scholarly journals 20 Year Outcomes of ACL Reconstruction with Hamstring Tendon Autograft. Does Age Matter?

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0017
Author(s):  
Justin Roe ◽  
Feisal Shah ◽  
Emma Fitzgibbon ◽  
Lucy Salmon ◽  
James Linklater ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Degenerative Change ◽  
Acl Injury ◽  
Tibial Slope ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Long Term Outcomes ◽  
Posterior Tibial ◽  
Tendon Autograft

Introduction: The purpose of this study was to document the prospective longitudinal outcome of ‘isolated’ anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft over 20 years. Long term outcomes were compared between those undergoing ACL reconstruction age 18 or less and those >18 years the time of surgery. Methods: A total of 100 consecutive men and 100 consecutive women with ‘isolated’ ACL rupture underwent four-strand hamstring tendon reconstruction with anteromedial portal femoral tunnel drilling and interference screw fixation by a single surgeon. At the time of ACL reconstruction 39 participants were aged 18 or less, 81 were aged 19 to 25 and 80 were over 25. Reviews were performed pre-operatively and at 1, 2, 7, 15 and 20 years post-operatively. Outcomes included further ACL injury, clinical examination, subjective and objective scoring systems, and radiological assessment. Results: Further ACL injury occurred in 55 of the 200 patients (28%), 37 ruptured the ACL graft and 22 ruptured the contralateral ACL. ACL graft rupture was significantly increased in the young; 39% in those aged 18 or less, 21% of those aged 19-25 and 6% of those over 25 years (p=0.001). Participants with a posterior tibial slope of 12 degrees or more sustained a further ACL injury in 65% of cases. Moderate to severe radiological degenerative change was evident in 14% at 20 years. Outcomes were not statistically different between those aged 18 or less and those >18 years for the variables of IKDC subjective score (p=0.98), rate of return to preinjury activity level (p=0.32), current activity level, or degree of radiological degenerative change at 20 years (p=0.65). Conclusions: ACL reconstructive surgery in patients with an ‘isolated’ rupture using this technique was associated with good long term outcomes and does not appear to cause osteoarthritis, regardless of age. However further ACL injury after ACL reconstruction is significantly more common in the young and those with a high posterior tibial slope. **This study was performed with support from AOA Research Foundation

scholarly journals 20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope

2017 ◽  
Vol 46 (3) ◽  
pp. 531-543 ◽  
Author(s):  
Lucy J. Salmon ◽  
Emma Heath ◽  
Hawar Akrawi ◽  
Justin P. Roe ◽  
James Linklater ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Degenerative Change ◽  
Acl Injury ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Acl Graft ◽  
Hamstring Tendon Autograft ◽  
Graft Rupture ◽  
Tendon Autograft

Background: No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored. Purpose: To compare the prospective longitudinal outcome of “isolated” ACL ruptures treated with anatomic endoscopic ACL reconstruction using hamstring tendon autograft over 20 years in adolescent and adult cohorts and to examine factors for repeat ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: A single-surgeon series of 200 consecutive patients undergoing isolated primary ACL reconstruction with hamstring tendon autograft were prospectively studied. Subjects were assessed preoperatively and at 2, 7, 15, and 20 years postoperatively. Outcomes included International Knee Documentation Committee (IKDC) Knee Evaluation, IKDC subjective scores, KT-1000 instrumented laxity testing, and radiological evaluation of degenerative change and medial tibial slope. Twenty-year outcomes were compared between those who underwent surgery at the age of 18 years or younger (adolescent group, n = 39) and those who underwent surgery when older than 18 years (adult group, n = 161). Results: At 20 years, 179 of 200 subjects were reviewed (89.5%). ACL graft rupture occurred in 37 subjects and contralateral ACL injury in 22 subjects. Of those with intact ACL grafts at 20 years, outcomes were not statistically different between adolescents and adults for the variables of IKDC subjective score ( P = .29), return to preinjury activity level ( P = .84), current activity level ( P = .69), or degree of radiological degenerative change at 20 years ( P = .51). The adolescent group had a higher proportion of grade 1 ligamentous laxity testing compared with the adult group ( P = .003). Overall, ACL graft survival at 20 years was 86% for adults and 61% for adolescents (hazard ration, 3.3; P = .001). The hazard for ACL graft rupture was increased by 4.8 in adolescent males and 2.5 in adolescent females compared with adults. At 20 years, the ACL survival for adolescents with a PTS of ≥12° was 22%. The hazard for ACL graft rupture was increased by 11 in adolescents with a PTS of ≥12° ( P = .001) compared with adults with a PTS <12°. Conclusion: Repeat ACL injury after isolated ACL reconstruction is common, occurring in 1 in 3 over 20 years. In the absence of further injury, isolated ACL reconstruction using this technique was associated with good long-term outcomes with respect to patient-reported outcomes and return to sports, regardless of age. However, mild ligament laxity and ACL graft rupture after ACL reconstruction are significantly more common in adolescents, especially adolescent males, compared with adults. PTS of 12° or more is the strongest predictor of repeat ACL injury, and its negative effect is most pronounced in adolescents.

