scholarly journals Comparison between functional outcome of arthroscopic anterior cruciate ligament reconstruction using single bundle six fold and four fold semitendinosus and gracilis graft

2018 ◽  
Vol 4 (2) ◽  
pp. 220
Author(s):  
Rahul G. Jaju ◽  
Jeevan B. Tonde
Keyword(s):  
Anterior Cruciate Ligament ◽  
Functional Outcome ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Single Bundle ◽  
Lachman Test ◽  
Anterior Drawer Test ◽  
Anterior Cruciate

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">With increase participation in sports activities, anterior cruciate ligament (ACL) tear is a common and functionally disabling injury. Hamstring tendon as autografts for arthroscopic ACL reconstructions have shown good clinical and functional outcome in patients. The purpose of present study was to compare the functional outcome of arthroscopic Anterior Cruciate ligament (ACL) reconstruction using single bundle six fold and four fold ST and G graft.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This was a prospective study conducted between period June 2008 to December 2010.181 patients undergoing ACL reconstruction were screened and 113 patients fulfilling the inclusion exclusion criteria were selected for the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">All patients completed a minimum of 1 years follow up. In 4 fold group 27.50% were having grade 1 anterior drawer test 22.50% were having grade 1 Lachman test and 17.50% had grade 1 pivot shift test as compared to 6 fold group 6.66% had grade 1 anterior drawer test, 11.66% had grade 1 Lachman test, and 3.33% had grade 1 pivot shift test respectively which was statistically significant (p&lt;0.05). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Arthroscopic ACL reconstruction using six fold graft is effective modality of treatment in patient with ACL deficient knee. Six fold graft is thicker in diameter and cross sectional area as compared to four fold graft which occupies more surface area of normal ACL foot print and gives better stability of knee joint in both AP and rotational plane.</span></p><p> </p>

scholarly journals A modified anterior drawer test for anterior cruciate ligament ruptures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Guang-lei Zhao ◽  
Jin-yang Lyu ◽  
Chang-quan Liu ◽  
Jian-guo Wu ◽  
Jun Xia ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Characteristic Curve ◽  
Pivot Shift Test ◽  
Anterior Drawer ◽  
Lachman Test ◽  
Anterior Drawer Test ◽  
Significant Difference ◽  
Anterior Cruciate

Abstract Objective This study was aimed to utilize a modified anterior drawer test (MADT) to detect the anterior cruciate ligament (ACL) ruptures and investigate its accuracy compares with three traditional tests. Methods Four hundred patients were prospectively enrolled between January 2015 and September 2017 preoperatively to undergo knee arthroscopic surgeries. The MADT, anterior drawer test, Lachman test, and pivot shift test were used in the outpatient clinical setting and were compared statistically for their accuracy in terms of ACL ruptures, with arthroscopic findings as the gold standard. Results The prevalence of ACL ruptures in this study was 37.0%. The MADT demonstrated the highest sensitivity (0.89) and accuracy (0.92) among the four tests and had comparable specificity (0.94) and a positive predictive value (0.90) compared with the anterior drawer test, Lachman test, and pivot shift test. The diagnostic odds ratio (DOR) of MADT was 122.92, with other test values of no more than 55.45. The area under the receiver operating characteristic curve (AUC) for the MADT was 0.92 ± 0.01, with a significant difference compared with that for the anterior drawer test (z = 17.00, p < 0.001), Lachman test (z = 9.66, p = 0.002), and pivot shift test (z = 16.39, p < 0.001). The interobserver reproducibility of the MADT was good, with a kappa coefficient of 0.86. When diagnosing partial tears of ACL, the MADT was significantly more sensitive than the anterior drawer test (p < 0.001), Lachman test (p = 0.026), and pivot shift test (p = 0.013). The MADT showed similar sensitivity in detecting anteromedial and posterolateral bundle tears (p = 0.113) and no difference in diagnosing acute and chronic ACL ruptures (χ2 = 1.682, p = 0.195). Conclusions The MADT is also an alternative diagnostic test to detect ACL tear, which is equally superior to the anterior drawer test, Lachman test, and pivot shifting test. It could improve the diagnosis of ACL ruptures combined with other clinical information including injury history, clinical examination, and radiological findings. Levels of evidence Level II/observational diagnostic studies Trial registration Chinese Clinical Trial Registry. ChiCTR1900022945 /retrospectively registered

scholarly journals Functional result of anterior cruciate ligament reconstruction by remnant preservation in a tertiary center in Eastern India

