A Comprehensive Framework to Evaluate the Effects of Anterior Cruciate Ligament Injury and Reconstruction on Graft and Cartilage Status through the Analysis of MRI T2 Relaxation Time and Knee Laxity: A Pilot Study

Background. Anterior cruciate ligament (ACL) tear represents a common orthopedic traumatic issue that often leads to an early development of osteoarthritis. To improve the diagnostic and prognostic techniques involved in the assessment of the joint after the trauma and during the healing process, the present work proposes a multi-parametric approach that aims to investigate the relationship between joint function and soft tissue status before and after ACL reconstruction. Methods. Thirteen consecutive patients who underwent ACL reconstruction were preliminarily enrolled in this study. Joint laxity assessment as well as magnetic resonance imaging with T2 mapping were performed in the pre-operative stage, at four and 18 months after surgery to acquire objective information to correlate knee function and soft tissue condition. Results. Correlations were found between graft and cartilage T2 signal, suggesting an interplay between these tissues within the knee joint. Moreover, graft maturation resulted in being connected to joint laxity, as underlined by the correlation between the graft T2 signal and the temporal evolution of knee function. Conclusions. This preliminary study represents a step forward in assessing the effects of ACL graft maturation on knee biomechanics, and vice versa. The presented integrated framework underlines the possibility to quantitatively assess the impact of ACL reconstruction on trauma recovery and cartilage homeostasis. Moreover, the reported findings—despite the preliminary nature of the clinical impacts—evidence the possibility of monitoring the surgery outcomes using a multi-parametric prognostic investigation tool.

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Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

The American Journal of Sports Medicine ◽

10.1177/03635465211027302 ◽

2021 ◽

pp. 036354652110273

Author(s):

Joshua S. Everhart ◽

Sercan Yalcin ◽

Kurt P. Spindler

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Knee Function ◽

Increased Risk ◽

Patient Reported ◽

The Mean ◽

Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

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POSTEROMEDIAL MENISCAL AND ANTERIOR CRUCIATE LIGAMENT STRAINS DURING DYNAMIC ACTIVITIES FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Journal of Musculoskeletal Research ◽

10.1142/s0218957720500104 ◽

2020 ◽

Vol 23 (02) ◽

pp. 2050010

Author(s):

Sebastian Tomescu ◽

Ryan Bakker ◽

David Wasserstein ◽

Mayank Kalra ◽

Micah Nicholls ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Strain Difference ◽

Cruciate Ligament ◽

Knee Simulator ◽

Lower Strain ◽

Healthy Knee ◽

Anterior Cruciate ◽

The Impact

Background: Meniscal strain patterns are not well understood during dynamic activities. Furthermore, the impact of ACL reconstruction on meniscal strain has not been thoroughly investigated. The purpose of this study was to characterize ACL and meniscal strain during dynamic activities and investigate the strain difference between ACL-intact and ACL-reconstructed ligament conditions. Methods: ACL and medial meniscal strain were measured in-vitro during gait, a double leg squat, and a single leg squat. For each activity kinematics and muscle forces were applied to seven cadaveric specimens using a dynamic knee simulator. Testing was performed in the ACL-intact and ACL-reconstructed ligament conditions. Results: Both the ACL and meniscus had distinct strain patterns that were found to have a significant interaction with knee angle during gait and double leg squat ([Formula: see text]). During gait, both tissues experienced lower strain during swing than stance (ACL: 3.0% swing, 9.1% stance; meniscus: 0.2% swing, 1.3% stance). Meniscal strain was not found to be different between ACL-intact and ACL-reconstructed conditions ([Formula: see text]). Conclusions: During dynamic activities, the strain in the meniscus was not altered between ACL ligament conditions. This indicates that meniscal mechanics after ACL reconstruction are similar to a healthy knee. These results help further the understanding of osteoarthritis risk after ACL reconstruction.

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Impact of Anterior Cruciate Ligament Reconstruction on NCAA FBS Football Players: Return to Play and Performance Vary by Position

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119841056 ◽

2019 ◽

Vol 7 (4) ◽

pp. 232596711984105 ◽

Cited By ~ 3

Author(s):

