Journal articles on the topic 'Anterior cruciate ligament reconstruction (ACLR)'
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Marques, Fabiano da Silva, Pedro Henrique Borges Barbosa, Pedro Rodrigues Alves, Sandro Zelada, Rodrigo Pereira da Silva Nunes, Marcio Régis de Souza, Márcio do Amaral Camargo Pedro, José Francisco Nunes, Wilson Mello Alves, and Gustavo Constantino de Campos. "Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 8, no. 10 (October 1, 2020): 232596712096108. http://dx.doi.org/10.1177/2325967120961082.
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Background: Anterior knee pain is a frequent condition after anterior cruciate ligament reconstruction (ACLR), but its origin remains uncertain. Studies have suggested that donor site morbidity in autologous bone–patellar tendon–bone reconstructions may contribute to patellofemoral pain, but this does not explain why hamstring tendon reconstructions may also present with anterior pain. Purpose: To evaluate the prevalence of anterior knee pain after ACLR and its predisposing factors. Study Design: Case-control study; Level of evidence, 3. Methods: We evaluated the records of all patients who underwent ACLR between 2000 and 2016 at a private facility. The prevalence of anterior knee pain after surgery was assessed, and possible risk factors (graft type, patient sex, surgical technique, range of motion) were evaluated. Results: The records of 438 patients (mean age, 30 years) who underwent ACLR were analyzed. Anterior knee pain was found in 6.2% of the patients. We found an increased prevalence of anterior knee pain with patellar tendon graft, with an odds ratio of 3.4 ( P = .011). Patients who experienced extension deficit in the postoperative period had an odds ratio of 5.3 of having anterior pain ( P < .001). Anterior knee pain was not correlated with patient sex or surgical technique. Conclusion: The chance of having anterior knee pain after ACLR was higher when patellar tendon autograft was used compared with hamstring tendon graft, as well as in patients who experienced extension deficit in the postoperative period.
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Shen, Xianyue, Tong Liu, Shenghao Xu, Bo Chen, Xiongfeng Tang, Jianlin Xiao, and Yanguo Qin. "Optimal Timing of Anterior Cruciate Ligament Reconstruction in Patients With Anterior Cruciate Ligament Tear." JAMA Network Open 5, no. 11 (November 17, 2022): e2242742. http://dx.doi.org/10.1001/jamanetworkopen.2022.42742.
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ImportanceThe timing of surgery has been regarded as a key factor in anterior cruciate ligament reconstruction (ACLR), and early vs delayed ACLR remains a controversial topic.ObjectiveTo synthesize up-to-date published data from randomized clinical trials (RCTs) comparing early vs elective delayed ACLR for patients with ACL deficiency, in terms of clinical outcomes and complications.Data SourcesThe PubMed, Cochrane Library, and Web of Science databases were systematically searched until September 9, 2022.Study SelectionAll published RCTs comparing clinical and functional outcomes and complications associated with early ACLR vs elective delayed ACLR.Data Extraction and SynthesisTwo reviewers independently extracted relevant data and assessed the methodological quality following the PRISMA guidelines.Main Outcomes and MeasuresDue to the clinical heterogeneity, the random-effects model was preferred. The primary outcomes were functional outcomes and complications. The Mantel-Haenszel test was used to evaluate dichotomous variables and the inverse variance method was used to assess continuous variables.ResultsThis meta-analysis included 972 participants in 11 RCTs stratified by follow-up duration. The following factors did not differ between early and delayed ACLR: operative time (mean difference, 4.97; 95% CI, −0.68 to 10.61; P = .08), retear (OR, 1.52; 95% CI, 0.52-4.43; P = .44), and infection (OR, 3.80; 95% CI, 0.77-18.79; P = .10). There were also no differences between groups in range of motion, knee laxity, International Knee Documentation Committee (IKDC rating scale), and Tegner score. IKDC score (mean difference, 2.77; 95% CI, 1.89-3.66; P &lt; .001), and Lysholm score at 2-year follow-up (mean difference, 2.61; 95% CI, 0.74-4.48; P = .006) significantly differed between early and delayed ACLR. In addition, the timing of surgery was redefined in the included RCTs and subgroup analyses were performed, which validated the robustness of the principal results.Conclusion and RelevanceThis systematic review and meta-analysis found that early ACLR was not superior to delayed ACLR in terms of most factors analyzed, except for IKDC and Lysholm scores. This information should be available to patients with ACL deficiency and clinicians as part of the shared decision-making process of treatment selection.
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Leite, Chilan Bou Ghosson, and Marco Kawamura Demange. "BIOLOGICAL ENHANCEMENTS FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION." Acta Ortopédica Brasileira 27, no. 6 (November 2019): 325–30. http://dx.doi.org/10.1590/1413-785220192706226481.
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ABSTRACT The anterior cruciate ligament (ACL) is mostly responsible for providing knee stability. ACL injury has a marked effect on daily activities, causing pain, dysfunction, and elevated healthcare costs. ACL reconstruction (ACLR) is the standard treatment for this injury. However, despite good results, ACLR is associated with a significant rate of failure. In this context, the mechanical and biological causes must be considered. From a biological perspective, the ACLR depends on the osseointegration of the graft in the adjacent bone and the process of intra-articular ligamentization for good results. Here, we discuss the mechanisms underlying the normal graft healing process after ACLR and its biological modulation, thus, presenting novel strategies for biological enhancements of the ACL graft. Level of evidence III, Systematic review of level III studies.
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Jacob, George, Kazunori Shimomura, Yogesh K, and Norimasa Nakamura. "Tissue Wrapping Augmentation for Anterior Cruciate Ligament Reconstruction." Biologic Orthopedics Journal 3, SP2 (December 20, 2021): e1-e6. http://dx.doi.org/10.22374/boj.v3isp2.31.
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Anterior cruciate ligament reconstruction (ACLR) has become a popular surgery in orthopedic practice today, and the technique has evolved significantly over time. Surgical procedure, graft choice, and fixation systems have varied over the years. Nonetheless, several challenges like insufficient graft ligamentization, tunnel enlargement, and insufficient reestablishment of proprioception remain in ACLR. A vision of better graft healing and integration for improved outcomes after ACLR introduced the idea of the biological ACLR. Various techniques with growth factors, cellular therapies, or tissue augment have been researched with ACLR surgery for better integration and ligamentization. This review highlights the tissue wrappingmodalities currently being explored in biological ACLR.
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DeFrancesco, Christopher J., Brendan M. Striano, Joshua T. Bram, Keith D. Baldwin, and Theodore J. Ganley. "An In-Depth Analysis of Graft Rupture and Contralateral Anterior Cruciate Ligament Rupture Rates After Pediatric Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 48, no. 10 (July 15, 2020): 2395–400. http://dx.doi.org/10.1177/0363546520935437.
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Background: Reported rates of graft rupture and contralateral anterior cruciate ligament (ACL) rupture after ACL reconstruction (ACLR) are higher among pediatric patients than adults. Previous series may have underestimated postoperative event risk because of small sample sizes and high proportions of dropouts. Purpose: To calculate rates of graft rupture and contralateral ACL rupture after ACLR in a large pediatric series. Study Design: Case series; Level of evidence, 4. Methods: ACLRs performed in our tertiary care children’s hospital system over a period of >7 years were identified through billing review. Cases were sorted based on operative technique, with all-epiphyseal ACLRs considered separately. Transphyseal ACLRs were divided into 2 groups based on patient age, with a cutoff of 16 years. Clinic follow-up data as well as prospectively collected survey data were used to note graft rupture and contralateral ACL rupture events. Rates of graft rupture and contralateral ACL rupture were calculated using Kaplan-Meier survival analysis. Results: The final data set included 996 patients. A total of 161 patients underwent all-epiphyseal ACLR. Of the remaining transphyseal surgeries, 504 patients were <16 years of age at the time of surgery and 331 were ≥16 years. The 4-year cumulative rate of graft rupture via Kaplan-Meier survival analysis was 19.7% among all patients. The rate was 18.2% among all-epiphyseal ACLRs, 21.6% among transphyseal ACLRs in patients <16 years, and 16.4% among transphyseal ACLRs in patients ≥16 years ( P = .855). Survival analysis estimated the 4-year cumulative rate of contralateral ACL rupture at 12.0% among all patients: 6.63% among all-epiphyseal ACLRs, 15.7% among transphyseal ACLRs in patients <16 years, and 8.05% among transphyseal ACLRs in patients ≥16 years ( P = .093). Conclusion: This is the largest series of pediatric ACLRs yet reported, and it shows that the risks of another ACL injury after first-time ACLR are higher than previously reported. The risk of contralateral ACL rupture was lower than that for graft rupture. Our methods, including prospective follow-up surveys and survival analysis to generate cumulative rate estimates, provide a best-practice example for future case series calculations. Our results provide insight into the postoperative course of pediatric patients undergoing ACLR and are crucial for preoperative patient and family counseling. Understanding these risks may also influence return-to-play decisions.
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Garcia, Grant Hoerig, Michael L. Redondo, Joseph Liu, David R. Christian, Adam Blair Yanke, and Brian J. Cole. "Anterior Cruciate Ligament Reconstruction with Concomitant Osteochondral Allograft Transplantation versus Anterior Cruciate Ligament Reconstruction: A Comparative Matched-Group Analysis of Return to Sport and Satisfaction." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0026. http://dx.doi.org/10.1177/2325967119s00262.
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Objectives: Anterior cruciate ligament (ACL) rupture is commonly associated with articular cartilage injury. Few studies have evaluated the influence of cartilage repair on the outcome of ACL reconstruction. Currently, no known study has examined the return to sport rates of concomitant ACL reconstruction and OCA. The purpose of this study is to evaluate rate and level of return to sports, as well as long-term outcomes, between a matched cohort of isolated ACL reconstruction (ACLR) versus ACL reconstruction with concomitant OCA (ACLR/OCA). Methods: A prospectively collected registry was queried retrospectively for consecutive patients who underwent ACL reconstruction with concomitant OCA. Inclusion criteria were preoperative diagnosis of ACL rupture and more than 2 years of follow-up. After meeting the inclusion criteria, all ACL reconstructions with concomitant OCA were matched to two isolated ACL reconstruction patients via +/- 5 years of age at time of surgery, gender, revision status, and ACL reconstruction graft type. At final follow-up, patients were asked to complete a subjective sports questionnaire, the Marx activity scale, a visual analog scale (VAS), and a satisfaction questionnaire. Results: Seventeen ACL/OCA patients met inclusion criteria. Fourteen eligible 2:1 matched pairs (28 ACLR; 14 ACLR/OCA;), were identified for analysis. The average age at the time of surgery was 33.89 +/- 8.64 and 35.92 +/- 6.22 for the ACLR and ACLR/OCA groups, respectively (P = .44). Average follow-up was 4.09 years and 5.14 years for the ACLR and ACLR/OCA groups, respectively (P = .17). At final follow-up, the average Marx activity scalescores were 6.54 for ACRL patients and 1.57 for ACLR/OCA patients; final scores were significantly different between groups (P < 0.01). The average VAS pain scores at final follow-up were 1.96 in the ACLR and 3.64 in ACLR/OCA groups with the ACLR/OCA patients displaying significantly worse final VAS pain scores (P = .03). 89.3% of ACLR patients (25 of 28) returned to at least 1 sport postoperatively compared with 57.1% of ACLR/OCA patients (8 of 14) (P=0.04). At final follow-up, 14.2% (2 of 14) of the ACLR/OCA group and 32.1% (9 of 28) of the ACLR group reported starting a new sport or activity. Average timing for full return to sports was 9.57 +/- 5.53 months and 9.27 +/- 3.25 months for the ACLR/OCA and ACLR groups, respectively (P = .86). At final follow-up, 33.3% and 57.1% of patients returned to better or same level of sport for the ACLR/OCA and ACLR groups, respectively (P = .06). Significantly more ACLR/OCA patients reported their activity level was hindered by their knee (92.8% ACLR/OCA; 60.7% ACLR). Significantly more ACLR patients reported satisfaction with their surgery compared with ACLR/OCA patients (89% vs 57%) (P < 0.01), however no statistical difference was observed in satisfaction with ability to play sports between groups. Conclusion: Significantly less ACLR/OCA patients (57.1%) were able to return to at least 1 sport when compared to a matched ACLR cohort (89.3%). At final follow-up, a higher percentage of ACLR patients were able to return to pretreatment activity intensity level or better (ACLR/OCA, 33.3%; ACLR, 57.1%). ACLR/OCA patients had significantly more pain and lower Marx activity scores. Despite a lower return to sport rate, there was no statistical difference in reported satisfaction with activity level between the groups, however the ACLR/OCA groups reported significantly lower overall surgical satisfaction.
