Skeletally immature patient showed lower graft maturity than skeletally mature patient after ACL reconstruction with a rounded rectangular femoral tunnel

Asai, Kazuki; Nakase, Junsuke; Shimozaki, Kengo; Yoshimizu, Rikuto; Kimura, Mitsuhiro; Tsuchiya, Hiroyuki

doi:10.1038/s41598-021-99532-1

Cited by 12 publications

(7 citation statements)

References 49 publications

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“…[ 61 ] Am J Sports Med Retrospective 68 25.0 Trans-epiphyseal 19 19 13.4 10 Asai et al. [ 62 ] Sci Rep Retrospective 66 23.0 Trans-epiphyseal 27 27 13.9 16 Bonnard et al. [ 63 ] J Bone Joint Surg Br Retrospective 72 66.0 All-epiphyseal 56 56 12.2 13 Calvo et al.…”

Section: Resultsmentioning

confidence: 99%

All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

Migliorini,

Pilone,

Memminger

et al. 2024

J Orthop Traumatol

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Background Anterior cruciate ligament (ACL) tears in skeletally immature patients are increasingly common. Evidence comparing the outcomes of all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients is limited, and the current literature could benefit from a comprehensive systematic review. The present study compared all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients. The outcomes of interest were to compare joint laxity, patient-reported outcome measures (PROMs), return to sport, and complications. Methods This study was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In November 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. No additional filters were used in the database search. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles that clearly stated the surgical technique (all- or trans-epiphyseal) were eligible. Only articles with a minimum of 6 months of follow-up were included. Only articles that clearly stated that surgeries were conducted in children with open physis were eligible. Results Data from 1489 patients (1493 procedures) were collected, of which 32% (490 of 1489 patients) were female. The mean length of follow-up was 46.6 months. The mean age of the patients was 12.7 years. No difference was found in joint laxity (Table 3): positive pivot shift (P = 0.4), positive Lachman test (P = 0.3), and mean arthrometer laxity (P = 0.1). No difference was found in PROMs (Table 4): International Knee Documentation Committee (IKDC) (P = 0.3), Lysholm (P = 0.4), and Tegner (P = 0.7). The trans-epiphyseal technique was associated with a greater rate of patients unable to return to sports (1% versus 7%, P = 0.0001) and with a longer time to return to sports (7.7 versus 8.6 months, P = 0.01). Though the trans-epiphyseal technique was associated with a lower rate of return to sport, this difference was not statistically significant (P = 0.8). No difference was evidenced in the rate of patients who had reduced their league or level of sports activity (P = 0.6) or in the rate of patients who had returned to their previous league or level of sports activity (P = 0.7). No difference was found in the rate of complication: re-tear (P = 0.8), reoperation (P = 0.7), increased laxity (P = 0.9), and persistent instability sensation (P = 0.3). Conclusion Trans-epiphyseal ACL reconstruction was associated with a greater rate of patients unable to return to sport and with a longer time to return to sport compared with the all-epiphyseal technique in skeletally immature patients. Level of evidence Level III, systematic review.

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Section: Resultsmentioning

confidence: 99%

All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

Migliorini,

Pilone,

Memminger

et al. 2024

J Orthop Traumatol

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“… 15 Wasserstein et al 28 analyzed more than 12,000 ACL reconstruction procedures and found that young age (15-19 years) was a significant independent risk factor for failure. Asai and colleagues 1 reported that 14.8% of skeletally immature patients required revision compared with 2.9% of adults. The explanation for this is likely multifactorial, including lower graft maturity rates, distinct intra-articular inflammatory environments, different autograft sizes and materials, and pediatric patients’ overall high activity levels and relative difficulty adhering to postoperative restrictions.…”

Section: Discussionmentioning

confidence: 99%

“…The explanation for this is likely multifactorial, including lower graft maturity rates, distinct intra-articular inflammatory environments, different autograft sizes and materials, and pediatric patients’ overall high activity levels and relative difficulty adhering to postoperative restrictions. 1 , 5 Finally, as pediatric patients have been shown to demonstrate significantly greater amounts of internal tibial rotation both before and after ACL reconstruction, 4 increased rotational instability has been a commonly cited reason for higher failure rates. Asai et al 1 reported that more than 20% of skeletally immature patients had persistent pivot shift postoperatively compared with a 4% positive postoperative pivot-shift rate in adults.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 5 Finally, as pediatric patients have been shown to demonstrate significantly greater amounts of internal tibial rotation both before and after ACL reconstruction, 4 increased rotational instability has been a commonly cited reason for higher failure rates. Asai et al 1 reported that more than 20% of skeletally immature patients had persistent pivot shift postoperatively compared with a 4% positive postoperative pivot-shift rate in adults. Given the role of KFs as a restraint against internal tibial rotation, 16 we expected a higher rate of KF injury in our cohort compared with the published literature on adult patients.…”

