Influence of hamstring autograft diameter on graft failure rate in Chinese population after anterior cruciate ligament reconstruction

Tang, Stephen Pui-Kit; Wan, Keith Hay-Man; Lee, Richard Hin-Lun; Wong, Kevin Kwun-Hung; Wong, Kam-Kwong

doi:10.1016/j.asmart.2020.07.005

Cited by 12 publications

(15 citation statements)

References 26 publications

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“…Similarly, a study of 4029 patients from the Norwegian Knee Ligament Registry also found that when compared with patients with an 8-mm graft, the risk of revision was no different in patients with a 7.5-mm (adjusted HR, 0.86 [95% CI, 0.52-1.43]) or a ≤7-mm graft (adjusted HR, 0.59; [95% CI, 0.30-1.14]). 12 Other retrospective studies performed by Tang et al 41 and Kamien et al 14 found no association between revision risk and grafts <8 mm. In contrast, a study of 18,425 patients combined from the Swedish and Norwegian national knee ligament registries found a higher revision risk when comparing <8-mm to ≥8-mm grafts (adjusted relative risk [RR], 1.25; P = .047).…”

Section: Discussionmentioning

confidence: 94%

Suspensory Versus Interference Tibial Fixation of Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction: Results From the New Zealand ACL Registry

Rahardja

Love²,

Clatworthy

et al. 2022

Am J Sports Med

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Background: The hamstring tendon is frequently used to reconstruct the anterior cruciate ligament (ACL), but there is a lack of consensus on the optimal method of fixation. Registry studies have shown that the type of femoral fixation device can influence the risk of revision ACL reconstruction (ACLR), but it is unclear whether the type of tibial fixation has an effect. In New Zealand, over 95% of hamstring tendon grafts are fixed with an adjustable loop suspensory device on the femoral side, with variable usage between suspensory and interference devices, with or without a sheath, on the tibial side. Purpose: To investigate the association between the type of tibial fixation device and the risk of revision ACLR. Study Design: Cohort Study; Level of evidence, 2. Methods: Prospective data recorded in the New Zealand ACL Registry were analyzed. Only primary ACLRs performed with a hamstring tendon autograft fixed with a suspensory device on the femoral side were included. A Cox regression survival analysis with adjustment for patient factors was performed to analyze the effects of the type of tibial fixation device, the number of graft strands, and graft diameter on the risk of revision. Results: A total of 6145 primary ACLRs performed between 2014 and 2019 were analyzed. A total of 59.6% of hamstring tendon autografts were fixed with a suspensory device on the tibial side (n = 3662), 17.6% with an interference screw with a sheath (n = 1079), and 22.8% with an interference screw without a sheath (n = 1404). When compared with suspensory devices, a higher revision risk was observed when using an interference screw with a sheath (adjusted hazard ratio [HR], 2.05; P = .009) and without a sheath (adjusted HR, 1.81; P = .044). The number of graft strands and a graft diameter of ≥8 mm were associated with the rate of revision on the univariate analysis; however, after adjusting for confounding variables on the multivariate analysis, they did not significantly influence the risk of revision. Conclusion: In this study of hamstring tendon autografts fixed with an adjustable loop suspensory device on the femoral side during primary ACLR, the use of an interference screw, with or without a sheath, on the tibial side resulted in a higher revision rate when compared with a suspensory device.

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Section: Discussionmentioning

confidence: 94%

Suspensory Versus Interference Tibial Fixation of Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction: Results From the New Zealand ACL Registry

Rahardja

Love²,

Clatworthy

et al. 2022

Am J Sports Med

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show abstract

“…Additionally, we observed that a graft of 4 mm radius leads to satisfactory responses as predicted by the model. This graft size is a common surgery choice as reported in literature 11 , 102 – 104 . Subsequently, we performed a sensitivity analysis to investigate the impact of pretension on knee laxity.…”

Section: Discussionmentioning

confidence: 96%

Evaluation of anterior cruciate ligament surgical reconstruction through finite element analysis

Risvas

Stanev

Benos

et al. 2022

Sci Rep

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Anterior cruciate ligament (ACL) tear is one of the most common knee injuries. The ACL reconstruction surgery aims to restore healthy knee function by replacing the injured ligament with a graft. Proper selection of the optimal surgery parameters is a complex task. To this end, we developed an automated modeling framework that accepts subject-specific geometries and produces finite element knee models incorporating different surgical techniques. Initially, we developed a reference model of the intact knee, validated with data provided by the Open Knee(s) project. This helped us evaluate the effectiveness of estimating ligament stiffness directly from MRI. Next, we performed a plethora of “what-if” simulations, comparing responses with the reference model. We found that (a) increasing graft pretension and radius reduces relative knee displacement, (b) the correlation of graft radius and tension should not be neglected, (c) graft fixation angle of 20$$^{\circ }$$ ∘ can reduce knee laxity, and (d) single-versus double-bundle techniques demonstrate comparable performance in restraining knee translation. In most cases, these findings confirm reported values from comparative clinical studies. The numerical models are made publicly available, allowing for experimental reuse and lowering the barriers for meta-studies. The modeling approach proposed here can complement orthopedic surgeons in their decision-making.

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“…Additionally, we observed that a graft of 4 mm radius leads to satisfactory responses as predicted by the model. This graft size is a common surgery choice as reported in literature 11,[99][100][101] . Subsequently, we performed a sensitivity analysis to investigate the impact of pretension on knee laxity.…”

Section: Discussionmentioning

confidence: 98%

Evaluation of Anterior Cruciate Ligament Surgical Reconstruction Through Finite Element Analysis

Risvas

Stanev

Benos³

et al. 2021

Preprint

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Anterior Cruciate Ligament (ACL) tear is one of the most common knee injuries. The ACL reconstruction surgery aims to restore healthy knee function by replacing the injured ligament with a graft. Proper selection of the optimal surgery parameters is a complex task. To this end, we developed an automated modeling framework that accepts subject-specific geometries and produces finite element knee models incorporating different surgical techniques. Initially, we developed a reference model of the intact knee, validated with data provided by the OpenKnee project. This helped us evaluate the effectiveness of estimating ligament stiffness directly from MRI. Next, we performed a plethora of “what-if” simulations, comparing responses with the reference model. We found that a) increasing graft pretension and radius reduces relative knee displacement, b) the correlation of graft radius and tension should not be neglected, c) graft fixation angle of 20 degrees can reduce knee laxity, and d) single-versus double-bundle techniques demonstrate comparable performance in restraining knee translation. In most cases, these findings confirm reported values from comparative clinical studies. The numerical models are made publicly available, allowing for experimental reuse and lowering the barriers for meta-studies. The modeling approach proposed here can complement orthopedic surgeons in their decision-making.

show abstract

Influence of hamstring autograft diameter on graft failure rate in Chinese population after anterior cruciate ligament reconstruction

Cited by 12 publications

References 26 publications

Suspensory Versus Interference Tibial Fixation of Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction: Results From the New Zealand ACL Registry

Suspensory Versus Interference Tibial Fixation of Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction: Results From the New Zealand ACL Registry

Evaluation of anterior cruciate ligament surgical reconstruction through finite element analysis

Evaluation of Anterior Cruciate Ligament Surgical Reconstruction Through Finite Element Analysis

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