Comparison of Clinical Results and Second-Look Arthroscopy Findings After Arthroscopic Anterior Cruciate Ligament Reconstruction Using 3 Different Types of Grafts

doi:10.1016/j.arthro.2009.06.026

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 26, Issue 1, January 2010, Pages 41-49

https://doi.org/10.1016/j.arthro.2009.06.026 Get rights and content

Purpose

The purpose of this study was to compare the outcomes after anterior cruciate ligament reconstructive surgery by use of bone–patellar tendon–bone (BPTB) allografts, tibialis anterior tendon (TA) allografts, and hamstring tendon (HA) autografts with respect to objective knee testing measures and second-look arthroscopy.

Methods

We analyzed 338 patients who had undergone anterior cruciate ligament reconstruction between March 2000 and February 2006. BPTB allografts were used in 60 cases, TA allografts in 153 cases, and HA autografts in 125 cases. We compared the grade of range of motion (ROM), Lachman test, pivot-shift test, KT-1000 arthrometric test (MEDmetric, San Diego, CA), and International Knee Documentation Committee (IKDC) knee examination form, as well as second-look arthroscopic findings, at least 1 year after reconstruction.

Results

The preoperative ROM was not different among the 3 groups (P > .05), but the BPTB group and TA group showed greater postoperative ROM than the HA group (P = .028 and P < .001, respectively). There was no difference among the 3 groups in the other objective testing measurements (P > .05). Synovial coverage of more than 50% was found in 62.5% cases in the BPTB allograft group, 72.3% cases in the TA allograft group, and 90.7% cases in the HA autograft group. The incidence of synovial coverage of more than 50% was higher in the HA autograft group than that in the BPTB and TA allograft groups (P = .018 and P = .026, respectively). With regard to the IKDC grade, grade A or B was found in 95.2% of the cases with synovial coverage of more than 50% and in 78.3% of the cases with coverage of less than 50% (P = .011).

Conclusions

There was no difference in objective knee testing measures among the 3 different graft groups except that the allograft groups showed greater postoperative ROM than the autograft group. However, the HA autograft group had better synovial coverage on second-look arthroscopy, and the group with better synovial coverage on second-look arthroscopy presented better clinical results on the IKDC objective examination form.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Patient Demographics

We retrospectively reviewed 442 patients who underwent arthroscopic ACL reconstruction by the senior orthopaedic surgeon (K.H.Y.) between March 2000 and February 2006 and were followed up for more than 2 years. Among these patients, we excluded cases with fracture, those with multiple-ligament injury in the ipsilateral knee, those that had undergone meniscal transplantation or revision surgery after ACL reconstruction, and those with concomitant fracture or ligament injury in the contralateral

Clinical

The preoperative ROM was not different among the 3 groups (P > .05), but the BPTB group and TA group showed greater ROM than the HA group at last follow-up (P = .028 and P < .001, respectively) (Table 3). There was no significant difference in Lachman test, pivot-shift test, and KT-1000 arthrometric test at last follow-up (P > .05) (Table 4, Table 5). For the IKDC knee score, there was also no difference in the distribution of each grade among the 3 groups (P > .05) (Table 6). At a mean of 4

Discussion

Many authors have described satisfactory results of ACL reconstruction using various types of allografts without side effects such as immunogenic reaction, and some authors have reported that allograft presented better results than autograft.11, 14 However, recently, some studies reported worse results after ACL reconstruction with allograft. Prodromos et al.¹² reported that autograft presented better stability in their meta-analysis of autograft versus allograft in ACL reconstruction, and

Conclusions

There was no difference in knee stability measured by physical and quantitative tests among BPTB allografts, TA allografts, and HA autografts used for ACL reconstruction except that the allograft groups showed greater postoperative ROM than the autograft group. However, the HA autograft group had better synovial coverage than the 2 allograft types on second-look arthroscopy, and the group with better synovial coverage on second-look arthroscopy presented better clinical results on the IKDC

