ADVANTAGES AND FEATURES OF ARTHROSCOPIC REINSERTION OF THE ANTERIOR CRUCIATE LIGAMENT OF THE KNEE JOINT WITH INTERNAL SPLINTING (internal brace technology)

Background. Despite the annual increase in the number of patients with knee injuries, there is no gen-erally accepted algorithm for treating patients with anterior cruciate ligament injury (ACL). Conservative treatment is ineffective, as in 75-87% gives chronic anterior medial instability, increases the risk of post-traumatic arthritis by 51,2%. There is a considerable interest in arthroscopic primary recovery of ACL. The aim of the study is to evaluate the results of treatment of patients with ACL rapture and to develop a differentiated approach in its treatment. Materials and methods. The results of treatment of patients with ACl rupture who underwent ligament reinsertion (n = 40) and ACL reconstruction (n = 50) were analyzed. The assessment was performed on the scale of VAS for 2 days, VAS and IKDC 2-6-12 weeks after surgery Results. On the second day after the ligament reinsertion, patients had less pain compared to their post-reconstruction sensations: VAS 4,1 versus 5,3. In the group of patients after reinsertion of ACL in the period of 2-6 weeks there were lower rates of pain, namely 2,25 compared with 3,4 in the group of ACL reconstruction. At 2 weeks after reinsertion, patients reported moderate pain and an activity level of 66,4 ± 3,5 compared with the 61,3 ± 2,6 ligament reconstruction group on the IKDC scale. At 6 weeks, the positive dynamics persists, 80,2 ± 2,8 and 76,9 ± 3,1 IKDC, respectively. In 12 weeks, patients in both groups recover almost completely and return to daily activity, 93,9 ± 3,6 and 91,7 ± 2,4 on the IKDC scale, respectively. Conclusions. Primary recovery for proximal ACL ruptures shows good results and may be an alternative to ACL reconstruction. Success is based on the location of the ligament rupture and the tissues quality. The possibility of the initial ACL recovery is solved during surgery. If there is any doubt about the suitability of tissues for recovery, it is recommended to perform a standard reconstruction of ACL.

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Arthroscopic incidence of lateral meniscal root avulsion in patients with anterior cruciate ligament injury

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00591-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Riccardo Ciatti ◽

Armando Gabrielli ◽

Germando Iannella ◽

Pier Paolo Mariani

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Acl Injury ◽

Activity Level ◽

Ligament Injury ◽

Root Avulsion ◽

Chronic Injury ◽

Meniscal Root ◽

Anterior Cruciate

Abstract Background To arthroscopically evaluate the incidence of lateral meniscal root avulsion (LMRA) and associated intra-articular injuries in patients undergoing anterior cruciate ligament (ACL) reconstruction. Materials and Methods From April 2014 to March 2017, 532 consecutive patients were diagnosed as having an ACL injury and underwent arthroscopic ACL reconstruction. The diagnosis of LMRA was made arthroscopically. The effects of gender, activity, grade of laxity, time from injury, and concomitant meniscal lesions were analyzed. Results Among 532 patients, 497 (93.4%) underwent primary ACL reconstruction and 35 (6.5%) underwent revision procedures. 383 were acute or subacute injuries (less than 6 months from injury to surgery) and 149 chronic (more than 6 months). Average age was 30.4 years (DS: ± 11.04); there were 422 (79.3%) males and 110 (20.6%) females. A LMRA associated with the ACL injury was detected in 72 cases (13.5%), with a significant prevalence observed in males ($${\chi ^2}$$ χ 2 = 4.65; P = 0.031, statistically significant). In the 149 patients with a chronic injury, 27 patients had LMRA (18.1%), while 45 of the 383 patients with an acute or subacute injury had LMRA (11.7%). There was a tendency, albeit not significant ($${\chi ^2}$$ χ 2 = 3.721; P = 0.054), for the prevalence to increase with time since the initial ACL injury. LMRA was significantly associated ($${\chi ^2}$$ χ 2 = 7.81; P = 0.006) with a meniscocapsular tear of the posterior horn of the medial meniscus (ramp lesion). No other significant associations, such as with severity of A-P translation (as measured by KT-2000) or activity level, were detected. Conclusion LMRA is a relatively common injury associated with both acute and chronic ACL tears. A relatively high incidence in cases of chronic ACL insufficiency suggests that LMRAs do not heal spontaneously or that they may appear with time, even when absent at the time of the initial injury. Level of evidence Level III, cross-sectional study.

