scholarly journals Failure Rates of 5-Strand and 6-Strand vs Quadrupled Hamstring Autograft ACL Reconstruction: A Comparative Study of 413 Patients With a Minimum 2-Year Follow-up

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094632
Author(s):  
Ahmed Khalil Attia ◽  
Hazem Nasef ◽  
Kareem Hussein ElSweify ◽  
Mohammed A. Adam ◽  
Faris AbuShaaban ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Control Group ◽  
Failure Rates ◽  
Hamstring Autograft ◽  
Level Of Evidence ◽  
Increased Risk ◽  
The Mean ◽  
Anterior Cruciate ◽  
Graft Diameter

Background: Anterior cruciate ligament reconstruction (ACLR) with hamstring autograft has gained popularity. However, an unpredictably small graft diameter has been a drawback of this technique. Smaller graft diameter has been associated with increased risk of revision, and increasing the number of strands has been reported as a successful technique to increase the graft diameter. Purpose: To compare failure rates of 5-strand (5HS) and 6-strand (6HS) hamstring autograft compared with conventional 4-strand (4HS) hamstring autograft. We describe the technique in detail, supplemented by photographs and illustrations, to provide a reproducible technique to avoid the variable and often insufficient 4HS graft diameter reported in the literature. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed prospectively collected data of all primary hamstring autograft ACLRs performed at our institution with a minimum 2-year follow-up and 8.0-mm graft diameter. A total of 413 consecutive knees met the study inclusion and exclusion criteria. The study population was divided into 5HS and 6HS groups as well as a 4HS control group. The primary outcome was failure of ACLR, defined as persistent or recurrent instability and/or revision ACLR. Results: The analysis included 224, 156, and 33 knees in the 5HS, 6HS, and 4HS groups, respectively. The overall ACLR failure rate in this study was 11 cases (8%): 5 cases for 5HS, 3 cases for 6HS, and 3 cases for 4HS. No statistically significant differences were found among groups ( P = .06). The mean graft diameter was 9 mm, and the mean follow-up was 44.27 months. Conclusion: The 5HS and 6HS constructs have similar failure rates to the conventional 4HS construct of 8.0-mm diameter and are therefore safe and reliable to increase the diameter of relatively smaller hamstring autografts. We strongly recommend using this technique when the length of the tendons permits to avoid failures reportedly associated with inadequate graft size.

Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

2021 ◽  
pp. 036354652110273
Author(s):  
Joshua S. Everhart ◽  
Sercan Yalcin ◽  
Kurt P. Spindler
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Increased Risk ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

Tear Rates of the Ipsilateral ACL Graft and the Contralateral Native ACL Are Similar following ACL Reconstruction

2020 ◽  
Author(s):  
Nadia Nastassia Ifran ◽  
Ying Ren Mok ◽  
Lingaraj Krishna
Keyword(s):  
Acl Reconstruction ◽  
Medical Records ◽  
Cruciate Ligament ◽  
Acl Graft ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Anterior Cruciate ◽  
Mean Time

AbstractThe aim of the study is to compare the tear rates of ipsilateral anterior cruciate ligament (ACL) grafts and the contralateral native ACL as well as to investigate the correlation of gender, age at time of surgery, and body mass index (BMI) with the occurrence of these injuries. The medical records of 751 patients who underwent ACL reconstruction surgery with follow-up periods of 2 to 7 years were retrospectively analyzed. Survival analyses of ipsilateral ACL grafts and contralateral native ACL were performed. Univariate and multivariate logistic regression analyses were performed to identify risk factors that were associated with these injuries. The tear rates of the ipsilateral ACL graft and contralateral ACL were 5.86 and 6.66%, respectively with no significant difference between groups (p = 0.998). The mean time of tears of the ipsilateral ACL and contralateral ACL was also similar (p = 0.977) at 2.64 and 2.78 years, respectively after surgery. Both the odds of sustaining an ipsilateral ACL graft and contralateral ACL tear were also significantly decreased by 0.10 (p = 0.003) and 0.14 (p = 0.000), respectively, for every 1-year increase in age at which the reconstruction was performed. However, graft type, gender, and BMI were not associated with an increased risk of these injuries. There was no difference between tear rates of ipsilateral ACL graft and contralateral ACL following ACL reconstruction. Patients who undergo ACL reconstruction at a young age are at an increased risk of both ipsilateral graft and contralateral ACL rupture after an ACL reconstruction. Patients who are young and more likely to return to competitive sports should be counselled of the risks and advised to not neglect the rehabilitation of the contralateral knee during the immediate and back to sports period of recovery. This is a Level III, retrospective cohort study.

