Biomaterials in the Arthroscopic Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 614 ◽  
pp. 157-162
Author(s):  
Gheorghe Ion Popescu ◽  
Cristina Patru ◽  
Camelia Tecu ◽  
Titi Bajenescu ◽  
Gabriela Soare
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Control Group ◽  
Cruciate Ligament Reconstruction ◽  
Post Surgery ◽  
Evaluation Point ◽  
Significant Difference ◽  
Anterior Cruciate

We conducted this clinical study in order to compare the quality of graft fixation with a bioabsorbable screw, as compared to a metal screw, in the anterior cruciate ligament reconstruction. A number of 124 patients were submitted to the surgical intervention and 113 out of them were kept under medical survey up to 1 year after the surgery. This included: anamnesis, physical examination, IKDC evaluation and the knee arthrometric measurements. After 1 year, there was no significant difference between the two groups, from the IKDC evaluation point of view. The final IKDC evaluation was normal or almost normal in 92% out of the patients in the group with absorbable screws and in 90% out of the patients making part of the control group. The incidence of post surgery complications was similar in both of the groups. The study shows that the absorbable screw is an efficient alternative to the fixation with a metal screw in the anterior cruciate ligament reconstruction.

Anterior Cruciate Ligament Reconstruction with and without a Ligament Augmentation Device

2002 ◽  
Vol 30 (6) ◽  
pp. 851-856 ◽  
Author(s):  
Jon Olav Drogset ◽  
Torbjørn Grøntvedt
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Control Group ◽  
Long Term Effects ◽  
Cruciate Ligament Reconstruction ◽  
Ligament Augmentation ◽  
Significant Difference ◽  
Anterior Cruciate

Background Ligament augmentation devices have been used in anterior cruciate ligament reconstruction since the suggestion of Kennedy et al. in 1980 that such devices would allow grafts to heal faster and more safely. Hypothesis Patients who had augmentation will have better outcomes after 8 years. Study Design Prospective randomized case control study. Methods Between 1991 and 1993, 100 patients were randomized to groups undergoing anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts with (49) or without (51) use of a Kennedy ligament augmentation device. Of these 100 patients, 94 were examined at an average of 8 years after surgery. Fifteen patients were excluded because of rupture in the other knee and 11 because of rerupture in the same knee. Results Of the remaining 68 patients, the mean Lysholm function score was 84 in the augmentation group and 87 in the control group. There was a statistically significant relationship between preoperatively detected cartilage injury and osteoarthritis. Almost half of the patients had developed osteoarthritis. We observed no significant difference between the two groups concerning rerupture rate, Lysholm or Lachman test scores, or KT-1000 arthrometer measurements. Conclusions We found no positive long-term effects supporting the use of augmentation in anterior cruciate ligament reconstruction.

scholarly journals Is Remnant Preservation in Anterior Cruciate Ligament Reconstruction Superior to the Standard Technique? A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-15 ◽  
Author(s):  
Han Wang ◽  
Ziming Liu ◽  
Yuwan Li ◽  
Yihang Peng ◽  
Wei Xu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Postoperative Knee

Purpose. This is a systematic review and meta-analysis of current evidence that aims at comparing the clinical outcomes of remnant-preserving anterior cruciate ligament reconstruction (ACLR) and standard ACLR. Methods. A systematic review of randomized controlled studies and cohort studies comparing remnant-preserving ACLR with standard ACLR with a minimum level of evidence of II was performed. Studies were included by strict inclusion and exclusion criteria. Extracted data were summarized as preoperative conditions, postoperative clinical outcomes, and postoperative complications. When feasible, meta-analysis was performed with RevMan5.3 software. Study methodological quality was evaluated with the modified Coleman methodology score (CMS). Results. Eleven studies (n = 466 remnant-preserving and n = 536 standard) met the inclusion criteria. The mean modified CMS for all included studies was 85.8 (range: 77–92 on a 100-point scale). In total, 466 patients underwent remnant-preserving ACLR by 3 different procedures: standard ACLR plus tibial remnant tensioning (n = 283), selective-bundle augmentation (n = 49), and standard ACLR plus tibial remnant sparing (n = 134). Remnant-preserving ACLR provided a superior outcome of postoperative knee anterior stability (WMD = −0.42, 95% CI, −0.66, −0.17; P<0.01) and Lysholm score (WMD = 2.01, 95% CI, 0.53 to 3.50; P<0.01). There was no significant difference between the two groups with respect to second-look arthroscopy (OR = 1.38, 95% CI, 0.53, 3.62; P=0.51), complications (OR = 1.24 95% CI, 0.76, 2.02; P=0.39), International Knee Documentation Committee (IKDC) subject scores, IKDC grades, Lachman test, and pivot-shift test. Summary/conclusion. Remnant-preserving ACLR promotes similar graft synovial coverage and revascularization to standard ACLR. Equivalent or superior postoperative knee stability and clinical scores were observed for remnant-preserving ACLR compared with standard ACLR. No significant difference in the total complication rate between the groups was evident.

