Predictive Value of the Magnetic Resonance Imaging–Based Coronal Lateral Collateral Ligament Sign on Adolescent Anterior Cruciate Ligament Reconstruction Graft Failure

2021 ◽  
Vol 49 (4) ◽  
pp. 935-940
Author(s):  
Brendon C. Mitchell ◽  
Matthew Y. Siow ◽  
Tracey Bastrom ◽  
James D. Bomar ◽  
Andrew T. Pennock ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Anterior Tibial Translation ◽  
Complex Injury ◽  
Patient Reported ◽  
Anterolateral Complex ◽  
Tibial Translation

Background: The coronal lateral collateral ligament (LCL) sign is the presence of the full length of the LCL visualized on a single coronal magnetic resonance imaging (MRI) slice at the posterolateral corner of the knee. The coronal LCL sign has been shown to be associated with elevated measures of anterior tibial translation and internal rotation in the setting of anterior cruciate ligament (ACL) tear. Hypothesis: The coronal LCL sign (with greater anterior translation, internal rotation, and posterior slope of the tibia) will indicate a greater risk for graft failure after ACL reconstructive surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective review was performed of adolescent patients with ACL reconstruction: a cohort without graft failure and a cohort with graft failure. MRI was utilized to measure tibial translation and femorotibial rotation and to identify the coronal LCL sign. The posterior tibial slope was measured on lateral radiographs. Patient-reported outcomes were collected. Results: We identified 114 patients with no graft failure and 39 patients with graft failure who met all criteria, with a mean follow-up time of 3.5 years (range, 2-9.4 years). Anterior tibial translation was associated with anterolateral complex injury ( P < .001) but not graft failure ( P = .06). Internal tibial rotation was associated with anterolateral complex injury ( P < .001) and graft failure ( P = .042). Posterior tibial slope was associated with graft failure ( P = .044). The coronal LCL sign was associated with anterolateral complex injury ( P < .001) and graft failure ( P = .013), with an odds ratio of 4.3 for graft failure (95% CI, 1.6-11.6; P = .003). Subjective patient-reported outcomes and return to previous level of sport were not associated with failure. Comparison of MRI before and after ACL reconstruction in the graft failure cohort demonstrated a reduced value in internal rotation ( P = .003) but no change in coronal LCL sign ( P = .922). Conclusion: Our study demonstrates that tibial internal rotation and posterior slope are independent predictors of ACL graft failure in adolescents. Although the value of internal rotation could be improved with ACL reconstruction, the presence of the coronal LCL sign persisted over time and was predictive of graft rupture (without the need to make measurements or memorize values of significant risk). Together, these factors indicate that greater initial knee deformity after initial ACL tear predicts greater risk for future graft failure.

Coronal Lateral Collateral Ligament Sign: A Novel Magnetic Resonance Imaging Sign for Identifying Anterior Cruciate Ligament–Deficient Knees in Adolescents and Summarizing the Extent of Anterior Tibial Translation and Femorotibial Internal Rotation

2021 ◽  
Vol 49 (4) ◽  
pp. 928-934
Author(s):  
Brendon C. Mitchell ◽  
Matthew Y. Siow ◽  
Tracey Bastrom ◽  
James D. Bomar ◽  
Andrew T. Pennock ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Internal Rotation ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Anterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation ◽  
Acl Deficient

