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1.
BMJ ; 372: n375, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687926

RESUMO

OBJECTIVE: To assess whether a clinically relevant difference exists in patients' perceptions of symptoms, knee function, and ability to participate in sports over a period of two years after rupture of the anterior cruciate ligament (ACL) between two commonly used treatment regimens. DESIGN: Open labelled, multicentre, parallel randomised controlled trial (COMPARE). SETTING: Six hospitals in the Netherlands, between May 2011 and April 2016. PARTICIPANTS: Patients aged 18 to 65 with an acute rupture of the ACL, recruited from six hospitals. Patients were evaluated at three, six, nine, 12, and 24 months. INTERVENTIONS: 85 patients were randomised to early ACL reconstruction and 82 to rehabilitation followed by optional delayed ACL reconstruction after a three month period (primary non-operative treatment). MAIN OUTCOMES: Patients' perceptions of symptoms, knee function, and ability to participate in sporting activities were assessed with the International Knee Documentation Committee score (optimum score 100) at each time point over 24 months. RESULTS: Between May 2011 and April 2016, 167 patients were enrolled in the study and randomised to one of two treatments (mean age 31.3; 67 (40.%) women), and 163 (98%) completed the trial. In the rehabilitation and optional delayed ACL reconstruction group, 41 (50%) patients underwent reconstruction during follow-up. After 24 months, the early ACL reconstruction group had a significantly better (P=0.026) but not clinically relevant International Knee Documentation Committee score (84.7 v 79.4 (difference between groups 5.3, 95% confidence interval 0.6 to 9.9). After three months of follow-up, the International Knee Documentation Committee score was significantly better (P=0.002) for the rehabilitation and optional delayed ACL reconstruction group (difference between groups -9.3, -14.6 to -4.0). After nine months of follow-up, the difference in the International Knee Documentation Committee score changed in favour of the early ACL reconstruction group. After 12 months, differences between the groups were smaller. In the early ACL reconstruction group, four re-ruptures and three ruptures of the contralateral ACL occurred during follow-up versus two re-ruptures and one rupture of the contralateral ACL in the rehabilitation and optional delayed ACL reconstruction group. CONCLUSIONS: In patients with acute rupture of the ACL, those who underwent early surgical reconstruction, compared with rehabilitation followed by elective surgical reconstruction, had improved perceptions of symptoms, knee function, and ability to participate in sports at the two year follow-up. This finding was significant (P=0.026) but the clinical importance is unclear. Interpretation of the results of the study should consider that 50% of the patients randomised to the rehabilitation group did not need surgical reconstruction. TRIAL REGISTRATION: Netherlands Trial Register NL 2618.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Tratamento Conservador/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Adolescente , Adulto , Idoso , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Recuperação de Função Fisiológica , Volta ao Esporte , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 330-336, 2021 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-33719242

RESUMO

Objective: To investigate the effectiveness of double-bundle anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament (ALL) reconstruction in the treatment of revision patients with ACL graft failure. Methods: Between January 2018 and June 2019, 15 patients underwent ACL revision with double-bundle ACL reconstruction combined with ALL reconstruction. There were 12 males and 3 females with an average age of 30.1 years (range, 17-49 years). The technique of primary ACL reconstruction included single-bundle reconstruction in 13 cases and double-bundle reconstruction in 2 cases. These reconstructions applied autografts in 14 cases and allograft in 1 case. The causes of ACL reconstruction failure were identified as traumatic rupture in 9 cases and non-traumatic failure in 6 cases, including 2 cases of graft absorption and 3 cases of graft laxity. The average time from the primary ACL reconstruction to revision was 28.5 months (range, 8-60 months). The subjective and objective indicators of knee joint function were compared before operation and at last follow-up to evaluate the effectiveness. The subjective indicators included International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score. The objective indicators included anterior tibial translation (dynamic and static) and side-to-side difference (SSD), pivot-shift test, Lachman test, the difference of single-legged hop test, and the loss ratio of extensor muscle strength on the affected side. Results: All incisions healed by first intetion, and no complications such as infection, venous thrombosis of lower extremity, or neurovascular injury occurred. All patients were followed up for an average of 19.1 months (range, 12-30 months). At last follow-up, all patients had returned to pre-injury sports level. The IKDC score, Lysholm score, and Tegner score were significantly improved ( P<0.05); anterior tibial translations (dynamic and static) significantly decreased when compared with preoperative one ( P<0.05) and returned to the physiological range. The SSD, Lachman test, pivot-shift test, the difference of single-legged hop test, and the loss ratio of extensor muscle strength on the affected side were significantly better than those before operation ( P<0.05).During the follow-up, there was no re-rupture of the graft, no stiffness of the knee joint and limitation of mobility; 1 case had a protruding femoral end compression screw, which was removed through the original incision under local anesthesia. Conclusion: Double-bundle ACL reconstruction combined with ALL reconstruction can significantly improve the knee function in revision patients with ACL graft failure. It can reduce the anterior translation of tibia, and effectively prevent postoperative rotational instability of the knee.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 337-342, 2021 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-33719243

