Meniscal resection increases the risk of residual knee laxity even in patients undergoing anatomic double-bundle anterior cruciate ligament reconstruction with eight strands of hamstring autografts

Abstract

Purpose To compare the midterm clinical outcomes of diferent meniscal surgeries in patients undergoing anatomic doublebundle anterior cruciate ligament reconstruction (DB-ACLR) with eight strands of hamstring (HT8) autografts and explore the potential predictive risk factors for residual knee laxity. Methods From 2010 to 2017, a total of 410 patients who underwent anatomic trans-tibial DB-ACLR with HT8 autografts (169 patients without meniscal surgery, 105 patients with meniscal repair, and 136 patients with meniscal resection) were included in this study. The equivalent graft diameter was introduced to make the total graft size of DB-ACLR comparable with that of single-bundle ACLR and calculated as the square root of the quadratic sum of the diameter for each bundle. Residual laxity was deined as excessive anterior tibial translation or residual pivot shift at any follow-up visit, while graft rupture was conirmed by second-look arthroscopy or magnetic resonance imaging. ResultsThe mean follow-up period was 8.3 ± 2.2 years. The mean equivalent graft diameter was 9.9 ± 0.7 mm. Graft rupture was conirmed in 16 (3.9%) patients, while residual laxity was detected in 72 (17.6%) patients (34 [25.0%] in the meniscal resection group vs. 22 [13.0%] in the no meniscal surgery group, p = 0.021). In the multivariate logistic regression analysis, high-grade preoperative knee laxity (odds ratio OR 2.04, p = 0.020), equivalent graft diameter < 9 mm (OR 3.31 compared with 9-10 mm, p = 0.012; OR 3.28 compared with ≥ 10 mm, p = 0.019), and meniscal resection (OR 1.94 compared with no meniscal surgery, p = 0.045) were associated with residual laxity. Conclusion During a midterm follow-up, meniscal resection increased the risk of residual knee laxity even in patients undergoing anatomic DB-ACLR with HT8 autografts. Increasing the hamstring graft diameter and preserving the menisci are important strategies for ACLR to restore knee stability. Level of evidence Level III.

Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

“…Liu et al 25 noted that high-grade pivot shift (grade 2 or 3) was correlated with excessive ATSLC (≥6 mm) in acute ACL injuries and with prolonged time and meniscal tears in chronic ACL injuries; however, the sample size in that study was quite limited for conducting multivariate analyses for the acute and chronic subgroups separately. In contrast, the present study emphasized that excessive ATSLC and secondary stabilizer injuries, rather than injury chronicity, were determinant predictors of high-grade knee laxity in patients with acute ACL injury as well as those with chronic ACL injury, suggesting that repairing the menisci 21,32,50 and strengthening the ALL 3,15,47 should be considered in all patients with concomitant injuries in order to restore as normal static and dynamic tibiofemoral relationships as possible.…”

“…8,22,33 Given the good consistency of ATS measurements, excessive ATSLC may be a more reliable indicator for surgeons to use in predicting high-grade knee laxity before anesthesia and conducting surgical planning in advance. Preparation for larger graft diameter, 20,41,50 selection of patellar tendon graft, 39,42 addition of a lateral extra-articular procedure, 15,48,51 and correction for abnormal PITS 43,52 may be considered in different patients with estimated high-grade knee laxity in order to reduce their risks of clinical failure.…”

The 50 most cited studies on posterior tibial slope in joint preserving knee surgery

“…All of the mentioned measurement techniques show inherent reliability but their comparability among each other are to a very limited extend [27, 32, 34, 38]. Outside of this list, there are other studies that compare measurement methods, showing that ultimately the literature does not conclusively agree on which method is best [10, 38, 51]. One has to admit, that due to the prompt, cheap and widespread availability of radiography, the PTS is predominantly measured on true lateral radiographs in clinical practice.…”

Predicting the Objective and Subjective Clinical Outcomes of Anterior Cruciate Ligament Reconstruction: A Machine Learning Analysis of 432 Patients: Response

“…We value the comments that Bullock and colleagues provide on our study 28 about developing applicable machine learning (ML) models and determining important predictors for the outcomes of anterior cruciate ligament (ACL) reconstruction (ACLR). 15 In our study, different ML models, including logistic regression, Gaussian naı ¨ve Bayes, random forest (RF), Extreme Gradient Boosting (XGBoost), isotonically calibrated XGBoost, and sigmoid calibrated XGBoost, were introduced as previously reported and validated by Ramkumar et al [18][19][20] The most important predictors were determined separately for the commonly used objective and subjective outcomes of ACLR, 26,27 such as graft failure, residual laxity, failure to achieve the minimal clinically important difference (MCID) of Lysholm or International Knee Documentation Committee scores, and return to preinjury or pivoting sports.…”