2021 ◽  
Vol 7 (4) ◽  
pp. 820
Author(s):  
Ritwik Ganguli ◽  
Swagatam Jash
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Return To Sports ◽  
Lachman Test ◽  
Remnant Preservation ◽  
Graft Rupture ◽  
Tertiary Center ◽  
Anterior Cruciate

<p><strong>Background:</strong> Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures in orthopaedics. Orthopaedic surgery is vastly evolving to give better functional outcome. Apart from stability, proprioception, ligament healing are important factors for return to sports. The presence of remnant containing mechanoreceptors and free neural endings can help reinnervate the ACL auto graft. Aims and objectives were to evaluate clinical outcomes in patients undergoing ACL reconstruction with remnant preservation.</p><p><strong>Methods</strong>: One hundred and six patients who underwent ACL reconstruction between April 2014 and March 2020. Among these 80 patients underwent remnant preservation. Analysis is done based on international knee documentation committee score (IKDC), modified Cincinnati knee rating system (MCKRS) and Tegner-Lysholm scoring system. Other factors are Lachman test, pivot shift test, return to sports and graft rupture rate.</p><p><strong>Results:</strong> Lachman test became negative in 98% at 12 weeks and in all the patients at 24 months post-operatively. 74 patients (92.5%) among 80 patients develop full range of knee movement after ACL surgery. Post-operative scores are 95, 93, and 92 respectively.</p><p><strong>Conclusions: </strong>Remnant preserving ACL reconstruction having excellent clinical outcome with good knee stability, early return to sports activities and no incidence of graft rupture in our series.</p>

Accessory Anteromedial Portal may not Provide Clinically Superior Results Compared with the Anteromedial Portal in Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 31 (08) ◽  
pp. 716-722
Author(s):  
Shu-Ming Ye ◽  
Jue-Hua Jing ◽  
Hao Lv ◽  
Ji-Sen Zhang ◽  
Xin-Zhong Xu ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Pivot Shift Test ◽  
Single Bundle ◽  
Anteromedial Portal ◽  
Anterior Cruciate

AbstractTechniques using the anteromedial portal (AMP) and accessory anteromedial portal (AAMP) are commonly used in anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate the radiological and clinical outcomes of arthroscopic single-bundle ACL reconstruction using the AMP or AAMP technique to drill the femoral tunnel. The records of 157 patients who underwent single-bundle ACL reconstruction using the AMP or AAMP technique between 2011 and 2015 were reviewed. The femoral tunnel clock-face position and femoral tunnel and tibial tunnel anterior–posterior (AP) inclination angles were assessed on axial or AP magnetic resonance images. At last follow-up, the Lachman test and pivot-shift test were used to evaluate AP and rotational stability, respectively. The Lysholm knee scoring scale and the International Knee Documentation Committee (IKDC) form were used to evaluate clinical and functional results. No statistically significant differences were found between the groups in patient age, sex, follow-up period, or affected side distribution. The mean femoral tunnel inclination angle was 31.13 ± 8.06 degrees in the AMP group and 30.17 ± 9.02 degrees in the AAMP group (p = 0.513). The tibial tunnel inclination angle in the AMP group (16.28 ± 7.89 degrees) was not different from that in the AAMP group (13.70 ± 6.08 degrees). No significant differences were observed between the two groups in the Lachman test, pivot-shift test, Lysholm knee scoring scale, or IKDC scores. The AAMP technique was not clinically superior to the AMP technique in ACL reconstruction. This is a retrospective comparative study and its level of evidence is III.

