scholarly journals Predictors for Anterior Cruciate Ligament (ACL) Re-injury after Successful Primary ACL Reconstruction (ACLR)

2020 ◽  
Vol 14 (3) ◽  
pp. 50-56
Author(s):  
Gupta R ◽  
Singhal A ◽  
Malhotra A ◽  
Soni A ◽  
Masih GD ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

scholarly journals Vancomycin presoaking of hamstring grafts removes the risk of infection in primary anterior cruciate ligament reconstruction

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0018
Author(s):  
Francisco Figueroa ◽  
David Figueroa ◽  
Rafael Calvo ◽  
Alex Vaisman ◽  
Mario López ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Septic Arthritis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Autograft ◽  
Exact Test ◽  
Previous Period ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction ◽  
Hamstring Grafts

Background: Several strategies have been studied to decrease the rate of infection after hamstring autograft anterior cruciate ligament (ACL) reconstruction. Our group started presoaking grafts with Vancomycin in November 2015 to decrease this risk. Purpose: The objective of the study is to compare the success of this protocol against the immediate previous period in which we did not use the protocol. Study design: Retrospective cohort. Level III. Methods: Consecutive periods were studied: April 2013-October 2015 (pre Vancomycin protocol) and November 2015- May 2018 (Vancomycin protocol). All patients that underwent a hamstring autograft primary ACL reconstruction during the periods studied were included. The final outcome was the presence of postoperative septic arthritis in both groups. Diagnosis of septic arthritis was made using the clinical picture plus cytological analysis of a joint aspiration (cell count > 50.000/uL + > 90% neutrophils) Statistical analysis was made using the Fisher’s exact test. Significance was set in p < 0.05. Results: 490 patients were included in the study, 230 in the pre Vancomycin protocol an 260 in the Vancomycin protocol. 4 postoperative septic arthritis were noted in the pre Vancomycin protocol (1.7%) while no septic arthritis was noted in the post Vancomycin protocol patients during the period studied. (p < 0.05) The 4 postoperative infections were presented at an average 21.7 days (range 16-25). Staphylococcus epidermidis was isolated in 2 of the cases, and in the other 2 no organism was isolated. Conclusion: Vancomycin presoaking of hamstring autografts in primary ACL reconstruction eliminated the risk of postoperative septic arthritis during the studied period compared to the immediate previous period, where no Vancomycin presoaking was used.

scholarly journals Factors Associated With Psychological Readiness to Return to Sports With Cutting, Pivoting, and Jump-Landings After Primary ACL Reconstruction

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096448
Author(s):  
Junya Aizawa ◽  
Kenji Hirohata ◽  
Shunsuke Ohji ◽  
Takehiro Ohmi ◽  
Hideyuki Koga ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Regression Analysis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Return To Sports ◽  
Factors Associated ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction ◽  
Jump Landings

Background: High psychological readiness is an important element for returning to sports after anterior cruciate ligament (ACL) reconstruction. Identifying factors that contribute to psychological readiness is essential for planning interventions to return to play. No studies have used multivariate analysis to clarify factors associated with psychological readiness to return to specific sports. Hypothesis: To identify factors that contribute to an athlete’s psychological readiness to return after ACL reconstruction to sports that require cutting, pivoting, and jump-landings. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Study participants were athletes who before injury had participated in sports with limited contact that required cutting, pivoting, and jump-landings (basketball, soccer, futsal, volleyball, badminton, tennis, and frisbee) and hoped to return to the same sport after reconstruction. Psychological readiness was measured using the Anterior Cruciate Ligament–Return to Sport After Injury Scale (ACL-RSI) in athletes more than 6 months after primary ACL reconstruction. To clarify factors associated with the ACL-RSI, univariate regression analysis and multivariate regression analysis were performed using the following independent variables: age, sex, body mass index, time from injury to reconstruction, time from reconstruction to testing, meniscal surgery, modified Tegner activity scale before injury, kinesiophobia, limb symmetry index of knee strength, limb symmetry indices of single-leg hop (SLH) distances, and subjective running ability. Results: Higher subjective running ability, a lower kinesiophobia score, and greater limb symmetry in the lateral SLH were positively associated with psychological readiness. Conclusion: The psychological readiness of athletes aiming to return after ACL reconstruction to limited-contact sports that require cutting, pivoting, and jump-landings was affected by subjective running ability, kinesiophobia, and asymmetry of lateral SLH distance. This information may be useful in planning appropriate interventions and thereby increasing the likelihood of an athlete’s returning to such sports.

