Clinical Comparison of Transfix and Tightrope Fixations in Patients with Arthroscopic Anterior Cruciate Ligament Reconstruction

Backgraound: Transfix and Tightrope are widely used devices for femoral graft fixation in arthroscopic anterior cruciate ligament (ACL) reconstruction. The purpose of the study is to reveal differences between Transfix and Tightrope fixation technique by evaluating clinical results of cases. Materials and Methods: 87 patients who underwent arthroscopic ACL reconstruction for ACL rupture between January 2013 and June 2017 by the same senior surgeon and in whom the fixation methods evaluated in this study had been employed were retrospectively reviewed. Transfix was used in 45 (52%) patients and ACL Tightrope was used in 42 (48%) patients. In the first group (Transfix) mean age was 26,3± 5.8 (18-45) second group (Tightrope) mean age was 26,7± 6.1 (17-46). Patients in both groups were retrospectively screened for anamnesis and physical examination records in the hospital registry system. In addition, IKDC(International Knee Documentation Committee) and Lysholm scores were calculated in the preoperative and postoperative follow-up period, and all findings were evaluated over a mean period of 42.5 ± 7.4 (24-54) months. Results: Clinical evaluation and stability tests indicated that statistically no significant difference found between two groups. For the first group preoperative Lysholm scores was 47,3 and postoperatively 93 and second group scores were respectivly 47,6 and 94 (P<0.05). IKDC scoring system for first group preoperatively there were 13 poor, 26 good and 6 fair knees ; postoperatively 2 fair, 27 good and 16 excellent .In the second group preoperatively 11 poor, 25 fair and 6 good knees and postoperatively 2 fair, 26 good and 14 excellent knees evaluated. Conclucions: In ACL reconstruction for fixation femoral graft, Transfix and Tightrope are frequently used implants. Therefore, both femoral fixation implants can be safely used in arthroscopic ACL reconstruction based on the experience and preference of the surgeon, provided that they are properly applied.

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Preliminary Results in Anatomic All-inside Anterior Cruciate Ligament Reconstruction

Journal of Interdisciplinary Medicine ◽

10.1515/jim-2016-0050 ◽

2016 ◽

Vol 1 (s2) ◽

pp. 23-26

Author(s):

Octav Russu ◽

Tiberiu Bățagă ◽

Andrei-Marian Feier ◽

Radu Prejbeanu ◽

Radu Fleaca ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Knee Laxity ◽

Clinical Results ◽

Lysholm Score ◽

X Rays ◽

The Mean ◽

Anterior Cruciate

Abstract Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common lesions in knee traumatology; therefore the number of ACL reconstructions is increasing worldwide. Usually, an anteromedial (AM) accessory portal is required in anatomical positioning of the femoral tunnel, which is not absolutely necessary in this technique. Aim: Assessment of all-inside ACL reconstruction preliminary clinical results with adjustable loops and buttons on both femoral and tibial surfaces. Method: Our prospective study included 28 subjects (19 male, 9 female) with chronic ACL ruptures. The mean age of the study population was 27.72 ± 8.23 years. In all cases ACL reconstruction was carried out with the use of quadrupled semitendinosus auto-grafts with adjustable loops and buttons on the femoral and tibial surfaces and anatomic placement of both tunnels, using an outside-in technique, with flipcutters (Arthrex®). Clinical and radiological evaluations were carried out before surgery and at 3 and 6 months postoperatively, with the Lysholm scoring system, the Tegner activity scale and anterior-posterior and latero-lateral X-rays. Anterior knee laxity was measured in 25° of flexion using a portable arthrometer (RolimeterTM, Aircast®) and maximum manual force. Results: During the final follow-up, the Lysholm score was good and excellent in 27 cases, with a mean Lysholm score of 95.55 ± 4.63; all results were classified as good. The mean preoperative Tegner activity score was 3.46 ± 1.71 (range: 1-7), and the post-operative mean score was 5.75 ± 2.24 (range: 2-10). We found no graft ruptures. Preoperative knee laxity measurements showed a mean displacement of 11.5 ± 3.1 mm and side-to-side differences of 5.6 ± 3.5 mm, while the postoperative measurements at the last follow-up were 6.3 ± 1.54 mm and 2.65 ± 1.86 mm, respectively. Conclusion: Short-term clinical outcomes of all-inside ACL restoration with anatomic placement femoral and tibial tunnels seem to recommend this surgical option, with good subjective and objective results. Additional research will have to prove the long-term success.