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Eufemio, Edgar Michael T. "Revision Anterior Cruciate Ligament (ACL) Reconstruction." Orthopaedic Journal of Sports Medicine 7, no. 11_suppl6 (November 1, 2019): 2325967119S0044. http://dx.doi.org/10.1177/2325967119s00445.
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The goal of an ACL reconstruction is to approximate the strength and characteristics of the native tissue. So, if the original ACL can rupture, it is logical to think that the reconstructed ligament can also tear. It is more difficult to deal with a revision case. Your decision what to do is dependent on what was done during the primary ACL reconstruction (ACLR). It is important to plan the surgery carefully and prepare for all possible scenarios intra-operatively. The three key questions you need to answer are the following? What was the GRAFT used? How were the TUNNELS made? What were the IMPLANTS used? It would be helpful to know who did the primary ACLR because you may be aware of some of the tendencies of that surgeon which may assist you in your surgery. There are seven situations that will be discussed: Bone-Patellar Tendon-Bone (BPTB) autograft using a trans-tibial technique Semitendinosus/Gracilis Tendon (ST/G) autograft using a trans-tibial technique With the advent of the medial portal technique, the position of the femoral tunnel changed dramatically. Five other circumstances arose from this: 3. ST/G autograft using endo-buttons 4. ST/G autograft using screws – femoral tunnel in ideal position 5. ST/G autograft using screws – femoral tunnel near where you want it to be 6. ST/G autograft using screws – femoral tunnel far from where you want it to be 7. Implant-less ACLR Always have a back-up plan when doing revisions. It is imperative that the rehabilitation program be delayed so as to give the graft more time to incorporate. Usually, twelve months before going back to sports is acceptable.
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Westermann, Robert, Kyle Duchman, Yubo Gao, Andrew Pugely, Carolyn Hettrich, Ned Amendola, Brian Wolf, and Chris Anthony. "Infection following Anterior Cruciate Ligament Reconstruction: An Analysis of 6,389 Cases." Journal of Knee Surgery 30, no. 06 (October 25, 2016): 535–43. http://dx.doi.org/10.1055/s-0036-1593617.
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AbstractInfection following anterior cruciate ligament reconstruction (ACLR) is rare. Previous authors have concluded that diabetes, tobacco use, and previous knee surgery may influence infection rates following ACLR. The purpose of this study was to identify a cohort of patients undergoing ACLR and define (1) the incidence of infection after ACLR from a large multicenter database and (2) the risk factors for infection after ACLR. We identified patients undergoing elective ACLRs in the American College of Surgeons National Surgical Quality Improvement Program database between 2007 and 2013. The primary outcome was any surgical site infection within 30 days of surgery. We performed univariate and multivariate analyses comparing infected and noninfected cases to identify risk factors for infection. In total, 6,398 ACLRs were available for analysis of which 39 (0.61%) were diagnosed with a postoperative infection. Univariate analysis identified preoperative dyspnea, low hematocrit, operative time > 1 hour, and hospital admission following surgery as predictors of postoperative infection. Diabetes, tobacco use, age, and body mass index (BMI) were not associated with infection (p > 0.05). After multivariate analysis, the only independent predictor of postoperative infection was hospital admission following surgery (odds ratio, 2.67; 95% confidence interval, 1.02–6.96; p = 0.04). Hospital admission following surgery was associated with an increased incidence of infection in this large, multicenter cohort. Smoking, elevated BMI, and diabetes did not increase the risk infection in the present study. Surgeons should optimize outpatient operating systems and practices to aid in same-day discharges following ACLR.
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Goes, Rodrigo A., Victor R. A. Cossich, Bráulio R. França, André Siqueira Campos, Gabriel Garcez A. Souza, Ricardo do Carmo Bastos, and João A. Grangeiro Neto. "RETURN TO PLAY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION." Revista Brasileira de Medicina do Esporte 26, no. 6 (December 2020): 478–86. http://dx.doi.org/10.1590/1517-8692202026062019_0056.
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ABSTRACT The anterior cruciate ligament (ACL) tear represents more than half of all knee injuries in sports that involve body rotations and sudden changes of direction. Discharging the athlete for return to play (RTP) post-ACL reconstruction (ACLR) is a difficult task with multidisciplinary responsibility. For many years, a six-month period post-ACLR was adopted as the only criterion for RTP. However, it is now suggested that RTP should not be exclusively time-based, but to clinical data and systematic assessments. Despite the importance of post-ACLR factors for RTP, pre- and peri-ACLR factors must also be considered. Historically, ACLR is performed with the hamstring or autologous patellar tendons, although the choice of graft is still an open and constantly evolving theme. Anterolateral ligament reconstruction and repair of meniscal ramp tear associated with ACLR have recently been suggested as strategies for improving knee joint stability. Subjective questionnaires are easy to apply, and help identify physical or psychological factors that can hamper RTP. Functional tests, such as hop tests and strength assessment by means of isokinetic dynamometers, are fundamental tools for decision making when associated with clinical evaluation and magnetic resonance imaging. Recently, the capacity to generate force explosively has been incorporated into the muscle strength assessment. This is quantified through the rate of torque development (RTD). Due to characteristics inherent to the practice of sport, there is an extremely short time available for produce strength. Thus, RTD seems to better represent athletic demands than the maximum strength assessment alone. This review investigates the pre-, peri- and post-ACLR factors established in the literature, and shares our clinical practice, which we consider to be best practice for RTP. Level of evidence V; Specialist opinion.
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Rao, Anita G., Priscilla H. Chan, Heather A. Prentice, Elizabeth W. Paxton, Tadashi T. Funahashi, and Gregory B. Maletis. "Risk Factors for Opioid Use After Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 47, no. 9 (July 2019): 2130–37. http://dx.doi.org/10.1177/0363546519854754.
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Background: The misuse of opioid medications has contributed to a significant national crisis affecting public health as well as patient morbidity and medical costs. After orthopaedic surgical procedures, patients may require prescription (Rx) opioid medication, which can fuel the opioid epidemic. Opioid Rx usage after anterior cruciate ligament reconstruction (ACLR) is not well characterized. Purpose: To determine baseline utilization of Rx opioids in patients undergoing ACLR and examine demographic, patient, and surgical factors associated with greater and prolonged postoperative opioid utilization. Study Design: Cohort study; Level of evidence, 3. Methods: Primary elective ACLRs were identified using Kaiser Permanente’s ACLR registry (2005-2015). We studied the association of perioperative risk factors on the number of dispensed opioid Rx in the early (0-90 days) and late (91-360 days) postoperative recovery periods using logistic regression. Results: Of 21,202 ACLRs, 25.5% used at least 1 opioid Rx in the 1-year preoperative period; 17.7% and 2.7% used ≥2 opioid Rx in the early and late recovery periods, respectively. Risk factors associated with greater opioid Rx in both the early and the late periods included the following: ≥2 preoperative opioid Rx, age ≥20 years, American Society of Anesthesiologists classification ≥3, other activity at the time of injury, chondroplasty, chronic pulmonary disease, and substance abuse. Risk factors associated with opioid Rx use during the early period only included the following: other race, acute injury, meniscal injury repair, multiligament injury, and dementia/psychosis. Risk factors associated with greater opioid Rx during the late period only included the following: 1 preoperative opioid Rx, female sex, body mass index ≥25 kg/m2, motor vehicle accident as the mechanism of injury, and hypertension. Conclusion: A quarter of ACLR patients had at least 1 opioid Rx before the procedure, but usage dropped to 2.7% toward the end of the postoperative year. We identified several perioperative risk factors for greater and prolonged opioid usage after ACLR.
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Wypych, Mikołaj, Robert Lundqvist, Dariusz Witoński, Rafał Kęska, Anna Szmigielska, and Przemysław T. Paradowski. "Prediction of improvement after anterior cruciate ligament reconstruction." Open Medicine 16, no. 1 (January 1, 2021): 833–42. http://dx.doi.org/10.1515/med-2021-0300.
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Abstract Objective The retrospective investigation was carried out to assess whether subjects who fulfilled our proposed recruitment criteria responded more favorably to anterior cruciate ligament reconstruction (ACLR) than those who did not. Methods We retrospectively analyzed 109 skeletally mature subjects (78 men and 31 women) according to the following proposed criteria of recruitment: (1) pre-injury Tegner activity score ≥7 and a wish to return to a professional sports activity, (2) residual knee instability following injury and/or (3) age <20 years at the operation. The primary outcome was an improvement between assessment A (before operation) and B (mean follow-up of 1.6 years) in the average score for four of the five Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, covering pain, symptoms, difficulty in sports and recreational activities, and quality of life (KOOS4). Results The proposed recruitment criteria for ACLR were met by 58 subjects (53%). There were 49 subjects (45%) who improved between assessment A and B. Subjects who met proposed recruitment criteria were more likely to improve clinically after ACLR (OR 5.7, 95% CI 2.5–13.3). Conclusions Fulfillment of proposed recruitment criteria was a strong predictive factor for outcome improvement in short- to medium-term follow-up after ACLR. Level of evidence Case-control study. Level of evidence 3.
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Rothrauff, Benjamin B., Eiji Kondo, Rainer Siebold, Joon Ho Wang, Kyoung Ho Yoon, and Freddie H. Fu. "Anterior cruciate ligament reconstruction with remnant preservation: current concepts." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 5, no. 3 (April 16, 2020): 128–33. http://dx.doi.org/10.1136/jisakos-2019-000321.
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Anterior cruciate ligament (ACL) tears are a common knee injury, and anatomic ACL reconstruction (ACLR) is now the standard of care to restore knee stability. Nevertheless, re-tear rates exceeding 5% are commonly reported, with an even higher percentage of patients unable to achieve preinjury knee function. As the torn ACL remnant contains elements (eg, cells, blood vessels and mechanoreceptors) essential to ACL function, it has been hypothesised that ACLR with remnant preservation may improve graft remodelling, in turn more quickly and completely restoring ACL structure and function. In this Current Concepts review, we summarise the present understanding of ACLR with remnant preservation, which includes selective bundle reconstruction of partial (one-bundle) ACL tears and single- and double-bundle ACLR with minimal to partial debridement of the torn ACL stump. Reported benefits of remnant preservation include accelerated graft revascularisation and remodelling, improved proprioception, decreased bone tunnel enlargement, individualised anatomic bone tunnel placement, improved objective knee stability and early mechanical support (with selective bundle reconstruction) to healing tissues. However, clinical studies of ACLR with remnant preservation are heterogeneous in the description of remnant characteristics and surgical technique. Presently, there is insufficient evidence to support the superiority of ACLR with remnant preservation over the standard technique. Future studies should better describe the ACL tear pattern, remnant volume, remnant quality and surgical technique. Progress made in understanding and applying remnant preservation may inform, and be reciprocally guided by, ongoing research on ACL repair. The goal of research on ACLR with remnant preservation is not only to achieve anatomic structural restoration of the ACL but also to facilitate biologic healing and regeneration to ensure a more robust and functional graft.
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Pache, Santiago, Juan Del Castillo, Gilbert Moatshe, and Robert F. LaPrade. "Anterior cruciate ligament reconstruction failure and revision surgery: current concepts." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 5, no. 6 (September 16, 2020): 351–58. http://dx.doi.org/10.1136/jisakos-2020-000457.
