilage and meniscal lesions. Finally, further studies with larger numbers of patients are needed to gain a better understanding of the outcomes of patients with SA after ACLR.

scholarly journals Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation

2017 ◽  
Vol 5 (2) ◽  
pp. 232596711769359 ◽  
Author(s):  
Andrew N. Pike ◽  
Tim Bryant ◽  
Takahiro Ogura ◽  
Tom Minas
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Autologous Chondrocyte Implantation ◽  
Cruciate Ligament ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
Anterior Cruciate ◽  
Autologous Chondrocyte

Background: Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects. Hypothesis: ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures. Results: Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with primary reconstructions. Conclusion: Challenging cases of ACL tears with large chondral defects treated with concurrent ACL reconstruction and ACI can lead to moderately improved pain and function at long-term follow-up. Factors associated with clinical failure are not clear. When combined with ACI, patients undergoing revision ACL reconstructions have worse function preoperatively compared with those undergoing primary reconstructions but have similar final outcomes.

Arthroscopic Two-Point Suture Bridge Fixation Technique for the Treatment of Anterior Cruciate Ligament Tibial Avulsion Fractures

2021 ◽  
Vol 11 (10) ◽  
pp. 1977-1982
Author(s):  
Dong Zheng ◽  
Jianjian Yin ◽  
Long Han ◽  
Jianchao Gui
Keyword(s):  
Anterior Cruciate Ligament ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Suture Fixation ◽  
Fixation Technique ◽  
Avulsion Fractures ◽  
Anterior Drawer ◽  
Kt 1000 ◽  
Anterior Cruciate

This study aimed to present and evaluate a new arthroscopic technique that uses two-point suture fixation for anterior cruciate ligament (ACL) tibial avulsion fractures. A total of 15 patients diagnosed with ACL tibial avulsion fracture underwent arthroscopic suture fixation from November 2018 to October 2019 and were treated using two-point suture fixation. The patients were followed up and evaluated according to Lysholm scores, International Knee Documentation Committee (IKDC) subjective scores, Tegner activity level scales, anterior drawer testing, and KT-1000 arthrometer testing. The mean follow-up period was 18 months (12 to 24). All patients had a negative Lachman test and anterior drawer test at final follow-up and showed the radiological union of avulsion fracture at 12-week postoperative radiograph. The Lysholm score improved significantly postoperatively with a mean score of 94.26±3.63 (87 to 98; p < 0.001). The Tegner score improved significantly postoperatively from 3.61 ±1.37 to 7.14±1.51 (P < 0.001). The KT-1000 measured value decreased significantly postoperatively from 7.3±1.5 to 1.4 ±1.2 (P < 0.001). The IKDC category was abnormal or severely abnormal preoperatively, and all patients improved to normal or nearly normal at final follow-up. Arthroscopic treatment using the two-point suture fixation technique is effective for ACL avulsion fracture and can restore the function and stability of the knee joint.

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