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Performance of the PROMIS in Patients After Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118774509 ◽

2018 ◽

Vol 6 (5) ◽

pp. 232596711877450 ◽

Cited By ~ 16

Author(s):

Elizabeth J. Scott ◽

Robert Westermann ◽

Nathalie A. Glass ◽

Carolyn Hettrich ◽

Brian R. Wolf ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Physical Function ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Sf 36 ◽

Significant Difference ◽

Patient Reported ◽

Floor Effects ◽

Anterior Cruciate ◽

Pro Instruments

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) is designed to advance patient-reported outcome (PRO) instruments by utilizing question banks for major health domains. Purpose: To compare the responsiveness and construct validity of the PROMIS physical function computer adaptive test (PF CAT) with current PRO instruments for patients before and up to 2 years after anterior cruciate ligament (ACL) reconstruction. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Initially, 157 patients completed the PROMIS PF CAT, Short Form–36 Health Survey (SF-36 physical function [PF] and general health [GH]), Marx Activity Rating Scale (MARS), Knee injury and Osteoarthritis Outcome Score (KOOS activities of daily living [ADL], sport, and quality of life [QOL]), and EuroQol–5 dimensions questionnaire (EQ-5D) at 6 weeks, 6 months, and 2 years after ACL reconstruction. Correlations between instruments, ceiling and floor effects, effect sizes (Cohen d), and standardized response means to describe responsiveness were evaluated. Subgroup analyses compared participants with and without additional arthroscopic procedures using linear mixed models. Results: At baseline, 6 weeks, and 6 months, the PROMIS PF CAT showed excellent or excellent-good correlations with the SF-36 PF ( r = 0.75-0.80, P < .01), KOOS-ADL ( r = 0.63-0.70, P < .01), and KOOS-sport ( r = 0.32-0.69, P < .01); excellent-good correlation with the EQ-5D ( r = 0.60-0.71, P < .01); and good correlation with the KOOS-QOL ( r = 0.52-0.58, P < .01). As expected, there were poor correlations with the MARS ( r = 0.00-0.24, P < .01) and SF-36 GH ( r = 0.16-0.34, P < .01 ). At 2 years, the PROMIS PF CAT showed good to excellent correlations with all PRO instruments ( r = 0.42-0.72, P < .01), including the MARS ( r = 0.42, P < .01), indicating frequent return to preinjury function. The PROMIS PF CAT had the fewest ceiling or floor effects of all instruments tested, and patients answered, on average, 4 questions. There was no significant difference in baseline physical function scores between subgroups; at follow-up, all groups showed improvements in scores that were not statistically different. Conclusion: The PROMIS PF CAT is a valid tool to assess outcomes after ACL reconstruction up to 2 years after surgery, demonstrating the highest responsiveness to change with the fewest ceiling and floor effects and a low time burden among all instruments tested. The PROMIS PF CAT is a beneficial alternative for assessing physical function in adults before and after ACL reconstruction.

