Clinical outcomes of combined anterior cruciate ligament and anterolateral ligament reconstruction: a systematic review and meta-analysis

( Diego Ariel De Lima ),( Lana Lacerda De Lima ),( Nayara Gomes Reis De Souza ),( Rodrigo Amorim De Moraes Perez ),( Marcel Faraco Sobrado ),( Tales Mollica Guimaraes ),( Camilo Partezani Helito ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Objectives: To compare the clinical outcomes of isolated anterior cruciate ligament (ACL) reconstruction with combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. Methods: A search was conducted on the PubMed, Medline, Google Scholar, EMBASE, and Cochrane library databases, in line with the PRISMA protocol. The indexation terms used were “anterior cruciate ligament” OR “acl” AND “anterolateral ligament” AND “reconstruction.” Articles that compared patients submitted to combined ACL and ALL reconstruction with those submitted to isolated reconstruction of the ACL, with levels of evidence I, II, and III, were included. Studies with follow-up of less than 2 years and articles that did not use “anatomical” techniques for ALL reconstruction, such as extraarticular tenodesis, were excluded. A meta-analysis with R software was conducted, with a random effects model, presented as risk ratio (RR) or mean difference (MD), with a 95% confidence level (CI) and statistically significant at p < 0.05. Results: Ten articles were selected, with a total of 1495 patients, most of whom were men, of whom 674 submitted to ACL and ALL reconstruction and 821 to isolated ACL reconstruction. Combined ACL and ALL reconstruction exhibited a statistically significant advantage in residual pivot shift (RR 0.34, 95% CI 0.24-0.47, I² = 0%, p < 0.01), rerupture rate (RR 0.34, 95% CI 0.19-0.62, I² = 0%, p < 0.01), Lachman test (RR 0.59, 95% CI 0.40-0.86, I² = 21%, p < 0.01), and postoperative Lysholm score (MD 2.28, CI 95% 0.75-3.81, I² = 73%, p < 0.01). Conclusions: Combined ACL and ALL reconstruction obtained better postoperative clinical outcomes when compared with isolated ACL reconstruction, especially in reducing residual pivot shift and rerupture rate.

Biomechanical Analysis of Three Different Reconstruction Techniques for Scapholunate Instability: A Cadaveric Study

Seung-Bum Chae,Jun Ho Nam,Il-Jung Park,Steve S. Shin,Michelle H. McGarry,Thay Q. Lee 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.4

Background: This study aimed to compare the biomechanical strength of 360° scapholunate interosseous ligament (SLIL) reconstruction only using an artificial material (AM), double dorsal limb (DDL) SLIL reconstruction only using AM, and the modified Brunelli technique (MBT) with ligament. Methods: Eight cadaver wrists were used for this study. The SL interval, SL angle, and radiolunate (RL) angle were recorded with MicroScribe. The SL distance was measured after dividing the volar and dorsal aspects. We utilized four different wrist postures (neutral, flexion, extension, and clenched fist) to compare five conditions: intact wrist, SLIL resection, 360° SLIL reconstruction using AM, DDL SLIL reconstruction using AM, and MBT SLIL reconstruction with ligament. Results: The dorsal SL distance in the SLIL resection was widened in all wrist positions. The dorsal SL distance was restored with all three techniques and in all wrist positions. The volar SL distance in the wrist extension position was widened in the SLIL resection condition. The volar SL distance was restored in the extension position after 360° SLIL reconstruction using AM condition. There were no statistically significant differences in SL and RL angles among the conditions. Conclusions: All three reconstruction techniques could restore the dorsal SL distance. However, only the 360° SLIL reconstruction using AM restored the volar SL distance in the wrist extension position. DDL SLIL reconstruction using AM tended to overcorrect, whereas 360° SLIL reconstruction using AM effectively stopped volar SL interval widening.

Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction

( Camilo Partezani Helito ),( Andre Giardino Moreira Da Silva ),( Tales Mollica Guimarães ),( Marcel Faraco Sobrado ),( José Ricardo Pécora ),( Gilberto Luis Camanho ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Background: Revision anterior cruciate ligament (ACL) reconstructions are usually complex owing to previous tunnels. The objective of this study is to report the results of a revision ACL reconstruction technique with a tibial tunnel performed from the anterolateral plateau associated with an anterolateral ligament (ALL) reconstruction. Methods: Patients with at least two ACL reconstructions that failed and who had significant enlargement and confluence of tunnels in the medial tibial plateau and underwent revision ACL reconstruction associated with ALL reconstruction with the tibial tunnel for the ACL performed from the lateral plateau between 2017 and 2019 were evaluated. All patients were evaluated by physical examination, International Knee Documentation Committee (IKDC), and Lysholm functional scales. Results: Six patients who underwent this surgical procedure were evaluated. All patients were sports practitioners and presented a grade 3 pivot shift. The mean age was 28.5 ± 8.2 years, and the mean follow-up time was 34.1 ± 12.8 months. No patient had a new graft rupture, but three (50%) had grade 1 pivot shift. Four patients had minor complications with no clinical impact on the final result. All except one patient were able to return to pre-injury type of sports, at a mean time of 14.6 ± 2.3 months after surgery. Conclusion: The anterolateral tibial tunnel technique using an Achilles tendon allograft for revision ACL reconstruction after multiple failures associated with an ALL reconstruction showed good results and no major complications. The anterolateral tunnel can be considered a good alternative in cases of medial tibial confluence or significant enlargement of the medial tunnels in re-revision procedures.

전방십자인대 재 재건술 후 슬관절 근력의 비교: 전방십자인대 최초 재건술과의 비교

김도경 ( Do Kyung Kim ),박원하 ( Won Hah Park ) 대한스포츠의학회 2016 대한스포츠의학회지 Vol.34 No.1

The purpose of this study was to assess the knee strength and anterior laxity in between primary and revision anterior cruciate ligament (ACL) reconstruction. It was a cross-sectional study; 28 patients who had undergone revision ACL reconstruction and the another 30 patients who had primary ACL reconstruction once were compared each other which they all had been operated during the same period of season with the same technique in the same hospital. The isokinetic equipment was used to measure the main outcome for knee strength, and KT-2000 arthrometer was used for measuring anterior drawer test in 12 months post-reconstruction surgery. In the anterior drawer test, we found out that there were significantly differences between primary and revision ACL reconstruction groups (1.5±1.1 mm vs. 2.6±1.5 mm, p=0.001). There was no significant difference in the deficits of knee extensor and flexor muscle strength between primary and revision ACL reconstruction. Revision reconstruction groups have more laxity in anterior drawer than primary reconstruction groups. After revision ACL, the deficits of knee extensor and knee flexor muscle strength have no significantly difference from primary ACL reconstruction.

Kinematic Analysis of Five Different Anterior Cruciate Ligament Reconstruction Techniques

( Hemanth R Gadikota ),( Ali Hosseini ),( Peter Asnis ),( Guoan Li ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.2

Several anatomical anterior cruciate ligament (ACL) reconstruction techniques have been proposed to restore normal joint kinematics. However, the relative superiorities of these techniques with one another and traditional single-bundle reconstructions are unclear. Kinematic responses of five previously reported reconstruction techniques (single-bundle reconstruction using a bone-patellar tendon-bone graft [SBR-BPTB], single-bundle reconstruction using a hamstring tendon graft [SBR-HST], single-tunnel double-bundle reconstruction using a hamstring tendon graft [STDBR-HST], anatomical single-tunnel reconstruction using a hamstring tendon graft [ASTR-HST], and a double-tunnel double-bundle reconstruction using a hamstring tendon graft [DBR-HST]) were systematically analyzed. The knee kinematics were determined under anterior tibial load (134 N) and simulated quadriceps load (400 N) at 0o, 15o, 30o, 60o, and 90o of flexion using a robotic testing system. Anterior joint stability under anterior tibial load was qualified as normal for ASTR-HST and DBR-HST and nearly normal for SBR-BPTB, SBR-HST, and STDBR-HST as per the International Knee Documentation Committee knee examination form categorization. The analysis of this study also demonstrated that SBR-BPTB, STDBR-HST, ASTR-HST, and DBR-HST restored the anterior joint stability to normal condition while the SBR-HST resulted in a nearly normal anterior joint stability under the action of simulated quadriceps load. The medial-lateral translations were restored to normal level by all the reconstructions. The internal tibial rotations under the simulated muscle load were over-constrained by all the reconstruction techniques, and more so by the DBR-HST. All five ACL reconstruction techniques could provide either normal or nearly normal anterior joint stability; however, the techniques over-constrained internal tibial rotation under the simulated quadriceps load.

