Does anterolateral ligament injury change the treatment option in patients with partial ACL tears?

Patients with ACL tears with ALL injury have more clinical complaints (instability, feeling of the pop on the knee or knee sliding). patients have ALL injury with partial ACL tears, It is unclear whether the choice of treatment will be conservative or surgical. This study aimed to determine the effect of anterolateral ligament (ALL) status, whether intact or ruptured, on the choice of conservative or surgical treatment in patients with partial anterior cruciate ligament (ACL) tears. Between 2015 and 2019, patients with suspected partial ACL tears were identified on both physical examination and MR imaging. 122 patients who had partial ACL tears and also status of patient’s ALL could be evaluated by radiologist were included in the study, retrospectively. Sixty-two patients who underwent ACL reconstruction were determined as group 1, and 60 patients who did not undergo ACL reconstruction were defined as group 2. In patients with partial ACL rupture with or without ACL reconstruction, it was evaluated whether a ruptured or non- ruptured ALL was effective in this decision of conservative or surgically. The MRIs of patients with partial ACL tears were evaluated by a radiologist and it was concluded that the ALLs of 50 patients were ruptured, and 72 were intact. The ALLs of 36 patients in group 1 were ruptured, and 26 patients were intact. Fourteen patients in group 2 had ruptured ALLs, 46 patient’s ALLs were intact. Seventy-two percent of the patients with partial ACL tears who had ruptured ALLs in MRI underwent ACL reconstruction. It was found that ACL reconstruction was performed more frequently in patients with partial ACL tears with ALL rupture. Therefore, we believe that preoperative evaluations of ALLs using MRI in patients with partial ACL tears are essential for surgical planning.

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Does the Application of Platelet-Rich Fibrin in Anterior Cruciate Ligament Reconstruction Enhance Graft Healing and Maturation? A Comparative MRI Study of 44 Cases

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120902013 ◽

2020 ◽

Vol 8 (2) ◽

pp. 232596712090201 ◽

Cited By ~ 1

Author(s):

Tahsin Beyzadeoglu ◽

Tuna Pehlivanoglu ◽

Kerem Yildirim ◽

Halil Buldu ◽

Reha Tandogan ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Synovial Fluid ◽

Acl Reconstruction ◽

Signal Intensity ◽

Cruciate Ligament ◽

Postoperative Blood Loss ◽

Platelet Rich Fibrin ◽

Group 2 ◽

Anterior Cruciate ◽

Group 1

Background: Anterior cruciate ligament (ACL) reconstruction performed with growth factors and activated platelets has been suggested to accelerate tendon ligamentization, leading to earlier return to daily activities and sports. Hypotheses: Platelet-rich fibrin (PRF) will result in improved graft maturation and healing as evaluated by magnetic resonance imaging (MRI) in patients undergoing hamstring ACL reconstruction. Hemostatic and analgesic properties of PRF will lead to less postoperative blood loss and pain. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 44 patients with isolated ACL injuries who underwent arthroscopic all-inside anatomic single-bundle ACL reconstruction with semitendinosus tendon graft were enrolled. Group 1 included 23 patients who had PRF sprayed to the surface of the graft; group 2 included 21 patients for whom no PRF was used. Patients were discharged after 24 hours and examined for hemarthrosis that needed to be aspirated. MRI was performed at the fifth postoperative month. A blinded radiologist evaluated graft maturation according to its signal intensity and the presence of synovial fluid at the tunnel-graft interface. Results: PRF-treated grafts demonstrated lower MRI signal intensity and less fluid in the graft-tunnel interface as compared with controls for the entire length of the graft. The mean full-length MRI signal intensities were 9.19 versus 16.59 ( P = .047) for groups 1 and 2, respectively. Subgroup analysis of the semitendinosus grafts demonstrated a signal intensity of 11.57 versus 23.98 ( P = .044) for the proximal third, 9.53 versus 13.83 ( P = .237) for the midbody, and 6.48 versus 11.98 ( P = .087) for the distal third. Synovial fluid at the graft-tunnel interface was detected in 1 patient in group 1 (4.3%) and 3 patients in group 2 (14.3%; P < .001). Patients in group 1 had significantly less hemarthrosis that needed to be aspirated ( P = .003), while postoperative analgesia requirements were similar in both groups ( P = .08). No clinical benefit of PRF could be demonstrated in clinical outcomes. Conclusion: Application of PRF led to superior graft integration and maturation in the proximal third of the ACL graft. There was no significant difference in MRI signal intensity in the midbody or distal tibial graft. Application of PRF also resulted in significantly lower rates of postoperative hemarthrosis that needed to be aspirated.