Background: Incompetence of the anterior cruciate ligament (ACL) confers knee laxity in the sagittal and axial planes that is measurable with clinical examination and diagnostic imaging. Hypothesis: An ACL-deficient knee will produce a more vertical orientation of the lateral collateral ligament (LCL), allowing for the entire length of the LCL to be visualized on a single coronal slice (coronal LCL sign) on magnetic resonance imaging. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Charts were retrospectively reviewed from April 2009 to December 2017 for all patients treated with ACL reconstruction (constituting the ACL-deficient cohort). A control cohort was separately identified consisting of patients with a normal ACL and no pathology involving the collateral ligaments or posterior cruciate ligament. Patients were excluded for follow-up <2 years, incomplete imaging, and age >19 years. Tibial translation and femorotibial rotation were measured on magnetic resonance images, and posterior tibial slope was measured on a lateral radiograph of the knee. Imaging was reviewed for the presence of the coronal LCL sign. Results: The 153 patients included in the ACL-deficient cohort had significantly greater displacement than the 70 control patients regarding anterior translation (5.8 vs 0.3 mm, respectively; P < .001) and internal rotation (5.2° vs −2.4°, P < .001). Posterior tibial slope was not significantly different. The coronal LCL sign was present in a greater percentage of ACL-deficient knees than intact ACL controls (68.6% vs 18.6%, P < .001). The presence of the coronal LCL sign was associated with greater anterior tibial translation (7.2 vs 0.2 mm, P < .001) and internal tibial rotation (7.5° vs –2.4°, P = .074) but not posterior tibial slope (7.9° vs 7.9°, P = .973) as compared with its absence. Multivariate analysis revealed that the coronal LCL sign was significantly associated with an ACL tear (odds ratio, 12.8; P < .001). Conclusion: Our study provides further evidence that there is significantly more anterior translation and internal rotation of the tibia in the ACL-deficient knee and proves our hypothesis that the coronal LCL sign correlates with the presence of an ACL tear. This coronal LCL sign may be of utility for identifying ACL tears and anticipating the extent of axial and sagittal deformity.

scholarly journals Anterior and Rotational Knee Laxity Does Not Affect Patient-Reported Knee Function 2 Years After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 47 (9) ◽  
pp. 2077-2085 ◽  
Author(s):  
Robert Magnussen ◽  
Emily K. Reinke ◽  
Laura J. Huston ◽  
Jack T. Andrish ◽  
Charles L. Cox ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Anterior Tibial Translation ◽  
Patient Reported ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
Tibial Translation ◽  
Rotational Knee Laxity

Background: While a primary goal of anterior cruciate ligament (ACL) reconstruction is to reduce pathologically increased anterior and rotational knee laxity, the relationship between knee laxity after ACL reconstruction and patient-reported knee function remains unclear. Hypothesis: There would be no significant correlation between the degree of residual anterior and rotational knee laxity and patient-reported outcomes (PROs) 2 years after primary ACL reconstruction. Study Design: Cross-sectional study; Level of evidence, 3. Methods: From a prospective multicenter nested cohort of patients, 433 patients younger than 36 years of age injured in sports with no history of concomitant ligament surgery, revision ACL surgery, or surgery of the contralateral knee were identified and evaluated at a minimum 2 years after primary ACL reconstruction. Each patient underwent Lachman and pivot-shift evaluation as well as a KT-1000 arthrometer assessment along with Knee injury and Osteoarthritis Outcome Score and subjective International Knee Documentation Committee (IKDC) scores. A proportional odds logistic regression model was used to predict each 2-year PRO score, controlling for preoperative score, age, sex, body mass index, smoking, Marx activity score, education, subsequent surgery, meniscal and cartilage status, graft type, and range of motion asymmetry. Measures of knee laxity were independently added to each model to determine correlation with PROs. Results: Side-to-side manual Lachman differences were IKDC A in 246 (57%) patients, IKDC B in 183 (42%) patients, and IKDC C in 4 (<1%) patients. Pivot-shift was classified as IKDC A in 209 (48%) patients, IKDC B in 183 (42%) patients, and IKDC C in 11 (2.5%) patients. The mean side-to-side KT-1000 difference was 2.0 ± 2.6 mm. No significant correlations were noted between pivot-shift or anterior tibial translation as assessed by Lachman or KT-1000 and any PRO. All predicted differences in PROs based on IKDC A versus B pivot-shift and anterior tibial translation were less than 4 points. Conclusion: Neither the presence of IKDC A versus B pivot-shift nor increased anterior tibial translation of up to 6 mm is associated with clinically relevant decreases in PROs 2 years after ACL reconstruction.

Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up

2019 ◽  
Vol 48 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Alexia G. Gagliardi ◽  
Patrick M. Carry ◽  
Harin B. Parikh ◽  
Jay C. Albright
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Acl Injuries ◽  
Patient Reported ◽  
Adolescent Patients ◽  
Anterior Cruciate

