共查询到20条相似文献,搜索用时 46 毫秒
1.
Femke Wolters Sharon H. A. Vrooijink Carola F. Van Eck Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2011,19(1):17-21
Purpose
The primary purpose of the current study is to identify a possible correlation between the femoral intercondylar notch size and the ACL insertion site size. The secondary purpose is to determine if there is a difference between male and female notch widths and insertion site sizes.Methods
For this study, 82 patients (41 men and 41 women) with an average age of 24.1 ± 10.0 years (range 13–58 years) undergoing anterior cruciate ligament (ACL) reconstruction were included. Arthroscopic measurements were taken at the base, middle, and top of the notch. Additionally, the notch height was measured at the highest point. The insertion sites of the ACL were identified, marked using electrocautery, and measured. The correlation between notch width and ACL insertion site size was calculated. In addition, differences between men and women with regard to the notch width and ACL insertion site size were determined.Results
Significant positive correlations were found between the notch widths and ACL insertion site measurements and ranged from 0.222 to 0.379 (P < 0.05). There were significant differences between men and women with regard to notch and insertion site size.Conclusion
The results of this study show that there is a significant, but weak correlation between the notch width and the ACL insertion site size. Women had a smaller notch and a smaller insertion site than men. This knowledge could influence pre-operative decision-making with regard to graft choice, single- or double-bundle surgery, and graft size.Level of evidence
Case series, Level IV.2.
Sharon H. A. Vrooijink Femke Wolters Carola F. Van Eck Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2011,19(1):12-16
Purpose
The primary purpose of this study was as follows: (1) to compare bony morphology in subjects with and without ACL injury. The secondary purposes were the following: (2) to compare bony morphology between men and women and (3) to determine whether MRI measurements of the notch correlate with intra-operative measurements.Methods
MRI measurements of NW, bicondylar width, medial condyle size and lateral condyle size, and medial-to-lateral condyle ratio (M:L) were taken from 45 subjects with ACL injury and 44 subjects without ACL injury, by two independent observers. In addition, notch width measurements were taken arthroscopically in the 45 injured subjects. Knee morphometrics were compared between men and women. Additionally, values of ACL-injured and non-injured subjects were compared for male and female subjects separately. Correlations between notch measurements taken from MRI and measured arthroscopically were determined. Reliability of the MRI measurements was calculated.Results
Significant differences were found for bicondylar width (P = 0.001), medial condyle width (P = 0.002), and lateral condyle width (P = 0.002) between male and female subjects. When bony morphology was compared between ACL-injured and non-injured subjects, the male subjects showed significant differences for bicondylar width (P = 0.002) and medial condyle width (P = 0.008). For the female subjects, significant differences were found for bicondylar width (P = 0.009) and lateral condyle width (P = 0.002). There was no correlation between notch width measured on the MRI’s and NW measured intra-operatively. The intra- and inter-observer reliability of the MRI measurements was satisfactory.Conclusions
There were differences in bony morphology between men and women and between subjects with and without ACL injury. The bony morphology that was different between ACL-injured and non-injured subjects varied between male and female subjects.Level of evidence
Case–control study, Level III.3.
Harald K. Widhalm Levent Surer Nikhil Kurapati Claudia Guglielmino James J. Irrgang Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2016,24(9):2787-2793
Purpose
This study was undertaken primarily to identify the tibial insertion site length of ruptured ACL fibres in patients undergoing primary ACL reconstruction. A secondary aim was to evaluate the correlation of pre- and intra-operative measurements.Methods
In 146 patients undergoing primary ACL reconstruction, a preoperative measurement on MRI of the tibial ACL insertion site length was taken by two raters and then compared with single surgeon’s intra-operative measurements using a specialized ruler. Inclusion criteria were primary ACL reconstruction and MRI performed within 3 months prior to surgery on one specific MRI machine at the study centre. Inter-rater and intra-rater reliability based on intra class correlation (ICC) was calculated. Additionally, correlation between preoperative and postoperative measurements and the anthropometric data was assessed using Pearson correlation.Results
The tibial ACL insertion site had a mean length of 16.6 ± 1.6 mm (11.9–21.0) as measured by MRI, and 16.4 ± 1.6 mm (11.0–20.0) as measured intra-operatively. The ICCs for intra- and inter-rater reliability of the MRI measurements were 0.99 (95 % CI 0.97; 0.99; p < 0.001) and 0.81 (95 % CI 0.75; 0.86; p < 0.001), respectively. Regression analysis demonstrated, after controlling for subject height and weight, that the MRI measurements significantly predicted intra-operative measurement of tibial insertion site length (β = 0.796; R 2-change 0.77; p < 0.001).Conclusion
Preoperative measurement of the tibial ACL length is possible using MRI and can be a valuable aid in more efficient preoperative planning given the knowledge of expected dimensions of special knee structures.Level of evidence
III.4.
