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1.
Arthroscopy ; 36(9): 2523-2525, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891252

RESUMO

Recurrent instability and future joint damage occur if there is a repeated anterior cruciate ligament injury after reconstruction. This prognostic declaration is said to those who have sustained a rupture to the repaired anterior cruciate ligament. Both younger and older patients seek stable knees to allow a return to stability and twisting activity without the risk of added joint damage. To achieve this goal, revision ligament surgery is needed.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Queijo , Ligamento Cruzado Anterior/cirurgia , Grupos Étnicos , Seguimentos , Humanos , Reoperação
2.
Medicine (Baltimore) ; 99(38): e21237, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957304

RESUMO

Arthroscopic techniques are considered the gold standard for treatment of displaced avulsion fractures of the anterior cruciate ligament. However, most arthroscopic surgical techniques and fixation methods are technically demanding and require removal of hard implant. This report describes a new, easy, safe, and all-arthroscopic method for reduction and fixation of displaced tibial intercondylar eminence fractures by using 1 anchor and 1 Pushlock.From January 2015 to June 2017, 8 adult patients with type II and III displaced tibial intercondylar eminence fractures were operated using this technique. Clinical assessment included patient demographics, cause of injury, delay before surgery, operation time, time to return to work and sport, International Knee Documentation Committee scores, and Lysholm knee scores.The average operation time was 48 minutes. The average follow-up period was 12.5 months. At the 6-month follow-up, all patients had acquired fracture union and complete functional recovery and were able to return to work. International Knee Documentation Committee objective scores and Lysholm knee scores were 92.4 (range 88-94) and 93.6 (range 90-96), respectively. At the last follow-up, anterior drawer, Lachman's test, and pivot shift tests were negative, and all patients had returned to their preinjury activity levels.Arthroscopic fixation by use of 1 anchor and 1 Pushlock is an easy, safe, and minimally invasive technique for treatment of displaced tibial intercondylar eminence fractures and does not require further surgery to remove fixation devices.Level of Evidence: Level IV, therapeutic case series.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Artroscopia/métodos , Tíbia/cirurgia , Adulto , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Duração da Cirurgia , Amplitude de Movimento Articular , Retorno ao Trabalho , Fatores Socioeconômicos , Técnicas de Sutura , Tempo para o Tratamento
3.
Arthroscopy ; 36(8): 2292-2294, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747068

RESUMO

The role of graft selection on clinical and functional outcomes following anterior cruciate ligament (ACL) reconstruction has gained significant attention in the orthopaedic sports medicine community in recent years. Bone-patellar tendon-bone (BPTB) and semitendinosus/gracilis hamstring tendon (HT) autografts are 2 of the most commonly used grafts, given their low failure rates, predictable outcomes, and ability to incorporate appropriately at the graft site. However, multiple studies have recently shown each of these graft options to have some potentially less-desirable characteristics in regards to outcomes in specific patient populations. More specifically, in 14- to 25-year-old athletes, HT autografts have been shown to result in decreased rotational stability, decreased return to sport rates, and increased graft failure rates. On the other hand, BPTB autografts can require a prolonged recovery period and have been associated with increased postoperative pain and long-term kneeling pain. HT and BPTB grafts are both excellent grafts; however, it is important to understand the differences in clinical and functional outcomes between these graft options for ACL reconstruction. The characteristics of the graft need to be considered and individualized for each patient who is being treated for an ACL injury.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Músculos Isquiossurais , Ligamento Patelar/cirurgia , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Seguimentos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Transplante Autólogo , Adulto Jovem
4.
Medicine (Baltimore) ; 99(31): e21540, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756207