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The Role of Patient Characteristics in the Success of Nonoperative Treatment of Anterior Cruciate Ligament Injuries

The American Journal of Sports Medicine ◽

10.1177/0363546520917386 ◽

2020 ◽

Vol 48 (7) ◽

pp. 1657-1664 ◽

Cited By ~ 1

Author(s):

Jelle P. van der List ◽

Frans J.A. Hagemans ◽

Dirk Jan Hofstee ◽

Freerk J. Jonkers

Keyword(s):

Anterior Cruciate Ligament ◽

Multivariate Analysis ◽

Physical Therapy ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Patient Characteristics ◽

Nonoperative Treatment ◽

Activity Level ◽

Acl Injuries ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears can either be treated nonoperatively with physical therapy and then treated operatively if persistent instability is present, or be directly treated operatively. Advantages of early ACL reconstruction surgery include shorter time from injury to surgery and potentially fewer meniscal injuries, but performing early ACL reconstruction in all patients results in surgery in patients who might not need ACL reconstruction. It is important to assess in which patients nonoperative treatment is successful and which patients will require ACL reconstruction and thus might be better treated surgically in an earlier phase. Purpose: To identify patient characteristics that predict the success of nonoperative treatment. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: All patients with complete ACL injuries who were evaluated between 2014 and 2017 at our clinic were included. The minimum follow-up was 2 years. The initial treatment and ultimate ACL reconstruction were reviewed. Univariate analysis was performed using Mann-Whitney U tests and chi-square tests and multivariate analysis using binary logistic regression. Results: A total of 448 patients were included with a median age of 26 years and median Tegner level of 7 and mean Tegner level of 6.4. At initial consultation, 210 patients (47%) were treated nonoperatively with physical therapy and 126 of these patients (60%) ultimately required ACL reconstruction. Nonoperative treatment failed in 88.9% of patients <25 years of age, 56.0% of patients 25 to 40 years, and 32.9% of patients >40 years ( P < .001); and 41.9% of patients with Tegner level 3 to 6, and 82.8% of patients with Tegner level 7 to 10. Age <25 years (odds ratio [OR], 7.4; P < .001) and higher Tegner levels (OR, 4.2; P < .001) were predictive of failing nonoperative treatment in multivariate analysis. Patients in the failed nonoperative group had longer time from diagnosis to surgery than the direct reconstruction group (6.2 vs 2.2 months; P < .001), and more frequently had new meniscal injuries (17.4% vs 3.1%; P < .001) at surgery. Conclusion: Nonoperative treatment of ACL injuries failed in 60% of patients and was highly correlated with age and activity level. In patients aged 25 years or younger or participating in higher-impact sports, early ACL reconstruction should be considered to prevent longer delay between injury and surgery, as well as new meniscal injuries.

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The 50 Most Cited Articles in the Indications, Risk Factors, Techniques, and Outcomes of ACL Revision Surgery

The Journal of Knee Surgery ◽

10.1055/s-0040-1702182 ◽

2020 ◽

Author(s):

Hayley E. Ennis ◽

Kevin Bondar ◽

Johnathon McCormick ◽

Clark Jia-Long Chen ◽

Chester J. Donnally ◽

...

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Risk Factor ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Ligament Injury ◽

Future Research ◽

Revision Acl Reconstruction ◽

Anterior Cruciate ◽

Number Of Citations

AbstractThe rate of anterior cruciate ligament (ACL) retear remains high and revision ACL reconstruction has worse outcomes compared with primaries. To make advances in this area, a strong understanding of influential research is necessary. One method for systematically evaluating the literature is by citation analysis. This article aims to establish and evaluate “classic” articles. With consideration of these articles, this article also aims to evaluate gaps in the field and determine where future research should be directed. The general approach for data collection and analysis consisted of planning objectives, employing a defined strategy, reviewing search results using a multistep and multiauthor approach with specific screening criteria, and analyzing data. The collective number of citations for all publications within the list was 5,203 with an average of 104 citations per publication. “Biomechanical Measures during Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport” by Paterno et al contained both the highest number of total citations and the highest number of citations per year, with 403 total citations and 43.9 citations per year. The most recurring level of evidence were level II (n = 18) and level III (n = 17). “Clinical Outcomes” was the most common article type (n = 20) followed by “Risk Factors” (n = 10). The American Journal of Sports Medicine had the highest recorded Cite Factor with over 50% of the articles (n = 27) published. The most productive authors included R.W. Wright (n = 6), S.D. Barber-Westin (n = 5), F.R. Noyes (n = 5), and K.P. Spindler (n = 5). Historically, influential studies have been published in the realms of clinical outcome and risk factor identification. It has been established that revision ACL reconstruction has worse outcomes and more high-level studies are needed. Additionally, prospective studies that apply the knowledge for current known risk factor mitigation are needed to determine if graft tear rates can be lowered.