Frank A. Petrigliano Volker Musahl Eduardo M. Suero Musa Citak Andrew D. Pearle 《Knee surgery, sports traumatology, arthroscopy》2011,19(1):86-93
Purpose
The menisci are known to be important secondary constraints to anterior translation of the tibia in the ACL-deficient knee. The effect of meniscal loss on knee stability as measured by the magnitude of the pivot shift following ACL reconstruction is unknown. The objective of this investigation was to determine the effect of meniscectomy on knee stability following two single-bundle ACL reconstruction strategies.Materials and Methods
A mechanized pivot shift was performed on cadaveric specimens in the ACL-intact and ACL-deficient state. Tibiofemoral translation was recorded using a surgical navigation system. The ACL was reconstructed utilizing a nonanatomic graft (n = 10) extending from the posterolateral tibial footprint to the anteromedial femoral footprint, or an anatomic anteromedial single-bundle graft extending from the anteromedial tibial footprint to the anteromedial femoral footprint (n = 10) and testing repeated. The medial or lateral meniscus was sectioned and the examination repeated. The other meniscus was sectioned and the examination subsequently repeated.Results
Lateral compartment translation during the pivot shift was significantly reduced following anatomic ACL reconstruction. In the nonanatomic group, lateral compartment translation increased by 9.1 mm (P < 0.001) after unicomparmental meniscectomy and 11.5 mm (P < 0.001) after bicompartmental meniscectomy. In the anatomic reconstruction group, lateral compartment translation increased by 7.6 mm (P < 0.001) after bicompartmental meniscectomy.Conclusion
With isolated ACL injury, anatomic single-bundle ACL reconstruction controlled the pivot shift during time zero testing. However, significant increases in lateral compartment translation during the pivot shift are seen following bicompartmental meniscectomy. Nonanatomic ACL reconstruction was less effective in controlling the pivot shift at time zero testing, and significant increases in lateral compartment translation during the pivot shift were seen following both unicomparmental and bicompartmental meniscectomy.5.
6.
Verena M. Schreiber Susan S. Jordan Gregory A. Bonci James J. Irrgang Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2017,25(5):1475-1481
Purpose
The aim of this study was to analyse early post-operative range of motion (ROM) as our anatomic double-bundle (DB) anterior cruciate (ACL) reconstruction technique with respect to tunnel placement evolved. It is the hypothesis of this study that more anatomic placement of the femoral insertion site of the anteromedial (AM) bundle of the ACL results in better restoration of early post-operative knee range of motion.Methods
Two methods of DB ACL reconstruction regarding more accurate placement of the femoral AM tunnel in relation to its anatomic origin were compared. Patients presenting for 1- and 3-month post-operative clinical visits were examined for passive extension and active flexion by members of the clinical staff. Only patients undergoing primary DB reconstruction with allograft were included in the analyses. To determine the effects of the modified AM bundle placement on recovery of post-operative ROM, patients undergoing surgery in the 6 months before July 2006 (Group A, n = 50) were compared to patients undergoing surgery in the 6 months after July 2006 (Group B, n = 49).Results
A total of 99 patients met the inclusion criteria. More accurate placement of the AM bundle of the ACL was associated with a smaller side-to-side difference in flexion at 1 month (n.s.) and at 3 months (3° reduction, p < 0.03) after surgery. There was no effect on extension (n.s.)Conclusion
More anatomic placement of the femoral insertion of the AM bundle was associated with improved knee flexion. The study translates the findings of previous anatomic basic science research to demonstrate improved restoration of normal joint motion. This ideally leads to improved long-term clinical outcomes and maintenance of joint and cartilage health.Level of evidence
III.7.