RESUMO

BACKGROUND: Contralateral anterior cruciate ligament (CACL) injury is one of the devastating complications after anterior cruciate ligament (ACL) reconstruction. Whether the risk of CACL tear is related to graft selection remains controversial due to contradictory results in studies. There are no meta-analyses to compare which graft has a higher CACL injury rate. Hence, this meta-analysis was conducted to compare the incidence of the CACL injury after ACL reconstruction with bone-patellar tendon-bone (BPTB) autografts compared with hamstring (HT) autografts. METHODS: A comprehensive search of literature published between 1980 and January 2020 was performed using MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases. RevMan 5.3 software was used for meta-analysis. The overall risk ratio (RR) was calculated using a fixed- or random-effects. The heterogeneity among the included results was analyzed by chi-square test with significance set at P < .10, and the heterogeneity was quantitatively detected by I-square tests. RESULTS: Fifteen prospective comparative studies met inclusion criteria. In the BPTB group, the CACL rupture rate ranged from 1.8% to 30%, with a pooled percentage of 8.5%. In the HT group, the CACL rupture rate ranged from 0% to 14.4%, with a pooled percentage of 3.3%. The overall CACL rupture rate was 3.1% and ranged from 1.1% to 27.1%, with a pooled percentage of 4.9%. The pooled results indicate that there was a statistical significant difference in CACL rupture risk rate between BPTB and HT autograft. (RR, 1.53; 95% CL, 1.21-1.91; P = .0004). CONCLUSION: This review showed that patients undergoing primary ACL reconstruction with BPTB autograft were more likely to have CACL rupture than patients treated with HT autograft.


Assuntos
Lesões do Ligamento Cruzado Anterior/etiologia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Tendões dos Músculos Isquiotibiais/transplante , Ligamento Patelar/cirurgia , Ligamento Cruzado Anterior/cirurgia , Autoenxertos/cirurgia , Humanos , Estudos Prospectivos
5.
Arthroscopy ; 36(7): 1882-1883, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32624124

RESUMO

The search for an isometric, anatomic, biomechanically optimal anterior cruciate ligament (ACL) reconstruction remains elusive. To better approximate the native ACL, surgeons have used a host of different graft options and repair techniques. Surgical techniques involving single-tunnel and double-tunnel (or even triple-tunnel!) fixation sites have been used in an attempt to re-create the "2 (or more) bundles" of the ACL. Transtibial and independent femoral drilling techniques are used in an effort to create a more "anatomic" femoral tunnel placement. Once the anatomic femoral attachment site is identified, there is then a debate on how best to "fill" the attachment site with the surgical graft. These are all important discussions and debates, but one question remains . . . Does any of it really matter?


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Patelar , Ligamento Cruzado Anterior/cirurgia , Fêmur/cirurgia , Humanos , Tíbia/cirurgia
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(7): 843-847, 2020 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-32666726

RESUMO

Objective: To investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction with the autologous ipsilateral peroneus longus tendon (PLT) under arthroscopy. Methods: A retrospective study was conducted on 35 patients with ACL rupture who underwent ACL reconstruction with autologous ipsilateral PLT under arthroscopy between October 2017 and October 2018. There were 19 males and 16 females with an average age of 43.4 years (range, 18-60 years), with 20 cases of left knee and 15 cases of right knee. The causes of injury included traffic accident in 14 cases, falling injury in 13 cases, and sports injury in 8 cases. The time from injury to operation ranged from 3 to 9 days (mean, 4.7 days). The patients suffered from swelling, pain, and limited mobility of knee joint before operation. The anterior drawer test, Lachman test, and pivot-shift test were positive before operation, whereas MRI was taken to confirm the ACL rupture. After operation, the patients were followed up every 3 months until the knee joint's function returned to normal. MRI and X-ray films were used to observe the tendon-bone healing as well as the position of Endobutton suspension plate and hollow nail. The anterior drawer test, Lachman test, and pivot-shift test were conducted to observe the improvement of knee joint mobility. The functional improvements were evaluated by the International Knee Documents Committee (IKDC) score, Lysholm score, knee injury and osteoarthritis (KOOS) score. Results: All the 35 patients were followed up 12-18 months, with an average of 14.2 months. The incisions healed by first intention, and no complications such as infection, joint stiffness, and rerupture occurred. Postoperative anterior drawer test, Lachman test, and pivot-shift test turned to be negative of all patients. MRI showed that the ACL was continuous, and the tendon-bone in the distal femur tunnel and proximal tibia tunnel recovered well after operation. X-ray films showed that the positions of Endobutton suspension plate and hollow nail were stable. The IKDC, Lysholm, and KOOS scores at 3, 6, and 12 months after operation were significantly improved when compared with those before operation, and the scores were further improved with time after operation ( P<0.05). Conclusion: For patients with ACL rupture, ACL reconstruction with the autologous ipsilateral PLT under arthroscopy has satisfactory effectiveness of quick recovery, good function, and great stability.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Artroscopia , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tendões , Resultado do Tratamento , Adulto Jovem
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(7): 848-853, 2020 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-32666727