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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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Incidence of Second Anterior Cruciate Ligament Tears (1990-2000) and Associated Factors in a Specific Geographic Locale

The American Journal of Sports Medicine ◽

10.1177/0363546517694026 ◽

2017 ◽

Vol 45 (7) ◽

pp. 1567-1573 ◽

Cited By ~ 22

Author(s):

Nathan D. Schilaty ◽

Nathaniel A. Bates ◽

Thomas L. Sanders ◽

Aaron J. Krych ◽

Michael J. Stuart ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Patellar Tendon ◽

Cruciate Ligament ◽

Population Based ◽

Contralateral Side ◽

Activity Level ◽

Acl Injuries ◽

Acl Tear ◽

Anterior Cruciate

Background: Second anterior cruciate ligament (ACL) tears after reconstruction occur at a reported rate of 20% to 30%. This high frequency indicates that there may be factors that predispose an athlete to graft failure and ACL tears of the contralateral knee. Purpose: To determine the incidence of second ACL injuries in a geographic population-based cohort over a 10-year observation period. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACL reconstruction were searched across the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 1990 and 2000. This cohort of patients was tracked for subsequent ACL injuries through December 31, 2015. The authors identified 1041 patients with acute, isolated ACL tears. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex by side of injury, and graft type. Results: Of the 1041 unique patients with a diagnosed ACL tear in Olmsted County, Minnesota, from 1990 to 2000, there were 66 (6.0%) second ACL tears; 66.7% of these tears occurred on the contralateral side. A second ACL injury was influenced by graft type ( P < .0001), election of ACL reconstruction ( P = .0060), and sex by side of injury ( P = .0072). Nonparametric analysis of graft disruption by graft type demonstrated a higher prevalence of second ACL tears with allografts compared with hamstring ( P = .0499) or patellar tendon autografts ( P = .0012). Conclusion: The incidence of second ACL tears in this population-based cohort was 6.0%, with 66.7% of these tears occurring on the contralateral side from the original injury. There was a high population incidence of second ACL injuries in female patients younger than age 20 years. The utilization of patellar tendon autografts significantly reduced the risk of second ACL injuries compared with allografts or hamstring autografts in this cohort.

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A Canine Arthroscopic Anterior Cruciate Ligament Reconstruction Model for Study of Synthetic Augmentation of Tendon Allografts

The Journal of Knee Surgery ◽

10.1055/s-0036-1597618 ◽

2016 ◽

Vol 30 (07) ◽

pp. 704-711 ◽

Cited By ~ 12

Author(s):

Pat Smith ◽

James Stannard ◽

Ferris Pfeiffer ◽

Keiichi Kuroki ◽

Chantelle Bozynski ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Quadriceps Tendon ◽

Preclinical Model ◽

The Novel ◽

Tendon Allograft ◽

Study Results ◽

Internal Brace ◽

Anterior Cruciate

AbstractNovel graft types, fixation methods, and means for augmenting anterior cruciate ligament (ACL) reconstructions require preclinical validation prior to safe and effective clinical application. The objective of this study was to describe and validate a translational canine model for all-inside arthroscopic complete ACL reconstruction using a quadriceps tendon allograft with internal brace (QTIB). With institutional approval, adult research hounds underwent complete transection of the native ACL followed by all-inside ACL reconstruction using the novel QTIB construct with suspensory fixation (n = 10). Contralateral knees were used as nonoperated controls (n = 10). Dogs were assessed over a 6-month period using functional, diagnostic imaging, gross, biomechanical, and histologic outcome measures required for preclinical animal models. Study results suggest that the novel QTIB construct used for complete ACL reconstruction can provide sustained knee stability and function without the development of premature osteoarthritis in a rigorous and valid preclinical model. The unique configuration of the QTIB construct—the combination of a tendon allograft with a synthetic suture tape internal brace—allowed for an effective biologic–synthetic load-sharing ACL construct. It prevented early failure, allowed for direct, four-zone graft-to-bone healing, and functional graft remodeling while avoiding problems noted with use of all-synthetic grafts.