Background: The incidence of anterior cruciate ligament (ACL) injury in the adolescent population is increasing. The quadriceps tendon–patellar bone autograft (QPA) has been established as a reliable graft choice for ACL reconstruction in the adult population. Purpose: To investigate graft failure, ability to return to sport, patient-reported functional outcomes, joint laxity, and subsequent injury among adolescent patients >2 years after primary ACL reconstruction with the QPA. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent QPA ACL reconstruction performed by a single surgeon were identified from an existing database. Information available in the database included demographics, concomitant/subsequent injuries, surgical procedures, graft failure, return to sport, and Lachman examination collected by medical record review. Pediatric International Knee Documentation Committee (Pedi-IKDC) and Lysholm scores were collected by telephone or during a clinic visit >2 years postoperatively. Results: The final cohort included 81 of 104 consecutive adolescent patients aged 10 to 18 years (mean ± SD, 15.9 ± 1.7 years at the time of surgery) for whom follow-up information was collected at >2 years after surgery. The cumulative incidence of graft failure within the 36-month follow-up period was 1.2% (95% CI, 0.1%-11.4%). The rate of ipsilateral non-ACL injuries was similar (1.2%; 95% CI, 0.2%-7.6%). Contralateral ACL and non-ACL injuries requiring surgical intervention were documented in 9.8% (95% CI, 4.9%-19.5%). The median Pedi-IKDC score was 94 (interquartile range, 89-98). The median Lysholm score was 99.5 (interquartile range, 89.0-100.0). At 36 months after surgery, 87.9% (95% CI, 81.4%-94.9%) of individuals had returned to play. Conclusion: The quadriceps tendon–patellar autograft is a novel graft that demonstrates excellent stability and favorable patient-reported outcomes. Based on these results, the QPA is a reliable choice for primary ACL reconstruction in adolescent patients.

Effects of Continuous Passive Motion on Anterior Laxity Following ACL Reconstruction with Autogenous Patellar Tendon Grafts

1993 ◽  
Vol 2 (3) ◽  
pp. 171-178 ◽  
Author(s):  
Michael R. McCarthy ◽  
Barton P. Buxton ◽  
Carlan K. Yates
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Continuous Passive Motion ◽  
Anterior Tibial Translation ◽  
Postoperative Rehabilitation ◽  
Passive Motion ◽  
Early Motion ◽  
Anterior Laxity ◽  
Tibial Translation

Continuous passive motion (CPM) is a modality used in the treatment, management, and rehabilitation of a variety of orthopedic problems. Recently, CPM devices have been therapeutically employed immediately after autogenous patellar tendon reconstruction of the anterior cruciate ligament (ACL). Whereas the concept of early motion is indicated, there is a concomitant concern that the implementation of immediate passive motion may stretch or rupture the graft. Twenty subjects scheduled to undergo ACL reconstruction were randomized into two groups (10 CPM and 10 non-CPM). All subjects performed the same postoperative rehabilitation with the exception of the CPM. Objective anterior tibial translation measurements were recorded with a KT-1000 for a 30-1b (133.5-N) Lachman test at 1 year postreconstruction. The results of this study indicated that the implementation of immediate continuous passive motion did not have any deleterious effects on the stability of the ligament reconstruction.

scholarly journals The correlation between posterior tibial slope and dynamic anterior tibial translation and dynamic range of tibial rotation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
M.J.M Zee ◽  
M.N.J Keizer ◽  
L Dijkerman ◽  
J.J.A.M van Raaij ◽  
J.M. Hijmans ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Dynamic Range ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Wedge Osteotomy ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Before And After ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract Purpose The amount of passive anterior tibial translation (ATT) is known to be correlated to the amount of posterior tibial slope (PTS) in both anterior cruciate ligament-deficient and reconstructed knees. Slope-altering osteotomies are advised when graft failure after anterior cruciate ligament (ACL) reconstruction occurs in the presence of high PTS. This recommendation is based on studies neglecting the influence of muscle activation. On the other hand, if dynamic range of tibial rotation (rTR) is related to the amount of PTS, a “simple” anterior closing-wedge osteotomy might not be sufficient to control for tibial rotation. The purpose of this study was to evaluate the correlation between the amount of PTS and dynamic ATT and tibial rotation during high demanding activities, both before and after ACL reconstruction. We hypothesized that both ATT and rTR are strongly correlated to the amount of PTS. Methods Ten subjects were studied both within three months after ACL injury and one year after ACL reconstruction. Dynamic ATT and dynamic rTR were measured using a motion-capture system during level walking, during a single-leg hop for distance and during a side jump. Both medial and lateral PTS were measured on MRI. A difference between medial and lateral PTS was calculated and referred to as Δ PTS. Spearman’s correlation coefficients were calculated for the correlation between medial PTS, lateral PTS and Δ PTS and ATT and between medial PTS, lateral PTS and Δ PTS and rTR. Results Little (if any) to weak correlations were found between medial, lateral and Δ PTS and dynamic ATT both before and after ACL reconstruction. On the other hand, a moderate-to-strong correlation was found between medial PTS, lateral PTS and Δ PTS and dynamic rTR one year after ACL reconstruction. Conclusion During high-demand tasks, dynamic ATT is not correlated to PTS. A compensation mechanism may be responsible for the difference between passive and dynamic ATT in terms of the correlation to PTS. A moderate-to-strong correlation between amount of PTS and rTR indicates that such a compensation mechanism may fall short in correcting for rTR. These findings warrant prudence in the use of a pure anterior closing wedge osteotomy in ACL reconstruction. Trial registration Netherlands Trial Register, Trial 7686. Registered 16 April 2016—Retrospectively registered. Level of evidence Level 2, prospective cohort study

