scholarly journals Long term results after ACL-reconstruction in childhood and adolescence

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0029
Author(s):  
Alexander Zimmerer ◽  
Andree Ellermann
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Activity Score ◽  
Long Term Results ◽  
Childhood And Adolescence ◽  
Severe Injuries ◽  
Children And Adolescent

Aims and Objectives: Ruptures of the anterior cruciate ligament in childhood and adolescence are severe injuries with increasing incidence over the last years. It is known today that the course of an unstable knee joint during growth can lead to poor subjective and objective results. The aim of the study is to record long-term results after transepiphyseal ACL reconstruction using autologous hamstring tendons and extracortical fixation in children and adolescents at least 15 years after surgery. Materials and Methods: We retrospectively evaluated patient who underwent ACL reconstruction in our clinic with arthroscopic transepiphyseal technique using hamstrings graft in childhood or adolescence with a follow-up of at least 15 years. In these patients, the Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Score (TAS), and Lysholm Score were collected, and clinical and MRI examinations were performed. Results: A total of 32 patients were identified, 5 of whom refused to participate. The average age at the time of surgery was 12 years, the average follow-up time was 17 years. In 3 patients a traumatic re-rupture was observed. None of the included patients showed a growth disorder at follow-up. The following subscores were found for the KOOS: KOOSpain 89, KOOSSymptom 82, KOOSADL 92, KOOSSport 75, KOOSQOL 82. The Tegner Activity score was 5.8, the Lysholm score 86 points. 13 of the 27 patients could also be examined clinically and by magnetic resonance imaging. In the MRI images, 95% of the patients showed intact grafts without evidence of cartilage or meniscus damage. The average lateral difference in the KT-1000 measurement was 1.5 mm. Conclusion: Transepiphyseal ACL reconstruction in children and adolescent with hamstrings is a save procedure leading to good long-term results. Secondary arthrosis signs can only be detected sporadically in MRI

17-Year Results following Transepiphyseal Anterior Cruciate Ligament Reconstruction in Children and Adolescents

2021 ◽  
Author(s):  
Alexander Zimmerer ◽  
Marco M. Schneider ◽  
Carina Semann ◽  
Wolfgang Schopf ◽  
Christian Sobau ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Long Term Results ◽  
Childhood And Adolescence ◽  
The Mean ◽  
Anterior Cruciate

Abstract Objective Rupture of the anterior cruciate ligament (ACL) in childhood and adolescence is a serious injury. It is now known that conservative therapy of an unstable knee joint in childhood or adolescence under can lead to poor subjective and objective results. The aim of this study is to record long-term results after transepiphyseal ACL reconstruction using autologous hamstring tendons and extracortical fixation in childhood and adolescence with open physes – at least 15 years after surgery. Methods Our internal registry was used to identify all patients who received surgical treatment of an acl tear during childhood and adolescence by transepiphyseal acl reconstruction more than 15 years previously. In these patients, the International Knee Documentation Committee for Subjective Knee Form (IKDCsubj.), Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Score (TAS) and Lysholm Score were collected, and clinical and magnetic resonance imaging (MRI) examinations were performed. Results A total of 22 patients were identified, 5 of whom could not be contacted. The mean age at the time of surgery was 13.1 years, and the mean follow-up time was 17.4 years. In 3 patients, a traumatic tear was observed with subsequent reconstruction of the ACL. None of the included patients showed a growth disorder during the course of the study. The IKDCsubj. was 92.4 ± 14.7 (48 – 100), the Lysholm score was 87.9 ± 16.9 (34 – 100), the TAS was 5.7 ± 2.3 (3 – 9) and the pain level based on VAS was 3.5 ± 2.6 (1 – 8) points. The values showed subjective and objective deterioration compared to the 10-year results, with no statistical significance. The following subscores were reported for the KOOS: KOOSpain 90.9 ± 17.6 (28 – 100); KOOSsymptom 82.9 ± 22.6 (11 – 100); KOOOSADL 94.3 ± 13.7 (44 – 100); KOOSSport 80.3 ± 26.4 (15 – 100); KOOSQOL 80.9 ± 25.8 (0 – 100). 13 of the 17 patients could also be clinically and radiologically examined. In 92% of patients, an intact acl reconstruction was found without evidence of cartilage or meniscus damage. The mean lateral difference in the KT-1000 measurement was 1.5 mm. Conclusion ACL reconstruction in childhood and adolescence provides good functionality and stability of the knee joint over the long term. Secondary signs of osteoarthritis can only be detected in isolated cases by MRI. ACL reconstruction using the transepiphyseal technique can be considered the method of choice for open growth plate knee joints.

