Implant preloading in extension reduces spring length change in dynamic intraligamentary stabilization: a biomechanical study on passive kinematics of the knee

Häberli, Janosch; Voumard, Benjamin; Kösters, Clemens; Delfosse, Daniel; Henle, Philipp; Eggli, Stefan; Zysset, Philippe

doi:10.1007/s00167-018-5002-7

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…The arthroscopic ACL repair technique with the most experimental and clinical data available is DIS [ 32 , 33 , 34 , 35 , 36 ]. Although several authors reported functional results comparable to our cohort, Ahmad et al reported low DIS survival rates (of only 70% at 5-year follow-up) and Osti et al reported a high rate of recurrent instability (of up to 17.5%) [ 22 , 32 , 35 , 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Good to Excellent Functional Short-Term Outcome and Low Revision Rates Following Primary Anterior Cruciate Ligament Repair Using Suture Augmentation

Schneider

Schliemann

Gosheger

et al. 2020

JCM

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The aim of this study was to evaluate the functional outcome of primary anterior cruciate ligament (ACL) repair using suture augmentation (SA) in 93 consecutive patients (67 female) with a minimum follow-up of 12 months. Patients’ outcomes were determined using International Knee Documentation Committee (IKDC) score, Lysholm score (LS) and Tegner score (TS). Knee-laxity was assessed using the KT-1000 arthrometer. Eighty-eight patients (67 female, mean age 42 years ± standard deviation (SD) 13) were available for follow-up after a mean time of 21 months (range 12–39). Three patients (3%) underwent revision surgery and were excluded from functional analysis. The mean IKDC score was 87.4 ± 11, mean LS was 92.6 ± 11, mean pre-traumatic TS was 6 ± 2 and mean postoperative TS was 6 ± 2, with a mean difference (TSDiff) of 1 ± 1. The interval from injury to surgery had no significant impact on the postoperative IKDC (p = 0.228), LS (p = 0.377) and TSDiff (p = 0.572). Patients’ age (>40 years), BMI (>30) and coexisting ligament or meniscal injuries did not seem to influence postoperative functional results. Primary ACL repair using SA provides good to excellent functional outcomes with a low probability of revision surgery at a minimum of 12 months.

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Section: Discussionmentioning

confidence: 99%

Good to Excellent Functional Short-Term Outcome and Low Revision Rates Following Primary Anterior Cruciate Ligament Repair Using Suture Augmentation

Schneider

Schliemann

Gosheger

et al. 2020

JCM

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“…In a biomechanical study in the human cadaveric knee, Zavras et al found that even the slightest misplacement of tunnels away from a small isometric area within the ACL's femoral attachment, corresponding to one of two points central or anterior in the ACL's tibial attachment, led to length change during flexion of the knee [15]. Furthermore, Haberli et al, more recently, reported that in augmented ACL suture repair dispersion of tunnel positions of only a few millimetres around their associated isometric points could already lead to an increase of 4.0-20.9 mm of anterior tibial translation across the arc of flexion of the knee [11]. The extent of dispersion of the actual femoral and tibial tunnel positions -even when targeting for their associated isometric point -in the present study imply that isometric positioning of the augmentation braid is not reliable in augmented ACL suture repair.…”

Section: Discussionmentioning

confidence: 99%

“…The extent of dispersion of the actual femoral and tibial tunnel positions -even when targeting for their associated isometric point -in the present study imply that isometric positioning of the augmentation braid is not reliable in augmented ACL suture repair. This leads to slackening/tightening of the augmentation braid across the arc of flexion of the knee, which leaves the suture-repaired ACL either unprotected or stretched; not only after static augmentation, but possibly also after dynamic augmentation, which can only compensate for 8 mm of length change [11].…”

Section: Discussionmentioning

confidence: 99%

“…Use of an image intensifier during tunnel placement might improve tunnel position and decrease anisometry. Furthermore, a dynamic augmentation device could neutralise some length change (up to eight millimeters) across the arc of flexion of an anisometrically positioned small diameter augmentation braid, and resulting cyclic loading and elongation of the sutured ACL [11]. Whether the remaining anterior tibial translation after static augmented ACL suture repair in biomechanical studies has clinical consequences remains a question unanswered [11,[32][33][34].…”

