Notchplasty in anterior cruciate ligament reconstruction in the setting of passive anterior tibial subluxation |
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| Affiliation: | 1. Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States;2. Department of Biomechanics and Implant Design, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States;1. Orthopaedic Research Lab, Radboud University Medical Center, Nijmegen, The Netherlands;2. Department of Orthopaedic Surgery, Via Sana Clinic, Mill, The Netherlands;3. Laboratory for Biomechanical Engineering, University of Twente, Enschede, The Netherlands;1. Department of Radiology, Norfolk & Norwich University Hospital, United Kingdom;2. Department of Trauma & Orthopaedics, Norfolk & Norwich University Hospital, United Kingdom;1. Department of Orthopaedic Surgery, Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan;2. Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;3. Center for Advanced Medical Engineering and Informatics, Osaka University, Suita, Osaka, Japan;1. Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA;2. Kaiser Permanente, San Diego, CA, USA;3. Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA;1. Faculty of Biomedical and Life Sciences, Thomson Building, University of Glasgow, University Avenue, Glasgow G12 8QQ, United Kingdom;2. Golden Jubilee National Hospital, Agamemnon Street, Clydebank, West Dunbartonshire G81 4DY, United Kingdom;3. William Hunter Lecturer in Anatomy, Faculty of Biomedical and Life Sciences, Thomson Building, University of Glasgow, University Avenue, Glasgow G12 8QQ, United Kingdom;1. Department of Orthopaedic Surgery, The Canterbury Hospital, Canterbury, NSW, Australia;2. Sydney Knee Specialists, St George Private Hospital, Sydney, NSW, Australia;3. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Australia;4. Bryant Radiology, St George Private Hospital, Sydney, NSW, Australia |
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| Abstract: | PurposeIn an effort to minimize graft impingement among various ACL deficient states, we sought to quantitatively determine requirements for bone resection during notchplasty with respect to both volumetric amount and location.MethodsA validated method was used to evaluate Magnetic Resonance Imaging scans. We measured the ATT of the medial and lateral compartments in the following four states: intact ACL (27 patients), acute ACL disruption; < 2 months post-injury (76 patients), chronic ACL disruption; 12 months post-injury (42 patients) and failed ACL reconstruction (75 patients). Subsequently, 11 cadaveric knees underwent Computed Tomography (CT) scanning. Specialized software allowed virtual anterior translation of the tibia according to the average ATT measured on MRI. Impingement volume was analyzed by performing virtual ACLRs onto the various associated CT scans. Location was analyzed by overlaying an on-screen protractor. The center of the notch was defined as 0°.ResultsAverage impingement volume changed significantly in the various groups compared to the intact ACL group (acute 577 ± 200 mm3, chronic 615 ± 199 mm3, failed ACLR 678 ± 210 mm3, p = 0.0001). The location of the required notchplasty of the distal femoral wall border did not change significantly. The proximal femoral border moved significantly towards the center of the notch (acute 8.6° ± 4.8°, chronic 7.8° ± 4.2° (p = 0.013), failed ACLR 5.1° ± 5.9° (p = 0.002)).ConclusionOur data suggests that attention should be paid peri-operatively to the required volume and location of notchplasty among the various ACL deficient states to minimize graft impingement. |
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