Complex knee injuries treated in acute phase: Long-term results using Ligament Augmentation and Reconstruction System artificial ligament (original) (raw)
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European Journal of …, 2002
A retrospective study was performed to determine the effect of a ligament augmentation device (LAD) combined with a tendon allograft for the treatment of chronic rupture of the anterior cruciate ligament (ACL). Fifty-four knees in 54 patients were divided into two groups. Group 1 consisted of 29 knees that were managed with a tibialis anterior allograft alone, and group 2 consisted of 25 knees that were managed with both the allograft and a Kennedy LAD. All patients were managed with the same post-operative programme of immediate motion and rehabilitation of the knee. Forty patients returned for evaluation at a mean of 84 months post-operatively. Results were evaluated with the International Knee Documentation Committee (IKDC) grades, the Lysholm score, and the Tegner scale. Use of the LAD did not improve reconstruction with regard to any of the individual variables of the overall score. Although the LAD reduced anterior-posterior displacement effectively for the first 20 weeks postoperatively, there was no difference between the groups in terms of the percentage of knees that had abnormal displacement at the latest follow-up. The overall rate of failure was 20% (8) of the 40 knees. Keywords Anterior cruciate ligament AE Ligament augmentation device AE Joint instability AE Tendon allograft AE Chronic instability Ligamentoplastie pour rupture chronique du ligament croise´ante´rieur par allogreffe: renfort synthe´tique ou non Re´sume´Nous avons effectue´une e´tude re´trospective sur l'effet d'un renforcement ligamentaire synthe´tique (ligament augmentation device-LAD) sur le re´sultat des plasties du ligament croise´ante´rieur (LCA) par allogreffe. Cinquante-quatre patients ont e´te´divise´s en deux groupes. Le groupe 1 consistait de 29 genoux re´pare´s par allogreffe et le groupe 2 consistait en 25 genoux re´pare´s par allogreffe et LAD. Tous les patients ont rec¸us le meˆme programme postope´ratoire de mobilisation imme´diate. Quarante patients ont e´te´revus avec un recul moyen de 84 mois. L'e´valuation a e´te´faite avec le document de l'International Knee Documentation Committee (IKDC), le score de Lysholm, et le score de Tegner. Les re´sultats des reconstructions par allogreffe et LAD n'e´taient pas supe´rieurs par rapport aux reconstructions par allogreffe seule. Le de´placement ante´ro-poste´rieur diminuait effectivement pour les premie`res 20 semaines post-ope´ratoires. Ne´anmoins, il n'y avait plus de diffe´rence entre le pourcentage de genoux des deux groupes ayant un de´placement anormal au dernier rappel. L'e´chec ge´ne´ral e´tait de 20% (8) sur 40 genoux. Mots cle´s Ligament croise´ante´rieur AE Renforcement ligamentaire AE Instabilite´articulaire AE Allogreffe tendineuse AE Laxite´chronique
The Knee, 2019
This study evaluated the long-term clinical follow-up results of patients who underwent double-bundle posterior cruciate ligament (PCL) reconstruction using the Ligament Advanced Reinforcement System (LARS). Methods: Patients were assessed using clinical scores that included the Tegner activity level scale, the Lysholm score, and the International Knee Documentation Committee (IKDC) score. KT-1000 was adopted to assess stability. Radiographs and magnetic resonance imaging (MRI) were used to evaluate osteoarthritis and LARS condition. Results: This study examined 38 patients, of which follow-up procedures were completed for 33 patients, resulting in a follow-up rate of 86.8%. The average follow-up period was 11.9 ± 1.2 years (range: 10.3-14.2 years). The median scores of the clinical scales were as follows: Tegner activity score, 6 (range: five to seven); Lysholm score, 90 (range: 67-100); and IKDC score, 89.7 (range: 46-100). The median of the side-to-side difference (SSD) was four millimeters (range: 0-10 mm). In radiographs, the moderate OA rate was 6.9%. MRI results revealed that 26 patients exhibited ingrowth and 11 patients exhibited partial rupture of the LARS. With SSD ≤ 3 mm set as the standard for successful knee stabilization, the optimal cutoff point of LARS midsubstance thickness in the receiver operating characteristic (ROC) curve analysis was 14.3 mm. Conclusions: Long-term follow-up of the studied patients demonstrated the durability of LARS. However, clinical outcomes showed no enhancement using LARS, so it is not recommended for routine use in PCL reconstruction.