scholarly journals Long term results after transepiphysal ACL reconstruction in children and adolescent

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0001
Author(s):  
Christian Eberle ◽  
Wolfgang Schopf ◽  
Andree Ellermann
Keyword(s):  
Acl Reconstruction ◽  
Cartilage Damage ◽  
Long Term Results ◽  
Angular Deformity ◽  
Leg Length ◽  
Growth Disturbance ◽  
Children And Adolescent ◽  
The Mean

The aim of our study was to review the long term clinical and radiological (MRI) outcomes of adult patients who underwent ACL reconstruction as children or adolescent with emphasize to the features of growth disturbance, angular deformity, meniscal and cartilage damage and revision rate We retrospectively evaluated patient who underwent ACL reconstruction in our clinic with arthroscopic transepiphyseal technique using hamstrings graft in childhood or adolescence between the years 1997 and 2009. A total of 43 Patients were assessed. 25 male and 18 female. The average age at time of surgery was 13,5 years (8 - 16 y.), at time of assessement 22,4 years (18 - 30 y.) . The mean follow up was 10 years (4 - 16 years). The physical development of the patients was assessed with the Lysholm score and the Cincinnati Knee score scale, their satisfaction was recorded on the basis of the IKDC subjective knee evaluation form and the Tegner activity score . Leg deformity or leg length discrepancy was evaluated clinically by the observers. The instrumented Lachman test using KT1000 and manual Pivot shift test was performed to assess knee stability. MRI was used to detect graft integrity, cartilage and meniscal damages. No significant leg deformities or leg length discrepancy had been detected. The average Lysholm score was 91 points (83 - 100), the Cincinnati Knee Score was 90,4 (79 - 100) points on average . The mean IKDC score was 92 points (82 -100). The Tegner-Activity-Score changed from preop 6,8 (2-10) to post op 5,8 (2-9). 2 Patient underwent revision ACL reconstruction due to rerupture (3 and 9 years post op). 2 Patients underwent meniscal surgery during follow up (1 resection and one refixation). KT1000 evaluation showed 67% excellent, 21% good and in 12% bad results. The MRI scan showed 42 intact grafts and one unverifiable graft. One patient with cartilage damage up to 3° (ICRS), 3 patients with meniscal degeneration up to grade 2. Each patient showed a free range of motion Our data underlines that transepiphyseal ACL reconstruction in children and adolescent with hamstrings is a save procedure leading to good long term results without causing angular deformity or growth disturbance

Long-Term Results of ACL Reconstruction Using a Nonanatomic Double-Bundle Technique with Extra-Articular Reinforcement

2019 ◽  
Author(s):  
J. Dalla-Rosa ◽  
A. Espejo-Reina ◽  
I. Tamimi ◽  
M. J. Espejo-Reina ◽  
M. Lombardo-Torre ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Degenerative Changes ◽  
Long Term Results ◽  
Rotational Stability ◽  
X Rays ◽  
Double Bundle Technique

AbstractExtra-articular procedures for the improvement in rotational stability after anterior cruciate ligament (ACL) reconstruction have gained popularity in the last decade. This surgical gesture hoped to improve resistance to the high tensional forces affecting the ACL graft during cutting and pivoting movements of the lower extremity and eventually prevent ACL reconstruction failure. We performed this study to analyze the long-term results of patients undergoing ACL reconstruction using a nonanatomic double-bundle technique with an additional extra-articular augmentation. All the cases that underwent an ACL reconstruction using a nonanatomic double-bundle technique with an extra-articular reinforcement during the period between 1992 and 1997 were reviewed. The inclusion criteria for this study included a minimum follow-up of 10 years and age between 14 and 45 years at the time of the surgery. Forty patients were included in this series (34 males and 6 females). The mean Lysholm score after a minimum follow-up period of 10 years was 92.3 (standard deviation [SD], 9.4). The average preoperative Tegner score of the participants was 7.0 (SD, 1.1). This score decreased to 5.7 (SD, 1.2) at the end of follow-up. Follow-up X-rays were reviewed to assess the degenerative changes in the three knee compartments. Degenerative changes ≥ Kellgren–Lawrence grade 2 were observed in our six (15%) patients, all of them in the medial knee compartment. With these results, we conclude that double-bundle nonanatomic ACL reconstruction combined with an extra-articular reinforcement resembling the anterolateral ligament offers good overall long-term results, with relatively low rates of osteoarthritis.

