High non-anatomic tunnel position rates in ACL reconstruction failure using both transtibial and anteromedial tunnel drilling techniques

Jaecker, Vera; Zapf, T.; Naendrup, Jan‐Hendrik; Pfeiffer, Thomas; Kanakamedala, Ajay C.; Wafaisade, Arasch; Shafizadeh, Sven

doi:10.1007/s00402-017-2738-3

Cited by 44 publications

(42 citation statements)

References 36 publications

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“…At the same time, current research is underlining that early ACLR improves the outcome after meniscal repair in conjunction with ACLR while protecting the knee from secondary injury like chondral lesions and aggravated meniscal lesions [1,2,34]. While osseous factors like tunnel positioning and tibial slope are established important factors for ACL graft failure, the role of periarticular structures, meniscal kinematics and strength deficits following ACLR is still a major focus of current research [6,[35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

The effect of meniscal repair on strength deficits 6 months after ACL reconstruction

Heitner²,

Mauch³

et al. 2020

Arch Orthop Trauma Surg

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Introduction Ruptures of the anterior cruciate ligament (ACL) can be accompanied by meniscal lesions. Generally, the rehabilitation protocols are altered by meniscal repair. Therefore, the aim of this study was to investigate the effect of meniscal repair on the early recovery of thigh muscle strength in ACL reconstruction (ACLR). Materials and methods We performed a matched cohort analysis of n = 122 isolated ACLR (CON) compared to n = 61 ACLR with meniscal repair (ACLR + MR). The subgroups of meniscal repair consisted of 30 patients who had undergone medial meniscus repairs (MM), 19 lateral meniscus repairs (LM) and 12 repairs of medial and lateral meniscus (BM). Isokinetic strength measurement was performed pre-operatively and 6 months post-surgery to perform a cross-sectional and a longitudinal analysis. All injuries were unilateral, and the outcome measures were compared to the non-affected contralateral leg. Results Six months postoperatively overall there is no significant difference between the groups (extension strength MR 82% vs. CON 85% and flexion strength 86% vs. 88%, resp.). Subgroup analysis showed that medial repairs exhibit a comparable leg symmetry while lateral repairs performed worse with leg symmetry being 76% in extension and 81% in flexion strength. Patients undergoing BM repair performed in between lateral and medial repairs (82% extension, 86% flexion). Conclusion Generally, meniscal repair in conjunction with ACLR does not significantly alter the recovery of limb symmetry in strength at 6 months postoperatively. Interestingly, medial repairs seem to perform superior to lateral meniscal repair and repair of both menisci. Since the recovery of symmetric strength is a major factor in rehabilitation testing, these results will help to advise surgeons on appropriate rehabilitation protocols and setting realistic goals for the injured athlete. Level of evidence III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

The effect of meniscal repair on strength deficits 6 months after ACL reconstruction

Heitner²,

Mauch³

et al. 2020

Arch Orthop Trauma Surg

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“…TT transtibial, TP Transportal, OI Outside-In, cOI Central Outside-In, amOI AM Outside-in, CENTRAL (TP + cOI). * P > 0.005 fibers in the ACL: direct and indirect [22]. In 2012, a histological study [23] pointed to a microscopic fourlayer structure in both the direct femoral and tibial insertion, demonstrating that the direct fibers are stronger and biomechanically more important, located in the lateral femoral intercondylar ridge.…”

Section: Discussionmentioning

confidence: 99%

Anteromedial positioning of the femoral tunnel in anterior cruciate ligament reconstruction is the best option to avoid revision: a single surgeon registry