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Reconstruction of anterior cruciate ligament by using two different techniques

Medicinski pregled ◽

10.2298/mpns1012845r ◽

2010 ◽

Vol 63 (11-12) ◽

pp. 845-850 ◽

Cited By ~ 2

Author(s):

Vladimir Ristic ◽

Srdjan Ninkovic ◽

Vladimir Harhaji ◽

Milan Stankovic ◽

Dragan Savic ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Bone Graft ◽

Scoring System ◽

Cruciate Ligament ◽

Group Versus ◽

International Knee Documentation Committee ◽

Rigid Fixation ◽

Postoperative Results ◽

Significant Difference ◽

Anterior Cruciate

Introduction. Modern literature concerning reconstructions of Anterior Cruciate Ligament is mostly focused on the choice of graft (hamstring or bone-tendon-bone), its placing, tensioning and fixation. The bone-hamstring-bone graft consists of compressed cancellous bone on its ends and it has been developed to achieve a more rigid fixation of the graft. The aim of this study was to compare the postoperative results in surgically treated patients two years after the reconstruction of anterior cruciate ligament. Material and methods. The study included 55 patients divided into two groups according to the implanted graft: bone-tendon-bone and bone-hamstring-bone graft. The results were assessed by Tegner and Lysholm scoring systems, arthrometric measurements, functional tests and International Knee Documentation Committee standard. Results. The average postoperative results did not show a statistically significant difference (p<0.05) between the two groups (94 in the bone-tendon-bone group versus 93 in the bone-hamstring-bone group) according to Lysholm scoring system, nor in the arthrometric measurements obtained by Lachman test (2.0:2.1). According to the International Knee Documentation Committee standard, the bone-hamstring-bone group had more excellent results, but also three unsatisfactory ones; so, the bone-tendon-bone group was found to have uniform and better results (100% of excellent and good results vs. 91% in the bone-hamstring-bone group). Better results were also recorded by Tegner scoring system in the bone-tendon-bone group (8.6 vs. 7.1) due to the fact that there were more active athletes and greater preoperative level of activities in this group (3.1 vs.7.l in the bone-hamstring group). Conclusions. The choice of graft is a less important factor in the reconstruction of anterior cruciate ligament than its placing, tensioning and fixation, because a significant difference between groups was recorded only by the International Knee Documentation Committee standard.

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Outcomes After Biologically Augmented Isolated Meniscal Repair With Marrow Venting Are Comparable With Those After Meniscal Repair With Concomitant Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546516686968 ◽

2017 ◽

Vol 45 (6) ◽

pp. 1341-1348 ◽

Cited By ~ 34

Author(s):

Chase S. Dean ◽

Jorge Chahla ◽

Lauren M. Matheny ◽

Justin J. Mitchell ◽

Robert F. LaPrade

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meniscal Repair ◽

Intercondylar Notch ◽

Inclusion Criteria ◽

Significant Difference ◽

Outcome Scores ◽

Anterior Cruciate ◽

Biological Augmentation

Background: Meniscal repair in the setting of anterior cruciate ligament (ACL) reconstruction has demonstrated superior outcomes compared with isolated meniscal repair. Limited evidence exists for the effects of biological augmentation in isolated meniscal repair, particularly as compared with meniscal repair with concomitant ACL reconstruction. Purpose/Hypothesis: The purpose of this study was to compare the outcomes and survivorship of meniscal repair in 2 cohorts of patients: meniscal repair with biological augmentation using a marrow venting procedure (MVP) of the intercondylar notch, and meniscal repair with concomitant ACL reconstruction. We hypothesized that the clinical outcomes and survivorship of meniscal repair with concomitant ACL reconstruction would be improved compared with meniscal repair with biological augmentation. Study Design: Cohort study; Level of evidence, 3. Methods: Inclusion criteria were skeletally mature patients aged ≥16 years who underwent inside-out meniscal repair and either a concomitant MVP of the intercondylar notch or ACL reconstruction. Patients were excluded from this study if they were skeletally immature, underwent meniscus root or radial tear repair, or underwent meniscal repair with concurrent ligamentous reconstruction not limited to the ACL. At the preoperative evaluation and a minimum 2 years after the index meniscal repair procedure, patients were administered a subjective questionnaire. Differences in outcome scores, survivorship, and failure rates between the cohorts were assessed. Failure was defined as reoperation with meniscectomy or revision meniscal repair. Results: There were 109 patients (52 female, 57 male) who met the inclusion criteria for this study. There were 37 knees in cohort 1 (isolated meniscal repair plus MVP) and 72 knees in cohort 2 (meniscal repair plus ACL reconstruction). The failure status was known in 95 patients, and patient-reported outcome scores were obtained in 89 (82%) patients. Both cohorts demonstrated a significant improvement in all outcome scores, and there was no significant difference in any of the preoperative or postoperative outcome measures. The overall failure rate was 9.5% (9/95). There were 4 (12.9%) failures in cohort 1 and 5 failures (7.8%) in cohort 2, with no significant difference in failures between the cohorts ( P = .429). There was a significant association between failure and female sex ( P = .001). Conclusion: The most important finding in this study was that there was no difference in outcomes in meniscal repair performed with biological augmentation using an MVP versus that performed concomitantly with ACL reconstruction. The similar outcomes reported for meniscal repair with an MVP and meniscal repair with ACL reconstruction may be partly attributed to biological augmentation.