RESUMO

Objective: To investigate the effect of vascularized peroneus longus tendon graft reconstruction on anterior cruciate ligament (ACL) insertion in rabbits. Methods: Eighty healthy New Zealand white rabbits were harvested to prepare ACL injury models and randomly divided into two groups ( n=40). The ACL was reconstructed with vascularized peroneus longus tendon graft in group A and peroneus longus tendon graft without blood supply in group B. The survival of animals and the healing of incision were observed after operation; the grafts were taken for gross and histological observations at 4, 8, and 16 weeks; the biomechanical test of the grafts was carried out to record the maximum tensile strength and incidence of ACL insertion rupture at 8 and 16 weeks. Results: All animals survived until the experiment completed. General observation showed that the tunnel was combined with grafts, the vascular infiltration was abundant, and no obvious boundary between the tunnel and grafts existed at 16 weeks in group A; there was still an obvious boundary between the tunnel and graft in group B. Histological observation showed that the collagen fibers between tendon and bone in group A increased gradually, the dense fiber connection was formed, and the "tidal-line" like structure similar to the normal ACL insertion was formed at 16 weeks; but the"tidal-line" like structure was not obvious in group B. Biomechanical test showed that there was no significant difference in the incidence of ACL insertion rupture at 8 and 16 weeks between group A and group B ( P=0.680; P=0.590), but the maximum tensile strength at 8 and 16 weeks were higher in group A than in group B ( t=18.503, P=0.001; t=25.391, P=0.001). Conclusion: The vascularized peroneus longus tendon graft for ACL reconstruction can obviously promote the outcome of the ACL insertion.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Animais , Ligamento Cruzado Anterior/cirurgia , Pé/cirurgia , Coelhos , Tendões/cirurgia
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(6): 720-725, 2020 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-32538562

RESUMO

Objective: To evaluate and compare knee joint stability of grade Ⅲ medial collateral ligament (MCL) injury treated by single-bundle and anatomical double-bundle reconstruction methods, thus providing biomechanical basis for clinical treatment. Methods: Nine fresh cadaver specimens of normal human knee joints were randomly divided into 3 groups on average. In intact MCL group: The anterior cruciate ligament (ACL) was detached and reconstructed with single-bundle techniques, and the MCL was intact. In single-bundle and double-bundle reconstruction groups, the superficial MCL (sMCL), posterior oblique ligament (POL), and ACL were all detached to manufacturing grade Ⅲ MCL injury models. After single-bundle reconstruction of ACL, the sMCL single-bundle reconstruction and anatomical double-bundle reconstruction of sMCL and POL were performed, respectively. Biomechanical evaluation indexes included anterior tibial translation (ATT), internal rotation (IR), valgus rotation (VAL), and stresses of MCL and ACL under internal rotation and valgus torques at different ranges of motion of the knee joint. Results: There was no significant difference in ATT at full extension and flexion of 15°, 30°, 45°, 60°, and 90° between groups ( P>0.05). At full extension and flexion of 15°, the IR and VAL were significantly higher in single-bundle reconstruction group than in double-bundle reconstruction group and intact MCL group ( P<0.05). At flexion of 30°, the VAL was significantly higher in single-bundle reconstruction group than in double-bundle reconstruction group and intact MCL group ( P<0.05). While there was no significant difference between double-bundle reconstruction group and intact MCL group ( P>0.05). There was no significant difference in the stresses of MCL and ACL between groups under the internal rotation and valgus torques at all positions ( P>0.05). Conclusion: MCL anatomical double-bundle reconstruction can acquire better valgus and rotational stability of the knee joint compared with single-bundle reconstruction.