Excellent bone plug–socket integration at 8 weeks after anterior cruciate ligament reconstruction using an adjustable-length loop cortical fixation device

2019 ◽  
Vol 4 (1) ◽  
pp. 9-14
Author(s):  
Ryohei Uchida ◽  
Norimasa Nakamura ◽  
Tomoyuki Suzuki ◽  
Masashi Kusano ◽  
Tatsuo Mae ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Interface Area ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Bone Integration ◽  
Anterior Cruciate ◽  
Bone Plug

ObjectivesRecently, adjustable-length loop cortical fixation devices (ALCFDs) have been developed. However, they are not frequently used for bone–patellar tendon–bone (BTB) grafting, mainly because it is uncertain whether an ALCFD enables sufficient integration of the bone plug. Thus, the purpose of this study was to evaluate bone plug–socket integration in anterior cruciate ligament reconstruction (ACL-R) with an ALCFD.MethodsTwenty consecutive patients with a mean age of 25±10 years underwent primary anatomic rectangular tunnel (ART) ACL-R with a BTB graft using BTB TightRope. The operated knees were evaluated by CT at 4 weeks and 8 weeks postoperatively. Union between the bone plug and the socket wall were assessed on 30 evaluation planes. No border between the plug and the socket wall, or trabecular continuity, were defined as complete union and a visible gap of >1 mm as incomplete union. When complete union was observed on >20, 11–20, 5–10 or <5 of the evaluation planes, bone integration was graded as excellent, good, fair or poor, respectively. In addition, the interface area between the plug and the socket wall was assessed by CT value index. Clinical evaluation was performed at 2 years postoperatively using the International Knee Documentation Committee (IKDC) form.ResultsThe proportion of patients with excellent bone integration was 20% at 4 weeks and 85% at 8 weeks, showing a significant difference (p=0.00015). Moreover, the CT value index of the interface area at 4 weeks was 25.8%±11.8% and that at 8 weeks was 15.3%±9.0%, again showing a significant difference (p=0.005). These suggest that bone integration of the interface area progresses over time and adequate at 8 weeks. Clinically, all 16 patients examined directly were rated their knees as normal or nearly normal with a mean side-to-side difference in anterior laxity at manual maximum force by KT-2000 of 0.2±0.3 mm.ConclusionExcellent bone plug–socket integration was observed at 8 weeks after ART ACL-R using an ALCFD with satisfactory clinical results. An ALCFD could be safely applied for ART ACL-R.Level of evidence4 (case series).

scholarly journals A complex approach in rehabilitation of the patients after the anterior cruciate ligament reconstruction

2019 ◽  
Vol 5 (3) ◽  
pp. 37
Author(s):  
I.Ya Hrubar ◽  
Yu.O. Hrubar ◽  
N.M. Grabyk
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Postoperative Period ◽  
Ligament Reconstruction ◽  
Clinical Course ◽  
Cruciate Ligament ◽  
Control Group ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Experimental Group