scholarly journals Clinical and radiological results after Internal Brace suture versus the all-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery

2020 ◽  
Author(s):  
Georg Mattiassich ◽  
Reinhold Ortmaier ◽  
Harald Kindermann ◽  
Jürgen Barthofer ◽  
Imre Vasvary ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
German Version ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
Internal Brace ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract Background Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee. Methods Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained a unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German version of the KOOS (Knee Osteoarthritis Outcome Score), and the German version of themodified Lysholm Score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 Arthrometer (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases. Results Twenty-three subjects (46 %) were men, and the mean age was 34.7 years. The objective IKDC scores were “normal” in 15 and 14 patients, “nearly normal” in 11 and 7 patients, and “abnormal” in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a sideto-side difference of more than 3 mm on maximum manual testing in 11 (44 %) and 6 subjects (28.6 %) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74 %) and 22 subjects (96 %) in the IB and AI groups had an intact ACL. Anterior tibial translation was significantly higher in the IB group compared with the AI group in the manual maximum test. Conclusions Preservation of the native ACL with the Internal Brace primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot-shift phenomenon were observed during the study period.

Clinical and radiological results after Internal Brace ® suture versus the all-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery.

2020 ◽  
Author(s):  
Georg Mattiassich ◽  
Reinhold Ortmaier ◽  
Harald Kindermann ◽  
Jürgen Barthofer ◽  
Imre Vasvary ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
German Version ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
Internal Brace ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract Background Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace® technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee. Methods Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace® technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German Version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German Version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German Version of the KOOS (Knee Osteoarthritis Outcome Score), and the German Version of the modified Lysholm-score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 arthrometer® (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases. Results Twenty-three subjects (46%) were men, and the mean age was 34.7 years. The objective IKDC scores were “normal” in 15 and 14 patients, “nearly normal” in 11 and 7 patients, and “abnormal” in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a side-to-side difference of more than 3 mm on maximum manual testing in 11 (44%) and 6 subjects (28.6%) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74%) and 22 subjects (96%) in the IB and AI groups showed an intact ACL. Anterior tibial translation was significantly higher in the IB group compared to the AI group in the manual maximum test. Conclusions Preservation of the native ACL with the Internal Brace ® primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot shift phenomenon were observed during the study period.

scholarly journals Effect of Graft Choice on the 6 Year Outcome of Revision Anterior Cruciate Ligament Reconstruction in the Multicenter ACL Revision Study (MARS) Cohort

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0028
Author(s):  
Mars Group ◽  
Rick W. Wright
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Patient Reported Outcome ◽  
Activity Level ◽  
Graft Choice ◽  
Patient Reported ◽  
Revision Reconstruction ◽  
Anterior Cruciate

