Intratunnel Versus Extratunnel Autologous Hamstring Double-Bundle Graft for Anterior Cruciate Ligament Reconstruction

Ibrahim, Samir Abdul Razik; Ghafar, Sami Abdul; Marwan, Yousef; Mahgoub, Abdelbary Mohamed; Misfer, Abdulrahman Al; Farouk, Hassan; Wagdy, Mohammad; Alherran, Hamad; Khirait, Sharif

doi:10.1177/0363546514554189

Cited by 37 publications

(44 citation statements)

References 35 publications

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“…These figures are broadly comparable to the findings of Lai et al, 6 who in a recent systematic review reported that a mean of 83% of elite athletes were able to return to the preinjury level of sport; they took a mean time of 6 to 13 months to do so, and the pooled graft rupture rate was 5.2%. However, it is important to note that both the return to sport rates (42%-100%) [22][23][24] and the graft rupture rates (0%-19.3%) 23,[25][26][27] reported in the studies included by Lai et al 6 varied broadly. This highlights the fact that the risk of graft rupture is higher in certain sports or even certain positions within the same sport.…”

Section: Discussionmentioning

confidence: 99%

Combined Anterior Cruciate and Anterolateral Ligament Reconstruction in the Professional Athlete: Clinical Outcomes From the Scientific Anterior Cruciate Ligament Network International Study Group in a Series of 70 Patients With a Minimum Follow-Up of 2 Years

Rosenstiel

Praz

Ouanezar

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose: To evaluate clinical outcomes in professional athletes after combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction at a minimum follow-up of 2 years. Methods: A retrospective analysis of prospectively collected data from the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group database was performed. All professional athletes who underwent primary combined ACL and ALL reconstruction between January 2011 and March 2016 were included. Patient assessment included physical examination, pre-and postoperative subjective and objective International Knee Documentation Committee (IKDC), Tegner activity scale, and Lysholm scores. Results: Seventy-two professional athletes underwent primary ACL and ALL reconstruction; 70 (97%) were available, with a mean follow-up of 3.9 years (range, 2-7). The preoperative side-to-side anteroposterior laxity difference was 7.1 AE 1.4 mm, and this decreased significantly after surgery to 0.4 AE 0.9 mm (P < .0001). Pivot-shift grade evolved from 16 grade I (22.8%) and 54 grade II or III (77.2%) preoperatively, to 66 absent pivot shift (94.3%) and 4 grade I (5.7; P < .001). By 1-year postoperatively, 60 athletes (85.7%) returned to professional sport, with a mean time interval of 7.9 months (range, 5-12). Preoperatively, the mean subjective IKDC was 56.1 AE 12.3, the Lysholm score was 48.4 AE 12.5, and the Tegner score was 9.3 AE 1. At final follow-up, the mean subjective IKDC was 90.5 AE 7.6 (P < .0001), the Lysholm score was 94.4 AE 7.5 (P < .0001), and the Tegner score was 8.8 AE 1.5 (P < .004). The objective IKDC evolved from 39 grade C (55.7%) and 31 grade D (44.3%) preoperatively to 65 grade A (92.9%) and 5 grade B (7.1%) (P < .0001). Eleven Patients (15,7%) underwent a subsequent ipsilateral reoperation including 4 (5.7%) revision ACL reconstructions. The risk of graft rupture was significantly higher in female patients (13.6% vs 2.1% in male patients; P ¼ .048). Conclusions: Combined ACL and ALL reconstruction is associated with excellent outcomes in professional athletes with respect to graft rupture rates, return to sport, knee stability, and reoperation rates after injury. Level of Evidence: Level IV, case series. See commentary on page 893 D espite a major focus on injury prevention, the rates of anterior cruciate ligament (ACL) rupture have remained relatively unchanged over the last 25 years. 1-3 ACL rupture continues to represent a devastating injury with potentially career-ending consequences for the professional athlete. Even for those

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Section: Discussionmentioning

confidence: 99%

Combined Anterior Cruciate and Anterolateral Ligament Reconstruction in the Professional Athlete: Clinical Outcomes From the Scientific Anterior Cruciate Ligament Network International Study Group in a Series of 70 Patients With a Minimum Follow-Up of 2 Years