<p><strong>The Purpose</strong> was to improve the treatment outcomes of patients who undergo ACL reconstruction under arthroscopic control through a comprehensive approach to their rehabilitation program.<strong> </strong></p><p><strong>Materials and methods. </strong>We have implemented a system of comprehensive rehabilitation of patients after the ACL reconstruction under arthroscopic control, which relied on the phase of the clinical course of the postoperative period.</p><p><strong>Results. </strong>The study involved 40 patients who underwent anterior cruciate ligament reconstruction under arthroscopic control. Experimental group (20 people) who applied a comprehensive approach in rehabilitation after ACL reconstruction, taking into account the phase of the clinical course of the postoperative period. The second group was the control group (20 patients) in which rehabilitation was carried out under the existing program. The use of cryotherapy with adjustable pulse compression in patients of the experimental group from the first day allowed to reduce twice the use of non-narcotic analgesics. Analyzing the dynamics of flexion in the knee joint, it was found that patients of the experimental group on the 25th day performed flexion by 88.46% of the appropriate maximum. Whereas in the control group just - 69.23%. Positive dynamics were noted in the indicators of myotonometry of the quadriceps muscle and measurement of the perimeter of the knee joint.</p><strong>Conclusions.</strong> The program of physical rehabilitation of patients after the anterior cruciate ligament reconstruction under arthroscopic control, which was built taking into account the phase of the clinical course of the postoperative period, has been developed and offered positive results in clinical practice. The effectiveness of the program was shown by the improvement of such indicators as: decrease in intensity of pain syndrome in the early postoperative period, increase in the range of motion in the knee joint, faster restoration of the tone of the quadriceps muscle of the thighs of patients of the experimental group as opposed to the control group

scholarly journals Effectiveness of platelet-rich plasma in the treatment of anterior cruciate ligament injuries: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Wenfan Gan ◽  
Zheng Xu ◽  
Chunmei Wu ◽  
Junzhi He
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Control Group ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Abstract Background: Recently, a number of randomized controlled trials (RCTs) have researched the efficacy of anterior cruciate ligament reconstruction (ACLR) combined with platelet-rich plasma (PRP) in the treatment of anterior cruciate ligament (ACL) injuries. Therefore, we updated a systematic review based on these RCTs to evaluate the effects of PRP on knee function and pain with different time.Methods: We searched in PubMed, Embase, Cochrane, Web of Science(WOS), China National Knowledge Infrastructure(CNKI), and WANFANG DATABASE, for human RCTs comparing the efficacy of intraarticular injection with no injection of PRP. Descriptive summaries and quality assessments were performed for all studies included in this meta-analysis. The outcomes of the stydy included the International Knee Documentation Committee (IKDC), Visual Analogue Scale (VAS), and Lysholm score.Results: Finally, we included 6 RCTs stydies, involving 315 patients. The control group consisted of blank group or placebo group. Follow-up periods ranged from 3 to 18 months. The results of bias risk assessment showed that all the 6 stuydies are unclear risk of bias. Compared with the control group, PRP group significantly improved IKDC score at 3, 6 and 12 months after operation (P = 0.00, 0.01, respectively). Lysholm score and VAS score also has significant differences at 3 months after operation (both P = 0.00).Conclusion: Our study has proved that PRP was more effective in the recovery of knee function and early pain relief after the ACLR than the ACLR alone. Review registration: PROSPERO CRD42021224182. Registered 6 April 2021. Keywords:anterior cruciate ligament injury; anterior cruciate ligament reconstruction; platelet rich plasma; system review; META analysisReview registration: PROSPERO CRD42021224182. Registered 6 April 2021.

scholarly journals Comparing the Kinematics of the Lower Limb Joints in Jump-Landing Maneuver Among Soccer Players With and Without Histories of Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 10 (3) ◽  
pp. 177-184
Author(s):  
Moosareza Ghorbani ◽  
◽  
Farideh Babakhani ◽  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Range Of Motion ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Soccer Players ◽  
Cruciate Ligament Reconstruction ◽  
Jump Landing ◽  
Significant Difference ◽  
Anterior Cruciate

