Increased Posterior Tibial Slope Is Associated With Greater Risk of Graft Roof Impingement After Anatomic Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110188
Author(s):  
Guan-yang Song ◽  
Qian-kun Ni ◽  
Tong Zheng ◽  
Hua Feng ◽  
Zhi-jun Zhang ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Pivot Shift Test ◽  
Control Group ◽  
Study Group ◽  
Meniscal Tears ◽  
Resonance Imaging ◽  
Kt 1000 ◽  
Anterior Cruciate

Background: Increased posterior tibial slope (PTS) has been reported to be associated with irreducible anterior tibial subluxation in extension after anatomic anterior cruciate ligament (ACL) reconstruction (ACLR), which raises concerns about the greater risk of graft roof impingement (GRI) although the tibial tunnel is positioned anatomically. Hypothesis: Increased PTS would be associated with greater risk of GRI after anatomic ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: Between January 2016 and December 2017, a total of 418 consecutive patients were diagnosed as having noncontact ACL injuries and underwent primary anatomic ACLR. Among them, 26 patients had ≥1 of the following features during the second-look arthroscopy: fractured/guillotined bundles at the tibial insertion or cyclops lesion. These patients were confirmed to have GRI and were allocated to the study group. They were also matched 1:2 to 52 control participants without GRI. PTS was measured on true lateral whole-leg radiographs. Intra-articular ACL graft signal intensity was evaluated on postoperative magnetic resonance imaging scans (mean, 32.8 months; range, 26-38 months) and divided into 3 grades (I, good; II, moderate; III, poor) based on degree of GRI. Moreover, anterior subluxation of the lateral compartment (ASLC) and medial compartment (ASMC) in extension relative to the femoral condyles were measured on postoperative magnetic resonance imaging scans and compared between the groups. In addition, predictors of GRI were evaluated using multivariate logistic regression analysis and included body mass index, PTS, pivot-shift test, KT-1000 side-to-side difference, and concomitant meniscal tears. Results: PTS in the study group was significantly higher than that in control group (mean ± SD, 13.8°± 1.5° vs 9.5°± 1.8°; P < .05). In the study group (n = 26), patients with grade III (poor) graft signal intensity (n = 9) showed significantly higher PTS than those with grade II (moderate; n = 17) (16.4°± 1.7° vs 12.4°± 1.3°; P < .05). Moreover, the mean postoperative ASLC and ASMC in extension were significantly larger in the study group than the control group (ASLC, 4.1 ± 1.3 vs 0.8 ± 0.4 mm; ASMC, 4.3 ± 1.5 vs 0.9 ± 0.3 mm; P < .05). Furthermore, the abnormal degree of PTS (≥12°) was determined to be an independent risk factor associated with GRI after anatomic ACLR (odds ratio, 9.0 [95% CI, 3.7-30.2]; P < .001), whereas body mass index, grade of pivot-shift test, KT-1000 side-to-side difference, and concomitant meniscal tears were not. Conclusion: Increased PTS (≥12°) was associated with greater risk of GRI after anatomic ACLR. This may provide additional information for counseling patients with greater risk of GRI.

Excessive Preoperative Anterior Tibial Subluxation in Extension Is Associated With Inferior Knee Stability After Anatomic Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 48 (3) ◽  
pp. 573-580 ◽  
Author(s):  
Guan-yang Song ◽  
Hui Zhang ◽  
Jin Zhang ◽  
Zhi-jun Zhang ◽  
Tong Zheng ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Control Group ◽  
Study Group ◽  
Knee Stability ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
Anterior Cruciate