Objectives: Most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome. The purpose of this study was to determine if revision ACL graft choice predicts outcomes related to sports function, activity level, OA symptoms, graft re-rupture, and reoperation at six years following revision reconstruction. We hypothesized that autograft use would result in increased sports function, increased activity level, and decreased OA symptoms (as measured by validated patient reported outcome instruments). Additionally, we hypothesized that autograft use would result in decreased graft failure and reoperation rate 6 years following revision ACL reconstruction. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled by 83 surgeons over 52 sites. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up for 6 years, and asked to complete the identical set of outcome instruments. Incidence of additional surgery and re-operation due to graft failure were also recorded. Multivariate regression models were used to determine the predictors (risk factors) of IKDC, KOOS, WOMAC, Marx scores, graft re-rupture, and re-operation rate at 6 years following revision surgery. Results: 1234 patients were successfully enrolled with 716 (58%) males. Median age was 26. In 87% this was their first revision. 367 (30%) were undergoing revision by the surgeon that had performed the previous reconstruction. 598 (48%) underwent revision reconstruction utilizing an autograft, 599 (49%) allograft, and 37 (3%) both autograft and allograft. Median time since their last ACL reconstruction was 3.4 years. Questionnaire follow-up was obtained on 810 subjects (65%), while phone follow-up was obtained on 949 subjects (76%). The IKDC, KOOS, and WOMAC scores (with the exception of the WOMAC stiffness subscale) all significantly improved at the 6-year follow-up time point (p<0.001). Contrary to the IKDC, KOOS, and WOMAC scores, the 6-year MARX activity scale demonstrated a significant decrease from the initial score at enrollment (p<0.001). Graft choice proved to be a significant predictor of 6-year Marx activity level scores (p=0.005). Specifically, the use of an autograft for revision reconstruction predicted improved activity levels [Odds Ratio (OR) = 1.54; 95% confidence intervals (CI) = 1.14, 2.04]. Graft choice proved to be a significant predictor of 6-year IKDC scores (p=0.018), in that soft tissue grafts predicted higher 6-year IKDC scores [OR = 1.62; 95% confidence intervals (CI) = 1.09, 2.414]. For the KOOS subscales, graft choice did not predict outcome score. Graft re-rupture was reported in 55/949 (5.8%) of patients by their 6-year follow-up: 37 allografts, 16 autografts, and 2 allograft + autograft. Use of an autograft for revision resulted in patients 6.04 times less likely to sustain a subsequent graft rupture than if an allograft was utilized (p=0.009; 95% CI=1.57, 23.2). Conclusion: Improved sports function and patient reported outcome measures are obtained when an autograft is utilized. Additionally, autograft type shows a decreased risk in graft re-rupture at six years follow-up. Surgeon education regarding the findings in this study can result in potentially improved revision ACLR results for our patients.

scholarly journals Knee laxity and functional knee outcome after contralateral ACLR are comparable to those after primary ACLR

2021 ◽  
Author(s):  
Riccardo Cristiani ◽  
Sofia Viheriävaara ◽  
Per-Mats Janarv ◽  
Gunnar Edman ◽  
Magnus Forssblad ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Anterior Tibial Translation ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Anterior Tibial ◽  
The Mean ◽  
Tibial Translation

Abstract Purpose To evaluate and compare knee laxity and functional knee outcome between primary and contralateral anterior cruciate ligament (ACL) reconstruction. Methods Patients who underwent primary and subsequent contralateral ACL reconstruction (ACLR) at Capio Artro Clinic, Stockholm, Sweden, from 2001 to 2017, were identified in our local database. The inclusion criteria were: the same patients who underwent primary and contralateral hamstring tendon or bone-patellar tendon-bone autograft ACLR and no associated ligament injuries. The KT-1000 arthrometer, with an anterior tibial load of 134 N, was used to evaluate knee laxity preoperatively and 6 months postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at the 1-year follow-up. Results A total of 326 patients with isolated primary and contralateral ACLR met the inclusion criteria (47.9% males; mean age at primary ACLR 23.9 ± 9.4 years and contralateral ACLR 27.9 ± 10.1 years). The arthrometric laxity measurements were available for primary and contralateral ACLR for 226 patients. The mean preoperative and postoperative anterior tibial translation (ATT), as well as the mean ATT reduction from preoperatively to postoperatively, did not differ significantly between primary and contralateral ACLR. The KOOS was available for primary and contralateral ACLR for 256 patients. No significant differences were found preoperatively and at the 1-year follow-up between primary and contralateral ACLR for any of the five KOOS subscales. Conclusion The findings in this study showed that anterior knee laxity and functional knee outcome after contralateral ACLR are comparable to those after primary ACLR. It is important for clinicians to counsel patients about their expectations after contralateral ACLR. This study shows that the results after contralateral ACLR in terms of knee laxity and functional knee outcome are predictable and likely to be comparable to those after primary ACLR. Level of evidence Level III.

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