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Surgical Management of Simultaneous Anterior Cruciate Ligament and Patellar Tendon Ruptures: A Systematic Review

The Journal of Knee Surgery ◽

10.1055/s-0037-1615814 ◽

2017 ◽

Vol 31 (09) ◽

pp. 875-883 ◽

Cited By ~ 2

Author(s):

Carlos Meheux ◽

Robert Jack ◽

Patrick McCulloch ◽

David Lintner ◽

Joshua Harris

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Activity Level ◽

Two Stage ◽

One Stage ◽

Significant Difference ◽

Anterior Cruciate ◽

The One

AbstractThis study performs a systematic review to determine (1) if a significant difference exists in return to preinjury activity level between one- and two-stage treatment of combined anterior cruciate ligament (ACL) and patellar tendon (PT) tears; and (2) if a significant difference exists in the number of postoperative complications between the two differing surgical treatment approaches. A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and registered on PROSPERO. MEDLINE, Cochrane Central Register of Controlled Trials, SCOPUS, and Sport Discus were searched for English language level I–IV evidence studies on either one- (simultaneous) or two-stage (sequential) surgical treatment of simultaneously sustained ipsilateral ACL and PT tears. The approach to initial evaluation, diagnosis, treatment, and outcomes were qualitatively analyzed. Methodological quality assessment of all included studies was completed using the Methodological Index for Non-randomized Studies (MINORS). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to assess quality of evidence and provide strength of recommendation. Statistical analyses were done using Fischer's exact test. Eleven articles (18 patients; 83% males; mean age, 31.1 ± 10.1 years; mean follow-up, 2.2 ± 1.7 years; and mean MINORS 7.8/16) were analyzed. Eight patients had a one-stage procedure (primary PT repair and ACL reconstruction), and 10 patients underwent a two-stage procedure (primary PT repair first followed by ACL reconstruction) with mean 28 ± 45.7 weeks (5 weeks–3 years) between surgeries. The rate for return to preinjury activity level after surgery was not significantly different between one- (88%) and two-stage (100%) (p = 0.444). There was a significantly higher complication rate (p = 0.023) in the one-stage (stiffness, instability, and patella baja) versus two-stage surgery (no complications). There was no significant difference in return to preinjury activity level between one- and two-stage PT repair and ACL reconstruction. However, the one-stage combined surgery had a significantly higher complication rate compared with two-stage surgery. The level of evidence is IV.