Association Between Psychological Readiness and Knee Laxity and Their Predictive Value for Return to Sport in Patients With Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110218
Author(s):  
Anne Gro Heyn Faleide ◽  
Liv Heide Magnussen ◽  
Bård Erik Bogen ◽  
Torbjørn Strand ◽  
Ingunn Fleten Mo ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
Anterior Cruciate

Background: Deciding when patients are ready to return to sport (RTS) after an anterior cruciate ligament (ACL) reconstruction (ACLR) is challenging. The understanding of which factors affect readiness and how they may be related is limited. Therefore, despite widespread use of RTS testing, there is a lack of knowledge about which tests are informative on the ability to resume sports. Purpose: To examine whether there is an association between knee laxity and psychological readiness to RTS after ACLR and to evaluate the predictive value of these measures on sports resumption. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged ≥16 years engaged in physical activity/sports before injury were recruited at routine clinical assessment 9-12 months after ACLR. Exclusion criteria were concomitant ligament surgery at ACLR and/or previous ACL injury in the contralateral knee. At baseline, a project-specific activity questionnaire and the ACL–Return to Sport After Injury (ACL-RSI) scale were completed. Knee laxity was assessed by use of the Lachman test, KT-1000 arthrometer, and pivot-shift test. Two years after surgery, knee reinjuries and RTS status (the project-specific questionnaire) were registered. Associations between psychological readiness and knee laxity were evaluated with the Spearman rho test, and predictive ability of the ACL-RSI and knee laxity tests were examined using regression analyses. Results: Of 171 patients screened for eligibility, 132 were included in the study. There were small but significant associations between the ACL-RSI score and the Lachman test (rho = −0.18; P = .046) and KT-1000 arthrometer measurement (rho = −0.18; P = .040) but no association between the ACL-RSI and the pivot-shift test at the time of recruitment. Of the total patients, 36% returned to preinjury sport level by 2 years after surgery. Higher age, better psychological readiness, and less anterior tibial displacement (KT-1000 arthrometer measurement) were significant predictors of 2-year RTS (explained variance, 33%). Conclusion: Small but significant associations were found between measurements of psychological readiness and anterior tibial displacement, indicating that patients with less knee laxity after ACLR feel more ready to RTS. ACL-RSI and KT-1000 arthrometer measurements were independent predictors of 2-year RTS and should be considered in RTS assessments after ACLR.

EVALUATE THE RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH THE USE OF AUTOGENOUS PATELLAR LIGAMENT AT HUE UNIVERSITY HOSPITAL

2011 ◽  
pp. 105-115
Author(s):  
Nghi Thanh Nhan Le ◽  
Huu Toan Bui
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
University Hospital ◽  
Patellar Ligament ◽  
Pivot Shift Test ◽  
Cruciate Ligament Reconstruction ◽  
Lachman Test ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) play the importance role in stability of knee. Our purpose was to report the stability and functional outcomes for a prospective series of patients with ACL injuries treated with reconstruction of use of autogenous patellar ligament. Methods: A prospective study of 30 patients with ACL ruptures treated with arthroscopically assisted reconstruction with autogenous patellar ligament was initiated from May 2008 to December 2010 at Hue University Hospital. Lachman test, anterior draw test, pivot shift test, functional Lysholm scores were obtained at each visit, including preoperatively and at the third and sixth month of follow-up visit. Results: Thirty patients (male : female = 2.3; with a mean age of thirty years) enrolled in the study. Twenty one knees had an isolated ACL tear, nine also had an associated PCL tear and/or meniscus injuries. Lachman test was positive in 100% of cases, draw test was positive in 86% and pivot-shift test was positive in 93%. Mean value of knee function according to Lysholm score was 56 points. Twenty-six patients were followed-up in six months. Lachman test was positive in 15% of all cases, draw test was positive in 7% and pivot-shift test was positive in 7%. Lysholm outcomes scores were improved to 89 points. Conclusions: Bone patellar tendon bone graft was a useful and safety technique for anterior cruciate ligament reconstruction.

scholarly journals Comparison of Clinical Outcomes between Anteromedial and Transtibial Techniques of Single-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 237-249
Author(s):  
Ran Li ◽  
Tao Li ◽  
Qiuping Zhang ◽  
Weili Fu ◽  
Jian Li
Keyword(s):  
Clinical Outcomes ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Controlled Trials ◽  
Single Bundle ◽  
Lachman Test ◽  
Randomized Controlled ◽  
Anterior Cruciate ◽  
Tegner Activity Scale