RESUMO

Objective: To investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique. Methods: Between July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction. Results: The operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant ( P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension. Conclusion: Using WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient's own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Adulto , Anestesia Local , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Suturas , Resultado do Tratamento , Adulto Jovem
4.
Acta Chir Orthop Traumatol Cech ; 88(1): 39-44, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-33764866

RESUMO

PURPOSE OF THE STUDY Knee injuries accompanied by anterior cruciate ligament (ACL) tears can also result in rotational instability of the joint. Subsequent insufficient rotational stability after the ACL reconstruction can be a direct consequence also of injuries to lateral knee structures, specifically the anterolateral ligament (ALL). This residual postoperative rotational instability may be prevented by multiple surgical techniques. The purpose of this study was (1) to evaluate the knee stability in internal rotation after the "anatomical" single-bundle (SB) anterior cruciate ligament reconstruction together with ALL reconstruction compared to the double-bundle (DB) ACL reconstruction two years after surgery; (2) to compare the knee joint stability after the ACL and ALL reconstruction with the healthy contralateral knee joint. MATERIAL AND METHODS All the measurements were conducted by the computer navigation system. The study included 20 patients after the single-bundle ACL and ALL reconstruction and 20 patients after the double-bundle ACL reconstruction. The follow-up examination was carried out at 25 months after surgery on average (24 months at least). All measurements were performed in both the healthy and operated knee. Once the data necessary for navigation were determined, the patient remained in standing position with both feet firmly placed on the mat with intermalleolar distance of 20 cm. Then, at 30-degree flexion of the knee joints, the patient first performed the joint internal rotation by trunk torsion, followed by external rotation. Each measurement was repeated 3 times. A non-parametric t-test was used for statistical processing. RESULTS The mean internal rotation in the injured knee joint was 19.1 degrees preoperatively and 8.1 degrees postoperatively, while in the healthy knee it was 8.4 degrees. External rotation was not assessed. The reported internal rotation in the knees after DB ACL reconstruction was 9.2 degrees (p ≥ 0.05). DISCUSSION The double-bundle ACL reconstruction is a complex technique that can lead to many intraoperative and postoperative complications. Grafts harvested from both hamstrings can have an effect on the rotational stability of the joint. In order to restore the knee rotational stability with fewer potential complications, the method of choice can be the ACL reconstruction using the quadriceps femoris muscle graft and the ALL reconstruction using the gracilis muscle graft, leaving the semitendinosus tendon intact. CONCLUSIONS The obtained values reveal that the single-bundle ACL reconstruction in combination with ALL reconstruction results in the same internal rotational stability in the knee joint as the double-bundle ACL reconstruction. Similar joint rotational stability is observed in all the knee joints reconstructed with the use of these techniques and in the contralateral healthy knee joint. Key words: anterolateral ligament, anterior cruciate ligament, internal rotational stability, objective measurement.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular
5.
Acta Chir Orthop Traumatol Cech ; 88(1): 58-62, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33764869

