Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort: A Report From the MARS Group

De, Cooper; Wr, Dunn; Huston, Laura J.; Ak, Haas; Kp, Spindler; Cr, Allen; Af, Anderson; DeBerardino, Thomas M.; Bba, Lantz; Mann, Barton J.; Stuart, MJ; Jp, Albright; An, Amendola; Jt, Andrish; Cc, Annunziata; Ra, Arciero; Br, Bach; Cl, Baker; Ar, Bartolozzi; Km, Baumgarten; Bechler,; Jh, Berg; Ga, Bernas; Sf, Brockmeier; Brophy, Robert H.; Ca, Bush-Joseph; Jb, Butler V; Jd, Campbell; Jl, Carey; Je, Carpenter; Bj, Cole; Jm, Cooper; C, Cox; Ra, Creighton; Dl, Dahm; David, Tal S.; Dc, Flanigan; Rw, Frederick; Tj, Ganley; Ea, Garofoli; Cj, Gatt; Gecha,; Giffin, J. Robert; Sl, Hame; Ja, Hannafin; Cd, Harner; Nl, Harris; Ks, Hechtman; Eb, Hershman; Rg, Hoellrich; Tm, Hosea; Dc, Johnson; Ts, Johnson; Jones, Morgan H.; Cc, Kaeding; Gv, Kamath; Te, Klootwyk; Ba, Levy; Cb, Ma; Gp, Maiers; Rg, Marx; Mj, Matava; Gm, Mathien; McAllister, David R.; Ec, McCarty; Rg, McCormack; Bs, Miller; Cw, Nissen; Df, O'Neill; Bd, Owens; Parker, R. David; Ml, Purnell; Aj, Ramappa; Ma, Rauh; Ac, Rettig; Jk, Sekiya; Kg, Shea; Oh, Sherman; Slauterbeck,; Mv, Smith; Jt, Spang; Sj, Svoboda; Tn, Taft; Jj, Tenuta; Em, Tingstad; Af, Vidal; Dg, Viskontas; Ra, White; Js, Williams; Ml, Wolcott; Wolf, Brian R.; Jj, York; Rw, Wright

doi:10.1177/0363546518777732

Cited by 51 publications

(17 citation statements)

References 30 publications

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Section: Discussionmentioning

confidence: 99%

“…Clinical research studies have shown conflicting results. Several studies have shown an association between knee hyperextension and preoperative instability, 4,43 postoperative instability, 56 and graft failure, 8 while others report no relationship between hyperextension and risk of laxity or rupture. 7 High-grade preoperative knee laxity, as determined by a grade 3 Lachman or pivot-shift test result, was significantly associated with 3-times greater odds of graft rupture within the Stability 1 Study, although it was not retained in the asymmetric pivot-shift model.…”

Section: Discussionmentioning

confidence: 99%

“…We selected 12 predictors for our analyses based on previous findings and clinical hypotheses: age, 25,28,49 sex, 31 treatment group (ACLR alone or ACLR 1 LET), 14 preoperative knee hyperextension on the contralateral side, 8 graft diameter, 28 posterior tibial slope, 58 time from injury to surgery (months), 48 preoperative high-grade knee laxity, 29,30 and meniscal treatment status (medial repair, medial excision, lateral repair, lateral excision). 42 Patients reported age, sex, and date of injury on a preoperative questionnaire.…”

Section: Predictorsmentioning

confidence: 99%

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Predictors of Graft Failure in Young Active Patients Undergoing Hamstring Autograft Anterior Cruciate Ligament Reconstruction With or Without a Lateral Extra-articular Tenodesis: The Stability Experience

Firth¹,

Bryant²,

Litchfield

et al. 2022

Am J Sports Med

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Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) has higher failure rates in young active patients returning to sports as compared with older, less active individuals. Augmentation of ACLR with an anterolateral procedure has been shown to reduce failure rates; however, indications for this procedure have yet to be clearly defined. Purpose/Hypothesis: The purpose of this study was to identify predictors of ACL graft failure in high-risk patients and determine key indications for when hamstring ACLR should be augmented by a lateral extra-articular tenodesis (LET). We hypothesized that different preoperative characteristics and surgical variables may be associated with graft failure characterized by asymmetric pivot shift and graft rupture. Study Design: Case-control study; Level of evidence, 3. Methods: Data were obtained from the Stability 1 Study, a multicenter randomized controlled trial of young active patients undergoing autologous hamstring ACLR with or without a LET. We performed 2 multivariable logistic regression analyses, with asymmetric pivot shift and graft rupture as the dependent variables. The following were included as predictors: LET, age, sex, graft diameter, tear chronicity, preoperative high-grade knee laxity, preoperative hyperextension on the contralateral side, medial meniscal repair/excision, lateral meniscal repair/excision, posterior tibial slope angle, and return-to-sports exposure time and level. Results: Of the 618 patients in the Stability 1 Study, 568 with a mean age of 18.8 years (292 female; 51.4%) were included in this analysis. Asymmetric pivot shift occurred in 152 (26.8%) and graft rupture in 43 (7.6%). The addition of a LET (odds ratio [OR], 0.56; 95% CI, 0.37-0.83) and increased graft diameter (OR, 0.62; 95% CI, 0.44-0.87) were significantly associated with lower odds of asymmetric pivot shift. The addition of a LET (OR, 0.40; 95% CI, 0.18-0.91) and older age (OR, 0.83; 95% CI, 0.72-0.96) significantly reduced the odds of graft rupture, while greater tibial slope (OR, 1.15; 95% CI, 1.01-1.32), preoperative high-grade knee laxity (OR, 3.27; 95% CI, 1.45-7.41), and greater exposure time to sport (ie, earlier return to sport) (OR, 1.18; 95% CI, 1.08-1.29) were significantly associated with greater odds of rupture. Conclusion: The addition of a LET and larger graft diameter were significantly associated with reduced odds of asymmetric pivot shift. Adding a LET was protective of graft rupture, while younger age, greater posterior tibial slope, high-grade knee laxity, and earlier return to sport were associated with increased odds of graft rupture. Orthopaedic surgeons should consider supplementing hamstring autograft ACLR with a LET in young active patients with morphological characteristics that make them at high risk of reinjury.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Predictorsmentioning

