scholarly journals Platelet-Rich Plasma in Anterior Cruciate Ligament Quadriceps Tendon Bone Reconstruction—Impact of PRP Administration on Pain, Range of Motion Restoration, Knee Stability, Tibial Tunnel Widening and Functional Results

2021 ◽  
Vol 11 (9) ◽  
pp. 3993
Author(s):  
Konrad Malinowski ◽  
Michał Ebisz ◽  
Robert F LaPrade ◽  
Marcin Mostowy
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Quadriceps Tendon ◽  
Functional Results ◽  
Tunnel Widening ◽  
Knee Stability ◽  
On Demand ◽  
The Mean ◽  
Anterior Cruciate

Background: Using Platetet-Rich Plasma (PRP) in anterior cruciate ligament reconstruction (ACLR) has been suggested to improve patient outcomes. The aim of this study was to assess the impact of PRP administration on pain, range of motion (ROM) restoration and the functional results of ACLR performed with quadriceps tendon bone (QTB) autografts. Methods: A total of 106 patients were included in this multicenter study. Fifty-two patients underwent single-bundle QTB ACLR and 54 patients underwent the same procedure with additional PRP administration. Results: Mean time of need for on-demand analgesia was 8 days in the PRP group and 11 days in no-PRP group. Symmetric full extension was restored in a mean of 40 days in the PRP group and 53 days in the no-PRP group. Ninety degrees of flexion was restored at a mean of 21 days in the PRP group and 25 days in the no-PRP group. At 18 months postoperatively, the mean side-to-side difference in anterior tibial translation with the use of an arthrometer (Rolimeter, Aircast Europa) was 1.3 mm in the PRP group vs. 2.7 mm in the no-PRP group. Mean tibial tunnel widening was 1.4 mm in the PRP group vs. 2.1 mm in the no-PRP group. The mean score in the pain section of the KOOS scale was 93 in the PRP group vs. 89 in the no-PRP group. For the IKDC scale, 53 patients in the PRP group graded A or B and 1 patient graded C. In the no-PRP group, 48 patients graded A or B and 4 patients graded C or D. Conclusions: The use of PRP in QTB ACLR may decrease the need for on-demand analgesia and accelerate ROM restoration as well as improve knee stability, lessen the extent of tibial tunnel widening and potentially diminish pain at 18 months postoperatively. Further studies will be needed to confirm all authors’ conclusions.

scholarly journals Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Incorporation

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096009
Author(s):  
Etienne Cavaignac ◽  
Timothée Mesnier ◽  
Vincent Marot ◽  
Andrea Fernandez ◽  
Marie Faruch ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Tunnel Widening ◽  
Graft Healing ◽  
Graft Incorporation ◽  
The Mean ◽  
Anterior Cruciate

Background: It has been shown that adding lateral extra-articular tenodesis (LET) to standard anterior cruciate ligament (ACL) reconstruction significantly decreases the loads on the ACL composite graft. To date, the possible effect of LET on ACL graft incorporation is not known. Purpose: To compare the incorporation in tibial bone tunnels of a standard quadrupled semitendinosus (ST4) graft to an ST4 graft plus LET at 1 year postoperatively using magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 62 patients who underwent ACL reconstruction were enrolled prospectively: 31 received an ST4 graft, and 31 received an ST4 graft plus LET. Graft incorporation was evaluated with MRI at the 1-year follow-up visit. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel widening, graft healing, and graft maturity according to the Howell scale. The primary endpoint was the SNQ of the ST4 graft at 1 year postoperatively; this parameter was adjusted because of unequal baseline characteristics between groups. Clinical and functional outcomes as well as incorporation of the graft were analyzed as secondary endpoints. Results: The mean adjusted SNQ was 0.5 ± 2.1 (95% CI, 0.4-4.6) in the ST4 + LET group and 5.9 ± 3.7 (95% CI, 4.7-7.0) in the ST4 group ( P = .0297). The mean tibial tunnel widening was 73.7% ± 42.2% in the ST4 + LET group versus 77.5% ± 46.7% in the ST4 group ( P = .5685). Howell grade I, indicative of better graft maturity, was statistically more frequent in the ST4 + LET group ( P = .0379). No statistically significant difference was seen between groups in terms of graft healing ( P = .1663). The Lysholm score was statistically higher in the ST4 + LET group ( P = .0058). No significant differences were found between groups in terms of the International Knee Documentation Committee subjective score ( P = .2683) or Tegner score ( P = .7428). The mean SNQ of the LET graft at the 1-year follow-up visit was 2.6 ± 4.9. Conclusion: At 1 year postoperatively, the MRI appearance of ACL grafts showed generally better incorporation and maturation when combined with LET.

