Individualized Anterior Cruciate Ligament Surgery

Hussein, Mohsen; Eck, Carola F. van; Čretnik, Andrej; Dinevski, Dejan; Fu, Freddie H.

doi:10.1177/0363546512446928

Cited by 130 publications

(69 citation statements)

References 46 publications

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“…The basic concept of anatomic ACL reconstruction and its procedures were recently reported in detail 53-55 . The surgical procedure is briefly described here.…”

Section: Methodsmentioning

confidence: 99%

In Vivo Analysis of Dynamic Graft Bending Angle in Anterior Cruciate Ligament–Reconstructed Knees During Downward Running and Level Walking: Comparison of Flexible and Rigid Drills for Transportal Technique

Tashiro

Sundaram

Thorhauer

et al. 2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose To determine in vivo dynamic graft bending angle (GBA) in anterior cruciate ligament (ACL) reconstructed knees, correlate the angle to tunnel positions and tunnel widening, and evaluate the effects of two femoral tunnel drilling techniques on GBA. Methods Patients with an isolated ACL injury undergoing reconstruction were included from 2011 to 2012. Trans-portal techniques were used to create femoral tunnels. Tunnel locations were determined using 3D-CT. Tibio-femoral kinematics during treadmill walking and running were assessed using dynamic stereo X-ray analysis 6 months and 2 years postoperatively. The GBA was calculated from the 3D angle between the graft and femoral tunnel vectors at each motion frame. Cross-sectional area of femoral tunnels were measured at 6 months and compared to initial size to assess tunnel widening. Results A total of 54 patients were included. Use of flexible drills resulted in significantly higher GBA during walking (80.6° ± 7.8°; p<0.001) and running (80.5° ± 9.0°; p=0.025) than rigid drills (walking: 67.5° ± 9.3°, running: 74.1° ± 9.6°). It led to greater tunnel widening of 113.9±17.6 %, compared with rigid drills of 97.7±17.5 % (p=0.003). Femoral and tibial apertures were located in similar anatomic positions in both groups, but femoral tunnel exits were located more anteriorly (p<0.001) in the flexible drill group. Higher GBA was highly correlated with anterior location of femoral exits (r=0.63, p<0.001) and moderately correlated with greater tunnel widening (r=0.48, p<0.001). Conclusions High GBA was identified during dynamic activities after anatomic ACL reconstruction using a trans-portal femoral tunnel drilling technique. The GBA was greater when flexible drills were used. The high bending angle resulted from more anterior location of femoral tunnel exits, and correlated with early bone tunnel widening at 6 months. These results suggest that high GBA may increase stress on the bone-graft interface and contribute to greater tunnel widening after anatomic ACL reconstruction, although clinical impact should be further investigated. Level of Evidence Level III, retrospective comparative study

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“…The basic concept of anatomic ACL reconstruction and its procedures were recently reported in detail 53-55 . The surgical procedure is briefly described here.…”

Section: Methodsmentioning

confidence: 99%

In Vivo Analysis of Dynamic Graft Bending Angle in Anterior Cruciate Ligament–Reconstructed Knees During Downward Running and Level Walking: Comparison of Flexible and Rigid Drills for Transportal Technique

Tashiro

Sundaram

Thorhauer

et al. 2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…41,42 Its potential clinical importance is exemplified by patients with possible combined ACL and ALL rupture who do not progress satisfactorily after isolated ACL reconstruction. 23,24 A recent anatomic study performed also suggested that a difference between the ALL in males and females might exist. 37 …”

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The Anterolateral Ligament: An Anatomic Study on Sex-Based Differences

