112 research outputs found
DS_10.1177_0363546519832868 – Supplemental material for Complete Capsular Repair Restores Native Kinematics After Interportal and T-Capsulotomy
No full textSupplemental material, DS_10.1177_0363546519832868 for Complete Capsular Repair Restores Native Kinematics After Interportal and T-Capsulotomy by Pardis Baha, Timothy A. Burkhart, Alan Getgood and Ryan M. Degen in The American Journal of Sports Medicine</p
ACL graft selection: state of the art
No full textDespite recent developments in anterior cruciate ligament (ACL) reconstruction techniques, there are still several intraoperative factors affecting clinical outcomes that remain widely debated. Among such factors, graft selection might be the most critical yet controversial question for surgeons. As the primary factor influencing a patient’s choice for the ACL graft is surgeon recommendation, surgeons have to consider several factors to select the best graft for each patient. Graft options currently include autograft, allograft or synthetic grafts. In terms of autograft, there are three main options: hamstring tendon, bone-patellar tendon-bone (BPTB) and quadriceps tendon, the two most commonly used being hamstring tendon and BPTB. Limited evidence is available to select the one best graft for every individual patient. Graft selection should be based on the reported rate of graft failure/revision and be individualised according to multiple factors such as gender, age, activity level and type of activity, complications and other patient needs and demands. Furthermore, surgeons should be familiar with a variety of grafts, their specific associated surgical procedures and the advantages and disadvantages of each, with the aim of offering the best graft selection for each individual patient
Lateral Extra-Articular Tenodesis Does Not Decrease Graft Failure in Revision ACL-R When Combined with Quadriceps Or Patella Tendon Grafts
No full textPurpose: The purpose of this study was to compare return to sports, graft failure rates, and clinical outcomes in patients who underwent to a revision ACL reconstruction (R-ACLR) and additional lateral extra-articular tenodesis (LET) compared to isolated R-ACLR. Methods: A retrospective review of medical records of patients who underwent R-ACLR with or without a modified Lemaire LET was performed. Seventy-four patients with ≥ 2 years follow-up, who had a high-grade positive pivot shift test were included. Concomitant procedures such as meniscectomy and meniscal repair were collected along with any complications and/or graft failure. Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) Subjective Knee Form were collected. The ability to return to sports was defined as fully, partially, or not returned. Results: Thirty-nine patients underwent isolated R-ACLR (mean age (SD±) 29.2 ±12.2) and 35 had an additional LET (24.6 ±7.4). The mean length of follow-up in the R-ACLR group was 56.6 ±26.5 months compared to 44.3 ±17.6 months (p = 0.02*) (range 24 - 120 months) in the R-ACLR+LET group. PROMs were higher in the LET group with KOOS ADL (93.5 ± 2.0; 97.2 ± 1.6; p=0.03) and KOOS Sport (63.0 ± 3.6; 74.3 ± 3.8; p=0.05) subdomains reaching statistical significance. No other differences were found in the other KOOS subdomains or IKDC scores. Failure rates were not significantly different between the groups (12.8% for R-ACLR vs 11.4% for R-ACLR+LET; p=0.99). Thirteen (72.2%) patients in the R-ACLR group and 14 (60.8%) patients in the R-ACLR+LET group did not return to sports. Conclusion: R-ACLR with additional LET showed a similar failure rate and RTS compared to isolated R-ACLR following failed ACLR. The R-ACLR + LET group demonstrated better functional results with significantly higher activities of daily living, and sport and recreation KOOS subdomain scores. However, the present study was unable to recommend the modified Lemaire LET to be used routinely in revision ACLR patients. Level of evidence: III, retrospective comparative therapeutic trial
Closing-Wedge Posterior Tibial Slope–Reducing Osteotomy in Complex Revision ACL Reconstruction
No full textBACKGROUND: A posterior tibial slope (PTS) >12° has been shown to correlate with failure of anterior cruciate ligament (ACL) reconstruction (ACLR). PTS-reducing osteotomy has been described to correct the PTS in patients with a deficient ACL, mostly after failure of primary ACLR. PURPOSE: To report radiologic indices, clinical outcomes, and postoperative complications after PTS-reducing osteotomy performed concurrently with revision ACLR (R-ACLR). STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A review of medical records at 3 institutions was performed of patients who had undergone PTS-reducing osteotomy concurrently with R-ACLR between August 2010 and October 2020. Radiologic parameters recorded included the PTS, patellar height according to the Caton-Deschamps Index (CDI), and anterior tibial translation (ATT). Patient-reported outcomes (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]), reoperations, and complications were evaluated. RESULTS: Included were 23 patients with a mean follow-up of 26.7 months (range, 6-84 months; median, 22.5 months). Statistically significant differences from preoperative to postoperative values were found in PTS (median [range], 14.0° [12°-18°] vs 4.0° [0°-15°], respectively; P < .001), CDI (median, 1.00 vs 1.10, respectively; P = .04) and ATT (median, 8.5 vs 3.6 mm, respectively; P = .001). At the final follow-up, the IKDC score was 52.4 ± 19.2 and the KOOS subscale scores were 81.5 ± 9.5 (Pain), 74 ± 21.6 (Symptoms), 88.5 ± 8 (Activities of Daily Living); 52.5 ± 21.6 (Sport and Recreation), and 48.8 ± 15.8 (Quality of Life). A traumatic ACL graft failure occurred in 2 patients (8.7%). Reoperations were necessary for 6 patients (26.1%) because of symptomatic hardware, and atraumatic recurrent knee instability was diagnosed in 1 patient (4.3%). CONCLUSION: Tibial slope–reducing osteotomy resulted in a significant decrease of ATT and can be considered in patients with a preoperative PTS ≥12° and ≥1 ACLR failure. In highly complex patients with multiple prior surgeries, the authors found a reasonably low graft failure rate (8.7%) when utilizing PTS-reducing osteotomy. Surgeons must be aware of potential complications in patients with multiple previous failed ACLRs
Hamstring Autograft Had Better Long-Term Survivorship Than Tibialis Posterior Tendon Allograft for Anterior Cruciate Ligament Reconstruction
No full textSoft tissue fixation with single posterior horn bone tunnel
No full textThis book covers the basics of meniscus anatomy, biomechanics and, importantly, techniques to address meniscal preservation. Sections of the book cover three distinct areas for consideration: pre-operative issues and decision-making, detailed and well-illustrated surgical techniques, and post-operative issues including outcome and rehabilitation. A thorough overview of the current concepts surrounding MAT by world-leading experts is provided. It will also serve as a template for current clinical paradigms, as well as provide guidance as to where future research could be directed. Members of the International Meniscus Reconstruction Experts Forum (IMREF) have combined to bring together this comprehensive review of MAT
Contributions of the anterolateral complex and the anterolateral ligament to rotatory knee stability in the setting of ACL Injury: a roundtable discussion
No full textPersistent rotatory knee laxity is increasingly recognized as a common finding after anterior cruciate ligament (ACL) reconstruction. While the reasons behind rotator knee laxity are multifactorial, the impact of the anterolateral knee structures is significant. As such, substantial focus has been directed toward better understanding these structures, including their anatomy, biomechanics, in vivo function, injury patterns, and the ideal procedures with which to address any rotatory knee laxity that results from damage to these structures. However, the complexity of lateral knee anatomy, varying dissection techniques, differing specimen preparation methods, inconsistent sectioning techniques in biomechanical studies, and confusing terminology have led to discrepancies in published studies on the topic. Furthermore, anatomical and functional descriptions have varied widely. As such, we have assembled a panel of expert surgeons and scientists to discuss the roles of the anterolateral structures in rotatory knee laxity, the healing potential of these structures, the most appropriate procedures to address rotatory knee laxity, and the indications for these procedures. In this round table discussion, KSSTA Editor-in-Chief Professor Jón Karlsson poses a variety of relevant and timely questions, and experts from around the world provide answers based on their personal experiences, scientific study, and interpretations of the literature. Level of evidence V
The Role of Meniscus Scaffolds in Meniscus Repair – Techiniques and Outcomes
No full textThis book covers the basics of meniscus anatomy, biomechanics and, importantly, techniques to address meniscal preservation. Sections of the book cover three distinct areas for consideration: pre-operative issues and decision-making, detailed and well-illustrated surgical techniques, and post-operative issues including outcome and rehabilitation.
A thorough overview of the current concepts surrounding MAT by world-leading experts is provided. It will also serve as a template for current clinical paradigms, as well as provide guidance as to where future research could be directed.
Members of the International Meniscus Reconstruction Experts Forum (IMREF) have combined to bring together this comprehensive review of MAT
Modified Lemaire Lateral Extra-Articular Tenodesis Augmentation of Anterior Cruciate Ligament Reconstruction
No full text- …
