scholarly journals Soft tissue allograft for primary anterior cruciate ligament reconstruction

2017 ◽  
Vol 3 (4) ◽  
pp. 718
Author(s):  
Rahul P. ◽  
Suraj H. P. ◽  
Satish Shervegar ◽  
Abhilash Palla
Keyword(s):  
Anterior Cruciate Ligament ◽  
Soft Tissue ◽  
Acl Reconstruction ◽  
Functional Disability ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Ligament Injury ◽  
Tissue Allograft ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Arthroscopic ACL reconstruction has become one of the most commonly performed arthroscopic surgeries. Inspite of extensive research on available autograft options, controversy still persists regarding the ideal graft. Allograft tendons usage in orthopedic operations has increased because of its advantages. This study was conducted to assess the functional outcome in patients undergoing ACL reconstruction with soft tissue allografts.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">15 patients with Anterior Cruciate Ligament injury presenting from 2012-2014 who underwent Arthroscopic ACL reconstruction with soft tissue allograft were the subjects of this Prospective study. Assessment of the involved knee was performed to obtain subjective measures of the clinical outcomes of the ACL reconstruction. All patients were followed up at regular intervals of 3 weeks, 6 weeks, 12 weeks, 6 months and 2 years</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">At the final follow up, </span><span lang="EN-IN">the patients had an average Lysholm knee score of 85.60, Tegner score of 7.24 and IKDC score of 85.28. Knee flexion of &gt;120<sup>0</sup> was achieved in &gt;80% of patients and minimal laxity in 60% patients but no functional disability in any of them. No graft failures were noted. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Contrary to the fear of graft failure and complications associated with allograft construct for primary ACL reconstruction, allografts yield the same clinical outcome as autografts with the advantages of reduced operative time, no donor site morbidity, preservation of native hamstring tendons, faster and comfortable rehabilitation. Allografts are a good alternative to autografts for primary ACL reconstruction.</span></p>

An Analysis of Soft Tissue Allograft Anterior Cruciate Ligament Reconstruction in a Rabbit Model

2007 ◽  
Vol 35 (6) ◽  
pp. 962-971 ◽  
Author(s):  
Michael Y. H. Soon ◽  
Afizah Hassan ◽  
James H. P. Hui ◽  
James C. H. Goh ◽  
E.H. Lee
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Anterior Cruciate Ligament ◽  
Soft Tissue ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Bone Interface ◽  
Tissue Allograft ◽  
Anterior Cruciate

Background Soft tissue allografts are essential for revision and multiple ligament surgeries in the knee, where donor-site morbidity is an issue. However, the use of allografts is associated with a higher failure rate of osteointegration. Mesenchymal stem cells (MSCs) are investigated as potential agents to enhance bone tunnel and tendon healing. Purpose This study was conducted to analyze the effect of coating allografts with MSCs on the quality and rate of osteointegration at the allograft tendon and bone interface, and the biomechanical properties of these enhanced anterior cruciate ligament (ACL) grafts compared with controls. Study Design Descriptive laboratory study. Methods Bilateral ACL reconstructions using Achilles tendon allografts were performed in 36 rabbits. On 1 limb, the graft was coated with autogenous MSCs in a fibrin glue carrier, while the contralateral limb served as a control with no MSCs. The reconstructions were assessed histologically and biomechanically at 2, 4, and 8 weeks. Results At 8 weeks, histologic analysis of the controls revealed the development of mature scar tissue resembling Sharpey fibers spanning the tendon-bone interface. In contrast, the MSC-enhanced reconstructions showed a mature zone of fibrocartilage blending from bone to the allograft, strongly resembling a normal ACL insertion. On biomechanical testing, the MSC-enhanced grafts had significantly higher load-to-failure rates than controls. However, the stiffness and Young's modulus were lower in the treatment group. Conclusions The application of MSCs at the allograft tendon-bone interface during ACL reconstruction results in the development of an intervening zone of fibrocartilage. The use of MSCs to enhance allograft osteointegration is a novel method offering the potential of more physiologic and earlier healing, although further investigation must be conducted to improve the biomechanical strength. Clinical Relevance Mesenchymal stem cells can improve the biologic properties of soft tissue allograft healing. Combined with the decrease in donor-site morbidity, allografts are a viable choice for the sports medicine surgeon.

scholarly journals A novel technique of treating anterior cruciate ligament injury: combining the ACL reconstruction and repair.