et al. 2020

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The aim of the study is to compare the risk of revision of single-bundle hamstring anterior cruciate ligament (ACL) reconstruction between the anteromedial, transtibial and outside-in techniques. Methods: This cohort study was based on data from a single surgeon's registry. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendon using the anteromedial portal, transtibial and outside-in technique, operated between 1 November 2003 to 31 December 2016, were eligible for inclusion. A minimum follow-up of 2 years was used, and the end-point of the study was revision surgery. Results: The total number of registered surgeries identified was 665; 109 were excluded, and 556 was the final sample. The overall revision rate was 8.7%. The transtibial technique presented 14/154 [9.9%] of revisions, the transportal 11/96 [11.4%] and the outside-in 22/306 [7.2%]. Separating the outside-in group into central outside-in and anteromedial (AM) outside-in, 18/219 [8.2%] was found for the central outside-in and 4/87 [4.5%] for the AM outside-in technique. Statistical evaluation of the first comparison (transtibial vs. transportal vs. outside-in) obtained p = (n.s.) The second comparison (transtibial vs. central transportal vs. central outside-in vs. AM outside-in, p = (n.s). Placement was also evaluated: high anteromedial placement (transtibial) vs. central (transportal and central outsidein technique) vs. AM placement (AM outside-in). The high AM placement presented 14/154 [9.9%] of revision, the central placement 29/315 [9.2%] and the AM placement 4/87 [4.5%], p = (n.s.) The AM placement was also compared with the other placements (high and central AM), p = (n.s.) Conclusion: Based on the registry of a single surgeon during 14 years of ACL reconstruction, the placement of the femoral tunnel in the high anteromedial region was associated with a rupture rate of 9.9%, central placement with 9.2% and anteromedial placement with 4.5%.

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“…However, in this study, about 54.17% (39/72) included patients had non-anatomical femoral tunnel position. Jaecker et al [36] analyzed 101 cases of ACLR failure and found 37 (36.6%) used AM technique. There were 73% non-anatomical femoral tunnel positions and 35.1% non-anatomical tibial tunnel positions in those patients with AM drilling techniques.…”

Section: Discussionmentioning

confidence: 99%

Comparison of hamstring and quadriceps strength after anatomical versus non-anatomical anterior cruciate ligament reconstruction: a retrospective cohort study

Jiang

Zhang

et al. 2020

Preprint

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Background Strength recovery of injured knee is an important parameter for patients who want to return to sport after anterior cruciate ligament reconstruction (ACLR). Comparison of muscle strength between anatomical and non-anatomical ACLR has not been reported. Purpose To evaluate the hamstring and quadriceps strength and clinical outcomes after anatomical and non-anatomical single-bundle ACLR. Methods Patients received unilateral primary single-bundle hamstring ACLR between January 2017 to January 2018 were recruited in this study. Patients were divided into anatomical reconstruction group (AR group) and non-anatomical reconstruction group (NAR group) according to femoral tunnel aperture position. The hamstring and quadriceps isokinetic strength including peak extension torque, peak flexion torque and H/Q ratio were measured at an angular velocity of 180°/s and 60°/s using an isokinetic dynamometer. The isometric extension and flexion torques were also measured. Hamstring and quadriceps strength were measured preoperatively and at 3, 6, and 12 months after surgery. Knee stability including Lachman test, pivot-shift test, and KT-1000 measurement and subjective knee function including International Knee Documentation Committee (IKDC) and Lysholm scores were evaluated during the follow-up. Results Seventy-two patients with an average follow-up of 30.4 months (range, 24–35 months) were included in this study. Thirty-three were in AR group and 39 in NAR group. The peak knee flexion torque was significant higher in AR group at 180°/s and 60°/s (P < 0.05 for both velocity) at 6 months postoperatively and showed no difference between the two groups at 12 months postoperatively. The isometric knee extension torque was significant higher in AR group at 6 months postoperatively (P < 0.05) and showed no difference between the two groups at 12 months postoperatively. No significant differences between AR group and NAR group were found regarding knee stability and subjective knee function evaluations at follow-up. Conclusion Compared with non-anatomical ACLR, anatomical ACLR showed a better recovery of hamstring and quadriceps strength at 6 months postoperatively. However, the discrepancy on hamstring and quadriceps strength between the two techniques vanished at 1 year postoperatively.

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High non-anatomic tunnel position rates in ACL reconstruction failure using both transtibial and anteromedial tunnel drilling techniques

Cited by 44 publications

References 36 publications

The effect of meniscal repair on strength deficits 6 months after ACL reconstruction

The effect of meniscal repair on strength deficits 6 months after ACL reconstruction

Anteromedial positioning of the femoral tunnel in anterior cruciate ligament reconstruction is the best option to avoid revision: a single surgeon registry

Comparison of hamstring and quadriceps strength after anatomical versus non-anatomical anterior cruciate ligament reconstruction: a retrospective cohort study

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