Background: Anterior tibial subluxation (ATS) in extension after anterior cruciate ligament (ACL) injury highlights an increased anterior position of the tibia relative to the femur. Recent studies demonstrated that subluxation is sometimes irreducible and the normal tibiofemoral relationship is not restored by ACL reconstruction (ACLR), which raises concerns regarding clinical outcomes after ACLR. Hypothesis: Excessive preoperative ATS in extension is associated with inferior knee stability after anatomic ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: From March 2016 to January 2017, a total of 487 consecutive patients with clinically diagnosed noncontact ACL injuries who underwent primary anatomic ACLR were retrospectively analyzed. Of these patients, 430 met the criteria for inclusion in this study. Anterior subluxation of the lateral and medial compartments (ASLC and ASMC) in extension relative to the femoral condyles was measured on preoperative magnetic resonance imaging. Twenty patients (study group) who demonstrated excessive (>10 mm) ASLC and ASMC in extension were matched 1:2 to 40 participants (control group) who showed minimal or no (<3 mm) ASLC and ASMC in extension. The amount of ASLC and ASMC in extension relative to the femoral condyles at 2 years postoperatively was the primary outcome. Moreover, the Lysholm score, IKDC grade (International Knee Documentation Committee), and stability assessments (pivot-shift test and KT-1000 arthrometer side-to-side difference) were evaluated preoperatively and at the last follow-up visit. Results: The preoperative mean ASLC and ASMC in extension of the study group were both significantly larger than those of the control group (study group vs control group: ASLC, 13.5 mm vs 1.2 mm; ASMC, 12.4 mm vs 1.0 mm; P < .05). Moreover, patients in the study group showed significantly larger posterior tibial slope than the patients in the control group (17.8°± 2.5° vs 9.5°± 1.5°; P < .05). At the final follow-up visit, the mean ASLC and ASMC of the study group were 8.1 mm and 7.3 mm, which were significantly larger than those of the control group (ASLC, 0.9 mm; ASMC, 0.7 mm; P < .05). In addition, the study group showed inferior knee stability when compared with the control group in terms of both the pivot-shift test (study group vs control group: 2 grade 2, 10 grade 1, and 8 grade 0 vs 1 grade 1 and 39 grade 0; P < .05) and the KT-1000 arthrometer side-to-side difference (study group vs control group: 4.4 ± 1.2 mm vs 1.5 ± 0.6 mm; P < .05). Furthermore, the study group showed significantly lower mean Lysholm score (study group vs control group: 80.3 ± 6.3 vs 93.3 ± 4.3, P < .05) and IKDC grading results (study group vs control group: 3 grade C, 16 grade B, and 1 grade A vs 3 grade B and 37 grade A; P < .05) as compared with the control group. Conclusion: In this short-term study, the excessive (>10 mm) preoperative ATS in extension after ACL injury was associated with inferior knee stability after anatomic ACLR.

Quantitative Assessment of Rotatory Instability after Anterior Cruciate Ligament Reconstruction

2009 ◽  
Vol 37 (5) ◽  
pp. 909-916 ◽  
Author(s):  
Yasutaka Tashiro ◽  
Ken Okazaki ◽  
Hiromasa Miura ◽  
Shuichi Matsuda ◽  
Takefumi Yasunaga ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Resonance Imaging ◽  
Rotatory Instability ◽  
Open Magnetic Resonance Imaging ◽  
Anterior Cruciate ◽  
Tibial Translation

Background Anterior cruciate ligament reconstruction successfully reduces anterior knee instability, but its effect on rotatory stability is not fully understood. In addition, a definitive method for the quantitative evaluation of rotatory instability remains to be established. Hypothesis Measurement of anterolateral tibial translation by open magnetic resonance imaging could positively correlate with the clinical grading of the pivot-shift test and would clarify residual rotatory abnormalities not shown by conventional methods for measurement of anterior stability. Study Design Controlled laboratory study. Methods An anterior cruciate ligament—reconstructed group (n = 21) and an anterior cruciate ligament—deficient group (n = 20) were examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging. Anterior tibial translation was measured at the medial and lateral compartments by evaluating sagittal images. Clinical knee stability was evaluated before the above measurement using the pivot-shift test, KT-2000 arthrometer, and stress radiography. A cutoff value for anterolateral tibial translation relating to pivot-shift was determined using a receiver operating characteristic curve. Results Side-to-side differences of anterolateral tibial translation correlated with clinical grade of the pivot-shift test and stress radiography but not with KT-2000 arthrometry in both groups. The cutoff value was established as 3.0 mm. Although the mean anterolateral translation showed no difference, 9 reconstructed knees revealed greater than 3 mm of anterolateral tibial translation, whereas only 3 uninjured knees did. Conclusion Measurement using an open magnetic resonance imaging successfully quantified the remaining rotatory instability in anterior cruciate ligament—reconstructed knees. Clinical Relevance This method is a useful means for quantifying anterior cruciate ligament function to stabilize tibial rotation.

