Revision Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft Combined With Modified Lemaire Technique Versus Hamstring Graft Combined With Anterolateral Ligament Reconstruction: A Clinical Comparative Matched Study With a Mean Follow-up of 5 Years From The SANTI Study Group

2021 ◽  
pp. 036354652110611
Author(s):  
Johnny Rayes ◽  
Herve Ouanezar ◽  
Ibrahim M. Haidar ◽  
Cedric Ngbilo ◽  
Thomas Fradin ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Return To Sports ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon ◽  
Tegner Activity Scale

Background: Additional lateral extra-articular tenodesis (LET) has recently been correlated with improved clinical outcomes and reduced failure rates in revision anterior cruciate ligament (ACL) reconstruction (ACLR). However, no data are available on clinical outcomes and reoperation after revision ACLR using different LET procedures. Purpose: To compare the clinical outcomes of ACL + anterolateral ligament (ALL) reconstruction using hamstring tendon graft (HT-ALL) and a bone–patellar tendon–bone (BPTB) graft + modified Lemaire tenodesis procedure (BPTB-Lemaire) in the setting of revision ACLR and to determine whether ALL reconstruction is associated with an increased rate of adverse outcomes when compared with a modified Lemaire tenodesis procedure. Study Design: Cohort study; Level of evidence, 3. Methods: Descriptive data and clinical outcomes were prospectively collected from patients who underwent revision ACLR with LET between 2009 and 2018 with a minimum follow-up of 2 years. Patients with an HT autograft combined with ALL reconstruction (HT-ALL group) were matched in a 1:1 propensity ratio to patients with a BPTB autograft combined with a modified Lemaire LET procedure (BPTB-Lemaire group). The evaluated parameters included complications and reoperations; knee laxity tests; return to sports; and various scores, including the Lysholm knee score, Tegner activity scale, Anterior Cruciate Ligament Return to Sport After Injury scale, Marx activity rating scale, International Knee Documentation Committee subjective knee evaluation form, and Knee injury and Osteoarthritis Outcome Score. Results: In total, 36 matched pairs were included in the analysis. The mean follow-up durations for the BPTB-Lemaire and HT-ALL groups were 56 ± 35 and 57 ± 23 months, respectively ( P = .91). No significant differences were found in graft rupture rate (HT-ALL, 0%; BPTB-Lemaire, 11.1%; P = .13) or reoperations (HT-ALL, 8.3%; BPTB-Lemaire, 22.2%; P = .23). No specific complications with regard to LET were noted in either group. Additionally, there were no significant differences in knee laxity parameters, return to sports, or clinical scores between the groups at the final follow-up, except for the Tegner activity scale score (HT-ALL, 6.4; BPTB-Lemaire, 7.3; P = .03). HT-ALL was associated with a shorter surgical time (41.4 vs 59.8 minutes; P < .0001). Conclusion: HT-ALL was at least equivalent, in terms of clinical outcomes, to the more commonly performed procedure, BPTB-Lemaire. Performing ALL reconstruction in the setting of revision ACLR is therefore safe and effective.

scholarly journals Allograft Use Results in Higher Re-revision Rate for Revision Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711877538 ◽  
Author(s):  
Kåre Amtoft Nissen ◽  
Niclas Højgaard Eysturoy ◽  
Torsten Grønbech Nielsen ◽  
Martin Lind
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Revision Rate ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Knee Stability ◽  
Anterior Cruciate ◽  
The Impact