Revision Risk of Soft Tissue Allograft Versus Hybrid Graft After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 48 (4) ◽  
pp. 799-805 ◽  
Author(s):  
Raffy Mirzayan ◽  
Heather A. Prentice ◽  
Anthony Essilfie ◽  
William E. Burfeind ◽  
David Y. Ding ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Autograft ◽  
Tissue Allograft ◽  
Aseptic Revision ◽  
Revision Risk ◽  
Anterior Cruciate ◽  
Graft Diameter

Background: When a harvested hamstring autograft is deemed by the surgeon to be of inadequate diameter, the options include using the small graft, using another autograft from a different site, augmenting with an allograft (hybrid graft), using a different configuration of the graft (eg, 5- or 6-stranded), or abandoning the autograft and using allograft alone. A small graft diameter is associated with a higher revision risk, and using another autograft site includes added harvest-site morbidity; therefore, use of a hybrid graft or an allograft alone may be appealing alternative options. Revision risk for hybrid graft compared with soft tissue allograft is not known. Purpose: To evaluate the risk for aseptic revision surgery after primary anterior cruciate ligament reconstruction (ACLR) using a soft tissue allograft compared with ACLR using a hybrid graft in patients 25 years and younger. Study Design: Cohort study; Level of evidence, 3. Methods: Data from a health care system’s ACLR registry were used to identify primary isolated unilateral ACLRs between 2009 and 2016 using either a hybrid graft (hamstring autograft with soft tissue allograft) or a soft tissue allograft alone. Multivariable Cox proportional hazards regression was used to evaluate risk for aseptic revision after ACLR according to graft used after adjustment for age, allograft processing, tunnel drilling technique, and region where the primary ACLR was performed. Results: The cohort included 2080 ACLR procedures; a hybrid graft was used for 479 (23.0%) ACLRs. Median follow-up time was 3.4 years (interquartile range, 1.8-5.1 years). The crude 2-year aseptic revision probability was 5.4% (95% CI, 4.3%-6.7%) for soft tissue allograft ACLR and 3.8% (95% CI, 2.3%-6.4%) for hybrid graft ACLR. After adjustment for covariates, soft tissue allograft ACLR had a higher risk of aseptic revision during follow-up compared with hybrid graft ACLR (hazard ratio, 2.00; 95% CI, 1.21-3.31; P = .007). Conclusion: Soft tissue allografts had a 2-fold higher risk of aseptic revision compared with hybrid graft after ACLR. Future studies evaluating the indications for using hybrid grafts and the optimal hybrid graft diameter is needed.

scholarly journals A Tomahawk Shaped Femur is a Risk Factor for Anterior Cruciate Ligament Injury

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0001
Author(s):  
Thomas Pfeiffer ◽  
Jeremy Burnham ◽  
Elmar Herbst ◽  
Sven Shafizadeh ◽  
Volker Musahl
Keyword(s):  
Acl Reconstruction ◽  
Roc Analysis ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Control Group ◽  
Acl Injuries ◽  
Injury Group ◽  
Increased Risk ◽  
The Mean ◽  
Anterior Cruciate

