The Augmentation of Revision Anterior Cruciate Ligament Reconstruction With Modified Iliotibial Band Tenodesis to Correct the Pivot Shift: A Computer Navigation Study

2018 ◽  
Vol 46 (4) ◽  
pp. 839-845 ◽  
Author(s):  
Mark D. Porter ◽  
Bruce Shadbolt ◽  
Samantha Pomroy
Keyword(s):  
Internal Rotation ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Computer Navigation ◽  
Iliotibial Band ◽  
Pivot Shift Test ◽  
Anterior Translation ◽  
Revision Acl Reconstruction ◽  
Group 2 ◽  
Group 1

Background: Iliotibial band (ITB) tenodesis improves stability and functional outcomes when added to anterior cruciate ligament (ACL) reconstruction. Its precise indications are unknown. Persistence of the pivot shift after revision ACL reconstruction may be one indication. Hypothesis: The addition of ITB tenodesis for a persistent pivot shift after revision ACL reconstruction will improve stability and activity levels. Study Design: Cohort study; Level of evidence, 2. Methods: Adults with recurrent ACL ruptures underwent revision ACL reconstruction, followed by a pivot-shift test before the surgery ended. If the pivot shift was grade 0 or 1, no further surgery was performed (group 1). If it was grade 2 or 3, ITB tenodesis was performed (group 2). The pivot-shift test was performed, graded, and measured using computer navigation before revision ACL reconstruction and after revision ACL reconstruction with and without ITB tenodesis. Tegner activity scores were obtained 2 years after surgery. Groups were compared with regard to anterior translation and internal rotation during the pivot shift as well as Tegner activity scores ( P < .05). Results: There were 20 patients in group 1 and 18 in group 2. The mean anterior translation improved in group 1, from 17.7 ± 3.5 mm to 6.6 ± 1.9 mm, and group 2, from 18.5 ± 3.3 mm to 6.1 ± 1.2 mm, after revision ACL reconstruction ( P < .001), with no difference between the groups ( P = .15). After ITB tenodesis, the reduction in anterior translation in group 2 (5.3 ± 1.5 mm) became greater than that in group 1 (6.6 ± 1.9 mm) ( P = .03). In both groups after revision ACL reconstruction, there was a reduction in internal rotation (group 1: 24.2° ± 4.0° to 10.3° ± 1.1°; group 2: 25.4° ± 3.7° to 14.6° ± 2.8°; P < .001), but this change was less in group 2 ( P = .02). After ITB tenodesis, internal rotation in group 2 (8.3° ± 2.6°) became less than that in group 1 (10.3° ± 1.1°) ( P = .02). The mean Tegner activity scores in group 1 were 8.1 ± 1.1 before surgery and 7.4 ± 0.9 after surgery, while in group 2 they were 7.0 ± 1.3 and 7.2 ± 0.4, respectively, and not significantly different ( P = .29). Conclusion: ITB tenodesis improved laxity, although it did not affect activity levels, when there was a persistent pivot shift after revision ACL reconstruction. Clinical Relevance: An indication to perform ITB tenodesis is the persistence of a grade ≥2 pivot shift after revision ACL reconstruction.

Is an Anterolateral Ligament Reconstruction Required in ACL-Reconstructed Knees With Associated Injury to the Anterolateral Structures? A Robotic Analysis of Rotational Knee Stability

2017 ◽  
Vol 45 (5) ◽  
pp. 1018-1027 ◽  
Author(s):  
Frank R. Noyes ◽  
Lauren E. Huser ◽  
Darin Jurgensmeier ◽  
James Walsh ◽  
Martin S. Levy
Keyword(s):  
Internal Rotation ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Anterolateral Ligament ◽  
Rotational Stability ◽  
Iliotibial Band ◽  
Pivot Shift Test ◽  
Knee Stability ◽  
Acl Graft ◽  
Tibial Translation