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Clinical Outcome of Fixed Versus Adjustable Loop Cortical Suspension Devices in Arthroscopic Anterior Cruciate Ligament Reconstruction

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.3234 ◽

2020 ◽

Vol 22 (3) ◽

pp. 181-185

Author(s):

Ramy Said Assaad Ahmed Mohamed ◽

Mohamed Hossam El-Din El-Shafie ◽

Mohamed Ahmed El-Sheikh

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Loop Group ◽

Lysholm Score ◽

Graft Fixation ◽

Cruciate Ligament Reconstruction ◽

Significant Difference ◽

Anterior Cruciate

Background. Anterior cruciate ligament (ACL) reconstruction has remained the gold standard for ACL injuries, especially for young individuals and athletes exposed to high level sporting activities aiming to return to their preinjury level of activity. Cortical suspensory femoral fixation is commonly performed for graft fixation to the femur in anterior cruciate ligament reconstruction using hamstring tendons. The aim of this study was to compare the clinical results of using fixed and adjustable loop cortical suspension devices in arthroscopic ACL reconstruction using the Lysholm Knee Scoring Scale after 12 months postoperatively. Material and methods. This study included a total of sixty patients who underwent transportal arthroscopic ACL reconstruction using a hamstring tendon autograft from November 2016 to December 2017. For femoral graft fixation, a fixed-length loop device was used in 30 patients (fixed-loop group) and an adjustable-length loop device was used in 30 patients (adjustable-loop group) randomly.For tibial graft fixation, interference screw was used for all patients. Results. The present study shows that there was no statistically significant difference between the two groups regarding the Lysholm score with highly statistically significant difference between preoperative and postoperative Lysholm score in each group separately. Conclusion. Both fixed loop and adjustable loop devices in ACL reconstruction provided good clinical outcomes but without significant statistical difference between both groups from the clinical point of view postoperatively using the Lysholm score.

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A comparative study of anterior cruciate ligament reconstruction with double, single, or selective bundle techniques

Journal of Orthopaedic Surgery ◽

10.1177/2309499018773124 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901877312 ◽

Cited By ~ 4

Author(s):

Zi-Yang Chia ◽

Jade N Chee ◽

Hamid Rahmatullah Bin-Abd-Razak ◽

Denny TT Lie ◽

Paul CC Chang

Keyword(s):

Anterior Cruciate Ligament ◽

Comparative Study ◽

Cruciate Ligament ◽

International Knee Documentation Committee ◽

Rotational Stability ◽

Single Bundle ◽

Stress Tests ◽

Significant Difference ◽

Anterior Cruciate

Purpose: Reconstruction of the anterior cruciate ligament (ACL) is the most frequently performed reconstructive surgery in the knee. Biomechanical studies have shown that double bundle (DB) reconstruction is better than single bundle (SB) reconstruction with regard to rotational stability. It is postulated that resection of ACL fibres that remain in continuity may be counterproductive for the knee as these fibres have the capacity to produce collagen. In this study, we aimed to evaluate the efficacy among selective bundle, DB and SB ACL reconstructions over a 2-year post-operative follow-up period. Methods: A retrospective comparative study was conducted for comparison between selective bundle, DB and SB reconstructions. Between 2012 and 2014, 291 ACL reconstructions were performed. Of these, 68 patients had selective ACL reconstructions (group SLB), 147 had DB ACL reconstructions (group DB) and 76 had SB ACL reconstructions (group SB). Institutional Review Board approval was obtained, and all patients provided informed consent. Clinical results were assessed with the International Knee Documentation Committee (IKDC), Lysholm and Tegner scores. Stability was measured using Lachman, pivot shift and anterior drawer stress tests using the KT1000 at 30° of knee flexion. Results: There was no significant difference in ligament grade, function grade, IKDC grade, as well as Tegner and Lysholm means among all three groups after a 2-year follow-up period. Conclusion: Selective bundle reconstruction provides comparable results to DB and SB reconstruction techniques. It is a viable alternative for patients with partial tears.

