Posterolateral Bundle Reconstruction With Anteromedial Bundle Remnant Preservation in ACL Tears: Clinical and MRI Evaluation of 39 Patients With 24-Month Follow-up (original) (raw)
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Posterolateral Bundle Reconstruction With Anteromedial Bundle Remnant Preservation in ACL Tears
Orthopaedic Journal of Sports Medicine, 2013
Background: Augmentation consisting of a selective reconstruction of the ruptured bundle while preserving the remnant bundle has been proposed as a treatment option for partial anterior cruciate ligament (ACL) tears. Good clinical outcomes after selective anteromedial (AM) bundle augmentation have been reported, whereas little is known about selective reconstruction of the posterolateral (PL) bundle with preservation of the AM bundle remnant. Purpose: The purpose of this study was to evaluate the clinical outcomes and the magnetic resonance imaging (MRI) characteristics of selective PL bundle reconstruction with a median follow-up of 24 months. Study Design: Case series; Level of evidence, 4. Methods: In a consecutive series of 741 ACL reconstructions, 44 patients underwent a selective PL bundle reconstruction with preservation of the AM remnant. Four patients with contralateral knee ligament surgery and 1 patient who sustained a traumatic rupture of his graft were excluded, leaving...
Partial ACL reconstruction with preservation of the posterolateral bundle
Orthopaedics & traumatology, surgery & research : OTSR, 2012
Over the past decade, our understanding of the anterior cruciate ligament (ACL) has evolved considerably. Based on this knowledge, ACL reconstruction techniques have changed and selective reconstruction procedures have been developed for partial tears. Our hypothesis was that stability and function can be restored to the knee with selective bundle reconstruction of partial ACL tears and preservation of the residual fibers. This was a multicenter retrospective study of 168 partial reconstructions of the anteromedial (AM) bundle of the ACL with preservation of the posterolateral (PL) bundle. All patients underwent a clinical evaluation based on the objective and subjective IKDC scores and the Lysholm score after a mean follow-up of 26 months (12-59 months). Preoperative and postoperative instrumental measurement of knee laxity was performed by arthrometer and/or by (Telos(®)) stress radiography. Statistical analysis and comparison was performed between pre- and postoperative results. ...
SELECTIVE BUNDLE RECONSTRUCTION IN PARTIAL ANTERIOR CRUCIATE LIGAMENT TEARS.
International Journal of Advanced Research (IJAR), 2018
Study Design: prospective non-randomized clinical study. Background Context:Diagnosis and treatment of partial ACL tear in young patients present a difficult challenge. It is based on clinical examination, radiological and MRI data, but the sure diagnosis is by arthroscopic probing that usually determine the type of partial tear. Saving ACL remnants during ACL reconstruction may have some biomechanical, vascular and proprioceptive advantages for the patient. First, ACL remnants may add biomechanical strength in the immediate post-operative period to the reconstruction, while the graft strength depends primarily on the fixation device. In this period, the augmentation may be protected by the intact remnantsand bundle and may allow accelerated rehabilitation and an earlier return to sports. Objective:This study will evaluate the effectiveness of diagnosis and treatment of partial ACL tear and identifies which bundle was torn AM or PL and selective reconstruction of torn bundle. Patients and Methods:Thirty patients with partial ACL tears were included in this prospective study. They wewe operated in ZagazigUniveristy Hospitals and followed up for two years. 22 of these patients underwnt isolated selective PL bundle reconstruction while preserving AM bundle remnant and 8 patients underwent an isolated AM budlereconstructio with preservin PL bundle remnant. All reconstructions were done using doupled or trippledsemitendnosis graft. In all cases the femoral side was fixed using endobutton (Smith and Nephew), while the tibial side was fixed using bioabsorbable interference screw We used Lysholm score andInternational Knee Documentation Committee (IKDC) to evaluate our results. Results:A significant improvement was detected in post-operative knee stability and Post-operative knee pain. Conclusion: Our study confirms that selective bundle reconstruction with preservation of the totnbundle restores knee stability and function. The clinical outcomes were statistically improved .
Knee Surgery, Sports Traumatology, Arthroscopy, 2017
force of the ACL during external rotation loading and the anatomic PL augmentation did not restore the in situ tissue force of the ACL during IR loading. Furthermore, there were no differences in ATT, IR, ER, and in situ tissue force under anterior tibial loading, IR and ER loading between the two reconstruction groups. Conclusion There were no significant differences between anatomic and non-anatomic PL augmentation using the porcine knee model.
Current Techniques in Anatomic Anterior Cruciate Ligament Reconstruction
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2007
The aim of this report is to summarize several techniques that are currently performed to reconstruct the anterior cruciate ligament (ACL) via an anatomic approach restoring the anteromedial (AM) bundle and posterolateral (PL) bundle separately. Methods: A survey containing questions about technique and rehabilitation protocol and a picture of an anatomic specimen, where study participants were asked to locate the tunnels, was created. This was sent to surgeons identified either through an Internet-based search via the National Library of Medicine or who have presented clinical studies about anatomic ACL reconstruction at international meetings. The questions were presented in an open-fashioned way in an Excel-based data file (Microsoft, Redmond, WA) and addressed the profile of the panelists, number of total and anatomic ACL reconstruction per year, graft choice, graft fixation, advantages and disadvantages of anatomic ACL reconstruction, and rehabilitation protocol. Results: One of the most common techniques used 2 femoral and 2 tibial tunnels with a soft-tissue graft. All but 1 panelist used a hamstring graft. A great variance in tunnel placement of the PL bundle was noted. Most surgeons prefer a transtibial technique for the AM bundle. Of the study participants, 67% start by placing a tunnel at the tibial insertion of the ACL. All of the surgeons who started at the femoral insertion with the PL bundle used an accessory medial portal technique. Conclusions: Anatomic reconstruction of the ACL remains a technically demanding procedure. Hamstring grafts are the most commonly used graft; an extracortical flip button technique is used at the femoral site, and a hybrid technique is used at the tibial site. The femoral tunnel placement of the PL bundle tunnel is statistically different from the AM bundle tunnel, and the same rehabilitation protocols as for single-bundle ACL reconstructions are used. Clinical Relevance: Knowledge of the pitfalls and current techniques used for an anatomic approach restoring both bundles of the ACL may provide important information for surgeons considering this technique. Level of Evidence: Level V, expert opinion.