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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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A study on functional outcome of arthroscopic anatomical reconstruction of anterior cruciate ligament using quadrupled hamstring graft

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172886 ◽

2017 ◽

Vol 3 (4) ◽

pp. 854

Author(s):

Jagdeesh P. C. ◽

Suhail R. Shaikh

Keyword(s):

Anterior Cruciate Ligament ◽

Functional Outcome ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Scoring Systems ◽

Activity Level ◽

Anatomical Reconstruction ◽

Proper Patient Selection ◽

Anterior Cruciate ◽

Hamstrings Tendon

Background: Various techniques and graft types are now available for the reconstruction of ACL. Opinions differ among experts with regard to the ideal technique and graft type to be used. Arthroscopic anatomical ACL reconstruction using quadrupled hamstring autograft with fixation in the femoral tunnel using tightrope and in the tibial tunnel with interference screw is a relatively new technique. Purpose of this study is to analyze the postoperative outcome in our experience with this procedure.Methods: This was a prospective study of patients with ACL injury who underwent Arthroscopic anatomical ACL reconstruction using quadrupled hamstrings autograft. All patients were operated upon by the same surgeon and had the same rehabilitation protocol. They were followed up for six months at regular intervals using IKDC, LGS scoring systems, tegner activity scale and a subjective questionnaire.Results: About 95% of the patients had a favorable outcome as per three scoring systems. (IKDC, Lysholm score, subjective questionnaire) all three scoring system had a very high correlation around 90% of individuals were able to return to their pre injury activity level.Conclusions: We conclude that the functional outcome of arthroscopic anatomical anterior cruciate ligament reconstruction using quadrupled hamstrings tendon autograft is excellent to good (95%). With proper patient selection and rehabilitation full occupational and recreational activities can be expected for most of the patients within four to six months of the procedure.

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Risk factors for bilateral anterior cruciate ligament injuries

Medicinski pregled ◽

10.2298/mpns1506192r ◽

2015 ◽

Vol 68 (5-6) ◽

pp. 192-197 ◽

Cited By ~ 2

Author(s):

Vladimir Ristic ◽

Sinisa Ristic ◽

Mirsad Maljanovic ◽

Vladimir Djan ◽

Vukadin Milankov ◽

...

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Activity Level ◽

The Other ◽

Ligament Injury ◽

Concomitant Injuries ◽

Contralateral Knee ◽

Anterior Cruciate ◽

Injured Knee

Introduction. The aim of this study has been to identify which risk factors can influence bilateral anterior cruciate ligament injury. Material and Methods. Thirty-two operated patients took part in this survey during the period of ten years. There were 5 women and 27 men, with average age of 30.46 years (19-55). The respondents filled in the questionnaire by answering the questions regarding the time when getting injured and operated, mechanism of injuries, genetic and anthropometric data, characteristics of sports and every day activities. Results. The incidence of reconstructed bilateral injuries in relation to unilateral ones was 2.3% (50/2168). The age of respondents and side of the injured knee did not correlate significantly with the achieved subjective physical activity level after the second knee surgery. The average time from the first injury to operation was 10 months and 4.3 years since that moment up to the injury of the other knee. It took more than 9 months on average until the reconstruction of contralateral anterior cruciate ligament. The most of athletes were injured in football matches. Three-quarters of athletes returned to competition activities after the first operation, which caused the same injury of the contralateral knee. Discussion and Conclusion. Anterior cruciate ligament rupture of the contralateral knee most often occurs in young active athletes within the first four years after the initial reconstruction. Its frequency is not affected by sex, side of extremity, genetic predisposition, type of sport, concomitant injuries and the choice of graft. Returning to the same or higher level of sports activities after the first reconstruction is one of the preconditions for injuring the other knee in the same way.

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Comparison of hamstring and patellar tendon grafts in anterior cruciate ligament reconstruction: A prospective randomized study

Journal of International Medical Research ◽

10.1177/0300060517722696 ◽

2017 ◽

Vol 46 (2) ◽

pp. 785-791 ◽

Cited By ~ 6

Author(s):

Katarzyna Stańczak ◽

Marzenna Zielińska ◽

Marek Synder ◽

Marcin Domżalski ◽

Michał Polguj ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Patellar Tendon ◽

Cruciate Ligament ◽

Randomized Study ◽

Activity Level ◽

Prospective Randomized Study ◽

Kujala Score ◽

Anterior Cruciate

Objective This prospective randomized study was performed to compare the outcomes of two operative methods of anterior cruciate ligament (ACL) reconstruction based on either bone–patellar tendon–bone (BTB) grafts or hamstring tendon (HT) grafts. Methods Among 100 patients, 96 completed the full follow-up period and were included in the final analysis (48 in the BTB group and 48 in the HT group). The patients were evaluated preoperatively and 1, 3, 6, and 12 months after ACL reconstruction. The Kujala score, Tegner score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were among the parameters used to evaluate the patients. Results Both groups were comparable in terms of sex, age, and body mass index. None of the analyzed scores were significantly different between the BTB and HT groups at either the initial or last visit. Both groups demonstrated improvement at the 12-year follow-up according to the Kujala score and most categories of the KOOS. The Tegner activity level score showed significant improvement in the HT but not BTB group. Conclusion Patients undergoing ACL reconstruction with BTB and HT grafts show comparable improvement in functional results after 1 year of rehabilitation.

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