scholarly journals Intact PCL is a potential predictor of ACL graft size in the skeletally immature knee and other anatomic considerations for ACL reconstruction

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
David M. Heath ◽  
Alexander V. Nguyen ◽  
Travis S. Bullock ◽  
Samuel S. Ornell ◽  
Katherine C. Bartush ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Tunnel Length ◽  
Graft Size ◽  
Level Of Evidence ◽  
Acl Graft ◽  
Drilling Method ◽  
Length Measurements ◽  
Width Measurements ◽  
Physeal Sparing ◽  
Made In

Abstract Purpose To develop a method for using an intact posterior cruciate ligament (PCL) as a predictor of anterior cruciate ligament (ACL) graft size and examine possible differences in tunnel length based on all-epiphyseal drilling method. Methods One hundred one patients 5–18 years of age with magnetic resonance imaging (MRI) of the knee at an outpatient pediatric orthopaedic clinic from 2008 to 2020 were included. ACL and PCL coronal, sagittal, and length measurements were made in all patients. Tunnel length measurements were made in patients with open physes. Statistical analyses were performed to evaluate potential associations in patient bony or ligamentous measurements. Results PCL sagittal width and PCL coronal width were statistically significant predictors of ACL sagittal width and ACL coronal width, respectively (p = 0.002, R = 0.304; p = 0.008, R = 0.264). The following equations were developed to calculate ACL coronal and sagittal width measurements from the corresponding measurement on an intact PCL; ACL Coronal Width (mm) = 6.23 + (0.16 x PCL Coronal Width); ACL Sagittal Width (mm) = 5.85 + (0.53 x PCL Sagittal Width). Mean tibial maximum oblique length (27.8 mm) was longer than mean tibial physeal sparing length (24.9 mm). Mean femoral maximum oblique length (36.9 mm) was comparable to mean femoral physeal sparing length (36.1 mm). Both were longer than mean femoral straight lateral length (32.7 mm). Conclusion An intact PCL is a predictor of native ACL size. Tunnel length differs based on chosen drilling method in all-epiphyseal technique. Level of evidence Diagnostic Level III.

Similar risk of ACL graft revision for alpine skiers, football and handball players: the graft revision rate is influenced by age and graft choice

2019 ◽  
Vol 54 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Arne Ekeland ◽  
Lars Engebretsen ◽  
Anne Marie Fenstad ◽  
Stig Heir
Keyword(s):  
Graft Survival ◽  
Cox Regression ◽  
Revision Rate ◽  
Cruciate Ligament ◽  
Survival Rates ◽  
Level Of Evidence ◽  
Acl Graft ◽  
Sport Type ◽  
Growth Zones ◽  
Alpine Skiers

ObjectivesThe risk of graft revision following ACL reconstruction may depend on the sport type the individuals are engaged in. The purpose of this study was to report the ACL graft revision rate in alpine skiers, football and handball players.Materials and methodsPrimary ACL reconstructions and graft revision data from 2004 to December 2016 were obtained from the Norwegian Cruciate Ligament Registry. The graft survival rates were calculated for individuals in each of the three sport types, for bone patellar tendon bone (BPTB) and hamstring tendons (HT) grafts separately, and related to age at primary operation and sex.ResultsA total of 711 grafts in 14 201 primary ACL reconstructions were revised (5.0%) after median 6 years, 3.8% in alpine skiers, 5.0% in soccer and 6.1% in handball players (p<0.001). Adjusted Cox regression showed similar ACL graft survival rates in the three groups. The HR for graft revision was 5 times higher for individuals aged ≤18 years than for those aged ≥35 years (p<0.001). The corresponding HR for graft type was 1.8 times higher for HT than for BPTB grafts (p<0.001), but 2.8 times higher for individuals aged ≤18 years (p<0.001). The 12 years survival of BPTB grafts was 96% compared with 93% for HT grafts (p <0.001).ConclusionThe revision rate for ACL grafts was similar among alpine skiers, football and handball players, and the results support the use of BPTB grafts in young athletes with closed growth zones in the knee.Study designCohort study; level of evidence, 2.

scholarly journals Biological enhancement of graft-tunnel healing in anterior cruciate ligament reconstruction

Joints ◽  
2016 ◽  
Vol 04 (03) ◽  
pp. 174-182
Author(s):  
Maristella Saccomanno ◽  
Luigi Capasso ◽  
Luca Fresta ◽  
Giuseppe Milano
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Practice ◽  
Clinical Studies ◽  
Cruciate Ligament ◽  
Healing Process ◽  
Bone Tunnel ◽  
Therapeutic Effects ◽  
Tunnel Length ◽  
Acl Graft ◽  
Anterior Cruciate