Background: The effect of an anterolateral ligament (ALL) reconstruction on rotational knee stability and corresponding anterior cruciate ligament (ACL) graft forces using multiple knee loading conditions including the pivot-shift phenomenon has not been determined. Purpose: First, to determine the rotational stability and ACL graft forces provided by an anatomic bone–patellar tendon–bone ACL reconstruction in the ACL-deficient knee alone and with an associated ALL/iliotibial band (ITB) injury. Second, to determine the added rotational stabilizing effect and reduction in ACL graft forces provided by an ALL reconstruction. Study Design: Controlled laboratory study. Methods: A 6 degrees of freedom robotic simulator was used to test 7 fresh-frozen cadaveric specimens during 5 testing conditions: intact, ACL-sectioned, ACL-reconstructed, ALL/ITB-sectioned, and ALL-reconstructed. Lateral and medial tibiofemoral compartment translations and internal tibial rotations were measured under Lachman test conditions, 5-N·m internal rotation, and 2 pivot-shift simulations. Statistical equivalence within 2 mm and 2° was defined as P < .05. Results: Single-graft ACL reconstruction restored central tibial translation under Lachman testing and internal rotation under 5-N·m internal rotation torque ( P < .05). A modest increase in internal rotation under 5-N·m internal rotation torque occurred after ALL/ITB sectioning of 5.1° (95% CI, 3.6° to 6.7°) and 6.7° (95% CI, 4.3° to 9.1°) at 60° and 90° of flexion, respectively ( P = .99). Lateral compartment translation increases in the pivot-shift tests were <2 mm. ALL reconstruction restored internal rotation within 0.5° (95% CI, –1.9° to 2.9°) and 0.7° (95% CI, –2.0° to 3.4°) of the ACL-reconstructed state at 60° and 90° of flexion, respectively ( P < .05). The ALL procedure reduced ACL graft forces, at most, 75 N in the pivot-shift tests and 81 N in the internal rotation tests. Conclusion: Although the ALL reconstruction corrected the small abnormal changes in the internal rotation limit at high flexion angles, the procedure had no effect in limiting tibiofemoral compartment translations in the pivot-shift test and produced only modest decreases in ACL graft forces. Accordingly, the recommendation to perform an ALL reconstruction to correct pivot-shift abnormalities is questioned. Clinical Relevance: The small changes in rotational stability after ALL/ITB sectioning would not seem to warrant the routine addition of an ALL reconstruction in primary ACL injuries. Clinical exceptions may exist, as in grossly unstable grade 3 pivot-shift knees and revision knees. However, the concern exists of overconstraining normal tibial rotations.

scholarly journals The Role of the Peripheral Passive Rotation Stabilizers of the Knee With Intact Collateral and Cruciate Ligaments: A Biomechanical Study

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770819 ◽  
Author(s):  
Alexander R. Vap ◽  
Jason M. Schon ◽  
Gilbert Moatshe ◽  
Raphael S. Cruz ◽  
Alex W. Brady ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
External Rotation ◽  
Rotational Stability ◽  
Iliotibial Band ◽  
Popliteus Tendon ◽  
Primary Role ◽  
Collateral Ligaments ◽  
Group 2 ◽  
Group 1