2020 ◽  
Author(s):  
Yuan Yang ◽  
Kang Chen ◽  
Wenzhe Feng ◽  
Weimin Zhu ◽  
Yuxiao Lai
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Anterior Cruciate Ligament Injury ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Ligament Injury ◽  
Knee Biomechanics ◽  
Knee Stability ◽  
Novel Technique ◽  
Anterior Cruciate

Abstract Background To illustrate a novel technique of treating anterior cruciate ligament injury. Methods If the ACL stump is strong enough and of good quality, we combine the ACL reconstruction and repair together. Results It is assumed that this will be better for the knee biomechanics in contrast to the simple reconstruction. This technique may also save the graft. That means we can only harvest one tendon gracilis or semitendinosus to satisfy the need of the knee stability. Conclusions This technique of combining the reconstruction and repair protects the knee proprioceptive feelings, accelerate the revascularization and strengthen the reconstructed ACL. This technique may also save the ligament graft and avoid the complications of the donor site. We are looking forward to comparing the outcomes of this technique to the outcomes of simple ACL reconstruction.

scholarly journals Vancomycin presoaking of hamstring grafts removes the risk of infection in primary anterior cruciate ligament reconstruction

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0018
Author(s):  
Francisco Figueroa ◽  
David Figueroa ◽  
Rafael Calvo ◽  
Alex Vaisman ◽  
Mario López ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Septic Arthritis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Autograft ◽  
Exact Test ◽  
Previous Period ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction ◽  
Hamstring Grafts

Background: Several strategies have been studied to decrease the rate of infection after hamstring autograft anterior cruciate ligament (ACL) reconstruction. Our group started presoaking grafts with Vancomycin in November 2015 to decrease this risk. Purpose: The objective of the study is to compare the success of this protocol against the immediate previous period in which we did not use the protocol. Study design: Retrospective cohort. Level III. Methods: Consecutive periods were studied: April 2013-October 2015 (pre Vancomycin protocol) and November 2015- May 2018 (Vancomycin protocol). All patients that underwent a hamstring autograft primary ACL reconstruction during the periods studied were included. The final outcome was the presence of postoperative septic arthritis in both groups. Diagnosis of septic arthritis was made using the clinical picture plus cytological analysis of a joint aspiration (cell count > 50.000/uL + > 90% neutrophils) Statistical analysis was made using the Fisher’s exact test. Significance was set in p < 0.05. Results: 490 patients were included in the study, 230 in the pre Vancomycin protocol an 260 in the Vancomycin protocol. 4 postoperative septic arthritis were noted in the pre Vancomycin protocol (1.7%) while no septic arthritis was noted in the post Vancomycin protocol patients during the period studied. (p < 0.05) The 4 postoperative infections were presented at an average 21.7 days (range 16-25). Staphylococcus epidermidis was isolated in 2 of the cases, and in the other 2 no organism was isolated. Conclusion: Vancomycin presoaking of hamstring autografts in primary ACL reconstruction eliminated the risk of postoperative septic arthritis during the studied period compared to the immediate previous period, where no Vancomycin presoaking was used.

scholarly journals Factors Associated With Psychological Readiness to Return to Sports With Cutting, Pivoting, and Jump-Landings After Primary ACL Reconstruction

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096448
Author(s):  
Junya Aizawa ◽  
Kenji Hirohata ◽  
Shunsuke Ohji ◽  
Takehiro Ohmi ◽  
Hideyuki Koga ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Regression Analysis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Return To Sports ◽  
Factors Associated ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction ◽  
Jump Landings