Section: Discussionmentioning

confidence: 99%

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Reliability of MRI Detection of Kaplan Fiber Injury in Pediatric and Adolescent Patients with ACL Tears

Shi

Levine

Ghazikhanian

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: While studies have described Kaplan fiber (KF) injury in up to 60% of adults with anterior cruciate ligament (ACL) tears, the incidence of KF injury in the pediatric and adolescent population remains unknown. Purpose: To (1) determine the reliability of using magnetic resonance imaging (MRI) to identify KF injury in the pediatric and adolescent population and (2) define the incidence of KF injury in these patients with acute ACL injuries. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The authors retrospectively identified patients ≤18 years of age who underwent ACL reconstruction for acute tears between 2013 and 2020. All preoperative MRI scans were reviewed independently and in a blinded fashion by 2 musculoskeletal radiologists, who noted the presence of the KF complex and any evidence of injury; interrater reliability was assessed. Patient characteristics, time from injury to MRI, laterality, and concomitant ligamentous or meniscal injuries were recorded, and associations between patient or injury characteristics and KF integrity on MRI were assessed. Results: In total, 51 patients (mean age, 14.9 years) met the inclusion criteria. Of these, 27 patients were female and 31 sustained an injury to the right knee. With respect to KF integrity, radiologist 1 visualized KF injury in 29% of patients, while radiologist 2 visualized KF injury in 35% of patients. In 12% of cases for radiologist 1 and 6% of cases for radiologist 2, KFs were unable to be visualized at all. The overall percentage agreement between the 2 radiologists was 76.5% with a kappa statistic of 0.57 (moderate agreement). There were no significant associations found between the presence of KF injury and patient age, sex, laterality, body mass index, concomitant ligamentous injury, or meniscal injury. However, visualization of KF injury on MRI was associated with a shorter time from index injury to MRI (15 days vs 23 days; P = .044). Conclusion: Approximately one-third of pediatric and adolescent patients who underwent ACL reconstruction were found to have KF injuries. Standard preoperative MRI scans can reliably be used to visualize KF injury in the majority of pediatric and adolescent patients with ACL tears, especially when the MRI is performed in the acute setting.

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“…Interestingly, we observed that 10 miRNAs were detectable in both adult and adolescent groups with ACL tears without a meniscal tear. More pre-clinical studies are needed to better understand the intraarticular biochemical process in the healing potential of ACL tears in skeletally immature patients [ 41 , 42 , 43 , 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Characterization of microRNA Levels in Synovial Fluid from Knee Osteoarthritis and Anterior Cruciate Ligament Tears

et al. 2022

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This study investigated modifications of microRNA expression profiles in knee synovial fluid of patients with osteoarthritis (OA) and rupture of the anterior cruciate ligament (ACL). Twelve microRNAs (26a-5p, 27a-3p, let7a-5p, 140-5p, 146-5p, 155-5p, 16-5p,186-5p, 199a-3p, 210-3p, 205-5p, and 30b-5p) were measured by real-time quantitative polymerase chain reaction (RT-qPCR) in synovial fluids obtained from 30 patients with ACL tear and 18 patients with knee OA. These 12 miRNAs were chosen on the basis of their involvement in pathological processes of bone and cartilage. Our results show that miR-26a-5p, miR-186-5p, and miR-30b-5p were expressed in the majority of OA and ACL tear samples, whereas miR-199a-3p, miR-210-3p, and miR-205-5p were detectable only in a few samples. Interestingly, miR-140-5p was expressed in only one sample of thirty in the ACL tear group. miR-140-5p has been proposed to modulate two genes (BGN and COL5A1100) that are involved in ligamentous homeostasis; their altered expression could be linked with ACL rupture susceptibility. The expression of miR-30b-5p was higher in OA and chronic ACL groups compared to acute ACL samples. We provide evidence that specific miRNAs could be detected not only in synovial fluid of patients with OA, but also in post-traumatic ACL tears.

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Skeletally immature patient showed lower graft maturity than skeletally mature patient after ACL reconstruction with a rounded rectangular femoral tunnel

Cited by 12 publications

References 49 publications

All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

Reliability of MRI Detection of Kaplan Fiber Injury in Pediatric and Adolescent Patients with ACL Tears

Characterization of microRNA Levels in Synovial Fluid from Knee Osteoarthritis and Anterior Cruciate Ligament Tears

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