Comparison of Differences in Thigh Muscle Morphology and Function According to Post-anterior Cruciate Ligament Surgery Period

전형필,장은욱 한국운동생리학회 2023 운동과학 Vol.32 No.1

PURPOSE: Quadriceps muscle weakness caused by muscle atrophy is a typical feature of individuals who undergo anterior cruciate ligament reconstruction. Although many studies have suggested an acceptable timing for returning to sports after anterior cruciate ligament reconstruction, there are still many controversies. Therefore, this study aimed to present an evidence-based recommendation for returning to sports after anterior cruciate ligament reconstruction by evaluating muscle size and function 9 months after the reconstruction. METHODS: Eighteen patients who underwent anterior cruciate ligament reconstruction were evaluated for quadricep thickness and isokinetic knee extension strength in both limbs. The Mann-Whitney U test was used to compare the differences 1) in thigh muscle thickness and isokinetic knee extension strength between the reconstructed limbs in “more than 9 months after surgery” and “less than 9 months after surgery” groups and 2) between the limb symmetry index of the two groups. RESULTS: The main findings were that the vastus medialis thickness and isokinetic knee extension strength for the reconstructed limbs were significantly greater in the more than 9 months after surgery group (vastus medialis: Z=12.00, p=.014; strength: Z=16.00, p= .034). The vastus medialis and vastus intermedius thicknesses in the more than 9 months after surgery group also showed a significant increase compared to those in the less than 9 months after surgery group (vastus medialis: Z=10.00, p=.006; vastus intermedius: Z= 10.00, p=.006). CONCLUSIONS: After anterior cruciate ligament reconstruction, selective muscle atrophy and weakness in the quadriceps muscles were observed. This study emphasizes the need for targeted early rehabilitation of specific quadriceps muscles to prevent muscle atrophy and weakness after anterior cruciate ligament reconstruction.

Ligament Reconstruction in Congenital Absence of the Anterior Cruciate Ligament: A Case Report

( Jae Jeong Lee ),( Won Taek Oh ),( Keun Young Shin ),( Min Seok Ko ),( Chong Hyuk Choi ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.4

Congenital absence of the cruciate ligament is an extremely rare condition that was fi rst reported in Giorgi`s radiographic study in 1956. The authors report on a case of anterior cruciate ligament reconstruction performed on a 21-year-old female patient with congenital anterior cruciate ligament absence. We also discuss radiographic evidence that could provide clues to the congenital absence and possible diffi culties that may be encountered during surgery with a review of the relevant literature.

Research on 3D Reconstruction Method ACL-based

Bing Wang,Chunlan Zhao 보안공학연구지원센터 2016 International Journal of Multimedia and Ubiquitous Vol.11 No.10

Anterior cruciate ligament (ACL) 3D reconstruction is a challenging problem for both orthopedic and sports surgeons. In this paper, to investigate the method of quickly establishing 3D digital model of ACL using 2D magnetic resonance images (MRI) and 2D computed tomography (CT) images, we propose an new scene-based segmentation 3D reconstruction method for anterior cruciate ligament. First, CCD camera is anglicized for 3D reconstruction method. Second, scene segmentation method is proposed to get image patch set. Third, the distance is calculated between the image patch and viewpoint of CCD camera. Finally, the proposed method is done for scene reconstruction. The performance of the proposed model is demonstrated on various 2D MRI and CT images. A relatively reliable ACL 3D reconstruction results indicate the validity of our method. The proposed method can provide a complete set of computer aided ACL operation system and realizing the individualized anatomical reconstruction of ACL.

