scholarly journals Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Autograft Versus Allograft Tissue

2009 ◽  
Vol 2 (1) ◽  
pp. 56-72 ◽  
Author(s):  
Lisa M. Tibor ◽  
Joy L. Long ◽  
Peter L. Schilling ◽  
Ryan J. Lilly ◽  
James E. Carpenter ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Anterior Cruciate Ligament ◽  
Sample Size ◽  
Randomized Clinical Trial ◽  
Acl Reconstruction ◽  
Outcome Measures ◽  
Cruciate Ligament ◽  
Allograft Reconstruction ◽  
Kt 1000 ◽  
Anterior Cruciate

Background: Clinical outcomes of autograft and allograft anterior cruciate ligament (ACL) reconstructions are mixed, with some reports of excellent to good outcomes and other reports of early graft failure or significant donor site morbidity. Objective: To determine if there is a difference in functional outcomes, failure rates, and stability between autograft and allograft ACL reconstructions. Data Sources: Medline, Cochrane Central Register of Controlled Trials (Evidence Based Medicine Reviews Collection), Cochrane Database of Systematic Reviews, Web of Science, CINAHL, and SPORTDiscus were searched for articles on ACL reconstruction. Abstracts from annual meetings of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America were searched for relevant studies. Study Selection: Inclusion criteria for studies were as follows: primary unilateral ACL injuries, mean patient age less than 41 years, and follow-up for at least 24 months postreconstruction. Exclusion criteria for studies included the following: skeletally immature patients, multiligament injuries, and publication dates before 1990. Data Extraction: Joint stability measures included Lachman test, pivot-shift test, KT-1000 arthrometer assessment, and frequency of graft failures. Functional outcome measures included Tegner activity scores, Cincinnati knee scores, Lysholm scores, and IKDC (International Knee Documentation Committee) total scores. Results: More than 5000 studies were identified. After full text review of 576 studies, 56 were included, of which only 1 directly compared autograft and allograft reconstruction. Allograft ACL reconstructions were more lax when assessed by the KT-1000 arthrometer. For all other outcome measures, there was no statistically significant difference between autograft and allograft ACL reconstruction. For all outcome measures, there was strong evidence of statistical heterogeneity between studies. The sample size necessary for a randomized clinical trial to detect a difference between autograft and allograft reconstruction varied, depending on the outcome. Conclusions: With the current literature, only KT-1000 arthrometer assessment demonstrated more laxity with allograft reconstruction. A randomized clinical trial directly comparing allograft to autograft ACL reconstruction is warranted, but a multicenter study would be required to obtain an adequate sample size.

The Effects of Early Aggressive Rehabilitation on Outcomes After Anterior Cruciate Ligament Reconstruction Using Autologous Hamstring Tendon: A Randomized Clinical Trial

2013 ◽  
Vol 22 (3) ◽  
pp. 191-201 ◽  
Author(s):  
Jesse C. Christensen ◽  
Laura R. Goldfine ◽  
Hugh S. West
Keyword(s):  
Clinical Trial ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Randomized Clinical Trial ◽  
Study Design ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Study Design:Prospective randomized clinical trial.Methods and Measures:Thirty-six patients who had a primary anterior cruciate ligament reconstruction (ACL-R) with a semitendinosus-gracilis (STG) autograft from a single orthopedic surgeon were prospectively randomized into 2 groups. Nineteen patients were randomized to the aggressive group (53% male, mean age 30.1 + 10.5 y) and 17 to the nonaggressive group (88% male, mean age 33.1 + 10.9 y). Impairment measures of anteroposterior (A-P) knee laxity, range of motion (ROM), and peak isometric force (PIF) values were obtained 12 wk postoperatively. Subjective response to the International Knee Documentation Committee knee form (IKDC) was collected 1, 12, and 24 wk postoperatively. One-way ANOVA was used to analyze differences between groups at 12 wk for A-P knee laxity, ROM, and PIF. Differences between the groups for the IKDC scores were determined using 1-way ANOVA with repeated measures 1, 12, and 24 wk postoperatively. Bonferroni adjustment was used for multiple comparisons.Results:There were no differences between the groups for the baseline characteristics (P > .05). There was no difference found between the groups in respect to A-P knee laxity, ROM, or PIF at 12 wk (P > .05). Further analysis also showed no significant differences in the IKDC scores between groups at 12 or 24 wk (P > .05).Conclusions:No differences were found between early aggressive and nonaggressive rehabilitation after an isolated ACL-R using STG autografts for the primary outcomes of A-P knee laxity and subjective IKDC score. In addition, no differences were observed for secondary outcomes between groups for differences in ROM and PIF values.

