Increased revision rate with posterior tibial tunnel placement after using the 70-degree tibial guide in ACL reconstruction

Inderhaug, Eivind; Raknes, Sveinung; Østvold, Thomas; Solheim, Eirik; Strand, Torbjørn

doi:10.1007/s00167-016-4341-5

Cited by 17 publications

(15 citation statements)

References 31 publications

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“…Among the most common are participation in high-level sports, 6,14,41,45 younger age, 30,42,45 and technical issues related to the surgery. 5,18,30,32 Several possible explanations for the residual knee laxity and risk of revision surgery after ACLR were seen in the current study. We found a nonsignificant tendency (P = .08) that athletes undergoing revision surgery were younger at the primary surgery (median, 20.5 years; n = 14) than the group not in need of revision surgery (median, 24 years; n = 135).…”

Section: Discussionmentioning

confidence: 69%

Effect of Early Residual Laxity After Anterior Cruciate Ligament Reconstruction on Long-term Laxity, Graft Failure, Return to Sports, and Subjective Outcome at 25 Years

et al. 2021

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Background: In spite of supposedly successful surgery, slight residual knee laxity may be found at follow-up evaluations after anterior cruciate ligament reconstruction (ACLR), and its clinical effect is undetermined. Purpose: To investigate whether a 3- to 5-mm increase in anterior translation 6 months after ACLR affects the risk of graft failure, rate of return to sports, and long-term outcome. Study Design: Cohort study; Level of evidence, 2. Methods: From a cohort of 234 soccer, team handball, and basketball players undergoing ACLR using bone–patellar tendon–bone graft, 151 athletes were included who attended 6-month follow-up that included KT-1000 arthrometer measures. A tight graft was defined as <3-mm side-to-side difference between knees (n = 129), a slightly loose graft as 3 to 5 mm (n = 20), and a loose graft as >5 mm (n = 2). Graft failure was defined as ACL revision surgery, >5-mm side-to-side difference, or anterolateral rotational instability 2+ or 3+ at 2-year follow-up. Finally, a 25-year evaluation was performed, including a clinical examination and questionnaires. Results: The rate of return to pivoting sports was 74% among athletes with tight grafts and 70% among those with slightly loose grafts. Also, return to preinjury level of sports was similar between those with slightly loose and tight grafts (40% vs 48%, respectively), but median duration of the sports career was longer among patients with tight grafts: 6 years (range, 1-25 years) vs 2 years (range, 1-15 years) ( P = .01). Five slightly loose grafts (28%) and 6 tight grafts (5%) were classified as failures after 2 years ( P = .002). Thirty percent (n = 6) of patients with slightly loose grafts and 6% (n = 8) with tight grafts had undergone revision ( P = .004) by follow-up (25 years, range, 22-30 years). Anterior translation was still increased among the slightly loose grafts as compared with tight grafts at long-term follow-up ( P < .05). In patients with tight grafts, 94% had a Lysholm score ≥84 after 24 months and 58% after 25 years, as opposed to 78% ( P = .02) and 33% ( P = .048), respectively, among patients with slightly loose grafts. Conclusion: A slightly loose graft at 6 months after ACLR increased the risk of later ACL revision surgery and/or graft failure, reduced the length of the athlete’s sports career, caused permanent increased anterior laxity, and led to an inferior Lysholm score.

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Section: Discussionmentioning

confidence: 69%

Effect of Early Residual Laxity After Anterior Cruciate Ligament Reconstruction on Long-term Laxity, Graft Failure, Return to Sports, and Subjective Outcome at 25 Years

et al. 2021

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“…In the current study, it was found that the tibial location significantly affected the mean anisometry. In the recent study by Inderhaug et al 32 it was shown that posterior tibial socket positioning was related to an increased rate of revision cases. Future studies may further explore the effect and its significance of the tibial socket positioning.…”

Section: Discussionmentioning

confidence: 96%

An In Vivo Prediction of Anisometry and Strain in Anterior Cruciate Ligament Reconstruction – A Combined Magnetic Resonance and Dual Fluoroscopic Imaging Analysis

Kernkamp

Varady

et al. 2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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An area of least anisometry was found in the proximal-distal direction just posterior to the intercondylar notch. ACL reconstruction at the isometric and OTT location resulted in nonanatomic graft behavior, which could overconstrain the knee at deeper flexion angles. Tibial location significantly affected graft strains for the anatomic, OTT, and isometric socket location. CLINICAL RELEVANCE: This study improves the knowledge on ACL anisometry and strain and helps surgeons to better understand the consequences of socket positioning during intra-articular ACL reconstruction.

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“…Inaccurate tunnel placement was found to predict ACLR failure in three studies [17][18][19], and it was an important cause of early graft failure, accounting for 60-79 % of failure cases [17]. Positioning errors in tunnel placement can involve the femoral tunnel and the tibial tunnel, which may lead to excessive graft forces and strain as well as graft impingement, and eventually result in persistent in-stability and loss of motion [79,80].…”

Section: Tunnel Placementmentioning

confidence: 99%

A Systematic Review of Risk Factors for Anterior Cruciate Ligament Reconstruction Failure

et al. 2021

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Although most studies have introduced risk factors related to anterior cruciate ligament reconstruction failure, studies on combinations of high-risk factors are rare. To provide a systematic review of the risk factors of anterior cruciate ligament reconstruction failure to guide surgeons through the decision-making process, an extensive literature search was performed of the Medline, Embase and Cochrane Library databases. Studies published between January 1, 2009, and September 19, 2019, regarding the existing evidence for risk factors of anterior cruciate ligament reconstruction failure or graft failure were included in this review. Study quality was evaluated with the quality index. Ultimately, 66 articles met our criteria. There were 46 cases classified as technical factors, 21 cases as patient-related risk factors, and 14 cases as status of the knee joint. Quality assessment scores ranged from 14 to 24. This systematic review provides a comprehensive summary of the risk factors for anterior cruciate ligament reconstruction failure, including technical factors, patient-related factors, and the factors associated with the status of the knee joint. Emphasis should be placed on avoiding these high-risk combinations or correcting modifiable risk factors during preoperative planning to reduce the rate of graft rupture and anterior cruciate ligament reconstruction failure.

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Increased revision rate with posterior tibial tunnel placement after using the 70-degree tibial guide in ACL reconstruction

Abstract: IV.

Cited by 17 publications

References 31 publications

Effect of Early Residual Laxity After Anterior Cruciate Ligament Reconstruction on Long-term Laxity, Graft Failure, Return to Sports, and Subjective Outcome at 25 Years

Effect of Early Residual Laxity After Anterior Cruciate Ligament Reconstruction on Long-term Laxity, Graft Failure, Return to Sports, and Subjective Outcome at 25 Years

An In Vivo Prediction of Anisometry and Strain in Anterior Cruciate Ligament Reconstruction – A Combined Magnetic Resonance and Dual Fluoroscopic Imaging Analysis

A Systematic Review of Risk Factors for Anterior Cruciate Ligament Reconstruction Failure

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