scholarly journals ACL Graft Signal Characteristics Measured by Quantitative MRI Are Significantly Correlated with Patient Reported Outcomes Two-Years after Hamstring Autograft ACL Reconstruction

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0035
Author(s):  
Drew A. Lansdown ◽  
Weiyuan Xiao ◽  
Alan L. Zhang ◽  
Christina R. Allen ◽  
Brian T. Feeley ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Quantitative Imaging ◽  
Relaxation Times ◽  
Tendon Graft ◽  
Hamstring Autograft ◽  
Acl Graft ◽  
Non Invasive ◽  
Patient Reported ◽  
Proteoglycan Content ◽  
Over Time

Objectives: Following surgical reconstruction of the anterior cruciate ligament (ACL), the tendon graft undergoes a remodeling process of ligamentization. Collagen within the ACL graft becomes organized along the long-axis of the ligament and the proteoglycan content increases. Quantitative imaging sequences, specifically T2 and T1rho, allow for a non-invasive assessment of collagen orientation and proteoglycan content, respectively. The purpose of this study was to investigate the longitudinal progression of T2 and T1rho relaxation times of the graft after ACL reconstruction and the relationship between these quantitative imaging markers and patient-reported outcome measures. We hypothesized that T2 and T1rho would decrease significantly over time, reflecting improved collagen organization and ncreased proteoglycan content, and that T2 and T1rho relaxation times would be inversely correlated with Knee Osteoarthritis Outcome Scores (KOOS). Methods: Thirty-two patients (mean age 29.4±8.2 years, 12 females) were followed prospectively after arthroscopic ACL reconstruction with hamstring autograft. Patients provided informed consent and all procedures were IRB-approved. Exclusion criteria included allograft reconstruction, other ligamentous injury, meniscal tear requiring repair, prior knee surgery, or history of arthritis. Post-operative MR imaging was obtained for 31 patients at 6 months, 30 patients at 12 months, 26 patients at 24 months, and 23 patients at 36 months after surgery. T2 and T1rho relaxation times were simultaneously acquired with a combined 3D sagittal sequence using a 3 T MR system (GE Healthcare) with a 1Tx/8Rx knee coil. The intra-articular ACL graft was identified on a fat-suppressed sagittal high-resolution 3D fast spin echo images and manually segmented. The T2 and T1rho relaxation times for the graft were recorded. Patients completed the KOOS at each imaging time point. Repeated measures analysis of variance (ANOVA) tests with Tukey corrections were used to compare T2 and T1rho relaxation times between time points. The relationship between KOOS and T2 and T1rho values at 2 years post-operative was investigated with Spearman’s rank correlation. Significance was defined as p<0.05. Results: The T2 relaxation times of the ACL graft were significantly higher at 6 months relative to 12 months (p<0.001), 24 months (p<0.001,) and 36 months (p<0.001) after ACL reconstruction, as well as significantly higher at 12 months relative to 36 months (p<0.001) (Figure 1A). The T1rho relaxation times of the ACL graft were significantly higher at 6 months relative to 12 months (p<0.001), 24 months (p<0.001), and 36 months (p<0.001) (Figure 1B). The two-year T2 relaxation times and T1rho relaxation times were significantly correlated with the KOOS Sports, Pain, Symptoms, and Activities of Daily Living sub-scores. Conclusion: We observed significant changes in the tendon graft over time following ACL reconstruction with hamstring autograft, reflecting a higher concentration of proteoglycan and more longitudinally-organized collagen structure over time. Improved collagen organization (lower T2 values) and increased proteoglycan content (lower T1rho values) were correlated with better outcomes based on KOOS scores. Quantitative T2 and T1rho relaxation times of ACL graft may offer a non-invasive method for monitoring graft maturation that correlates with patient-reported knee function after ACL reconstruction. [Figure: see text][Table: see text]

scholarly journals Bridge-Enhanced ACL Repair: Two Year Results of the First In Human Study

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0019
Author(s):  
Martha M. Murray ◽  
Leslie Kalish ◽  
Braden C. Fleming ◽  
Brett Flutie ◽  
Laura Thurber ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Human Study ◽  
Hamstring Tendon ◽  
Suture Repair ◽  
Hamstring Autograft ◽  
Acl Repair ◽  
Time Points ◽  
Patient Reported ◽  
Kt 1000 ◽  
Objective Score