8.
Yasutaka Tashiro Gian Andrea Lucidi Tom Gale Kanto Nagai Elmar Herbst James J. Irrgang Yasuharu Nakashima William Anderst Freddie H. Fu 《Knee surgery, sports traumatology, arthroscopy》2018,26(2):485-490
Purpose
To clarify the morphology of anterior cruciate ligament (ACL) tibial insertion site in healthy young knees using high-resolution 3-T MRI.Methods
Subjects were 50 ACL-reconstructed patients with a mean age of 21.4 ± 6.8 years. The contralateral healthy knees were scanned using high-resolution 3-T MRI. The tibial insertion sites of the anteromedial (AM) and posterolateral (PL) bundle fibres, and the ACL attachment on the anterior horn of lateral meniscus (AHLM) were segmented from the MR images, and 3D models were reconstructed to evaluate the morphology. The shape of ACL footprint was qualitatively analysed, and the size of AM and PL attachments and AHLM overlapped area was measured digitally.Results
Tibial AM and PL bundles were clearly identified in 42 of 50 knees (84.0%). Morphology of the whole ACL tibial insertion site was elliptical in 23 knees (54.8%) and triangular in 19 knees (45.2%), but not classified as C-shape in any knees. However, the AM bundle attachment was of C-shape in 29 knees (69.0%) and band-like in 13 knees (31.0%). Overlap of ACL on AHLM was found in 26 knees (61.9%), and the size of the overlapped area was 4.8 ± 4.7% of the whole ACL insertion site.Conclusion
3D morphology of the intact ACL tibial insertion site analysed by high-resolution 3-T MRI was elliptical or triangular in healthy young knees. However, the AM bundle insertion site was of C-shape or band-like. A small lateral portion of the ACL was overlapped with the AHLM. As for clinical relevance, these findings should be considered in order to reproduce the native ACL insertion site sufficiently.Level of evidence
III.9.
Daisuke Araki Eric Thorhauer Scott Tashman 《Knee surgery, sports traumatology, arthroscopy》2018,26(5):1311-1318
Purpose
This study quantified the error in anterior cruciate ligament (ACL) insertion site location and area estimated from three-dimensional (3D) isotropic magnetic resonance imaging (MRI) by comparing to native insertion sites determined via 3D laser scanning.Methods
Isotropic 3D DESS MRI was acquired from twelve fresh-frozen, ACL-intact cadaver knees. ACL insertion sites were manually outlined in each MRI slice, and the resulting contours combined to determine the 3D insertion site shape. Specimens were then disarticulated, and the boundaries of the ACL insertion sites were digitized using a high-accuracy laser scanner. MRI and laser scan insertion sites were co-registered to determine the percent overlapping area and difference in insertion centroid location.Results
Femoral ACL insertion site area averaged 112.7 ± 17.9 mm2 from MRI and 109.7 ± 10.9 mm2 from laser scan (p = 0.345). Tibial insertion area was 134.7 ± 22.9 mm2 from MRI and 135.2 ± 15.1 mm2 from laser scan (p = 0.881). Percentages of overlapping area between modalities were 82.2 ± 10.2% for femurs and 81.0 ± 9.0% for tibias. The root-mean-square differences for ACL insertion site centroids were 1.87 mm for femurs and 2.49 mm for tibias. The MRI-estimated ACL insertion site centroids were biased on average 0.6 ± 1.6 mm proximally and 0.3 ± 1.9 mm posteriorly for femurs, and 0.3 ± 1.1 mm laterally and 0.5 ± 1.5 mm anteriorly for tibias.Conclusion
Errors in ACL insertion site location and area estimated from 3D-MRI were determined via comparison with a high-accuracy 3D laser scanning. Results indicate that MRI can provide estimates of ACL insertion site area and centroid location with clinically applicable accuracy. MRI-based assessment can provide a reliable estimate of the native ACL anatomy, which can be helpful for surgical planning as well as assessment of graft tunnel placement.10.
