Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction

Helito, Camilo Partezani; Silva, Andre Giardino Moreira da; Guimarães, Tales Mollica; Sobrado, Marcel Faraco; Pécora, José Ricardo; Camanho, Gilberto Luís

doi:10.1186/s43019-022-00153-3

Cited by 20 publications

(10 citation statements)

References 29 publications

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“…An additional 17 articles were excluded based on the aforementioned inclusion and exclusion criteria [ 10 ]. This left 10 studies for analysis [ 1 – 3 , 7 , 9 , 11 , 13 , 14 , 31 , 32 ]. Figure 1 shows the flowchart depicting the selection process for the studies.…”

Section: Resultsmentioning

confidence: 99%

Multiple revision anterior cruciate ligament reconstruction: not the best but still good

D’Ambrosi

Meena

Raj

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Given the paucity of literature on the re-revision of ACL, the current study was undertaken. The purpose of this systematic review was to synthesise and qualitatively assess the currently available evidence in the literature regarding the re-revision of ACL reconstruction (rrACLR). Methods A systematic review was conducted based on the PRISMA guidelines. The following search terms were used in the title, abstract and keywords fields: “ACL” or “anterior cruciate ligament” AND “revision” or “multiple” or “repeat”. The outcome data extracted from the studies were the Lysholm score, Subjective IKDC, Marx Score, Tegner, Marx Score, KOOS score, radiological changes and the rate of return to sports. Complications, failures and/or revision surgery were also analysed. Results The cohort consisted of 295 patients [191 (64.7%) men and 104 (35.3%) women] with a mean age of 29.9 ± 2.8 years (range 14–58 years) from 10 studies. The mean postoperative follow-up (reported in all studies except one) was 66.9 ± 44.7 months (range 13–230.4 months). Associated injuries were 103 (34.9%) medial meniscus tears, 57 (19.3%) lateral meniscus tears, 14 (4.7%) combined medial plus lateral meniscus tears, 11 (3.7%) meniscal tears (not specified), 252 (85.4%) cartilage lesions, 6 (2.0%) medial collateral ligament injury and 2 (0.7%) lateral collateral ligament injuries. In 47 (15.9%) patients an extra-articular plasty was performed for the anterolateral ligament. In all studies that reported pre- and post-operative IKDC (subjective and objective) and Lysholm score, there was a significant improvement compared to the pre-operative value (p < 0.05). At the final follow-up, laxity measured with KT-1000 was found to be 2.2 ± 0.6 mm. 31 (10.5%) out of 295 patients returned to their pre-injury activity level. A total of 19 (6.4%) re-ruptures were found, while only 4 (1.4%) complications (all minors) were reported, out of which 2 (0.7%) were superficial infections, 1 (0.3%) cyclops lesion and 1 (0.3%) flexion loss. Conclusion Multiple revisions of anterior cruciate ligament reconstruction allow acceptable clinical results and a good degree of knee stability with a low rate of subsequent new re-ruptures but the possibility of regaining pre-injury sports activity is poor; whenever possible, it is preferred to revise the ligament in one stage. This surgery remains a challenge for orthopaedic surgeons and many doubts persist regarding the ideal grafts, additional extra-articular procedures and techniques to use. Level of evidence IV. Study registration PROSPERO-CRD42022352164 (https://www.crd.york.ac.uk/prospero/).

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Section: Resultsmentioning

confidence: 99%

Multiple revision anterior cruciate ligament reconstruction: not the best but still good

D’Ambrosi

Meena

Raj

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…ROM exercise can reduce the risk of scar tissue adhesions and restriction of joint mobility. 27 28 29 30 31) There is also evidence that early passive ROM exercise does not cause knee damage. 32) However, early ROM exercise and WB can cause damage on suture-meniscal tissue and bone-to-meniscus interface, which can result in unfavorable meniscal healing and loosening of fixation.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation after Repair of Medial Meniscus Posterior Root Tears: A Systematic Review of the Literature