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Bone Contusions After Acute Noncontact Anterior Cruciate Ligament Injury Are Associated With Knee Joint Laxity, Concomitant Meniscal Lesions, and Anterolateral Ligament Abnormality

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2016.03.015 ◽

2016 ◽

Vol 32 (11) ◽

pp. 2331-2341 ◽

Cited By ~ 40

Author(s):

Guan-yang Song ◽

Hui Zhang ◽

Qian-qian Wang ◽

Jin Zhang ◽

Yue Li ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Joint ◽

Anterior Cruciate Ligament Injury ◽

Cruciate Ligament ◽

Anterolateral Ligament ◽

Ligament Injury ◽

Meniscal Lesions ◽

Knee Joint Laxity ◽

Anterior Cruciate ◽

Bone Contusions

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Adolescents show a lower healing rate of anterolateral ligament injury and a higher rotational laxity than adults after anterior cruciate ligament reconstruction

The Knee ◽

10.1016/j.knee.2021.03.020 ◽

2021 ◽

Vol 30 ◽

pp. 113-124

Author(s):

Dhong Won Lee ◽

Joon Kyu Lee ◽

Sae Him Kwon ◽

Sung Gyu Moon ◽

Seung Ik Cho ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Healing Rate ◽

Cruciate Ligament ◽

Anterolateral Ligament ◽

Ligament Injury ◽

Rotational Laxity ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

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Anterolateral ligament of the knee: back to the future in anterior cruciate ligament reconstruction

Orthopedic Reviews ◽

10.4081/or.2015.5773 ◽

2015 ◽

Vol 7 (2) ◽

Cited By ~ 12

Author(s):

Davide Edoardo Bonasia ◽

Andrea D'Amelio ◽

Pietro Pellegrino ◽

Federica Rosso ◽

Roberto Rossi

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Double Bundle ◽

Anterolateral Ligament ◽

Rotational Instability ◽

Small Subset ◽

Acl Injuries ◽

Anterior Cruciate ◽

Double Bundle Acl Reconstruction

Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes.

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Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00272 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0027

Author(s):

Osman Çiloğlu ◽

Hakan Çiçek ◽

Ahmet Yılmaz ◽

Metin Özalay ◽

Gökhan Söker ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Muscle Strength ◽

Surgical Technique ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Tunnel Widening ◽

Isokinetic Muscle Strength ◽

Group 2 ◽

Anterior Cruciate ◽

Group 1

Objectives: We investigated the effects anatomic or nonanatomic femoral tunnel positions and tunnel fixation methods obtained using two different surgery methods on tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions. Methods: Patients with isolated anterior cruciate ligament rupture are included to study who don’t have intra-and extra-articular additional pathology of the knee, without previously a history of operations of both knees. 2 groups were created. Group 1 Aperfix implant were used which can be able to perform non anatomical femoral tunnel and intra tunnel fixation with transtibial technique. In Group 2 Endobutton CL implant were used which can make fixation from outside the cortex with anatomic femoral tunnel in use of anteromedial portal techniques. 27 patients (average age 29,33, range 18 to 55 years) in group 1 and 27 patients (average age 27,51, range 16 to 45 years) in group 2 totally 54 patients were performed surgery. All patients were assessed using the IKDC (International knee documentation committee), Tegner Activity Scala and Lysholm II Functional Scores. Muscle strength measurements in both groups compared to intact knee was measured with an isokinetic dynamometer Biodex System 3 Pro. The location of the femoral tunnel aperture and tunnel widening were imaged with 3D reconstructive computed tomography. All measurements were performed using the same software application by the same radiologist. Results: The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). After surgery in both groups, the clinical scores showed significant improvement compared to preoperative (p=0,0001). However, postoperative clinical outcomes in the two groups did not show a difference significantly (p>0,005). Isokinetic muscle strength study showed significant differences between the two groups (p=0,0001). Location of femoral tunnel aperture on the medial wall of the lateral femoral condyle showed a significant differences in the two groups (p=0,0001). The expansion of proximal and distal femoral tunnel in two groups showed significant differences (p=0,0001). There was relationship between distal femoral tunnel widening and location of femoral tunnel aperture. Conclusion: Although there is no statistically significant difference between the two groups clinically, difference noticed in terms of isokinetic muscle strength may be due to differences in the degree of shift as a result of multiple loading depending on the biomechanical properties of materials. We thought that the difference seen in the widening of tunnel in the proximal or distal may be due to, the technique of graft fixation, the distance between the fixation point and the joint, and to the location of the femoral tunnel aperture on medial wall of lateral condyle from anatomical or non anatomical region. There is no golden standard in neither surgical technique nor material of fixation. Proper theoretical knowledge and extensive clinical experience are important in the light of an accurate surgical technique applied. We thought that information we have reached in our study should be supported by biomechanical studies