Incidence and Risk Factors of Subsequent Meniscal Surgery After Successful Anterior Cruciate Ligament Reconstruction: A Retrospective Study With a Minimum 2-Year Follow-up

2020 ◽  
Vol 48 (14) ◽  
pp. 3525-3533
Author(s):  
Yuka Kimura ◽  
Eiji Sasaki ◽  
Yuji Yamamoto ◽  
Shizuka Sasaki ◽  
Eiichi Tsuda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Laxity ◽  
Meniscal Surgery ◽  
Anterior Cruciate ◽  
Femoral Tunnel Drilling ◽  
Primary Acl Reconstruction

Background: One of the goals of anterior cruciate ligament (ACL) reconstruction is a meniscal protective effect on the knee. Despite the advancement of ACL reconstruction techniques, subsequent meniscal tears after ACL reconstruction remain a problem, and the risk factors for recurring lesions are still unclear. Purpose: To investigate the incidence of subsequent meniscal surgery after primary ACL reconstruction without revision ACL surgery and to determine the risk factors associated with this reoperation. Study Design: Case series; Level of evidence, 4. Methods: Overall, 518 patients who underwent primary ACL reconstruction between 2004 and 2012 at one instution participated in this study. Data on body mass index, graft type and femoral tunnel-drilling technique of ACL reconstruction, and location and type of meniscal injury and its treatment at ACL reconstruction were collected from medical records. Clinical outcomes were investigated, including side-to-side difference of anterior laxity, pivot-shift grade, and subsequent meniscal surgery without ACL insufficiency (at minimum 2-year follow-up). Results: The prevalence of tears to the medial meniscus (MM) at the primary ACL reconstruction was 43.6% (226/518), 140 of which were repaired; on the contrary, tears of the lateral meniscus (LM) had a prevalence of 55.8% (289/518), 42 of which were repaired. At a mean 30.3 months (range, 8-124 months) after ACL reconstruction, 20 patients (3.9%; 14 MM tears, 3 LM tears, 3 MM + LM tears) required meniscal surgery without ACL reinjury or recurrence of instability. Of these, 14 MMs and 3 LMs had been repaired at primary ACL reconstruction. The failure rates of repaired MM and LM were 10.0% (14/140) and 7.1% (3/42), respectively. The failure rate of MM repair using the all-inside technique (6/36) was significantly higher compared with no treatment, inside-out repair, or partial resection ( P = .045). In multiple regression analysis, the presence of MM injury at the time of ACL reconstruction (odds ratio [OR], 7.81; P = .003), the side-to-side difference of postoperative anterior tibial translation (OR, 1.91; P = .032), and follow-up period after ACL reconstruction (OR, 1.02; P = .003) were risk factors of subsequent meniscal surgery after ACL reconstruction. Conclusion: Incidence of subsequent meniscal surgery after successful ACL reconstruction was <5%. Presence of MM tear at the time of ACL reconsturuction, small amount of increased anterior laxity, and long-term period after ACL reconstruction were predictive of subsequent meniscal surgery.

scholarly journals Revision Anterior Cruciate Ligament Reconstruction

2013 ◽  
Vol 6 (6) ◽  
pp. 504-518 ◽  
Author(s):  
Jeffrey Wilde ◽  
Asheesh Bedi ◽  
David W. Altchek
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Instability ◽  
Return To Play ◽  
Revision Acl Reconstruction ◽  
Pubmed Database ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B.

scholarly journals A 5-Strand Hamstring Autograft Achieves Outcomes Comparable to Those of a 4-Strand Hamstring Autograft With a Graft Diameter of 8 mm or More in Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876081 ◽  
Author(s):  
Lingaraj Krishna ◽  
Xin Yang Tan ◽  
Francis Keng Lin Wong ◽  
Shi Jie Toh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Physical Component Summary ◽  
Cruciate Ligament ◽  
Primary Study ◽  
Hamstring Autograft ◽  
Sf 36 ◽  
Anterior Cruciate ◽  
Graft Diameter ◽  
Primary Acl Reconstruction