et al. 2023

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Background There is no consensus established on postoperative rehabilitation after medial meniscus posterior root tear (MMPRT) repair, including when and how physicians can apply range of motion (ROM) exercise, weight-bearing (WB), brace use, and return to sports (RTS). The purpose of this study was to systematically review the literature on postoperative rehabilitation characteristics of MMPRT repair regarding ROM, WB, brace use, and RTS. Methods A literature search was performed using the Medline/PubMed, Cochrane Central Register of Controlled Trials, and Embase databases. The inclusion criteria were English language, human clinical studies, and studies describing rehabilitation protocols after MMPRT repair such as ROM, WB, brace use, and RTS. Abstracts, case reports, cohort studies, controlled laboratory studies, human cadaveric or animal studies, systematic reviews, and meta-analyses were excluded. Results Thirteen studies were included. Of the 12 ROM studies, ROM was started immediately within 1 or 2 days after operation in 6 studies and after 2 to 3 weeks of knee immobilization in the rest. Of the 13 WB studies, partial weight-bearing was initiated 1 to 4 weeks after operation in 8 studies and 6 weeks in the rest. Of the 9 brace studies, patients were immobilized by a splint for 2 weeks in 3 studies, and in the rest, a brace with full extension was applied for 3 to 6 weeks after several days of splint application. Of the 7 RTS studies, RTS was allowed at 6 months in 6 studies and 5 to 7 months in 1 study. Conclusions This systematic review revealed conservative rehabilitation protocols were more widely adapted as ROM and WB were restricted at certain degrees during postoperative periods in most protocols analyzed. However, it is impossible to identify a consensus on rehabilitation protocols as the protocols analyzed in this review were distinct each other and heterogeneous. In the future, a well-designed comparative study among different rehabilitation protocols is essential to establish a consensus.

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“…Demographic data, including age, sex, body mass index (BMI), and direction, were obtained. Clinical outcomes, including range of motion (ROM), Lysholm score [22], International Knee Documentation Committee (IKDC) score [8], and Tegner activity score [21], were evaluated preoperatively and 2 years postoperatively. The pre‐ and postoperative clinical outcomes were compared.…”

Section: Methodsmentioning

confidence: 99%

Serial change of femoral and tibial tunnel width after anterior cruciate ligament reconstruction with allograft

Lee,

Lee

2023

Knee surg. sports traumatol. arthrosc.

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Purpose To investigate progressive tunnel widening and its correlation with postoperative outcomes after anterior cruciate ligament (ACL) reconstruction using allografts. Methods Sixty-ive patients who underwent ACL reconstruction using a tibialis anterior allograft between 2015 and 2017 were enrolled. Femoral and tibial tunnel widths were measured on anteroposterior (AP) and lateral radiographs immediately and at 3, 6, 12, and 24 months postoperatively. Average femoral and tibial tunnel widths in AP and lateral views were calculated at three diferent measurement points. Tunnel widening was calculated as the diference in tunnel width immediately and 2 years postoperatively. The correlation between tunnel widening and the postoperative results was analysed. Results Tunnel width changes between immediate and 2 years postoperatively were as follows, in AP and lateral views, respectively: femur, 3.0 mm ± 1.5 mm and 2.4 mm ± 1.4 mm; and tibia, 2.8 mm ± 1.4 mm and 2.9 mm ± 1.5 mm. Femoral tunnel widths signiicantly increased until 1 year, but not from 1 to 2 years postoperatively. Tibial tunnel width signiicantly increased until 2 years postoperatively. In all tunnels, the increments in tunnel widening decreased over time. Increased knee laxity signiicantly correlated with greater femoral tunnel widening in AP (r = 0.346, P = 0.006) and lateral views (r = 0.261, P = 0.049). Conclusion Femoral tunnel widths gradually increased until 1 year postoperatively, and tibial tunnel widths increased until 2 years after ACL reconstruction with allografts. The tunnel widening rate gradually decreased over time. Femoral tunnel widening of 3.7 mm and 3.2 mm on AP and lateral views, respectively, were the cut-of values for postoperative knee laxity. Level of evidence Level III.

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Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction

Cited by 20 publications

References 29 publications

Multiple revision anterior cruciate ligament reconstruction: not the best but still good

Multiple revision anterior cruciate ligament reconstruction: not the best but still good

Rehabilitation after Repair of Medial Meniscus Posterior Root Tears: A Systematic Review of the Literature

Serial change of femoral and tibial tunnel width after anterior cruciate ligament reconstruction with allograft

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