This study compared clinical outcomes obtained after single-bundle anterior cruciate ligament (ACL) reconstruction using the anteromedial (AM) and transtibial (TT) techniques, which comprise the conventional transtibial (cTT) and modified transtibial (mTT) techniques. This study included clinical randomized controlled trials and prospective and retrospective controlled trials with AM and TT techniques from the PubMed and Embase databases and the Cochrane Library. All databases were searched from January 2010 to July 2020. Two independent evaluators verified the quality of the included studies using the Cochrane Collaboration’s risk of bias tool and the Newcastle-Ottawa Scale (NOS). Outcome measures analysed included the Lachman test, pivot-shift test, side-to-side difference (SSD), Lysholm score, Tegner activity scale, International Knee Documentation Committee (IKDC) grade and score. Ten randomized controlled trials (RCTs) and 16 prospective and retrospective controlled trials were included with a total of 2202 patients. There were 1180 patients and 1022 patients in the AM and TT groups, respectively. Compared to the cTT group, superior postoperative results were observed in the AM group based on the negative rate of the Lachman test and the pivot-shift test, IKDC grade and score, Lysholm score, Tegner activity scale and SSD (p < 0.05). However, there was no significant difference between the AM and mTT groups (p > 0.05). Compared to the conventional TT technique, the AM technique exhibited superior clinical outcomes. Nevertheless, the modified TT and AM techniques had comparable results. With neither of the techniques (mTT or AM) producing significantly superior outcomes, surgeons can choose either of them depending on their preferences.

scholarly journals Surgical intra- and extra-articular anterior cruciate ligament reconstruction: a meta-analysis

2020 ◽  
Author(s):  
Xiangyun Cheng ◽  
Fanxiao Liu ◽  
Dongsheng Zhou ◽  
Alexander C. Paulus
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Pivot Shift Test ◽  
Reconstruction Technique ◽  
Anterior Cruciate

Abstract Background: It is still controversial whether the combination of anterior cruciate ligament (ACL) reconstruction and extra-articular reconstruction (EAR) have good clinical efficacy. This meta-analysis aims to compare the clinical effectiveness of ACL reconstruction and combined reconstruction. Methods: Electronic databases, including Medline/PubMed, Embase and the Cochrane Library, were systematically searched to identify targeted studies. A meta-analysis aims to pool the outcome estimates of interest, such as the Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores and the results from the KT-1000/2000 arthrometer test, the Lachman test and the pivot shift test. Results : Twelve studies involving 1146 knees were identified. Compared with single ACL reconstruction, combined reconstruction had better results for a pivot shift of grade 1 (relative ratio [RR] = 0.88, 95% CI: 0.83-0.94) and grade 2 (RR = 0.95, 95% CI: 0.91-0.99) rather than grade 3 (RR = 0.98, 95% CI: 0.90-1.06) and no statistically significant difference for both Lachman grade 1 (RR = 0.96, 95% CI: 0.89-1.05) and grade 2 (RR = 0.96, 95% CI: 0.90-1.03). Combined reconstruction resulted in significant improvements on the instrumented joint laxity test when considering a failure standard of more than 5 mm (a side-to-side arthrometric difference) (RR = 0.94, 95% CI: 0.89-0.98) rather than 3 mm (RR = 0.94, 95% CI: 0.86-1.03). Moreover, combined reconstruction increased the IKDC score at the 12-month (weighted mean difference [WMD] = -6.38, 95% CI: -9.66 to -3.10), 24-month (WMD = -5.60, 95% CI: -8.54 to -2.66) and 36-month follow-ups (WMD = -4.71, 95% CI: -7.59 to -1.83) and the Tegner score at the 36-month follow-up (WMD = -0.53, 95% CI: -0.97 to -0.09), but it did not increase the Lysholm score at the 36-month follow-up (WMD = -0.84, 95% CI: -2.02 to 0.34). Conclusion : With the advances in reconstruction techniques, combined reconstructions were found to be effective in improving rotational stability and to lead to good functional scores. However, obviously, the combined reconstruction technique is more time-consuming and requires an additional incision, which is not suitable for all ACL-deficient patients. Therefore, programs should be personalized and customized for the specific situation of each patient.

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