Patrick Martin Wise ◽

Robert A. Gallo

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

National Collegiate Athletic Association ◽

Functional Performance ◽

Cruciate Ligament ◽

Return To Play ◽

Football Players ◽

Significant Performance ◽

Anterior Cruciate ◽

The Impact

Background: Anterior cruciate ligament (ACL) injuries are devastating for college football players. Although the change in functional performance of National Collegiate Athletic Association (NCAA) football players after reconstruction has been shown to be negligible, studies have failed to analyze the statistical performance of these players upon their return. Purpose/Hypothesis: The purpose of this study was to quantify the impact of ACL reconstruction on the statistical performance of collegiate football players. We hypothesized that statistical performance would vary by position and that running backs, wide receivers, and defensive backs, compared with preinjury and controls, would experience the largest decline in performance after returning from ACL reconstruction. Study Design: Descriptive epidemiology study. Methods: NCAA Football Bowl Subdivision (FBS) football players who experienced ACL tears between the years 2010 and 2015 were identified. The rates of return to play after surgery were determined for each position. Preinjury and postoperative performance statistics of each running back, receiver, defensive lineman, linebacker, and defensive back who met inclusion criteria were compared. A t-test analysis was used to compare the performance changes experienced by these players versus the performance changes of matched controls. Results: A total of 349 players were identified. Only 63.64% of eligible offensive linemen returned to play. Upon return, running backs experienced significant performance decreases compared with controls in carries (mean ± SD, –2.4 ± 2.7 vs 2.8 ± 1.6; P = .003), yards (–12.3 ± 15.5 vs 13.8 ± 7.8; P = .006), and receptions (–0.22 ± 0.32 vs 0.32 ± 0.23; P = .011) per game. Receivers displayed significant performance decreases compared with controls in number of touchdowns (–0.019 ± 0.110 vs 0.18 ± 0.06; P = .004), receptions (–0.11 ± 0.79 vs 1.2 ± 0.4; P = .004), and yards (–3.2 ± 10.6 vs 18.6 ± 5.4; P = .0009) per game. Linebackers demonstrated less improvement than controls in tackles for loss (0.007 ± 0.115 vs 0.31 ± 0.11; P = .0003) and sacks (0.001 ± 0.061 vs 0.10 ± 0.06; P = .026). Conclusion: Although offensive linemen were the least likely to return to play, running backs and receivers returned to play at a lower level of performance. The performance of defensive players was less affected by ACL reconstruction.

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Soft tissue allograft for primary anterior cruciate ligament reconstruction

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172058 ◽

2017 ◽

Vol 3 (4) ◽

pp. 718

Author(s):

Rahul P. ◽

Suraj H. P. ◽

Satish Shervegar ◽

Abhilash Palla

Keyword(s):

Anterior Cruciate Ligament ◽

Soft Tissue ◽

Acl Reconstruction ◽

Functional Disability ◽

Cruciate Ligament ◽

Donor Site ◽

Ligament Injury ◽

Tissue Allograft ◽

Anterior Cruciate ◽

Primary Acl Reconstruction

Background: Arthroscopic ACL reconstruction has become one of the most commonly performed arthroscopic surgeries. Inspite of extensive research on available autograft options, controversy still persists regarding the ideal graft. Allograft tendons usage in orthopedic operations has increased because of its advantages. This study was conducted to assess the functional outcome in patients undergoing ACL reconstruction with soft tissue allografts.Methods: 15 patients with Anterior Cruciate Ligament injury presenting from 2012-2014 who underwent Arthroscopic ACL reconstruction with soft tissue allograft were the subjects of this Prospective study. Assessment of the involved knee was performed to obtain subjective measures of the clinical outcomes of the ACL reconstruction. All patients were followed up at regular intervals of 3 weeks, 6 weeks, 12 weeks, 6 months and 2 years.Results: At the final follow up, the patients had an average Lysholm knee score of 85.60, Tegner score of 7.24 and IKDC score of 85.28. Knee flexion of >1200 was achieved in >80% of patients and minimal laxity in 60% patients but no functional disability in any of them. No graft failures were noted. Conclusions: Contrary to the fear of graft failure and complications associated with allograft construct for primary ACL reconstruction, allografts yield the same clinical outcome as autografts with the advantages of reduced operative time, no donor site morbidity, preservation of native hamstring tendons, faster and comfortable rehabilitation. Allografts are a good alternative to autografts for primary ACL reconstruction.

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Varying femoral-sided fixation techniques in anterior cruciate ligament reconstruction have similar clinical outcomes: a network meta-analysis

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2018-000206 ◽

2018 ◽

Vol 3 (4) ◽

pp. 220-228

Author(s):

Ajay Shah ◽

Daniel Joshua Hoppe ◽

David M Burns ◽

Joseph Menna ◽

Daniel Whelan ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Soft Tissue ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meta Analysis ◽

