scholarly journals Does Manual Drilling Improve the Healing of Bone–Hamstring Tendon Grafts in Anterior Cruciate Ligament Reconstruction? A Histological and Biomechanical Study in a Rabbit Model

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091160
Author(s):  
Matteo Maria Tei ◽  
Giacomo Placella ◽  
Marta Sbaraglia ◽  
Roberto Tiribuzi ◽  
Anastasios Georgoulis ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Bone Healing ◽  
Ultimate Load ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Load To Failure ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B

Background: Heat necrosis due to motorized drilling during anterior cruciate ligament (ACL) reconstruction could be a factor in delayed healing at the bone–tendon graft interface. Hypothesis: The process of osteointegration could be enhanced using manual drilling. It reduces the invasiveness of mechanical-thermal stress normally caused by the traditional motorized drill bit. Study Design: Controlled laboratory study. Methods: ACL reconstruction using semitendinosus tendon autografts was performed in 28 skeletally mature female New Zealand white rabbits, which were randomly divided into 3 groups. In group A (n = 12), the tunnels were drilled using a motorized device; in group B (n = 12), the tunnels were drilled using a manual drill bit; and group C (n = 4) served as a control with sham surgical procedures. The healing process in the tunnels was assessed histologically at 2, 4, 8, and 12 weeks and graded according to the Tendon–Bone Tunnel Healing (TBTH) scoring system. In addition, another 25 rabbits were used for biomechanical testing. The structural properties of the femur–ACL graft–tibia complex, from animals sacrificed at 8 weeks postoperatively, were determined using uniaxial tests. Stiffness (N/mm) and ultimate load to failure (N) were determined from the resulting load-elongation curves. Results: The time course investigation showed that manual drilling (group B) had a higher TBTH score and improved mechanical behavior, reflecting better organized collagen fiber continuity at the bone–fibrous tissue interface, better integration between the graft and bone, and early mineralized chondrocyte-like tissue formation at all the time points analyzed with a maximum difference at 4 weeks (TBTH score: 5.4 [group A] vs 12.3 [group B]; P < .001). Stiffness (23.1 ± 8.2 vs 17.8 ± 6.3 N/mm, respectively) and ultimate load to failure (91.8 ± 60.4 vs 55.0 ± 18.0 N, respectively) were significantly enhanced in the specimens treated with manual drilling compared with motorized drilling ( P < .05 for both). Conclusion: The use of manual drilling during ACL reconstruction resulted in better tendon-to-bone healing during the crucial early weeks. Manual drilling was able to improve the biological and mechanical properties of bone–hamstring tendon graft healing and was able to restore postoperative graft function more quickly. Tunnel drilling results in bone loss and deficient tendon-bone healing, and heat necrosis after tunnel enlargement may cause mechanical stress, contributing to a delay in healing. Manual drilling preserved the bone stock inside the tunnel, reduced heat necrosis, and offered a better microenvironment for faster healing at the interface. Clinical Relevance: Based on study results, manual drilling could be used successfully in human ACL reconstruction, but further clinical studies are needed. A clinical alternative, called the original “all-inside” technique, has been developed for ACL reconstruction. In this technique, the femoral and tibial tunnels are manually drilled only halfway through the bone for graft fixation, reducing bone loss. Data from this study suggest that hamstring tendon–to–bone healing can be improved using a manual drilling technique to form femoral and tibial tunnels.

scholarly journals Biomechanical Comparison of Quadriceps and 6-Strand Hamstring Tendon Grafts in Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 7 (10) ◽  
pp. 232596711987911
Author(s):  
Ryan Urchek ◽  
Spero Karas
Keyword(s):  
Ultimate Load ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Biomechanical Properties ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Quadriceps Tendon Graft ◽  
Load To Failure ◽  
Tendon Grafts ◽  
Anterior Cruciate