Background: The literature on revision anterior cruciate ligament (ACL) reconstruction (ACLR) outcomes is generally sparse, but previous studies have demonstrated that autograft use results in improved sports function and patient-reported outcome measures compared with allograft. However, knowledge is still lacking regarding the impact of graft type on rates of re-revision. Purpose: To investigate the clinical outcomes and failure rates of revision ACLRs performed with either allograft or autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A search of the Danish Knee Ligament Reconstruction Registry identified 1619 revision ACLRs: 1315 were autograft procedures and 221 were allograft procedures (type of graft was not identified for 83 procedures). Clinical outcomes after 1 year were reported via the Knee injury and Osteoarthritis Outcome Score (KOOS), the Tegner activity score, and an objective knee stability measurement that determined side-to-side differences in instrumented sagittal knee laxity. Failure was determined as re-revision. Outcomes for revision were provided for the full life of the registry, up to 10 years. Results: The re-revision rate was significantly higher for allograft compared with autograft (12.7% vs 5.4%; P < .001), leading to a hazard ratio for re-revision of 2.2 (95% CI, 1.4-3.4) for allografts compared with autografts when corrected for age. At 1-year follow-up, objective knee stability was significantly different (2.1 ± 2.1 mm for allograft vs 1.7 ± 1.8 mm for autograft; P = .01), and the KOOS subscale scores for symptoms, pain, activities of daily living, sports, and quality of life were 67, 76, 84, 49, and 46 for allograft and 67, 78, 84, 51, and 48 for autograft, respectively, with no difference between groups. Conclusion: In this observational population-based study, the ALCR re-revision rate was 2.2 times greater for allograft compared with autograft procedures. Allograft was associated with greater knee laxity at 1-year follow-up. However, subjective clinical outcomes and knee function were not inferior for allograft patients. These results indicate that autograft is a better graft choice for revision ALCR.

scholarly journals Prospective Comparative Study of Anterior Cruciate Ligament Reconstruction Using the Double-Bundle and Single-Bundle Techniques

2009 ◽  
Vol 37 (9) ◽  
pp. 1705-1711 ◽  
Author(s):  
Eun Kyoo Song ◽  
Luke S. Oh ◽  
Thomas J. Gill ◽  
Guoan Li ◽  
Hemanth R. Gadikota ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Single Bundle ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background The intent of double-bundle anterior cruciate ligament reconstruction is to reproduce the normal anterior cruciate ligament anatomy and improve knee joint rotational stability. However, no consensus has been reached on the advantages of this technique over the single-bundle technique. Hypothesis We hypothesized that double-bundle anterior cruciate ligament reconstruction could provide better intraoperative stability and clinical outcome than single-bundle reconstruction. Type of study: Cohort study; Level of evidence, 2. Methods Forty patients with anterior cruciate ligament injury in one knee were recruited; 20 were allocated to a double-bundle anterior cruciate ligament reconstruction group and 20 to a single-bundle anterior cruciate ligament reconstruction group. Intraoperative stabilities at 30° of knee flexion were compared between the 2 groups using a navigation system. Clinical outcomes including Lysholm knee scores, Tegner activity scores, Lachman and pivot-shift test results, and radiographic stabilities were also compared between the 2 groups after a minimum of 2 years of follow-up. Results Intraoperative anterior and rotational stabilities after anterior cruciate ligament reconstruction in the double-bundle group were significantly better than those in single-bundle group (P = .020 and P < .001, respectively). Nineteen patients (95%) in each group were available at a minimum 2-year follow-up. Clinical outcomes including Lysholm knee and Tegner activity scores were similar in the 2 groups at 2-year follow-up (P > .05). Furthermore, stability results of the Lachman and pivot-shift tests, and radiologic findings at 2-year follow-up failed to reveal any significant intergroup differences (P > .05). Conclusion Although double-bundle anterior cruciate ligament reconstruction produces better intraoperative stabilities than single-bundle anterior cruciate ligament reconstruction, the 2 modalities were found to be similar in terms of clinical outcomes and postoperative stabilities after a minimum of 2 years of follow-up.

scholarly journals Anterior Cruciate Ligament Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Versus Hamstrings Alone: A Comparative Cohort Study

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110466
Author(s):  
Randeep S. Aujla ◽  
Jay R. Ebert ◽  
Peter T. Annear
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cohort Study ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Cruciate Ligament Reconstruction ◽  
Ligament Augmentation ◽  
Anterior Cruciate