Assuntos
Ligamento Cruzado Anterior , Ligamentos Colaterais , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Ligamentos Colaterais/cirurgia , Humanos , Técnicas In Vitro , Instabilidade Articular , Distribuição Aleatória , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/normas , Rotação
9.
Clinics (Sao Paulo) ; 75: e1123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32556055

RESUMO

OBJECTIVE: The objective of this study was to compare two postero-lateral bundle (PLB) tibial fixation techniques for the reconstruction of the anterior cruciate ligament with double bundle: a technique without the use of an interference screw, preserving the native tibial insertion of the tendons of the gracilis and semitendineous muscles, and a technique with the use of an interference screw and without preserving the insertion of the tendons. METHODS: A comparative study was conducted in cadavers with a universal mechanical test machine. In total, 23 cadaver knees were randomized for tibial fixation of the PLB using the two techniques: Maintaining the tibial insertion of the tendons during reconstruction, without the use of an interference screw (group A, 11 cases); and fixating the graft with an interference screw, without maintaining the insertion of the tendons (group B, 12 cases). A continuous traction was performed (20 mm/min) in the same direction as the produced tunnel, and force (N), elongation (mm), rigidity (N/mm), and tension (N/mm2) were objectively determined in each group. RESULTS: Group A exhibited a maximum force (MF) of 315.4±124.7 N; maximum tension of 13.57±3.65 N/mm2; maximum elongation of 19.73±4.76 mm; force at the limit of proportionality (FLP) of 240.6±144.0 N; and an elongation at the limit of proportionality of 14.37±6.58 mm. Group B exhibited a MF of 195.7±71.8 N; maximum tension of 8.8±3.81 N/mm2; maximum elongation of 15.3±10.73 mm; FLP of 150.1±68.7 N; and an elongation at the limit of proportionality of 6.86±2.42 mm. When comparing the two groups, significant differences were observed in the variables of maximum force (p=0.016), maximum tension (p=0.019), maximum elongation (p=0.007), and elongation at the limit of proportionality (p=0.003). CONCLUSION: The use of the native insertion of the semitendineous and gracilis tendons, without an additional fixation device, presented mechanical superiority over their fixation with interference screws.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Parafusos Ósseos , Tendões dos Músculos Isquiotibiais/cirurgia , Músculo Esquelético/transplante , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Tíbia/cirurgia , Fenômenos Biomecânicos , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estresse Mecânico
10.
Arthroscopy ; 36(5): 1374-1375, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370899

RESUMO

There is a vast amount of conflicting literature evaluating the anatomic, biomechanical, and clinical outcomes of combined anterior cruciate ligament (ACL) and anterolateral complex injury. This has become-and remains-one of the most controversial topics in the ACL-deficient knee literature, thus requiring further inquiry with clear and systematic approaches to biomechanical analysis, indications, graft selection, surgical technique, and clinical outcome evaluation. The considerable variety of procedures to address anterolateral rotatory instability in the setting of ACL deficiency described in the literature strongly suggests the lack of a reliable and reproducible technique. Anterolateral complex reconstruction may provide protection to the ACL-reconstructed knee without detrimental overconstraint.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular/cirurgia , Tenodese , Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular
11.
Arthroscopy ; 36(5): 1417-1418, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370903