Background: High psychological readiness is an important element for returning to sports after anterior cruciate ligament (ACL) reconstruction. Identifying factors that contribute to psychological readiness is essential for planning interventions to return to play. No studies have used multivariate analysis to clarify factors associated with psychological readiness to return to specific sports. Hypothesis: To identify factors that contribute to an athlete’s psychological readiness to return after ACL reconstruction to sports that require cutting, pivoting, and jump-landings. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Study participants were athletes who before injury had participated in sports with limited contact that required cutting, pivoting, and jump-landings (basketball, soccer, futsal, volleyball, badminton, tennis, and frisbee) and hoped to return to the same sport after reconstruction. Psychological readiness was measured using the Anterior Cruciate Ligament–Return to Sport After Injury Scale (ACL-RSI) in athletes more than 6 months after primary ACL reconstruction. To clarify factors associated with the ACL-RSI, univariate regression analysis and multivariate regression analysis were performed using the following independent variables: age, sex, body mass index, time from injury to reconstruction, time from reconstruction to testing, meniscal surgery, modified Tegner activity scale before injury, kinesiophobia, limb symmetry index of knee strength, limb symmetry indices of single-leg hop (SLH) distances, and subjective running ability. Results: Higher subjective running ability, a lower kinesiophobia score, and greater limb symmetry in the lateral SLH were positively associated with psychological readiness. Conclusion: The psychological readiness of athletes aiming to return after ACL reconstruction to limited-contact sports that require cutting, pivoting, and jump-landings was affected by subjective running ability, kinesiophobia, and asymmetry of lateral SLH distance. This information may be useful in planning appropriate interventions and thereby increasing the likelihood of an athlete’s returning to such sports.

Incidence and Risk Factors of Subsequent Meniscal Surgery After Successful Anterior Cruciate Ligament Reconstruction: A Retrospective Study With a Minimum 2-Year Follow-up

2020 ◽  
Vol 48 (14) ◽  
pp. 3525-3533
Author(s):  
Yuka Kimura ◽  
Eiji Sasaki ◽  
Yuji Yamamoto ◽  
Shizuka Sasaki ◽  
Eiichi Tsuda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Laxity ◽  
Meniscal Surgery ◽  
Anterior Cruciate ◽  
Femoral Tunnel Drilling ◽  
Primary Acl Reconstruction

Background: One of the goals of anterior cruciate ligament (ACL) reconstruction is a meniscal protective effect on the knee. Despite the advancement of ACL reconstruction techniques, subsequent meniscal tears after ACL reconstruction remain a problem, and the risk factors for recurring lesions are still unclear. Purpose: To investigate the incidence of subsequent meniscal surgery after primary ACL reconstruction without revision ACL surgery and to determine the risk factors associated with this reoperation. Study Design: Case series; Level of evidence, 4. Methods: Overall, 518 patients who underwent primary ACL reconstruction between 2004 and 2012 at one instution participated in this study. Data on body mass index, graft type and femoral tunnel-drilling technique of ACL reconstruction, and location and type of meniscal injury and its treatment at ACL reconstruction were collected from medical records. Clinical outcomes were investigated, including side-to-side difference of anterior laxity, pivot-shift grade, and subsequent meniscal surgery without ACL insufficiency (at minimum 2-year follow-up). Results: The prevalence of tears to the medial meniscus (MM) at the primary ACL reconstruction was 43.6% (226/518), 140 of which were repaired; on the contrary, tears of the lateral meniscus (LM) had a prevalence of 55.8% (289/518), 42 of which were repaired. At a mean 30.3 months (range, 8-124 months) after ACL reconstruction, 20 patients (3.9%; 14 MM tears, 3 LM tears, 3 MM + LM tears) required meniscal surgery without ACL reinjury or recurrence of instability. Of these, 14 MMs and 3 LMs had been repaired at primary ACL reconstruction. The failure rates of repaired MM and LM were 10.0% (14/140) and 7.1% (3/42), respectively. The failure rate of MM repair using the all-inside technique (6/36) was significantly higher compared with no treatment, inside-out repair, or partial resection ( P = .045). In multiple regression analysis, the presence of MM injury at the time of ACL reconstruction (odds ratio [OR], 7.81; P = .003), the side-to-side difference of postoperative anterior tibial translation (OR, 1.91; P = .032), and follow-up period after ACL reconstruction (OR, 1.02; P = .003) were risk factors of subsequent meniscal surgery after ACL reconstruction. Conclusion: Incidence of subsequent meniscal surgery after successful ACL reconstruction was <5%. Presence of MM tear at the time of ACL reconsturuction, small amount of increased anterior laxity, and long-term period after ACL reconstruction were predictive of subsequent meniscal surgery.