Objectives: The Bridge-Enhanced ACL Repair (BEAR) procedure is an alternate form of anterior cruciate ligament (ACL) surgery that involves suture repair of the ligament combined with a scaffold to bridge the gap between the torn ligament ends. In this paper, we report outcomes of this procedure and a non-randomized concurrent control group receiving ACL reconstruction with quadrupled hamstring tendon autograft. We hypothesized that patients treated with Bridge-Enhanced ACL Repair would have physical exam findings, patient reported outcomes and adverse events at one and two years that were similar to patients treated with ACL reconstruction. Methods: This was an observational cohort study. Twenty patients were enrolled. Ten patients received a Bridge-Enhanced ACL Repair (BEAR®) and 10 received a hamstring autograft ACL reconstruction. Outcomes were assessed at time points up to 2 years post-operatively, including the International Knee Documentation Committee (IKDC) Subjective Score, the IKDC Objective score, KT-1000 testing for AP laxity and functional testing. Results: There were no graft or repair failures in the first two years after surgery. The IKDC Subjective Scores in both groups improved significantly from baseline (p< 0.0001) but were similar in BEAR and ACL reconstruction groups at 12 and 24 months. An IKDC Objective score of A (normal) was found in 44% of the patients in the BEAR group and 29% of the patients in the ACL reconstruction group at two years; no patients in either group had a grade of C (abnormal) or D (severely abnormal). KT-1000 testing demonstrated a side to side difference that was similar in the two groups at 2 years (mean(±SD) 1.9(± 2.1) mm in the BEAR group, 3.1(± 2.7) mm in the ACLR group). Functional hop testing results were similar in the two groups at 1 and 2 years after surgery. Hamstring strength indices measured by dynamometer were significantly higher at all time points in the BEAR group than in the hamstring autograft group (mean percentages relative to contralateral side at two years, 98.6%(±10.5%) vs 56.3%(±19.0%), p=0.0001). Conclusion: In a small first-in-human study, Bridge-Enhanced ACL Repair produced similar outcomes to ACL reconstruction with autograft quadruple bundle hamstring tendon.

scholarly journals ACL Reconstruction In High School and College-aged Athletes: Does Autograft Choice Affect Recurrent ACL Revision Rates?

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0028
Author(s):  
Christopher C. Kaeding ◽  
Kurt P. Spindler ◽  
Laura J. Huston ◽  
Alex Zajichek ◽  
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Knee Laxity ◽  
Hamstring Graft ◽  
Hamstring Autograft ◽  
Acl Graft ◽  
Percentage Points ◽  
Competition Level ◽  
Risk Patients

Objectives: Physicians’ and patients’ decision-making process between bone-patellar tendon-bone (BTB) versus hamstring autografts for ACL reconstruction (ACLR) may be influenced by a patient’s gender, laxity level, sport played, and/or competition level in the young, active athlete. The purpose of this study was to determine the incidence of subsequent ligament disruption for high school and college-aged athletes between autograft BTB versus hamstring grafts for ACLRs. Our hypothesis is there would be no recurrent ligament failure differences between autograft types at 6-year follow-up. Methods: Our inclusion criteria were patients aged 14-22 who were injured in sport (basketball, football, soccer, other), had a contralateral normal knee, and were due to have a unilateral primary ACLR with either a BTB or hamstring autograft. All patients were prospectively followed at two and six years and contacted by phone and/or email to determine whether any subsequent surgery had occurred to either knee since their initial ACLR. If so, operative reports were obtained, whenever possible, in order to document pathology and treatment. Multivariable regression modeling controlled for age, gender, ethnicity/race, body mass index, sport and competition level, activity level, knee laxity, and graft type. The six-year outcomes of interest were the incidence of subsequent ACL reconstruction to either knee. Results: Eight hundred thirty-nine (839) patients were eligible, of which 770 (92%) had 6-year follow-up for subsequent surgery outcomes. The median age was 17, with 48% females, and the distribution of BTB to hamstring was 492 (64%) and 278 (36%) respectively. Thirty-three percent (33%) of the cohort was classified as having “high grade” knee laxity preoperatively. The overall ACL revision rate was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal ACL, and 19.7% had one or the other within 6 years of the index ACLR surgery. High-grade laxity (OR: 2.4; 95% CI: 1.4, 3.9; p=0.001), autograft type (OR: 2.1; 95% CI: 1.3, 3.5; p=0.004), and age (OR: 0.8; 95% CI: 0.7, 0.96; p=0.009) were the 3 most influential predictors of a recurrent ACL graft revision on the ipsilateral knee, respectively, whereas the sport of the index injury (OR: 0.3; 95% CI: 0.2, 0.7; p=0.002) was the most influential predictor of a subsequent primary ACL reconstruction on the contralateral knee. The odds of a recurrent ACL graft revision on the ipsilateral knee for patients receiving a hamstring autograft were 2.1 times the odds of a patient receiving a BTB autograft (95% CI: 1.3, 3.5). For low-risk patients (5% incidence of graft failure), a hamstring graft can increase the risk of recurrent ACL graft revision by 5 percentage points, from 5% to 10%. For high-risk patients (35% incidence of graft failure), a hamstring graft can increase the risk of recurrent ACL graft revision by 15 percentage points, from 35% to ˜ 50%. An individual prediction risk calculator for a subsequent ACL graft revision can be determined by the nomogram in Figure 1. Conclusion: There is a high rate of subsequent ACL tears in both the ipsilateral and contralateral knees in this young athletic cohort, with evidence suggesting that incidence of ACL graft revisions at 6 years following index surgery is significantly higher in hamstring autograft compared to BTB autograft. [Figure: see text]