Bony morphologic characteristics have been demonstrated to increase the risk of anterior cruciate ligament (ACL) injury. The purpose of the study was to examine distal femoral morphology relative to ACL injury, reconstruction failure, and contralateral ACL injury. It was hypothesized that an increased posterior femoral condylar depth, quantified as the tomahawk ratio, would correlate with increased risk of primary ACL ruptures, ACL reconstruction failures, and contralateral ACL injuries. Consecutive patients undergoing arthroscopic knee surgery at an academic medical center from 2012-2016 with minimum 24-month follow-up were retrospectively reviewed. Subjects were stratified into four groups: a control group consisting of patients with no ACL injuries and three groups of patients with a primary ACL injury, failed ACL reconstruction, or previous ACL injury with subsequent contralateral ACL injury. Using lateral radiographs, the ratio of posterior condylar depth over total condylar distance was defined as the tomahawk ratio. Analysis-of-variance (ANOVA) and post-hoc testing were used to test for differences in the mean tomahawk ratio between study groups (p<0.05). Receiver Operating Characteristic (ROC) analysis was performed to determine the optimal tomahawk ratio cut-off for detecting increased risk for ACL injury 175 patients met inclusion criteria. The mean tomahawk ratios in the control group, primary ACL injury group, failed ACL reconstruction group, and contralateral ACL injury group were 61.1% (± 2.1), 64.2% (± 3.8), 64.4% (± 3.6), and 66.9% (± 4.0), respectively. Patients with a primary ACL injury, failed ACL reconstruction, or contralateral ACL injury had a significantly higher tomahawk ratio compared to the control group (p<0.008). ROC analysis demonstrated a tomahawk ratio of 63% or greater to be associated with an increased risk for ACL injury with a sensitivity of 83% and a specificity of 71%. The data from this study show that an increased posterior femoral condylar depth, or tomahawk ratio, is associated with increased risk of ACL injury, including primary ACL injury, failed ACL reconstruction, and contralateral ACL injury. Readily identifiable risk factors, such as an increased tomahawk ratio, could assist clinicians in identifying at-risk individuals who may experience greater benefit from targeted ACL injury prevention counseling and intervention. The presence of the tomahawk-shaped femur could also be used to guide treatment decisions and identify ACL reconstruction patients who may benefit from additional surgical procedures such as extra articular tenodesis.

scholarly journals Five-Strand Hamstring Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982609 ◽  
Author(s):  
John-Rudolph H. Smith ◽  
Darby A. Houck ◽  
Jessica A. Hart ◽  
Armando F. Vidal ◽  
Rachel M. Frank ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Cruciate Ligament Reconstruction ◽  
The Mean ◽  
Anterior Cruciate ◽  
Graft Diameter

Background: Recent studies have described surgical techniques to increase the hamstring graft diameter for anterior cruciate ligament reconstruction (ACLR), particularly for 5-strand hamstring (5HS) autografts. Purpose: To review the literature examining the biomechanical and clinical outcomes of 5HS autografts for ACLR. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines was performed by searching PubMed, Embase, and the Cochrane Library for studies reporting the biomechanical and clinical outcomes of 5HS autografts. All English-language literature published from 2012 to 2018 that reported the biomechanical properties of 5HS grafts and/or clinical outcomes after ACLR with 5HS autografts with a minimum 1-year follow-up was reviewed by 2 independent reviewers. Graft diameter, stiffness, displacement, strength, failure rates, anteroposterior knee laxity, and patient-reported outcome scores were collected. The study methodology was evaluated using the modified Coleman Methodology Score. Results: Two biomechanical and 3 clinical studies (1 with level 2 evidence, 2 with level 3 evidence) were included. The biomechanical studies compared the results of fourteen 4-strand hamstring (4HS) and fourteen 5HS graft specimens for ACLR (ovine grafts, n = 12; cadaveric grafts, n = 16) and found no significant differences in ultimate load, stiffness, displacement, and stress relaxation ( P > .05), likely attributed to insufficient incorporation of the fifth strand. The mean 5HS cadaveric graft diameter (8.2 mm) was significantly greater than that of 4HS grafts (6.8 mm) ( P = .002), whereas the mean ovine graft diameters were not significantly different (4HS, 5.2 mm; 5HS, 5.3 mm) ( P > .05). Two clinical studies compared the outcomes after ACLR of 53 patients with a 4HS autograft versus 62 patients with a 5HS autograft, while 1 clinical study reported the outcomes of 25 patients after ACLR with a 5HS autograft (mean age, 28.7 years; mean follow-up, 24.8 months). The overall mean diameter for 4HS and 5HS autografts was 8.4 and 9.1 mm, respectively. There was no significant difference in failure rates between 4HS and 5HS autografts ( P = .82). None of the comparative studies reported significant differences in any clinical outcomes ( P > .05 for all). Conclusion: The available literature on traditional 4HS and 5HS autografts for ACLR is limited. Of the available data, clinical and biomechanical studies suggest no difference in outcomes after ACLR with either graft construct. Additional research is needed to determine whether creating a 5HS graft is beneficial.

