Functional outcomes and health-related quality of life after robot-assisted anterior cruciate ligament reconstruction with patellar tendon grafts

Abstract

During a short period of time, surgical robots had been propagated for automated tunnel placement in anterior cruciate ligament (ACL) reconstruction. Clinical outcome data are currently unavailable. Between 2000 and 2003, 152 patients underwent ACL replacement with the assistance of the Computer Assisted Surgical Planning and Robotics system (CASPAR, OrtoMaquet, Germany) at our hospital. After minimal invasive pin placement in both the tibia and femur, computed tomography was used to register anatomical landmarks and to plan graft tunnel alignment. The robot was used to drill tibial and femoral tunnels in an outside-in fashion according to pre-operative planning. There was one procedure-specific Serious Adverse Event (i.e., an intraoperative transection of the posterior cruciate ligament). After IRB approval, all patients were invited for a follow-up examination. Data from 100 patients (35 women, 65 men, mean age 35 [SD 11] years, median follow-up 61 [range 42-77] months) form the basis of this report. Side-to-side differences in anterior laxity were measured with the KT-1000 arthrometer. Patient-centered outcomes included the Lysholm-Score, the lower extremity functional scale (LEFS), and the Short Form 36 (SF36). The mean KT-1000 side-to-side difference was 0.89 [95% confidence interval (CI) 0.52-1.26] mm. Eight and five patients had a positive Lachman and pivot shift test, respectively. The Lysholm-Score averaged 86 (95% CI 83-89) points. Excellent, good, fair, and poor outcomes were reported by 38, 32, 20, and 10 patients. The LEFS averaged 85 (95% CI 82-88) points. The mean SF36 Physical Component Score was 48.4 (95% CI 46.5-50.3), indicating residual deficits compared to the population norm. All tibial graft tunnels did not cross the Blumensaat line, but were placed slightly anterior to the optimal center of 42% reported in previous studies. Compared to literature data, robot-assisted ACL reconstruction with BTB grafts may lead to higher knee stability, but poorer functional outcomes. The immense additional efforts with the procedure did not pay off in a benefit to patients.

A Between Sex Comparison of Anterior-Posterior Knee Laxity after Anterior Cruciate Ligament Reconstruction with Patellar Tendon or Hamstrings Autograft

“…The remaining studies, which were of a much stronger methodological design, reported no significant difference in AP knee laxity between sexes following an ACL reconstruction with a BTB graft. These results are consistent with other studies in the literature that reported no sex differences in AP knee laxity [31,32] or graft failure [33,34] after an ACL reconstruction with a BTB graft.…”

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

“…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.…”

“…In the case of the type IV graft, only a rudimentary graft without evidence of biomechanical stability and function was found on arthroscopic re-examination. Evaluation of the clinical and functional results according to the subjective and objective questionnaire of IKDC score on follow-up were comparable to those found in literature [5,38,39]. Various authors reported high satisfaction rates and good to excellent clinical outcomes according to the IKDC (84-94 points on average) score based on a population of similar age and overall constitution [4,5].…”

A Theoretical Framework for Understanding Neuromuscular Response to Lower Extremity Joint Injury

“…Disability is common following joint injury and/or surgery, including anterior cruciate ligament ruptures and reconstructions, 3,43,49,67,76 meniscectomy, 71 osteoarthritis, 15,72 total knee arthroplasties, 4,32 acute ankle sprain, 8 and chronic ankle instability. 16,45 Neuromuscular alterations following ankle and knee injuries may play a role in altering functional performance, potentially contributing to disability in different populations.…”