Background: A subset of patients have clinical internal and/or external knee rotational instability despite no apparent injury to the cruciate or collateral ligaments. Purpose/Hypothesis: The purpose of this study was to assess the effect of sequentially cutting the posterolateral, anterolateral, posteromedial, and anteromedial structures of the knee on rotational stability in the setting of intact cruciate and collateral ligaments. It was hypothesized that cutting of the iliotibial band (ITB), anterolateral ligament and lateral capsule (ALL/LC), posterior oblique ligament (POL), and posteromedial capsule (PMC) would significantly increase internal rotation, while sectioning of the anteromedial capsule (AMC) and the popliteus tendon and popliteofibular ligament (PLT/PFL) would lead to a significant increase in external knee rotation. Study Design: Controlled laboratory study. Methods: Ten pairs (N = 20) of cadaveric knees were assigned to 2 sequential cutting groups (group 1: posterolateral-to-posteromedial [PL → PM] and group 2: posteromedial-to-posterolateral [PM → PL]). Specimens were subjected to applied 5-N·m internal and external rotation torques at knee flexion angles of 0°, 30°, 60°, and 90° while intact and after each cut state. Rotational changes were measured and compared with the intact and previous cut states. Results: Sectioning of the ITB significantly increased internal rotation at 60° and 90° by 5.4° and 6.2° in group 1 (PL → PM) and 3.5° and 3.8° in group 2 (PM → PL). PLT/PFL complex sectioning significantly increased external rotation at 60° and 90° by 2.7° and 2.9° in group 1 (PL → PM). At 60° and 90° in group 2 (PM → PL), ALL/LC sectioning produced significant increases in internal rotation of 3.1° and 3.5°, respectively. In group 2 (PM → PL), POL sectioning produced a significant increase in internal rotation of 2.0° at 0°. AMC sectioning significantly increased external rotation at 30° to 90° of flexion with a magnitude of change of <1° in both groups 1 (PL → PM) and 2 (PM → PL). Conclusion: Collectively, the anterolateral corner structures provided primary internal rotation control of the knee from 60° to 90° of knee flexion in knees with intact cruciate and collateral ligaments. The ITB was the most significant primary stabilizer of internal rotation. The POL had a primary role for internal rotational stability at full extension. The PLT/PFL complex was a primary stabilizer for external rotation of the knee at 60° and 90°. Clinical Relevance: This study delineates the primary and secondary roles of the ITB, ALL/LC, POL, and PLT/PFL to rotatory stability of the knee and provides new information to understand knee rotational instabilities.

Stacked Biocomposite Screws in a Single-Stage Revision Anterior Cruciate Ligament Reconstruction Has Acceptable Fixation Strength in a Porcine Cadaveric Model

2021 ◽  
pp. 036354652110151
Author(s):  
Hasan Baydoun ◽  
Ian D. Engler ◽  
Ali Hosseini ◽  
Lance LeClere ◽  
Joeri Zoon ◽  
...  
Keyword(s):  
Bone Loss ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Single Stage ◽  
Fixation Strength ◽  
Revision Acl Reconstruction ◽  
Group 2 ◽  
Bone Tunnels ◽  
Primary Acl Reconstruction

Background: Stacked screws is a commonly used technique in single-stage revision anterior cruciate ligament (ACL) reconstruction in the setting of bone loss, but there are limited data to support its use. Hypothesis: Two configurations of a biocomposite stacked screws construct have similar fixation strength and linear stiffness as a primary ACL reconstruction construct in a biomechanical model. Study Design: Controlled laboratory study. Methods: A total of 30 porcine legs were divided into 3 groups. Group 1 underwent primary ACL reconstruction with a patellar tendon graft fixed into the femur, with an 8-mm biocomposite interference screw of beta-tricalcium phosphate and poly lactide-co-glycolide. For a revision ACL reconstruction model, groups 2 and 3 had bone tunnels created and subsequently filled with 12-mm biocomposite screws. New bone tunnels were drilled through the filler screw and the surrounding bone, and the patellar bone plug was inserted. Group 2 was fixed with 8-mm biocomposite screws on the side of the graft opposite the filler screw, while group 3 had the interference screw interposed between the graft and the filler screw. The construct was loaded at 1.5 mm/s in line with the tunnel until failure. Load to failure, linear stiffness, and mode of failure were recorded. Results: The mean pullout strength for groups 1, 2, and 3 was 626 ± 145 N, 653 ± 152 N, and 720 ± 125 N, respectively ( P = .328). The mean linear stiffness of the construct in groups 1, 2, and 3 was 71.4 ± 9.9 N/mm, 84.1 ± 11.1 N/mm, and 82.0 ± 10.8 N/mm, respectively. Group 2 was significantly stiffer than group 1 ( P = .037). Conclusion: Two configurations of a biocomposite stacked screws construct for a single-stage revision ACL reconstruction in the setting of bone loss show a similar fixation strength and linear stiffness to a primary ACL reconstruction at time zero in a porcine model. Clinical Relevance: In the setting of bone loss from tunnel malpositioning, a single-stage revision ACL reconstruction using a stacked screws construct may provide adequate fixation strength and linear stiffness.

scholarly journals Stability Outcomes following Computer-Assisted ACL Reconstruction