The sites where graft healing occurs within the bone tunnel and where the intra-articular ligamentization process takes place are the two most important sites of biological incorporation after anterior cruciate ligament (ACL) reconstruction, since they help to determine the mechanical behavior of the femur-ACL graft-tibia complex. Graft-tunnel healing is a complex process influenced by several factors, such as type of graft, preservation of remnants, bone quality, tunnel length and placement, fixation techniques and mechanical stress. in recent years, numerous experimental and clinical studies have been carried out to evaluate potential strategies designed to enhance and optimize the biological environment of the graft-tunnel interface.Modulation of inflammation, tissue engineering and gene transfer techniques have been applied in order to obtain a direct-type fibrocartilaginous insertion of the ACL graft, similar to that of native ligament, and to accelerate the healing process of tendon grafts within the bone tunnel. Although animal studies have given encouraging results, clinical studies are lacking and their results do not really support the use of the various strategies in clinical practice. Further investigations are therefore needed to optimize delivery techniques, therapeutic concentrations, maintenance of therapeutic effects over time, and to reduce the risk of undesirable effects in clinical practice.

scholarly journals Autograft diameter in ACL reconstruction: size does matter

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 16
Author(s):  
Fahad N.A. Alkhalaf ◽  
Sager Hanna ◽  
Mohammed Saleh Hattab Alkhaldi ◽  
Fares Alenezi ◽  
Aliaa Khaja
Keyword(s):  
Anterior Cruciate Ligament ◽  
Revision Surgery ◽  
Cruciate Ligament ◽  
Case Series ◽  
Failure Rates ◽  
Graft Size ◽  
Level Of Evidence ◽  
Acl Injuries ◽  
Tertiary Center ◽  
Anterior Cruciate

Background: Anterior cruciate ligament injuries are commonly seen in orthopedic surgery practice. Although anterior cruciate ligament reconstruction (ACLR) has come a long way, the causes of failure have yet to be fully understood. Objective: The aim of this study was to investigate whether or not the intraoperative 4-strand hamstring autograft diameter does in fact influence the failure rates of ACLR. Methods: Retrospective intraoperative data were collected from ACLR patients from the only tertiary center available in Kuwait. Patients who underwent ACLR from 2012 to 2018 for isolated ACL injuries were included in this study, allowing for a 24 month follow-up period The cohorts were categorized into 3 groups: patients with graft size≤8mm, 2, patients with graft sizes≥8mm with 4-strands and patients with graft sizes≥8mm with 4-strands or more. ANOVA analysis was applied to address group differences between mean graft size and strand numbers and subsequently the failure rates for each group. In addition, the Mann–Whitney U test was used to investigate the relationship between revision and initial ACL graft size. Results: Out of the 711 out of 782 patients were included in this study. Only 42.6% of the patients did not need more than 4-strands to achieve an 8mm sized autograft. The patients who had autografts≤8mm in this study accounted for 17.1% of the population. About 7.2% of these patients required revision surgery. Patients with a 4-strand autograft size that was less than 8mm were 7.2 times more at risk for ACLR failure (RR=7.2, 95% CI: 6.02; 8.35, p=0.007). Conclusions: There is a significant correlation between 4-strand autograft diameter size and the need for ACLR revision surgery. Level of evidence: IV case series

scholarly journals Higher frequency of osteoarthritis in patients with ACL graft rupture than in those with intact ACL grafts 30 years after reconstruction

2019 ◽  
Vol 28 (7) ◽  
pp. 2139-2146 ◽  
Author(s):  
Tomas Söderman ◽  
Marie-Louise Wretling ◽  
Mari Hänni ◽  
Christina Mikkelsen ◽  
Robert J. Johnson ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Pivot Shift Test ◽  
Level Of Evidence ◽  
Acl Graft ◽  
Anterior Knee Laxity ◽  
Kt 1000 ◽  
Anterior Knee