Optimal Method ◽

Femoral Fixation ◽

Kt 1000 ◽

Level I ◽

Anterior Cruciate

ImportanceThere is significant controversy regarding the optimal femoral fixation method in anterior cruciate ligament (ACL) reconstruction. Given the importance of ACL reconstruction in patient return to sport and quality of life, it is imperative to identify the optimal method of femoral fixation.ObjectiveThe primary objective of this study is to identify the optimal method of femoral fixation in ACL reconstruction with soft tissue grafts. There are three main techniques for femoral-sided fixation in ACL reconstruction: suspensory extracortical buttons (EC), interference screws (IS) and transfemoral crosspins (TF). Previous primary studies have provided conflicting results regarding the superior method, and prior systematic reviews have failed to identify a difference; however, these analyses were only able to make comparisons between two of the treatments directly. This study employed a network meta-analysis technique to maximise sample size and statistical power, increasing the validity of its findings.Evidence reviewA network meta-analysis was conducted using results from 19 randomised controlled trials. Only studies with level I or II evidence, directly comparing two interventions in ACL soft tissue graft reconstruction, were included. Graft failure rates, International Knee Documentation Committee scores and KT-1000 knee arthrometer scores were the primary outcomes measured. Secondary outcomes included Lysholm, Tegner, Lachman and Pivot Shift scores.FindingsAn overall sample of 1372 patients was analysed. No statistically significant differences were detected among outcomes, except for the KT-1000 analysis which slightly favoured EC over IS and TF fixation (mean difference (MD)=−0.53 mm; 95% CI −0.07 to –0.98), and TF over IS fixation (MD=−0.41 mm; 95% CI −0.05 to –0.76). The clinical consequences of this difference are likely minimal.ConclusionsBased on the results of this network meta-analysis, there is no clear statistically superior method of femoral fixation in soft tissue ACL reconstruction.Level of evidenceLevel II (systematic review of level I and II studies).

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VARIATION IN PREFERRED TECHNIQUE FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN THE SKELETALLY IMMATURE: WHERE DO WE STAND?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00112 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0011

Author(s):

Neeraj M. Patel ◽

Nakul S. Talathi ◽

Divya Talwar ◽

Peter D. Fabricant ◽

Mininder S. Kocher ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Fellowship Training ◽

Reconstruction Technique ◽

Hybrid Technique ◽

Skeletally Immature ◽

Anterior Cruciate ◽

Age Range ◽

The Impact

Purpose: Despite several well-described operative techniques, the optimal management of anterior cruciate ligament (ACL) injuries in pediatric patients remains unclear. The goal of this study was to identify preferred techniques in skeletally immature patients of various ages and analyze differences in operative strategy based on surgeon and practice demographics. Methods: An electronic survey was administered to members of the Pediatric Research in Sports Medicine society, a cohort of experienced surgeons who perform a high volume of pediatric ACL reconstructions. The survey presented a scenario of a patient who had a physical exam and imaging consistent with an acute, isolated ACL tear. The respondent was asked to select their preferred reconstruction technique for females and males at consecutive skeletal ages from 8 to 15 years. Surgeon and practice demographic information was recorded. Univariate analysis was followed by stepwise multinominal logistic regression to control for confounders. Results: Eighty-eight of 103 surgeons (85%) responded to the survey, the majority of whom (68%) performed more than 25 pediatric ACL reconstructions annually. The greatest variation in technique was from ages 11 to 13 in females and 11 to 14 in males. The modified MacIntosh was the most frequently utilized from ages 8 to 10. An all-epiphyseal technique was preferred over a broader age range in males than females, with peak utilization at age 11 in both. A partial trans-physeal (hybrid) technique was preferred in slightly older patients, with peak utilization at age 12 in females and 13 in males. The trans-physeal technique was most widely used at age 13 and up in females and 14 and up in males. The impact of fellowship training on technique preference was statistically significant for males ages 11-13 and females 11 and 12 (p<0.05 for all). Surgeons with pediatric orthopaedic training tended to prefer an all-epiphyseal reconstruction, while those with both pediatric and sports training preferred the modified MacIntosh. Conclusions: The preferred ACL reconstruction technique for skeletally immature patients varied considerably, especially in the 11-13 year-old age range, highlighting a lack of consensus among orthopedic surgeons for the optimal ACL reconstruction strategy in skeletally immature patients. Surgeon’s fellowship training was significantly associated with their preferred surgical technique.

