Arthroscopic ACL reconstruction-functional outcome with BPTB graft with interferential screws

Background: Functional outcome scores provide valuable data, yet they can be burdensome to patients and require significant resources to administer. The Knee injury and Osteoarthritis Outcome Score (KOOS) is a knee-specific patient-reported outcome measure (PROM) and is validated for anterior cruciate ligament (ACL) reconstruction outcomes. The KOOS requires 42 questions in 5 subscales. We utilized a machine learning (ML) algorithm to determine whether the number of questions and the resultant burden to complete the survey can be lowered in a subset (activities of daily living; ADL) of KOOS, yet still provide identical data. Hypothesis: Fewer questions than the 17 currently provided are actually needed to predict KOOS ADL subscale scores with high accuracy. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Pre- and postoperative patient-reported KOOS ADL scores were obtained from the Surgical Outcome System (SOS) data registry for patients who had ACL reconstruction. Categorical Boosting (CatBoost) ML models were built to analyze each question and its value in predicting the patient’s actual functional outcome (ie, KOOS ADL score). A streamlined set of minimal essential questions were then identified. Results: The SOS registry contained 6185 patients who underwent ACL reconstruction. A total of 2525 patients between the age of 16 and 50 years had completed KOOS ADL scores presurgically and 3 months postoperatively. The data set consisted of 51.84% male patients and 48.16% female patients, with a mean age of 29 years. The CatBoost model predicted KOOS ADL scores with high accuracy when only 6 questions were asked ( R2 = 0.95), similar to when all 17 questions of the subscale were asked ( R2 = 0.99). Conclusion: ML algorithms successfully identified the essential questions in the KOOS ADL questionnaire. Only 35% (6/17) of KOOS ADL questions (descending stairs, ascending stairs, standing, walking on flat surface, putting on socks/stockings, and getting on/off toilet) are needed to predict KOOS ADL scores with high accuracy after ACL reconstruction. ML can be utilized successfully to streamline the burden of patient data collection. This, in turn, can potentially lead to improved patient reporting, increased compliance, and increased utilization of PROMs while still providing quality data.

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A biomechanical analysis of tibial ACL reconstruction with graft length mismatch

Journal of Orthopaedic Surgery ◽

10.1177/2309499017690983 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901769098

Author(s):

Evan B Gaines ◽

Diana Lau ◽

Qais Naziri ◽

Westley Hayes ◽

Julio J. Jauregui ◽

...

Keyword(s):

Cyclic Loading ◽

Acl Reconstruction ◽

Surgical Techniques ◽

The Other ◽

Biomechanical Analysis ◽

Graft Fixation ◽

Bptb Graft ◽

Load To Failure ◽

Group 3 ◽

Graft Length

Introduction: The incidence of graft length mismatch (GLM) during anterior cruciate ligament (ACL) reconstruction is reported to be up to 13%, with a rate of 20% when using bone-patellar tendon-bone (BPTB) allografts. Multiple techniques have been described to accommodate for the longer BPTB graft. As no study has compared the biomechanical properties of these methods (with cyclic loading), we evaluated the strength of four different surgical techniques used to accommodate for GLM during ACL reconstruction. Methods: A total of 32 fresh-frozen bovine tibiae and patellar tendons were divided into four groups based on the method of tibial graft fixation: (1) sutures tied over a post, (2) bone staples, (3) screws and washers, and (4) soft-tissue conversion with interference screw. Biomechanical testing was performed comparing the tensile properties of graft fixation techniques under cyclic loading. Ability to withstand 1500 cycles of load, the maximum tensile strength at load-to-failure, and the mode-of-failure were evaluated. Results: Only group 4 had all grafts intact after 1500 loading cycles, while the other groups had one graft failure at 338 (group 1), 240 (group 2), and 309 (group 3) cycles. The highest mean load-to-failure was observed in group 3 at 762 ± 173 N, which was found to be significantly higher than the other groups. The mean loads to failure in groups 1–4 were 453 ± 86 N, 485 ± 246 N, 762 ± 173 N, and 458 ± 128 N. Conclusion: While there are multiple viable techniques for fixation of a BPTB graft in the case of GLM, this study demonstrated that direct screw fixation offers the strongest construct.