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Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed procedures in orthopaedic sports medicine. Despite developments in understanding the anatomy and biomechanics of the knee joint, a fairly large subset of patients has ACLR failure. Outcomes after revision ACLR are historically inferior to primary ACLR. Thus, a systematic approach is necessary to identify all potential causes of failure and addressing them in conjunction with a revision ACLR to mitigate the risk of revision failure and to maximise improved patient outcomes.
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Lee, Joo-Hyun, Soul Cheon, Hyung-Pil Jun, Yu-Lun Huang, and Eunwook Chang. "Bilateral Comparisons of Quadriceps Thickness after Anterior Cruciate Ligament Reconstruction." Medicina 56, no. 7 (July 3, 2020): 335. http://dx.doi.org/10.3390/medicina56070335.
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Background and objectives: Anterior cruciate ligament reconstruction (ACLR) often results in quadricep atrophy. The purpose of this study was to compare the bilateral thickness of each quadricep component before and after ACLR. Materials and Methods: Cross-sectional study design. In 14 patients who underwent ACLR, bilateral quadricep muscle thicknesses were measured using a portable ultrasound device, 1 h before and 48–72 h after ACLR. Two-way analysis of variance (ANOVA) was used to compare muscle thickness pre- and post-ACLR between the limbs. Results: The primary finding was that the vastus intermedius (VI) muscle was significantly smaller in the reconstructed limb after ACLR compared to that in the healthy limb (Reconstructed limb; RCL = Pre-operated (PRE): 19.89 ± 6.91 mm, Post-operated(POST): 16.04 ± 6.13 mm, Healthy limb; HL = PRE: 22.88 ± 6.07, POST: 20.90 ± 5.78 mm, F = 9.325, p = 0.009, η2p = 0.418). Conclusions: The results represent a selective surgical influence on the quadricep muscle thickness. These findings highlight the need of advanced strengthening exercises in order to restore VI thickness after ACLR.
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Baawa-Ameyaw, Joanna, Ricci Plastow, Fahima Aarah Begum, Babar Kayani, Hyder Jeddy, and Fares Haddad. "Current concepts in graft selection for anterior cruciate ligament reconstruction." EFORT Open Reviews 6, no. 9 (September 2021): 808–15. http://dx.doi.org/10.1302/2058-5241.6.210023.
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Graft selection for anterior cruciate ligament reconstruction (ACLR) is important for optimizing post-operative rehabilitation, facilitating return to full sporting function and reducing the risk of complications. The most commonly used grafts for ACLR include hamstring tendon autografts, bone–patellar tendon–bone autografts, quadriceps tendon autografts, allografts and synthetic grafts. This instructional review explores the existing literature on clinical outcomes with these different graft types for ACLR and provides an evidence-based approach for graft selection in ACLR. The existing evidence on the use of extra-articular tenodesis to provide additional rotational stability during ACLR is also revisited. Cite this article: EFORT Open Rev 2021;6:808-815. DOI: 10.1302/2058-5241.6.210023
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Yao, Shiyi, Bruma Sai-Chuen Fu, and Patrick Shu-Hang Yung. "Graft healing after anterior cruciate ligament reconstruction (ACLR)." Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 25 (July 2021): 8–15. http://dx.doi.org/10.1016/j.asmart.2021.03.003.
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Davi, Steven M., Colleen K. Woxholdt, Justin L. Rush, Adam S. Lepley, and Lindsey K. Lepley. "Alterations in Quadriceps Neurologic Complexity After Anterior Cruciate Ligament Reconstruction." Journal of Sport Rehabilitation 30, no. 5 (July 1, 2021): 731–36. http://dx.doi.org/10.1123/jsr.2020-0307.
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Context: Traditionally, quadriceps activation failure after anterior cruciate ligament reconstruction (ACLR) is estimated using discrete isometric torque values, providing only a snapshot of neuromuscular function. Sample entropy (SampEn) is a mathematical technique that can measure neurologic complexity during the entirety of contraction, elucidating qualities of neuromuscular control not previously captured. Objective: To apply SampEn analyses to quadriceps electromyographic activity in order to more comprehensively characterize neuromuscular deficits after ACLR. Design: Cross-sectional. Setting: Laboratory. Participants: ACLR: n = 18; controls: n = 24. Interventions: All participants underwent synchronized unilateral quadriceps isometric strength, activation, and electromyography testing during a superimposed electrical stimulus. Main Outcome Measures: Group differences in strength, activation, and SampEn were evaluated with t tests. Associations between SampEn and quadriceps function were evaluated with Pearson product–moment correlations and hierarchical linear regressions. Results: Vastus medialis SampEn was significantly reduced after ACLR compared with controls (P = .032). Vastus medialis and vastus lateralis SampEn predicted significant variance in activation after ACLR (r2 = .444; P = .003). Conclusions: Loss of neurologic complexity correlates with worse activation after ACLR, particularly in the vastus medialis. Electromyographic SampEn is capable of detecting underlying patterns of variability that are associated with the loss of complexity between key neurophysiologic events after ACLR.
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Spindler, Kurt P., Laura J. Huston, Alexander Zajichek, Emily K. Reinke, Annunziato Amendola, Jack T. Andrish, Robert H. Brophy, et al. "Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates?" American Journal of Sports Medicine 48, no. 2 (January 9, 2020): 298–309. http://dx.doi.org/10.1177/0363546519892991.
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Background: Physicians’ and patients’ decision-making process between bone–patellar tendon–bone (BTB) and hamstring tendon autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by a variety of factors in the young, active athlete. Purpose: To determine the incidence of both ACL graft revisions and contralateral ACL tears resulting in subsequent ACLR in a cohort of high school– and college-aged athletes who initially underwent primary ACLR with either a BTB or a hamstring autograft. Study Design: Cohort study; Level of evidence, 2. Methods: Study inclusion criteria were patients aged 14 to 22 years who were injured in sports, had a contralateral normal knee, and were scheduled to undergo unilateral primary ACLR with either a BTB or a hamstring autograft. All patients were prospectively followed for 6 years to determine whether any subsequent ACLR was performed in either knee after their initial ACLR. Multivariable regression modeling controlled for age, sex, ethnicity/race, body mass index, sport and competition level, baseline activity level, knee laxity, and graft type. The 6-year outcomes were the incidence of subsequent ACLR in either knee. Results: A total of 839 patients were eligible, of which 770 (92%) had 6-year follow-up for the primary outcome measure of the incidence of subsequent ACLR. The median age was 17 years, with 48% female, and the distribution of BTB and hamstring grafts was 492 (64%) and 278 (36%), respectively. The incidence of subsequent ACLR at 6 years was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal knee, and 19.7% for either knee. High-grade preoperative knee laxity (odds ratio [OR], 2.4 [95% confidence interval [CI], 1.4-3.9]; P = .001), autograft type (OR, 2.1 [95% CI, 1.3-3.5]; P = .004), and age (OR, 0.8 [95% CI, 0.7-1.0]; P = .009) were the 3 most influential predictors of ACL graft revision in the ipsilateral knee. The odds of ACL graft revision were 2.1 times higher for patients receiving a hamstring autograft than patients receiving a BTB autograft (95% CI, 1.3-3.5; P = .004). No significant differences were found between autograft choices when looking at the incidence of subsequent ACLR in the contralateral knee. Conclusion: There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft.
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Başar, Selda, Enes Büyükafşar, Zeynep Hazar, Baybars Ataoğlu, and Ulunay Kanatlı. "Functional Outcomes of Primary Anterior Cruciate Ligament Reconstruction with Tibialis Anterior Allograft." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0015. http://dx.doi.org/10.1177/2325967114s00154.
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Objectives: Allografts have potential advantages in primary anterior cruciate ligament reconstruction (ACLR), including the absence of donor site morbidity, shorter operative times, improved cosmesis, and easier rehabilitation. There is limited and conflicting outcome data for ACLR with tibialis anterior allograft. The purpose of this study was to evaluate the functional outcomes of ACLR with tibialis anterior allograft. Methods: We retrospectively evaluated patients underwent ACLR using with tibialis anterior allograft between 2005 and 2013. Totally 12 patients who were performed suspensory fixation technique were included in this study (range: 25-43 years). Exclusion criteria included double bundle, bone tendon bone technique and revision surgery. Clinical outcomes were measured by subject part of International Knee Documentation Committee (IKDC) and Lysholm scores. Results: A significant increase was reported in all the clinical scores. In particular, the IKDC-subjective score increased from a basal value of 45.5±12.7 to 84.3±5.50 at the 12 months' evaluation (p<0.05). The Lysholm score revealed a significant improvement from 49.7±14.2 to 83.5±20.5 at the 12 months' evaluation (p<0.05). Conclusion: ACLR with tibialis anterior allograft is an effective treatment for correcting loss of function and increasing quality of life.
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Salem, Hytham S., Do H. Park, Jamie L. Friedman, Steven D. Jones, Jonathan T. Bravman, Eric C. McCarty, and Rachel M. Frank. "Return to Driving After Anterior Cruciate Ligament Reconstruction: A Systematic Review." Orthopaedic Journal of Sports Medicine 9, no. 1 (January 1, 2021): 232596712096855. http://dx.doi.org/10.1177/2325967120968556.
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Background: Guidelines for return to driving after anterior cruciate ligament reconstruction (ACLR) have not been established. Purpose: To review the literature pertaining to driving after ACLR and provide evidence-based guidelines to aid clinicians in counseling patients about driving after ACLR. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two independent reviewers searched PubMed, EMBASE, and the Cochrane Library using the terms anterior cruciate ligament, ACL, drive, and driving. Studies reporting on functional recovery after ACLR were included when data regarding return to driving were reported. Results: Five studies were included. Two studies included patients who underwent right-sided ACLR. Of these, 1 study evaluated bone-patellar tendon-bone autograft and reported that brake response time (BRT) returned to normal approximately 4 to 6 weeks postoperatively. The other study found that BRT returned to normal 3 weeks after allograft ACLR, but 6 weeks elapsed after autograft ACLR before values were not significantly different than controls. One study reported that patients who underwent left-sided hamstring tendon autograft ACLR demonstrated BRTs similar to controls within 2 weeks, while those with right-sided ACLR had significantly slower BRTs until 6 weeks postoperatively. Another study including patients who underwent either right- or left-sided ACLR and employed a manual transmission simulator found that 4 to 6 weeks should elapse after ACLR with hamstring tendon autograft. Survey data from 1 study demonstrated that the mean time for patients to resume driving was 13 and 10 days after right- and left-sided ACLR, respectively. Conclusion: BRT returned to normal values approximately 4 to 6 weeks after right-sided ACLR and approximately 2 to 3 weeks after left-sided ACLR. According to 1 study in this review, ACLR laterality should be disregarded for patients who drive manual transmission automobiles, as a 4- to 6-week time period was required for driving ability to reach the level of healthy controls. Future studies should aim to elucidate the influence of graft choice and transmission type on return to driving after ACLR.
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Lee, Chul-Soo, Seung-Beom Han, and Ki-Mo Jang. "Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using a Single Achilles Tendon Allograft: A Technical Note." Medicina 58, no. 7 (July 13, 2022): 929. http://dx.doi.org/10.3390/medicina58070929.
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Clinical outcomes after anterior cruciate ligament reconstruction (ACLR) have improved remarkably. However, residual rotational instability of the knee joint remains a major concern. The anterolateral ligament (ALL) has recently gained interest as a secondary stabilizer of knee joint rotatory instability, and this has led to the attempt of ALL reconstruction (ALLR) in combination with ACLR to restore rotational stability in patients with anterior cruciate ligament (ACL) injury. Although several techniques for ALLR have recently been introduced, the ideal graft type and surgical technique for combined ACLR and ALLR are yet to be established. This technical note therefore aimed at introducing a novel surgical procedure involving the use of a single Achilles tendon allograft as a relatively simple and minimally invasive procedure for combined ALL and ACL reconstruction.
