scholarly journals A Randomized Controlled Trial of PEEK Versus Titanium Interference Screws for Anterior Cruciate Ligament Reconstruction With 2-Year Follow-up

2019 ◽  
Vol 47 (10) ◽  
pp. 2386-2393 ◽  
Author(s):  
Sarah Shumborski ◽  
Emma Heath ◽  
Lucy J. Salmon ◽  
Justin P. Roe ◽  
James P. Linklater ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Clinical Performance ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Cyst Formation ◽  
Metal Artifact ◽  
Interference Screws ◽  
Novel Technique ◽  
Randomized Controlled ◽  
Anterior Cruciate

Background: Graft fixation with interference screws for anterior cruciate ligament (ACL) reconstruction is a highly successful technique. Polyether ether ketone (PEEK) is a novel thermoplastic polymer with high biocompatibility and mechanical properties that mimic native bone, and it can be imaged on computed tomography or magnetic resonance imaging (MRI) without signal flare. Purpose: To compare the clinical performance of ACL reconstruction with PEEK and titanium interference screws at 2 years and to evaluate a novel method of measuring tunnel volume. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 133 patients underwent arthroscopic ACL reconstruction with 4-strand hamstring autografts and were randomized to have titanium or PEEK interference screws for femoral and tibial tunnel fixation. At 2 years, subjective Lysholm and International Knee Documentation Committee scores were assessed and clinical examination performed. At 12 months, MRI was performed to assess graft incorporation and cyst formation, and a novel technique was employed to measure tunnel volumes. Results: There were no significant differences in graft rerupture rate, contralateral ACL rupture rate, subjective outcomes, or objective outcomes. In the titanium and PEEK groups, MRI demonstrated high overall rates of graft integration (96%-100% and 90%-93%, respectively) and ligamentization (89% and 84%) and low rates of synovitis (22% and 10%) and cyst formation (0%-18% and 13%-15%). There was a higher proportion of patients with incomplete graft integration within the femoral tunnel in the PEEK group as compared with the titanium group (10% vs 0%, P = .03); however, the authors suggest that metal artifact precluded proper assessment of the graft in the titanium group by MRI. Tunnel volumes also appeared to be equivalent in the 2 groups and were measured with a novel technique that was highly reproducible in the PEEK group secondary to the absence of flare. Conclusion: Two-year clinical analysis of PEEK interference screws for femoral and tibial fixation of ACL reconstructions showed equivalent clinical performance to titanium interference screws. Given the excellent mechanical characteristics, biological compatibility, and absence of metal artifact on MRI, PEEK has become our material of choice for interference screw fixation in ACL reconstruction.

Adductor Canal Block Versus Femoral Nerve Block for Pain Control After Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial

2018 ◽  
Vol 47 (2) ◽  
pp. 355-363 ◽  
Author(s):  
Jonathan R. Lynch ◽  
Kelechi R. Okoroha ◽  
Vincent Lizzio ◽  
Charles C. Yu ◽  
Toufic R. Jildeh ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pain Control ◽  
Femoral Nerve Block ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Femoral Nerve ◽  
Thigh Circumference ◽  
Randomized Controlled ◽  
Anterior Cruciate ◽  
Straight Leg Raise

Background: Femoral nerve block (FNB) is a commonly performed technique that has been proven to provide effective regional analgesia after anterior cruciate ligament (ACL) reconstruction. The adductor canal block (ACB) uses a similar sensory block around the knee while avoiding motor blockade of the quadriceps muscles. Purpose/Hypothesis: The purpose of our study was to compare the efficacy of FNB versus ACB for pain control after ACL reconstruction. It was hypothesized that there would be no difference in pain levels or opioid requirements between the 2 groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: We performed a prospective, double-blinded, randomized controlled trial. Sixty patients undergoing primary ACL reconstruction with bone-patellar tendon-bone autograft were randomized to receive either an ACB or an FNB preoperatively. The primary outcomes assessed were pain levels (visual analog scale) and narcotic requirements for 4 days after surgery. Secondary outcomes included ability to perform a straight leg raise in the recovery room and difference in thigh circumference between the operative and nonoperative leg measured at 7 days postoperatively. Results: Morphine requirements were less in the ACB group in the first 4 hours postoperatively ( P = .02). Aside from this time interval, no differences were found between the 2 groups with regard to opioid requirements and pain scores at any other time. Similarly, no differences were noted in patients’ ability to perform a straight leg raise in the recovery room ( P = .13) or in thigh circumference at the first postoperative visit ( P = .09). Conclusion: The results of our study suggest similar efficacy in perioperative pain control with the use of an ACB for ACL reconstruction when compared with FNB. The potential long-term benefit of quadriceps preservation with the ACB is worthy of future study. Registration: NCT03033589 (ClinicalTrials.gov identifier).

