Contralateral Patellar Tendon Autograft in Anterior Cruciate Ligament Reconstruction

Júnior, Paulo Lobo; Neto, Eugênio dos Santos; Borges, José Humberto de Souza; Dias, Luana Junqueira Resende Volpe; Machado, Ronny de Souza; Freitas, Anderson

doi:10.1590/1413-785220182602185594

Cited by 4 publications

(6 citation statements)

References 18 publications

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“…The procedures were based on previous studies. 30 , 44 , 45 All approaches were performed using the anatomic technique, via the medial portal, simultaneously in both knees (receptor and donor). A tourniquet was also used on both knees.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies 6 , 30 , 36 demonstrated the clinical results of short- and medium-term recovery of patients who underwent ACL reconstruction with a contralateral bone–patellar tendon–bone (BPTB) graft and were rehabilitated under the same conditions as described by Shelbourne and Klotz. 45 The patients were satisfied with their function, but the isokinetic evaluation at multiple time points showed the presence of significant differences in muscle performance between each lower limb, of which the donor limb, (ie, the healthy limb), was shown to be more deficient.…”

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confidence: 97%

“… 45 The patients were satisfied with their function, but the isokinetic evaluation at multiple time points showed the presence of significant differences in muscle performance between each lower limb, of which the donor limb, (ie, the healthy limb), was shown to be more deficient. 6 , 30 , 36 Symmetry of muscle strength is thought to be an essential criterion for a safe return to sports. 21 However, limited evidence is available regarding the most effective interventions to achieve symmetry.…”

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confidence: 99%

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Unilateral Versus Bilateral Resistance Exercise in Postoperative Rehabilitation After ACL Reconstruction With Bone–Patellar Tendon–Bone Graft: A Randomized Controlled Trial

Oliveira

Júnior

Imoto

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Lower limb muscle strength symmetry has been suggested as an essential criterion for the safe return to sports after anterior cruciate ligament (ACL) reconstruction. Limited evidence is available regarding the most effective intervention to achieve symmetry after reconstruction with contralateral bone–patellar tendon–bone (BPTB) graft. Purpose: To verify whether unilateral isotonic resistance exercise is more effective than bilateral exercise for obtaining postoperative functional and muscular strength symmetry between the donor limb and reconstructed limb for patients who received BPTB graft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 88 patients were randomly divided into a control group (n = 44) and an intervention group (n = 44). All participants performed an 8-week exercise program starting at the beginning of the fourth postoperative month and were evaluated before and after the program. The control group performed bilateral exercises, and the intervention group performed unilateral exercises for the donor limb only (the limb with the greatest disability). The primary outcome was muscle strength (peak torque and hamstrings to quadriceps [H:Q] ratio), and the secondary outcomes were range of motion (ROM; goniometry), KT-1000 arthrometer side-to-side difference in anteroposterior knee laxity, and objective (single-leg hop test) and subjective (Lysholm score) functionality. Results: Both groups improved significantly from before to after the exercise program. The improvements were significantly greater in the intervention group regarding peak torque, H:Q ratio, flexion ROM, single-leg hop test, and Lysholm score in the donor limb ( P < .001 for all), and the improvements were significantly greater in the control group regarding peak torque and single-leg hop test in the reconstructed limb ( P < .001 for both). Comparison between the groups showed significantly increased symmetry regarding peak torque, H:Q ratio, and single-leg hop test in the intervention group compared with the control group ( P < .001), with large effect sizes (>0.80) except for the H:Q ratio. Conclusion: Although postoperative, bilateral, isotonic resistance exercise provided better strength gains to the reconstructed limb, unilateral exercise was more effective in obtaining functional and muscle strength between-limb symmetry in patients who underwent ACL reconstruction with contralateral BPTB graft. Registration: Brazilian Registry of Clinical Trials (number RBR-22rnjh).

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Section: Methodsmentioning

confidence: 99%

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confidence: 97%

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Unilateral Versus Bilateral Resistance Exercise in Postoperative Rehabilitation After ACL Reconstruction With Bone–Patellar Tendon–Bone Graft: A Randomized Controlled Trial

Oliveira

Júnior

Imoto

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Disadvantages of allograft include a slower incorporation rate, the potential for transmission of viral disease, and observations by some authors that there may be more residual laxity and less strength than with autologous reconstructions. Some investigators have concluded that autologous patellar tendon grafts should be the first choice, and that allografts should be suggested for revision surgery (new ACL tear already repaired) or when multiple grafts are needed due to complex instabilities; they are most effective when used in patients who perform low-intensity physical activity (8,(38)(39)(40).…”

