ACL Reconstruction

Patients who have anterior cruciate ligament injuries are likely to question their primary care physicians about their treatment options, which include surgical reconstruction. Although surgery cannot restore knees to their original condition, a successful reconstruction will provide stability to the knee and allow patients to lead fairly active lives.     

Individualized ACL reconstruction

The pivot shift test is the only physical examination test capable of predicting knee function and osteoarthritis development after an ACL injury. However, because interpretation and performance of the pivot shift are subjective in nature, the validity of the pivot shift is criticized for not providing objective information for a complete surgical planning for the treatment of rotatory knee laxity. The aim of ACL reconstruction was eliminating the pivot shift sign. Many structures and anatomical characteristics can influence the grading of the pivot shift test and are involved in the genesis and magnitude of rotatory instability after an ACL injury. The objective quantification of the pivot shift may be able to categorize knee laxity and provide adequate information on which structures are affected besides the ACL. A new algorithm for rotational instability treatment is presented, accounting for patients’ unique anatomical characteristics and objective measurement of the pivot shift sign allowing for an individualized surgical treatment. Level of evidence V.     

前交叉韧带止点形态学测量及重建骨道直径探讨

目的:在膝关节尸体标本上测量前交叉韧带(ACL)止点的形态大小,探讨重建ACL时骨道直径的最佳选择。方法:解剖26具新鲜冷冻的膝关节尸体标本,标记ACL股骨和胫骨止点边界和前内束(AM)和后外束(PL)的分界。确定ACL、AM和PL纵轴并测量其长度,经过纵轴中点作其垂线,沿垂线测量止点宽度,该宽度则为重建骨道的最大直径。结果:测量值用均数(第25百分位数～第75百分位数)表示。ACL、AM和PL胫骨止点纵轴宽度分别为9.06(7.65~9.88)mm,8.47(6.85~9.23)mm和6.43(5.01~7.88)mm;其股骨止点纵轴宽度分别为10.31(8.75~11.50)mm,8.60(7.79~9.23)mm和6.74(5.54~8.00)mm。根据解剖重建和胫骨、股骨骨道相一致的原则,依据镜下测量结果,决定ACL重建时骨道直径。单束重建骨道直径可从7.5 mm到9.5 mm,均值为9 mm。双束重建AM骨道直径可从6.5 mm到9.0 mm,均值为8 mm;PL骨道的直径可从5.0 mm到7.5 mm,均值为6 mm。     

Inferior results after revision ACL reconstructions: a comparison with primary ACL reconstructions

Purpose

Anterior cruciate ligament (ACL) ruptures are common, especially among young athletes, and such injuries may have considerable impact on both sport careers and everyday life. ACL reconstructions are successful for most patients, but some suffer from persistent giving-way symptoms and/or re-ruptures requiring revision surgery. The aim of this study was to evaluate the results after revision ACL reconstructions and compare them with the results in a control group consisting of primary ACL reconstructions.

Methods

This retrospective study included 56 patients undergoing revision ACL reconstruction and 52 patients receiving primary ACL reconstructions. The follow-up evaluation included clinical examination, instrumented laxity testing, testing of muscle strength, Tegner activity score, Lysholm score, Knee injury and osteoarthritis outcome score (KOOS) and radiological grading of osteoarthritis.

Results

The median time from the last ACL reconstruction to follow-up was 90 months in the revision ACL reconstruction group and 96 months in the primary ACL reconstruction group. The revision group had significantly inferior KOOS and Lysholm scores compared with the primary group. Patients in the revision group also showed greater laxity measured with the pivot shift test, a larger reduction in the Tegner activity score, reduced muscle strength in the injured knee, and more severe radiological osteoarthritis; however, no difference in anterior-posterior translation was found.

Conclusion

Inferior results were found on several of the testing parameters in the revision group compared with the primary group. Patients should receive this information prior to revision ACL reconstructions.

Level of evidence

III.