Posterior Tibial Slope in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft: Analysis of Subsequent ACL Graft Tear or Contralateral ACL Tear

2021 ◽  
Vol 49 (3) ◽  
pp. 620-625
Author(s):  
K. Donald Shelbourne ◽  
Rodney W. Benner ◽  
Jonathan A. Jones ◽  
Tinker Gray
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Revision Surgery ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
The Mean ◽  
Anterior Cruciate ◽  
Tendon Autograft

Background: Reports on greater posterior tibial slope (PTS) and its relationship to subsequent anterior cruciate ligament (ACL) injury show conflicting results; it has not been studied much in patients after ACL reconstruction with patellar tendon autograft (PTG). Hypothesis: Patients who suffered a subsequent ACL injury would have a larger PTS than patients who did not suffer a subsequent injury after primary or revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Patients received primary (n = 2439) or revision (n = 324) ACL reconstruction with PTG and were followed prospectively to determine the rate of graft tear and contralateral ACL tear. The PTS was measured preoperatively on digital lateral view radiographs. Intersecting lines were drawn along the medial tibial plateau and posterior tibia; the value of the acute angle at the lines’ intersection was then subtracted from 90° to obtain the PTS. This procedure was completed by a clinical assistant with an intrarater reliability of 0.89. Chi-square analysis and t tests were used to determine the differences between rate of tears and measurements between groups. A threshold of PTS ≥10° was used for analysis. Results: The mean follow-up time was 11.6 ± 4.0 years. After primary surgery, the mean PTS in patients with graft tears was 5.4°± 3.1° versus 4.8°± 2.9° for patients without a tear ( P = .041). The mean PTS was 4.9°± 3.4° for patients with contralateral tears (not statistically significantly different than the no-tear group; P = .80). Furthermore, patients with primary reconstruction with PTS ≥10° had a statistically significantly higher rate of graft tear (9.7%) than patients with PTS ≤9° (4.8%) ( P = .003), but not a higher rate of contralateral tear. Among patients undergoing revision surgery, there were no statistically significant differences between the graft tear, contralateral tear, and no-tear groups with relation to PTS ≥10°. Conclusion: After primary ACL reconstruction, patients with PTS >10° had a higher rate of subsequent graft tear but not a higher rate of contralateral tear. With revision surgery, there was no significant association between PTS and the rate of subsequent tear. Therefore, caution should be exercised when considering more radical interventions, such as osteotomy, to prevent retear in patients with high PTS.

scholarly journals Increased Radiographic Posterior Tibial Slope Is Associated With Subsequent Injury Following Revision Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711987937 ◽  
Author(s):  
Richard J. Napier ◽  
Enrique Garcia ◽  
Brian M. Devitt ◽  
Julian A. Feller ◽  
Kate E. Webster
Keyword(s):  
Risk Factor ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Revision Acl Reconstruction ◽  
Injury Group ◽  
Anterior Cruciate

Background: Increased posterior tibial slope has been identified as a possible risk factor for injury to the anterior cruciate ligament (ACL) and has also been shown to be associated with ACL reconstruction graft failure. It is currently unknown whether increased posterior tibial slope is an additional risk factor for further injury in the context of revision ACL reconstruction. Purpose: To determine the relationship between posterior tibial slope and further ACL injury in patients who have already undergone revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 330 eligible patients who had undergone revision ACL reconstruction between January 2007 and December 2015 were identified from a clinical database. The slope of the medial and lateral tibial plateaus was measured on perioperative lateral radiographs by 2 fellowship-trained orthopaedic surgeons using a digital software application. The number of subsequent ACL injuries (graft rupture or a contralateral injury to the native ACL) was determined at a minimum follow-up of 2 years (range, 2-8 years). Tibial slope measurements were compared between patients who sustained further ACL injury to either knee and those who did not. Results: There were 50 patients who sustained a third ACL injury: 24 of these injuries were to the knee that underwent revision ACL reconstruction, and 26 were to the contralateral knee. Medial and lateral slope values were significantly greater for the third-injury group compared with the no–third injury group (medial, 7.5° vs 6.3° [ P = .01]; lateral, 13.6° vs 11.9° [ P = .001]). Conclusion: Increased posterior tibial slope, as measured from lateral knee radiographs, was associated with increased risk of graft rupture and contralateral ACL injury after revision ACL reconstruction. This is consistent with the concept that increased posterior slope, particularly of the lateral tibial plateau, is an important risk factor for recurrent ACL injury.