The Knee, 2007
A composite carbon fibre polyester scaffold class ligament (ABC-Active Biosynthetic Composite Ligament, Surgicraft Ltd., Redditch) has been used for primary reconstruction of the torn anterior cruciate ligament at Mayday University Hospital since 1985. A cohort of patients followed up until 1996 showed a high incidence of early failure of the implant due to rupture and stretching. This led to a detailed mode of failure analysis and as a result the surgical technique was modified and new instrumentation was introduced in 1992 leading to a substantial improvement in early and mid-term survivorship. However, from 1996 onwards a large number of patients was lost to follow-up and therefore in 2000 a second cohort of patients was recalled for retrospective review. All the patients in this cohort had undergone surgery after 1992 and following the introduction of new instrumentation and alteration in surgical technique. Review of the results in the second cohort showed a very low initial failure rate (0% in the first 3 years), but with an increasing incidence of failure (27.9%) noted between 5 and 7 years post-operatively.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2005
Posterior cruciate ligament (PCL) reconstruction procedures have not been thoroughly evaluated under cyclic loading conditions. We tested the hypothesis that PCL reconstruction with a quadrupled flexor-tendon graft and fixation using tapes and staples is biomechanically superior to that fixed with sutures, a button, and a post-screw, and is comparable to reconstruction with a bonepatellar tendon-bone (BPTB) graft. Study Design: In vitro biomechanical study. Methods: A total of 45 porcine knees were used. The quadrupled flexor-tendon graft was fixed using the suture/button/ post-screw procedure in 15 knees, and with the tape/staples procedure in another 15 knees. The remaining 15 knees underwent reconstruction with a BPTB graft secured with screws as the standard control. In each group of 15 knees, 5 underwent tensile testing without cyclic loading, and 10 underwent the same tensile test after 5,000 cycles of load-controlled or displacement-controlled loading. Results: Each type of cyclic loading produced larger biomechanical changes in the knees fixed with the suture/button/post-screw procedure than in the knees secured using the other 2 procedures. Conclusions: In PCL reconstruction, the tape/staples procedure is biomechanically superior to the suture/button/post-screw procedure, and is comparable to the BPTB/screws procedure with regard to the ultimate failure load. Neither of the procedures using the quadrupled flexor-tendon graft was comparable to the BPTB graft in linear stiffness and the initial displacement after load-controlled cyclic testing. Clinical Relevance: The biomechanical behaviors of PCL-reconstructed knees are significantly different, depending on surgical techniques.
Knee Surgery, Sports Traumatology, Arthroscopy, 2018
Purpose Knowledge about treatment injuries (technical failures and complications) in relation to knee ligament reconstructions is sparse. Our purpose was to describe treatment injuries to knee ligament reconstruction in Denmark during a 10-year period and to suggest initiatives to reduce the risk for treatment injuries. Methods Treatment injuries after knee ligament reconstructions reported to the Danish Patient Compensation Association (DPCA) 2005-2014 were analyzed and compared to information from the Danish Kneeligament Reconstruction Register and Danish National Patient Register. Results The number of knee ligament reconstructions in Denmark 2005-2014, including revisions, was 31,326. Of the 704 cases claimed to DPCA, 371 were approved as treatment injuries (1.42% of all operations). Tunnel malpositioning (135 = 0.43% of all operations), deep infection (0.27%), nerve injury (0.17%), pain (0.12%) and unrecognized combined instability (0.11%) were the most common. Patients operated with anteromedial technique for femoral tunnel placement had a lower incidence (p < 0.0001) of tunnel malpositioning compared to other techniques. Public and private hospitals had the same risk of treatment injures. Hospitals that performed the largest number of reconstructions/year had the smallest risk of a treatment injury (p < 0.001). The total compensation was 7.6 m EURO, which equals 243 EURO/performed knee ligament reconstruction. Conclusion Treatment injuries as defined in this study were rare, with tunnel malpositioning being the most common. Analyses of the results indicate that it may be clinically relevant to reduce the number of treatment injures that knee ligament reconstructions are concentrated in clinics with high volume. Also, malpositioning might be reduced by routine documentation of K-wire position before tunnels are drilled. Level of evidence III.