Increased Postoperative Manual Knee Laxity at 2 Years Results in Inferior Long-term Subjective Outcome After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 46 (11) ◽  
pp. 2632-2645 ◽  
Author(s):  
David Sundemo ◽  
Ninni Sernert ◽  
Jüri Kartus ◽  
Eric Hamrin Senorski ◽  
Eleonor Svantesson ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Lysholm Score ◽  
Pivot Shift Test ◽  
Subjective Outcome ◽  
Kt 1000 ◽  
Ikdc Score

Background: Increased postoperative rotatory knee laxity after anterior cruciate ligament (ACL) reconstruction may be associated with an increased risk of osteoarthritis and inferior subjective outcome, although long-term studies are lacking. In terms of anteroposterior knee laxity, this association has not yet been established. Purpose/Hypothesis: The purpose was to investigate whether postoperative knee laxity is associated with inferior long-term outcome in patients who have undergone ACL reconstruction. The hypothesis was that increased laxity would cause an inferior long-term clinical and radiographic outcome. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 193 patients underwent ACL reconstruction and were examined at both 2 and 16 years postoperatively. At the 2-year follow-up, knee laxity was tested by use of the Lachman test, the anterior drawer test, the pivot-shift test, and the KT-1000 arthrometer. Outcome variables examined at the 16-year follow-up involved a radiographic assessment of osteoarthritis, patient-reported outcome measurements, and the single-legged hop test. Results: At the long-term follow-up, 147 (76%) patients were examined. The mean follow-up period for the included patients was 16.4 ± 1.2 years. A negative Lachman test at 2 years resulted in a superior International Knee Documentation Committee (IKDC) score (76.3 ± 19.4 vs 67.8 ± 19.3, P < .05) and Lysholm score (85.2 ± 11.9 vs 76.9 ± 17.8, P < .05) at the 16-year follow-up. Correspondingly, a negative anterior drawer test at 2 years was associated with a superior IKDC score (75.3 ± 18.7 vs 62.9 ± 20.2, P < .05) and Lysholm score (84.1 ± 12.1 vs 72.6 ± 20.2, P < .05) at 16 years. A negative pivot-shift test resulted in a superior IKDC score (74.5 ± 18.8 vs 46.9 ± 17.8, P < .05), a superior Lysholm score (83.3 ± 13.4 vs 58.9 ± 23.0, P < .05), and an increased level of activity (Tegner activity scale, median [range]: 4 [1-10] vs 3 [0-5], P < .05). Osteoarthritis was overrepresented in patients with positive manual knee laxity tests, but the difference was not statistically significant. The KT-1000 arthrometer result was not correlated with any outcome variables assessed in this study. Conclusion: Increased manual anteroposterior and rotatory knee laxity 2 years after ACL reconstruction is associated with an inferior long-term subjective outcome.

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 Poor Associations Between Radiographic Tibiofemoral Osteoarthritis and Patient-Reported Outcomes at 16 Years After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095117
Author(s):  
Fredrik Identeg ◽  
Eric Hamrin Senorski ◽  
Eleonor Svantesson ◽  
Kristian Samuelsson ◽  
Ninni Sernert ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Grade 3