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In Vitro Testing of 2 Adjustable-Loop Cortical Suspensory Fixation Systems Versus Interference Screw for Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211031652 ◽

2021 ◽

Vol 9 (9) ◽

pp. 232596712110316

Author(s):

Gerardo L. Garcés ◽

Oscar Martel ◽

Alejandro Yánez ◽

Ignacio Manchado-Herrera ◽

Luci M. Motta

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Failure Load ◽

Cruciate Ligament ◽

Interference Screw ◽

Yield Load ◽

Ultimate Failure Load ◽

Significant Difference ◽

Ultimate Failure ◽

Anterior Cruciate

Background: It is not clear whether the mechanical strength of adjustable-loop suspension devices (ALDs) in anterior cruciate ligament (ACL) reconstruction is device dependent and if these constructs are different from those of an interference screw. Purpose: To compare the biomechanical differences of 2 types of ALDs versus an interference screw. Study Design: Controlled laboratory study. Methods: ACL reconstruction was performed on porcine femurs and bovine extensor tendons with 3 types of fixation devices: interference screw, UltraButton (UB) ALD, and TightRope (TR) ALD (n = 10 for each). In addition to specimen testing, isolated testing of the 2 ALDs was performed. The loading protocol consisted of 3 stages: preload (static 150 N load for 5 minutes), cyclic load (50-250 N at 1 Hz for 1000 cycles), and load to failure (crosshead speed 50 mm/min). Displacement at different cycles, ultimate failure load, yield load, stiffness, and failure mode were recorded. Results: In specimen testing, displacement of the ALDs at the 1000th cycle was similar (3.42 ± 1.34 mm for TR and 3.39 ± 0.92 mm for UB), but both were significantly lower than that of the interference screw (7.54 ± 3.18 mm) ( P < .001 for both). The yield load of the UB (547 ± 173 N) was higher than that of the TR (420 ± 72 N) ( P = .033) or the interference screw (386 ± 51 N; P = .013), with no significant difference between the latter 2. In isolated device testing, the ultimate failure load of the TR (862 ± 64 N) was significantly lower than that of the UB (1879 ± 126 N) ( P < .001). Conclusion: Both ALDs showed significantly less displacement in cyclic loading at ultimate failure than the interference screw. The yield load of the UB was significantly higher than that of the other 2. The ultimate failure occurred at a significantly higher load for UB than it did for TR in isolated device testing. Clinical Relevance: Both UB and TR provided stronger fixation than an interference screw. Although difficult to assess, intrinsic differences in the mechanical properties of these ALDs may affect clinical outcomes.

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The Influence of Anterior Cruciate Ligament Remnant on Postoperative Clinical Results in Patients with Remnant Preserving Anterior Cruciate Ligament Reconstruction

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2017.096 ◽

2017 ◽

Vol 5 (5) ◽

pp. 624-629 ◽

Cited By ~ 4

Author(s):

Alan Goce Andonovski ◽

Sonja Topuzovska ◽

Milan Samardziski ◽

Zoran Bozinovski ◽

Biljana Andonovska ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Clinical Results ◽

Control Group ◽

Single Bundle ◽

Knee Stability ◽

The Mean ◽

Anterior Cruciate ◽

Proprioceptive Function

BACKGROUND: Anterior Cruciate Ligament (ACL) remnants have important biomechanical, vascular and proprioceptive function.AIM: To determine the influence of the ACL residual remnants after partial and complete ACL ruptures on postoperative clinical results in patients with remnant preserving ACL reconstruction.PATIENTS AND METHODS: The study included 66 patients divided into two groups. In patients from the investigation group remnant preserving ACL reconstruction was performed, in patients from the control group single bundle ACL reconstruction was performed. The results were assessed by Rolimeter measurements, Lysholm and Tegner scores and proprioception evaluation.RESULTS: The mean side-to-side difference of anterior tibia displacement (mm) was improved from 4.4 ± 1.06 to 0.4 ± 0.7 in the investigation group, and from 4.6 ± 0.68 to 1.9 ± 0.64 in the control group (p < 0.001). Difference in the angles in which the knee was placed by the device and the patient has improved from 1.5 ± 0.96° to 0.5 ± 0.53° in the investigation group and from 1.8 ± 0.78° to 1.3 ± 0.97° in the control group (p < 0.05). Tegner and Lysholm scores showed no difference between the groups.CONCLUSION: Preservation of the ACL residual bundle provides a better knee stability and proprioceptive function.