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Lopes, Thiago Jambo Alves, Milena Simic, and Evangelos Pappas. "EPIDEMIOLOGY OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN BRAZIL'S PUBLIC HEALTH SYSTEM." Revista Brasileira de Medicina do Esporte 22, no. 4 (August 2016): 297–301. http://dx.doi.org/10.1590/1517-869220162204159074.
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ABSTRACT Introduction: Several studies have reported on the epidemiology of Anterior Cruciate Ligament Reconstruction (ACLR) in Europe and North America; however, there is currently no data relating to Brazil. Objective: To describe the incidence of ACLR in Brazil and investigate temporal trends and differences between age and sex groups. Methods: All reported ACLR cases in the public hospital system between January 2008 and December 2014 were extracted from the Information Technology Department of the Brazilian Ministry of Health. Linear regression analysis was used to assess changes in ACLR incidence in the overall population and among sex and age groups, hospitalization time, and health care costs. Results: A total of 48,241 ACLR were reported from 2008-2014 with an overall incidence of 3.49 per 100,000 persons/year. Males accounted for 82% of the procedures. The incidence of ACLR increased by 56% among males (p=0.01) and by 112% among females (p=0.001). The mean hospitalization time decreased from 2.4 days in 2008 to 1.8 day in 2014 (R2 = 0.883, p= 0.002). The total cost across all years was US$56 million, with a mean of US$1,145 per ACLR. Conclusion: Although the total incidence of ACLR in Brazil is lower compared to other countries, it has increased over the years, especially in females. The creation of an ACLR registry is necessary in the future, for more accurate control and new investigations.
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Ranuccio, Francesco, Filippo Familiari, Giuseppe Tedesco, Francesco La Camera, and Giorgio Gasparini. "Effects of Notchplasty on Anterior Cruciate Ligament Reconstruction: A Systematic Review." Joints 05, no. 03 (August 8, 2017): 173–79. http://dx.doi.org/10.1055/s-0037-1605551.
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Purpose Notchplasty is a complementary surgical procedure often performed during anterior cruciate ligament reconstruction (ACLR) with the aim to widen the intercondylar notch and to avoid graft impingement. The aim of this review was to analyze the current literature evidence concerning the effects of notchplasty on clinical outcome after primary ACLR. Methods Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE were used to search English language studies, from January 1990 to July 2015, concerning the effects of the notchplasty on ACLR, using the following keywords: “ACL” OR “anterior cruciate ligament” OR “ACL reconstruction” OR “anterior cruciate ligament reconstruction” AND “notch” OR “notchplasty” OR “intercondylar notch”. Randomized and nonrandomized trials, case series, technical notes, biomechanical studies and radiological study were included. Results At the final screening 16 studies were included. Despite widely used, the usefulness of notchplasty during ACLR remains unclear. Some concerns emerged regarding potential harmful effects of notchplasty, mostly related to the knee biomechanics and postoperative blood loss. Notchplasty can be useful in the treatment of arthrofibrosis and in presence of bony spurs of the notch both in primary and revision surgery. However, the level of evidence of available literature is poor and there is a strong need for randomized controlled trials investigating the role of notchplasty on ACLR. Conclusion We suggest being aware of potential complications following notchplasty during ACLR before deciding to perform notchplasty in primary ACLR, reserving it for the surgical management of arthrofibrosis, treatment of notch osteophytosis and revision ACLR. Level of Evidence Level IV, systematic review of level II-IV studies.
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Kuenze, Christopher M., Jay Hertel, Arthur Weltman, David Diduch, Susan A. Saliba, and Joseph M. Hart. "Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction." Journal of Athletic Training 50, no. 3 (March 1, 2015): 303–12. http://dx.doi.org/10.4085/1062-6050-49.5.06.
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Context: Return to activity in the presence of quadriceps dysfunction may predispose individuals with anterior cruciate ligament reconstruction (ACLR) to long-term joint degeneration. Asymmetry may manifest during movement and result in altered knee-joint–loading patterns; however, the underlying neurophysiologic mechanisms remain unclear. Objective: To compare limb symmetry of quadriceps neuromuscular function between participants with ACLR and participants serving as healthy controls. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 22 individuals with ACLR (12 men, 10 women) and 24 individuals serving as healthy controls (12 men, 12 women). Main Outcome Measure(s): Normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/kg), quadriceps central activation ratio (CAR) (%), quadriceps motor-neuron–pool excitability (Hoffmann reflex to motor wave ratio), and quadriceps active motor threshold (AMT) (% 2.0 T) were measured bilaterally and used to calculate limb symmetry indices for comparison between groups. We used analyses of variance to compare quadriceps Hoffmann reflex to motor wave ratio, normalized knee-extension MVIC torque, quadriceps CAR, and quadriceps AMT between groups and limbs. Results: The ACLR group exhibited greater asymmetry in knee-extension MVIC torque (ACLR group = 0.85 ± 0.21, healthy group = 0.97 ± 0.14; t44 = 2.26, P = .03), quadriceps CAR (ACLR group = 0.94 ± 0.11, healthy group = 1.00 ± 0.08; t44 = 2.22, P = .04), and quadriceps AMT (ACLR group = 1.13 ± 0.18, healthy group = 1.02 ± 0.11; t34 = −2.46, P = .04) than the healthy control group. Conclusions: Asymmetries in measures of quadriceps function and cortical excitability were present in patients with ACLR. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Measuring the magnitude of asymmetry after ACLR represents an important step in understanding long-term reductions in self-reported function and increased rate of subsequent joint injury in otherwise healthy, active individuals after ACLR.
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Mirzayan, Raffy, Heather A. Prentice, Anthony Essilfie, William E. Burfeind, David Y. Ding, and Gregory B. Maletis. "Revision Risk of Soft Tissue Allograft Versus Hybrid Graft After Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 48, no. 4 (March 2020): 799–805. http://dx.doi.org/10.1177/0363546520903264.
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Background: When a harvested hamstring autograft is deemed by the surgeon to be of inadequate diameter, the options include using the small graft, using another autograft from a different site, augmenting with an allograft (hybrid graft), using a different configuration of the graft (eg, 5- or 6-stranded), or abandoning the autograft and using allograft alone. A small graft diameter is associated with a higher revision risk, and using another autograft site includes added harvest-site morbidity; therefore, use of a hybrid graft or an allograft alone may be appealing alternative options. Revision risk for hybrid graft compared with soft tissue allograft is not known. Purpose: To evaluate the risk for aseptic revision surgery after primary anterior cruciate ligament reconstruction (ACLR) using a soft tissue allograft compared with ACLR using a hybrid graft in patients 25 years and younger. Study Design: Cohort study; Level of evidence, 3. Methods: Data from a health care system’s ACLR registry were used to identify primary isolated unilateral ACLRs between 2009 and 2016 using either a hybrid graft (hamstring autograft with soft tissue allograft) or a soft tissue allograft alone. Multivariable Cox proportional hazards regression was used to evaluate risk for aseptic revision after ACLR according to graft used after adjustment for age, allograft processing, tunnel drilling technique, and region where the primary ACLR was performed. Results: The cohort included 2080 ACLR procedures; a hybrid graft was used for 479 (23.0%) ACLRs. Median follow-up time was 3.4 years (interquartile range, 1.8-5.1 years). The crude 2-year aseptic revision probability was 5.4% (95% CI, 4.3%-6.7%) for soft tissue allograft ACLR and 3.8% (95% CI, 2.3%-6.4%) for hybrid graft ACLR. After adjustment for covariates, soft tissue allograft ACLR had a higher risk of aseptic revision during follow-up compared with hybrid graft ACLR (hazard ratio, 2.00; 95% CI, 1.21-3.31; P = .007). Conclusion: Soft tissue allografts had a 2-fold higher risk of aseptic revision compared with hybrid graft after ACLR. Future studies evaluating the indications for using hybrid grafts and the optimal hybrid graft diameter is needed.
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Chandra, Abhijit, Oliva Kar, Kuan-Chuen Wu, Michelle Hall, and Jason Gillette. "Prognosis of anterior cruciate ligament reconstruction: a data-driven approach." Proceedings of the Royal Society A: Mathematical, Physical and Engineering Sciences 471, no. 2176 (April 2015): 20140526. http://dx.doi.org/10.1098/rspa.2014.0526.
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Individuals who suffer anterior cruciate ligament (ACL) injury are at higher risk of developing knee osteoarthritis (OA) and almost 50% display symptoms 10–20 years post injury. Anterior cruciate ligament reconstruction ( ACLR ) often does not protect against knee OA development . Accordingly, a multi-scale formulation for data-driven prognosis (DDP) of post-ACLR is developed. Unlike traditional predictive strategies that require controlled off-line measurements or ‘training’ for determination of constitutive parameters to derive the transitional statistics, the proposed DDP algorithm relies solely on in situ measurements. The proposed DDP scheme is capable of predicting onset of instabilities. As the need for off-line testing (or training) is obviated, it can be easily implemented for ACLR, where such controlled a priori testing is almost impossible to conduct. The DDP algorithm facilitates hierarchical handling of the large dataset and can assess the state of recovery in post-ACLR conditions based on data collected from stair ascent and descent exercises of subjects. The DDP algorithm identifies inefficient knee varus motion and knee rotation as primary difficulties experienced by some of the post-ACLR population. In such cases, levels of energy dissipation rate at the knee, and its fluctuation may be used as measures for assessing progress after ACL reconstruction.
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Valette, Arnault, Dany Mouarbes, Vincent Marot, and Etienne Cavaignac. "Combined Anterior Cruciate Ligament Reconstruction Revision and Double-Bundle Medial Collateral Ligament and Posterior Oblique Ligament Reconstruction." Video Journal of Sports Medicine 1, no. 2 (March 2021): 263502542110007. http://dx.doi.org/10.1177/26350254211000751.
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Background: Nonsurgical treatment of concomitant medial collateral ligament (MCL) in the setting of anterior cruciate ligament reconstruction (ACLR) increases the risk of graft failure. Few published cases of medial complex reconstruction combined with ACLR with no clear consensus on the optimal technique to treat these complex injuries. Indications: A female patient aged 41 years, with failure of ACLR in 2009 and 2 revisions in 2013 and 2014, associated with concomitant nontreated MCL and posterior oblique ligament (POL) injury. Physical examination showed valgus test laxity grade III at 30° of knee flexion and at full extension, with Lachman and pivot-shift test grade III. Imaging showed normal long-leg standing axis with 10° posterior tibial slope on radiograph, and associated MCL and POL injury on magnetic resonance imaging. Technique Description: ACLR and anterolateral tenodesis using the fascia lata leaving its distal insertion on the Gerdy tubercle, with double-stranded contralateral gracilis, was completed. A new femoral tunnel was made from outside to inside, with preservation of the previous tibial tunnel. The transplant was fixed with 2 interference screws. Second, the contralateral semitendinous autograft was used for MCL and POL reconstruction. A single strand of the graft was used for femoral fixation created on femoral epicondyle to cover MCL and POL origins, and double strands were used for distal fixation of MCL at the level of hamstring insertion and POL at the posteromedial corner of medial tibial plateau. The graft was secured with 3 interference screws at 30 knee flexion for MCL and full extension for POL. Results: The results include favorable functional and clinical outcome with improvement in the anteroposterior and rotatory knee stability at mid-term follow-up. Lateral extra-articular tenodesis in supplementing ACLR controls internal tibial rotatory knee stability. Double-bundle reconstruction of MCL and POL improved both valgus and anteromedial rotatory instability by restraining external rotation. Discussion/Conclusion: Surgeons should consider the need for surgical treatment of concomitant MCL injury to prevent chronic valgus laxity and increased strain on the anterior cruciate ligament (ACL) graft, potentially increasing the risk of ACLR revision. Our described technique offers a safe method for ACLR and lateral tenodesis with an advantage to avoid tunnel convergence, and medial stabilization to restore native valgus and rotatory stability and prevent increased stress on ACL graft.
