The Effect of Postoperative KT-1000 Arthrometer Score on Long-Term Outcome After Anterior Cruciate Ligament Reconstruction

Goodwillie, Andrew; Shah, Sarav S.; McHugh, Malachy P.; Nicholas, Stephen

doi:10.1177/0363546517690525

Cited by 31 publications

(26 citation statements)

References 40 publications

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“…While the bulk of the current literature supports better results with single-bundle grafts positioned in the middle of both insertions, it is not yet clear that the anisometry associated with this graft position—despite being similar to the native ACL—is desirable. While a recent long-term follow-up study suggests even abnormally increased graft lengthening may be very well tolerated clinically, 15 recent reports imply that even better graft function might be achieved by choosing femoral tunnel positions prioritized less on the geometric center of the femoral insertion and more on a “functional” center where the most important elements of the ligament exist. 26 , 37 For the purposes of our study results, it is important to note that our investigation was never intended to endorse one graft position over another—only to evaluate HTT, AM portal, and TT abilities to position grafts in the best way the literature currently suggests.…”

Section: Discussionmentioning

confidence: 99%

Transtibial Versus Anteromedial Portal ACL Reconstruction: Is a Hybrid Approach the Best?

Jennings¹,

Leas

Fleischli

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Improved biomechanical and clinical outcomes are seen when the femoral tunnels of the anterior cruciate ligament (ACL) are placed in the center of the femoral insertion. The transtibial (TT) technique has been shown to be less capable of this than an anteromedial (AM) portal approach but is more familiar to surgeons and less technically challenging. A hybrid transtibial (HTT) technique using medial portal guidance of a transtibial guide wire without knee hyperflexion may offer anatomic tunnel placement while maintaining the relative ease of a TT technique.Purpose:To evaluate the anatomic and biomechanical performance of the HTT technique compared with TT and AM approaches.Study Design:Controlled laboratory study.Methods:Thirty-six paired, fresh-frozen human knees were used. Twenty-four knees (12 pairs) underwent all 3 techniques (TT, AM, HTT) for femoral tunnel placement, with direct measurement of femoral insertional overlap and femoral tunnel length. The remaining 12 knees (6 pairs) underwent completed reconstructions to evaluate graft anisometry and tunnel orientation, with each technique performed in 4 specimens and tested using motion sensors with a quad-load induced model. Graft length changes and graft/femoral tunnel angle were measured at varying degrees of flexion.Results:Percentage overlap of the femoral insertion averaged 37.0% ± 28.6% for TT, 93.9% ± 5.6% for HTT, and 79.7% ± 7.7% for AM, with HTT significantly greater than both TT (P = .007) and AM (P = .001) approaches. Graft length change during knee flexion (anisometry) was 30.1% for HTT, 12.8% for AM, and 8.5% for TT. When compared with the TT approach, HTT constructs exhibited comparable graft–femoral tunnel angulation (TT, 150° ± 3° vs HTT, 142° ± 2.3°; P < .001) and length (TT, 42.6 ± 2.8 mm vs HTT, 38.5 ± 2.0 mm; P = .12), while AM portal tunnels were significantly shorter (31.6 ± 1.6 mm; P = .001) and more angulated (121° ± 6.5°; P < .001).Conclusion:The HTT technique avoids hyperflexion and maintains femoral tunnel orientation and length, similar to the TT technique, but simultaneously achieves anatomic graft positioning.Clinical Relevance:The HTT technique offers an anatomic alternative to an AM portal approach while maintaining the technical advantages of a traditional TT reconstruction.

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Section: Discussionmentioning

confidence: 99%

Transtibial Versus Anteromedial Portal ACL Reconstruction: Is a Hybrid Approach the Best?

Jennings¹,

Leas

Fleischli

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…KT-1000 is an objective measure of AP knee laxity that, although a good research tool and easily standardised among patients, has been heavily criticised for lack of associating its measures to clinical outcomes 19. One such explanation is that it solely measures the passive restraints of the ligament in one plane, while the dynamic stabilisers (ie, muscles) remain silent 20. Tests of rotational laxity, such as the Pivot Shift test, involve more planes of movement and correlate better to PROMs 21 22…”

Section: Discussionmentioning

confidence: 99%

Varying femoral-sided fixation techniques in anterior cruciate ligament reconstruction have similar clinical outcomes: a network meta-analysis

et al. 2018

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“…Each patient underwent clinical examinations at 2 years after surgery. The side-to-side difference in anterior laxity was measured with a KT-2000 arthrometer (Medmetric) at 30° of knee flexion under an anterior drawer force of 133 N, although Goodwillie et al 16 found that the side-to-side difference may play less of a role in clinical outcomes. A well-trained physical therapist and a surgeon, who were blinded to the surgical timing, collected the KT-2000 arthrometer results postoperatively.…”

Section: Methodsmentioning

confidence: 99%

Impact of Surgical Timing on Clinical Outcomes in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autografts

Baba

Kondo

Iwasaki

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:To date, no studies have analyzed the influence on clinical outcomes of the interval between an anterior cruciate ligament (ACL) injury and double-bundle (DB) reconstruction with hamstring tendon autografts.Hypotheses:(1) Performing ACL reconstruction sooner after an injury will reduce postoperative anterior and rotatory knee instability, (2) postoperative range of knee motion or functional results will not be affected by different intervals between injury and surgery, and (3) preoperative isokinetic peak torque of the quadriceps and hamstring muscles will be lower in patients undergoing surgery earlier, while postoperative muscle strength will not be affected by surgery timing.Study Design:Cohort study; Level of evidence, 3.Methods:This study was conducted on a total of 171 patients who had undergone anatomic DB ACL reconstruction with hamstring tendon autografts. The patients were divided into 3 groups based on the time to surgery: (1) ≤1 month after the injury (group E; n = 25), (2) between 1 and 3 months after the injury (group M; n = 72), and (3) >3 months after the injury (group D; n = 74). Patients were assessed for a minimum of 2 years after surgery.Results:Concerning postoperative anterior laxity, 1-way analysis of variance demonstrated a significant difference (P = .0274) among the 3 groups. Anterior laxity was significantly less in group E than in group D (P = .0206). Spearman rank correlation analysis showed a significant correlation (ρ = 0.200; P = .0327) between anterior knee laxity and time to surgery. Also, a significant correlation (P = .0461) was found between the degree of the pivot-shift phenomenon and time to surgery. There were no significant differences in loss of knee extension or flexion among the 3 groups, nor were there any differences in the Lysholm knee score or International Knee Documentation Committee grade. Postoperatively, there were no significant differences in peak torque of the quadriceps or hamstring muscles among the 3 groups.Conclusion:Early DB reconstruction led to significantly less anterior laxity compared with delayed reconstruction. There were no significant differences in postoperative range of knee motion or functional results among the 3 time intervals between injury and surgery in this study.

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The Effect of Postoperative KT-1000 Arthrometer Score on Long-Term Outcome After Anterior Cruciate Ligament Reconstruction

Cited by 31 publications

References 40 publications

Transtibial Versus Anteromedial Portal ACL Reconstruction: Is a Hybrid Approach the Best?

Transtibial Versus Anteromedial Portal ACL Reconstruction: Is a Hybrid Approach the Best?

Varying femoral-sided fixation techniques in anterior cruciate ligament reconstruction have similar clinical outcomes: a network meta-analysis

Impact of Surgical Timing on Clinical Outcomes in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autografts

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