Association Between Psychological Readiness and Knee Laxity and Their Predictive Value for Return to Sport in Patients With Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110218
Author(s):  
Anne Gro Heyn Faleide ◽  
Liv Heide Magnussen ◽  
Bård Erik Bogen ◽  
Torbjørn Strand ◽  
Ingunn Fleten Mo ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
Anterior Cruciate

Background: Deciding when patients are ready to return to sport (RTS) after an anterior cruciate ligament (ACL) reconstruction (ACLR) is challenging. The understanding of which factors affect readiness and how they may be related is limited. Therefore, despite widespread use of RTS testing, there is a lack of knowledge about which tests are informative on the ability to resume sports. Purpose: To examine whether there is an association between knee laxity and psychological readiness to RTS after ACLR and to evaluate the predictive value of these measures on sports resumption. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged ≥16 years engaged in physical activity/sports before injury were recruited at routine clinical assessment 9-12 months after ACLR. Exclusion criteria were concomitant ligament surgery at ACLR and/or previous ACL injury in the contralateral knee. At baseline, a project-specific activity questionnaire and the ACL–Return to Sport After Injury (ACL-RSI) scale were completed. Knee laxity was assessed by use of the Lachman test, KT-1000 arthrometer, and pivot-shift test. Two years after surgery, knee reinjuries and RTS status (the project-specific questionnaire) were registered. Associations between psychological readiness and knee laxity were evaluated with the Spearman rho test, and predictive ability of the ACL-RSI and knee laxity tests were examined using regression analyses. Results: Of 171 patients screened for eligibility, 132 were included in the study. There were small but significant associations between the ACL-RSI score and the Lachman test (rho = −0.18; P = .046) and KT-1000 arthrometer measurement (rho = −0.18; P = .040) but no association between the ACL-RSI and the pivot-shift test at the time of recruitment. Of the total patients, 36% returned to preinjury sport level by 2 years after surgery. Higher age, better psychological readiness, and less anterior tibial displacement (KT-1000 arthrometer measurement) were significant predictors of 2-year RTS (explained variance, 33%). Conclusion: Small but significant associations were found between measurements of psychological readiness and anterior tibial displacement, indicating that patients with less knee laxity after ACLR feel more ready to RTS. ACL-RSI and KT-1000 arthrometer measurements were independent predictors of 2-year RTS and should be considered in RTS assessments after ACLR.

Outcomes After Isolated Acute Anterior Cruciate Ligament Reconstruction Are Inferior in Patients With an Associated Anterolateral Ligament Injury

2020 ◽  
Vol 48 (13) ◽  
pp. 3177-3182
Author(s):  
Marcel Faraco Sobrado ◽  
Pedro Nogueira Giglio ◽  
Marcelo Batista Bonadio ◽  
Paulo Victor Partezani Helito ◽  
Tales Mollica Guimarães ◽  
...  
Keyword(s):  
Failure Rate ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Resonance Imaging ◽  
Acl Injuries ◽  
Knee Hyperextension ◽  
Kt 1000 ◽  
Anterior Cruciate

