scholarly journals Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kathleen Andrä ◽  
Robert Prill ◽  
Enes Kayaalp ◽  
Lars Irlenbusch ◽  
Eckehard Liesaus ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Frontal Plane ◽  
Cartilage Degeneration ◽  
Lateral View ◽  
Tunnel Placement ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Roof Angle

Abstract Purpose Degeneration of the cartilage after anterior cruciate ligament reconstruction (ACL-R) is known, and further deterioration can be expected in patients with tunnel malplacement or partial meniscal resection. It was hypothesized that there is a significant increase in cartilage degeneration after failed ACL-R. Material and methods Isolated ACL revision surgery was performed in 154 patients at an interval of 46 ± 33 months (5–175 months) between primary and revision surgery. Cartilage status at the medial, lateral femorotibial, and patellofemoral compartments were assessed arthroscopically during primary and revision ACL-R in accordance with the Outerbridge classification. Tunnel placement, roof angle, and tibial slope was measured using anteroposterior and lateral radiographic views. Results Cartilage degeneration increased significantly in the medial femorotibial compartment, followed by the lateral and patellofemoral compartments. There was a correlation between both cartilage degeneration in the patellofemoral compartment (PFC) (rs = 0.28, p = 0.0012) and medial tibial plateau (Rs = 0.24, p = 0.003) in relation to the position of tibial tunnel in the frontal plane. Worsening of the cartilage status in the medial femorotibial compartment, either femoral or tibial, was correlated with the tibial aperture site in the lateral view (Rs = 0.28, p < 0.001). Cartilage degeneration in the lateral compartment of the knee, on both femoral or tibial side, was inversely correlated with the femoral roof angle (Rs = −0.1985, p = 0.02). Meniscal tears, either at the medial or lateral site or at both, were found in 93 patients (60%) during primary ACL-R and increased to 132 patients (86%) during revision ACL-R. Discussion Accelerated cartilage degeneration and high prevalence of meniscal lesions are seen in failed ACL-R. Tunnel placement showed significant impact on cartilage degeneration and may partially explain the increased risk of an inferior outcome when revision surgery is required after failed primary ACL-R. Level of evidence: Level IV—retrospective cohort study.

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.

Revision Single-Stage Anterior Cruciate Ligament Reconstruction Using an Anterolateral Tibial Tunnel

2019 ◽  
Vol 33 (04) ◽  
pp. 410-416
Author(s):  
Sohrab Keyhani ◽  
Behzad Hanafizadeh ◽  
René Verdonk ◽  
Mohammadreza Minator Sajjadi ◽  
Mehran Soleymanha
Keyword(s):  
Revision Surgery ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Clinical Results ◽  
Activity Level ◽  
Acl Revision ◽  
Anterior Cruciate ◽  
Level Scale ◽  
Tegner Activity Level ◽  
Acl Revision Surgery

AbstractRevision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24–51 months). The clinical results were evaluated by means of the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity level scale, and the knee stability was assessed by the Lachman test, pivot shift test, and anterior drawer test. Magnetic resonance imaging (MRI) of the index knee before the surgery and 2 years after revision surgery was assessed. The mean IKDC subjective score, mean Tegner activity level scale, and mean Lysholm score significantly improved in all study participants. This study showed that ACL revision surgery with ALTT can reliably restore stability and provide fair functional outcomes in patients with ACL retear. One could expect acceptable lateral tibial tunnel length compared with medial tibial tunnel in classic ACL revision, intact bony surround, and good graft fixation. This technique is clinically relevant in that making an anterolateral tunnel in one-stage ACL revision surgery had a good subjective result with low complication rate in midterm follow-up.

scholarly journals TECHNICAL VARIATION IN AFFIXING HAMSTRING GRAFTS TO THE TIBIA IN ACL RECONSTRUCTION

2018 ◽  
Vol 26 (2) ◽  
pp. 94-97
Author(s):  
MARCUS VINICIUS DANIELI ◽  
JOÃO PAULO FERNANDES GUERREIRO ◽  
ALEXANDRE OLIVEIRA QUEIROZ ◽  
CARLOS ROBERTO PADOVANI
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Case Series ◽  
International Knee Documentation Committee ◽  
Interference Screw ◽  
Anatomic Reconstruction ◽  
Anatomic Acl Reconstruction ◽  
Level Of Evidence ◽  
Hamstring Grafts

ABSTRACT Purpose: To present a technical variation in tibial fixation of quadruple hamstring grafts during anatomic reconstruction of the anterior cruciate ligament (ACL). The secondary purpose was to decrease the costs associated with this procedure. Methods: Twenty patients who underwent ACL reconstruction were selected. A tibial tunnel was constructed using standard techniques, and a femoral tunnel was anatomically created using the outside-in technique. The hamstring autograft was passed (with its bend) into the tibial tunnel and affixed to the tibia using the suspensory technique and a simple staple. Femoral fixation was performed using a titanium interference screw. The patients underwent postoperative evaluations at 0, 3, 6 and 12 months using the subjective International Knee Documentation Committee (IKDC) form and Lysholm knee scores. Results: The IKDC and Lysholm score results improved over time (p<0.001) without major complications. The cost of the procedure could be reduced by using lower-cost hardware (staples). Conclusion: The proposed technique for anatomic ACL reconstruction using inverted hamstring grafts with their bend in the tibial tunnel, suspension-type fixation using a staple demonstrated good to excellent results after 1 year of follow up, with lower aggregate costs. Level of Evidence IV; Case series.

The effects of tibial tunnel placement and roofplasty on reconstructed anterior cruciate ligament knees

1995 ◽  
Vol 11 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Takeshi Muneta ◽  
Haruyasu Yamamoto ◽  
Toshiro Ishibashi ◽  
Shintaro Asahina ◽  
Shunich Murakami ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Tunnel Placement ◽  
Anterior Cruciate

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.

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