Daggett

Helito²,

Cullen

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The anterolateral ligament (ALL) has been shown to have an important role in rotatory stability of the knee. While there is abundant research on sex-based differences related to anterior cruciate ligament (ACL) rupture, there is a paucity of literature related to such differences in the ALL.Purpose:To define any sex-based differences in the ALL with regard to length, width, and thickness.Study Design:Descriptive laboratory study.Methods:The ALL was initially evaluated in 165 unpaired knees (92 males and 65 females after exclusion criteria applied). The length, width, and thickness of the ALL were measured using a digital caliper. Width and thickness were measured at the joint line just superior to the lateral meniscus. The Mann-Whitney test and Student t tests were used to compare measurements between males and females. The Pearson product-moment correlation was subsequently used to determine the correlation between height and weight and the statistically different morphometric variables.Results:The mean (±SD) thickness of the ALL in males was 2.09 ± 0.56 mm, almost twice as thick as females (1.05 ± 0.49 mm; P = 8.8 × 10−20). There was also a statistically significant difference in ALL length (P = 3.8 × 10−7), but no significant difference was found for width. A moderate association was found between donor height and ALL thickness and length.Conclusion:The anatomic measurements of the ALL demonstrate a difference between sexes, and the ALL is significantly thicker in males than females.Clinical Relevance:As the role of the ALL in rotatory stability of the knee becomes better understood, the difference in the thickness of the ALL we have found between the sexes may be another factor why female athletes have an increased incidence of ACL rupture compared with males. This may also help explain why females have issues with knee laxity and rotatory instability.

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“…3,9,22 Although numerous advances have been made in surgical reconstruction techniques and graft choices, it is well recognized that some patients continue to experience persistent rotatory knee instability after ACL reconstruction. 16,17,34,36 It has been suggested that failure to address additional secondary stabilizers may contribute to this postoperative instability. In fact, unaddressed meniscal tears, underappreciated meniscocapsular injuries, increased posterior tibial slope, and anterolateral capsular injuries have all been demonstrated to play a role in rotatory knee stability.…”

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confidence: 99%

The Anterolateral Complex of the Knee

Herbst

Albers

Burnham

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Significant controversy exists regarding the anterolateral structures of the knee.Purpose:To determine the layer-by-layer anatomic structure of the anterolateral complex of the knee.Study Design:Descriptive laboratory study.Methods:Twenty fresh-frozen cadaveric knees (age range, 38-56 years) underwent a layer-by-layer dissection to systematically expose and identify the various structures of the anterolateral complex. Quantitative measurements were performed, and each layer was documented with high-resolution digital imaging.Results:The anterolateral complex of the knee consisted of different distinct layers, with the superficial and deep iliotibial band (ITB) representing layer 1. The superficial ITB had a distinct connection to the distal femoral metaphysis and femoral condyle (Kaplan fibers), and the deep layers of the ITB were identified originating at the level of the Kaplan fibers proximally. This functional unit, consisting of the superficial and deep ITB, was reinforced by the capsulo-osseous layer of the ITB, which was continuous with the fascia of the lateral gastrocnemius and biceps femoris muscles. These 3 components of the ITB became confluent distally, and the insertion spanned from the Gerdy tubercle anteriorly to the lateral tibia posteriorly on a small tubercle (lateral tibial tuberosity). Layer 3 consisted of the anterolateral capsule, in which 35% (7/20) of specimens had a discreet mid-third capsular ligament.Conclusion:The anterolateral complex consists of the superficial and deep ITB, the capsulo-osseous layer of the ITB, and the anterolateral capsule. The anterolateral complex is defined by the part of the ITB between the Kaplan fibers proximally and its tibial insertion, which forms a functional unit. A discrete anterolateral ligament was not observed; however, the anterolateral ligament described in recent studies likely refers to the capsulo-osseous layer or the mid-third capsular ligament.Clinical Relevance:The anterolateral knee structures form a complex functional unit. Surgeons should use caution when attempting to restore this intricate structure with extra-articular procedures designed to re-create a single discreet ligament.

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Individualized Anterior Cruciate Ligament Surgery

Abstract: Anatomic double-bundle reconstruction is not superior to anatomic single-bundle reconstruction when an individualized ACL reconstruction technique is used.

Cited by 130 publications

References 46 publications

In Vivo Analysis of Dynamic Graft Bending Angle in Anterior Cruciate Ligament–Reconstructed Knees During Downward Running and Level Walking: Comparison of Flexible and Rigid Drills for Transportal Technique

In Vivo Analysis of Dynamic Graft Bending Angle in Anterior Cruciate Ligament–Reconstructed Knees During Downward Running and Level Walking: Comparison of Flexible and Rigid Drills for Transportal Technique

The Anterolateral Ligament: An Anatomic Study on Sex-Based Differences

The Anterolateral Complex of the Knee

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