Background: The quadriceps tendon is becoming a popular graft option for anterior cruciate ligament (ACL) reconstruction. Few studies have examined the biomechanics of the quadriceps tendon compared with more commonly used graft choices. Due to the risk associated with small-diameter hamstring tendon grafts, various modifications of hamstring tendon preparation techniques have been described—specifically, a tripled, 6-strand hamstring tendon construct. This is the first study to directly compare the biomechanical properties of quadriceps tendon and hamstring tendon grafts. Purpose/Hypothesis: The purpose of this study was to quantify the biomechanical properties of the quadriceps tendon and 6-strand hamstring tendon grafts, specifically evaluating ultimate load to failure, load at 3 mm of displacement, and stiffness. These parameters characterize the time zero, in vitro, static tensile properties of these graft options. Our hypothesis was that for grafts of similar size, there would not be a significant difference in the biomechanical properties. Study Design: Controlled laboratory study. Methods: Quadriceps and hamstring tendon grafts were harvested from 6 human cadaveric knees (mean age, 61.17 ± 10.38 years). These matched grafts were prepared and biomechanically tested using an all-electric dynamic test load system. The mean diameter, stiffness, ultimate load to failure, and load to 3 mm of displacement were evaluated and analyzed. Results: The mean diameters of the 6-strand hamstring and quadriceps tendons were 11.33 and 10.16 mm, respectively ( P = .03). Despite these significantly different diameters, no differences were found in graft ultimate load to failure or load at 3 mm of displacement. The 6-strand hamstring tendon graft was significantly stiffer compared with the quadriceps tendon (1147.65 vs 808.65 N/mm; P = .04). Conclusion: The 6-strand hamstring tendon and quadriceps tendon graft had similar biomechanical properties with respect to ultimate load to failure and load at 3 mm of displacement in 6 matched cadaveric specimens. Both grafts were significantly stiffer than the native ACL, and the hamstring tendon construct was significantly stiffer than the quadriceps tendon. Clinical Relevance: The quadriceps tendon graft is a reliable alternative to a 6-strand hamstring tendon graft for ACL reconstruction.

Is Intraoperative Fluoroscopy Necessary to Confirm Device Position for Femoral-Sided Cortical Suspensory Fixation during Anterior Cruciate Ligament Reconstruction?

2019 ◽  
Vol 33 (03) ◽  
pp. 265-269
Author(s):  
B. Christian Balldin ◽  
Clayton W. Nuelle ◽  
Thomas M. DeBerardino
Keyword(s):  
Acl Reconstruction ◽  
Intraoperative Imaging ◽  
Cruciate Ligament ◽  
Intraoperative Fluoroscopy ◽  
Suspensory Fixation ◽  
Fluoroscopic Imaging ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B ◽  
Device Location

AbstractIncreased laxity within the graft construct system can lead to graft failure after anterior cruciate ligament (ACL) reconstruction. Suboptimal cortical device positioning could lead to increased laxity within the system, which could influence the mechanics and function of the graft reconstruction. This study evaluates the benefit of intraoperative fluoroscopy to confirm device position on the femur during ACL reconstruction using cortical suspensory fixation. One hundred consecutive patients who underwent soft tissue ACL reconstruction using a suspensory cortical device for femoral fixation were retrospectively evaluated. Patients were split into two groups: Group A utilized anteromedial portal visualization and had intraoperative fluoroscopic imaging performed at the time of ACL graft fixation to confirm femoral device placement on the lateral femoral metaphyseal cortex. Group B utilized anteromedial portal visualization alone. Both groups had radiographic X-rays performed at the first postoperative visit to evaluate device location and all images were independently evaluated by three fellowship trained orthopaedic surgeons. Device position was classified as optimal if there was complete apposition of the entire device against the femoral cortex and suboptimal if it was > 2 mm off the cortex. Fisher's exact test, analysis of variance, and 95% confidence intervals were calculated to compare the groups for statistical significance. The results showed 0/60 (0%) patients in group A had suboptimal device position at postoperative follow-up, while 4/40 (10%) patients in group B had suboptimal device position (p = 0.013). There were no graft failures in group A and one graft failure in group B. There was a significant difference in cortical device position in patients who had intraoperative fluoroscopic imaging versus patients who had no intraoperative imaging. The use of confirmatory intraoperative imaging may be beneficial to confirm appropriate device location when using a femoral cortical suspensory fixation technique for ACL reconstruction.

scholarly journals Safety of the application of Rigidfix cross-pin system via different tibial tunnels for tibial fixation during anterior cruciate ligament reconstruction

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Jian Wang ◽  
Hua-qiang Fan ◽  
Wenli Dai ◽  
Hong-Da Li ◽  
Yang-pan Fu ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Tibial Fixation ◽  
Group A ◽  
Coronal Section ◽  
Anterior Cruciate ◽  
Group B ◽  
External Aperture