Abstract Purpose The aim was to assess the results of anterior cruciate ligament (ACL) reconstruction regarding graft failure, knee laxity, and osteoarthritis (OA) from a longterm perspective. It was hypothesized that intact ACL graft reduces the risk for increased OA development. Methods The cohort comprised 60 patients with a median follow-up 31 (range 28–33) years after ACL reconstruction. They were evaluated with magnetic resonance imaging, radiography, KT-1000 arthrometer and the pivot shift test. Results Out of the 60 patients, 30 (50%) showed an intact ACL graft and 30 (50%) a ruptured or absent ACL graft. Patients with ruptured ACL grafts had more medial tibiofemoral compartment OA than those with an intact ACL graft (p = 0.0003). OA was asymmetric in patients with ruptured ACL grafts with more OA in the medial than in the lateral tibiofemoral compartment (p = 0.013) and the patellofemoral compartment (p = 0.002). The distribution of OA between compartments was similar in patients with an intact ACL graft. KT-1000 values of anterior knee laxity were higher in patients with ruptured compared to those with intact ACL grafts (p = 0.012). Side-to-side comparisons of anterior knee laxity showed higher KT-1000 values in patients with ruptured ACL graft (p = 0.0003) and similar results in those with intact graft (p = 0.09). The pivot shift grade was higher in the group with a ruptured ACL graft (p < 0.0001). Conclusions Median 31 (range 28–33) years after ACL reconstruction, 50% of the patients showed an intact ACL graft and no side-to-side difference regarding anterior knee laxity. Patients with ruptured ACL grafts had more OA of the medial tibiofemoral compartment than those with intact ACL grafts. Level of evidence Retrospective cohort study, Level III.

scholarly journals Anterior cruciate ligament reconstruction, can an anatomic femoral tunnel be achieved with the trans-tibial technique? Cadaveric study

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Daniel Acevedo Tobler ◽  
Santiago Hermosilla ◽  
Natalia Otero ◽  
Juan Kenny ◽  
Juan Del Castillo
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Joint Line ◽  
Level Of Evidence ◽  
Mean Values ◽  
Anterior Cruciate ◽  
Portal Technique ◽  
Made In

Abstract Purpose To evaluate the possibility to access the anatomic femoral insertion of the anterior cruciate ligament (ACL) through trans-tibial (TT) and trans-portal technique, for ACL reconstruction in an independent way. To register anatomical characteristics of the TT tunnels. Methods Ten formaldehyde preserved knee anatomic articular specimens were dissected. Femoral tunnels were confectioned reproducing the original topography of the ACL. First, the femoral tunnel was made with the independent trans-portal technique. Then, utilizing the tibial stump of the ACL and tibial guides at 45°, the TT tunnels were confectioned trying to match the previously made femoral tunnel by trans-portal technique. Results In all specimens, match between the TT tunnel with the independent trans-portal tunnel was achieved. Mean values for TT coronal angle was 53,0°, for transversal angle 43,3° and for distance from tunnel to joint line 2,55 cm. A horizontalization and medialization of the TT tunnels had to be made to adequately match with the femoral tunnel made by the independent trans-portal technique. Conclusions By macroscopic anatomic and independent means, an anatomic femoral tunnel was confectioned with the TT technique matching with the anatomic femoral tunnel made in an independent way. As clinical relevance, the present study allows to anatomically assess the possibility to perform an anatomic femoral tunnel through the TT technique. Level of evidence V

scholarly journals One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years

2020 ◽  
Vol 12 (6) ◽  
pp. 587-597 ◽  
Author(s):  
Sue Barber-Westin ◽  
Frank R. Noyes
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Neuromuscular Control ◽  
Postoperative Rehabilitation ◽  
Level Of Evidence ◽  
Acl Graft ◽  
Male Patients

Context: Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures. Objective: To determine RTS rates; the effect of participation in high-risk sports, sex, and graft type on ACL reinjury rates; and whether objective test criteria before RTS correlate with lower reinjury rates. Data Sources: A systematic review of the literature from inception to May 31, 2019, was conducted using the PubMed and Cochrane databases. Study Selection: Studies on transphyseal ACLR in athletes <20 years old with a minimum mean follow-up of 2 years that reported reinjury rates, the number that RTS, and detailed the type of sport were included. Study Design: Systematic review. Level of Evidence: Level 4. Results: A total of 1239 patients in 8 studies were included; 87% returned to sport and 80% resumed high-risk activities. Of the patients, 18% reinjured the ACL graft and/or the contralateral ACL. Nine percent of patellar tendon autografts and 15% of hamstring autografts failed (odds ratio [OR], 0.52; P = 0.002). Of reinjuries, 90% occurred during high-risk sports. Male patients had a significantly higher rate of ACL graft failure than female patients (OR, 1.64; P = 0.01). There was no sex-based effect on contralateral ACL injuries. Only 1 study cited objective criteria for RTS. Conclusion: A high percentage of athletes returned to sport, but 1 in 5 suffered reinjuries to either knee. Male patients were more likely to reinjure the ACL graft. Objective criteria for RTS were rarely mentioned or not detailed. The need for testing of knee stability, strength, neuromuscular control, agility, and psychological measures before RTS remains paramount in young athletes.