scholarly journals Repair versus reconstruction for proximal anterior cruciate ligament tears: a study protocol for a prospective multicenter randomized controlled trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jelle P. van der List ◽  
Harmen D. Vermeijden ◽  
Inger N. Sierevelt ◽  
Maarten V. Rademakers ◽  
Mark L. M. Falke ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Acl Reconstruction ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Return To Sports ◽  
Acl Repair ◽  
Randomized Controlled ◽  
Ikdc Score ◽  
Anterior Cruciate

Abstract Background For active patients with a tear of the anterior cruciate ligament (ACL) who would like to return to active level of sports, the current surgical gold standard is reconstruction of the ACL. Recently, there has been renewed interest in repairing the ACL in selected patients with a proximally torn ligament. Repair of the ligament has (potential) advantages over reconstruction of the ligament such as decreased surgical morbidity, faster return of range of motion, and potentially decreased awareness of the knee. Studies comparing both treatments in a prospective randomized method are currently lacking. Methods This study is a multicenter prospective block randomized controlled trial. A total of 74 patients with acute proximal isolated ACL tears will be assigned in a 1:1 allocation ratio to either (I) ACL repair using cortical button fixation and additional suture augmentation or (II) ACL reconstruction using an all-inside autologous hamstring graft technique. The primary objective is to assess if ACL repair is non-inferior to ACL reconstruction regarding the subjective International Knee Documentation Committee (IKDC) score at two-years postoperatively. The secondary objectives are to assess if ACL repair is non-inferior with regards to (I) other patient-reported outcomes measures (i.e. Knee Injury and Osteoarthritis Outcome Score, Lysholm score, Forgotten Joint Score, patient satisfaction and pain), (II) objective outcome measures (i.e. failure of repair or graft defined as rerupture or symptomatic instability, reoperation, contralateral injury, and stability using the objective IKDC score and Rollimeter/KT-2000), (III) return to sports assessed by Tegner activity score and the ACL-Return to Sports Index at two-year follow-up, and (IV) long-term osteoarthritis at 10-year follow-up. Discussion Over the last decade there has been a resurgence of interest in repair of proximally torn ACLs. Several cohort studies have shown encouraging short-term and mid-term results using these techniques, but prospective randomized studies are lacking. Therefore, this randomized controlled trial has been designed to assess whether ACL repair is at least equivalent to the current gold standard of ACL reconstruction in both subjective and objective outcome scores. Trial registration Registered at Netherlands Trial Register (NL9072) on 25th of November 2020.

scholarly journals Whether sutures reduce the graft laceration caused by interference screw in anterior cruciate ligament reconstruction? A biomechanical study in vitro

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuanjun Teng ◽  
Xiaohui Zhang ◽  
Lijun Da ◽  
Jie Hu ◽  
Hong Wang ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Biomechanical Study ◽  
Interference Screws ◽  
Suture Group ◽  
Anterior Cruciate ◽  
Biomechanical Tests ◽  
Single Insertion