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Melissa A. Christino ◽  
Bryan G. Vopat ◽  
Alexander Mayer ◽  
Andrew P. Matson ◽  
Steven E. Reinert ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Acl Reconstruction ◽  
External Rotation ◽  
Patient Characteristics ◽  
Computer Assisted ◽  
Single Bundle ◽  
Anterior Instability ◽  
Knee Stability ◽  
Anterior Translation ◽  
Stability Measurements

Purpose. The purpose of this study was to determine whether intraoperative prereconstruction stability measurements and/or patient characteristics were associated with final knee stability after computer-assisted ACL reconstruction.Methods. This was a retrospective review of all patients who underwent computer-assisted single-bundle ACL reconstruction by a single surgeon. Prereconstruction intraoperative stability measurements were correlated with patient characteristics and postreconstruction stability measurements. 143 patients were included (87 male and 56 female). Average age was 29.8 years (SD ± 11.8).Results. Females were found to have significantly more pre- and postreconstruction internal rotation than males (P< 0.001 andP= 0.001, resp.). Patients with additional intra-articular injuries demonstrated more prereconstruction anterior instability than patients with isolated ACL tears (P< 0.001). After reconstruction, these patients also had higher residual anterior translation (P= 0.01). Among all patients with ACL reconstructions, the percent of correction of anterior translation was found to be significantly higher than the percent of correction for internal or external rotation (P< 0.001).Conclusion. Anterior translation was corrected the most using a single-bundle ACL reconstruction. Females had higher pre- and postoperative internal rotation. Patients with additional injuries had greater original anterior translation and less operative correction of anterior translation compared to patients with isolated ACL tears.

Effect of Meniscocapsular and Meniscotibial Lesions in ACL-Deficient and ACL-Reconstructed Knees: A Biomechanical Study

2018 ◽  
Vol 46 (10) ◽  
pp. 2422-2431 ◽  
Author(s):  
Nicholas N. DePhillipo ◽  
Gilbert Moatshe ◽  
Alex Brady ◽  
Jorge Chahla ◽  
Zachary S. Aman ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Medial Meniscus ◽  
Pivot Shift ◽  
External Rotation ◽  
Posterior Horn ◽  
Pivot Shift Test ◽  
Anterior Tibial Translation ◽  
Anterior Tibial ◽  
Tibial Translation ◽  
Acl Deficient

Background: Ramp lesions were initially defined as a tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction. The separate biomechanical roles of the meniscocapsular and meniscotibial attachments of the posterior medial meniscus have not been fully delineated. Purpose: To evaluate the biomechanical effects of meniscocapsular and meniscotibial lesions of the posterior medial meniscus in anterior cruciate ligament (ACL)–deficient and ACL-reconstructed knees and the effect of repair of ramp lesions. Study Design: Controlled laboratory study. Methods: Twelve matched pairs of human cadaveric knees were evaluated with a 6 degrees of freedom robotic system. All knees were subjected to an 88-N anterior tibial load, internal and external rotation torques of 5 N·m, and a simulated pivot-shift test of 10-N valgus force coupled with 5-N·m internal rotation. The paired knees were randomized to the cutting of either the meniscocapsular or the meniscotibial attachments after ACL reconstruction (ACLR). Eight comparisons of interest were chosen before data analysis was conducted. Data from the intact state were compared with data from the subsequent states. The following states were tested: intact (n = 24), ACL deficient (n = 24), ACL deficient with a meniscocapsular lesion (n = 12), ACL deficient with a meniscotibial lesion (n = 12), ACL deficient with both meniscocapsular and meniscotibial lesions (n = 24), ACLR with both meniscocapsular and meniscotibial lesions (n = 16), and ACLR with repair of both meniscocapsular and meniscotibial lesions (n = 16). All states were compared with the previous states. For the repair and reconstruction states, only the specimens that underwent repair were compared with their intact and sectioned states, thus excluding the specimens that did not undergo repair. Results: Cutting the meniscocapsular and meniscotibial attachments of the posterior horn of the medial meniscus significantly increased anterior tibial translation in ACL-deficient knees at 30° ( P ≤ .020) and 90° ( P < .005). Cutting both the meniscocapsular and meniscotibial attachments increased tibial internal (all P > .004) and external (all P < .001) rotation at all flexion angles in ACL-reconstructed knees. Reconstruction of the ACL in the presence of meniscocapsular and meniscotibial tears restored anterior tibial translation ( P > .053) but did not restore internal rotation ( P < .002), external rotation ( P < .002), and the pivot shift ( P < .05). To restore the pivot shift, an ACLR and a concurrent repair of the meniscocapsular and meniscotibial lesions were both necessary. Repairing the meniscocapsular and meniscotibial lesions after ACLR did not restore internal rotation and external rotation at angles >30°. Conclusion: Meniscocapsular and meniscotibial lesions of the posterior horn of the medial meniscus increased knee anterior tibial translation, internal and external rotation, and the pivot shift in ACL-deficient knees. The pivot shift was not restored with an isolated ACLR but was restored when performed concomitantly with a meniscocapsular and meniscotibial repair. However, the effect of this change was minimal; although statistical significance was found, the overall clinical significance remains unclear. The ramp lesion repair used in this study failed to restore internal rotation and external rotation at higher knee flexion angles. Further studies should examine improved meniscus repair techniques for root tears combined with ACLRs. Clinical Relevance: Meniscal ramp lesions should be repaired at the time of ACLR to avoid continued knee instability (anterior tibial translation) and to eliminate the pivot-shift phenomenon.