Background: Isolated reconstruction of the anterior cruciate ligament (ACL) does not reestablish the normal knee biomechanics in cases of associated injuries to the anterolateral structures. Studies evaluating the potential clinical effect of anterolateral ligament (ALL) injury on the treatment of ACL injuries are necessary to validate the findings of biomechanical studies. Purpose: To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed using magnetic resonance imaging. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL group) or absence (no-ALL group) of ALL injury on preoperative magnetic resonance imaging scans. Both groups underwent anatomic reconstruction of the ACL with autologous hamstring tendon grafts. The Lysholm and subjective IKDC scores (International Knee Documentation Committee), KT-1000 arthrometer and pivot-shift test results, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. Results: A total of 182 patients were evaluated. Postoperative mean ± SD follow-up was 33.6 ± 7.1 and 36.1 ± 8.1 months for the ALL and no-ALL groups, respectively. No significant differences were found between the groups in terms of age, sex, knee hyperextension, duration of injury before reconstruction, follow-up time, or associated meniscal injuries. In the preoperative evaluation, the pivot-shift grade was similar, and the ALL group had worse KT-1000 arthrometer values (7.9 ± 1.2 mm vs 7.2 ± 1.1 mm; P < .001). In the postoperative evaluation, patients in the no-ALL group had a lower reconstruction failure rate (10.2% vs 1.4%; P = .029) and better clinical outcomes according to the IKDC subjective (85.5 ± 10.7 vs 89.1 ± 6.6; P = .035) and Lysholm scores (85.9 ± 10.1 vs 92.0 ± 6.3; P < .001). There was no postoperative difference in the KT-1000 or pivot-shift results. Conclusion: Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 2 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores.

Slope-Reducing Tibial Osteotomy Combined With Primary Anterior Cruciate Ligament Reconstruction Produces Improved Knee Stability in Patients With Steep Posterior Tibial Slope, Excessive Anterior Tibial Subluxation in Extension, and Chronic Meniscal Posterior Horn Tears

2020 ◽  
Vol 48 (14) ◽  
pp. 3486-3494
Author(s):  
Guan-yang Song ◽  
Qian-kun Ni ◽  
Tong Zheng ◽  
Zhi-jun Zhang ◽  
Hua Feng ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Tibial Osteotomy ◽  
Knee Stability ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
The Mean ◽  
Anterior Cruciate

Background: Steep posterior tibial slope (PTS; >13°), excessive anterior tibial subluxation (ATS) in extension (>10 mm), and meniscus posterior horn tears (MPHTs) have been identified to be associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure. Recent studies have reported that steep PTS is directly correlated with excessive ATS in extension and concomitant MPHTs, especially for those patients with chronic (>6 months) ACL deficiency. There is increasing biomechanical evidence that slope-reducing tibial osteotomy decreases ATS in extension and protects the ACL graft. Hypothesis: Slope-reducing tibial osteotomy combined with primary ACLR is effective for producing improved knee stability in patients with steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months). Study Design: Case series; Level of evidence, 4. Methods: Between June 2016 and January 2018, 18 patients with ACL injuries who had steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months) underwent slope-reducing tibial osteotomy combined with primary ACLR. The PTS and anterior subluxation of the lateral and medial compartment (ASLC and ASMC) in extension before and after the index procedures were regarded as primary clinical outcomes. Moreover, Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) objective grade, pivot-shift test, and KT-1000 side-to-side difference were evaluated preoperatively and at the minimum 2-year follow-up visit. Results: The mean PTS was 18.5° (range, 17°-20°) preoperatively and 8.1° (range, 7°-9°) postoperatively ( P < .01). The mean ASLC and ASMC in extension were 12.1 mm and 11.9 mm preoperatively, which reduced to 1.0 mm and 1.5 mm at the last follow-up visit ( P < .05). In addition, all of the following showed significant improvements (pre- vs postoperatively): mean Lysholm score (46.5 vs 89.5; P < .05), mean Tegner activity score (5.7 vs 7.3; P < .05), IKDC objective grading results (18 grade D vs 14 grade A and 4 grade B; P < .05), pivot-shift tests (15 grade 2+ and 3 grade 3+ vs 18 grade 0; P < .01), and KT-1000 side-to-side difference (13.0 mm vs 1.6 mm; P < .01). Moreover, no graft reruptures were found at the final follow-up visit. Conclusion: In this study, slope-reducing tibial osteotomy combined with primary ACLR effectively improved knee stability in patients with steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months).