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.

Biomechanical Analysis of Ideal Knee Flexion Angle for ACL Graft Tensioning Utilizing Multiple Femoral and Tibial Tunnel Locations

2021 ◽  
Author(s):  
Jon E. Hammarstedt ◽  
J. Jared Guth ◽  
Patrick J. Schimoler ◽  
Alexander Kharlamov ◽  
Mark C. Miller ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Biomechanical Analysis ◽  
Flexion Angle ◽  
Anatomic Reconstruction ◽  
Anatomic Acl Reconstruction ◽  
Level Of Evidence ◽  
Acl Graft ◽  
Tibial Footprint

AbstractAnterior cruciate ligament (ACL) graft failure rate has been reported to be greater than 5% at 5 years. Our study evaluated ACL excursion with anatomic and nonanatomic femoral and tibial tunnels to determine optimal flexion angle to tension the ACL to minimize excursion. Ten cadaveric knee specimens were used. The ACL was sectioned and the femoral and tibial attachments were marked. A 1/16-inch drill created a tunnel in the center of the ACL footprint on the tibia and femur and additional tunnels were made 5 mm from this. A suture was passed through each tunnel combination and attached to a string potentiometer. The knee was ranged from full extension to 120 degrees of flexion for 10 cycles while mounted in a custom fixture. The change in length (excursion) of the suture during movement was recorded for each combination of femoral and tibial tunnels. Anatomic reconstruction of the ACL with tunnel placement in the center of the femoral and tibial footprint did not result in an isometric graft, with excursion of the ACL during knee motion of 7.46 mm (standard deviation [SD]: 2.7mm), greatest at 2.84 degrees of flexion (SD: 4.22). The tunnel combination that resulted in the least excursion was a femoral footprint 5 mm anterior to the femoral and 5 mm posterior to the tibial footprint (4. 2mm, SD: 1.37 mm). The tunnel combination that resulted in the most excursion utilized femoral footprint 5 mm proximal to the femoral and 5 mm posterior to the tibial footprint (9.81 mm, SD: 2.68 mm). Anatomic ACL reconstruction results in significant excursion of the ACL throughout motion. If not tensioned properly, the ACL can stretch during range of motion, potentially leading to rerupture. To prevent stretching of the graft, the current biomechanical study recommends tensioning an anatomic ACL reconstruction at its point of maximal excursion, or between 0 and 5 degrees of flexion. Level of Evidence IV

The Effects of Graft Size and Insertion Site Location During Anterior Cruciate Ligament Reconstruction on Intercondylar Notch Impingement

2016 ◽  
Author(s):  
Hamid Nayeb Hashemi ◽  
Alexander D. Orsi ◽  
Ashkan Vaziri ◽  
Masoud Olia
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Maximum Size ◽  
Intercondylar Notch ◽  
Site Location ◽  
Graft Size ◽  
Femoral Insertion ◽  
Acl Graft ◽  
Anterior Cruciate

Intercondylar notch impingement is detrimental to the anterior cruciate ligament (ACL). Notchplasty is a preventative remodeling procedure performed on the intercondylar notch during ACL reconstruction (ACLR). This study investigates how ACL graft geometry and both tibial and femoral insertion site location affect ACL-intercondylar notch interactions post ACLR. A range of ACL graft sizes are reported during ACLR, from 6mm–11mm in diameter. Minor variability of up to 3mm in ACL insertion site locations is reported during ACLR. Several 3D finite element (FE) knee joint models were constructed using three ACL graft sizes and polar arrays of tibial and femoral insertion site locations. Each knee model was subjected to flexion, tibial external rotation, and valgus motion. Impingement force and contact area between the ACL and the intercondylar notch compared well with published cadaver study results. A 3mm shift in the antero-lateral direction of the tibial insertion site of the average and maximum size ACL increased impingement force by 155.4% and 242.9% respectively. A 3mm shift in the anterior-proximal direction of the femoral insertion site of the average and maximum size ACL increased impingement by 292.6%, and 346.2% respectively. Simulated notchplasties of 4mm and 5mm reduced graft impingement force by 89.4% and 100% respectively for the simulations with greatest impingement. For the kinematics applied, the results show that small differences in graft size and insertion site location may lead to large increases in impingement force and contact area. The study aims to improve ACLR success rates by understanding how minor variations in graft size and insertion site location affect intercondylar notch impingement. Because minor variations in insertion site location during ACLR are a known occurrence, the results of this study may support the argument for performing notchplasty during ACLR.

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