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Mechanical Effects of Defect Closure Following BPTB Graft Harvest for ACL Reconstruction

International Journal of Sports Medicine ◽

10.1055/s-0033-1353175 ◽

2013 ◽

Vol 35 (05) ◽

pp. 438-442

Author(s):

M. Sobieraj ◽

A. Egol ◽

F. Kummer ◽

E. Strauss

Keyword(s):

Acl Reconstruction ◽

Defect Closure ◽

Mechanical Effects ◽

Bptb Graft ◽

Graft Harvest

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Femoral Fixation With the ZipLoop System Using BPTB Graft in ACL Reconstruction

Techniques in Knee Surgery ◽

10.1097/btk.0b013e3182485e71 ◽

2012 ◽

Vol 11 (1) ◽

pp. 57-60

Author(s):

Donato Rosa ◽

Arcangelo Russo ◽

Giovanni Balato ◽

Giuseppe Di Napoli ◽

Giovanni Ciaramella

Keyword(s):

Acl Reconstruction ◽

Femoral Fixation ◽

Bptb Graft

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The role of graft size and surgical technique on functional outcome following ACL reconstruction

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/s0749-8063(96)90136-x ◽

1996 ◽

Vol 12 (3) ◽

pp. 380 ◽

Cited By ~ 1

Keyword(s):

Surgical Technique ◽

Functional Outcome ◽

Acl Reconstruction ◽

Graft Size

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A study on the functional outcome of arthroscopic anterior cruciate ligament reconstruction done with bone patellar tendon bone graft using the IKDC score

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164166 ◽

2016 ◽

Vol 2 (4) ◽

pp. 346

Author(s):

Vineet Thomas Abraham ◽

Krishnagopal R. ◽

Vamsi Kondreddi ◽

Swagat Mahapatra

Keyword(s):

Standard Deviation ◽

Bone Graft ◽

Acl Reconstruction ◽

Patellar Tendon ◽

Subjective Assessment ◽

Subjective Outcome ◽

Bptb Graft ◽

Ikdc Score ◽

The Mean ◽

Bone Patellar Tendon

Background: ACL injuries result in persistent recurrent instability and increased risk of meniscal tears and intra-articular damage, leading on to degenerative changes in the knee. There are many studies about ACL reconstruction using bone patellar tendon bone graft (BPTB) and its outcome, but there is not enough literature on the subjective assessment following reconstruction. We decided to do a study of the patient’s subjective outcome as per the International knee documentation committee score (IKDC) and other clinical parameters following ACL reconstruction using the BPTB graft.Methods: This was a prospective study consisting of 50 patients who presented with ACL injury and underwent arthroscopic ACL reconstruction using BPTB graft in our hospital in the period from May 2008 to July 2010. Patients were followed at regular intervals at 4 weeks, 8 weeks, 3 months & 6 months and 1 year. Patients were assessed at every visit with clinical tests and IKDC subjective assessment score.Results: 50 patients with ACL insufficiency underwent ACL reconstruction. Postoperative knee flexion improved; the mean flexion was 131.70 with standard deviation of 6.534, which was significant. The mean preoperative IKDC was 56.97 and standard deviation of 9.188 and postoperative IKDC score was 92.33 and standard deviation 5.198 which showed a marked improvement and was statistically significant. The complications included; 8 patents with anterior knee pain, 1 case of patellar fracture while harvesting graft, which healed with wiring and 2 patients, had re-rupture of ACL due to road traffic accident.Conclusions: ACL reconstruction with BPTB graft showed a significantly good subjective outcome on assessment using IKDC score. Isolated ACL reconstruction showed a better subjective outcome compared to the patients who had associated meniscal injury.

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A study on functional outcome of arthroscopic anatomical reconstruction of anterior cruciate ligament using quadrupled hamstring graft

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172886 ◽

2017 ◽

Vol 3 (4) ◽

pp. 854

Author(s):

Jagdeesh P. C. ◽

Suhail R. Shaikh

Keyword(s):

Anterior Cruciate Ligament ◽

Functional Outcome ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Scoring Systems ◽

Activity Level ◽

Anatomical Reconstruction ◽

Proper Patient Selection ◽

Anterior Cruciate ◽

Hamstrings Tendon

Background: Various techniques and graft types are now available for the reconstruction of ACL. Opinions differ among experts with regard to the ideal technique and graft type to be used. Arthroscopic anatomical ACL reconstruction using quadrupled hamstring autograft with fixation in the femoral tunnel using tightrope and in the tibial tunnel with interference screw is a relatively new technique. Purpose of this study is to analyze the postoperative outcome in our experience with this procedure.Methods: This was a prospective study of patients with ACL injury who underwent Arthroscopic anatomical ACL reconstruction using quadrupled hamstrings autograft. All patients were operated upon by the same surgeon and had the same rehabilitation protocol. They were followed up for six months at regular intervals using IKDC, LGS scoring systems, tegner activity scale and a subjective questionnaire.Results: About 95% of the patients had a favorable outcome as per three scoring systems. (IKDC, Lysholm score, subjective questionnaire) all three scoring system had a very high correlation around 90% of individuals were able to return to their pre injury activity level.Conclusions: We conclude that the functional outcome of arthroscopic anatomical anterior cruciate ligament reconstruction using quadrupled hamstrings tendon autograft is excellent to good (95%). With proper patient selection and rehabilitation full occupational and recreational activities can be expected for most of the patients within four to six months of the procedure.

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