Steep Posterior Tibial Slope and Excessive Anterior Tibial Translation Are Predictive Risk Factors of Primary Anterior Cruciate Ligament Reconstruction Failure: A Case-Control Study With Prospectively Collected Data

2020 ◽  
Vol 48 (12) ◽  
pp. 2954-2961 ◽  
Author(s):  
Qian-kun Ni ◽  
Guan-yang Song ◽  
Zhi-jun Zhang ◽  
Tong Zheng ◽  
Zheng Feng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Pivot Shift Test ◽  
Control Group ◽  
Anterior Tibial Translation ◽  
Cutoff Values ◽  
Kt 1000 ◽  
Predictive Risk ◽  
Tibial Translation

Background: Steep posterior tibial slope (PTS) and excessive anterior tibial translation (ATT) have been identified as important anatomic risk factors for anterior cruciate ligament (ACL) injury, which have raised concerns about clinical outcomes after primary ACL reconstruction (ACLR). Purpose: To investigate anatomic risk factors of primary ACLR failure and to determine the cutoff values of PTS and ATT for predicting primary ACLR failure. Study Design: Case-control study; Level of evidence, 3. Methods: Between November 2015 and May 2017, a total of 215 consecutive patients with clinically diagnosed noncontact ACL injuries who underwent primary anatomic ACLR were retrospectively analyzed. Among them, 25 patients who showed complete discontinuity of ACL fibers on final follow-up magnetic resonance imaging scans were allocated into the failure group (study group). They were matched 1:2 to 50 control participants who showed clear and continuous ACL fibers on magnetic resonance imaging scans (control group). PTS and ATT were measured on preoperative weightbearing whole leg lateral radiographs and compared between the groups. The cutoff values of PTS and ATT for predicting primary ACLR failure were determined by the receiver operating characteristic curve. Moreover, predictors of primary ACLR failure were assessed by multivariate logistic regression analysis, including sex, age, body mass index, concomitant meniscal tears, degree of pivot-shift test, and KT-1000 arthrometer side-to-side difference, PTS, and ATT. Results: PTS and ATT values in the study group were significantly higher than those in the control group (mean ± SD: PTS, 17.2°± 2.2° vs 14.4°± 2.8°; ATT, 8.3 ± 3.4 mm vs 4.1 ± 3.1 mm; P < .001). The cutoff values of PTS and ATT for predicting primary ACLR failure were 17° (sensitivity, 66.7%; specificity, 90.9%) and 6 mm (sensitivity, 87.5%; specificity, 79.5%), respectively. Additionally, PTS ≥17° (odds ratio, 15.6; 95% CI, 2.7-91.5; P = .002) and ATT ≥6 mm (odds ratio, 9.9; 95% CI, 1.9-51.4; P = .006) were determined to be risk factors of primary ACLR failure, whereas sex, age, body mass index, concomitant meniscal tears, degree of the pivot-shift test, and KT-1000 arthrometer side-to-side difference were not. Conclusion: In this study, PTS ≥17° and ATT ≥6 mm, as measured on weightbearing whole leg radiographs, were identified to be predictive risk factors of primary ACLR failure. This study adds to the existing knowledge about potential surgical indications of simultaneous slope-reducing high tibial osteotomy to mitigate the primary ACLR failure rate.

All-Inside Single-Bundle Reconstruction of the Anterior Cruciate Ligament with the Anterior Half of the Peroneus Longus Tendon Compared to the Semitendinosus Tendon: A Two-Year Follow-Up Study

2018 ◽  
Vol 31 (10) ◽  
pp. 1022-1030 ◽  
Author(s):  
Mingguang Bi ◽  
Chen Zhao ◽  
Shuijun Zhang ◽  
Bin Yao ◽  
Zheping Hong ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Pivot Shift Test ◽  
Single Bundle ◽  
Knee Stability ◽  
Peroneus Longus Tendon ◽  
Kt 1000 ◽  
Anterior Cruciate