Section: Graft Selectionmentioning

confidence: 99%

Anterior Cruciate Ligament, Description, Rupture and Treatment

Pesántez¹,

García²,

Ulloa³

et al. 2023

EPRA

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Introduction: the anterior cruciate ligament (ACL) along with the posterior cruciate ligament are the central stabilizers of the knee. Rupture of the ACL usually occurs in active and young people. For a correct diagnosis it is necessary a good clinical history, examination and a complementary study. The literature recommends surgical treatment in athletes and young people. Objective: to detail current information related to anterior cruciate ligament injury, embryology, anatomy, biomechanics, incidence, risk factors, diagnosis, management, approach and treatment of the disease. Methodology: a total of 72 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 46 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar, SciELO and Cochrane; the terms used to search for information in Spanish, Portuguese, German and English were: ACL, anterior cruciate ligament, anterior cruciate ligament, Vordere Kreuzband. Results: ACL deficiency not only causes instability episodes but also changes in joint mechanics that may lead to degenerative changes. Meniscal lesions are linked to 50% of these injuries. The Lachman test is the most accurate clinical diagnostic test, with a reported combined sensitivity of 85% and specificity of 94%. The anterior drawer test has high sensitivity and specificity for chronic ACL tears (92% sensitivity and 91% specificity), but lower accuracy for acute cases. In MRI, the following statistics were found in patients with acute ACL injuries in several studies: specificity 98-100% and sensitivity 94%. Conclusions: The ACL is a specialized band of connective tissue located in the knee joint that joins the tibia and femur. It consists primarily of collagen fibers, making up 70% of its dry weight.Variation in the anatomy of the intercondylar groove of the distal femur is a factor that appears to be related to an increased risk of ACL injury. ACL injuries are rarely diagnosed with an MRI, but in some circumstances, such as a meniscal tear or bone contusion, this test may be useful. The decision on the course of treatment for a patient with an ACL injury depends on a number of variables. Surgical reconstruction in anterior cruciate ligament (ACL) tears has proven to be a very effective technique that usually provides satisfactory results. Patients with ACL insufficiency may receive conservative treatment, which may involve activity modification, rehabilitation, and sometimes bracing. Proprioception and strength deficits should be taken into account when designing rehabilitation programs for knees with ACL insufficiency. KEY WORDS: ligament, anterior cruciate, ACL, rupture.

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“…While the use of contralateral graft harvest in ACL revision surgery is not uncommon [1], few surgeons have adopted this approach in primary ACL‐R [2]. When comparing contralateral and ipsilateral graft harvest, it has previously been reported that no differences at short‐term follow‐up were found in morbidity with both patellar bone tendon bone and semitendinosus and gracilis (STG) grafts [3, 4].…”

Section: Introductionmentioning

confidence: 99%

No differences found in long-term outcomes of a randomized controlled trial comparing ipsilateral versus contralateral hamstring graft in ACL reconstruction

Beaudoin

Ogborn

McRae

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeContralateral graft harvest in primary ACL reconstruction is relatively uncommon and the long‐term comparative of this approach relative to ipsilateral harvest has not been described. The purpose of this study was to evaluate ACL graft and contralateral rupture following ipsilateral or contralateral semitendinosus and gracilis (STG) graft harvest at follow‐up of a minimum 10 years post‐reconstruction in the treatment of a complete ACL tear. MethodsPatients from a previous randomized trial were evaluated. The primary outcome measures were ipsilateral and contralateral reinjury as well as the International Knee Documentation Committee (IKDC) knee assessment form, the ACL Quality of Life questionnaire (ACL‐QoL) and the Tegner activity scale. Participants completed four different single‐leg hop tests and concentric knee flexion and extension strength were assessed on an isokinetic dynamometer. ResultsOf the original 100 patients, 50 patients (41.3 ± 9.5 years of age, 31 males, 19 females) reported on re‐injury at 12.6 ± 1.4 years post‐operative. Thirty‐eight patients returned for full assessment and 12 responded by mail or phone survey. There were no differences between groups for graft rupture, contralateral injury, ACL‐QoL score, IKDC categorization, or anterior tibial translation, though both groups experienced a reduction in the Tegner Activity Scale from their preinjury scores. There was no difference in knee flexor and extensor isokinetic concentric strength, or single leg hop test performance. Knee flexor strength limb symmetry index was reduced when measured in the supine relative to the seated position in both groups, indicating persistent deficits in knee flexor strength when measured in the supine position. ConclusionContralateral hamstring harvest does not put patients at an increased risk of a contralateral ACL tear and long‐term outcomes of ACL reconstruction do not differ based on the side of graft harvest. Contralateral STG harvest may provide a safe alternative surgical option for select patients. Level of evidenceLevel II.

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Contralateral Patellar Tendon Autograft in Anterior Cruciate Ligament Reconstruction

Cited by 4 publications

References 18 publications

Unilateral Versus Bilateral Resistance Exercise in Postoperative Rehabilitation After ACL Reconstruction With Bone–Patellar Tendon–Bone Graft: A Randomized Controlled Trial

Unilateral Versus Bilateral Resistance Exercise in Postoperative Rehabilitation After ACL Reconstruction With Bone–Patellar Tendon–Bone Graft: A Randomized Controlled Trial

Anterior Cruciate Ligament, Description, Rupture and Treatment

No differences found in long-term outcomes of a randomized controlled trial comparing ipsilateral versus contralateral hamstring graft in ACL reconstruction

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