Lower patient-reported function at 2 years is associated with elevated knee cartilage T1rho and T2 relaxation times at 5 years in young athletes after ACL reconstruction

2018 ◽  
Vol 27 (8) ◽  
pp. 2643-2652 ◽  
Author(s):  
Matthew P. Ithurburn ◽  
Andrew M. Zbojniewicz ◽  
Staci Thomas ◽  
Kevin D. Evans ◽  
Michael L. Pennell ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Relaxation Times ◽  
Knee Cartilage ◽  
T2 Relaxation ◽  
Young Athletes ◽  
Patient Reported

scholarly journals A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures

2021 ◽  
Author(s):  
Philipp W. Winkler ◽  
Nyaluma N. Wagala ◽  
Jonathan D. Hughes ◽  
Bryson P. Lesniak ◽  
Volker Musahl
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Tibial Slope ◽  
Patient Reported Outcome ◽  
Acl Graft ◽  
Revision Acl Reconstruction ◽  
Patient Reported ◽  
Outcome Scores ◽  
Activity Scale ◽  
Tegner Activity Scale

Abstract Purpose To compare clinical outcomes, radiographic characteristics, and surgical factors between patients with single and multiple anterior cruciate ligament (ACL) graft failures. It was hypothesized that patients experiencing multiple ACL graft failures exhibit lower patient-reported outcome scores (PROs) and a higher (steeper) posterior tibial slope (PTS) than patients with single ACL graft failure. Methods Patients undergoing revision ACL reconstruction with a minimum follow-up of 12 months were included in this retrospective cohort study. Based on the number of ACL graft failures, patients were assigned either to the group “single ACL graft failure “or” multiple ACL graft failures “. The PTS was measured on strict lateral radiographs. Validated PROs including the International Knee Documentation Committee (IKDC) subjective knee form, Knee Injury and Osteoarthritis Outcome Score, Lysholm Score, Tegner Activity Scale, ACL-Return to Sport after Injury Scale, and Visual Analogue Scale for pain were collected. Results Overall, 102 patients were included with 58 patients assigned to the single ACL graft failure group and 44 patients to the multiple ACL graft failures group. Quadriceps tendon autograft was used significantly more often (55% vs. 11%, p < 0.001) and allografts were used significantly less often (31% vs. 66%, p < 0.001) as the graft for first revision ACL reconstruction in patients with single versus multiple ACL graft failures. Patients with multiple ACL graft failures were associated with statistically significantly worse PROs (IKDC: 61.7 ± 19.3 vs. 77.4 ± 16.8, p < 0.05; Tegner Activity Scale: 4 (range, 0–7) vs. 6 (range 2–10), p < 0.05), higher PTS (12 ± 3° vs. 9 ± 3°, p < 0.001), and higher rates of subsequent surgery (73% vs. 14%, p < 0.001) and complications (45% vs. 17%, p < 0.05) than patients with single ACL graft failure. Conclusion Compared to single ACL graft failure in this study multiple ACL graft failures were associated with worse PROs, higher PTS, and allograft use. During the first revision ACL reconstruction, it is recommended to avoid the use of allografts and to consider slope-reducing osteotomies to avoid multiple ACL graft failures and improve PROs. Level of evidence Level 3.

scholarly journals The effect of tourniquet type and thigh conicity on the length of hamstring autograft