The 50 Most Cited Articles in the Indications, Risk Factors, Techniques, and Outcomes of ACL Revision Surgery

2020 ◽  
Author(s):  
Hayley E. Ennis ◽  
Kevin Bondar ◽  
Johnathon McCormick ◽  
Clark Jia-Long Chen ◽  
Chester J. Donnally ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Risk Factor ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Future Research ◽  
Revision Acl Reconstruction ◽  
Anterior Cruciate ◽  
Number Of Citations

AbstractThe rate of anterior cruciate ligament (ACL) retear remains high and revision ACL reconstruction has worse outcomes compared with primaries. To make advances in this area, a strong understanding of influential research is necessary. One method for systematically evaluating the literature is by citation analysis. This article aims to establish and evaluate “classic” articles. With consideration of these articles, this article also aims to evaluate gaps in the field and determine where future research should be directed. The general approach for data collection and analysis consisted of planning objectives, employing a defined strategy, reviewing search results using a multistep and multiauthor approach with specific screening criteria, and analyzing data. The collective number of citations for all publications within the list was 5,203 with an average of 104 citations per publication. “Biomechanical Measures during Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport” by Paterno et al contained both the highest number of total citations and the highest number of citations per year, with 403 total citations and 43.9 citations per year. The most recurring level of evidence were level II (n = 18) and level III (n = 17). “Clinical Outcomes” was the most common article type (n = 20) followed by “Risk Factors” (n = 10). The American Journal of Sports Medicine had the highest recorded Cite Factor with over 50% of the articles (n = 27) published. The most productive authors included R.W. Wright (n = 6), S.D. Barber-Westin (n = 5), F.R. Noyes (n = 5), and K.P. Spindler (n = 5). Historically, influential studies have been published in the realms of clinical outcome and risk factor identification. It has been established that revision ACL reconstruction has worse outcomes and more high-level studies are needed. Additionally, prospective studies that apply the knowledge for current known risk factor mitigation are needed to determine if graft tear rates can be lowered.

scholarly journals Revision Anterior Cruciate Ligament Reconstruction

2013 ◽  
Vol 6 (6) ◽  
pp. 504-518 ◽  
Author(s):  
Jeffrey Wilde ◽  
Asheesh Bedi ◽  
David W. Altchek
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Instability ◽  
Return To Play ◽  
Revision Acl Reconstruction ◽  
Pubmed Database ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B.

scholarly journals A 5-Strand Hamstring Autograft Achieves Outcomes Comparable to Those of a 4-Strand Hamstring Autograft With a Graft Diameter of 8 mm or More in Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876081 ◽  
Author(s):  
Lingaraj Krishna ◽  
Xin Yang Tan ◽  
Francis Keng Lin Wong ◽  
Shi Jie Toh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Physical Component Summary ◽  
Cruciate Ligament ◽  
Primary Study ◽  
Hamstring Autograft ◽  
Sf 36 ◽  
Anterior Cruciate ◽  
Graft Diameter ◽  
Primary Acl Reconstruction

Background: Quadrupled (4-strand) hamstring tendon autografts are commonly used in anterior cruciate ligament (ACL) reconstruction, but there is significant variability in their diameter. The 5-strand hamstring autograft has been used as a means of increasing the graft diameter in patients with undersized hamstring grafts. Purpose: To report the outcomes of primary ACL reconstruction using 5-strand hamstring autografts in patients in whom the 4-strand configuration produced a graft diameter of <8 mm and to compare these outcomes with those of ACL reconstruction using 4-strand semitendinosus-gracilis autografts with a graft diameter of ≥8 mm. Study Design: Cohort study; Level of evidence, 2. Methods: The primary study group comprised 25 patients who underwent ACL reconstruction using a 5-strand hamstring autograft. The comparison group comprised 20 patients who underwent ACL reconstruction using a 4-strand hamstring autograft with a graft diameter of ≥8 mm. Interference screw fixation was used at the tibial and femoral ends for both groups of patients. Subjective questionnaires, including the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score, and the Physical Component Summary and Mental Component Summary of the Short Form–36 (SF-36), were administered preoperatively as well as at 1- and 2-year follow-up visits. Results: There were no significant differences in the patient demographics and preoperative scores between the 2 groups. The mean graft diameter was 9.06 ± 0.60 mm in the 5-strand group and 8.13 ± 0.32 mm in the 4-strand group ( P < .05). There was no statistically significant difference between groups on postoperative Lysholm, KOOS Pain, KOOS Symptoms, KOOS Activities of Daily Living, KOOS Sports, KOOS Quality of Life, and SF-36 Physical Component Summary scores. Conclusion: In primary ACL reconstruction, the 5-strand hamstring autograft achieves clinical outcomes that are comparable to those of the 4-strand hamstring autograft with a graft diameter of ≥8 mm. The 5-strand graft technique is therefore a useful means of increasing the graft diameter when faced with an undersized hamstring graft.

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