“…[7][8][9][10][11] These concerns led to the widespread abandonment of open ACL repair in the 1980s and 1990s, when the documented success of ACL reconstruction, with predictable functional outcomes and immediate rehabilitation, completely changed the management approach to ACL injuries in that era. 12 Although arthroscopic primary ACL reconstruction is now recognized as the gold standard treatment for ACL injury, 13,14 clinical outcomes continue to require significant improvement. Even in 2019, primary ACL reconstruction in high-risk populations is associated with graft rupture rates of 18% to 28%, [15][16][17] non-graft ruptureerelated reoperation rates of approximately 7% to 15%, [18][19][20][21] and return to preinjury levels of sports participation in only 50% to 65%.…”
Purpose: To perform a systematic review of contemporary studies reporting clinical outcomes of primary anterior cruciate ligament (ACL) repair to determine whether these studies demonstrate any significant benefit of ACL repair and whether there is evidence of a deterioration of mid-term outcomes as seen in historical data. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A PubMed search using the keywords "repair" AND "Anterior Cruciate Ligament" was performed (limits: English language, publication date between January 1, 2014, and January 13, 2019). All identified studies reporting clinical outcomes of arthroscopic ACL repair were included. Critical appraisal was conducted using the Cochrane Risk of Bias Tool for Randomized Clinical Trials and the Methodological Index for Non-Randomized Studies. Basic parameters of each study including population characteristics, repair technique, physical examination findings, and clinical outcome scores were recorded and evaluated. Results: Nineteen eligible studies were identified (including 5 comparative studies). None of the comparative studies showed any significant difference between repair and reconstruction groups with respect to International Knee Documentation Committee (IKDC), Lysholm, Tegner, side-to-side laxity difference, Lachman, pivot shift tests, or graft rupture rates. Four non-comparative studies reported outcomes at medium-to long-term follow up (range of mean follow up 43.3-79 months) with a mean Lysholm score between 85.3 and 100, mean IKDC subjective score between 87.3 and 100, and mean Tegner activity score between 5 and 7. Conclusions: Comparative studies identified no significant differences between ACL repair and reconstruction with respect to Lysholm, IKDC, side-to-side laxity difference, pivot shift grade, or graft rupture rates. However, these studies had major limitations including small numbers and short durations of follow up. Case series demonstrated that excellent outcomes can be achieved at medium-to long-term follow up with the SAR technique. Level of Evidence: IV; Systematic review of Level II to IV investigations. See related article on page 613 H istorical results of open primary repair of the anterior cruciate ligament (ACL) have been characterized in the literature by good initial clinical outcomes, 1-6 with a significant deterioration at midterm follow-up and high rates of additional surgery (64%), including reoperation for ACL reconstruction (13%
“…[7][8][9][10][11] These concerns led to the widespread abandonment of open ACL repair in the 1980s and 1990s, when the documented success of ACL reconstruction, with predictable functional outcomes and immediate rehabilitation, completely changed the management approach to ACL injuries in that era. 12 Although arthroscopic primary ACL reconstruction is now recognized as the gold standard treatment for ACL injury, 13,14 clinical outcomes continue to require significant improvement. Even in 2019, primary ACL reconstruction in high-risk populations is associated with graft rupture rates of 18% to 28%, [15][16][17] non-graft ruptureerelated reoperation rates of approximately 7% to 15%, [18][19][20][21] and return to preinjury levels of sports participation in only 50% to 65%.…”
Purpose: To perform a systematic review of contemporary studies reporting clinical outcomes of primary anterior cruciate ligament (ACL) repair to determine whether these studies demonstrate any significant benefit of ACL repair and whether there is evidence of a deterioration of mid-term outcomes as seen in historical data. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A PubMed search using the keywords "repair" AND "Anterior Cruciate Ligament" was performed (limits: English language, publication date between January 1, 2014, and January 13, 2019). All identified studies reporting clinical outcomes of arthroscopic ACL repair were included. Critical appraisal was conducted using the Cochrane Risk of Bias Tool for Randomized Clinical Trials and the Methodological Index for Non-Randomized Studies. Basic parameters of each study including population characteristics, repair technique, physical examination findings, and clinical outcome scores were recorded and evaluated. Results: Nineteen eligible studies were identified (including 5 comparative studies). None of the comparative studies showed any significant difference between repair and reconstruction groups with respect to International Knee Documentation Committee (IKDC), Lysholm, Tegner, side-to-side laxity difference, Lachman, pivot shift tests, or graft rupture rates. Four non-comparative studies reported outcomes at medium-to long-term follow up (range of