RESUMO

An understanding of expected morbidity of various anterior cruciate ligament graft options is important to inform patient expectations and facilitate successful return to sport following anterior cruciate ligament reconstruction. Hamstring harvest results in decreased hamstring strength. Gracilis preservation may mitigate the degree of strength loss, particularly in deep knee flexion. The extent to which knee flexion strength at high flexion angles is important to return to play and functional outcomes remains unknown and is likely sport-dependent.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Humanos , Tendões
12.
Medicine (Baltimore) ; 99(20): e20256, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443364

RESUMO

INTRODUCTION: Rehabilitation after anterior cruciate ligament (ACL) reconstruction is critical to patient outcome. Despite its importance; however, hospital-based rehabilitation is limited, with barriers, including distance and cost. With recent technological advancements, wearable devices have actively been used to address these barriers. In this study, we propose a randomized controlled trial protocol investigating the efficacy and feasibility of home-based rehabilitation after ACL reconstruction using a smart wearable device providing electrical stimulation that allows knee exercise. METHODS AND ANALYSIS: This is a protocol proposal for a prospective, single-center, randomized, controlled study. We plan to recruit adults discharged after ACL reconstruction; the recruited subjects will be randomly allocated to 1 of 2 groups, using a computer-generated randomization method: the intervention (n = 20) or control group (n = 20). The intervention group will receive a 6-week home-based rehabilitation program using smart wearable device. The control group will undergo a 6-week self-exercise program as normal. The following outcomes will be assessed at baseline, 2 weeks, and 6 weeks post the 6-week intervention program: quadriceps strength of the affect side as measured by a dynamometer (primary outcome); range of motion; root mean square of quadriceps muscle using surface electromyography; knee function using questionnaire; quality of life; subject's satisfaction score using questionnaire; frequency and duration of exercise; and knee pain. An intention-to-treat analysis will be conducted for the primary outcome. DISCUSSION: This study is a prospective, single-center, randomized, controlled study. This study aims to research the feasibility and efficacy of a 6-week, structured home-based rehabilitation program for patients after ACL reconstruction using a smart wearable device. The findings of this study will help to establish a home-based rehabilitation program to better recovery in patients with ACL reconstruction. TRIAL REGISTRATION NUMBER: This protocol was registered in ClinicalTrials.gov, under the number NCT04079205.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Estimulação Elétrica/instrumentação , Terapia por Exercício/instrumentação , Serviços de Assistência Domiciliar/normas , Reabilitação/normas , Adulto , Ligamento Cruzado Anterior/anormalidades , Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/reabilitação , Lesões do Ligamento Cruzado Anterior/cirurgia , Protocolos Clínicos , Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Serviços de Assistência Domiciliar/tendências , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação/instrumentação , Reabilitação/métodos , Inquéritos e Questionários , Resultado do Tratamento
13.
Tunis Med ; 98(2): 156-160, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32395806

RESUMO

BACKGROUND: The practice of hypnoanalgesia in orthopedics is rare and the literature is poor. AIM: The purpose of this pilot study was to verify the efficacy of hypnosis for the management of postoperative analgesia after arthroscopic repair of anterior cruciate ligament. METHODS: This was a prospective clinical trial over a period of 6 months (March - August 2015) including 25 patients scheduled for arthroscopic repair of anterior cruciate ligament under spinal anesthesia. All these patients had preoperative hypnosis in addition to the standard multimodal analgesia protocol (group H) and were compared to historical group (group S) who received only a standard multimodal analgesia protocol. RESULTS: Pain scores were significantly lower for the hypnosis group during the first 48 hours postoperatively (p = 0,006). The total dose of morphine at 48 hours was: 13,6 mg (95% CI [4,58; 22,62]) in the group H and 10,2 mg (95% CI [1,64 ; 18,76]) in group S with no statistically significant difference (p = 0,178) Conclusion: Results of this pilot study in orthopedic surgery suggested that hypnosis reduced postoperative pain scores as demonstrated in other surgeries.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Artroscopia , Hipnose , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios/métodos , Analgesia/métodos , Anestesia Epidural/métodos , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia/efeitos adversos , Artroscopia/métodos , Terapia Combinada/métodos , Estudo Historicamente Controlado , Humanos , Hipnose/estatística & dados numéricos , Manejo da Dor/efeitos adversos , Medição da Dor , Dor Pós-Operatória/etiologia , Projetos Piloto , Resultado do Tratamento
14.
Am J Sports Med ; 48(7): 1665-1672, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32368935