Twenty-Year Experience of a Double-Bundle Anterior Cruciate Ligament Reconstruction

Takeshi Muneta 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.2

Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using a four-strand semitendinosus tendon was started in our department in July 1994. The motivation for starting the procedure was that the EndoButton with an inside-out procedure instrument became available in Japan. A review article of our DB ACL reconstruction procedure was summarized for the twentieth anniversary of the surgical procedure. Initial tension setting of the two grafts was changed in the first 8 years to achieve better stability during DB ACL reconstruction. A randomized clinical trial (RCT) was started in July 2002 to clarify superiority of the DB procedure to single-bundle (SB) reconstruction under the concept of anatomic reconstruction. Several anatomic studies were performed to describe normal ACL anatomy, which is essential for realizing anatomic reconstruction. A remnant-preserving technique would be an additional option for our DB procedure to improve reconstruction outcomes. Thus, a new remnant-preserving DB procedure was started in 2012. The reproducibility of the new procedure was investigated using three-dimensional computed tomography images. More complex procedures were performed using a transtibial technique and EndoButtons. Initial tension balancing between the two grafts was important for a better outcome. Superiority of knee stability after the DB compared to that after the SB procedure was clarified by the RCT. However, no patient consensus has been reached on any subjective advantage to the DB procedure. Studies of normal ACL anatomy have left questions unresolved regarding where the two tunnels should be created for direct and indirect insertions based on normal anatomy. A new remnant-preserving DB ACL procedure has been practiced. The procedure was more reproducible with respect to creating the femoral tunnel. DB ACL reconstruction using a semitendinosus tendon is an attractive option when pursuing a better outcome for patients.

Concomitant Acromioclavicular and Coracoclavicular Ligament Reconstruction with a Duo-Figure-8 Autogenic Graft Wrapping Technique for Treating Chronic Acromioclavicular Separation

Fu-Ting Huang,Kai-Cheng Lin,Chih-Yang Lin,Wei-Ning Chang 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.3

Background: Coracoacromial ligament transfer is the traditional procedure for treating chronic acromioclavicular separation, but it is significantly inferior to ligament reconstruction according to biomechanical and clinical studies. However, ligament reconstruction carries the risk of complications of graft loosening and peri-tunnel fractures. Currently, there is no ligament reconstruction procedure optimal for preventing such complications. The purpose of this study was to describe and retrospectively analyze the clinical and radiological outcomes of a “duo-figure-8” autogenic graft wrapping technique, which was used to concomitantly reconstruct the acromioclavicular and coracoclavicular ligaments. Methods: Preoperative, immediate postoperative, and final follow-up oputcomes were evaluated in 10 enrolled patients. Radiographic outcomes were indicated by the bilateral difference of the coracoclavicular distance (CCD) and overlapping length of the acromioclavicular joint (OLac). Quality of reduction was classified into 4 grades according to bilateral CCD difference into overreduction (< 0 mm), anatomic reduction (0–4 mm), partial loss of reduction (4–8 mm), and recurrent dislocation (> 8 mm). Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores. Results: The mean side-to-side differences for CCD were 11.9 mm (preoperative), −0.1 mm (immediate postoperative), and 3.4 mm (final follow-up); those for OLac were 9.4 mm (preoperative) and 2.7 mm (final follow-up). CCD and OLac outcomes significantly improved at final follow-up (p < 0.05). At the immediate postoperative stage, 6 and 4 patients had overreduction and anatomic reduction, respectively. At final follow-up, 7 and 3 patients had anatomic reduction and partial loss of reduction, respectively. The magnitude of improvement of ASES scores for patients with anatomic reduction and partial loss of reduction (p = 0.20) was 18.1 and 20.0, respectively. The magnitude of improvement of Constant scores in patients with anatomic reduction and partial loss of reduction (p = 0.25) was 19.9 and 22.3, respectively. Conclusions: The technique yielded acceptable functional outcomes in patients with anatomic reduction or partial loss of reduction. The “duo-figure-8” wrapping method—a single autogenic tendon graft passing beneath the coracoid process with a tendonknot fixation over the distal clavicle and looping around the acromion intramedullary—did not increase the risk of peri-tunnel fractures over the clavicle, coracoid process, or acromion.