Background: Jumping and landing are common activities in soccer, i.e., associated with Anterior Cruciate Ligament (ACL) injuries in the players, especially when experiencing fatigue. The current study aimed to compare the kinematics of the lower limb joints in jump-landing maneuver among soccer players with and without a history of anterior cruciate ligament reconstruction. Methods: Among active soccer players in the provincial league level in Hamedan Province, Iran, 12 individuals with the intact knee (control group), and 12 individuals with 6 to 24 months post anterior cruciate ligament reconstruction (experimental group) were selected by convivence sampling method as the study participants. During the jump-landing task, the range of motion and the joints' angle at the contact instance were measured before and after performing plyometric fatigue protocol using the Vicon motion capture system. Multivariate Analysis of Variance (MANOVA) at a significance level of P<0.05 was used for intergroup comparisons. Results: Plyometric fatigue did not affect most of the kinematic variables before and after fatigue experience. Besides, only the hip range of motion revealed a significant difference between the study groups (P=0.38). Conclusion: Fatigue had more effect on some variables in individuals with ACL reconstruction, including the left and right hips angles. Moreover, there was a significant difference in some variables between the study groups; the range of motion of the left hip, the contact angle of the right hip before fatigue experience, and the contact angle of the right and left hips after fatigue. In general, a proper rehabilitation program is recommended for athletes with ACL reconstruction to reduce the risk of recurrence of jumping movements in exercise.

scholarly journals Improving Maximal Strength in the Initial Postoperative Phase After Anterior Cruciate Ligament Reconstruction Surgery: Randomized Controlled Trial of an App-Based Serious Gaming Approach (Preprint)

2019 ◽  
Author(s):  
Jan-Dierk Clausen ◽  
Niclas Nahen ◽  
Hauke Horstmann ◽  
Florian Lasch ◽  
Werner Krutsch ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Intervention Group ◽  
Maximum Strength ◽  
Control Group ◽  
Serious Gaming ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

BACKGROUND Anterior cruciate ligament reconstruction surgery is one of the most common orthopedic procedures. One of the main factors that influence the outcome is regaining strength in the postoperative phase. Because anterior cruciate ligament reconstruction surgeries are often performed in young patients, we combined the concept of prehabilitation with an app-based serious gaming approach to improve maximal strength postoperatively. OBJECTIVE Our objective was to conduct a prospective randomized trial to evaluate whether an app-based active muscle training program (GenuSport Knee Trainer) can improve postoperative strength by starting rehabilitation immediately after primary anterior cruciate ligament reconstruction surgery. METHODS We designed a pilot study in which we randomly assigned patients receiving primary anterior cruciate ligament reconstruction to either the serious gaming training (intervention) group or a conventional rehabilitation (control) group. Except for the serious gaming-based training, both groups followed the same postoperative treatment protocol. Outcome parameters were absolute and relative change in maximal strength, as well as the International Knee Documentation Committee Subjective Knee evaluation form, Knee Injury and Osteoarthritis Outcome Score, and Lysholm Knee Score. RESULTS In total 26 patients agreed to participate (14 patients in the intervention group and 12 patients in the control group, 1 of whom was lost to follow-up). We noted a difference in absolute maximum strength between the exergaming intervention and the control groups. Mean maximum strength preoperatively was 155.1 (SD 79.2) N in the intervention group (n=14) and 157.0 (SD 40.8) N in the control group (n=11). Postoperative mean maximum strength was 212.8 (SD 78.5) N in the intervention group and 154.5 (SD 27.1) N in the control group. Mean absolute change in maximum strength was 57.7 (SD 95.2) N in the intervention group and –4.8 (22.2) N in the control group. The analysis of covariance model with absolute change as the dependent variable and treatment group and baseline maximum strength as covariates showed a relevant difference in relative change between treatment groups (intervention – control) of 59.7 N (95% CI 10.1-109.3; <i>P</i>=.02). Similarly to the absolute increase, the relative change in maximum strength was relevantly higher in the exergaming group. The mean relative change in maximum strength was 1.7 (SD 1.17) in the intervention group and 1 (SD 0.13) in the control group. No adverse events or problems were reported during the study period. CONCLUSIONS Implementation of an app-based active muscle training program in the early postoperative therapy scheme was associated with an improvement in maximal strength. Therefore, we considered the use of GenuSport training after anterior cruciate ligament reconstruction to be a helpful complement to rehabilitation after anterior cruciate ligament reconstruction surgery to improve strength in the early postoperative phase. To our knowledge this was the first study to analyze immediate postoperative serious gaming-based training with the GenuSport device based on strength improvement.