mean follow up 43.3-79 months) with a mean Lysholm score between 85.3 and 100, mean IKDC subjective score between 87.3 and 100, and mean Tegner activity score between 5 and 7. Conclusions: Comparative studies identified no significant differences between ACL repair and reconstruction with respect to Lysholm, IKDC, side-to-side laxity difference, pivot shift grade, or graft rupture rates. However, these studies had major limitations including small numbers and short durations of follow up. Case series demonstrated that excellent outcomes can be achieved at medium-to long-term follow up with the SAR technique. Level of Evidence: IV; Systematic review of Level II to IV investigations. See related article on page 613 H istorical results of open primary repair of the anterior cruciate ligament (ACL) have been characterized in the literature by good initial clinical outcomes, 1-6 with a significant deterioration at midterm follow-up and high rates of additional surgery (64%), including reoperation for ACL reconstruction (13%
“…Also, we reproduced the anatomy of the ALL by making our reconstruction in a double bundle way. 1 , 40 Given increasing knowledge about the anatomy of the ALL, double bundle reconstruction of the ALL will reproduce the triangular or the inverted Y shape of the native ALL with its narrow femoral attachment and broad tibial attachment 21 , 22 , 25 , 32 ( Fig 8 ). Fig 8 Cadaveric specimen of the right knee showing the anatomy of the ALL with its narrow proximal femoral attachment (proximal and posterior to the lateral femoral epicondyle [LFE]) and its broad distal tibial attachment (midway between Gerdy's tubercle [GT] and fibular head [FH]).…”
Section: Discussionmentioning
confidence: 99%
“…Anterior cruciate ligament (ACL) reconstruction is a common surgical procedure performed by orthopaedic surgeons, particularly in association with sports-related injuries. 1 ACL injury is one of the most frequent sports injuries, with an incidence of approximately 35/100,000 people per year. 2 …”
The results of arthroscopic anterior cruciate ligament (ACL) reconstruction are so far satisfactory and improving over time as a result of the improved understanding of the anatomy and biomechanics of the ACL. Rotational instability confirmed by a positive pivot shift is present in more than 15% of cases who underwent successful ACL reconstruction. Persistent rotational instability interferes with performing pivoting sports, and also may lead to meniscal and chondral injuries, or re-rupture of the reconstructed ACL. Surgeons reconsidered the anatomy and biomechanics of the ACL and introduced the double bundle ACL reconstruction technique aiming to achieve a more rotational control by reconstructing the anteromedial and anterolateral bundles of the ACL. To date, the results of double bundle ACL reconstruction are mixed and inconsistent. The improved understanding of the existence, function, and biomechanical role of the anterolateral ligament (ALL) in controlling the rotational instability of the knee has redirected and refocused attention on a supplemental extra-articular reconstruction of the ALL in conjunction with the intra-articular ACL reconstruction so as to restore normal kinematics of the knee. In this Technical Note, we describe a technique that allows for a combined ACL and double bundle ALL reconstruction using autogenous hamstring graft (semitendinosus and gracilis) tendons. This technique is an extension of our previously described technique of a combined anatomic ACL and single bundle ALL reconstruction. The improved understanding of the anatomy of the ALL makes a double bundle ALL reconstruction more anatomic than single bundle ALL reconstruction, as the native ALL is triangular or inverted Y in shape, with a narrow proximal femoral attachment and a broad distal tibial attachment between Gerdy's tubercle and the head of the fibula.
“…Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic procedures performed worldwide. It is considered the standard of care for young active patients who wish to return to sport practice after ACL injury[ 1 ]. Despite the lack of clear evidence of its ability to reduce the onset and progression of knee osteoarthritis (OA), ACL reconstruction is expected to prevent further meniscal and cartilage lesions that could occur in the ACL-deficient knee[ 2 , 3 ].…”
Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic procedures performed worldwide. In this regard, magnetic resonance imaging (MRI) represents a useful pre-operative tool to confirm a disruption of the ACL and to assess for potential associated injuries. However, MRI is also valuable post-operatively, as it is able to identify, in a non-invasive way, a number of aspects and situations that could suggest potential problems to clinicians. Graft signal and integrity, correct tunnel placement, tunnel widening, and problems with fixation devices or the donor site could all compromise the surgical outcomes and potentially predict the failure of the ACL reconstruction. Furthermore, several anatomical features of the knee could be associated to worst outcomes or higher risk of failure. This review provides a practical guide for the clinician to evaluate the post-surgical ACL through MRI, and to analyze all the parameters and features directly or indirectly related to ACL reconstruction, in order to assess for normal or pathologic conditions.
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