scholarly journals The effects of partial meniscectomy and meniscal repair on the knee proprioception and function

2020 ◽  
Vol 28 (1) ◽  
pp. 230949901989491 ◽  
Author(s):  
Betül Başar ◽  
Gökhan Başar ◽  
Ahmet Aybar ◽  
Akif Kurtan ◽  
Hakan Başar
Keyword(s):  
Acl Reconstruction ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Partial Meniscectomy ◽  
Acl Rupture ◽  
Knee Motion ◽  
Female Patients ◽  
Group 2 ◽  
And Function ◽  
Group 1

Purpose: Aim of our study was to compare the effects of partial meniscectomy and meniscus repair on knee proprioception and function. Methods: The study included 46 patients with clinical and radiological diagnosis of meniscal tear and accompanying anterior cruciate ligament (ACL) rupture. The patients were evaluated under two groups: group 1: partial meniscectomy and ACL reconstruction, and group 2: meniscal repair and ACL reconstruction. Proprioceptive and functional evaluation of all patients was performed prior to surgery and on postoperative 12th month. Results: Group 1 consists of 18 male and 1 female patients with an average age of 28.78 ± 3.50. Group 2 consists of 23 male and 4 female patients with an average age of 27.14 ± 3.65. Preoperative evaluation revealed significant differences in knee joint position sense values on wide range of knee motion (15°, 30°, 45°, 60°, and 75°) in both groups. The statistically significant difference was observed in only the range of knee motion of 60° in patients underwent meniscal repair (group 2), whereas in the range of knee motion of 45°, 60°, and 75° in patients underwent partial meniscectomy (group 1) at 12th-month control. According to Lysholm knee scoring system, significantly better results were achieved with meniscal repair compared to the partial meniscectomy at 12th-month control. Conclusion: In case of ACL rupture accompanied by meniscal tear, the meniscal repair should be sutured, if possible, in order to obtain better results in terms of knee function and proprioception.

scholarly journals The effect of combined cryotherapy/compression versus cryotherapy following ACL reconstruction with regard to return-to-sports 3 months after surgery

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0032
Author(s):  
Thore Zantop ◽  
Christian Zantop ◽  
Anja Hönninger ◽  
Dominik Hauner ◽  
Przemyslaw Warminski
Keyword(s):  
Acl Reconstruction ◽  
Motion Analysis ◽  
Patient Outcomes ◽  
Isokinetic Strength ◽  
Return To Sports ◽  
3D Motion ◽  
Compression Device ◽  
3D Motion Analysis ◽  
Group 2 ◽  
Group 1