The Israel Medical Association journal : IMAJ, 2017
BACKGROUND The debate continues regarding the best way to manage partial anterior cruciate ligament (ACL) tears. OBJECTIVES To prospectively compare the clinical outcomes of remnant-preserving augmentation (RPA) and double-bundle reconstruction (DBR) in patients with ACL tears. METHODS In this prospective study, we included 13 cases of RPA and 30 cases of DBR with a follow-up period of 6 months, 12 months and 24 months. We clinically compared the preoperative and postoperative range of motion, Knee Society Score (KSS), Visual Analog Scale (VAS), Lysholm score, Tegner activity score, Short Form Health Survey (SF-36), thigh and calf circumference and anterior translation (Using the KT-1000 knee arthrometer). RESULTS There were no significant differences in Lysholm score, Tegner score, VAS or KSS within the two groups at any time. The KT-1000 arthrometer results were higher in the RPA group at 6 months than in the DBR group; however, it did not reach statistical significance. CONCLUSIO...
Imaging evaluation of the postoperative knee ligaments
European Journal of Radiology, 2005
Until the advent of magnetic resonance imaging (MRI), evaluation of ligament reconstruction of the knee was largely based on clinical examination and radiographs. MRI is the modality of choice for noninvasive evaluation of reconstructed ligaments, menisco-capsular structures and soft tissues. This article reviews the surgical techniques, normal and abnormal appearances of the ACL and PCL grafts and common complications following ligament reconstruction.
Graft Rupture and Failure After ACL Reconstruction
Controversies in the Technical Aspects of ACL Reconstruction, 2017
Purpose The aim was to assess the results of anterior cruciate ligament (ACL) reconstruction regarding graft failure, knee laxity, and osteoarthritis (OA) from a longterm perspective. It was hypothesized that intact ACL graft reduces the risk for increased OA development. Methods The cohort comprised 60 patients with a median follow-up 31 (range 28-33) years after ACL reconstruction. They were evaluated with magnetic resonance imaging, radiography, KT-1000 arthrometer and the pivot shift test. Results Out of the 60 patients, 30 (50%) showed an intact ACL graft and 30 (50%) a ruptured or absent ACL graft. Patients with ruptured ACL grafts had more medial tibiofemoral compartment OA than those with an intact ACL graft (p = 0.0003). OA was asymmetric in patients with ruptured ACL grafts with more OA in the medial than in the lateral tibiofemoral compartment (p = 0.013) and the patellofemoral compartment (p = 0.002). The distribution of OA between compartments was similar in patients with an intact ACL graft. KT-1000 values of anterior knee laxity were higher in patients with ruptured compared to those with intact ACL grafts (p = 0.012). Side-to-side comparisons of anterior knee laxity showed higher KT-1000 values in patients with ruptured ACL graft (p = 0.0003) and similar results in those with intact graft (p = 0.09). The pivot shift grade was higher in the group with a ruptured ACL graft (p < 0.0001). Conclusions Median 31 (range 28-33) years after ACL reconstruction, 50% of the patients showed an intact ACL graft and no side-to-side difference regarding anterior knee laxity. Patients with ruptured ACL grafts had more OA of the medial tibiofemoral compartment than those with intact ACL grafts. Level of evidence Retrospective cohort study, Level III.
Journal of Bone and Joint Surgery, 2008
Definition of Failure of Anterior Cruciate Ligament Reconstruction We define failure of anterior cruciate ligament reconstruction by both objective and subjective parameters. Objectively, a knee lacking 10° of extension or 10° of flexion or a knee that demonstrates instability and giving-way is considered a failure. Furthermore, we recognize that a patient's perception of failure may extend beyond strictly objective criteria. An athlete who has pain or who senses subtle instability may also define his or her reconstruction as a failure even if the Lachman, KT-1000 arthrometer, and pivot-shift values fall within an acceptable range 12,13. Causes of Failure of Anterior Cruciate Ligament Reconstruction The technical aspects of anterior cruciate ligament reconstruction that lead to failure are well established. A common etiology is nonanatomic tunnel placement, which may result in graft impingement and/or stretching of the graft. Inadequate tensioning and insufficient fixation of the graft are also implicated in the failure of anterior cruciate ligament reconstruction. Other causes of failure include premature return to sports and absent secondary stabilizers as a result of torn menisci or laxity of the medial or posterolateral structures. Functional Anatomy of the Anterior Cruciate Ligament The remnants of the anterior cruciate ligament and osseous ridges are important anatomic landmarks in identifying anterior cruciate ligament insertion sites. The lateral intercondylar ridge (or resident's ridge 14) and the lateral bifurcate ridge are essential to the identification of the femoral insertions of the anteromedial and posterolateral bundles. The femoral in-A Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.