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Gergely, I., O. M. Russu, Ancuţa Zazgyva, O. Nagy, and T. S. Pop. "Quality of life after anterior cruciate ligament reconstruction." ARS Medica Tomitana 18, no. 4 (November 1, 2012): 168–73. http://dx.doi.org/10.2478/v10307-012-0031-9.
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Abstract The purpose of this study was to assess the quality of life of patients who underwent anterior cruciate ligament single-bundle reconstruction (ACLR) which involves reconstructing the ligament using autologous graft (semitendinosus and gracilis tendon). This is a retrospective study undertaken between the 1st of January 2010 and December 31, 2011 at the Clinic of Orthopedics and Traumatology Tîrgu-Mureş, involving 30 patients (6 women, 24 men), 17 to 54 years old (mean age of 30.13 years). All the patients underwent ACLR, with the above mentioned technique. The instrument chosen to assess the quality of life was the Short-Form 36 (SF-36) Questionnaire, completed by telephone. This questionnaire has 8 scales which are noted according to the received answers: Physical Functioning (PF), RF (Role Physical), BP (Bodily Pain), GH (General Health), VT (Vitality), SF (Social Functioning), RE (Role Emotional) and MH (Mental Health). The best way to score these scales is by comparing them to the healthy population, which is why this study uses normbased scales where the mean value is 50 and the standard deviation is 10. The scales used in the questionnaire are showed the next results: mean norm-based PF 49.19, RF 46.11, BP 49.82, GH 52.19, VT 52.14, SF 50.43, RE 41.36 and MH 47.18. The general Physical Component showed a mean of 48.93 and the Mental Component a mean of 47.33, close to the standard mean of 50. All these results were included in the standard deviation, which showed that the patients’ quality of life was very close to the quality of life of the normal population. Patients who have a history of ACLR tend to have a quality of life similar to the normal, healthy population.
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Rodríguez-Merchán, Emerito Carlos. "Anterior Cruciate Ligament Reconstruction: Is Biological Augmentation Beneficial?" International Journal of Molecular Sciences 22, no. 22 (November 22, 2021): 12566. http://dx.doi.org/10.3390/ijms222212566.
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Surgical reconstruction in anterior cruciate ligament (ACL) ruptures has proven to be a highly effective technique that usually provides satisfactory results. However, despite the majority of patients recovering their function after this procedure, ACL reconstruction (ACLR) is still imperfect. To improve these results, various biological augmentation (BA) techniques have been employed mostly in animal models. They include: (1) growth factors (bone morphogenetic protein, epidermal growth factor, granulocyte colony-stimulating factor, basic fibroblast growth factor, transforming growth factor-β, hepatocyte growth factor, vascular endothelial growth factor, and platelet concentrates such as platelet-rich plasma, fibrin clot, and autologous conditioned serum), (2) mesenchymal stem cells, (3) autologous tissue, (4) various pharmaceuticals (matrix metalloproteinase-inhibitor alpha-2-macroglobulin bisphosphonates), (5) biophysical/environmental methods (hyperbaric oxygen, low-intensity pulsed ultrasound, extracorporeal shockwave therapy), (6) biomaterials (fixation methods, biological coatings, biosynthetic bone substitutes, osteoconductive materials), and (7) gene therapy. All of them have shown good results in experimental studies; however, the clinical studies on BA published so far are highly heterogeneous and have a low degree of evidence. The most widely used technique to date is platelet-rich plasma. My position is that orthopedic surgeons must be very cautious when considering using PRP or other BA methods in ACLR.
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Vap, Alexander R., Robert F. LaPrade, and Lars Engebretsen. "Outcomes and Predictors of Revision Anterior Cruciate Ligament Reconstruction: An Evaluation of the Norwegian Knee Ligament Registry." Orthopaedic Journal of Sports Medicine 6, no. 3_suppl (March 1, 2018): 2325967118S0000. http://dx.doi.org/10.1177/2325967118s00002.
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Objectives: The Norwegian Ligament Registry (NKLR) provides an opportunity for quality surveillance and research. Intraoperative findings and outcome after revision anterior cruciate ligament reconstruction (RACLR) is not as well studied as after primary ACL reconstruction. There were two objectives of this study. First, to evaluate the Norwegian Knee Ligament Registry (NKLR) for the occurrence, failure rate, graft choice, patient demographic profile (gender, age, body mass index), sport at time of injury and associated pathology (cartilage injuries, meniscal tears, other ligament injuries) for revision anterior cruciate ligament reconstructions (RACLR). Second, to match compare RACLR patients to primary ACL reconstructions in order to define possible predictors for those patients who will require RACLR. Methods: All patients identified in the NKLR from June 2004 until September 2016 that did not undergo cartilage restoration, meniscal transplant nor had a documented fracture at the primary reconstruction were included in the study. Revision rates at 1, 2 and 5 years were estimated with Kaplan-Meier analysis, and the estimated risk of RACLR based upon demographic and associated pathology was estimated with Cox regression analysis. Results: 784 patients with an average age of 25.6 years (25.0-26.3) met the inclusion and exclusion criteria with 53.1% being male. 62.1% of revisions were performed with bone patellar bone (BPTB) autograft while 23% used hamstring autograft. Associated injuries of the menisci, cartilage, and other ligaments and the sport at the time of injury are listed (Table 1). 12.9% of RACLR patients went on to have a Re-revision ACLR at 5 years postop (Figure 1). Match comparisons of primary ACLR patients with RACLR demonstrated no significant difference in occurrence based upon age (<20, 20-30, and >30 years), graft choice (BPTB, Hamstring, Allograft, Bone Quadriceps Tendon (BQT)), cartilage injury (No injury, ICRS 1-2, ICRS 3-4), meniscal Injury, associated ligament injury, sport at time of injury or Body Mass Index (BMI). Conclusion: Based upon review of a large ligament reconstruction registry, one can expect that less than 13% of patients undergo a Re-revision ALCR following failure of a RALCR at 5 years. Match comparison of primary ACLR versus RACLR demonstrated no significant predictor of RACLR based upon age, graft choice, cartilage injury, meniscal injury, associated ligament injury, sport or BMI.
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Jaffri, Abbis H., Maggie Lynch, Susan A. Saliba, and Joseph M. Hart. "Quadriceps Oxygenation During Exercise in Patients With Anterior Cruciate Ligament Reconstruction." Journal of Athletic Training 56, no. 2 (January 5, 2021): 170–76. http://dx.doi.org/10.4085/1062-6050-0415.19.
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ContextThe causes of persistent muscle weakness after anterior cruciate ligament reconstruction (ACLR) are not well known. Changes in muscle oxygenation have been proposed as a possible mechanism.ObjectiveTo investigate changes in quadriceps muscle oxygenation during knee extension in ACLR-involved and ACLR-uninvolved limbs.DesignCase-control study.SettingLaboratory.Patients or Other ParticipantsA total of 20 individuals: 10 patients with primary, unilateral ACLR (7 women, 3 men; age = 22.90 ± 3.45 years, height = 170.81 ± 7.93 cm, mass = 73.7 ± 15.1 kg) and 10 matched control individuals (7 women, 3 men; age = 21.50 ± 2.99 years, height = 170.4 ± 10.7 cm, mass = 68.86 ± 9.51 kg).Intervention(s)Each participant completed a single data-collection session consisting of 5-second isometric contractions at 25%, 50%, and 75% of the volitional maximum followed by a 30-second maximal isometric knee-extension contraction.Main Outcome Measure(s)Oxygenated hemoglobin (O2Hb) measures in the reconstructed thigh were continuously recorded (versus the uninvolved contralateral limb as well as the nondominant thigh of healthy control individuals) using 3 wearable, wireless near-infrared spectroscopy units placed superficially to the vastus medialis, vastus lateralis, and rectus femoris muscles. Relative changes in oxygenation were ensemble averaged and plotted for each contraction intensity with associated 90% CIs. Statistical significance occurred where portions of the exercise trials with CIs on the O2Hb graph did not overlap. Effect sizes (Cohen d, 90% CI) were determined for statistical significance.ResultsWe observed less relative change in O2Hb in patients with ACLR than in healthy control participants in the rectus femoris at 25% (d = 2.1; 90% CI = 1.5, 2.7), 50% (d = 2.8; 90% CI = 2.6, 2.9), and 75% (d = 2.0; 90% CI = 1.9, 2.2) and for the vastus medialis at 75% (d = 1.5; 90% CI = 1.4, 1.5) and 100% (d = 2.6; 90% CI = 2.5, 2.7). Less relative change in O2Hb was also noted for the vastus medialis in ACLR-involved versus ACLR-uninvolved limbs at 100% (d = 2.62; 90% CI = 2.54, 2.70).ConclusionsQuadriceps muscle oxygenation during exercise differed between patients with ACLR and healthy control individuals. However, not all portions of the quadriceps were affected uniformly across contraction intensities.
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Burroughs, Patrick J., Joseph B. Kahan, Harold G. Moore, Jonathan N. Grauer, and Elizabeth C. Gardner. "Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 9, no. 2 (February 1, 2021): 232596712098229. http://dx.doi.org/10.1177/2325967120982293.
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Background: Physical therapy (PT) rehabilitation is critical to successful outcomes after anterior cruciate ligament reconstruction (ACLR). Later-stage rehabilitation, including sport-specific exercises, is increasingly recognized for restoring high-level knee function. However, supervised PT visits have historically been concentrated during the early stages of recovery after ACLR. Purpose/Hypothesis: To assess the number and temporal utilization of PT visits after ACLR in a national cohort. We hypothesized that PT visits would be concentrated early in the postoperative period. Study Design: Descriptive epidemiological study. Methods: The Humana PearlDiver database was searched to identify patients who underwent ACLR between 2007 and 2017. Patients with additional structures treated were excluded. The mean ± SD, median and interquartile range (IQR), and range of number of PT visits for each patient were determined for the 52 weeks after ACLR. PT visits over time were also assessed in relation to patient age and sex. Results: In total, 11,518 patients who underwent ACLR met the inclusion criteria; the mean age was 32.62 ± 13.70 years, and 42.7% were female patients. Of this study cohort, 10,381 (90.4%) had documented PT postoperatively; the range of PT visits was 0 to 121. On average, patients had 16.90 ± 10.60 PT visits (median [IQR], 16 [9-22]) after ACLR. Patients completed a mean of 52% of their PT visits in the first 6 weeks, 75% in the first 10 weeks, and 90% in the first 16 weeks after surgery. Patients aged 10 to 19 years had the highest number of PT visits (mean ± SD, 19.67 ± 12.09; median [IQR], 18 [12-25]), significantly greater than other age groups ( P < .001). Conclusion: PT after ACLR is concentrated in the early postoperative period. Physicians, therapists, and patients may consider adjusting the limited access to PT to optimize patient recovery. Clinical Relevance: As supervised PT visits may be limited, the appropriate temporal utilization of supervised PT visits must be maximized. Strategies to ensure sessions for later neuromuscular and activity-specific rehabilitation are needed.
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Partan, Matthew J., Cesar R. Iturriaga, and Randy M. Cohn. "Recent Trends in Concomitant Meniscal Procedures During Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 9, no. 2 (February 1, 2021): 232596712098413. http://dx.doi.org/10.1177/2325967120984138.