Abstract Background Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction. However, previous studies had reported that the insertion of interference screws significantly caused graft laceration. The purposes of this study were to (1) quantitatively evaluate the graft laceration from one single insertion of PEEK interference screws; and (2) determine whether different types of sutures reduced the graft laceration after one single insertion of interference screws in ACL reconstruction. Methods The in-vitro ACL reconstruction model was created using porcine tibias and bovine extensor digitorum tendons of bovine hind limbs. The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra-high molecular weight polyethylene (UHMWPE) sutures. Poly-ether-ether-ketone (PEEK) interference screws were used for tibial fixation. This study was divided into five groups (n = 10 in each group): the non-fixed group, the non-sutured group, the absorbable suture group, the Ethibond suture group and the UHMWPE suture group. Biomechanical tests were performed using the mode of pull-to-failure loading tests at 10 mm/min. Tensile stiffness (newtons per millimeter), energy absorbed to failure (in joules) and ultimate load (newtons) were recorded for analysis. Results All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre-tension of the tendons, tibial bone mineral density) among all groups (P > 0.05). The biomechanical tests demonstrated that PEEK interference screws significantly caused the graft laceration (P < 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction (P > 0.05). Conclusions Our biomechanical study suggested that the ultimate failure load of grafts was reduced of approximately 25 % after one single insertion of a PEEK interference screw in ACL reconstruction. Suturing the ends of the grafts using different sutures (absorbable, Ethibond and UHMWPE sutures) did not decrease the graft laceration caused by interference screws.

scholarly journals Nonsurgical Management of an Anterior Cruciate Ligament-Deficient Knee in a Women's Soccer Player: A Validation Clinical Case Report

2017 ◽  
Vol 52 (11) ◽  
pp. 1079-1083
Author(s):  
Courtney E. Gray ◽  
Chris Hummel ◽  
Todd Lazenby
Keyword(s):  
Randomized Controlled Trial ◽  
Anterior Cruciate Ligament ◽  
Case Report ◽  
Soccer Player ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Randomized Controlled ◽  
Anterior Cruciate ◽  
Acl Deficient

Background:  A collegiate women's soccer player sustained an isolated anterior cruciate ligament (ACL) tear and expressed a desire to continue her season without surgical intervention. Design:  Case report. Intervention(s):  Using the results of a randomized controlled trial and published clinical guidelines, the clinicians classified the patient as an ACL-deficient coper. The patient completed her soccer season without incident, consistent with the findings of the established clinical guidelines. However, 6 months later, she sustained a meniscal tear, which was not unexpected given that 22% of ACL-deficient copers in the randomized controlled trial incurred a meniscal tear within 24 months of ACL injury. Conclusion:  The external evidence was helpful in making informed clinical decisions regarding patient care.

scholarly journals Whether Sutures Reduce the Graft Laceration Caused by Interference Screw in Anterior Cruciate Ligament Reconstruction a Biomechanical Study in Vitro

2021 ◽  
Author(s):  
Yuanjun Teng ◽  
Lijun Da ◽  
Xiaohui Zhang ◽  
Hong Wang ◽  
Hua Han ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Biomechanical Study ◽  
Protective Effects ◽  
Mineral Density ◽  
Interference Screws ◽  
Anterior Cruciate

Abstract Background: Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction However, previous studies h a d reported that the insertion of interference screws significantly caused graft laceration . The purpose of this study was to determine whether sutures reduce d the graft laceration from the insertion of interference screws in ACL reconstruction. Methods: Porcine tibias and bovine extensor tendons were used for establishing a knee model of ACL reconstruction in vitro . The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra high molecular weight polyethylene (UHMWPE) sutures Poly ether ether ketone (PEEK) interference screw s w ere used fortibial fixation Biomechanical tests were performed to investigate the protective effects of different sutures on grafts Results : All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre tension of the tendons, tibial bone mineral density) among all groups ( P 0.05). The biomechanical test s demonstrated that PEEK interference screw s significantly caused the graft laceration P 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction P 0.05). Conclusions : PEEK interference screw s significantly weakened the biomechanical properties of grafts during tibial fixation in ACL reconstruction. Absorbable Ethibond and UHMWPE sutures did not provide protective effects on grafts during ACL reconstruction.

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