RESUMO

BACKGROUND: Arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) with a bone-patellar tendon-bone graft (BTB) is a reliable surgical option for the control of anterior knee laxity after ACL injury. The addition of a lateral extra-articular tenodesis (LET) may improve control of rotation knee laxity and improve short-term graft survival in high-risk patients. PURPOSE: The aims of this study were to compare long-term patient-reported outcomes, graft survival, and risk of osteoarthritis between ACLR with and without LET. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: This study included 121 consecutive knees (120 patients) presenting to a single center with an ACL rupture between 1998 and 1999. In total, 61 knees were randomized to an isolated BTB ACLR, and 60 knees were randomized to a BTB ACLR with an extra-articular lateral tenodesis with gracilis tendon (modified Lemaire). RESULTS: Eighty knees in 79 patients (66%) were available for follow-up at a postoperative mean of 19.4 years (range, 19-20.2). Of those patients, 43 had a clinical examination and completed patient-reported outcome questionnaires, and the other 37 patients were evaluated through the questionnaires alone. Standard radiographs were available for 45 patients and laximetry (TELOS) for 42 patients. Mean subjective International Knee Documentation Committee score at last follow-up was 81.8, and no differences were noted between the BTB and BTB-LET groups (P = .7). Two-thirds of patients were still participating in pivoting sports. A total of 17 knees (21%) experienced a graft failure, 5 of which (6%) underwent revision ACLR. There was no significant difference in graft failure risk between the BTB group (29%) and the BTB-LET group (13%; P = .1). Lateral tibiofemoral osteoarthritis was significantly more frequent in the BTB-LET group (59%) as compared with the BTB group (22%; P = .02). Lateral compartment osteoarthritis was correlated with partial lateral meniscectomy. CONCLUSION: There were no significant differences in long-term patient-reported outcomes after ACLR with or without an LET. LET may increase the risk of lateral compartment osteoarthritis at long-term follow-up. There was a trend toward decreased graft failure risk with the addition of LET but this study was underpowered to assess this outcome.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Enxerto Osso-Tendão Patelar-Osso/métodos , Tenodese/métodos , Adolescente , Adulto , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Masculino , Osteoartrite do Joelho , Medidas de Resultados Relatados pelo Paciente , Radiografia , Fatores de Risco , Adulto Jovem
15.
Am J Sports Med ; 48(7): 1682-1688, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32379980