Background: Radiographic tibiofemoral (TF) osteoarthritis (OA) is common in patients after anterior cruciate ligament (ACL) reconstruction at long-term follow-up. The association between radiographic OA and patient-reported outcomes has not been thoroughly investigated. Purpose: To determine the association between radiographic TF OA and patient-reported outcome measure (PROM) scores at 16 years after ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: This study was based on 2 randomized controlled studies comprising 193 patients who underwent unilateral ACL reconstruction. A long-term follow-up was carried out at 16.4 ± 1.7 years after surgery and included a radiographic examination of the knee and recording of PROM scores. Correlation analyses were performed between radiographic OA (Kellgren-Lawrence [K-L], Ahlbäck, and cumulative Fairbank grades) and the PROMs of the International Knee Documentation Committee (IKDC) subjective knee form, Lysholm score, and Tegner activity scale. A linear univariable regression model was used to assess how the IKDC score differed with each grade of radiographic OA. Results: Of 193 patients at baseline, 147 attended the long-term follow-up. At long-term follow-up, 44.2% of the patients had a K-L grade of ≥2 in the injured leg, compared with 6.8% in the uninjured leg. The mean IKDC score at follow-up was 71.2 ± 19.9. Higher grades of radiographic OA were significantly correlated with lower IKDC and Lysholm scores ( r = –0.36 to –0.22). Patients with a K-L grade of 3 to 4 had significantly lower IKDC scores compared with patients without radiographic OA (K-L grade 0-1). Adjusted beta values were –15.7 (95% CI, –27.5 to –4.0; P = .0093; R 2 = 0.09) for K-L grade 3 and –25.2 (95% CI, –41.7 to –8.6; P = .0033; R 2 = 0.09) for K-L grade 4. Conclusion: There was a poor but significant correlation between radiographic TF OA and more knee-related limitations, as measured by the IKDC form and the Lysholm score. Patients with high grades of radiographic TF OA (K-L grade 3-4) had a statistically significant decrease in IKDC scores compared with patients without radiographic TF OA at 16 years after ACL reconstruction. No associations were found between radiographic TF OA and the Tegner activity level.

scholarly journals Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation

2017 ◽  
Vol 5 (2) ◽  
pp. 232596711769359 ◽  
Author(s):  
Andrew N. Pike ◽  
Tim Bryant ◽  
Takahiro Ogura ◽  
Tom Minas
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Autologous Chondrocyte Implantation ◽  
Cruciate Ligament ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
Anterior Cruciate ◽  
Autologous Chondrocyte

Background: Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects. Hypothesis: ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures. Results: Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with primary reconstructions. Conclusion: Challenging cases of ACL tears with large chondral defects treated with concurrent ACL reconstruction and ACI can lead to moderately improved pain and function at long-term follow-up. Factors associated with clinical failure are not clear. When combined with ACI, patients undergoing revision ACL reconstructions have worse function preoperatively compared with those undergoing primary reconstructions but have similar final outcomes.

scholarly journals Arthroscopic Transphyseal Anterior Cruciate Ligament Reconstruction in Adolescent Athletes

2016 ◽  
Vol 24 (3) ◽  
pp. 307-311 ◽  
Author(s):  
Luca Dei Giudici ◽  
Roberto Fabbrini ◽  
Luca Garro ◽  
Serena Arima ◽  
Antonio Gigante ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Leg Length ◽  
Adolescent Athletes ◽  
Ikdc Score ◽  
The Mean ◽  
Anterior Cruciate ◽  
Tegner Activity Scale

Purpose To evaluate the 5-year outcome of arthroscopic transphyseal anterior cruciate ligament (ACL) reconstruction in 19 adolescent athletes. Methods 14 male and 5 female adolescent athletes aged 12 to 16 (mean, 13.9) years with Tanner stage 2 or 3 open physes underwent arthroscopic transphyseal ACL reconstruction by a single surgeon and were followed up for 5 years. Patients were evaluated using the numerical rating score (NRS) for pain, knee osteoarthritis outcome score (KOOS), International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, and Lysholm Score, as well as the leg length discrepancy, femorotibial alignment, varus or valgus deformities, active and passive knee range of motion. Results At 5-year follow-up, physes were closed in all patients. The mean NRS for pain improved from 7.2 to 1.6; the KOOS improved from 55.3 to 88; the mean IKDC score improved from 34.5 to 84; the mean Tegner Activity Scale improved from 2.7 to 8.2 and was comparable with that before injury (8.4); and the mean Lysholm score improved from 36.3 to 84.6. All except 2 patients returned to their pre-injury level of sports activity after a mean of 25 weeks. The 2 exceptions had a 2+ Jerk test and a 3+ Lachman test; one of them also had positive signs for a lateral meniscal lesion. Both had sustained a second trauma not long before the 5-year follow-up. Two patients had reduced sensitivity in the anteromedial aspect of the proximal third of the tibia. One patient had leg length discrepancy of +1.5 cm owing to overgrowth response of the physis. Conclusion Transphyseal ACL reconstruction is a viable option for skeletally immature patients, with high reproducibility, a high rate of return to sport, and a low incidence of growth disturbance. Early surgery can prevent the onset of meniscal lesions and early osteoarthritis.

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