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Background: The chondroprotective effect and secondary stabilizing role of the meniscus has been well-established. Meniscal preservation during anterior cruciate ligament reconstruction (ACLR) has been advocated in the literature and supported by advancements in surgical techniques. Purpose: To examine the recent trends in concomitant partial meniscectomy and meniscal repair procedures with ACLR. Study Design: Descriptive epidemiological study. Methods: Patients who underwent arthroscopic meniscectomy (Current Procedural Terminology [CPT] codes 29880, 29881), meniscal repair (CPT codes 29882, 29883), and ACLR (CPT code 29888) between 2010 and 2018 were identified using the National Surgical Quality Improvement Program database. We calculated the proportion of patients who underwent each surgery type, stratified by year and by patient age and body mass index (BMI) groups. The Cochran-Armitage test for trend was used to analyze yearly proportions of concomitant meniscal surgery types. Results: During the 9-year study period, 22,760 patients underwent either isolated ACLR (n = 10,562) or ACLR with concomitant meniscal surgery (either meniscectomy [n = 8931] or meniscal repair [n = 3267]). There was a gradual decrease in the proportion of meniscectomies (from 80.8% of concomitant procedures in 2010 to 63.8% in 2018), while the proportion of meniscal repairs almost doubled (from 19.2% in 2010 to 36.2% in 2018) (trend, P < .001). ACLR with meniscal repair increased in patients aged 35 to 44 years and 45 to 54 years (trend, P = .027) between 2010 and 2018; at the same time, the proportion of normal weight patients decreased by 17.7%, the proportion of overweight patients increased by 13.2%, and increases were seen in BMI groups corresponding to obesity classes 1 to 3 (trend, P < .001). In 2010, the average BMI of patients undergoing ACLR with meniscectomy versus meniscal repair differed by 2 ( P = .004), but by 2018 the difference was nonsignificant (28.83 ± 5.80 vs 28.53 ± 5.73; P = .113). Conclusion: Between 2010 and 2018, there was an upward trend in the proportion of meniscal repairs performed during ACLR, with notable increases in the proportion of repairs being performed on older, overweight, and obese patients.
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Pamukoff, Derek N., Brian G. Pietrosimone, Eric D. Ryan, Dustin R. Lee, and J. Troy Blackburn. "Quadriceps Function and Hamstrings Co-Activation After Anterior Cruciate Ligament Reconstruction." Journal of Athletic Training 52, no. 5 (May 1, 2017): 422–28. http://dx.doi.org/10.4085/1062-6050-52.3.05.
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Context: Individuals with anterior cruciate ligament reconstruction (ACLR) have quadriceps dysfunction that contributes to physical disability and posttraumatic knee osteoarthritis. Quadriceps function in the ACLR limb is commonly evaluated relative to the contralateral uninjured limb. Bilateral quadriceps dysfunction is common in individuals with ACLR, potentially biasing these evaluations. Objective: To compare quadriceps function between individuals with ACLR and uninjured control participants. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Twenty individuals with unilateral ACLR (age = 21.1 ± 1.7 years, mass = 68.3 ± 14.9 kg, time since ACLR = 50.7 ± 21.3 months; females = 14; Tegner Score = 7.1 ± 0.3; 16 patellar tendon autografts, 3 hamstrings autografts, 1 allograft) matched to 20 control participants (age = 21.2 ± 1.2 years, mass = 67.9 ± 11.3 kg; females = 14; Tegner Score = 7.1 ± 0.4) on age, sex, body mass index, and Tegner Activity Scale. Main Outcome Measure(s): Maximal voluntary isometric knee extension was performed on an isokinetic dynamometer. Peak torque (PT), rate of torque development (RTD), electromyographic (EMG) amplitude, central activation ratio (CAR), and hamstrings EMG amplitude were assessed during maximal voluntary isometric knee extension and compared between groups using independent-samples t tests. Relationships between hamstrings co-activation and quadriceps function were assessed using Pearson correlations. Results: Participants with anterior cruciate ligament reconstruction displayed lesser quadriceps PT (1.86 ± 0.74 versus 2.56 ± 0.37 Nm/kg, P = .001), RTD (39.4 ± 18.7 versus 52.9 ± 16.4 Nm/s/kg, P = .03), EMG amplitude (0.25 ± 0.12 versus 0.37 ± 0.26 mV, P = .04), and CAR (83.3% ± 11.1% versus 93.7% ± 3.2%, P = .002) and greater hamstrings co-activation (27.2% ± 12.8% versus 14.3% ± 3.7%, P < .001) compared with control participants. Correlations were found between hamstrings co-activation and PT (r = −0.39, P = .007), RTD (r = −0.30, P = .03), and EMG amplitude (r = −0.30, P = .03). Conclusions: Individuals with ACLR possessed deficits in PT, RTD, and CAR compared with control participants. Peak torque is the net result of all agonist and antagonist activity, and lesser PT in individuals with ACLR is partially attributable to greater hamstrings co-activation.
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Igah, A. Newton, C. Moezinia, C. Austria, A. Galea, and N. Marauthainar. "Post operative anterior cruciate ligament reconstruction (ACLR) rehabilitation compliance." International Journal of Surgery 36 (November 2016): S113. http://dx.doi.org/10.1016/j.ijsu.2016.08.410.
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Karns, Michael R., Daniel L. Jones, Dane C. Todd, Travis G. Maak, Stephen K. Aoki, Robert T. Burks, Minkyoung Yoo, Richard E. Nelson, and Patrick E. Greis. "Patient- and Procedure-Specific Variables Driving Total Direct Costs of Outpatient Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 6, no. 8 (August 1, 2018): 232596711878854. http://dx.doi.org/10.1177/2325967118788543.
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Background: Few studies have investigated the influence of patient-specific variables or procedure-specific factors on the overall cost of anterior cruciate ligament reconstruction (ACLR) in an ambulatory surgery setting. Purpose: To determine patient- and procedure-specific factors influencing the overall direct cost of outpatient arthroscopic ACLR utilizing a unique value-driven outcomes (VDO) tool. Study Design: Cohort study (economic and decision analysis); Level of evidence, 3. Methods: All ACLRs performed by 4 surgeons over 2 years were retrospectively reviewed. Cost data were derived from the VDO tool. Patient-specific variables included age, body mass index, comorbidities, American Society of Anesthesiologists (ASA) classification, smoking status, preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computerized Adaptive Testing (PF-CAT) score, and preoperative Single Assessment Numeric Evaluation (SANE) score. Procedure-specific variables included graft type, revision status, associated injuries and procedures, time from injury to ACLR, surgeon, and operating room (OR) time. Multivariate analysis determined patient- and procedure-related predictors of total direct costs. Results: There were 293 autograft reconstructions, 110 allograft reconstructions, and 31 hybrid reconstructions analyzed. Patient-specific factors did not significantly influence the ACLR cost. The mean OR time was shorter for allograft reconstruction ( P < .001). Predictors of an increased direct cost included the use of an allograft or hybrid graft (44.5% and 33.1% increase, respectively; P < .001), increased OR time (0.3% increase per minute; P < .001), surgeon 3 or 4 (9.1% or 5.9% increase, respectively; P < .001 or P = .001, respectively), and concomitant meniscus repair (24.4% increase; P < .001). Within the meniscus repair cohort, all-inside, root, and combined repairs correlated with a 15.5%, 31.4%, and 53.2% increased mean direct cost, respectively, compared with inside-out repairs ( P < .001). Conclusion: This study failed to identify modifiable patient-specific factors influencing direct costs of ACLR. Allografts and hybrid grafts were associated with an increased total direct cost. Meniscus repair independently predicted an increased direct cost, with all-inside, root, and combined repairs being costlier than inside-out repairs. The time-saving potential of all-inside meniscus repair was not realized in this study, making implant use a significant factor in the overall cost of ACLR with meniscus repair.
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Hexter, A. T., T. Thangarajah, G. Blunn, and F. S. Haddad. "Biological augmentation of graft healing in anterior cruciate ligament reconstruction." Bone & Joint Journal 100-B, no. 3 (March 2018): 271–84. http://dx.doi.org/10.1302/0301-620x.100b3.bjj-2017-0733.r2.
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AimsThe success of anterior cruciate ligament reconstruction (ACLR) depends on osseointegration at the graft-tunnel interface and intra-articular ligamentization. Our aim was to conduct a systematic review of clinical and preclinical studies that evaluated biological augmentation of graft healing in ACLR.Materials and MethodsIn all, 1879 studies were identified across three databases. Following assessment against strict criteria, 112 studies were included (20 clinical studies; 92 animal studies).ResultsSeven categories of biological interventions were identified: growth factors, biomaterials, stem cells, gene therapy, autologous tissue, biophysical/environmental, and pharmaceuticals. The methodological quality of animal studies was moderate in 97%, but only 10% used clinically relevant outcome measures. The most interventions in clinical trials target the graft-tunnel interface and are applied intraoperatively. Platelet-rich plasma is the most studied intervention, but the clinical outcomes are mixed, and the methodological quality of studies was suboptimal. Other biological therapies investigated in clinical trials include: remnant-augmented ACLR; bone substitutes; calcium phosphate-hybridized grafts; extracorporeal shockwave therapy; and adult autologus non-cultivated stem cells.ConclusionThere is extensive preclinical research supporting the use of biological therapies to augment ACLR. Further clinical studies that meet the minimum standards of reporting are required to determine whether emerging biological strategies will provide tangible benefits in patients undergoing ACLR. Cite this article: Bone Joint J 2018;100-B:271–84.
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Kelly, Shayne R., Brendan M. Cutter, and Eric G. Huish. "Biomechanical Effects of Combined Anterior Cruciate Ligament Reconstruction and Anterolateral Ligament Reconstruction: A Systematic Review and Meta-analysis." Orthopaedic Journal of Sports Medicine 9, no. 6 (June 1, 2021): 232596712110098. http://dx.doi.org/10.1177/23259671211009879.
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Background: Combined anterior cruciate ligament (ACL) reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) are performed with the intention to restore native knee kinematics after ACL tears. There continue to be varying results as to the difference in kinematics between combined and isolated procedures, including anterior tibial translation (ATT) and internal tibial rotation (IR). Purpose: To perform a systematic review and meta-analysis to evaluate the kinematic changes of a combined ACLR/ALLR versus isolated ACLR and to assess the effects of different fixation techniques. Study Design: Systematic review. Methods: We conducted a systematic review and meta-analysis of 15 human cadaveric biomechanical studies evaluating combined ACLR/ALLR versus isolated ACLR and their effects on ATT and IR in 149 specimens. The primary outcomes were ATT and IR. Secondary outcomes included graft type and size as well as fixation methods such as type, angle, tension, and position of fixation. Meta-regression was used to examine the effect of various cofactors on the resulting measures. Results: Compared with isolated ACLR, combined ACLR/ALLR decreased ATT and IR by 0.01 mm (95% CI, –0.059 to 0.079 mm; P = .777) and 1.64° (95% CI, 1.30°-1.98°; P < .001), respectively. Regarding ACLR/ALLR, increasing the knee flexion angle and applied IR force led to a significant reduction in IR ( P < .001 and P = .044, respectively). There was also a significant reduction in IR in combined procedures with semitendinosus ALL graft, higher flexion fixation angles, and tension but no change in IR with differing femoral fixation points ( P < .001, P < .001, and P = .268, respectively). Multivariate meta-regression showed that the use of tibial-sided suture anchor fixation significantly reduced IR ( P < .001). Conclusion: These results suggest that a combined ACLR/ALLR procedure significantly decreases IR compared with isolated ACLR, especially at higher knee flexion angles. Semitendinosus ALL graft, fixation at higher knee flexion, increased tensioning, and tibial-sided interference screw fixation in ALLR may help to further reduce IR.
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Lovecchio, Francis, Ajay Premkumar, Tyler Uppstrom, Jeffrey Stepan, Brittany Ammerman, Moira McCarthy, Beth Shubin Stein, et al. "Opioid Consumption After Arthroscopic Meniscal Procedures and Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 8, no. 4 (April 1, 2020): 232596712091354. http://dx.doi.org/10.1177/2325967120913549.