Section: Specimenmentioning

confidence: 99%

“…In contrast to the larger diameter native ACL or ACL reconstruction with a tendon graft, the small diameter augmentation braid yields a point-to-point like fixation. Therefore, since in static ACL suture repair the augmentation braid is fixed directly to both the femur and tibia, this implies the necessity for an isometric position of the augmentation braid, to prevent length change within the arc of flexion of the knee and resulting cyclic loading and elongation of the sutured ACL [7,8,10,11]. However, in 'dynamic' augmented ACL suture repair the augmentation braid is fixed to the tibia indirectly through an additional elastic link consisting of a threaded sleeve housing with a preloaded spring to which the augmentation braid is fixed, which could compensate for the presence of cyclic length changes up to eight millimetres across the arc of flexion of the knee, precluding the need for a femoral and tibial isometric tunnel combination [8,11,12].…”

Section: Introductionmentioning

confidence: 99%

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Isometric placement of the augmentation braid is not attained reliably in contemporary ACL suture repair

et al. 2020

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Background: To assess if during arthroscopic braid-augmented ACL suture repair (ACLSR), the actual positions of the augmentation braids' tunnels corresponded with the positions of their intended and targeted isometric points, and to test the hypothesis that there would be no dispersion in actual positions of the augmentation braids' tunnels compared to their intended and targeted isometric points. Methods: In 12 human cadaveric knees, the positions of the augmentation braids' tunnels and their intended and targeted isometric points relative to a femoral and tibial grid were analysed. Furthermore, vector length between these positions was calculated to assess the accuracy and precision of the augmentation braids' tunnel placement. Results: There was dispersion for all of the augmentation braids' tunnel positions compared to their intended isometric points. The femoral and tibial vector lengths (mean ± SD (range)) were 2.9 ± 1.0 (1.1-4.1) and 7.1 ± 2.0 (3.2-9.8) mm respectively. Conclusion: In augmented ACLSR, with the ruptured ACL in situ, there was dispersion of the positions of the actual small diameter femoral and tibial augmentation braids' tunnels away from their desired isometric points. Clinical relevance: The extent of dispersion of the position of both the femoral and tibial tunnels away from their intended isometric positions may cause cyclic length changes with knee motion. An ACLSR with static braid augmentation will thus be vulnerable to cyclic stretchingout. The difficulty of obtaining an isometric tunnel combination for the small diameter augmentation braid may influence the clinician's choice between non-, static or dynamic augmented ACLSR techniques.

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Dynamic intraligamentary stabilization for ACL repair: a systematic review

Ahmad

Schreiner

Hirschmann

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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PurposeIt was the aim to assess all published original research dealing with dynamic repair of the anterior cruciate ligament (ACL) and to provide a semi‐quantitative analysis of clinical outcome reports. MethodsBoth OVIS and MEDLINE databases were utilized for allocation of articles. All preclinical and clinical studies related to dynamic intraligamentary stabilization (DIS) were identified. Results were tabulated and semi‐quantitative analysis performed. ResultsTwenty‐three articles related to DIS were identified. The predominant level of evidence ranged between II and IV, with only one level I study. Reported failure rates ranged between 4% and 13.6%. Most clinical studies only reported revision rates without referring to failure of restoring stability. Highest success was achieved with proximal ACL ruptures. Both the level of physical activity and patient age have been found to influence the risk of failure. ConclusionThere is sufficient evidence to support that DIS repair may be an effective modality for the treatment of acute proximal tears of the ACL. However, comparative studies are lacking. Upcoming studies should compare the technique to ACL reconstruction with failure as an endpoint. Comparison to rigid methods of proximal fixation is also necessary to justify the need for dynamic fixation. Overall, there is evidence to suggest the potential space for ACL repair in the decision tree for individualized treatment planning. The best outcome will be in the hands of the best patient selectors. Level of evidenceIV.

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Implant preloading in extension reduces spring length change in dynamic intraligamentary stabilization: a biomechanical study on passive kinematics of the knee

Cited by 7 publications

References 24 publications

Good to Excellent Functional Short-Term Outcome and Low Revision Rates Following Primary Anterior Cruciate Ligament Repair Using Suture Augmentation

Good to Excellent Functional Short-Term Outcome and Low Revision Rates Following Primary Anterior Cruciate Ligament Repair Using Suture Augmentation

Isometric placement of the augmentation braid is not attained reliably in contemporary ACL suture repair

Dynamic intraligamentary stabilization for ACL repair: a systematic review

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