Erik Hohmann Adam Bryant Peter Reaburn Kevin Tetsworth 《Knee surgery, sports traumatology, arthroscopy》2011,19(1):109-114
Purpose
The purpose of this study was (1) to determine differences in posterior tibial slope (PTS) between subjects who underwent ACL reconstruction following a non-contact ACL injury and a matched control uninjured group and (2) to investigate gender differences between ACL-injured subjects and gender-matched controls.Methods
A retrospective chart review was conducted of all 316 ACL-deficient patients at a large regional academic teaching hospital. A control group was established searching the database of the same hospital for subjects who underwent knee radiographs for acute knee complaints with no ACL injury. Subjects (n = 272; males n = 199; females n = 73) were included if a non-contact mechanism could be established. Exclusion criteria included previous ipsilateral knee injury and/or knee previous surgery. PTS was measured on a digitalized lateral radiograph using the axis of the posterior tibial cortex as a reference.Results
There was a significant difference (P = 0.008) within the ACL injury group between males and females. There was no significant difference in the PTS angle between those patients with an ACL injury (5.8 ± 3.5 degrees) and the uninjured control group (5.6 ± 3.2 degrees), or between the male ACL injury patients (5.5 ± 3.4) and their control group (5.8 ± 3.1). However, there was a significant difference between the female ACL injury patients (6.7 ± 3.7) and their uninjured control group (5.0 ± 3.4) (P = 0.004).Conclusion
The results of this study suggest that increased posterior tibial slope appears to contribute to non-contact ACL injuries in females, but not in males.Level of evidence
Case–control study, Level III.11.
Joan W. H. Luites Nico Verdonschot 《Knee surgery, sports traumatology, arthroscopy》2017,25(8):2321-2329
Purpose
Femoral tunnel positioning is an important factor in anatomical ACL reconstructions. To improve accuracy, lateral radiographic support can be used to determine the correct tunnel location, applying the quadrant method. Piefer et al. (Arthroscopy 28:872–881, 2012) combined various outcomes of eight studies applying this method to one guideline. The studies included in that guideline used various insertion margins, imaging techniques and measurement methods to determine the position of the ACL centres. The question we addressed is whether condensing data from various methods into one guideline, results in a more accurate guideline than the results of one study.Methods
The accuracy of the Piefer’s guideline was determined and compared to a guideline developed by Luites et al. (2000). For both guidelines, we quantified the mean absolute differences in positions of the actual anatomical centres of the ACL, AM and PL measured on the lateral radiographs of twelve femora with the quadrant method and the positions according to the guidelines.Results
The accuracy of Piefer’s guidelines was 2.4 mm (ACL), 2.7 mm (AM) and 4.6 mm (PL), resulting in positions significantly different from the actual anatomical centres. Applying Luites’ guidelines for ACL and PL resulted in positions not significantly different from the actual centres. The accuracies were 1.6 mm (ACL) and 2.2 mm (PL and AM), which were significantly different from Piefer for the PL centres, and therefore more accurate.Conclusions
Condensing the outcomes of multiple studies using various insertion margins, imaging techniques and measurement methods, results in inaccurate guidelines for femoral ACL tunnel positioning at the lateral view.Clinical relevance
An accurate femoral tunnel positioning for anatomical ACL reconstruction is a key issue. The results of this study demonstrate that averaging of various radiographic guidelines for anatomical femoral ACL tunnel placement in daily practice, can result in inaccurate tunnel positions.Level of evidence
Diagnostic study, Level 1.12.
Pieter Van Dyck Stefan Clockaerts Filip M. Vanhoenacker Valérie Lambrecht Kristien Wouters Eline De Smet Jan L. Gielen Paul M. Parizel 《European radiology》2016,26(10):3383-3391
Objective
To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns.Methods
Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI.Results
Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p?=?0.008). Collateral ligament (p?≤?0.05) and osseous injuries (p?=?0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees.Conclusion
ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries.Key Points
? ALL injuries are fairly common in patients with acute ACL rupture. ? ALL injuries are highly associated with lateral meniscal and osseous injuries. ? MRI assessment of ACL-injured knees should include evaluation of the ALL.13.