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Background: Procedure-specific opioid-prescribing guidelines have the potential to decrease the number of unused pills in the home without compromising patient satisfaction. However, there is a paucity of data on the minimum necessary quantity to prescribe for outpatient orthopaedic surgeries. Purpose: To prospectively record daily opioid use and pain levels after arthroscopic meniscal procedures and anterior cruciate ligament reconstruction (ACLR) at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 95 adult patients who underwent primary arthroscopic knee surgery (meniscectomy, repair, or ACLR) were enrolled. Patients with a history of opioid dependence were ineligible. Daily opioid consumption and Numeric Rating Scale pain scores were collected through an automated text-messaging platform starting on postoperative day 1 (POD1). At 6 weeks or at patient-reported cessation of opioid use, final survey questions were asked. Patients who failed to complete data collection were excluded. Opioid use was converted into “pills” (oxycodone 5-mg equivalents) to facilitate comparisons and clinical applications. Factors associated with high and low opioid use were compared. Results: Of the 95 patients enrolled, 71 (74.7%) were included in the final analysis. Of these, 40 (56.3%) underwent meniscal surgery and 31 (43.7%) underwent ACLR. After outpatient arthroscopic meniscectomy or repair, the total median postdischarge opioid use was 0.3 pills (oxycodone 5-mg equivalents), with 75% of patients consuming 3.3 or fewer pills (range, 0-19 pills). For ACLR, the median postdischarge consumption was 7 pills (75th percentile, 23.3 pills; range, 0-41 pills). Almost one-third of patients (32.3%) took no opioids after surgery (3 ACLR, 20 meniscus). All meniscus patients and 71% of ACLR patients ceased opioid consumption by postoperative day 7. Conclusion: Opioids may not be necessary in all patients, particularly after meniscal surgery and in comparison with ACLR. For patients requesting opioids for pain relief, reasonable prescription quantities are 5 oxycodone 5-mg pills after arthroscopic meniscal procedures and 20 5-mg pills after ACLR. Slowing the current opioid epidemic and preventing future crises is dependent on refining prescribing habits. Clinicians should strongly consider patient education regarding expected pain as well as pain management strategies.
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Suh, Dongwhan, Moon Jong Chang, Hyung Jun Park, Chong Bum Chang, and Seung-Baik Kang. "Assessment of Anterolateral Ligament of the Knee After Primary Versus Revision Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 9, no. 10 (October 1, 2021): 232596712110262. http://dx.doi.org/10.1177/23259671211026237.
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Background: The anterolateral ligament of the knee (ALL) is a component of the lateral complex that stabilizes the structure against rotational force and may be associated with the outcome of anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose: To (1) find whether the visibility of the structure of the ALL is different in primary and revision ACLR groups, (2) determine whether the abnormal findings of the ALL structure on magnetic resonance imaging (MRI) scans are associated with type of trauma in ACL injury and mode of graft failure, and (3) determine whether there are differences in knee functional scores between patients with or without abnormal findings of the ALL structure on MRI scans in primary and revision ACLR groups. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 40 patients who underwent primary ACLR and 39 patients who underwent revision ACLR. Conventional MRI (1.5-T) scans taken before primary or revision ACLR were obtained and analyzed for visibility of the ALL, frequency and degree of injury of the ALL, and ALL signal anomalies. We also evaluated 1-year postoperative functional knee scores using the subjective International Knee Documentation Committee and Lysholm scores. Results: Visibility of the ALL was better in the primary ACLR group than the revision ACLR group (38% vs 14%; P = .041). The primary ACLR group showed a lower degree of injury across the femoral, meniscal, and tibial attachment sites than did the revision ACLR group (30% vs 13%, 41% vs 8%, and 62% vs 26%, respectively). Relative signal anomaly of the ALL was more frequent in the case of contact versus noncontact trauma of the ACL (85% vs 15%; P = .035), while absolute signal anomaly was equally observed between cases of contact and noncontact trauma in the primary ACLR group (50% vs 50%). No association was observed between ALL signal anomalies and 1-year postoperative functional knee scores. Conclusion: The revision ACLR group offered less visibility and showed a tendency for more frequent, higher degree of injury to the structure of the ALL. Regardless of observational differences between the 2 groups, no definite relevance was observed between the image and the functional outcome. For the assessment of the ALL, routinely performed conventional MRI alone is insufficient to make a clinical decision.
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Dashti Rostami, Komeil, Mohammad Hossein Alizadeh, Hooman Minoonejad, and Hamidreza Yazdi. "Effect of Fatigue on Ground Reaction Force Variables During Single-leg Landing in Athletes With the History of Anterior Cruciate Ligament Injury." Journal of Exercise Science and Medicine 11, no. 1 (January 1, 2020): 13–22. http://dx.doi.org/10.32598/jesm.11.1.2.
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Introduction: Since people experience fatigue after anterior cruciate ligament injury during exercises, it is important to understand how fatigue affects the biomechanical movement patterns. Therefore, this study aimed to investigate the effect of fatigue on ground reaction force variables during single-leg landing in athletes with a history of an anterior cruciate ligament sprain. Methods: it was a case-control study conducted in the University Laboratory. The sample consisted of 36 male athletes who were divided into three groups: 12 people with Anterior Cruciate Ligament Reconstruction (ACLR), 12 people with Anterior Cruciate Ligament Deficiency (ACLD), and 12 people as the control group. Fatigue was induced via the repetitive sets of double-leg squats (n=8), which were interspersed with the sets of countermovement jumps (n=2) and single-leg landings (n=3) until squats were no longer possible. A 2×2 repeated-measures multivariate analysis of variance was used to detect the main effects of group (ACLD, ACLR, control) and fatigue state (prefatigue, postfatigue) on the ground reaction forces variables. Results: The results showed a significant decrease in the peak vertical force and internal-external ground reaction force in the ACLD group after fatigue. Regardless of the fatigue state, the peak vertical ground reaction force in ACLD and ACLR groups was significantly lower than that in the control group. Conclusion: The athletes with the ACL injury, regardless of the selective treatment type, use compensatory strategies to reduce the contact forces on the lower extremity, compared with healthy athletes.
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Schneider, Matheus B., Justin E. Kung, Tina Zhang, Michael S. Rocca, Michael J. Foster, Sean J. Meredith, Natalie L. Leong, Jonathan D. Packer, and R. Frank Henn. "Patient Perception of Being “Completely Better” After Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 50, no. 5 (February 28, 2022): 1215–21. http://dx.doi.org/10.1177/03635465221074331.
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Background: Contextualizing patient-reported outcomes (PROs) by defining clinically relevant differences is important. Considering that anterior cruciate ligament reconstruction (ACLR) ideally results in the restoration of normal knee function, an assessment of patients’ perception of being “completely better” (CB) may be of particular value. Purpose: The purpose of this study was to assess the prevalence and characteristics of patients who self-report a CB status after ACLR. Additionally, we aimed to determine whether PROs were associated with a CB status after ACLR as well as to determine CB status thresholds for 2-year and change in values. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively analyzed data from an orthopaedic registry at a single institution. Patients were administered the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), and International Knee Documentation Committee (IKDC) Subjective Knee Form preoperatively and at 2 years after ACLR. Additionally, patients completed a CB anchor question at 2 years after ACLR. Thresholds for 2-year and change in PRO scores associated with achieving a CB status were identified with 90% specificity. Results: Overall, 95 of the 136 patients (69.9%) considered their condition to be CB at 2 years after surgery. The 2-year and change in PROMIS PF, PROMIS PI, and IKDC scores were significantly better in the CB group than in the non-CB group. Thresholds associated with a CB status for 2-year PROMIS PF, PROMIS PI, and IKDC scores were more reliable than those for changes in scores and were ≥63, ≤44, and ≥80, respectively. Thresholds for the change in PROMIS PF, PROMIS PI, and IKDC scores were ≥19, ≤–16, and ≥44, respectively. Conclusion: The majority of patients reported that they were CB at 2 years after ACLR. This study may serve as a reference for orthopaedic surgeons and researchers when considering outcomes after ACLR.
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Ridley, Taylor J., Christopher T. Rud, Aaron J. Krych, and Jeffrey A. Macalena. "Bacterial Contamination of a Marking Pen in Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 6, no. 5 (May 1, 2018): 232596711877204. http://dx.doi.org/10.1177/2325967118772043.
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Background: A sterile surgical marking pen is commonly used during anterior cruciate ligament reconstruction (ACLR) to outline the proposed skin incision and then to mark the graft during preparation. Once in contact with the skin, the pen is a potential source of bacterial transmission and subsequent infections after ACLR. Purpose/Hypothesis: The purpose of this study was to assess whether the skin marking pen is a fomite for contamination during arthroscopic ACLR. We hypothesized that there would be a difference in the rate of culture-positive pens between control pens and the study pens used to delineate the proposed skin incision. Study Design: Controlled laboratory study. Methods: Twenty surgical marking pens were collected prospectively from patients undergoing ACLR over a 12-month period. All patients underwent standard preoperative sterile preparation and draping procedures. Proposed incisions were marked with a new sterile pen, and the pen tip was immediately sent for a 5-day inoculation in broth and agar. Negative controls (unopened new pen) and positive controls (used to mark the skin incisions preoperatively) were also cultured. Additionally, blank culture dishes were observed during the growth process. All pens were removed from the surgical field before incision, and new marking pens were used when needed during the procedure. Results: Three of the 20 study pens (15%) demonstrated positive growth. All 3 pens grew species of Staphylococcus. None of the negative controls demonstrated growth, 6 of the 12 positive controls showed growth, and none of the blank dishes exhibited growth. Conclusion: This study found a 15% rate of surgical marking pen contamination by Staphylococcus during ACLR. It is recommended that the skin marking pen not be used for any further steps of the surgical case and be discarded once used. Clinical Relevance: Infections after ACLR are rare but may result in significant morbidity, and all measures to reduce them should be pursued. Surgeons performing ACLR should dispose of the surgical marking pen after skin marking and before intraoperative use such as graft markup.
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Setuain, Igor, Mikel Izquierdo, Fernando Idoate, Eder Bikandi, Esteban M. Gorostiaga, Per Aagaard, Eduardo L. Cadore, and Jesús Alfaro-Adrián. "Differential Effects of 2 Rehabilitation Programs Following Anterior Cruciate Ligament Reconstruction." Journal of Sport Rehabilitation 26, no. 6 (November 2017): 544–55. http://dx.doi.org/10.1123/jsr.2016-0065.
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Context:The muscular function restoration related to the type of physical rehabilitation followed after anterior cruciate ligament reconstruction (ACLR) using autologous hamstring tendon graft in terms of strength and cross-sectional area (CSA) remain controversial.Objective:To analyze the CSA and force output of quadriceps and hamstring muscles in subjects following either an Objective Criteria-Based Rehabilitation (OCBR) algorithm or the usual care (UCR) for ACL rehabilitation in Spain, before and 1 year after undergoing an ACLR.Design:Longitudinal clinical double-blinded randomized controlled trial.Setting:Sports-medicine research center.Patients:40 recreational athletes (30 male, 10 female [24 ± 6.9 y, 176.55 ± 6.6 cm, 73.58 ± 12.3 kg]).Intervention:Both groups conducted differentiated rehabilitation procedures after ACLR. Those belonging to OCBR group were guided in their recovery according to the current evidence-based principles. UCR group followed the national conventional approach for ACL rehabilitation.Main Outcome Measures:Concentric isokinetic knee joint flexor-extension torque assessments at 180°/s and Magnetic Resonance Imaging (MRI) evaluations were performed before and 12 months after ACLR. Anatomical muscle CSA (mm2) was assessed, in Quadriceps, Biceps femoris, Semitendinous, Semimembranosus, and Gracilis muscles at 50% and 70% femur length.Results:Reduced muscle CSA was observed in both treatment groups for Semitendinosus and Gracilis 1 year after ACLR. At 1-year follow-up, subjects allocated to the OCBR demonstrated greater knee flexor and extensor peak torque values in their reconstructed limbs in comparison with patients treated by UCR.Conclusions:Objective atrophy of Semitendinosus and Gracilis muscles related to surgical ACLR was found to persist in both rehabilitation groups. However, OCBR after ACLR lead to substantial gains on maximal knee flexor strength and ensured more symmetrical anterior-posterior laxity levels at the knee joint.
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Khair, Mahmoud Michael, Hassan Ghomrawi, Sean Wilson, and Robert G. Marx. "Patient and Surgeon Expectations Prior to Anterior Cruciate Ligament Reconstruction." HSS Journal ® 14, no. 3 (August 13, 2018): 282–85. http://dx.doi.org/10.1007/s11420-018-9623-7.
