Transportal central femoral tunnel placement has a significantly higher revision rate than transtibial AM femoral tunnel placement in hamstring ACL reconstruction

Clatworthy, Mark; Sauer, Steffen; Nicholson-Roberts, T C

doi:10.1007/s00167-018-5036-x

Cited by 35 publications

(36 citation statements)

References 29 publications

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confidence: 99%

“…35,53 Additionally, higher failure rates have been reported in a number of studies in which an anatomic surgical technique was performed, suggesting that a more anatomic ACL graft placement may lead to greater forces being placed on the ACL graft, resulting in a subsequent increase in risk of graft rupture. 9,42 More recently, a significant focus has been placed upon the anterolateral complex (ALC), a combination of structures on the lateral side of the knee that have been demonstrated to aid in the control of anterolateral rotatory laxity. 8,15,20,39 The ALC includes the superficial and deep iliotibial band (ITB), the capsulo-osseous layer of the ITB, 19,27 and a thickening of the lateral capsule referred to as the anterolateral ligament (ALL).…”

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confidence: 99%

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Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial

Getgood¹,

Bryant²,

Litchfield³

et al. 2020

Am J Sports Med

447

439

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Background: Persistent anterolateral rotatory laxity after anterior cruciate ligament (ACL) reconstruction (ACLR) has been correlated with poor clinical outcomes and graft failure. Hypothesis: We hypothesized that a single-bundle, hamstring ACLR in combination with a lateral extra-articular tenodesis (LET) would reduce the risk of ACLR failure in young, active individuals. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This is a multicenter, prospective, randomized clinical trial comparing a single-bundle, hamstring tendon ACLR with or without LET performed using a strip of iliotibial band. Patients 25 years or younger with an ACL-deficient knee were included and also had to meet at least 2 of the following 3 criteria: (1) grade 2 pivot shift or greater, (2) a desire to return to high-risk/pivoting sports, (3) and generalized ligamentous laxity (GLL). The primary outcome was ACLR clinical failure, a composite measure of rotatory laxity or a graft rupture. Secondary outcome measures included the P4 pain scale, Marx Activity Rating Scale, Knee injury Osteoarthritis and Outcome Score (KOOS), International Knee Documentation Committee score, and ACL Quality of Life Questionnaire. Patients were reviewed at 3, 6, 12, and 24 months postoperatively. Results: A total of 618 patients (297 males; 48%) with a mean age of 18.9 years (range, 14-25 years) were randomized. A total of 436 (87.9%) patients presented preoperatively with high-grade rotatory laxity (grade 2 pivot shift or greater), and 215 (42.1%) were diagnosed as having GLL. There were 18 patients lost to follow-up and 11 who withdrew (~5%). In the ACLR group, 120/298 (40%) patients sustained the primary outcome of clinical failure, compared with 72/291 (25%) in the ACLR+LET group (relative risk reduction [RRR], 0.38; 95% CI, 0.21-0.52; P < .0001). A total of 45 patients experienced graft rupture, 34/298 (11%) in the ACLR group compared with 11/291 (4%) in the ACL+LET group (RRR, 0.67; 95% CI, 0.36-0.83; P < .001). The number needed to treat with LET to prevent 1 patient from graft rupture was 14.3 over the first 2 postoperative years. At 3 months, patients in the ACLR group had less pain as measured by the P4 ( P = .003) and KOOS ( P = .007), with KOOS pain persisting in favor of the ACLR group to 6 months ( P = .02). No clinically important differences in patient-reported outcome measures were found between groups at other time points. The level of sports activity was similar between groups at 2 years after surgery, as measured by the Marx Activity Rating Scale ( P = .11). Conclusion: The addition of LET to a single-bundle hamstring tendon autograft ACLR in young patients at high risk of failure results in a statistically significant, clinically relevant reduction in graft rupture and persistent rotatory laxity at 2 years after surgery. Registration: NCT02018354 ( ClinicalTrials.gov identifier)