RESUMO

BACKGROUND: For many athletes, a tear of the anterior cruciate ligament (ACL) represents a significant injury that requires a prolonged period away from the sport with substantial rehabilitation. HYPOTHESIS: There will be no difference in return to play (RTP) and career length after hamstring tendon (HT) ACL reconstruction in a group of Canadian Football League professional players as compared with what has been already been reported in the literature among professional football players. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Data on athletes who sustained an ACL injury were collected by team physicians and head athletic trainers from 2002 to 2017 from 2 Canadian Football League teams. Patient details included age at the time of injury, initial injury date, position, practice versus game injury, and primary versus rerupture with injury-specific data, such as affected limb, concomitant injuries, graft choice, and procedure performed. RTP rates and career length data were collected through publically available internet sources. Comparisons between the non-RTP and RTP groups were made with independent-sample t tests. Binomial logistic regression was performed to determine variables (ie, games preinjury, graft type, meniscal injury, collateral ligament injury) that contributed to players not being able to RTP. RESULTS: A total of 44 ACL reconstructions were performed over the study period (HT, n = 32 [72.7%]; bone-patellar tendon-bone [BPTB], n = 8 [18.2%]; allograft, n = 4 [9.1%]). Overall, 69.8% (n = 30) were able to RTP in at least 1 game, while 30.2% (n = 13) did not return. Mean time to return was 316.1 days (range, 220-427 days), or 10.4 months. For those players who did RTP, mean career length after ACL reconstruction was 2.8 seasons, or 34.4 games. The majority (56.8%) of injuries occurred early in the season. Breakdown by graft type demonstrated RTP rates among HT, BPTB, and allograft of 64.5% (n = 20), 87.5% (n = 7), and 75% (n = 3), respectively. Career length among HT, BPTB, and allograft was 2.9, 2.4, and 3 seasons. Logistic regression analysis found only concomitant medial collateral ligament (MCL) injuries to be a negative predictor for RTP. Meniscal injuries were associated with a decreased RTP rate and career length, but this was not statistically significant. CONCLUSION: The RTP rates after ACL reconstruction in this study are similar to those reported in National Football League players. A concomitant injury to the MCL injury was a negative predictor of RTP. Meniscal injuries demonstrated a trend for decreased RTP rate and career length, but this was not a significant predictor. A large portion of injuries occur early in the season, and further study should be done to examine potential preventative strategies to reduce ACL injuries.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Futebol Americano/lesões , Volta ao Esporte , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/complicações , Enxerto Osso-Tendão Patelar-Osso , Canadá , Estudos de Casos e Controles , Tendões dos Músculos Isquiotibiais/transplante , Humanos , Masculino , Lesões do Menisco Tibial/complicações , Lesões do Menisco Tibial/cirurgia , Fatores de Tempo , Transplante Homólogo
16.
Bone Joint J ; 102-B(4): 442-448, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228066

RESUMO

AIMS: The objectives of this study were to assess the effect of anterior cruciate ligament (ACL) resection on flexion-extension gaps, mediolateral soft tissue laxity, maximum knee extension, and limb alignment during primary total knee arthroplasty (TKA). METHODS: This prospective study included 140 patients with symptomatic knee osteoarthritis undergoing primary robotic-arm assisted TKA. All operative procedures were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess study outcomes pre- and post-ACL resection with knee extension and 90° knee flexion. This study included 76 males (54.3%) and 64 females (45.7%) with a mean age of 64.1 years (SD 6.8) at time of surgery. Mean preoperative hip-knee-ankle deformity was 6.1° varus (SD 4.6° varus). RESULTS: ACL resection increased the mean extension gap significantly more than the flexion gap in the medial (mean 1.2 mm (SD 1.0) versus mean 0.2 mm (SD 0.7) respectively; p < 0.001) and lateral (mean 1.1 mm (SD 0.9) versus mean 0.2 mm (SD 0.6) respectively; p < 0.001) compartments. The mean gap differences following ACL resection did not create any significant mediolateral soft tissue laxity in extension (gap difference: mean 0.1 mm (SD 2.4); p = 0.89) or flexion (gap difference: mean 0.2 mm (SD 3.1); p = 0.40). ACL resection did not significantly affect maximum knee extension (change in maximum knee extension = mean 0.2° (SD 0.7°); p = 0.23) or fixed flexion deformity (mean 4.2° (SD 3.2°) pre-ACL release versus mean 3.9° (SD 3.7°) post-ACL release; p = 0.61). ACL resection did not significantly affect overall limb alignment (change in alignment = mean 0.2° valgus (SD 1.0° valgus; p = 0.11). CONCLUSION: ACL resection creates flexion-extension mismatch by increasing the extension gap more than the flexion gap. However, gap differences following ACL resection do not create any mediolateral soft tissue laxity in extension or flexion. ACL resection does not affect maximum knee extension or overall limb alignment. Cite this article: Bone Joint J 2020;102-B(4):442-448.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Adulto , Idoso , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/cirurgia , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Procedimentos Cirúrgicos Robóticos/métodos
17.
Arthroscopy ; 36(4): 1083-1085, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32247405