scholarly journals Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110566
Author(s):  
Masaki Nagashima ◽  
Kenichiro Takeshima ◽  
Nobuto Origuchi ◽  
Ryo Sasaki ◽  
Yoshifumi Okada ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Control Group ◽  
Level Of Evidence ◽  
Surgical Field ◽  
The Mean ◽  
Anterior Cruciate ◽  
Without Tourniquet

Background: Deep venous thrombosis (DVT) and pulmonary embolism are serious potential complications after anterior cruciate ligament reconstruction (ACLR). Little is known about the influence of tourniquet use on the incidence of DVT after ACLR. Purpose: To compare the incidence of DVT after ACLR with and without the use of a tourniquet. Study Design: Cohort study; Level of evidence, 3. Methods: Between November 2018 and May 2020, a total of 60 consecutive ACLRs in 60 patients, including 7 revision surgeries, were performed without tourniquet use at our hospital and were enrolled in this study (T– group). In addition, 55 consecutive ACLRs in 55 patients, including 10 revision surgeries, were performed with tourniquet use between April 2017 and September 2018 and were enrolled as the control group (T+ group). DVT was diagnosed using ultrasonography of both legs performed preoperatively and at postoperative week 1. The incidence of postoperative DVT was compared between the T– and T+ groups. Logistic regression analysis was performed to evaluate the effect of older age (≥40 vs <40 years) and tourniquet use on the occurrence of DVT. Results: No DVTs were detected preoperatively. The incidence of postoperative DVT was significantly lower in the T– group compared with the T+ group (1 patient [1.7%] vs 9 patients [16.4%]; P = .005). All patients with DVT were asymptomatic. Although the mean operative time was not significantly different (80.8 minutes in the T+ group vs 78.5 minutes in the T– group; P = .461), the mean blood loss from the drain was significantly lower in the T– group than in the T+ group (149.9 vs 201.9 mL; P < .001). Age ≥40 years and tourniquet use were significantly related to the occurrence of DVT (odds ratio, 8.3 [95% CI, 1.9-36.8]; P = .005; and odds ratio, 8.8 [95% CI, 1.0-75.3]; P = .047, respectively). Conclusion: ACLRs performed without tourniquet resulted in a significantly lower incidence of DVT after ACLR and significantly less bleeding from drains. If adequate visibility of the surgical field is obtained, ACLR without tourniquet use may reduce the incidence of DVT.

Does Allograft Augmentation of Small-Diameter Hamstring Autograft ACL Grafts Reduce the Incidence of Graft Retear?

2016 ◽  
Vol 45 (2) ◽  
pp. 334-338 ◽  
Author(s):  
Andrew T. Pennock ◽  
Brian Ho ◽  
Kristina Parvanta ◽  
Eric W. Edmonds ◽  
Henry G. Chambers ◽  
...  
Keyword(s):  
Graft Failure ◽  
Cruciate Ligament ◽  
Small Diameter ◽  
Hamstring Tendon ◽  
Failure Rates ◽  
Graft Size ◽  
Level Of Evidence ◽  
Tissue Allograft ◽  
The Mean