Rosenstiel

Praz

Ouanezar

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The causes of these results are not yet fully determined, but it seems most likely to be related to altered bone remodeling processes 11 . In literature an active debate is focused on articular versus extra-articular tendon graft fixation as well as the graft choice itself [13][14][15][16][17] . It is still unclear which graft type and fixation methodis superior.…”

Section: Methodsmentioning

confidence: 99%

“…Significant correlations and trends in bold, *p<0.1, **p<0.05. modeling within the tunnels after ACL reconstruction. Strengths and weaknesses in relation to other studies: A considerable number of studies have assessed biomechanical differences in graft type and fixation method after ACL reconstruction [13][14][15][16] . Most of them used computer or finite element models to calculate changes in stress around the femoral or tibial tunnels.…”

mentioning

confidence: 99%

In vivo bone tunnel remodeling in symptomatic patients after ACL reconstruction: a retrospective comparison of articular and extra-articular fixation

Mathis

Rasch

Hirschmann

2019

Muscle Ligaments and Tendons J

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Background: there is only a paucity of studies dealing with bone remodeling within the tunnels after anterior cruciate ligament (ACL) reconstruction. The objective of this study was to evaluate the influence of tendon graft type and surgical fixation technique on bone tunnel remodeling in patients with symptomatic knees after ACL reconstruction. Methods: in a retrospective study 99mTc-HDP bone tracer uptake (BTU) in SPECT/CT of 57 knees with symptoms of pain and/or instability after ACL reconstruction was investigated. All 57 knees were subdivided according their anatomy (femur and tibia), fixation (articular versus extraarticular fixation) and graft types into eight groups: femoral-articular versus extra-articular fixation using bone-patellar tendon-bone (BPTB) and hamstring autografts; tibial-articular versus extra-articular fixation using patellar tendon and hamstring autografts; BTU grading for each area of the localisation scheme were recorded. Tunnel diameter and length was measured in the CT scans. Results: BTU was higher for the articular fixation in the femur and for the extra-articular fixation in the tibial tunnel. Patellar tendon graft fixation showed a significantly higher BTU in the superior-lateral and posterior-central area of the tibia, meaning the areas of the tibial tunnel near the entrance into the joint. Tunnel enlargement correlated significantly with increased BTU (p<0.05). Conclusion: assessment of in vivo bone tunnel remodelling in symptomatic patients after ACL reconstruction revealed different patterns of BTU with regards to graft and fixation method.

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“…However, an increased risk of tunnel enlargement has been reported in some studies, according to a potential ‘bungee effect’ (or pistoning) and ‘windshield effect’ 76. Nevertheless, a meta-analysis and high-quality studies have reported no clinically significant differences in knee AP stability or functional outcomes comparing interference screw and suspensory fixation for soft tissue grafts 77 78. Biomechanical studies have compared different types of cortical suspensory devices and have found some mechanical differences between them under different loads79 (tables 5 and 6).…”

Section: Acl Reconstruction: Current State Of the Artmentioning

confidence: 99%

Anterior cruciate ligament reconstruction

et al. 2016

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Intratunnel Versus Extratunnel Autologous Hamstring Double-Bundle Graft for Anterior Cruciate Ligament Reconstruction

Cited by 37 publications

References 35 publications

Combined Anterior Cruciate and Anterolateral Ligament Reconstruction in the Professional Athlete: Clinical Outcomes From the Scientific Anterior Cruciate Ligament Network International Study Group in a Series of 70 Patients With a Minimum Follow-Up of 2 Years

Combined Anterior Cruciate and Anterolateral Ligament Reconstruction in the Professional Athlete: Clinical Outcomes From the Scientific Anterior Cruciate Ligament Network International Study Group in a Series of 70 Patients With a Minimum Follow-Up of 2 Years

In vivo bone tunnel remodeling in symptomatic patients after ACL reconstruction: a retrospective comparison of articular and extra-articular fixation

Anterior cruciate ligament reconstruction

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