AbstractThe anterior half of the peroneus longus tendon (AHPLT) has been reported to be acceptable for ligament reconstruction with respect to strength and safety. However, there is little information regarding the clinical outcomes after using the AHPLT compared with other autograft tendons. A prospective randomized controlled study was performed to compare the results of 62 cases of all-inside anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using the AHPLT and 62 cases using semitendinosus graft with an average of 30.0 ± 3.6 months' follow-up. Tunnel placements of enrolled cases were measured on three-dimensional (3D) computed tomography (CT) and X-ray imaging. Knee stability was assessed using the anterior drawer test, pivot shift test, and KT-1000. The International Knee Documentation Committee (IKDC) 2000 subjective score was used to evaluate functional outcomes. The American Orthopedic Foot and Ankle Score (AOFAS) and the assessment of eversion muscle strength were performed to evaluate the function of the ankle donor site. Tunnel positions, which were confirmed with 3D CT, were in the anatomical positions. At the final follow-up, there were no significant differences between the semitendinosus group and the AHPLT group in the IKDC score (90.4 ± 7.1 vs. 89.3. ± 8.4), KT 1000 measurements (1.71 ± 0.57 vs. 1.85 ± 0.77), pivot shift test, and Visual Analogue Scale (VAS) (0.15 ± 0.36 vs. 0.10 ± 0.30). No obvious ankle site complications were found at 24 months. The average AOFAS score of the AHPLT group was comparable to that of the semitendinosus tendon group (99.1 ± 1.40 vs. 99.5 ± 1.21). There was no significant difference in clinical outcomes or knee stability between the semitendinosus group and the AHPLT group at the 2-year follow-up. An AHPLT autograft may be a good alternative for all-inside ACL reconstruction with respect to its strength, safety, and donor site morbidity.

scholarly journals The Role of the Posterolateral Tibial Slope in the Rotational Instability of the Knee in Patients Affected by a Complete Isolated Anterior Cruciate Ligament Injury: Its Value in the Decision-Making Process during the Anterolateral Ligament Reconstruction

Joints ◽  
2020 ◽  
Author(s):  
Marco Bargagliotti ◽  
Francesco Benazzo ◽  
Johan Bellemans ◽  
Jan Truijen ◽  
Luigi Pietrobono ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Anterolateral Ligament ◽  
Pivot Shift Test ◽  
Group A ◽  
Anterior Cruciate ◽  
Posterior Shift

Abstract Purpose The aim of this retrospective, multicenter study was to investigate the correlation between a high degree of rotatory instability, posterolateral tibial slope (PLTS), and anterolateral ligament (ALL) injury. Methods The study population consisted of 76 adults with isolated, complete noncontact anterior cruciate ligament (ACL) tear. The sample was divided into two groups according to the preoperative degree of rotator instability (group A: pivot-shift test grades 2 and 3; group B: pivot-shift test grade 1). Preoperative magnetic resonance imaging (MRI) assessment included angle of PLTS, posterior shift of the lateral femoral condyle (16 mm) on the tibial plateau, and the presence/absence of ALL injury. The two groups were compared for differences. Results There was a statistically significant association between pivot-shift test grades 2 and 3 (group A), PLTS slope angle > 9 degrees, and ALL injury (p < 0.05). Group A also demonstrated a greater posterior shift of lateral femoral condyle (>11 mm), which was, however, not statistically significant when evaluated as an isolated variable. Conclusion Our study indicates that an increased PLTS is associated with an increased incidence of ALL injury and an increased grade of pivot shift in patients with ACL tear. Assessment of posterolateral tibial slope on MRI can therefore play a key adjunct role in the surgical planning of ALL reconstruction, especially in cases when ALL damage is radiologically difficult to detect or doubtful. Level of Evidence This is a retrospective comparative level III study.

scholarly journals Surgical Treatment of Segond Fractures in Acute Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711772999 ◽  
Author(s):  
Andrea Ferretti ◽  
Edoardo Monaco ◽  
Megan Rianne Wolf ◽  
Matteo Guzzini ◽  
Angelo De Carli ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Case Series ◽  
Pivot Shift Test ◽  
Segond Fracture ◽  
Acl Tear ◽  
Kt 1000 ◽  
Anterior Cruciate

