Association of KT-1000 Measurements With Clinical Tests of Knee Stability 1 Year Following Anterior Cruciate Ligament Reconstruction

ImportanceThis review highlights the differences in outcomes between anatomical and non-anatomical anterior cruciate ligament reconstruction (ACLR) techniques.ObjectiveTo compare clinical and functional outcomes between anatomical and non-anatomical ACLR techniques.Evidence reviewA search of MEDLINE, Embase and PubMed from 1 January 2000 to 24 October 2019 was conducted. Randomised and prospective primary ACLR studies using autograft and a minimum of 2 years of follow-up were included. The Anatomic Anterior Cruciate Ligament Reconstruction Checklist (AARSC) was used to categorise studies as anatomical. Outcomes analysed included failure rate, knee stability and functional outcomes. A meta-analysis using risk ratio and mean differences was conducted using a random effects model.FindingsThirty-six studies were included, representing 3710 patients with a follow-up range of 24–300 months. The overall failure rate was 96/1470 (6.5%) and 131/1952 (6.7%) in the anatomical group and non-anatomical group, respectively. The pooled results of the overall failure rate showed that there was no statistically significant difference between the anatomical and the non-anatomical groups (p=0.96). There were 37/60 (61.7%) and 29/67 (43.3%) traumatic failures in the anatomical and non-anatomical groups, respectively. The number of patients with the negative postoperative pivot-shift test was 995/1252 (79.5%) and 1140/1589 (71.1%) in the anatomical and non-anatomical groups, respectively. The pooled results indicated a statistically significant higher number of patients with a positive pivot shift in the non-anatomical group compared with the anatomical group (p=0.03).Conclusions and relevanceThis study demonstrated that the overall failure rate was similar between the anatomical and non-anatomical approaches. However, the anatomical ACLR demonstrated a significantly superior restoration of rotatory stability, as evidenced by a higher percentage with a negative postoperative pivot-shift test. Non-anatomical ACLR resulted in higher rates of atraumatic graft ruptures and persistent rotatory knee instability. Surgeons should consider anatomical ACLR when treating rotatory knee stability in patients.Level of evidenceII, systematic review and meta-analysis of level I and II studies.

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Primary Anterior Cruciate Ligament Reconstruction Using Fresh-Frozen, Nonirradiated Patellar Tendon Allograft

The American Journal of Sports Medicine ◽

10.1177/0363546504267347 ◽

2005 ◽

Vol 33 (2) ◽

pp. 284-292 ◽

Cited By ~ 79

Author(s):

Bernard R. Bach ◽

Kirk J. Aadalen ◽

Michael G. Dennis ◽

Dominic S. Carreira ◽

John Bojchuk ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Patellar Tendon ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Radiographic Evaluation ◽

Cruciate Ligament Reconstruction ◽

Kt 1000 ◽

Fresh Frozen ◽

Anterior Cruciate

Background There are conflicting reports of allograft performance, immune response, tissue incorporation, and rerupture rates when used for anterior cruciate ligament reconstruction. Purpose To evaluate the clinical outcome of a fresh-frozen, nonirradiated, patellar tendon allograft for primary anterior cruciate ligament reconstruction surgery. Study Design Case series; Level of evidence, 4. Methods Patients who underwent endoscopic primary anterior cruciate ligament reconstruction with allograft tissue a minimum of 2 years ago were evaluated with physical examinations, the KT-1000 arthrometer, functional testing, radiographic evaluation, subjective assessment, and outcomes tools. Results Fifty-nine patients (60 knees) were evaluated at an average of 51 months after surgery. Ninety-four percent of patients were mostly or completely satisfied. A negative pivot shift test result was noted in 90% of subjects. The KT-1000 arthrometer side-to-side differences were = 3 mm in 95% of patients, and no patient exceeded 5 mm. The mean International Knee Documentation Committee score was 78 (SD = 19), and the mean Lysholm score was 82 (SD = 17). There were no clinical symptoms consistent with graft rejection or infection. Radiographic evaluation demonstrated infrequent significant tunnel widening. Conclusions Use of a fresh-frozen, nonirradiated allograft for primary reconstruction of the anterior cruciate ligament is a successful procedure both subjectively and functionally for restoring stability in patients selected for allograft reconstruction. In the patients selected for this surgical procedure, clinical, arthrometric stability testing, and subjective satisfaction were comparable to our previously published cohort studies using patellar tendon autograft at similar postoperative follow-up.

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