Andreas Weiler Michael Wagner Christoph Kittl 《Knee surgery, sports traumatology, arthroscopy》2018,26(5):1384-1391
Purpose
Femoral tunnel placement is essential for good outcome in anterior cruciate ligament (ACL) reconstruction. In the past, several attempts have been made to optimize femoral tunnel placement. It was observed that the posterior horn of the lateral meniscus was always located directly below to the desired femoral ACL tunnel position, when the knee was brought to deep flexion (>?120°). The goal of the present study was to verify the hypothesis that the posterior horn of the lateral meniscus can be used as a landmark for femoral tunnel placement.Methods
Out of a consecutive series of ACL reconstructions done by a single surgeon, 55 lateral radiographs were evaluated according to the quadrant method by Bernard and Hertel. Additionally, on anterior-posterior radiographs the femoral tunnel angle was determined.Results
In the present case series the posterior horn of the lateral meniscus could be identified and used as a landmark for femoral tunnel placement in all cases. The mean tunnel depth was 24?±?5.1% and the mean tunnel height was 31.3?±?5.7%. The mean femoral tunnel angle was 41?±?4.9° using the anatomical axis as a reference. Compared to previous cadaver studies the data of the present study were within their anatomical range of the native ACL insertion site.Conclusion
The suggested technique using the posterior horn of the lateral meniscus as a landmark for femoral tunnel placement showed reproducible results and matches the native ACL insertion site compared to previous cadaveric studies. In particular, non-experienced ACL surgeons will benefit from this apparent landmark and the corresponding easy-to-use ACL reconstruction method.Level of evidence
IV.14.
Hiroto Inoue Takayuki Furumatsu Shinichi Miyazawa Masataka Fujii Yuya Kodama Toshifumi Ozaki 《Knee surgery, sports traumatology, arthroscopy》2018,26(2):434-441
Purpose
Anterior cruciate ligament (ACL) reconstruction can reduce the risk of developing osteoarthritic knees. The goals of ACL reconstruction are to restore knee stability and reduce post-traumatic meniscal tears and cartilage degradation. A chronic ACL insufficiency frequently results in medial meniscus (MM) injury at the posterior segment. How ACL reconstruction can reduce the deformation of the MM posterior segment remains unclear. In this study, we evaluated the form of the MM posterior segment and anterior tibial translation before and after ACL reconstruction using open magnetic resonance imaging (MRI).Methods
Seventeen patients who underwent ACL reconstructions without MM injuries were included in this study. MM deformation was evaluated using open MRI before surgery and 3 months after surgery. We measured medial meniscal length (MML), medial meniscal height (MMH), medial meniscal posterior body width (MPBW), MM–femoral condyle contact width (M-FCW) and posterior tibiofemoral distance (PTFD) at knee flexion angles of 10° and 90°.Results
There were no significant pre- and postoperative differences during a flexion angle of 10°. At a flexion angle of 90°, MML decreased from 43.7 ± 4.5 to 41.4 ± 4.5 mm (P < 0.001), MMH from 7.5 ± 1.4 to 6.9 ± 1.4 mm (P = 0.006), MPBW from 13.1 ± 2.0 to 12.2 ± 1.9 mm (P < 0.001) and M-FCW from 10.0 ± 1.5 to 8.5 ± 1.5 mm (P < 0.001) after ACL reconstruction. The PTFD increased from 2.1 ± 2.8 to 2.7 ± 2.4 mm after ACL reconstruction (P = 0.015).Conclusions
ACL reconstruction affects the contact pattern between the MM posterior segment and medial femoral condyle and can reduce the deformation of the MM posterior segment in the knee-flexed position by reducing abnormal anterior tibial translation. It possibly prevents secondary injury to the MM posterior segment and cartilage that progresses to knee osteoarthritis.Level of evidence
IV.15.