Abstract Background We investigate the safety of the application of the Rigidfix cross-pin system via different tibial tunnels in the tibial fixation during anterior cruciate ligament (ACL) reconstruction. Methods Five adult fresh cadaver knees were fixed with the Rigidfix cross-pins in the tibial fixation site during ACL reconstruction. Two different tibial tunnel groups were established: in group A, the tunnel external aperture was placed at the 25° angle of coronal section; in group B, the tunnel external aperture was placed at the 45° angle of coronal section. The guide was placed at the plane 0.5 mm below articular facet through the tibial tunnel, with three rotation positions set at 0°, 30°, and 60° slopes. The incidences of iatrogenic injuries at tibial plateau cartilage (TPC), medial collateral ligament (MCL), and patellar tendon in three different slope angles were calculated in groups A and B and the results were analyzed by using chi square test. Results The iatrogenic injuries at MCL, TPC, and patellar tendon could occur after the Rigidfix cross-pin system was placed 5 mm below tibial plateau cartilage for ACL reconstruction. The incidences of TPC injury (χ2 = 5.662, P = 0.017) and MCL injury (P = 0.048, Fisher exact probability method) were significantly lower in group A than in group B. However, the incidence of patellar tendon injury showed no significant difference between these two groups (χ2 = 0.120, P = 0.729). Conclusions When the Rigidfix cross-pin system is used for ACL reconstruction at the tibial fixation site, the external aperture of tibial tunnel should not be placed at the excessively posterosuperior site, to avoid MCL and TPC injuries.

Modified Iliotibial Band Tenodesis Is Indicated to Correct Intraoperative Residual Pivot Shift After Anterior Cruciate Ligament Reconstruction Using an Autologous Hamstring Tendon Graft: A Prospective Randomized Controlled Trial

2020 ◽  
Vol 48 (5) ◽  
pp. 1069-1077 ◽  
Author(s):  
Mark Porter ◽  
Bruce Shadbolt
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Similar Rate ◽  
Iliotibial Band ◽  
Group A ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Group B

Background: The indications for the addition of anterolateral soft tissue augmentation to anterior cruciate ligament (ACL) reconstruction and its effectiveness remain uncertain. Purpose: To determine if modified iliotibial band tenodesis (MITBT) can improve clinical outcomes and reduce the recurrence of ACL ruptures when added to ACL reconstruction in patients with a residual pivot shift. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients with a primary ACL rupture satisfying the following inclusion criteria were enrolled: first ACL rupture, involved in pivoting sports, skeletally mature, no meniscal repair performed, and residual pivot shift relative to the contralateral uninjured knee immediately after ACL reconstruction. Patients were randomized to group A (no further surgery) or group B (MITBT added) and were followed up for 2 years. The patient-reported outcome (PRO) measures used were the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) subscale of sport/recreation (Sport/Rec), KOOS subscale of quality of life (QoL), Lysholm knee score (LKS), Tegner activity scale (TAS), recurrent ACL ruptures, or need for further surgery in either knee. Analysis of variance was used to compare PROs; the Wilcoxon test was used for the TAS; and the chi-square test was used for recurrence of ACL ruptures, meniscal injuries, and contralateral ACL ruptures ( P < .05). Results: A total of 55 patients were randomized: 27 to group A (female:male ratio = 15:12; mean age, 22.3 ± 3.7 years) and 28 to group B (female:male ratio = 17:11; mean age, 21.8 ± 4.1 years). At 2-year follow-up, group A had a similar IKDC score (90.9 ± 10.7 vs 94.2 ± 11.2; respectively; P = .21), lower KOOS Sport/Rec score (91.5 ± 6.4 vs 95.3 ± 4.4, respectively; P = .02), similar KOOS QoL score (92.0 ± 4.8 vs 95.1 ± 4.3, respectively; P = .14), lower LKS score (92.5 ± 4.8 vs 96.8 ± 8.0, respectively; P = .004), lower TAS score (median, 7 [range, 7-9] vs 8 [range, 8-10], respectively; P = .03), higher rate of recurrence (14.8% vs 0.0%, respectively; P < .001), similar rate of meniscal tears (14.8% vs 3.6%, respectively; P = .14), and similar rate of contralateral ACL ruptures (3.7% vs 3.6%, respectively; P = .99) relative to group B. Conclusion: The augmentation of ACL reconstruction with MITBT reduced the risk of recurrent ACL ruptures in knees with a residual pivot shift after ACL reconstruction and improved KOOS Sport/Rec, LKS, and TAS scores. Registration: ACTRN12618001043224 (Australian New Zealand Clinical Trials Registry)

scholarly journals Poredjenje klinickih rezultata rekonstrukcije prednjeg ukrstenog ligamenta koriscenjem dvaju razlicitih postupaka