RESUMO

When considering repair of the meniscal cartilages of the knee, the indications for repair must be carefully considered. The morphology of the tear, the zone of injury, and likely vascularity have an impact on patient selection. Patient factors, chronicity of tear, medial or lateral tear, and tear complexity all have a bearing on whether to repair or resect and how best to achieve stable repair. The consequences of meniscectomy are well established, and meniscal tissue resection comes at a cost. The success rates of meniscal cartilage repair are greater when performed in conjunction with anterior cruciate ligament reconstruction. Patient outcomes are better for anterior cruciate ligament reconstruction when performed with meniscal repair than when partial meniscectomy is performed. The optimal configuration of sutures, the suture material used, and the type of suture technique are all important considerations. The focus of this commentary is on the use of absorbable versus nonabsorbable suture material.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Menisco , Lesões do Menisco Tibial/cirurgia , Ligamento Cruzado Anterior/cirurgia , Humanos , Meniscos Tibiais/cirurgia , Suturas
18.
Arthroscopy ; 36(4): 1103-1104, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32247407

RESUMO

Debate remains on which technique(s) of femoral tunnel drilling is most able to recreate an anatomic femoral footprint in anterior cruciate ligament reconstruction. The most commonly used techniques are the transtibial, anteromedial rigid reamer (AM-RR), anteromedial flexible reamer (AM-FR), and outside-in. Technique is based solely on surgeon preference. Each technique carries its own risks, benefits, advantages, and disadvantages, and there remains no single "gold standard." The AM-RR, AM-FR, and outside-in methods are considered independent or "unconstrained" methods that allow more variability in recreating anatomic angles compared with the transtibial technique, which is "constrained" by the tibial tunnel. Historically, the AM-RR and AM-FR techniques have not been subdivided in the orthopaedic literature. Further study is needed to determine whether there is a significant difference between the 2 techniques with respect to anatomical, biomechanical, and clinical results.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Fêmur/cirurgia , Humanos , Tíbia/cirurgia
19.
Arthroscopy ; 36(4): 1112-1113, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32247408

RESUMO

In our experience, arthroscopic tunnel widening is one of the major complications after anterior cruciate ligament (ACL) reconstruction. Even though this complication doesn't require an acute correction or intervention, patients with failed ACL reconstruction along with tunnel widening may need a 2-stage revision in which we have to fill the gap in the tunnels first. Otherwise, this tunnel widening after ACL reconstruction doesn't affect the clinical outcomes of the primary surgery and it won't affect the success of the surgery in the aspects of clinical and functional outcomes.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Músculos Isquiossurais , Ligamento Cruzado Anterior/cirurgia , Fêmur/cirurgia , Humanos , Tíbia/cirurgia
20.
Arthroscopy ; 36(4): 1202-1203, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32247414

RESUMO

Use of allograft/autograft hybrid hamstring anterior cruciate ligament grafts has gained popularity as a method to ensure appropriate graft diameter when autograft alone is insufficient. Several institutional series have been published with conflicting results. When there is any concern for autograft hamstring diameter, it is potentially better to consider other graft options. Patellar tendon autograft remains an excellent graft option for many patients. In patients where a soft-tissue graft is desired, including adolescents, quadriceps tendon has emerged as a promising option with excellent clinical outcomes. Even in patients in which hamstrings are used as a graft, when insufficient diameter is encountered, newer techniques, including the use of retrograde reamers, allows for creation of a bulleted graft of sufficient diameter without the need for allograft augmentation. We have completely abandoned the use of hybrid grafts in this younger population at our institution for these reasons. Because there are numerous other options available for anterior cruciate ligament reconstruction in patients where hamstring size may be a concern, this may become less of a debate over the next decade.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Adolescente , Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Automóveis , Humanos , Transplante Autólogo
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