Background: Quadrupled (4-strand) hamstring tendon autografts are commonly used in anterior cruciate ligament (ACL) reconstruction, but there is significant variability in their diameter. The 5-strand hamstring autograft has been used as a means of increasing the graft diameter in patients with undersized hamstring grafts. Purpose: To report the outcomes of primary ACL reconstruction using 5-strand hamstring autografts in patients in whom the 4-strand configuration produced a graft diameter of <8 mm and to compare these outcomes with those of ACL reconstruction using 4-strand semitendinosus-gracilis autografts with a graft diameter of ≥8 mm. Study Design: Cohort study; Level of evidence, 2. Methods: The primary study group comprised 25 patients who underwent ACL reconstruction using a 5-strand hamstring autograft. The comparison group comprised 20 patients who underwent ACL reconstruction using a 4-strand hamstring autograft with a graft diameter of ≥8 mm. Interference screw fixation was used at the tibial and femoral ends for both groups of patients. Subjective questionnaires, including the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score, and the Physical Component Summary and Mental Component Summary of the Short Form–36 (SF-36), were administered preoperatively as well as at 1- and 2-year follow-up visits. Results: There were no significant differences in the patient demographics and preoperative scores between the 2 groups. The mean graft diameter was 9.06 ± 0.60 mm in the 5-strand group and 8.13 ± 0.32 mm in the 4-strand group ( P < .05). There was no statistically significant difference between groups on postoperative Lysholm, KOOS Pain, KOOS Symptoms, KOOS Activities of Daily Living, KOOS Sports, KOOS Quality of Life, and SF-36 Physical Component Summary scores. Conclusion: In primary ACL reconstruction, the 5-strand hamstring autograft achieves clinical outcomes that are comparable to those of the 4-strand hamstring autograft with a graft diameter of ≥8 mm. The 5-strand graft technique is therefore a useful means of increasing the graft diameter when faced with an undersized hamstring graft.

scholarly journals Soft tissue allograft for primary anterior cruciate ligament reconstruction

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

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">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.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">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</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">At the final follow up, </span><span lang="EN-IN">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 &gt;120<sup>0</sup> was achieved in &gt;80% of patients and minimal laxity in 60% patients but no functional disability in any of them. No graft failures were noted. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">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.</span></p>

scholarly journals Advanced Patellar Tendinopathy Is Associated With Increased Rates of Bone–Patellar Tendon–Bone Autograft Failure at Early Follow-up After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880771 ◽  
Author(s):  
Alexander L. Lazarides ◽  
Eduard Alentorn-Geli ◽  
Emily N. Vinson ◽  
Thomas W. Hash ◽  
Kristian Samuelsson ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Patellar Tendinopathy ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction ◽  
Bone Patellar Tendon

Background: Revision anterior cruciate ligament (ACL) reconstruction can be potentially devastating for a patient. As such, it is important to identify prognostic factors that place patients at an increased risk for graft failure. There are no data on the effects of patellar tendinopathy on failure of ACL reconstruction when using a bone–patellar tendon–bone (BPTB) autograft. Purpose/Hypothesis: The purpose of this study was to investigate the association of patellar tendinopathy with the risk of graft failure in primary ACL reconstruction when using a BPTB autograft. The hypothesis was that patellar tendinopathy would result in higher rates of graft failure when using a BPTB autograft for primary ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing ACL reconstruction at a single institution from 2005 to 2015 were examined. A total of 168 patients undergoing primary ACL reconstruction with a BPTB autograft were identified. Patients’ magnetic resonance imaging scans were reviewed for the presence and grade of patellar tendinopathy by 2 musculoskeletal fellowship–trained radiologists; both were blinded to the aim of the study, patient demographics, surgical details, and outcomes. Patients were divided into 2 groups: failure (defined as presence of symptomatic laxity or graft insufficiency) and success of the ACL graft. Statistical analyses were run to examine the association of patellar tendinopathy with failure of ACL reconstruction using a BPTB autograft. Results: At a mean follow-up of 18 months, there were 7 (4.2%) patients with graft failure. Moderate or severe patellar tendinopathy was associated with ACL graft failure ( P = .011). Age, sex, and side of reconstruction were not associated with the risk of graft failure, although the majority of patients who failed were younger than 20 years. The use of patellar tendons with moderate to severe tendinopathy was associated with a relative risk of ruptures of 6.1 (95% CI, 1.37-27.34) as compared with autograft tendons without tendinopathy. Conclusion: Moderate or severe patellar tendinopathy significantly increases the risk of graft failure when using a BPTB autograft for primary ACL reconstruction. Patellar tendinopathy should be considered when determining the optimal graft choice for patients undergoing primary ACL reconstruction with autograft tendons.