2005 ◽  
Vol 52 (2) ◽  
pp. 89-94
Author(s):  
S. Ninkovic ◽  
D. Savic ◽  
M. Stankovic ◽  
S. Radic ◽  
A. Milicic ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Patella Tendon ◽  
Significant Difference ◽  
Golden Standard ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B ◽  
Hamstrings Tendon

During the last two decades the "golden standard" in reconstruction of anterior cruciate ligament knee was the middle third of patellar tendon, but now are more used hamstrings tendon autograft. The aim of this work was to compare our results of the artroscopic reconstruction ACL ( anterior cruciate ligament) of the knee using two different techniques. We were controling 60 patients within the period of two years after operation. Group A was composed of 39 patients which had reconstructed ACL done with bone-patella tendon-bone autografts, in the group B were 21 patients and at them as autographts have been used hamstring tendon. Difference between health and the ill knee by the Lachman?s test after operation, in the group A was 2,4mm , but in the group B was 2,2mm (p> 0,05 ). Postoperative middle value of the Lysholm and Gillquist score in the group A was 97,74, in the group B it was 96,67 (p>0,05). IKDC score results are following: Group A- mark A 32 patients (84,6%); mark B 5 (12,8%); mark C 1 (2,6%) and in the group B: mark A 17 patients (81%); mark B 3 (14,28%): mark C 1 (4,72%) (p> 0,05). Postoperative value for the Tegner and Lyscholm score activity in the A group was 8,23, in B group it was 8,81. The reconstruction of ACL with bone-patella tendon-bone grafts gave better results then the reconstruction with the hamstring tendon only according to Tegner score values. In other parameters between those two groups there was no statistically significant difference.

scholarly journals High Tibial Valgus Osteotomy and Concomitant Anterior Cruciate Ligament Reconstruction. Which is the most appropriate surgical technique?

2014 ◽  
Vol 2 (12_suppl4) ◽  
pp. 2325967114S0023
Author(s):  
Matías Costa Paz ◽  
Juan José Deré ◽  
Carlos Heraldo Yacuzzi
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Lysholm Score ◽  
Peroneal Nerve Injury ◽  
Group A ◽  
High Tibial Valgus Osteotomy ◽  
Anterior Cruciate ◽  
Group B ◽  
Tibial Valgus

Introduction: The aim of this study is to evaluate advantages of close vs. open HTO of a group of patients who underwent a one-stage combined operation for chronic ACL rupture and early medial compartment arthritis. Material and Methods: We retrospective evaluated two series of patients operated on for anterior cruciate ligament (ACL) reconstruction combined with high tibial valgus osteotomy (HTO) for chronic anterior knee instability associated with medial tibio femoral osteoarthritis. Close HTO using rigid plate fixation and ACL reconstruction with bone patellar tendon bone graft was performed in Group A (7 patients). An open HTO using Puddu plate and ACL reconstruction with hamstring tendon graft was performed in Group B (9 patients). The mean age in Group A was 41 years old with an average varus of 8 degrees. Mean age in Group B was 42 years old and with 4 degrees of varus. Lysholm Score, HSS and Radiographs were performed. Results: Group A obtained a mean Lysholm score of 94, mean HSS of 91. Group B showed a mean Lysholm score of 83, mean HSS of 87. The mean follow-up was 5 years in both groups. In all cases osteotomies consolidated. Discussion: Technically we found that open HTO with hamstrings had several advantages such as lower risk of peroneal nerve injury, use of one incision, no problems as regards graft length, possibility of fixing the graft in the proximal tibia, maintenance of tibial slope and preservation of bone stock. The Open HTO need of osseous graft, may produce patella baja and the risk of nonunion is higher. This technique is indicated for relaxed medial collateral ligament. As regards the Close HTO there may be possibilities of a peroneal nerve injury, it may decrease the tibial slope, patellar ascent, loss of bone, the need to disrupt either the fibula or proximal tibio-fibular joint and may generate instability in the posterolateral corner and the screws could compromise the tunnels path. The advantages are provision of bone to bone contact with excellent union rates and the potential for full early weight-bearing. Conclusion: In spite of these issues, both procedures relieved pain and restored knee stability and the choice will depend on each particular case.

