Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Versus Hamstring Tendon: A Prospective Comparative Study With 9-Year Follow-Up

Wipfler, Benjamin; Donner, Stefanie; Zechmann, Christian M.; Springer, Jan; Siebold, Rainer; Paessler, Hans H.

doi:10.1016/j.arthro.2011.01.015

Cited by 114 publications

(111 citation statements)

References 39 publications

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“…The mean Lysholm score of more than 92 points was similar to other studies that have reported scores between 87 and 94 points [4,5,38]. Overall performance concerning the anterior translation measured on KT-1000™ arthrometer showing satisfactory to excellent results is comparable with results provided in the literature, with 80 % to 90 % of patients having a KT-1000™ arthrometer result of less than three millimetres [5,6,22,39]. The authors hold the view that the deterioration of the clinical results was influenced by adverse foreign body reactions of released polyethylene terephthalate fibres, at least to a certain extent.…”

Section: Discussionsupporting

confidence: 77%

Second-look arthroscopic findings and clinical results after polyethylene terephthalate augmented anterior cruciate ligament reconstruction

Struewer¹,

Ziring

Ishaque

et al. 2012

International Orthopaedics (SICOT)

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Purpose Based on the revival of artificial ligaments containing polyethylene terephthalate, this study aimed to evaluate objective intra-articular findings within scheduled secondlook arthroscopy, patient-reported clinical outcome and stability after isolated augmented ACL reconstruction with polyethylene terephthalate (Trevira®) augmented patella-bonetendon-bone graft. Methods In a retrospective analysis of our institutional database, we found 126 patients with polyethylene terephthalate (Trevira®) augmented ACL reconstruction. All these patients underwent standardised second-look arthroscopic evaluation when removal of the augmentation became necessary. These second-look arthroscopic analyses focused on graft integration and remodelling in line with the polyethylene terephthalate augmentation. Arthroscopic re-examination comprised a graft evaluation including a structural and functional classification according to the Marburger Arthroscopy Score (MAS).Additional clinical evaluation was performed via the IKDC score and the scores of Tegner and Lysholm. Instrumental anterior laxity testing was carried out with a KT-1000™ arthrometer. Furthermore, a correlation analysis between the clinical parameters, the instrumental stability assessment and the corresponding arthroscopic graft condition was performed.Results The arthroscopic evaluation showed rupture of 87 (69 %) of 126 augmentation devices. In 27 (31 %) of these 87 cases, synovial reactions were found particularly in the anterior compartment. An intact synthetic augmentation with signs of graft integration with intact synovial coating was only found in 30 %. Evaluation according to the MAS showed good to excellent structural and functional characteristics in 88 % of patients. Presence of a type III graft (MAS) was found in an additional 11 %. A rudimentary (type IV) graft was only detected once. Eighty-five percent of patients were graded A or B according to IKDC score. The Lysholm score was 92.4± 4.8. Correlation analysis demonstrated a significant relationship between clinical outcome according to the IKDC score (p<0.05), instrumental stability performance according to the KT-1000™ assessment (p<0.05) and the corresponding arthroscopic graft evaluation according to the MAS. Conclusion Graft integration and remodelling has complex and multi-factorial origins, particularly with artificial augmentation. Correlation analysis showed a significant relation between clinical condition, instrumental stability performance and arthroscopic graft constitution. The release of polyethylene terephthalate fibres caused inflammation of synovial tissue of the knee. Characteristic sub-clinical graft changes of structural, morphological and functional qualities of the inserted graft appear on second-look arthroscopy despite good clinical results.

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Section: Discussionsupporting

confidence: 77%

Second-look arthroscopic findings and clinical results after polyethylene terephthalate augmented anterior cruciate ligament reconstruction

Struewer¹,

Ziring

Ishaque

et al. 2012

International Orthopaedics (SICOT)

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“…[6] Although satisfactory short-and mid-term followup results have been reported in the literature, the effects of ACL reconstruction surgery on early degenerative changes of knee articular cartilage is contradictory. [1,[7][8][9][10] While some long-term studies (with a mean follow-up of 8.8 years) report no difference of articular cartilage and meniscal degeneration between operated and non-operated knees, [10] other studies report increased risk of knee degeneration if there is accompanying cartilage injury or if menisectomy is also performed during ACL reconstruction. [6] Thickness measurement and echogenicity evaluation of distal femoral cartilage by gray scale ultrasound (US) has been reported previously.…”