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Meniscal Repair with Concurrent Anterior Cruciate Ligament Reconstruction: Is ACL Graft Choice Predictive of Meniscal Repair Success?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00359 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0035

Author(s):

Hytham S. Salem ◽

Laura J. Huston ◽

Alex Zajichek ◽

Michelle Lora Wolcott ◽

Eric C. McCarty ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meniscal Tear ◽

Meniscal Repair ◽

Acl Graft ◽

Baseline Activity ◽

Graft Choice ◽

Significant Difference ◽

Anterior Cruciate

Objectives: The success rate of meniscal repair is known to increase with concurrent anterior cruciate ligament (ACL) reconstruction. However, the influence of ACL graft choice has not been described. The current study examines the effect of ACL graft choice on the outcome of meniscal repair performed in conjunction with ACL reconstruction (ACLR). Methods: Patients who underwent meniscal repair with concurrent primary ACLR were identified from a longitudinal, prospective cohort. Patient demographics and subjective outcome measures including the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity rating scale were collected preoperatively. Arthroscopic assessment of meniscal tear characteristics and associated repair technique were recorded intraoperatively. Patients with subsequent repair failure, defined as any subsequent surgical procedure addressing the meniscus repaired at index surgery, were identified and operative notes were obtained in order to accurately classify pathology and treatment. A logistic regression model was built to assess the association of patient specific factors, ACL graft, baseline Marx activity level and meniscal tear laterality with the occurrence of repair failure at 6-year follow-up. Results: A total of 646 patients underwent ACLR with concurrent meniscal repair. Bone-patellar tendon-bone (BTB) and soft tissue (ST) autograft were used in 55.7% and 33.9% of cases, respectively, while allografts were utilized in the remaining cases. Table 1 summarizes the univariate analysis of each baseline variable. A total of 101 patients (15.6%) required subsequent surgery on the meniscus repaired at index surgery, including 89 meniscectomies (87 partial, 2 subtotal), 11 revision meniscal repairs, and 1 meniscus allograft transplantation. No statistically significant difference in meniscal repair failure rate was observed based on patient age, sex, BMI or smoking status. The odds of meniscal repair failure within 6 years of surgery for patients with only a lateral meniscal repair are 68% less than those with only a medial meniscal repair (CI: 41%, 83%; p<0.001). There is a statistically significant relationship between baseline Marx activity and the risk of subsequent meniscal repair, though it is nonlinear—patients with low or high baseline activity are at the highest risk of meniscal repair failure (CI: 1.05,1.31; p=0.004, Figure 1). The estimated odds of meniscal repair failure for BTB allograft, ST allograft, and ST autograft were 2.78 (CI: 0.84,9.19; p=0.09), 2.29 (CI: 0.97,5.45; p=0.06), and 1.42 (CI:0.87,2.32; p=0.16) times that of BTB autograft, respectively, although none proved statistically significant. Meniscal repair failure is associated with significantly lower 6-year scores for all KOOS components and the IKDC (p<0.001). However, there was no significant difference in MARX activity at 6-years (p=0.27). Conclusion: In the setting of primary ACLR, the risk of meniscal repair failure is increased with medial versus lateral meniscal repair. Patients with low or high baseline activity levels are also at an increased risk. ACL graft choice seems to have an effect on meniscal repair failure that approaches but does not reach statistical significance. A larger sample size may be required to accept the null hypothesis. [Table: see text][Figure: see text]

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