RESUMO

PURPOSE OF THE STUDY To compare the early clinical results of patients who had anterior cruciate ligament (ACL) reconstruction with peroneus longus allograft versus hamstring tendon autograft. MATERIAL AND METHODS Forty patients who underwent ACL reconstruction were included in the study. Patients were grouped by their graft preference. Lachman and Pivot-shift tests were performed to the patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. The maximum force values of nonoperated knee and the operated knee were recorded with Cybex II isokinetic dynamometer (HUMAC) and compared to each other. International Knee Documentation Committee (IKDC) form, modified Lysholm and Cincinnati evaluation forms were compared between two groups. RESULTS Twenty patients included into peroneus longus allograft (Group 1) and 20 patients were included into hamstring autograft group (Group 2). The mean age of patients Group 1 and 2 were 34.25 ± 6.73, and 29.6 ± 4.55, respectively. No significant difference was noted between two groups at modified Lysholm, Cincinati and IKDC scores (p > 0.01). There was no statistically significant difference between the Lachman and Pivot hift levels (p > 0.01). No significant difference was found in KT-1000 device measurements between groups according to the performed techniques (p > 0.01). There was no statistically significant difference between Cybex extension-flexion 60 /sec measurement and extension 240 /sec measurement of the patients (p > 0.01). DISCUSSION Allografts can be preferred because of the advantages, such as lack of donor site morbidity, short operative time, large graft, small incision, minimal scar, good cosmetic appearance, less postoperative pain, less movement restriction, and less arthrofibrosis. However, there are disadvantages, such as disease transmission, low biocompatibility, immune response, long recovery time, and high cost. Although it is difficult to compare the stability and functionality of allografts and autografts because of the differences in graft processing, fixation methods, and surgical techniques in studies, similar clinical results are reported in long-term follow-ups CONCLUSIONS Graft preference is dependent on surgical experience, patient age, activity status, comorbidities, presurgical status, and patient decision. Allograft ACL reconstruction is a good alternative to arthroscopic ACL reconstruction performed with hamstring tendon graft. Key words: anterior cruciate ligament, peroneus longus allograft, hamstring autograft, ACL reconstruction.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Aloenxertos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Articulação do Joelho/cirurgia , Transplante Autólogo , Resultado do Tratamento
6.
Arthroscopy ; 37(3): 1053-1054, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673959

RESUMO

Many different autografts are available for anterior cruciate ligament reconstruction. Although patellar tendon graft and hamstrings are most commonly used, quadriceps tendon with or without a bone plug is gaining popularity. Preliminary evidence suggests that quad tendon without a bone plug performs at least as well as with a plug, although more comparative information is needed. In the meantime, surgeons should strive to gain experience with multiple anterior cruciate ligament grafts.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Humanos , Tendões , Transplante Autólogo
9.
Arthroscopy ; 37(3): 961-963, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673974

RESUMO

An increasing number of surgeons adopt the concept of vancomycin soaking of the graft in anterior cruciate ligament reconstruction and report drastically reduced numbers of postoperative septic knee arthritis. This reduction of incidence is supported by in vitro data, showing no influence of vancomycin on tendon material properties. Although the applied antibiotic concentration has reported to be potent in eradicating graft contamination, no evidence of chondrotoxicity has been shown. Based on the increasing evidence, the call for randomized controlled trials stands in ethical contrast with the medical responsibility not to withhold patients an infection prophylaxis that has already been proven to be safe and effective.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Artrite Infecciosa , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/prevenção & controle , Artrite Infecciosa/cirurgia , Fenômenos Biomecânicos , Humanos , Padrões de Referência , Vancomicina
10.
Arthroscopy ; 37(3): 985-988, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673976

RESUMO

Magnetic resonance imaging of the torn anterior lateral ligament (ALL) is inconsistent and subject to significant intra- and interobserver variability. Like that of an anterior cruciate ligament (ACL), an ALL tear can vary in degree (first, second, or third) and location (tibial or femoral side). These variations may impact the appropriate surgical intervention. Relevant biomechanical data indicate that the deep iliotibial band fibers are more important than the ALL in controlling pivot shift. Lateral compartment overconstraint after ALL reconstruction does not appear to be a biomechanical or clinical issue. An ALL reconstruction creates a nonisometric construct (tight in extension and lax in flexion), allowing physiologic internal tibial rotation at 90° flexion, whereas lateral extra-articular tenodesis (LET) is more isometric, limiting physiologic internal tibial rotation at 90° flexion. The indications for a combined ACL/ALL reconstruction are evolving, but a Segond fracture and ligamentous hyperlaxity of ≥5 using the modified Beighton system seem reasonable. An ACL/LET reconstruction results in better stability for patients with high-grade pivot shifts.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Tenodese , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Estudos Retrospectivos , Rotação
11.
Zhongguo Gu Shang ; 34(3): 269-74, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787174