scholarly journals Reducing Intra-Articular Haemarthrosis After Arthroscopic Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0013
Author(s):  
Fatih Karaaslan ◽  
Sinan Karaoğlu ◽  
Musa Uğur Mermerkaya
Keyword(s):  
Anterior Cruciate Ligament ◽  
Blood Loss ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Control Group ◽  
Double Blind Study ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Objectives: A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. Haemarthrosis and pain adversely affects the functional outcome of ACL reconstruction. The purpose of the study was to evaluate the effect of tranexamic acid (TXA) administration to minimize pain and stiffness of knee joint by reducing haemarthrosis. Methods: The study enrolled 123 patients who underwent arthroscopic anterior cruciate ligament reconstruction in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group (71 patients) received both intravenous and intra-articular TXA. The control group (52 patients) did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 minutes before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 minutes before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 hours. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively. Results: The mean (± SD) postoperative volume of blood loss from the drain in the TXA and control groups was 100.6 ± 72mL and 164.3 ± 75mL ml, respectively. The difference between the two groups was significant (p < 0.005). Conclusion: This prospective randomized study showed that during arthroscopic anterior cruciate ligament reconstruction, TXA reduced blood loss and helped to reduce haemarthrosis amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for puncturing associated with arthroscopic anterior cruciate ligament reconstruction without enhancing the risk of deepssssssahrombosis.

scholarly journals Comparison of Short-term Biodex Results After Anatomic Anterior Cruciate Ligament Reconstruction Among 3 Autografts

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984763 ◽  
Author(s):  
Jonathan D. Hughes ◽  
Jeremy M. Burnham ◽  
Angela Hirsh ◽  
Volker Musahl ◽  
Freddie H. Fu ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Return To Play ◽  
Quadriceps Weakness ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Anterior Cruciate

Background: An individualized approach to anterior cruciate ligament reconstruction (ACLR) typically includes criteria-based postoperative rehabilitation. However, recent literature has suggested residual quadriceps weakness up to 12 months after ACLR, especially with a quadriceps tendon (QT) autograft. Hypothesis: The QT would have poorer quadriceps strength symmetry at 5 to 8 months compared with the hamstring tendon (HS) and patellar tendon (BPTB), but there would be no significant difference at 9 to 15 months among all 3 groups. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent anatomic primary ACLR with an autograft were reviewed retrospectively. Isometric quadriceps and hamstring strength measurements were obtained clinically at 5 to 8 months and 9 to 15 months postoperatively. Return-to-running and return-to-play criteria included greater than 80% and 90% quadriceps strength symmetry, respectively. Results: A total of 73 patients with 5- to 8-month follow-up were identified, and 52 patients had 9- to 15-month data. The QT group had a significantly lower quadriceps index at 5 to 8 months (69.5 ± 17.4) compared with the BPTB (82.8 ± 14.6; P = .014) and the HS (86.0 ± 18.6; P = .001) groups. More patients with an BPTB autograft met criteria for return to running and return to play (60% and 47%, respectively) compared with the QT group (26% and 13%, respectively) at 5 to 8 months. Given the sample sizes available, we observed no significant difference in the quadriceps index and return-to-play and return-to-running criteria at 9 to 15 months among those undergoing ACLR with a QT, BPTB, or HS graft. Conclusion: Patients undergoing ACLR with a QT graft demonstrated clinically meaningful quadriceps asymmetry at 5 to 8 months and 9 to 15 months postoperatively. Additionally, fewer patients in the QT group met criteria for return to play and running at 5 to 8 months than the BPTB and HS groups. These data suggest that a longer time to return to play and specific rehabilitation protocols that emphasize quadriceps strengthening may be necessary because of residual quadriceps weakness after ACLR with a QT graft.

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