scholarly journals Significant Increase in the Rate of Meniscal and Chondral Injuries Between Primary and Revision Anterior Cruciate Ligament Reconstruction. (188)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
Adnan Saithna ◽  
Charles Pioger ◽  
Johnny Rayes ◽  
Ibrahim Haidar ◽  
Thomas FRADIN ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Chondral Lesions ◽  
Revision Acl Reconstruction ◽  
Meniscal Lesions ◽  
The Mean ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

Objectives: Anterior cruciate ligament (ACL) injuries are often associated with meniscal and chondral lesions. Meniscal lesions are present in up to 50% of ACL injured knees, and chondral lesions occur with an incidence of 20% to 40% in acute ACL-injured knees. The major importance of this lies in the fact that menisectomy and severe chondral damage are important predictors of poor outcomes including the subsequent development of knee osteoarthritis. Furthermore, patient reported outcomes following revision ACL reconstruction remain inferior to primary ACL reconstruction and this may, at least in part, be due to an increased incidence and severity of meniscal and chondral injuries. Although multiple studies have demonstrated that meniscal and chondral lesions are generally present at a higher rate at the time of revision ACL reconstruction when compared to primary ACL reconstruction, large studies following individual patients through primary and revision ACL reconstruction and tracking the change in the occurence of these injuries are scarce. The primary objective of this study was to determine the proportion of patients with meniscal and chondral injuries at the time of primary ACL reconstruction and determine how this rate changed by the time they underwent revision ACL reconstruction. The hypothesis was that the proportion of patients with meniscal and/or chondral lesions would be significantly greater at revision ACL reconstruction when compared to the primary procedures. Methods: Consecutive patients who underwent primary and then revision ACL reconstruction between March 1999 and February 2018 were identified using a single center registry. Patient characteristics, and intraoperative data from each procedure were collected and analyzed. This specifically included the occurrence and type of meniscal and chondral pathology. Descriptive statistics were used to evaluate the study sample using medians, descriptive data analysis was conducted depending on the nature of the criteria. Comparison between variables were assessed with student’s t test for quantitative variables and Mcnemar test for categorical variables. Statistical significance was set a t p<0.05. Results: 213 consecutive patients underwent both primary ACL reconstruction and then revision surgery during the study period. The average time from primary ACLR to Revision was 46.8 ± 36.6 months (range 5-181).The mean age of patients at primary ACLR was 22.21±7.21 years. The mean age of patients at revision ACLR 26.1 ± 8.3 years. The mean IKDC for the entire population was 85.53 ± 11.59, The mean ACL-RSI score was 71.89 ± 23.95. The mean Lysholm score was 91.77±10.24. The proportion of patients with chondral lesions significantly increased from 7% at primary ACL to 15.5% at revision ACL (p < 0.05). Meniscal lesions also significantly increased from 44.6 % at primary ACLR to 70% at revision ACLR (p < 0.05). There was no significant difference in the rate of lateral meniscal lesions (11.7 vs 13.1, p > 0.05). However, the proportion of patients with a medial meniscus lesion (25.4 vs 36.2, p < 0.05) and bimeniscal lesions (7.5 vs 20.7, p < 0.05) increased significantly at revision ACL reconstruction. Conclusions: The proportion of patients with meniscal and//or chondral injuries at the time of revision ACL reconstruction is significantly higher than at the time of primary ACL reconstruction. Specifically, the rate of medial meniscus and bimeniscal injuries is significantly higher in patients undergoing revision ACL reconstruction

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