Background: Few studies have reported the return-to-sports (RTS) rate in patients after augmentation of autologous anterior cruciate ligament reconstruction (ACLR) with the Ligament Augmentation and Reconstruction System (LARS). Purpose/Hypothesis: The purpose of this study was to compare postoperative outcomes in patients who underwent ACLR with single-bundle 4-strand hamstring autograft either without augmentation (HA-ACLR group) or with LARS augmentation (AUG-ACLR group). It was hypothesized that clinical outcomes and RTS rates would be better in the AUG-ACLR group at the 1-year follow-up, with similar outcomes in both cohorts by 2 years. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACLR between April 2014 and December 2017 were included in the current comparative study if they were skeletally mature and had 1- and 2-year follow-up outcomes; patients with concomitant meniscal surgery were also included. Included were 66 patients with AUG-ACLR (mean age, 26.8 years; 67% male) and 130 patients with HA-ACLR (mean age, 27.5 years; 61% male). Subjective outcome measures included the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee injury and Osteoarthritis Outcome Score, Lysholm scale, Tegner activity scale, and the Noyes sports activity rating scale. Objective measures included knee laxity, maximal isokinetic knee flexion and extension strength, and the results of 4 functional hop tests. Results: There were no significant differences between the study groups in age, sex distribution, body mass index, time to surgery, or number of concurrent meniscal surgeries. At the 1-year follow-up, the AUG-ACLR group had a significantly higher Tegner score ( P = .001) and rates of RTS ( P = .029) and return to preinjury level of sport ( P = .003) compared with the HA-ACLR group. At the 2-year follow-up, there were no differences in these measures between groups. There were no between-group differences in other subjective outcomes, knee laxity, or strength and hop test results at either postoperative time point. There were also no differences in rerupture rates or other complications between the groups. Conclusion: Patients with AUG-ACLR had higher 1-year postoperative Tegner scores and rates of RTS and preoperative sport level compared with the HA-ACLR group. The 2-year rerupture rate for the AUG-ACLR group was low, and no intra-articular inflammatory complications were noted.

scholarly journals Patients return to sports and to work after successful treatment of septic arthritis following anterior cruciate ligament reconstruction

2021 ◽  
Author(s):  
Alexander Themessl ◽  
Felix Mayr ◽  
Kate Hatter ◽  
Marco-Christopher Rupp ◽  
Jonas Pogorzelski ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Septic Arthritis ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sports ◽  
Cruciate Ligament Reconstruction ◽  
Ikdc Score ◽  
Anterior Cruciate

Abstract Purpose To determine specific return to sports (RTS) and return to work (RTW) rates of patients with septic arthritis following anterior cruciate ligament reconstruction (ACLR), and to assess for factors associated with a diminished postoperative return to physical activity after successful eradication of the infection. Methods In this study, patients who were treated for postoperative septic arthritis of the knee following anterior cruciate ligament reconstruction between 2006 and 2018 were evaluated at a minimum follow-up (FU) of 2 years. Patients’ outcomes were retrospectively analyzed using standardized patient-reported outcome scores including the Lysholm score and the subjective IKDC score, as well as return to sports and return to work questionnaires to assess for the types, number, and frequency of sports performed pre- and postoperatively and to evaluate for potential occupational changes due to septic arthritis following ACLR. To assess for the signifiance of the graft at follow-up, outcomes were compared between patients with a functioning graft at FU and those without, as well as between patients with initial graft retention and those with graft removal and consecutive revision ACLR. Results Out of 44 patients eligible for inclusion, 38 (86%) patients at a mean age of 36.2 ± 10.3 years were enrolled in this study. At a mean follow-up of 60.3 ± 39.9 months, the Lysholm score and the subjective IKDC score reached 80.0 ± 15.1 and 78.2 ± 16.6 points, respectively. The presence of a graft at FU yielded statistically superior results only on the IKDC score (p = 0.014). There were no statistically significant differences on the Lysholm score (n.s.) or on the IKDC score (n.s.) between patients with initial graft retention and those with initial removal who had undergone revision ACLR. All of the included 38 patients were able to return to sports at a median time of 8 (6–16) months after their last surgical intervention. Among patients who performed pivoting sports prior to their injury, 23 (62.2%) returned to at least one pivoting sport postoperatively. Overall, ten patients (26.3%) returned to all their previous sports at their previous frequency. The presence of a graft at FU resulted in a significantly higher RTS rate (p = 0.010). Comparing patients with initial graft retention and those with graft removal and consecutive revision ACLR, there was no statistically significant difference concerning the RTS rate (n.s.). Thirty-one patients (83.8%) were able to return to their previous work. Conclusion Successful eradication of septic arthritis following anterior cruciate ligament reconstruction allows for a postoperative return to sports and a return to work particularly among patients with ACL-sufficient knees. However, the patients’ expectations should be managed carefully, as overall return rates at the pre-injury frequency are relatively low. Level of evidence IV.

Sign in / Sign up

Export Citation Format

Share Document