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901879818
Author(s):  
Mehmet Faruk Çatma ◽  
Alper Öztürk
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Group Versus ◽  
Tendon Graft ◽  
Medial Malleolus ◽  
Strong Positive Correlation ◽  
Hamstring Autograft ◽  
Thigh Circumference ◽  
Pneumatic Tourniquet ◽  
Graft Length

Purpose: We studied the effect of using wide contoured pneumatic tourniquet (PT) versus ultra-narrow sterile exsanguination tourniquet (SET) on the length of hamstring autograft for anterior cruciate ligament (ACL) reconstruction in patients with tubular and conical thighs. Methods: Fifty-eight patients undergoing ACL reconstruction between 2012 and 2013 were assigned to either SET or PT groups. We measured the tendon graft length and width as well as the patients’ height, weight, and thigh circumference of 10 cm proximal to the patella and the distance from the anterior–superior iliac spine to the medial malleolus (ASIS-MM). We defined the ratio between the ASIS-MM and the thigh circumference as the conicity index (CI). All grafts were measured after folding into half, and the found value was recorded as functional graft length (FGL). Tendon graft dimensions were correlated with the individual anthropometric data and with CI in each of the groups. Results: PT was used in 34 patients and SET on 24 patients. FGL was 12.7 ± 0.84 mean + standard deviation for the SET group versus 11.5 ± 1.61 for the PT group ( p = 0.0011) with a strong positive correlation between FGL and CI for the PT group ( R2 = 0.625; p = 2.6 × 10−8) but nonsignificant correlation for the SET ( R2 = 0.222). Graft thickness was correlated with the patient age ( R2 = 0.450) but not with CI or type of tourniquet used. We found the CI to be a better measure of thigh conicity than thigh circumference, length, height, weight, or body mass index individually. Conclusion: We conclude that using the SET which occupies less space on the thigh yielded significantly longer hamstring autologous ACL graft compared to the PT and the FGL became essentially independent from the CI when the SET was used.

853 Microblading in Patients with Facial Burn Injuries

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S264-S265
Author(s):  
Melissa Brown ◽  
Lori Turgeon ◽  
Branko Bojovic
Keyword(s):  
Body Image ◽  
Burn Injury ◽  
Scar Tissue ◽  
Self Esteem ◽  
Post Treatment ◽  
Non Invasive ◽  
Patient Reported ◽  
The Impact ◽  
Over Time ◽  
Facial Burn

Abstract Introduction The experience of a burn injury is devastating. Physical and emotional recovery can be lengthy and often difficult. Many patients tire of constant surgical interventions required to achieve optimal functional and cosmetic outcomes. Identifying non-invasive interventions for patients with extensive facial burns that positively affect quality of life is appealing. Microblading, semi-permanent eyebrow tattooing, is one such option. Little research exists on the durability and longevity of microblading in burns, or its impact on body-image and self-esteem. The purpose of this case review is to identify possible benefits microblading may have physically and psychologically. Methods Case report looking at the impact of microblading on a young adult female over 18 years, who sustained a facial burn injury at age one year. Following consultation with her plastic surgeon, she was referred to a licensed body art facility to assess the viability of microblading over scar tissue. First treatment occurred at the facility in March of 2019 with a second session in May, as is standard practice. Patient photos obtained before and after procedures assessed longevity of microblading over scar tissue. Self-reported patient outcomes obtained following the procedure addressed the impact on perceived self-esteem and body-image. Results Photos were taken pre-treatment, directly post-treatment, 2 months, and 6 months post-treatment. Comparisons of photos immediately post treatment to those 6 months out showed appearance of tattooing remains the same. Eyebrows did not fade with time and continue to hold the same color and shape. Assessment of psychological impact was conducted through patient interview and self-report. Patient reported satisfaction with the procedure and cosmetic appearance following initial treatment. Over time, patient noted feeling more positive about body image and improvement in self-esteem. Conclusions Eyebrows are a critically important part of facial expression, which can be lost following a devastating facial burn. Initial data demonstrate the effectiveness of tattooing in recreating the appearance and function of eyebrows over scar tissue. Over time, the eyebrows maintained color without fading and shape did not change, demonstrating durability and longevity in this patient population. Early reports of improved self-image also remained unchanged over time. Microblading presents a possible low risk, inexpensive, effective alternative to expensive or potentially ineffective cosmetic surgery. This case establishes a need for further research on efficacy of microblading over scar tissue, with the hope of incorporating it into burn reconstruction as an alternative therapy and advocate for insurance coverage for qualifying patients. Applicability of Research to Practice Research supports microblading as a potential non-invasive, inexpensive treatment modality for loss of eyebrows.

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