Aims and Objectives: Morbidity following ACL reconstruction may be a key factor to reduce muscular dysfunction and increase physical activity. While intra-operative factors have been the focus of standardization within the last years, strategies reducing the morbidity such as postoperative cryotherapy have been investigated less. Goal of this study was to compare subjective and objective patient outcomes following ACL reconstruction with combined compression and cryotherapy compared with traditional ice therapy alone. We hypothesized that ryotherapy/compression will show significantly better results three months after ACL reconstruction compared to cryotherapy alone. Materials and Methods: A total of 40 Patients undergoing ACL reconstruction are prospectively randomized to be treated with cryotherapy/compression device (GameReady, CA/USA, group 1) or a cryotherapy device (Aircast Cryocuff, DJO CA/USA, group 2). ACL reconstructions were performed by a single surgeon with semitendinosus graft and standardized rehabilitation protocol. Patients were instructed to use the ice therapy devices 4 times per day for 30min. Pain management directly postoperatively was analyzed as recorded during clinical records and VAS. Follow-up was performed at 12 weeks postoperatively using visual analog scale (VAS), Lysholm knee score, Short Form 36 (SF36), and Tegner acitiy score. Additionally, a functional “return-to-sports” analysis including isokinetic strength measurements (BTE-primus), proprioceptive tests (MTF tests) and a 3d-motion analysis (myomotion, Noraxon) during bilateral drop jumps and single leg hop tests was performed. Results: VAS and comparison of the administrated painkillers showed no significant differences between the two groups. Both groups used the cryotherapy/compression device and the cryotherapy device as determined by the study protocol. At 12 weeks, there was no significant difference between the two groups with regard to Lysholm score, Tegner score, and SF-36, however there was a trend towards better scores in group 1. The was a higher range of motion in group 1 compared to group 2. Functional analysis with isokinetic strength measurements, proprioceptive test and a 3d-motion analysis revealed better functional results in patients of the group cryotherapy/compression device compared to cryotherapy alone. Conclusion: This prospective analysis of 40 patients following semitendinosus ACL reconstruction with one single surgeon implicates that the use of a cryotherapy/compression device (GameReady) showed significantly better objective patient outcomes following ACL reconstruction compared to cryotherapy alone.

scholarly journals Preoperative Knee Instability Affects Residual Instability as Evaluated by Quantitative Pivot-Shift Measurements During Double-Bundle ACL Reconstruction

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095902
Author(s):  
Yusuke Kawanishi ◽  
Masahiro Nozaki ◽  
Makoto Kobayashi ◽  
Sanshiro Yasuma ◽  
Hiroaki Fukushima ◽  
...  
Keyword(s):  
Angular Velocity ◽  
General Anesthesia ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Pivot Shift Test ◽  
Important Indicator ◽  
Quantitative Measurements ◽  
Double Bundle Acl Reconstruction

Background: The pivot-shift test is an important indicator of functional outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR). Preoperative instability as indicated by the pivot-shift test is associated with residual instability after ACLR. Few studies have used quantitative means to evaluate the pivot shift after ACLR. Purpose: To investigate the relationship between preoperative and residual instability and to identify the risk factors for residual instability by using quantitative measurements of the pivot shift. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 91 patients undergoing primary double-bundle ACLR were retrospectively enrolled. Quantitative measurements of instability for ACL-deficient knees (ACLD) and uninjured contralateral knees (intact) preoperatively, as well as ACLR knees intraoperatively, were performed under general anesthesia using the pivot-shift test, with inertial sensors to measure acceleration and external rotational (ER) angular velocity. The ratios of intact to ACLD (ACLD/I) and intact to ACLR (ACLR/I) were measured. Patients who showed an ACLR/I of >1 were classified into the residual instability group, and those with an ACLR/I of ≤1 were classified into the noninstability group. Regarding demographic, surgical, and quantitative measurement factors, between-group comparisons and multivariate logistic regression were conducted for predictors of residual instability. Receiver operating characteristic curves were used to evaluate the correlations between ACLD/I and ACLR/I and the cutoff value of ACLD/I in predicting residual instability. Results: The predictive factors for intraoperative residual instability included female sex (odds ratio [OR], 0.3 [95% CI, 0.1-0.9]; P = .034) and ACLD/I for acceleration (OR, 1.6 [95% CI, 1.2-2.1]; P < .001), and ACLD/I for ER angular velocity (OR, 1.9 [95% CI, 1.2-3.1]; P = .013). Correlations between ACLD/I and ACLR/I were moderate with respect to both acceleration ( r = 0.435; P < .001) and ER angular velocity ( r = 0.533; P < .001). The cutoff points for ACLD/I were 4.9 for acceleration (sensitivity, 65.1%; specificity, 85.7%; area under the curve [AUC], 0.76) and 2.4 for ER angular velocity (sensitivity, 80.0%; specificity, 50.0%; AUC, 0.74). Conclusion: Greater preoperative instability was a risk factor for residual instability as measured intraoperatively by a quantitatively evaluation in the pivot shift during ACL reconstruction. Quantitative measurements of instability during the pivot shift mechanism under general anesthesia may enable surgeons to predict postoperative residual instability.

