“Vertical Grafts”: A Common Reason for Functional Failure After ACL Reconstruction

Stevenson, Willis; Johnson, Darren L.

doi:10.3928/01477447-20070301-17

Cited by 31 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Abnormal mechanical relationships may arise due to suboptimal technique, whereby placement of the graft insertion in vertical or horizontal alignment is still under discussion [36], or they may be caused by the level of tension in hamstring tendon grafts [10]. According to Stergiou et al [35] activities that are more demanding than walking can cause excessive anterior and rotational loading of the knee.…”

Section: Grade III Grade Ii Grade Imentioning

confidence: 99%

Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment

Keßler

Behrend

Henz

et al. 2008

Knee Surg Sports Traumatol Arthr

367

368

View full text Add to dashboard Cite

ACL-reconstruction aims to restore joint stability and prevent osteoarthritis; however, malfunction and osteoarthritis are often the sequelae. Our study asks whether ACL-reconstruction or conservative treatment lead to better long-term results. In this retrospective cohort study, 136 patients with isolated ACL-rupture who had been treated by bone-ligament-bone transplant or conservatively were identified. Twenty-seven of these were excluded because of a revision operation in the 11.1 years follow-up period, leaving 109 patients (60 reconstructions and 49 conservatively treated) for evaluation based on clinical, radiological and internationally accepted knee-scores (Tegner, IKDC, Kellgren and Lawrence). An individual cohort study is classified as EBM level 2b according to the Oxford Centre of EBM. We observed significantly better knee-stability (P = 0.008) but more osteoarthritis (Grade II or higher) after ACL-reconstruction (42% vs. 25%). Physical activity levels were similar in both groups during the follow-up period (P = 0.16). Eleven years after ACL-rupture the physical activity levels are similar for both groups. After ACL-reconstruction, stability is higher as is osteoarthritis, whereby the result is not necessarily perceived as better subjectively. Specifically, this retrospective study yielded a 24% incidence of oseoarthrits 11 years after conservative management of ACL-rupture in patients not needing secondary surgery. The risk of secondary meniscal tears is reduced after ACL reconstruction, which reduces the negative effects of OA after surgery. The ultimate objective would be to achieve a good subjective outcome by conservative treatment followed by a rehabilitation program designed to keep secondary meniscus tears at a low level.

show abstract

Section: Grade III Grade Ii Grade Imentioning

confidence: 99%

Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment

Keßler

Behrend

Henz

et al. 2008

Knee Surg Sports Traumatol Arthr

367

368

View full text Add to dashboard Cite

show abstract

“…In addition, several long‐term clinical trials have revealed suboptimal results when non‐anatomic techniques are used [4, 5, 13, 21, 25]. Non‐anatomic bone tunnel placement is often cited as the most common cause of clinical failure [10, 15, 19, 24]. A multi‐centre study by the MARS group revealed that in at least 50% of the revision cases, technical error was either a predominant or contributing factor [28].…”

Section: Introductionmentioning

confidence: 99%

Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register

Desai

Andernord

Sundemo

et al. 2016

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeTo investigate the association between surgical variables and the risk of revision surgery after ACL reconstruction in the Swedish National Knee Ligament Register.MethodsThis cohort study was based on data from the Swedish National Knee Ligament Register. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendon were included. Follow-up started with primary ACL reconstruction and ended with ACL revision surgery or on 31 December, 2014, whichever occurred first. Details on surgical technique were collected using an online questionnaire. All group comparisons were made in relation to an “anatomic” reference group, comprised of essential AARSC items, defined as utilization of accessory medial portal drilling, anatomic tunnel placement, visualization of insertion sites and pertinent landmarks. Study end-point was revision surgery.ResultsA total of 108 surgeons (61.7%) replied to the questionnaire. A total of 17,682 patients were included [n = 10,013 males (56.6%) and 7669 females (43.4%)]. The overall revision rate was 3.1%. Older age as well as cartilage injury evident at index surgery was associated with a decreased risk of revision surgery. The group using transtibial drilling and non-anatomic bone tunnel placement was associated with a lower risk of revision surgery [HR 0.694 (95% CI 0.490–0.984); P = 0.041] compared with the anatomic reference group. The anatomic reference group showed no difference in risk of revision surgery compared with the transtibial drilling groups with partial anatomic [HR 0.759 (95% CI 0.548–1.051), n.s.] and anatomic tunnel placement [HR 0.944 (95% CI 0.718–1.241), n.s.]. The anatomic reference group showed a decreased risk of revision surgery compared with the transportal drilling group with anatomic placement [HR 1.310 (95% CI 1.047–1.640); P = 0.018].ConclusionNon-anatomic bone tunnel placement via transtibial drilling resulted in the lowest risk of revision surgery after ACL reconstruction. The risk of revision surgery increased when using transportal drilling. Performing anatomic ACL reconstruction utilizing eight selected essential items from the AARSC lowered the risk of revision surgery associated with transportal drilling and anatomic bone tunnel placement. Detailed knowledge of surgical technique using the AARSC predicts the risk of ACL revision surgery.Level of evidenceIII.

show abstract

“…Anterior cruciate ligament (ACL) reconstruction techniques have continued to evolve with normal Lachman and/or KT 1000 values reported in 80–95% of patients [1, 9, 22]. Even with clinical reports of patient return to pre‐injury activities, recent studies have suggested vertical graft placement may not restore knee kinematics close to the native state, particularly in regard to rotation of the tibia on the femur [5, 8, 30].…”

Section: Introductionmentioning

confidence: 99%

“…Instead, this technique may result in a more vertical graft with the femoral tunnel at the AM bundle and the tibial tunnel at the position of the posterolateral (PL) bundle [33]. Other cadaveric and computer‐navigated studies have also described the anatomic location of graft tunnel placement for conventional, transtibial single‐bundle reconstructions as being more vertical than the native ACL [2, 3, 10, 18, 24, 29, 30].…”

Section: Introductionmentioning

confidence: 99%

Comparison of tunnel positions in single-bundle anterior cruciate ligament reconstructions using computer navigation

Voos

Musahl

Maak

et al. 2010

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Recurrent rotational instability has been identified as a potential source of failure of anterior cruciate ligament (ACL) reconstructions. The aim of the study was to assess whether knee kinematics in the horizontal configuration more closely resemble the intact knee when compared with other single-bundle configurations. Using the Praxim computer navigation system, ACL reconstructions were performed with tibialis anterior grafts in six fresh-frozen whole lower extremity cadaver specimens (12 knees). In each knee, all four reconstruction configurations: conventional (PL tibia to AM femur), anteromedial (AM), posterolateral (PL), and horizontal (AM tibia to PL femur) were performed. Standardized Lachman and pivot shift examinations were performed. For all graft positions during the pivot shift, decreases in the amount of ATT were observed compared with the ACL-deficient state. The knees with grafts placed in the anterior tibial footprint (AM and horizontal) had less ATT with the Lachman and pivot shift maneuvers than knees with grafts placed in the posterior tibial footprint (PL and conventional). A significant difference in depth of impingement was noted only between the AM position and the PL position. Single-bundle ACL reconstructions using graft placement within the anterior footprint on the tibia may reduce rotational instability when compared with more vertical configurations.

show abstract

“Vertical Grafts”: A Common Reason for Functional Failure After ACL Reconstruction

Cited by 31 publications

References 0 publications

Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment

Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment

Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register

Comparison of tunnel positions in single-bundle anterior cruciate ligament reconstructions using computer navigation

Contact Info

Product

Resources

About