Background: The Segond fracture is an avulsion-type fracture located on the anterolateral aspect of the tibia associated with a ligament recently termed the anterolateral ligament. This injury has been described as pathognomonic for an anterior cruciate ligament (ACL) tear and is associated with a higher grade pivot shift. Purpose: To present and report 2-year clinical outcomes of a surgical technique for acute ACL reconstruction with fixation of a concomitant Segond fracture. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review was performed of patients who underwent acute reconstruction for a complete ACL tear with concomitant Segond fracture fixation between January 2010 and December 2014; surgery was performed by a single surgeon. Patients underwent direct Segond fracture repair by either suture alone, suture anchor, or cannulated screw fixation based on the size of the lesion, followed by a 2-incision hamstring autograft intra-articular reconstruction. Pre- and postoperative KT-1000 arthrometer assessment, Lachman test, and pivot-shift test were performed, and patients were administered validated subjective outcome surveys. Results: Twelve patients met inclusion criteria for this review. The measured pre- and postoperative objective and subjective scores were significantly improved in all patients. Side-to-side anterior laxity was significantly improved in all patients based on Lachman and KT-1000 arthrometer testing. A significant pivot shift demonstrated preoperatively (3+, n = 11 [92%]; 2+, n = 1 [8%]) was corrected after fixation, except in 1 patient (8%), who maintained a 1+ pivot shift. Lysholm, Tegner, and International Knee Documentation Committee subjective and objective scores were significantly improved. At a minimum 2-year follow-up, no patients reported rerupture, and only 1 patient (8%) underwent a subsequent procedure (a meniscectomy). No major or minor complications were reported, and all patients returned to their previous activity levels at a mean of 6 months postoperatively. Conclusion: Direct repair of the Segond fracture and plication of the anterolateral capsule in patients with an ACL rupture and a high-grade pivot shift demonstrate good clinical outcomes, restoration of rotational stability, and maintenance of knee range of motion at 2 years postoperatively, with no major complications.

scholarly journals Xenograft for anterior cruciate ligament reconstruction was associated with high graft processing infection

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Willem Van Der Merwe ◽  
Martin Lind ◽  
Peter Faunø ◽  
Kees Van Egmond ◽  
Stefano Zaffagnini ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Infection Rate ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Tunnel Widening ◽  
Kt 1000 ◽  
Anterior Cruciate

Abstract Purpose To evaluate clinical ad radiological outcomes of anterior cruciate ligament (ACL) reconstruction with an immunochemically modified porcine patellar tendon xenograft controlled against human Achilles tendon allograft at 24-month minimum follow-up. Methods 66 patients undergoing arthroscopic ACL reconstruction were randomized into 2 groups: 34 allografts and 32 xenografts treated to attenuate the host immune response. Follow-up was 24-month minimum. Anterior knee stability was measured as KT − 1000 side-to-side laxity difference (respect to the contralateral healthy knee). Functional performance was assessed by one-legged hop test. Objective manual pivot-shift test and subjective (IKDC, Tegner and SF-36) outcomes were collected. MRI and standard X-Ray were performed. Results 61 subjects (32 allograft, 29 xenograft) were evaluated at 12 and 24 months. Six of the subjects in xenograft group (20.6%) got an infection attributed to a water-based pathogen graft contamination in processing. Intention-to-treat analysis (using the last observation carried forward imputation method) revealed higher KT − 1000 laxity in xenograft group at 24-month follow-up (P = .042). Also pivot-shift was higher in xenograft group at 12-month (P = .015) and 24-month follow-up (P = .038). Per-protocol analysis (missing/contaminated subjects excluded) did not revealed clinical differences between groups. Tibial tunnel widening in the allograft group was low, whereas xenograft tunnel widening was within the expected range of 20–35% as reported in the literature. No immunological reactivity was associated to xenograft group. Conclusions High infection rate (20.6%) was reported in xenograft group. Both groups of patients achieved comparable clinical outcomes if missing/contaminated subjects are excluded. Improved harvesting/processing treatments in future studies using xenografts for ACL reconstruction are needed to reduce infection rate, otherwise xenograft should not be used in ACL reconstruction. Level of evidence Multicenter and double-blinded Randomized Controlled Clinical Trial, Level I.

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