Background: Small-diameter hamstring tendons are frequently encountered during anterior cruciate ligament (ACL) reconstructions in patients with short stature or those who are skeletally immature. The role of augmenting these small-diameter autografts with allograft is unclear. Purpose: To assess clinical outcomes and failure rates in adolescent patients with small hamstring tendon autografts (<7 mm) that were either augmented with soft tissue allograft or accepted “as is” and not augmented. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review of all primary ACL reconstructions performed with hamstring autografts identified 385 patients, of whom 50 (13%) had a quadrupled (semitendinosus-gracilis) graft size less than 7 mm. Patients were grouped based on the surgeon’s preference either to augment these grafts with allograft (augmented group; n = 26) or to accept the smaller autograft (nonaugmented group; n = 24). Preoperative demographic, injury, and intraoperative data were documented. All patients were contacted to obtain information about outcome scores, subsequent procedures, and complications. Forty patients (20 in each group) were available for 2-year follow-up. Results: The mean age of the entire cohort was 15.7 years (range, 12-18 years), and 38% were male. No between-group differences were found with respect to any of the preoperative or intraoperative variables except extremity side. The mean graft size for the augmented group was 8.9 mm and for the nonaugmented group was 6.4 mm. At a mean follow-up of 3 years, 6 (30%) of the patients in the augmented group had a graft failure, whereas only 1 (5%) in the nonaugmented group had a failure ( P = .04). Five of the 6 augmented failures occurred within 1 year of surgery, whereas the single failure in the nonaugmented group occurred 2.7years postoperatively. No differences were noted in the reported outcomes between patients in the augmented and nonaugmented groups who did not experience graft failure (Lysholm score, 88 vs 92; Tegner score, 6.4 vs 6.3; single-assessment numeric evaluation score, 86 vs 86; satisfaction, 8.4 vs 8.9, respectively). Conclusion: Adolescents undergoing an ACL reconstruction frequently have small hamstring tendon autograft size. The augmentation of these small grafts with allograft does not reduce graft failure rates and may in fact lead to higher retear rates, with earlier graft failure.

Outcomes More Than 2 Years After Meniscal Repair for Longitudinal Tears of the Lateral Meniscus Combined With Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652098197
Author(s):  
Akira Tsujii ◽  
Yasukazu Yonetani ◽  
Kazutaka Kinugasa ◽  
Tomohiko Matsuo ◽  
Kenji Yoneda ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Complete Healing ◽  
Control Group ◽  
Study Group ◽  
Meniscal Extrusion ◽  
Second Look ◽  
Anterior Cruciate

Background: Meniscal function after repair of longitudinal tears of the lateral meniscus (LM) with anterior cruciate ligament reconstruction (ACLR) has not been comprehensively investigated. Purpose: To evaluate not only the clinical outcomes and radiographic findings of patients who underwent repair of longitudinal tears of the LM combined with ACLR but also the healing status of the repaired meniscus and changes in chondral status with second-look arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Among 548 patients who underwent primary anatomic ACLR at our institution between 2010 and 2017, 39 who had concomitant longitudinal tears of the LM and underwent repair were studied. During follow-up for more than 2 years, all patients were evaluated clinically (pain, range of motion, swelling, and knee instability) and with imaging (plain radiograph and magnetic resonance imaging [MRI]), and compared with a matched control group (based on age, sex, body mass index, and follow-up period) without any concomitant injuries who underwent ACLR. Measurements on MRI were recorded preoperatively, immediately after surgery, and at final follow-up, and the change in the values over time was assessed. Of the 39 patients in each group, 24 were assessed by second-look arthroscopy with hardware removal 2 years postoperatively. Results: The mean follow-up times of the study and control group were at a mean of 42.4 and 45.4 months, respectively. There were no significant differences in clinical findings, lateral joint space narrowing on radiographs, and chondral status at the lateral compartment between groups, whereas lateral and posterior meniscal extrusion on MRI progressed significantly in the study group (0.43 ± 1.0 mm vs -0.29 ± 1.1 mm, P = .003; 1.9 ± 1.9 mm vs 0.14 ± 1.1 mm, P < .0001, respectively). Second-look arthroscopy revealed complete healing in 12 patients (50%), partial healing in 9 (37.5%), and failure in 3 (12.5%) in the study group, and no new tear in the control group. Conclusion: The clinical and imaging outcomes after repair of longitudinal tears of the LM combined with anatomic ACLR were successful and comparable with those after isolated ACLR without any other injuries at 42 months postoperatively, although meniscal extrusion showed progression on coronal/sagittal MRI. Based on the MRI findings and the result that only half of patients achieved complete healing, meniscal function could not be fully restored even after repair. Although degenerative changes were not apparent, longer-term follow-up is needed.