RESUMO

OBJECTIVE: To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) with a tibialis anterior allograft (TAA)versus hamstring tendon autograft (HTA) after 10 years follow-up. METHODS: A clinical data of 107 patients who underwent arthroscopic ACLR with a single bundle tendon between March 2007 and March 2010 was retrospectively analyzed. Among the patients, 48 patients were reconstructed with a tibialis anterior allograft (TAA group), including 26 males and 22 females, ranging in age from 16 to 38 years, with a mean of 27.2±6.2 years;59 patients were reconstructed with a hamstring tendon autograft (HTA group), including 31 males and 28 females, ranging in age from 16 to 40 years, with a mean of 28.0±7.6 years. The preoperative tibial anterior displacement and knee joint function, as well as knee joint stability, tibial anterior displacement and knee joint function at 10 years after operation were observed. Lachman test was used to evaluate the forward joint stability and pivot shift test to evaluate the rotational stability of the knee;KT-2000 side-to-side difference (SSD) was used to measure tibial anterior displacement;International Knee Documentation Committee(IKDC) score and Lysholm score were used to evaluate knee function. RESULTS: The incisions of both groups were healed by first intention, and no early complications occurred after operation. All patients were followed-up 10 to 13 years, the mean time was 11.7 years. There was no graft failure were found during the follow up period. The KT-2000 SSD of the TAA group and the HTA group at ten years after operation were 1.9±0.7 and 1.8±0.6 respectively, which were significantly improved than 8.8±0.9 and 8.6±1.0 preoperatively(P<0.05), but there were no significant difference between the two groups(P>0.05). The total Lysholm score of the TAA group and the HTA group at ten years after operation were 90.4±4.4 and 90.7±3.4 respectively, which were significantly improved than 51.4±13.3 and 51.2±14.6 preoperatively(P<0.05), but there were no significant difference between the two groups(P>0.05). The total IKDC score of the TAA group and the HTA group at ten years after operation were 91.5±4.1 and 90.9±3.2 respectively, which were significantly improved than 45.8±12.2 and 47.0±14.5 preoperatively(P<0.05), but there were no significant difference between the two groups(P>0.05). No significant difference were found between the two groups in Lachman test and pivot shift test at 10 years after operation (P>0.05). CONCLUSION: The TAA and HTA have equal long term effect in ACL reconstruction, doctors and patients can choose the graft according to the actual situation.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Adolescente , Adulto , Aloenxertos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Autoenxertos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(2): 171-177, 2021 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-33624469

RESUMO

Objective: To investigate the effectiveness of arthroscopic reinforced reconstruction of anterior cruciate ligament (ACL) with autologous hamstring tendon combined with anchor suture band. Methods: Between February 2016 and March 2018, 60 patients who were to be treated with arthroscopic ACL reconstruction and met the selection criteria were selected in the study. Among them, 30 cases were reconstructed with autologous hamstring tendon combined with anchor suture band (trial group), and 30 cases were reconstructed with simple autologous hamstring tendon (control group). There was no significant difference in gender, age, disease duration, cause of injury, injury side, and preoperative Lysholm score, Tegner score, and International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). After reconstruction, the patients in the trial group were allowed to start knee flexion and extension activities early without wearing an adjustable brace, while the patients in the control group were required to wear an adjustable brace for 12 weeks. The knee joint function (Lysholm score, Tegner score, IKDC score) and stability (Lachman test and pivot shift test) were compared between the two groups after operation. Results: There was no significant difference in graft diameter between the two groups ( t=1.061, P=0.115). Compared with the control group, the operation time of the trial group was significantly different ( t=4.924, P=0.000). All incisions healed primarily. In the control group, the intramuscular venous thrombosis occurred in 2 cases after operation. Both groups were followed up 18 months. The Lysholm score, Tegner score, and IKDC score of the two groups at each time point after operation were significantly higher than those before operation ( P<0.05); the above scores in the trial group were significantly higher than those in the control group at 3, 6, and 9 months after operation ( P<0.05); there was no significant difference between the two groups at 18 months after operation ( P>0.05). There was no significant difference in Lachman test results between the two groups at each time point after operation ( P>0.05). There was a significant difference in pivot shift test results at 6 months after operation between the two groups ( P<0.05); but there was no significant difference at other time points ( P>0.05). Conclusion: The effectiveness of ACL reinforcedreconstruction with autologous hamstring tendon combined with anchor suture band is satisfactory. Compared with using autologous hamstring tendon alone, it has better initial strength and joint stability, and is more conducive to early postoperative functional exercise and functional recovery of knee joint.