Varying femoral-sided fixation techniques in anterior cruciate ligament reconstruction have similar clinical outcomes: a network meta-analysis

2018 ◽  
Vol 3 (4) ◽  
pp. 220-228
Author(s):  
Ajay Shah ◽  
Daniel Joshua Hoppe ◽  
David M Burns ◽  
Joseph Menna ◽  
Daniel Whelan ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Soft Tissue ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Optimal Method ◽  
Femoral Fixation ◽  
Kt 1000 ◽  
Level I ◽  
Anterior Cruciate

ImportanceThere is significant controversy regarding the optimal femoral fixation method in anterior cruciate ligament (ACL) reconstruction. Given the importance of ACL reconstruction in patient return to sport and quality of life, it is imperative to identify the optimal method of femoral fixation.ObjectiveThe primary objective of this study is to identify the optimal method of femoral fixation in ACL reconstruction with soft tissue grafts. There are three main techniques for femoral-sided fixation in ACL reconstruction: suspensory extracortical buttons (EC), interference screws (IS) and transfemoral crosspins (TF). Previous primary studies have provided conflicting results regarding the superior method, and prior systematic reviews have failed to identify a difference; however, these analyses were only able to make comparisons between two of the treatments directly. This study employed a network meta-analysis technique to maximise sample size and statistical power, increasing the validity of its findings.Evidence reviewA network meta-analysis was conducted using results from 19 randomised controlled trials. Only studies with level I or II evidence, directly comparing two interventions in ACL soft tissue graft reconstruction, were included. Graft failure rates, International Knee Documentation Committee scores and KT-1000 knee arthrometer scores were the primary outcomes measured. Secondary outcomes included Lysholm, Tegner, Lachman and Pivot Shift scores.FindingsAn overall sample of 1372 patients was analysed. No statistically significant differences were detected among outcomes, except for the KT-1000 analysis which slightly favoured EC over IS and TF fixation (mean difference (MD)=−0.53 mm; 95% CI −0.07 to –0.98), and TF over IS fixation (MD=−0.41 mm; 95% CI −0.05 to –0.76). The clinical consequences of this difference are likely minimal.ConclusionsBased on the results of this network meta-analysis, there is no clear statistically superior method of femoral fixation in soft tissue ACL reconstruction.Level of evidenceLevel II (systematic review of level I and II studies).

scholarly journals The Long-term Consequence of Anterior Cruciate Ligament and Meniscus Injuries

2007 ◽  
Vol 35 (10) ◽  
pp. 1756-1769 ◽  
Author(s):  
L. Stefan Lohmander ◽  
P. Martin Englund ◽  
Ludvig L. Dahl ◽  
Ewa M. Roos
Keyword(s):  
Clinical Trial ◽  
Anterior Cruciate Ligament ◽  
Randomized Clinical Trial ◽  
Randomized Clinical Trials ◽  
Cruciate Ligament ◽  
Meniscus Tear ◽  
Critical Study ◽  
Consistent Finding ◽  
Anterior Cruciate

The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome. Injuries of the anterior cruciate ligament and menisci are common in both athletes and the general population. At 10 to 20 years after the diagnosis, on average, 50% of those with a diagnosed anterior cruciate ligament or meniscus tear have osteoarthritis with associated pain and functional impairment: the young patient with an old knee. These individuals make up a substantial proportion of the overall osteoarthritis population. There is a lack of evidence to support a protective role of repair or reconstructive surgery of the anterior cruciate ligament or meniscus against osteoarthritis development. A consistent finding in a review of the literature is the often poor reporting of critical study variables, precluding data pooling or a meta-analysis. Osteoarthritis development in the injured joints is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcome is reinforced by additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity, and reinjury. A better understanding of these variables may improve future prevention and treatment strategies. In evaluating medical treatment, we now expect large randomized clinical trials complemented by postmarketing monitoring. We should strive toward a comparable level of quality of evidence in surgical treatment of knee injuries. In instances in which a randomized clinical trial is not feasible, natural history and other observational cohort studies need to be as carefully designed and reported as the classic randomized clinical trial, to yield useful information.

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.

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