confidence: 99%

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Predictors of Graft Failure in Young Active Patients Undergoing Hamstring Autograft Anterior Cruciate Ligament Reconstruction With or Without a Lateral Extra-articular Tenodesis: The Stability Experience

Firth¹,

Bryant²,

Litchfield

et al. 2022

Am J Sports Med

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“…[10][11][12] Another multicenter study showed that knee recurvatum by more than 5° is a significant independent predictor of ACL graft failure. [22] Vaishya and Hasija reported that joint hypermobility is more common in patients with ACL injury than in control groups. [23] In a prospective study of 1558 athletes, Myer et al [11] reported that the presence of knee hyperextension beyond neutral resulted in a five-fold higher risk of ACL injury, taking into account the GJH measurements.…”

Section: Discussionmentioning

confidence: 98%

“…22 (IBM SPSS Statistics for Windows, Armonk, NY; IBM Corp., Released 2013). First, a Kolmogorov-Smirnov test was used to determine which variables should be included in the data analysis and whether the data for the variables were normally distributed.…”

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confidence: 99%

Does anterolateral ligament internal bracing improve the outcomes of anterior cruciate ligament reconstruction in patients with generalized joint hypermobility?

Toker¹

2022

Ulus Travma Acil Cerrahi Derg

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The anterolateral ligament (ALL) has been identified as a supporter to the anterolateral rotational stability of the knee joint, and it has a strong association with ACL ruptures. [4][5][6] Ferretti et al. [7] reported that approximately 90% of ALL injuries are associated with ACL tears, and due to this strong relationship, recent studies have focused on clearly demonstrating the biomechanical and anatomical features of the ALL. In a recent biomechanical study, Nitri et al. [8] reported that concurrent ACL reconstruction and ALL reconstruction significantly improve the rotatory stability of the knee compared with ACL reconstruction only.

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Anterolateral augmentation procedures during anterior cruciate ligament reconstructions in skeletally immature patients: Scoping review of surgical techniques and outcomes

Dietvorst,

Verhagen,

van der Steen

et al. 2024

J. exp. orthop.

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PurposeGraft failure rates after anterior cruciate ligament reconstruction (ACLR) in children and adolescents are higher compared to adults. Anterolateral augmentation procedures have recently generated increased focus regarding their ability to reduce graft failure rates. Concerns in skeletally immatures are potential growth disturbances and overconstraint after anterolateral augmentation. The aim of this scoping review is to provide an overview of all current anterolateral augmentation procedures in skeletally immature patients and to discuss surgical techniques, clinical and biomechanical outcomes.MethodsThis scoping review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analysis) statement extension for scoping reviews. On 22 December 2022, an information specialist performed a systematic literature search in Cochrane, PubMed (Medline) and EMBASE databases. Inclusion criteria were anterolateral augmentation procedures, including lateral extra‐articular tenodesis (LET) and anterolateral ligament reconstruction (ALLR), in combination with ACLR in skeletally immatures.ResultsTwenty studies were included after screening 1.485 abstracts. Seventeen studies describe LET techniques, four studies ALLR techniques and one study both techniques. Biomechanical data is scarce and shows conflicting results. Two studies compared ACLR with LET to ACLR in skeletally immatures with promising results in favour of the combined procedure. There were no differences in outcomes between LET and ALLR.ConclusionsSeveral LET and ALLR techniques have been described for skeletally immature patients and the first clinical data on LET and ALLR is available, which showed promising results. Further research is necessary to evaluate the risk of growth disturbances and overconstraint in skeletally immatures.Level of EvidenceLevel IV.

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Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort: A Report From the MARS Group

Cited by 51 publications

References 30 publications

Predictors of Graft Failure in Young Active Patients Undergoing Hamstring Autograft Anterior Cruciate Ligament Reconstruction With or Without a Lateral Extra-articular Tenodesis: The Stability Experience

Predictors of Graft Failure in Young Active Patients Undergoing Hamstring Autograft Anterior Cruciate Ligament Reconstruction With or Without a Lateral Extra-articular Tenodesis: The Stability Experience

Does anterolateral ligament internal bracing improve the outcomes of anterior cruciate ligament reconstruction in patients with generalized joint hypermobility?

Anterolateral augmentation procedures during anterior cruciate ligament reconstructions in skeletally immature patients: Scoping review of surgical techniques and outcomes

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