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These features are in agreements with those described by other groups [3,5,35]. Furthermore, a number of studies reported allowing their patients with ACLR who completed physical rehabilitation to return to sports activities when then the LSI of quadriceps strength was ≥80% [36,37]. In this study, the corresponding LSI was 88.1%, suggesting that their quadriceps strength was relatively good compared with those of previous studies.
A limb symmetry index (LSI) of ≥90% for the quadriceps is recommended for return to sports activity after anterior cruciate ligament reconstruction (ACLR). However, there is no information on differences in muscle fatigability between patients with LSI of <90% and ≥90%. The aim of this study was to assess the difference in quadriceps muscle fatigability on the involved side between post-ACLR patients with LSI of <90% and ≥90%. We hypothesized that there were differences between the two groups in muscle fatigability on the involved side reflecting difference in muscle fiber composition in the vastus medialis (VM) muscle.
The study subjects were 18 adult men who had undergone ACLR followed by rehabilitation therapy. LSI was <90% in 10 and ≥90% in 8 adult men. Surface electromyography (EMG) of the VM muscle was recorded during sustained quadriceps muscle isometric contraction. The median frequency (MF) was computed from the raw EMG signal using fast Fourier transform spectrum analysis. The MF slope was also calculated.
There were no differences in anthropometric characteristics, time since ACLR, anterior tibial translation and peak torque of knee extension on the involved side between the two groups. However, MF slope was significantly lower in the LSI ≥ 90% group than the <90% group.
Our results demonstrated fatigue-resistant vastus medialis in post-ACLR patients with LSI ≥90% compared to those with LSI <90%. The finding adds support to the use of ≥90% as the cutoff value for LSI for return of post-ACLR patients to sports activity.
Graft healing after anterior cruciate ligament reconstruction (ACLR)
2021, Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology
Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure in Orthopaedic sports medicine. With advances in surgical techniques providing better positioning and fixation of the graft, subsequent graft failure to certain extent should be accounted by poor graft healing. Although different biological modulations for enhancement of graft healing have been tried in different clinical and animal studies, complete graft incorporation into bone tunnels and the “ligamentization” of the intra-articular part have not been fully achieved yet. Based on the understanding of graft healing process and its failure mechanism, the purpose of this review is to combine both the known basic science & clinical evidence, to provide a much clearer picture of the obstacle encountered in graft healing, so as to facilitate researchers on subsequent work on the enhancement of ACL graft healing.
Synovialization and Revascularization Enhancement in Repaired and Reconstructed ACL: PCL Fat Pad Transfer Technique
2020, Arthroscopy Techniques
The rapid development of anterior cruciate ligament (ACL) reconstruction and repair techniques has significantly improved the outcomes of these procedures. However, there is still some place for how to improve surgical techniques to limit the amount of revision surgeries. Over the past decade, biological solutions and methods of ligament remodeling enhancement have been proposed. The use of the native ACL remnants has been the most thoroughly analyzed technique. However, despite its benefits, this technique may not to be sufficient to improve outcomes and may cause some technical difficulties. On the other hand, the posterior cruciate ligament (PCL) fat pad contains an abundant synovial vascular network and is located in close proximity to the ACL, which makes it a potential biological donor place of cells and tissue that could enhance the ligamentization of the repaired or reconstructed ACL. To optimize the use of this donor site, we propose the technique of ACL synovialization and revascularization enhancement with a PCL fat pad transfer.
Comparison of Clinical and Radiologic Outcomes and Second-Look Arthroscopic Findings After Anterior Cruciate Ligament Reconstruction Using Fixed and Adjustable Loop Cortical Suspension Devices
2019, Arthroscopy - Journal of Arthroscopic and Related Surgery
To compare clinical and radiological outcomes, including tunnel widening, and to evaluate graft status by second-look arthroscopy after anterior cruciate ligament (ACL) reconstruction using 2 different femoral cortical suspension devices (fixed and adjustable loop).
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At the final follow-up, the mean Tegner activity, Lysholm, and International Knee Documentation Committee scores were improved in both groups and there were no statistically significant differences (5.1 ± 1.6 and 5.5 ± 2.1, P = .312; 90.4 ± 7.8 and 91.0 ± 6.5, P = .525; and 87.4 ± 6.7 and 88.7 ± 5.3, P = .127, respectively). There were no statistical significances in the both groups in terms of Lachman test and pivot-shift tests (P = .392, .559) as well as anterior stress radiographs (mean 3.2 ± 1.4 mm and 2.9 ± 1.1 mm, P = .343). Moreover, radiologic measurements comparing femoral tunnel widening at proximal and distal half also showed no significant differences (P = .540 and .412 on anteroposterior view; P = .254 and .437 on lateral view). In the second-look arthroscopy findings for graft tear and synovial coverage, there were no significant differences (P = .784 and .897).
Both fixed loop and adjustable loop devices in ACL reconstruction provided good clinical and radiological outcomes. In patients with both devices, femoral tunnel widening at proximal and distal portion have no significant differences after ACL reconstruction. Moreover, second-look arthroscopy revealed no significant differences in terms of synovial coverage and rupture of the graft.
Level II, prospective comparative study.
Influence of anterolateral ligament injuries on stability and second-look arthroscopic findings after allograft transtibial anterior cruciate ligament reconstruction
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First, no gold standard modality was used for the characterization and comparison of ALL injuries suggested by MRI findings. Although MRI is a method with great potential, the injury criteria were established arbitrarily on the basis of the experience of the authors and previous studies that evaluated this structure [3–5,7–10,17,28]. Second, the lack of association between the location of the ALL and the instability might have been a source of a type 2 error due to the sample size used, and this should also be considered as a limitation of this study.
The purpose of this study was to evaluate the influence of anterolateral ligament (ALL) injuries on stability and second-look arthroscopic findings after anterior cruciate ligament (ACL) reconstruction.
One-hundred and nineteen consecutive patients underwent a second-look arthroscopic surgery after ACL reconstruction and magnetic resonance imaging (MRI) examination of the ALL. The patients were divided into an ALL intact group (n = 39) and ALL injured group (n = 80). The ALL injuries were divided according to the three anatomical parts of the ALL (femoral, meniscal, and tibial) using MRI evaluation. Stability and clinical results were evaluated using the Lachman test, pivot-shift test, KT-2000 arthrometer, and Lysholm score. On second-look arthroscopy, graft tension and synovial coverage were evaluated.
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: The authors report no conflict of interest.

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Original ArticleComparison of Clinical Results and Second-Look Arthroscopy Findings After Arthroscopic Anterior Cruciate Ligament Reconstruction Using 3 Different Types of Grafts

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Patient Demographics

Clinical

Discussion

Conclusions

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Knee

Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitationA two- to nine-year followup

Am J Sports Med

Anterior cruciate ligament: Injuries and treatment

Instr Course Lect

Bone-patellar ligament-bone and fascia lata allografts for reconstruction of the anterior cruciate ligament

J Bone Joint Surg Am

Graft fixation in cruciate ligament surgery: Current concepts

Am J Sports Med

Clinical outcome of anterior cruciate ligament reconstruction with quadrupled hamstring tendon graft and bioabsorbable interference screw fixation

Am J Sports Med

The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstructionPart I: Femoral site

Am J Sports Med

Original Article
Comparison of Clinical Results and Second-Look Arthroscopy Findings After Arthroscopic Anterior Cruciate Ligament Reconstruction Using 3 Different Types of Grafts