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Biomechanical Evaluation of Pediatric Anterior Cruciate Ligament (ACL) Reconstruction Techniques With and Without the Anterolateral Ligament (ALL)

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000001078 ◽

2020 ◽

Vol 40 (1) ◽

pp. 8-16 ◽

Cited By ~ 6

Author(s):

Natasha Trentacosta ◽

James L. Pace ◽

Melodie Metzger ◽

Max Michalski ◽

Trevor Nelson ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Anterolateral Ligament ◽

Biomechanical Evaluation ◽

Anterior Cruciate

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Septic Arthritis After Anterior Cruciate Ligament Reconstruction: How Important Is Graft Salvage?

The American Journal of Sports Medicine ◽

10.1177/0363546518782433 ◽

2018 ◽

Vol 46 (10) ◽

pp. 2376-2383 ◽

Cited By ~ 7

Author(s):

Jonas Pogorzelski ◽

Alexander Themessl ◽

Andrea Achtnich ◽

Erik M. Fritz ◽

Klaus Wörtler ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Resonance Imaging ◽

Kt 1000 ◽

Graft Removal ◽

Group 2 ◽

Anterior Cruciate ◽

Group 1

Background: Septic arthritis (SA) of the knee after anterior cruciate ligament reconstruction (ACLR) is a rare but potentially devastating condition. In certain cases, graft removal becomes necessary. Purpose: To evaluate clinical, subjective, and radiologic outcomes of patients with SA after ACLR and assess whether graft retention has superior clinical results as compared with graft removal. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who were at least 12 months out from arthroscopic treatment of SA after isolated ACLR at our institution were eligible for inclusion. Patients were categorized into 2 groups: group 1, patients with initial graft retention; group 2, patients with initial graft removal. Group 2 was subdivided into 2 groups: group 2a, patients with graft reimplantation; group 2b, patients without graft reimplantation. Objective and subjective assessments were obtained at follow-up, including the International Knee Documentation Committee (IKDC) knee examination form, KT-1000 arthrometer measurements, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score, Lysholm score, and IKDC subjective evaluation. Radiologic assessment was performed with pre- and postoperative magnetic resonance imaging. Results: Of the 41 patients included, 33 (81%) were available for follow-up at a mean ± SD 54.7 ± 24.4 months at an age of 28.4 ± 9.3 years. When compared with patients from group 2 (n = 12), patients from group 1 (n = 21) obtained significantly better results on the objective IKDC score (normal or nearly normal: group 1, 66.6%; group 2, 36.4%; P = .047) and KT-1000 measurements (group 1, 1.3 ± 1.0 mm; group 2, 2.9 ± 1.5 mm; P = .005). Group 1 also scored better than group 2 on the Lysholm ( P = .007), IKDC subjective ( P = .011), and WOMAC ( P = .069) measures. Between groups 2a (n = 4) and 2b (n = 8), no significant differences in outcomes could be detected ( P values, .307-.705), although patients with anterior cruciate ligament graft reimplantation showed a clear tendency toward better results in objective and not subjective parameters. Magnetic resonance imaging evaluation showed higher rates of cartilage damage and meniscal tears among patients with graft resection versus graft retention. Conclusion: Patients with graft retention showed superior postoperative results when compared with patients who underwent initial graft resection, although subanalysis showed comparable outcomes between graft retention and reimplantation. Thus, while graft-retaining protocols should have the highest priority in the treatment of SA after ACLR, graft reimplantation should be performed in cases where graft resection becomes necessary, to avoid future cartilage and meniscal lesions. Finally, further studies with larger numbers of patients are needed to gain a better understanding of the outcomes of patients with SA after ACLR.

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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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