Takanori Iriuchishima Freddie H. Fu Keinosuke Ryu Makoto Suruga Yoshiyuki Yahagi Shin Aizawa 《Knee surgery, sports traumatology, arthroscopy》2018,26(4):1110-1116
Purpose
The purpose of this study was to reveal the correlation between femoral tunnel length and the morphology of the femoral intercondylar notch in anatomical single bundle anterior cruciate ligament (ACL) reconstruction using three-dimensional computed tomography (3D-CT).Methods
Thirty subjects undergoing anatomical single bundle ACL reconstruction were included in this study (23 female, 7 male: average age 45.5?±?16.7). In the anatomical single bundle ACL reconstruction, the femoral and tibial tunnels were created close to the antero-medial bundle insertion site with trans-portal technique. Using post-operative three-dimensional computed tomography (3D-CT), accurate axial and lateral views of the femoral condyle were evaluated. The correlation of femoral tunnel length, which was measured intra-operatively, with the transepicondylar length (TEL), notch width index, notch outlet length, the notch area (axial), length of Blumensaat’s line, and the height and area of the lateral wall of the femoral intercondylar notch was statistically analyzed. Tunnel placement was also evaluated using a Quadrant method.Results
The average femoral tunnel length was 35.4?±?4.4 mm. The average TEL, NWI, notch outlet length, and the axial notch area, were 76.9?±?5.1 mm, 29.1?±?3.8%, 19.5?±?3.9 mm, and 257.4?±?77.4 mm2, respectively. The length of Blumensaat’s line and the height and area of the lateral wall of the femoral intercondylar notch were 33.8?±?3.2 mm, 22.8?±?2.3 mm, and 738.7?±?129 mm2, respectively. The length of Blumensaat’s line, the height, and the area of the lateral wall of the femoral intercondylar notch were significantly correlated with femoral tunnel length. Femoral tunnel placement was 23.4?±?4.5% in a shallow-deep direction and 35.4?±?8.8% in a high-low direction.Conclusion
The length of Blumensaat’s line, height, and area of the lateral wall of the femoral intercondylar notch are correlated with femoral tunnel length in anatomical single bundle ACL reconstruction. For clinical relevance, these parameters are useful in predicting the length of the femoral tunnel in anatomical single bundle ACL reconstruction for the prevention of extremely short femoral tunnel creation.Level of evidence
Case controlled study, Level III.16.
Li H Hosseini A Li JS Gill TJ Li G 《Knee surgery, sports traumatology, arthroscopy》2012,20(8):1496-1502
Purpose
To analyze the morphological change in the cartilage of the knee after anterior cruciate ligament (ACL) injury by comparing with that of the intact contralateral knee.Methods
A total of 22 participants (12 male and 10 female patients) who had unilateral ACL injury underwent MRI scan of both the injured and intact contralateral knees. Sagittal plane images were segmented using a modeling software to determine cartilage volume and cartilage thickness in each part of the knee cartilage that were compared between the ACL-injured and the intact contralateral knees. Furthermore, the male and female patients’ data were analyzed in subgroups.Results
The ACL-injured knees had statistically significant lower total knee cartilage volume than the intact contralateral knees (P = 0.0020), but had similar mean thickness of total knee cartilage (not significant: n.s.). In the male subgroup, there was no significant difference in cartilage volume and thickness between normal and ACL-injured knees. In the female subgroup, the ACL-injured knees demonstrated statistically significant difference in total knee cartilage volume (P = 0.0004) and thickness (P = 0.0024) compared with the normal knees. The percentage change in the cartilage thickness in women was significantly greater than that in men.Conclusion
Cartilage volume was significantly smaller in the ACL-injured knees than in the contralateral intact knees in this cohort. Women tended to display greater cartilage volume and thickness change after ACL injury than men. These findings indicated that women might be more susceptible to cartilage alteration after ACL injuries.Level of evidence
III.17.
Hirotaka Mutsuzaki Tomonori Kinugasa Kotaro Ikeda Masataka Sakane 《Knee surgery, sports traumatology, arthroscopy》2018,26(2):500-507
Purpose
This study aimed to clarify the effect of calcium phosphate (CaP)-hybridized tendon grafting versus unhybridized tendon grafting on the morphological changes to the bone tunnels at the aperture 1 year after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction.Methods
Seventy-three patients were randomized to undergo the CaP (n = 37) or the conventional method (n = 36). All patients underwent computed tomography (CT) evaluation 1 week and 1 year post-operatively. The femoral and tibial tunnels at the aperture were evaluated on reconstructed 3D CT images. Changes in the cross-sectional area (CSA) and diameters of the femur and the tibia, and the translation rate of the tunnel walls and the morphological changes of both tunnels were assessed.Results
There was a significant reduction in the increase in the CSA and the anterior–posterior and proximal–distal tunnel diameters on the femoral side in the CaP group as compared with the conventional group. On the femoral side, the translation rate of the posterior wall was significantly larger in the CaP group than in the conventional group, whereas the translation rate of the distal wall was significantly smaller in the CaP group than in the conventional group.Conclusions
As compared with the conventional method, the CaP-hybridized tendon graft reduced bone tunnel enlargement on the femoral side 1 year after anatomic single-bundle ACL reconstruction due to an anterior shift of the posterior wall and reduced distal shift in the femoral bone tunnel. Clinically, the CaP-hybridized tendon grafts can prevent femoral bone tunnel enlargement in anatomic single-bundle ACL reconstruction.Level of evidence
I.18.