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Abstract Background When discussing potential treatment with patients choosing to undergo surgery for disruption of the anterior cruciate ligament (ACL) and their families, surgeons spend considerable time discussing expectations of the short- and long-term health of the knee. Most of the research examining patient expectations in orthopedic surgery has focused largely on arthroplasty. Questions/Purposes The purpose of this study was to quantitatively assess the differences between the patient’s and the surgeon’s expectations before primary anterior cruciate ligament reconstruction (ACLR). Methods In this case series, we prospectively enrolled 93 patients scheduled for primary ACLR between 2011 and 2014. Expectations were measured using the Hospital for Special Surgery 23-item Knee Expectations Survey; scores were calculated for each subject. Results In all but six categories, patients had expectations that either aligned with their surgeons’ or were lower. The largest discordance between surgeon and patient expectations in which the patient had lower expectations was employment; 75% of patients had similar expectations to the surgeon when asked if the knee would be “back to the way it was before the problem started,” less than 1% had higher expectations, and 17% had lower expectations. Conclusion In general, patient expectations align well with surgeon expectations. Patients who are older, have a lower activity level, and who have selected allograft over autograft for ACLR could also be at risk for greater discordance. Understanding these differences, and their predictors, will help guide physicians when they are counseling patients about ACLR and also help them interact with patients after surgery as they assess outcomes.
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Southam, Brendan R., Angelo J. Colosimo, and Brian Grawe. "Underappreciated Factors to Consider in Revision Anterior Cruciate Ligament Reconstruction: A Current Concepts Review." Orthopaedic Journal of Sports Medicine 6, no. 1 (January 1, 2018): 232596711775168. http://dx.doi.org/10.1177/2325967117751689.
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Primary anterior cruciate ligament (ACL) reconstructions (ACLRs) are being performed with increasing frequency. While many of these will have successful outcomes, failures will occur in a subset of patients who will require revision ACLRs. As such, the number of revision procedures will continue to rise as well. While many reviews have focused on factors that commonly contribute to failure of primary ACLR, including graft choice, patient factors, early return to sport, and technical errors, this review focused on several factors that have received less attention in the literature. These include posterior tibial slope, varus malalignment, injury to the anterolateral ligament, and meniscal injury or deficiency. This review also appraised several emerging techniques that may be useful in the context of revision ACL surgery. While outcomes of revision ACLR are generally inferior to those of primary procedures, identifying these potentially underappreciated contributing factors preoperatively will allow the surgeon to address them at the time of revision, ideally improving patient outcomes and preventing recurrent ACL failure.
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Stone, Amanda E., Jaimie A. Roper, Daniel C. Herman, and Chris J. Hass. "Cognitive Performance and Locomotor Adaptation in Persons With Anterior Cruciate Ligament Reconstruction." Neurorehabilitation and Neural Repair 32, no. 6-7 (May 21, 2018): 568–77. http://dx.doi.org/10.1177/1545968318776372.
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Background. Persons with anterior cruciate ligament reconstruction (ACLR) show deficits in gait and neuromuscular control following rehabilitation. This altered behavior extends to locomotor adaptation and learning, however the contributing factors to this observed behavior have yet to be investigated. Objective. The purpose of this study was to assess differences in locomotor adaptation and learning between ACLR and controls, and identify underlying contributors to motor adaptation in these individuals. Methods. Twenty ACLR individuals and 20 healthy controls (CON) agreed to participate in this study. Participants performed four cognitive and dexterity tasks (local version of Trail Making Test, reaction time test, electronic pursuit rotor test, and the Purdue pegboard). Three-dimensional kinematics were also collected while participants walked on a split-belt treadmill. Results. ACLR individuals completed the local versions of Trails A and Trails B significantly faster than CON. During split-belt walking, ACLR individuals demonstrated smaller step length asymmetry during EARLY and LATE adaptation, smaller double support asymmetry during MID adaptation, and larger stance time asymmetry during DE-ADAPT compared with CON. Conclusions. ACLR individuals performed better during tasks that required visual attention and task switching and were less perturbed during split-belt walking compared to controls. Persons with ACLR may use different strategies than controls, cognitive or otherwise, to adapt locomotor patterns.
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Delaloye, Jean-Romain, christoph Hartog, Samuel Blatter, Dominik Müller, Michel Schläppi, Dario Denzler, Jozef Murar, and Peter Koch. "A biomechanical study after combined reconstruction of the anterior cruciate and anterolateral ligaments: Comparison between anatomic anterolateral ligament reconstruction and lateral tenodesis using the modified Lemaire technique." Orthopaedic Journal of Sports Medicine 8, no. 2_suppl (February 1, 2020): 2325967120S0000. http://dx.doi.org/10.1177/2325967120s00003.
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Objectives: To determine the stabilizing role of the anterolateral ligament reconstruction (ALLR) and the modified Lemaire lateral extraarticular tenodesis (LET) performed in combination with anterior cruciate ligament reconstruction (ACLR) and to determine if one of these two procedures was superior to the other. Methods: Six non paired cadaveric knees were tested with a 6 degrees of freedom robotic system (KUKA Robotics). Internal rotation and anterior tibial translation were measured between 0 and 90° knee flexion after applying 5 N-m Torque and a 134-N anterior load, respectively. A full kinematics assessment was performed in each following conditions: intact knee, after section of the anterior cruciate ligament (ACL), after section of the ACL and anterolateral ligament (ALL) and Kaplan fibers, after isolated ACLR, after combined ACLR+LET and ACLR+ALLR. ALLR was performed using Gracilis tendon while central strip of the ilio-tibial band was used for the modified Lemaire procedure. These different states were compared using a Tukey paired comparison test. Results: In combined ACL and anterolateral deficient knee, anterior translation and internal rotation remained significantly increased after isolated ACLR compared to intact knee (+2.33 ± 1.44 mm and +1.98 ± 1.06°; p > 0.01). On the other hand, the addition of an ALLR or a modified Lemaire LET to the ACLR allowed to restore anterior translation and internal rotation to values similar to the intact knee. Finally, the two anterolateral procedures had not significantly different values in both tests. This difference was 0.67 ± 1.46 mm for anterior translation (p=0.79) and 0.11 ± 1.11° for internal rotation (p=0.99). Conclusion: In ACL and anterolateral deficient knee, combined ACLR and anterolateral reconstruction allowed restoration of native stability of the knee in anterior translation and internal rotation contrary to isolated ACLR. Additionally, both types of extra-articular reconstruction, ALLR or modified Lemaire procedure, were similar in terms of restoring knee kinematics and neither overconstrained the knee.
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Nagai, Kanto, Tom Gale, James J. Irrgang, Scott Tashman, Freddie H. Fu, and William Anderst. "Anterior Cruciate Ligament Reconstruction Affects Tibiofemoral Joint Congruency During Dynamic Functional Movement." American Journal of Sports Medicine 46, no. 7 (April 3, 2018): 1566–74. http://dx.doi.org/10.1177/0363546518764675.
Full textAbstract:
Background: Anterior cruciate ligament reconstruction (ACLR) has been shown to alter kinematics, which may influence dynamic tibiofemoral joint congruency (a measure of how well the bone surfaces fit together). This may lead to abnormal loading of cartilage and joint degeneration. However, joint congruency after ACLR has never been investigated. Hypotheses: The ACLR knee will be more congruent than the contralateral uninjured knee, and dynamic congruency will increase over time after ACLR. Side-to-side differences (SSD) in dynamic congruency will be related to cartilage contact location/area and subchondral bone curvatures. Study Design: Descriptive laboratory study. Methods: The authors examined 43 patients who underwent unilateral ACLR. At 6 months and 24 months after ACLR, patients performed downhill running on a treadmill while synchronized biplane radiographs were acquired at 150 images per second. Dynamic tibiofemoral kinematic values were determined by use of a validated volumetric model-based tracking process that matched patient-specific bone models, obtained from computed tomography, to biplane radiographs. Patient-specific cartilage models, obtained from magnetic resonance imaging, were registered to tracked bone models and used to calculate dynamic cartilage contact regions. Principle curvatures of the subchondral bone surfaces under each cartilage contact area were calculated to determine joint congruency. Repeated-measures analysis of variance was used to test the differences. Multiple linear regression was used to identify associations between SSD in congruency index, cartilage contact area, contact location, and global curvatures of femoral or tibial subchondral bone. Results: Lateral compartment congruency in the ACLR knee was greater than in the contralateral knee ( P < .001 at 6 months and P = .010 at 24 months). From 6 to 24 months after surgery, dynamic congruency decreased in the medial compartment ( P = .002) and increased in the lateral compartment ( P = .007) in the ACLR knee. In the lateral compartment, SSD in joint congruency was related to contact location and femur global curvature, and in the medial compartment, SSD in joint congruency was related to contact area. Conclusion: ACLR appears to affect dynamic joint congruency. SSD in joint congruency was associated with changes in contact location, contact area, and femoral bony curvature. Clinical Relevance: Alterations in tibiofemoral contact location, contact area, and bone shape affect dynamic joint congruency, potentially contributing to long-term degeneration after ACLR.
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Sanders, Thomas L., Hilal Maradit Kremers, Andrew J. Bryan, Kristin M. Fruth, Dirk R. Larson, Ayoosh Pareek, Bruce A. Levy, Michael J. Stuart, Diane L. Dahm, and Aaron J. Krych. "Is Anterior Cruciate Ligament Reconstruction Effective in Preventing Secondary Meniscal Tears and Osteoarthritis?" American Journal of Sports Medicine 44, no. 7 (March 8, 2016): 1699–707. http://dx.doi.org/10.1177/0363546516634325.
Full textAbstract:
Background: Reconstruction of anterior cruciate ligament (ACL) tears may potentially prevent the development of secondary meniscal injuries and arthritis. Purpose/Hypothesis: The purpose of this study was to (1) evaluate the protective benefit of ACL reconstruction (ACLR) in preventing subsequent meniscal tears or arthritis, (2) determine if earlier ACLR (<1 year after injury) offers greater protective benefits than delayed reconstruction (≥1 year after injury), and (3) evaluate factors predictive of long-term sequelae after ACLR. The hypothesis was that the incidence of secondary meniscal tears, arthritis, and total knee arthroplasty (TKA) would be higher in patients treated nonoperatively after ACL tears than patients treated with surgical reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included a population-based incidence cohort of 964 patients with new-onset, isolated ACL tears between 1990 and 2000 as well as an age- and sex-matched cohort of 964 patients without ACL tears. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. A total of 509 patients were treated with early ACLR, 91 with delayed ACLR, and 364 nonoperatively. All patients were retrospectively followed (range, 2 months to 25 years) to determine the development of subsequent meniscal tears, arthritis, or TKA. Results: At a mean follow-up of 13.7 years, patients treated nonoperatively after ACL tears had a significantly higher likelihood of developing a secondary meniscal tear (hazard ratio [HR], 5.4; 95% CI, 3.8-7.6), being diagnosed with arthritis (HR, 6.0; 95% CI, 4.3-8.4), and undergoing TKA (HR, 16.7; 95% CI, 5.0-55.2) compared with patients treated with ACLR. Similarly, patients treated with delayed ACLR had a higher likelihood of developing a secondary meniscal tear (HR, 3.9; 95% CI, 2.2-6.9) and being diagnosed with arthritis (HR, 6.2; 95% CI, 3.4-11.4) compared with patients treated with early ACLR. Age >21 years at the time of injury, articular cartilage damage, and medial/lateral meniscal tears were predictive of arthritis after ACLR. Conclusion: Patients treated with ACLR have a significantly lower risk of secondary meniscal tears, symptomatic arthritis, and TKA when compared with patients treated nonoperatively after ACL tears. Similarly, early ACLR significantly reduces the risk of subsequent meniscal tears and arthritis compared with delayed ACLR.