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confidence: 99%

“…[15] In a recent study, it has been reported that healthy and pathologic cartilages can be differentiated by measuring strain ratios using real-time sonoelastography. [16] Since the results of studies reporting the effects of ACL reconstruction on cartilage degenerative changes were contradictory, [1,[7][8][9][10] there is still a need for a cartilage structure-screening tool in ACL reconstructed patients. We hypothesized that sonoelastography may be a useful method to detect the early changes in cartilage tissue stiffness after ACL reconstruction.…”

mentioning

confidence: 99%

Sonoelastographic evaluation of the distal femoral cartilage in patients with anterior cruciate ligament reconstruction

Akkaya

Gungor

et al. 2016

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada ön çapraz bağ (ÖÇB) tamiri yapılan hastalarda distal femoral kıkırdağın sonoelastografik özellikleri değerlendirildi. Hastalar ve yöntemler: Tek taraflı ÖÇB tamiri yapılan 28 hastanın (27 erkek, 1 kadın, ort. yaş 31.7±7.1 yıl; dağılım 22-48 yıl) demografik özellikleri ve ameliyat verileri değerlendirildi. Yirmi iki hastada (%78.6) patellar tendon grefti ve altı hastada (%21.4) hamstring tendon grefti ile tamir uygulandı. Fonksiyonel değerlendirme için Lysholm diz skoru ve alt ekstremite gücü için sandalyeye oturma kalkma testi kullanıldı. Ameliyat edilen dizler ve sağlıklı dizlerde medial, interkondiler ve lateral distal femoral kıkırdak kalınlıkları B-mod ultrasonografi, gerilim oranları ise gerçek zamanlı sonoelastografi ile ölçüldü. Bulgular: Ameliyat sonrası ortalama takip süresi 20.4±9.8 ay idi. Ortalama Lysholm diz ve hasta memnuniyeti skorları sırasıyla 88.0±8.5 ve 8.2±1.8 idi. Kıkırdak kalınlıkları ameliyatlı ve sağlıklı dizler arasında benzerdi (tamamı p>0.05). Ameliyatlı dizlerde medial distal femoral kıkırdağın sonoelastografik gerilim oranı anlamlı olarak yüksek idi (daha yumuşak kıkırdak) (p= 0.026). Ameliyatlı dizlerde medial kıkırdak gerilim oranı farklılığı ile alt ekstremite kas gücü arasında negatif korelasyon vardı (p= 0.009, r= -0.487). Sonuç: B-mod ultrasonografi ile değerlendirildiğinde ameliyatlı ve sağlıklı dizler arasında kıkırdak kalınlığı açısından farklılık olmasa da ameliyatlı taraflarda medial distal femoral kıkırdakta sonoelastografik gerilim oranı değişikliklerinin saptanması ÖÇB tamirini takiben erken yapısal değişikliklere işaret ediyor olabilir. Kıkırdak yapısındaki değişiklikler ile sonoelastografi özellikleri arasındaki bu ilişkinin klinik etkilerinin açığa çıkarılması için ileri çalışmalara ihtiyaç vardır.Anahtar sözcükler: Ön çapraz bağ; distal femoral kıkırdak; elastografi; gerilim oranı; ultrason. ABSTRACT Objectives:This study aims to evaluate sonoelastographic properties of the distal femoral cartilage in patients with anterior cruciate ligament (ACL) reconstruction. Patients and methods: Demographic characteristics and operative data of 28 patients (27 males, 1 female; mean age 31.7±7.1 years; range 22 to 48 years) with unilateral ACL reconstruction were evaluated. Reconstruction was performed with patellar tendon graft in 22 patients (78.6%) and hamstring tendon graft in six patients (21.4%). Lysholm knee score was used for functional evaluation and chair stand test was used for lower extremity strength. Medial, intercondylar, and lateral distal femoral cartilage thicknesses of operated knees and healthy knees were measured with B-mode ultrasound, while strain ratios were measured with real time sonoelastography. Results: Postoperative mean follow-up duration was 20.4±9.8 months. Mean Lysholm knee and patient satisfaction scores were 88.0±8.5 and 8.2±1.8, respectively. Cartilage thicknesses were similar between operated and healthy knees (all p>0.05). Sonoelastographic strain ratio of medial distal femoral cartilage in operated knees was significa...