Benjamin S. Kester Omar A. Behery Shobhit V. Minhas Wellington K. Hsu 《Knee surgery, sports traumatology, arthroscopy》2017,25(10):3031-3037
Purpose
To identify the impact of anterior cruciate ligament (ACL) reconstruction on performance and career longevity for National Basketball Association (NBA) players.Methods
Seventy-nine players (80 knees) with acute ACL tears in the NBA between the 1984–2014 seasons, and 112 age, height, weight, and performance-matched controls were identified. Pre- and post-injury performance outcomes including seasons played, games played, games started, minutes per game, points per game, field goals, 3-point shots, rebounds, assists, steals, blocks, turnovers, personal fouls, usage percentage and player efficiency ratings were compared between cases and controls using independent samples t tests and Fisher’s exact tests.Results
Sixty-eight of seventy-nine players (86.1 %) returned to play in the NBA following ACL reconstruction. Mean length of post-operative play was 1.84 years shorter than matched controls (P = 0.001). There was a significantly higher rate of attrition from professional basketball for players with a history of ACL reconstruction (P = 0.014). In the first full season following surgery, players started in 15.5 fewer games (P = 0.001), they played in 17.3 fewer games (P < 0.001), and had combined player efficiency ratings 2.35 points lower (P = 0.001) when compared to matched controls. Over the length of their careers, players competed in 22.2 fewer games per season (P = 0.009).Conclusions
There is a high rate of return to sport in the NBA following ACL reconstruction, although playing time, games played, player efficiency ratings and career lengths are significantly impacted in the post-operative period. These data should be used to manage patients’ expectations regarding their abilities to return to elite levels of athletic performance.19.
Shinya Yanagisawa Masashi Kimura Keiichi Hagiwara Atsuko Ogoshi Tomoyuki Nakagawa Hiroyuki Shiozawa Takashi Ohsawa Hirotaka Chikuda 《Knee surgery, sports traumatology, arthroscopy》2018,26(2):491-499
Purpose
The aim of the present study was to investigate the correlation between postoperative tunnel enlargement after ACLR and remnant tissue preservation using the hamstring tendon.Methods
One hundred and ninety-two subjects (male, n = 101; female, n = 91; mean age 27.1) who had undergone double-bundle ACL reconstruction were included in the present study. The patients were divided into two groups: the remnant tissue preservation group (Group R) and the non-remnant tissue preservation group (Group N). Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months after surgery. The area of the tunnel aperture for the anteromedial femoral tunnel (FAMT), posterolateral femoral tunnel (FPLT), anteromedial tibial tunnel (TAMT), and posterolateral tibial tunnel (TPLT) was measured. The area at 2 weeks after ACLR was subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. The differences in the outcomes and characteristics of the two groups were evaluated.Results
Seventy-seven knees were classified into Group R, and 115 knees were classified into Group N. The age, gender, and body mass index did not differ to a statistically significant extent. The percentages of FAMT and TAMT enlargement in Group R were significantly smaller in comparison with Group N (P = 0.003 and P = 0.03, respectively). The percentage of FPLT and TPLT enlargement in the two groups did not differ to a statistically significant extent.Conclusion
The remnant-preserving technique reduces the amount of bone tunnel enlargement. The present findings indicate the advantages of the remnant-preserving ACLR technique, and therefore the remnant-preserving technique should be recommended.Level of evidence
II.20.
Shinya Oka Peter Schuhmacher Axel Brehmer Ulrike Traut Joachim Kirsch Rainer Siebold 《Knee surgery, sports traumatology, arthroscopy》2016,24(3):747-753