The Fixation Strength of Six Hamstring Tendon Graft Fixation Devices in Anterior Cruciate Ligament Reconstruction: Part I: Femoral Site

2003 ◽  
Vol 31 (2) ◽  
pp. 174-181 ◽  
Author(s):  
Petteri Kousa ◽  
Teppo L. N. Järvinen ◽  
Mika Vihavainen ◽  
Pekka Kannus ◽  
Markku Järvinen
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Fixation Strength ◽  
Single Cycle ◽  
Hamstring Tendon Graft ◽  
Fixation Devices ◽  
Load To Failure ◽  
Anterior Cruciate

Background: Strength of graft fixation is the weakest link in anterior cruciate ligament reconstruction. Hypothesis: There is no difference in initial fixation strength between different hamstring tendon graft femoral fixation devices. Study Design: Randomized experimental study. Methods: Each of six devices was used in the fixation of 10 quadrupled human semitendinosus-gracilis tendon grafts in tunnels drilled in porcine femora and tested 10 times with a single-cycle load-to-failure test at a rate of 50 mm/min and 10 times with a 1500-cycle loading test between 50 and 200 N at one cycle every 2 seconds. The specimens that survived the cyclic loading were subjected to a single-cycle load-to-failure test. Results: The Bone Mulch Screw (1112 N) was strongest in the single-cycle load-to-failure test, followed by EndoButton CL (1086 N), RigidFix (868 N), SmartScrew ACL (794 N), BioScrew (589 N), and RCI screw (546 N). It also showed the lowest residual displacement (2.2 mm) and was strongest in the single-cycle load-to-failure test after cyclic loading. Conclusions: The Bone Mulch Screw was superior to all other devices. Clinical Relevance: Caution may be warranted in employing aggressive rehabilitation after reconstruction with these devices. Preconditioning of the graft-implant complex before fixation is important.

scholarly journals Graft tunnel integration occurs early in the tibial tunnel compared with the femoral tunnel after anterior cruciate ligament reconstruction with preserved insertion hamstring tendon graft

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ravi Gupta ◽  
Sandeep Singh ◽  
Anil Kapoor ◽  
Ashwani soni ◽  
Ravinder Kaur ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Hamstring Tendon Graft ◽  
The Mean ◽  
Anterior Cruciate

Abstract Background Preservation of hamstring tendon insertion at the time of anterior cruciate ligament (ACL) reconstruction is a well-known technique; however, its effect on graft integration is not well studied. The present study was conducted to study the graft integration inside the tibial and femoral tunnels, respectively, after ACL reconstruction using hamstring tendon graft with preserved insertion. Methods Twenty-five professional athletes who underwent ACL reconstruction using hamstring tendon graft with preserved tibia insertion were enrolled in the study. Functional outcomes were checked at final follow-up using Lysholm score and Tegner activity scale. Magnetic resonance imaging (MRI) was done at 8 months and 14 months follow-up to study the graft tunnel integration of the ACL graft at both tibial and femoral tunnels. Results The mean Fibrous interzone (FI) score (tibial tunnel) decreased from 2.61 (1–5) at 8 months to 2.04 (1–4) at 14 months follow-up (p = 0.02). The mean FI score (femoral side) decreased from 3.04 (2–5) at 8 months to 2.57 (2–4) at 14 months (p = 0.02). Conclusions Graft integration occurs early in the tibial tunnel as compared with the femur tunnel with preserved insertion hamstring tendon autograft. Trial registration CTRI/2019/07/020320 [registered on 22/07/2019]; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33884&EncHid=&modid=&compid=%27,%2733884det%27

ACCELERATED REHABILITATION VERSUS CONVENTIONAL REHABILITATION AFTER ACL RECONSTRUCTION: A COMPARATIVE STUDY.

2021 ◽  
pp. 76-77
Author(s):  
Deepshikha Beniwal ◽  
Sushmita Kushwaha ◽  
Rajesh Rohilla ◽  
Vishal Bhardwaj ◽  
Bhupesh Goyal
Keyword(s):  
Acl Reconstruction ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Visual Analogue Score ◽  
Acl Surgery ◽  
Accelerated Rehabilitation ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B ◽  
And Function

Objective: To know whether accelerated or conventional rehabilitation is effective after Anterior Cruciate ligament reconstruction. Material & Methods: 30 subjects were selected who fullled the predetermined inclusive and exclusive criteria. The subjects were divided into two groups, 15 in each group. Group A underwent Accelerated Rehabilitation and Group B underwent Conventional rehabilitation post ACL surgery. Visual analogue score(VAS) and Knee injury and osteoarthritis outcome Score(KOOS) was used as a measure of pain and function respectively. Results: Reduction in pain and improvement in function following rehabilitation is seen in both the groups. There is signicant difference in VAS(p<0.001) and KOOS(p<0.001) in group receiving accelerated rehabilitation following ACL reconstruction. Conclusion: Accelerated rehabilitation is effective over convential rehabilitaion post ACL surgery

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