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“…kneeling pain more frequently than do HS grafts (range, 36% to 84% v 19% to 53%). 5,7,9,12,13,16,17 However, some studies could not detect a significant difference in the incidence of anterior knee pain associated with BPTB versus HS grafts (range, 16% to 43% v 7% to 33%). [4][5][6][7][8][9]11 Furthermore, one study has shown that BPTB autografts have an advantage because the allograft group had a failure rate 15 times greater than that in the autograft group.…”

Section: Discussionmentioning

confidence: 99%

Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Autograft to Avoid Harvest-Site Morbidity in Knee Arthroscopy

Koh¹,

Takemura

et al. 2015

Arthroscopy Techniques

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Although anterior cruciate ligament reconstruction using a boneepatellar tendonebone (BPTB) autograft has many advantages (e.g., high strength and solid fixation), there are also several complications (e.g., anterior knee pain or kneeling pain) due to harvest-site morbidity associated with the use of this graft type compared with the use of hamstring tendon. Therefore the ultimate goal of anterior cruciate ligament reconstruction using a BPTB graft is to minimize harvestsite morbidity. We have used a technique for harvesting central-third BPTB grafts that involves only a 3-cm-long, longitudinal, curved incision in the medial tibial tuberosity for both graft harvesting and fixation. The purpose of this report is to describe the technique, which can avoid the harvest-site morbidities associated with BPTB autografts during knee arthroscopy. We believe that this less invasive reconstruction may reduce the harvest-site morbidities associated with BPTB grafts because it allows for BPTB graft harvesting without incising the synovial bursa or paratenon and mitigates scarring and adhesion formation.A nterior cruciate ligament (ACL) ruptures are among the most frequent ligament injuries. Given that obtaining sufficient regeneration is difficult in cases of a torn ACL because of its poor healing potential, reconstruction surgery is the first choice for treatment of ACL ruptures. Thus boneepatellar tendonebone (BPTB) and hamstring tendon (HS) autografts are the 2 most commonly used reconstruction techniques. In 1963 Jones 1 pioneered the use of BPTB grafts, and this technique has since been considered the gold-standard technique. The BPTB graft is most frequently used because it provides high strength and stiffness, graft size consistency, harvesting ease, early graft incorporation, and solid fixation. However, reconstruction using a BPTB graft is not a perfect solution and may result in harvest-site morbidities, including anterior knee pain or kneeling pain. To avoid the harvest-site morbidities associated with BPTB grafts, HS grafts have recently been used for ACL reconstruction 2 ; however, they are associated with graft loosening, require more expensive implants, and have the potential for knee flexion weakness. In fact, many surgeons who regularly use HS grafts advocate the use of BPTB grafts in athletes and heavy laborers. 3 We believe that the ultimate goal of ACL reconstruction, using a BPTB graft, is to minimize harvest-site morbidity.We have successfully used a technique for harvesting central-third BPTB grafts that involves only 1 longitudinal, curved incision, approximately 3 cm in length, in the medial tibial tuberosity for both graft harvesting and fixation. This technique, performed using devices previously developed by us, not only involves a small skin incision but also allows for BPTB graft harvesting without incising the synovial bursa or paratenon. Subsequently, the BPTB graft can be fixed through the same incision using an all-inside technique. In this report we describe our technique, which m...

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Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Versus Hamstring Tendon: A Prospective Comparative Study With 9-Year Follow-Up

Cited by 114 publications

References 39 publications

Second-look arthroscopic findings and clinical results after polyethylene terephthalate augmented anterior cruciate ligament reconstruction

Second-look arthroscopic findings and clinical results after polyethylene terephthalate augmented anterior cruciate ligament reconstruction

Sonoelastographic evaluation of the distal femoral cartilage in patients with anterior cruciate ligament reconstruction

Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Autograft to Avoid Harvest-Site Morbidity in Knee Arthroscopy

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