Assuntos
Lesões do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Humanos , Suturas , Tendões
15.
Am J Sports Med ; 49(2): 374-383, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33523751

RESUMO

BACKGROUND: Long-term patient-reported outcome measures (PROMs) and predictors of success or failure after anterior cruciate ligament (ACL) reconstruction are not fully understood, especially when combined with a lateral extra-articular reconstruction. PURPOSE: To assess the long-term PROMs, revision rate, and predictors of success or failure after ACL reconstructions using an over-the-top surgical technique with single-bundle hamstring tendon autografts and a lateral extra-articular reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The study cohort consisted of 267 consecutive patients (mean age, 30.7 years) who underwent ACL reconstruction with an over-the-top surgical technique with single-bundle hamstring tendon autografts and a lateral extra-articular augmentation between November 2007 and May 2009. The number of subsequent ACL revisions and reoperations were recorded. Subjective clinical status was assessed with PROMs-specifically, the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and visual analog scale for pain-at a minimum follow-up of 10 years. RESULTS: Overall, 3% of patients underwent ACL revision, with a 10-year survival rate of 96.3%. High sport activity (hazard ratio, 6.9; P = .285) and concomitant meniscal lesion (hazard ratio, 2.6; P = .0487) were predictors of ACL revision or new meniscectomy. The mean ± SD Lysholm score was 94.1 ± 10.8, while that for the visual analog scale for pain was 0.2 ± 0.9 at rest and 2.1 ± 2.6 during activity. KOOS subscale scores were as follows: 95.7 ± 8.1 for Pain, 92.5 ± 10.5 for Symptoms, 98.4 ± 7.4 for Activities of Daily Living, 90.7 ± 17.2 for Sport, and 91.2 ± 17.1 for Quality of Life; respectively, 88%, 99%, 81%, 89%, and 91% of patients achieved the Patient Acceptable Symptom State. Female sex and chondropathy with Outerbridge grade ≥2 were predictors of worse KOOS subscales. Overall, 82% of patients returned to sport, and 57% were still participating at the 10-year evaluation. CONCLUSION: ACL reconstruction with an over-the-top surgical technique with single-bundle hamstring autografts and a lateral extra-articular reconstruction provided satisfactory results in terms of function, symptoms, sports, and quality of life in 80% to 90% of patients after 10 years. Long-term survivorship was 96%. Sport participation declined from 82% postoperatively to 57% at long-term follow-up. A concomitant medial meniscal lesion was a predictor of higher risk of ACL failure or new meniscal lesion, while advanced chondropathy and female sex were predictors of higher pain, lower function, and poor quality of life scores.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/métodos , Tendões dos Músculos Isquiotibiais/transplante , Atividades Cotidianas , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Sobrevivência
16.
Arthroscopy ; 37(2): 586-587, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33546796

RESUMO

Anterior cruciate ligament graft diameter is of concern to every orthopaedic surgeon who's ever performed an anterior cruciate ligament reconstruction. The current standard is to obtain a graft of at least 8 mm in diameter. The 5-bundle construct is an option to increase the graft diameter in the situation in which a smaller diameter 4-strand hamstring autograft is encountered. The question is whether bigger is better once one obtains an 8-mm diameter graft.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Humanos , Estudos Prospectivos , Transplante Autólogo
17.
Arthroscopy ; 37(2): 606-608, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33546798

RESUMO

Patient-reported outcome measures (PROMs) have been developed and used as the primary determinant of successful patient-centered results. The patient acceptable symptomatic state delineates an absolute value for PROMs indicating that patients are satisfied with their outcome. When this metric is used for anterior cruciate ligament reconstruction, patients reach a satisfactory outcome at between 6 and 8 months postoperatively, and more than 90% reach a satisfactory outcome at 12 months. Preoperative variables such as preoperative exercise, Workers' Compensation, and diabetes impact patient outcomes, whereas preoperative PROMs and use of the anteromedial portal technique for femoral tunnel drilling have a limited impact on satisfaction. Iliotibial band tenodesis shows a large impact on satisfactory outcomes; however, this result may be affected by patient demographic issues (selection bias). Ultimately, a "satisfactory" outcome is a very general term and may not necessarily apply to active athletes desiring a return to competitive sport. Thus, the patient acceptable symptomatic state should be interpreted in combination with a surgeon's experience. Ultimately, the success of a surgical procedure could be determined, in large part, based on the patient's individual preoperative expectations.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Diabetes Mellitus , Tenodese , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Satisfação do Paciente , Volta ao Esporte , Indenização aos Trabalhadores
18.
Arthroscopy ; 37(2): 617-618, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33546799