scholarly journals Preliminary Results in Anatomic All-inside Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 1 (s2) ◽  
pp. 23-26
Author(s):  
Octav Russu ◽  
Tiberiu Bățagă ◽  
Andrei-Marian Feier ◽  
Radu Prejbeanu ◽  
Radu Fleaca ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Clinical Results ◽  
Lysholm Score ◽  
X Rays ◽  
The Mean ◽  
Anterior Cruciate

Abstract Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common lesions in knee traumatology; therefore the number of ACL reconstructions is increasing worldwide. Usually, an anteromedial (AM) accessory portal is required in anatomical positioning of the femoral tunnel, which is not absolutely necessary in this technique. Aim: Assessment of all-inside ACL reconstruction preliminary clinical results with adjustable loops and buttons on both femoral and tibial surfaces. Method: Our prospective study included 28 subjects (19 male, 9 female) with chronic ACL ruptures. The mean age of the study population was 27.72 ± 8.23 years. In all cases ACL reconstruction was carried out with the use of quadrupled semitendinosus auto-grafts with adjustable loops and buttons on the femoral and tibial surfaces and anatomic placement of both tunnels, using an outside-in technique, with flipcutters (Arthrex®). Clinical and radiological evaluations were carried out before surgery and at 3 and 6 months postoperatively, with the Lysholm scoring system, the Tegner activity scale and anterior-posterior and latero-lateral X-rays. Anterior knee laxity was measured in 25° of flexion using a portable arthrometer (RolimeterTM, Aircast®) and maximum manual force. Results: During the final follow-up, the Lysholm score was good and excellent in 27 cases, with a mean Lysholm score of 95.55 ± 4.63; all results were classified as good. The mean preoperative Tegner activity score was 3.46 ± 1.71 (range: 1-7), and the post-operative mean score was 5.75 ± 2.24 (range: 2-10). We found no graft ruptures. Preoperative knee laxity measurements showed a mean displacement of 11.5 ± 3.1 mm and side-to-side differences of 5.6 ± 3.5 mm, while the postoperative measurements at the last follow-up were 6.3 ± 1.54 mm and 2.65 ± 1.86 mm, respectively. Conclusion: Short-term clinical outcomes of all-inside ACL restoration with anatomic placement femoral and tibial tunnels seem to recommend this surgical option, with good subjective and objective results. Additional research will have to prove the long-term success.

scholarly journals Injury Risk Associated With Sports Specialization and Activity Volume in Youth

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987012 ◽  
Author(s):  
Alison E. Field ◽  
Frances A. Tepolt ◽  
Daniel S. Yang ◽  
Mininder S. Kocher
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
The United States ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Risk Of Injury ◽  
Increased Risk ◽  
Anterior Cruciate

Background: Sports specialization has become increasingly common among youth. Purpose/Hypothesis: To investigate the relative importance of specialization vs volume of activity in increasing risk of injury. Hypotheses were that specialization increases the risk of injury and that risk varies by sport. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective analysis was conducted with data collected from 10,138 youth in the Growing Up Today Study—a prospective cohort study of youth throughout the United States—and their mothers. Activity was assessed via questionnaires in 1997, 1998, 1999, and 2001. Sports specialization was defined as engaging in a single sport in the fall, winter, and spring. Injury history was provided by participants’ mothers via questionnaire in 2004. The outcome was incident stress fracture, tendinitis, chondromalacia patella, anterior cruciate ligament tear, or osteochondritis dissecans or osteochondral defect. Results: Females who engaged in sports specialization were at increased risk of injury (hazard ratio [HR], 1.31; 95% CI, 1.07-1.61), but risk varied by sport. Sports specialization was associated with greater volume of physical activity in both sexes ( P < .0001). Total hours per week of vigorous activity was predictive of developing injury, regardless of what other variables were included in the statistical model (males: HR, 1.04; 95% CI, 1.02-1.06; females: HR, 1.06; 95% CI, 1.05-1.08). Among females, even those engaging in 3 to 3.9 hours per week less than their age were at a significantly increased risk of injury (HR, 1.93; 95% CI, 1.34-2.77). In males, there was no clear pattern of risk. Conclusion: Sports specialization is associated with a greater volume of vigorous sports activity and increased risk of injury. Parents, coaches, and medical providers need to be made aware of the volume threshold above which physical activity is excessive.

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