Length of the Tendon within the Tibial Tunnel Affects Tibial Tunnel Widening following Anatomic Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Graft

2019 ◽  
Vol 33 (05) ◽  
pp. 445-451
Author(s):  
Shuji Taketomi ◽  
Hiroshi Inui ◽  
Ryota Yamagami ◽  
Kohei Kawaguchi ◽  
Keiu Nakazato ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Pivot Shift Test ◽  
Tunnel Widening ◽  
Tendon Length ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

AbstractThe purpose of this study was to retrospectively investigate the effects of variations in the length of the tendon within the tibial tunnel on tunnel widening (TW) following anatomical anterior cruciate ligament (ACL) reconstruction using a bone–patellar tendon–bone (BTB) graft. In total, 68 patients who underwent isolated ACL reconstructions using BTB grafts were included in this study. The patients were divided into two groups according to the length of the tendon within the tibial tunnel: group S (n = 30; tendon length, < 10 mm) and group L (n = 38; tendon length, ≥ 10 mm). Tunnel aperture area was measured using three-dimensional computed tomography (3D CT) at 1 week and 1 year postoperatively, and tibial TW (%) was calculated. The correlation coefficient between the length of the tendon within the tibial tunnel and tibial TW was also calculated. Clinical assessment was performed 1 year postoperatively, corresponding to the period of CT assessment, which involved the evaluation of the Lysholm's score, measurement of anterior knee stability using a KneeLax3 arthrometer, and the pivot-shift test. A weak positive correlation was observed between the length of the tendon within the tibial tunnel and tibial TW (r = 0.270, p = 0.026). Mean tibial tunnel aperture area increased by 19.3 ± 17.4% and 35.8 ± 25.4% in the groups S and L, respectively. TW in the group L was significantly greater than that in the group S (p = 0.004). No significant difference was observed between the two groups in any clinical outcomes. In conclusion, a longer tendinous portion within the tibial tunnel resulted in a greater tibial TW following anatomical ACL reconstructions using a BTB graft.

scholarly journals The Effects of Tunnel Position in Patients Who Underwent the Anterior Cruciate Ligament Reconstruction with Transfix Method on the Clinical and Functional Results

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0005
Author(s):  
Tayyar Taylan Öz ◽  
Kaya Akan ◽  
İrfan Esenkaya ◽  
Samet Erinç ◽  
Burak Özturan ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Functional Results ◽  
Cruciate Ligament Reconstruction ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Tunnel Positions

Objective: The aim of this study is to analyse the effects of femoral and tibial tunnel localization in the sagittal plane in the patients who underwent the anterior cruciate ligament reconstruction with transfix method in our clinic on the clinical and functional results. Methods: 36 patients underwent the anterior cruciate ligament reconstruction performed by different surgeons with the same method between January 2010 and December 2014 in Istanbul Medeniyet University Goztepe Training and Research Hospital Orthopaedics and Traumatology Clinic. Femoral and tibial tunnel localization was conducted on the lateral radiography of the knee of the patients. The clinical evaluations of the patients were carried out with lysholm score, IKDC score, tegner activity score, extensor and flexor measured by CYBEX CSMI dynamometer for muscular strength loss. Results: It was observed that femoral tunnel positions of 47.2% (n=17) of the patients were at the intended location while the ones of 52.8% (n=19) were in anterior. Tibial tunnel positions of 52.8% (n=19) of the patients were at the intended location while the ones of 33.3% (n=12) were in anterior, and the ones of 13.9% (n=5) were in posterior. The postoperative lysholm scores of F (+) T (+) group were significantly higher than F (+) T (-) (p=0.004), F (-) T (+) (p=0.004) and F (-) T (-) (p=0.004) groups. The postoperative IKDC score normality of F (+) T (+) group were significantly higher than F (-) T (+). The postoperative tegner measurements of F (+) T (+) group were significantly higher than F (-) T (+). The measurements of extensor deficit of F (+) T (+) (p=0.022) group and F (+) T (-) (p=0.049) group were significantly lower than F (-) T (-) group. The measurements of flexor deficit of F (+) T (+) group were significantly lower than F (-) T (+) (p=0.011) group and F (-) T (-) (p=0.040) group and F (+) T (-) group of flexor deficit measurements significantly lower than F (-) T (+) group (p=0.028) (p<0.05). Conclusion: Misplacement of femoral and tibial tunnels has negative effects on clinic functional results. While misplacement of tibial tunnel can be tolerated better, the placement of femoral tunnel in anterior cannot be tolerated and has further effects on the results.