RESUMO

The quest for improvement of anterior cruciate ligament (ACL) reconstruction results is a continuous struggle as we endeavor different technique adjustments that could form a missing piece of the holy ACL grail puzzle. Independent suture tape reinforcement (ISTR) is a small addition to the familiar ACL reconstruction technique with the potential to improve reconstruction results. Biomechanical studies show a decreased graft elongation and increased ultimate load to failure with ISTR. Clinical studies are scarce. In contrast to the ACL augmentation results in the 1980s, 2 retrospective comparative studies do not report negative results, which would support further research. Larger clinical trials will have to prove whether this small addition to ACL reconstruction will have a positive impact on ACL reconstruction results. For now, it is promising to note that no "red flags" have been described for ACL reconstruction with ISTR.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Fenômenos Biomecânicos , Humanos , Estudos Retrospectivos , Suturas
19.
Am J Sports Med ; 49(2): 442-449, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33395319

RESUMO

BACKGROUND: The association between activity level after anterior cruciate ligament (ACL) reconstruction (ACLR) and development of posttraumatic osteoarthritis (PTOA) remains unclear. This study investigated the relationship of patient-reported outcomes and progressive cartilage degenerative changes at 3 years after ACLR. HYPOTHESIS: Higher activity levels, as measured by Marx scores, are significantly correlated with early cartilage degeneration after ACLR. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 35 patients (16 women; mean age, 31.0 ± 7.6 years) with isolated ACLR and without pre-existing arthritis were prospectively enrolled. Patients reported Marx activity scores and Knee injury and Osteoarthritis Outcome Score (KOOS) scores and underwent T1ρ magnetic resonance imaging (MRI) preoperatively, 6 months, 1 year, 2 years, and 3 years after ACLR with soft tissue graft (22 autograft). The change in cartilage relaxation times between preoperative and 3-year imaging was used to identify cartilage degeneration, defined as an increase in T1ρ values by 14.3%. Correlation between Marx activity levels, KOOS scores, and T1ρ degeneration was performed with the Spearman rank test. The Fisher exact test was used to test for association between Marx activity score cutoffs and degeneration. The Student t test was used to compare Whole-Organ Magnetic Resonance Imaging Score (WORMS) and T1ρ relaxation times. Significance was defined as P < .05. RESULTS: Sixteen patients (45.7%) showed evidence of cartilage degeneration at 3 years, most frequently in the medial compartment (n = 12; 34%). Higher Marx activity scores at 3 years correlated with cartilage degeneration in the medial femur (rho = 0.34; P = .045), and medial tibia (rho = 0.43; P = .01). A Marx score of 11 or greater at 3 years was significantly associated with medial compartment degeneration (P = .03), with a positive predictive value of 52.6%. No Marx score cutoff at years 1 or 2 predicted future cartilage degeneration. The KOOS Quality of Life score was inversely correlated with cartilage degeneration (rho = 0.38; P = .02). WORMS did not correlate with degeneration of the medial compartment. CONCLUSION: Increased activity at 3 years after ACLR was significantly associated with increased risk of medial compartment PTOA. While further research is needed to fully define these relationships, patients may be counseled that return to Marx activity levels of greater than 11 may be associated with a higher risk of medial compartment cartilage degeneration.


Assuntos
Lesões do Ligamento Cruzado Anterior/complicações , Reconstrução do Ligamento Cruzado Anterior , Cartilagem Articular/patologia , Exercício Físico , Osteoartrite do Joelho/etiologia , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Cartilagem Articular/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto Jovem
20.
Instr Course Lect ; 70: 399-414, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438924

RESUMO

As the number of pediatric and adolescent patients participating in sports continues to increase, so too does the incidence of anterior cruciate ligament (ACL) tears in this population. There is increasing research on pediatric and adolescent ACL tears; hundreds of articles on the topic have been published in the past few years alone. It is important to highlight the most pertinent information in the past decade. In discussing pediatric ACL tears, it is also important to review tibial spine fractures. These injuries are rightfully grouped together because tibial spine fractures often occur with a mechanism of injury similar to that of ACL tears, but typically in a younger age group. Because management is different, understanding the similarities and differences between the two pathologies is important. Recent updates on the epidemiology, diagnosis, management, and outcomes of both pediatric ACL tears and tibial spine fractures need to be reviewed.


Assuntos
Lesões do Ligamento Cruzado Anterior , Fraturas da Coluna Vertebral , Fraturas da Tíbia , Lesões do Menisco Tibial , Adolescente , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Criança , Humanos , Articulação do Joelho , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/epidemiologia , Fraturas da Tíbia/cirurgia
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