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Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques

The American Journal of Sports Medicine ◽

10.1177/0363546511420810 ◽

2011 ◽

Vol 39 (12) ◽

pp. 2604-2610 ◽

Cited By ~ 43

Author(s):

Jae Ang Sim ◽

Hemanth R. Gadikota ◽

Jing-Sheng Li ◽

Guoan Li ◽

Thomas J. Gill

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Joint ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Joint Laxity ◽

Normal Knee ◽

Anterior Tibial ◽

Anterior Cruciate ◽

Tibial Translation ◽

Reconstructed Knee

Background: Recently, anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity. Study Design: Controlled laboratory study. Hypothesis: Anterior cruciate ligament reconstruction by the anteromedial (AM) portal technique, outside-in (OI) technique, and modified transtibial (TT) technique can equally restore the normal knee joint laxity and ACL forces. Methods: Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system under an anterior tibial load (134 N) at 0°, 30°, 60°, and 90° of flexion and combined torques (10-N·m valgus and 5-N·m internal tibial torques) at 0° and 30° of flexion. Knee joint kinematics, ACL, and ACL graft forces were measured in each knee specimen under 5 different conditions (ACL-intact knee, ACL-deficient knee, ACL-reconstructed knee by AM portal technique, ACL-reconstructed knee by OI technique, and ACL-reconstructed knee by TT technique). Results: Under anterior tibial load, no significant difference was observed between the 3 reconstructions in terms of restoring anterior tibial translation ( P > .05). However, none of the 3 ACL reconstruction techniques could completely restore the normal anterior tibial translations ( P < .05). Under combined tibial torques, both AM portal and OI techniques closely restored the normal knee anterior tibial translation ( P > .05) at 0° of flexion but could not do so at 30° of flexion ( P < .05). The ACL reconstruction by the TT technique was unable to restore normal anterior tibial translations at both 0° and 30° of flexion under combined tibial torques ( P < .05). Forces experienced by the ACL grafts in the 3 reconstruction techniques were lower than those experienced by normal ACL under both the loading conditions. Conclusion: Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques are biomechanically comparable with each other in restoring normal knee joint laxity and in situ ACL forces. Clinical Relevance: Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques result in similar knee joint laxities. Technical perils and pearls should be carefully considered before choosing a tunnel creating technique.

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Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft

Joints ◽

10.11138/jts/2015.3.3.102 ◽

2015 ◽

Vol 03 (03) ◽

pp. 102-108 ◽

Cited By ~ 5

Author(s):

Shuji Taketomi ◽

Hiroshi Inui ◽

Kensuke Nakamura ◽

Ryota Yamagami ◽

Keitaro Tahara ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Soft Tissue ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Case Series ◽

Femoral Fixation ◽

Bptb Graft ◽

Anterior Cruciate ◽

Bone Plug ◽

Rectangular Tunnel

Purpose: the efficacy and safety of using a suspensory button for femoral fixation in anatomical anterior cruciate ligament (ACL) reconstruction with bonepatellar tendon-bone (BPTB) graft have not been established. The purpose of the current study was to evaluate bone plug integration onto the femoral socket and migration of the bone plug and the EndoButton (EB) (Smith & Nephew, Andover, MA, USA) after rectangular tunnel ACL reconstruction with BPTB autograft. Methods: thirty-four patients who underwent anatomical rectangular ACL reconstruction with BPTB graft using EB for femoral fixation and in whom three-dimensional (3D) computed tomography (CT) was performed one week and one year after surgery were included in this study. Bone plug integration onto the femoral socket, bone plug migration, soft tissue interposition, EB migration and EB rotation were evaluated on 3D CT. The clinical outcome was also assessed and correlated with the imaging outcomes. Results: the bone plug was integrated onto the femoral socket in all cases. The incidence of bone plug migration, soft tissue interposition, EB migration and EB rotation was 15, 15, 9 and 56%, respectively. No significant association was observed between the imaging outcomes. The postoperative mean Lysholm score was 97.1 ± 5.0 points. The postoperative side-to-side difference, evaluated using a KT-2000 arthrometer, averaged 0.5 ± 1.3 mm. There were no complications associated with EB use. Imaging outcomes did not affect the postoperative KT side-to-side difference. Conclusions: the EB is considered a reliable device for femoral fixation in anatomical rectangular tunnel ACL reconstruction with BPTB autograft. Level of evidence: Level IV, therapeutic case series.