Comparison of Acorn and Fluted Reamers on Tibial Tunnel Outer Aperture Dimensions in Anterior Cruciate Ligament Reconstruction

2020 ◽  
Author(s):  
Adam D. Gerrard ◽  
Chris M. Jump ◽  
Paul Sutton ◽  
Charalambos P. Charalambous
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Aperture Width ◽  
The Mean ◽  
Anterior Cruciate ◽  
Degree Deviation ◽  
Substantial Change

AbstractThe aim of this study was to determine if the type of reamer used in tibial tunnel creation during anterior cruciate ligament (ACL) reconstruction influences the dimensions of the tunnel's outer aperture. Tibial tunnels were created in tibial saw bones by reaming over a guidewire using an 8 mm acorn or fluted reamer in an antegrade manner. Reaming was aimed either in line with the guidewire, or with 10-degree inferior/superior deviation in relation to the wire. The shape and size of the outer aperture of the tibial tunnel were compared between the two reamers. When using the acorn reamer, a 10-degree deviation in relation to the guidewire resulted in minimal change in outer aperture length (mean 13.6 vs. 15.6 mm, p = 0.11) and width (11.6 vs. 11.1 mm, p = 0.51). However, when using the fluted reamer, although the aperture width showed no substantial change with reamer/guidewire deviation (11.4 vs. 11.2 mm, p = 0.71), the mean length almost doubled (14.7 vs. 28.1 mm, p = 0.002). The use of a fluted reamer when reaming the tibial tunnel creates a distal aperture which is inconsistently sized, larger, and of oblong shape compared with an acorn-shaped reamer. This should be taken in consideration when using a fluted reamer for creating the tibial tunnel in ACL reconstruction.

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

2017 ◽  
Vol 5 (5) ◽  
pp. 624-629 ◽  
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.

Correlation Between Endobutton Loop Length and Tunnel Widening After Hamstring Anterior Cruciate Ligament Reconstruction

2012 ◽  
Vol 41 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Nam-Hong Choi ◽  
Jong-Seok Oh ◽  
Seok-Hyun Jung ◽  
Brian N. Victoroff
Keyword(s):  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Pivot Shift Test ◽  
Tunnel Widening ◽  
Significant Difference ◽  
Kt 1000 ◽  
The Mean ◽  
Anterior Cruciate ◽  
Tegner Activity Scale

Background: Previous reports have shown that graft fixation with the Endobutton is associated with tunnel widening because it provides distant fixation rather than aperture fixation. Hypothesis: A longer loop of the Endobutton results in greater tunnel widening than a shorter loop. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 171 consecutive patients underwent hamstring anterior cruciate ligament (ACL) reconstruction fixed with the Endobutton. They were followed for a minimum of 2 years postoperatively. A 15-mm loop was used in 20 patients, a 20-mm loop in 53, a 25-mm loop in 58, and a >30-mm loop in 40. On anterior-posterior (AP) and lateral radiographs, the measured diameters of the femoral tunnel at 2 years after surgery were compared with the diameter of the reamer used at surgery. The measured diameter of the tibial tunnel at 2 years after surgery was compared with measurements taken on the immediate postoperative day. The center of the tibial tunnel and direction of the ACL graft were also measured. Postoperative knee stability was evaluated using the Lachman test, pivot-shift test, and KT-1000 arthrometer. Functional evaluations were performed using the Lysholm score and Tegner activity scale. All measurements were compared among the 4 groups according to the length of the Endobutton loop. Results: The mean ± standard deviation (SD) diameter of the femoral tunnel increased by 50.7% ± 23.3% and 37.0% ± 18.8% on AP and lateral radiographs at 2 years after surgery, respectively. The mean ± SD diameter of the tibial tunnel increased by 40.8% ± 19.3% and 46.4% ± 22.6% on AP and lateral radiographs, respectively. No significant difference in tunnel widening was present according to the length of the Endobutton loop. There were no significant differences in the average center of the tibial tunnel or the average angle of the direction of the ACL graft among the 4 groups. There was no significant difference in Lachman test results, postoperative KT-1000 arthrometer side-to-side differences, Lysholm score, and Tegner activity scale score among the 4 groups. The group with a >30-mm loop showed a significant difference in the pivot-shift test than the other 3 groups ( P = .023). Conclusion: A longer Endobutton loop did not result in greater tunnel widening than a shorter loop. Long fixation distance may not be associated with tunnel widening after hamstring ACL reconstructions.

scholarly journals Tibial tunnel widening following anterior cruciate ligament reconstruction: A retrospective seven-year study evaluating the effects of initial graft tensioning and graft selection

The Knee ◽  
2018 ◽  
Vol 25 (6) ◽  
pp. 1107-1114 ◽  
Author(s):  
Steven F. DeFroda ◽  
Naga Padmini Karamchedu ◽  
Brett D. Owens ◽  
Steven L. Bokshan ◽  
Kayleigh Sullivan ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Tunnel Widening ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Graft Selection
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