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.

Modified Iliotibial Band Tenodesis Is Indicated to Correct Intraoperative Residual Pivot Shift After Anterior Cruciate Ligament Reconstruction Using an Autologous Hamstring Tendon Graft: A Prospective Randomized Controlled Trial

2020 ◽  
Vol 48 (5) ◽  
pp. 1069-1077 ◽  
Author(s):  
Mark Porter ◽  
Bruce Shadbolt
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Similar Rate ◽  
Iliotibial Band ◽  
Group A ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Group B

Background: The indications for the addition of anterolateral soft tissue augmentation to anterior cruciate ligament (ACL) reconstruction and its effectiveness remain uncertain. Purpose: To determine if modified iliotibial band tenodesis (MITBT) can improve clinical outcomes and reduce the recurrence of ACL ruptures when added to ACL reconstruction in patients with a residual pivot shift. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients with a primary ACL rupture satisfying the following inclusion criteria were enrolled: first ACL rupture, involved in pivoting sports, skeletally mature, no meniscal repair performed, and residual pivot shift relative to the contralateral uninjured knee immediately after ACL reconstruction. Patients were randomized to group A (no further surgery) or group B (MITBT added) and were followed up for 2 years. The patient-reported outcome (PRO) measures used were the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) subscale of sport/recreation (Sport/Rec), KOOS subscale of quality of life (QoL), Lysholm knee score (LKS), Tegner activity scale (TAS), recurrent ACL ruptures, or need for further surgery in either knee. Analysis of variance was used to compare PROs; the Wilcoxon test was used for the TAS; and the chi-square test was used for recurrence of ACL ruptures, meniscal injuries, and contralateral ACL ruptures ( P < .05). Results: A total of 55 patients were randomized: 27 to group A (female:male ratio = 15:12; mean age, 22.3 ± 3.7 years) and 28 to group B (female:male ratio = 17:11; mean age, 21.8 ± 4.1 years). At 2-year follow-up, group A had a similar IKDC score (90.9 ± 10.7 vs 94.2 ± 11.2; respectively; P = .21), lower KOOS Sport/Rec score (91.5 ± 6.4 vs 95.3 ± 4.4, respectively; P = .02), similar KOOS QoL score (92.0 ± 4.8 vs 95.1 ± 4.3, respectively; P = .14), lower LKS score (92.5 ± 4.8 vs 96.8 ± 8.0, respectively; P = .004), lower TAS score (median, 7 [range, 7-9] vs 8 [range, 8-10], respectively; P = .03), higher rate of recurrence (14.8% vs 0.0%, respectively; P < .001), similar rate of meniscal tears (14.8% vs 3.6%, respectively; P = .14), and similar rate of contralateral ACL ruptures (3.7% vs 3.6%, respectively; P = .99) relative to group B. Conclusion: The augmentation of ACL reconstruction with MITBT reduced the risk of recurrent ACL ruptures in knees with a residual pivot shift after ACL reconstruction and improved KOOS Sport/Rec, LKS, and TAS scores. Registration: ACTRN12618001043224 (Australian New Zealand Clinical Trials Registry)

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