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confidence: 99%

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confidence: 99%

Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial

Getgood¹,

Bryant²,

Litchfield³

et al. 2020

Am J Sports Med

447

439

View full text Add to dashboard Cite

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“…Thus, the findings of recent clinical studies, suggesting a significantly higher rate of graft failure in the central footprint ACL reconstruction group than in the AM footprint reconstruction group, could be reinforced by our results. 6,39 However, the results and clinical relevance of this study should be carefully interpreted in light of its several limitations. First, the effect on potential graft failure of an approximate 10 difference in GTA and 4-MPa difference in contact stress has yet to be clearly defined.…”

Section: Discussionmentioning

confidence: 97%

“…Thus, an excessively inferior femoral tunnel was created, resulting in a graft location within the indirect insertion area where the contribution of the load was relatively low. 29,36,42 Furthermore, several studies, such as the Danish Knee Ligament Reconstruction Register 39 and the prospective and comparative study of Clatworthy et al, 6 reported that the central graft yielded a higher revision rate than the AM graft. The Danish registry study proposed that the steep technical learning curve resulted in higher failure using the transportal technique targeting the femoral central footprint.…”

Section: Discussionmentioning

confidence: 99%

Creating a Femoral Tunnel Aperture at the Anteromedial Footprint Versus the Central Footprint in ACL Reconstruction: Comparison of Contact Stress Patterns

Kim

Song

Kim

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: It remains unclear whether an anteromedial (AM) footprint or a central footprint anterior cruciate ligament (ACL) graft exhibits less contact stress with the femoral tunnel aperture. This contact stress can generate graft attrition forces, which can lead to potential graft failure. Purpose/Hypothesis: The purpose of this study was to compare the difference in contact stress patterns of the graft around a femoral tunnel that is created at the anatomic AM footprint versus the central footprint. It was hypothesized that the difference in femoral tunnel positions would influence the contact stress at the interface between the reconstructed graft and the femoral tunnel orifice. Study Design: Controlled laboratory study. Methods: A total of 24 patients who underwent anatomic single-bundle ACL reconstruction were included in this study. In 12 patients, the femoral tunnels were created at the center of the native AM footprint (AM group), and in the remaining 12 patients the center of the femoral tunnel was placed in the anatomic central footprint (central group). Three-dimensional knee models were created and manipulated using several modeling programs, and the graft-tunnel angle (GTA) was determined using a special software program. The peak contact stresses generated on the virtual ACL graft around the femoral tunnel orifice were calculated using a finite element method. Results: The mean GTA was significantly more obtuse in the AM group than in the central group (124.2° ± 5.9° vs 112.6° ± 7.9°; P = .001). In general, both groups showed high stress distribution on the anterior surface of the graft, which came in contact with the anterior aspect of the femoral tunnel aperture. The degree of stress in the central group (5.3 ± 2.6 MPa) was significantly higher than that in the AM group (1.2 ± 1.1 MPa) ( P < .001). Conclusion: Compared with the AM footprint ACL graft, the central footprint ACL graft developed significantly higher contact stress in the extended position, especially around the anterior aspect of the femoral tunnel orifice. Clinical Relevance: The contact stress of the ACL graft at the extended position of the knee may be minimized by creating the femoral tunnel at the AM-oriented footprint.

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“…“In addition to graft choice, the surgeon must also decide which surgical technique to use. Anteromedial and transtibial techniques are the most commonly used, with most orthopaedic surgeons using the anteromediel technique, as it allows for unconstrained anatomic placement of both the tibial and femoral tunnels” 33…”

Section: Contralateral Acl Rupturementioning

confidence: 99%

Current evidence around patellar tendon graft in ACLR for high-risk patients: current concepts

2020

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Transportal central femoral tunnel placement has a significantly higher revision rate than transtibial AM femoral tunnel placement in hamstring ACL reconstruction

Abstract: Level II-prospective comparative study.

Cited by 35 publications

References 29 publications

Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial

Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial

Creating a Femoral Tunnel Aperture at the Anteromedial Footprint Versus the Central Footprint in ACL Reconstruction: Comparison of Contact Stress Patterns

Current evidence around patellar tendon graft in ACLR for high-risk patients: current concepts

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