scholarly journals Posterior tibial slope in patients undergoing anterior cruciate ligament (ACL) reconstruction with patellar tendon autograft: Analysis of subsequent ACL graft tear or contralateral ACL tear

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0035
Author(s):  
Rodney Benner ◽  
Jonathan Jones ◽  
Tinker Gray ◽  
K. Donald Shelbourne
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Revision Surgery ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Acl Tear ◽  
Posterior Tibial ◽  
Revision Acl Reconstruction ◽  
The Mean ◽  
Tendon Autograft

Objectives: To examine the relationship of posterior tibial slope and rate of graft tear or contralateral anterior cruciate ligament (ACL) tear among patients undergoing primary or revision ACL reconstruction with patellar tendon autograft. Methods: From June 2001 to 2015, 2,796 patients received primary or revision ACL reconstruction with patellar tendon autograft (PTG) and were followed prospectively to determine rate of graft tear and contralateral ACL tear. Minimum follow-up for study inclusion was 4 years. Posterior tibial slope (PTS) was measured preoperatively on digital lateral view radiographs with knee flexion between 30° and 45°. Intersecting lines were drawn along the medial tibial plateau and the posterior tibia; the value of the acute angle at the lines’ intersection was then subtracted from 90° to obtain the PTS. This procedure was carried out by a clinical assistant with interrater reliability of 0.89. Chi-square analysis, Pearson correlation, and t-tests were used to determine relationships between rate of graft tear or contralateral ACL tear and PTS, age, and sex among primary and revision surgery groups. A threshold of PTS ≥10° was used for analysis. Results: The mean age of patients was 24.3±10.2 years for patients undergoing primary ACL reconstruction (n=2472) and 24.3±8.8 years for revision ACL reconstruction (n=324). The mean follow-up time was 11.6 ± 4.0 years. The rate of primary graft tear was 5.1% (n=126), and primary contralateral ACL tear rate was 4.9% (n=121). The rate of revision graft tear was 5.9% (n=19), and revision contralateral tear rate was 1.9% (n=6). Among primary reconstructions, the mean surgery age of patients who experienced graft tear (19.2 ± 6.3 years) or contralateral tear (21.5 ± 9.5 years) were significantly younger (P<.001, P=.0011, respectively) than patients who did not suffer a subsequent tear (24.7 ± 10.3 years). The mean PTS among primary graft tears was 5.4 ± 3.1°, which was statistically significantly higher than the mean of 4.8 ± 2.9° for patients without tear (P=.041). The mean PTS was 4.9 ± 3.3° for patients with contralateral tears, which was not statistically significant different than other groups. Furthermore, primary reconstruction patients with PTS≥10° had a significantly higher rate of graft tear (9.6%) than patients with PTS ≤9° (4.7%) (P=0.004), but not a higher rate of contralateral tear. Among patients undergoing revision surgery, there were no statistically significant differences between graft tear, contralateral tear, and no tear groups with relation to age, PTS, or PTS ≥10°. Among all patients (primary or revision group), there was no difference in PTS between sexes (P=0.278), nor was surgery age significantly correlated to PTS (R=0.0226). Conclusion: Higher PTS appears to be correlated to higher rates of ACL graft tear in patients undergoing primary ACL reconstruction with PTG, particularly when PTS is greater than 10°. However, rate of graft tear remains low (5.1% overall, 9.6% with PTS≥10°). Furthermore, for patients undergoing revision surgery, there is no significant association between PTS and rate of subsequent tear. Therefore, caution should be exercised when considering more radical interventions, such as osteotomy, to prevent retear in patients with high PTS.

scholarly journals Patient-Reported Outcomes with Tibial Baseplate Position and PCL Status in Conforming Total Knee Arthroplast

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Joseph A. Madden, BS ◽  
Payton K. Arnold, MS ◽  
Evan R. Deckard, BSE ◽  
R. Michael Meneghini, MD
Keyword(s):  
Tibial Slope ◽  
Activity Level ◽  
Posterior Tibial Slope ◽  
Consecutive Series ◽  
Posterior Tibial ◽  
Primary Tkas ◽  
Measurement Protocol ◽  
Patient Reported ◽  
Total Knee ◽  
Climbing Stairs