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Effect of COVID-19 Social Isolation Policies on Rehabilitation After Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211047216 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110472

Author(s):

Kate E. Webster ◽

Haydn J. Klemm ◽

Brian M. Devitt ◽

Timothy S. Whitehead ◽

Julian A. Feller

Keyword(s):

Health Care ◽

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Social Isolation ◽

Employment Status ◽

Cruciate Ligament ◽

Self Report ◽

Face To Face ◽

Anterior Cruciate ◽

The Impact

Background: The coronavirus 2019 (COVID-19) pandemic has had a profound impact on health care in Australia. To contain the spread of the virus, strict physical distancing and social isolation policies were implemented from late March 2020. This presented a situation in which patients recovering from anterior cruciate ligament (ACL) reconstruction had limited access to face-to-face supervised rehabilitation and rehabilitation facilities. Purpose: To explore the impact of social distancing and isolation policies on postoperative rehabilitation in patients after ACL reconstruction. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients who had ACL reconstruction from October 2019 until the end of March 2020 (6 months before the implementation of COVID-19 restrictions) completed an online self-report questionnaire containing 5 sections: utilization of health care professionals for rehabilitation, frequency of rehabilitation, patient concerns and attitude, perceived impact on recovery, and changes to employment status. We compared the responses of patients who had surgery in 2019 with those who had surgery in 2020. Statistical analysis was performed using frequency statistics and central tendency measures. Results: A total of 185 patients (97 men, 88 women) completed the survey, for a 73% response rate. Patients had a mean age of 28 years (range, 13-57 years) and had undergone surgery a mean 4.5 months prior (range, 1.5-8 months). Most patients (80%) maintained face-to-face rehabilitation, predominantly with a physical therapist, regardless of whether their surgery took place in 2019 or 2020; rehabilitation with active, supervised exercises was most common. Almost all patients were performing strengthening exercises (164/185), and most were performing range-of-motion (139/185) and aerobic (123/185) activities at their homes. Patients were minimally concerned about access to supervised rehabilitation and knee reinjury, but they were concerned about access to equipment. Because of COVID-19, 30% were working from home; 17% were on reduced hours and 8% on increased hours; 15% were on leave or unemployed; and 30% reported no change in employment status. Conclusion: Patients who had undergone ACL reconstruction just before or during the first few months of the COVID-19 pandemic were able to maintain in-person contact with their health professionals during rehabilitation, and they had a positive outlook and managed well despite the restrictions.

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Subsequent Surgery for Loss of Motion After Anterior Cruciate Ligament Reconstruction Does Not Influence Function at 2 Years: A Matched Case-Control Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546519863347 ◽

2019 ◽

Vol 47 (11) ◽

pp. 2550-2556 ◽

Cited By ~ 1

Author(s):

Jacob Worsham ◽

Walter R. Lowe ◽

Dorcas Copa ◽

Shelby Williams ◽

Jacquelyn Kleihege ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Surgical Treatment ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Knee Function ◽

Quality Data ◽

Control Group ◽

Manipulation Under Anesthesia ◽

Anterior Cruciate ◽

Loss Of Motion

Background: Loss of motion (LOM) remains a common complication after anterior cruciate ligament (ACL) reconstruction and can be detrimental to patient outcomes after surgery. LOM is multifactorial, but nonsurgical and surgical solutions to this complex problem are available. A paucity of quality data exists evaluating clinical outcomes after the surgical treatment of patients with LOM after ACL reconstruction. Hypothesis: Patients undergoing surgical lysis of adhesions and manipulation under anesthesia for LOM after ACL reconstruction will exhibit decreased function, lower outcome scores, and delayed time of release to play when compared with matched controls without LOM. Study Design: Cohort study; Level of evidence, 3 Methods: A database of 1572 patients undergoing ACL reconstruction was sampled from 2013 to 2017 to identify a total of 58 patients (LOM group [n = 29] vs matched control group [n = 29]). Group comparisons were examined for patients requiring a second surgical procedure for LOM versus matched controls after ACL reconstruction for differences in surgical timing, self-reported International Knee Disability Committee scores, objective function at release to play, and subjective knee function at 2 years with the Single Assessment Numeric Evaluation. The risk of a type I error was set at α = .05 for all statistical analyses. Results: Patients who underwent lysis of adhesions and manipulation under anesthesia for LOM after ACL reconstruction exhibited no differences in Single Assessment Numeric Evaluation knee function at 2 years when compared with matched controls (85.8 ± 14.9 vs 88.0 ± 10.8, P = .606). All patients met release-to-play criteria. Only International Knee Disability Committee scores ( P = .046) and single-legged hop testing ( P = .050) reached statistically significant differences, with higher scores in the control group. There was no difference in the time to release to play ( P = .034) or level of participation ( P = .180) between the control and surgical groups. Subjective function scores at 2 years were not significantly different between groups. Tourniquet time during the index ACL reconstruction was shorter in the control group ( P = .034). Conclusion: The findings of this study suggest that patients who undergo surgical treatment for LOM after ACL reconstruction can release to play at similar times but display relative deficits in single-legged-hop symmetry and lower self-reported function when compared with matched controls. Longer surgical times may increase the risk for LOM after ACL reconstruction. Registration: NCT03704376 (ClinicalTrials.gov identifier)

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