An evaluation of posterior cruciate ligament reconstruction surgery
BMC Musculoskeletal Disorders
Background: The nature of posterior cruciate ligament (PCL) injuries and the scarcity of data on this issue have made reports on clinical and epidemiological features of PCL injuries valuable. We aimed to report our experiences with PCL injuries in our region. Methods: Any patient who referred with a diagnosis of PCL rupture from 2004 to 2018 to our center, was included in this report. We evaluated pre-and postoperative outcomes and compared patients with isolated and combined (multi-ligament) PCL injuries. Results: Overall, 55 patients were included in our study. Majority of patients were men (87.2%). Mean age of patients was 28.12 ± 8.53 years old. Average follow-up period was 28.83 ± 20.62 months and mean duration between trauma and surgery was 27.8 ± 38.0 months. Most common cause of PCL injury was traffic accidents (70.9%) followed by sports injuries (5.5%). Majority of patients (69.1%) had combined PCL injuries. Majority of patients underwent single tibial-double femoral tunnel reconstruction (56.4%), followed by single tibialsingle femoral tunnel (34.5%) reconstruction. Allografts were used in 60% of patient. Average Cincinnati knee rating scale (CKRC) was 35.87 ± 11.4, which improved significantly after PCL reconstruction (79.45 ± 11.90, p < 0.001). Full range of motion only existed in 29.1% of patient prior to surgery, which improved after surgery (92.7%, p < 0.001). Three patients had postoperative arthrofibrosis and motion stiffness, 1 had deep vein thrombosis and 3 patients had infections. Those with isolated PCL injuries had higher pre-operative CKRS (42.05 ± 8.96 vs. 33.10 ± 11.45, p = 0.006) and lower pre-operative posterior drawer test (2.76 ± 0.43 vs. 3.1 ± 0.6, p = 0.042) compared to those with combined injuries. Conclusion: Today with advances in surgical techniques, considering treatment of collateral ligament injuries, use of stronger allografts and more secure fixation methods, better rehabilitation programs and early range of motion, results of reconstruction of the PCL has become very promising. Accordingly we recommend surgical treatment even for isolated PCL tears, with the goal to prevent functional deficit and to prevent degenerative arthritis.
Trauma monthly, 2020
Background: Multi-ligament knee injury is common after knee dislocation. There are different approaches for treating multi-ligament knee injuries; however, choosing the best approach is a challenging issue. Objectives: This study aimed to investigate the efficacy of early reconstruction of collateral ligaments and delayed reconstruction of cr uciate ligaments in multi-ligament knee injury. Methods: In this prospective study, 24 patients who had a grade 3 tear in one collateral ligament in addition to tears in two other knee ligaments were enrolled. At the first stage, collateral ligaments were reconstructed; after the patient gained full range of motion, reconstruction was done for the cruciate ligaments. Patients were followed-up for one year and postoperative evaluations were conducted through clinical tests, International Knee Documentation Committee scores, and Lysholm scales. Results: Twenty-four patients were entered into the final analysis. Synchronous injury of anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, posterior oblique ligament, posterolateral corner, and lateral collateral ligament had the highest frequency (37.5%). At the one-year follow-up, the average Lysholm and IKDC scores were 86.4 ± 3.5 and 83.8 ± 4, respectively. Range of motion was normal in all patients at the end of the study. Furthermore, in varus and valgus stress tests, the outcomes of reconstruction were better on the lateral side of the knee than on the medial side. Conclusion: The results revealed that a two-stage surgery consisting of early reconstruction of collateral ligaments and delayed reconstruction of cruciate ligaments have good clinical and functional outcomes in multi-ligament knee injuries.