Background and Hypothesis: Anteroposterior (AP) tibial baseplate position, posterior tibial slope, and posterior cruciate ligament (PCL) status in total knee arthroplasty (TKA) undoubtedly affect kinematic patterns. Further, few studies document patient-reported outcome measures (PROMS) in conforming polyethylene TKA with these varying parameters. The purpose of this study was to correlate PROMS with the interaction of AP tibial baseplate position, tibial slope, and PCL status in a consecutive series of primary TKAs with conforming polyethylene. We hypothesized that pain, function, and satisfaction may correlate with a combination of these three parameters. Experimental Design or Project Methods: 589 consecutive primary TKAs of a single implant design performed by a single surgeon between January 2016 and October 2018 were retrospectively reviewed. AP tibial baseplate position (relative to the middle of the tibial canal) and posterior tibial slope measurements were performed on 4-week postoperative sagittal view radiographs with a standardized measurement protocol by two independent blinded raters. Validated PROMS related to activity level, pain, and function were evaluated at minimum one-year. Results: Analyses indicated differences based on ≥8mm vs. <8mm of posterior distance of the tibial baseplate from the tibial canal and whether or not the PCL was released. Four analysis groups (PCL-preserved <8mm, PCL-preserved ≥8mm, PCL-resected <8mm, and PCL-resected ≥8mm) did not differ by demographics/covariates (p≥0.150), tibial slope (p≥0.132), or preoperative PROMS (p≥0.088). The PCL-released <8mm group achieved clinically meaningful higher absolute (92.0) and delta (42.0) median KOOS Jr. scores, higher satisfaction (96.3%), and the greatest reduction in pain while climbing stairs (-7.0) although some findings lacked statistical significance. Conclusion and Potential Impact: In conforming polyethylene TKAs, releasing the PCL in combination with AP tibial baseplate placement <8mm from the tibial canal may eliminate kinematic conflict between the PCL and tibial baseplate leading to improved satisfaction, function, and pain while climbing stairs.

scholarly journals The difference between the medial and lateral posterior tibial slope is associated with greater internal tibial rotation

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0003
Author(s):  
Elmar Herbst ◽  
Andreas Imhoff ◽  
James Irrgang ◽  
William Anderst ◽  
Freddie Fu
Keyword(s):  
Acl Reconstruction ◽  
Tibial Slope ◽  
Tibial Rotation ◽  
Tibial Shaft ◽  
Posterior Tibial ◽  
Downhill Running ◽  
Lateral Posterior ◽  
Internal Tibial Rotation ◽  
The Difference

The objective of this study was to investigate the effect of lateral and medial posterior tibial slope (PTS) and meniscal slope (PMS) on in-vivo anterior tibial translation (ATT) and internal tibial rotation (IR) during downhill running on the healthy contralateral knee twenty-four months after ACL reconstruction. Forty-two individuals (twenty-six males; mean age 21.2 ± 6.9 years) who underwent unilateral ACL reconstruction were included in this study. Morphologic parameters were measured on 3 T magnetic resonance images (MRI) using the 3D DESS sequence on the ACL reconstructed and healthy contralateral knee. Lateral and medial PTS and PMS were measured according to the method described by Hudek et al. Briefly, the tibial shaft axis was determined by connecting the centroids of two circles fitting the tibial shaft on the central sagittal MRI slice. The PTS and PMS were determined by the angle between the tibial shaft axis and the line connecting the two most proximal anterior and posterior subchondral bone and meniscal points in the center of each joint compartment. Three-dimensional in-vivo kinematics data were acquired using dynamic stereo x-ray during downhill running (3.0 m/s, 10° slope) at 150 Hz twenty-four months after unilateral ACL reconstruction. A multiple regression analysis was performed (p < .05). The lateral and medial PTS and PMS as well as the differences between the medial and lateral compartment slopes were not significantly related to ATT in the healthy contralateral knees twenty-four months after ACL reconstruction (p > .05). The lateral and medial PTS and PMS were not significantly related to peak internal tibial rotation (p > .05). However, the difference between the medial and lateral PTS as well as PMS was associated with greater internal tibial rotation (PTS: b=1.55, p < .001; PMS: b = .71, p = .02). The most important finding of the present study is that the difference between the medial and lateral posterior tibial and meniscal slope are related to in-vivo internal tibial rotation during downhill running. ATT was not significantly influenced by the tibial bony and meniscal morphology. Taking into account the results of the present study, the difference between the medial and the lateral PTS and PMS may contribute to IR when an ACL injury occurs. However, the analyzed movement was a straight-ahead run without any cutting or pivoting maneuvers commonly related to ACL tears. In such motion patterns, the correlations may be even stronger compared to the results of this study.

Sign in / Sign up

Export Citation Format

Share Document