A comparison of the outcomes of anterior curciate ligament reconstruction with large-size graft versus reconstruction with average-size graft combined with extraarticular tenodesis

El-Azab, Hossam; Moursy, Mohamed; Mohamed, Mohamed A.; Elsayed, Moustafa

doi:10.1016/j.injury.2023.01.033

Cited by 7 publications

(9 citation statements)

References 36 publications

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“…In ACL reconstruction surgery, the importance of surgical planning is supported by the evidence that up to 8.2% of ACLR end in graft failure [7, 9, 11, 19, 22, 29, 34].…”

Section: Discussionmentioning

confidence: 99%

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A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction

Minoli,

Travi,

Monti

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The aim of this study is to describe and validate a simple and reliable method to pre-operatively predict the size of the ACL graft in the double strand technique with autologous semitendinosus–gracilis tendons on the same MRI used for ACL rupture diagnosis. Methods The study included 92 patients, with a median age of 31 years (IQR 26–41 years), 73/92 (79%) of whom were males. All patients that underwent an ACL reconstruction with doubled ST + GT between 2017 and 2022 were counted in the study. Results Overall, the median predicted graft diameter from MR imaging was similar to the actual graft diameter with no significant differences (n.s.). Regarding the comparison between predicted and actual graft size, concordance was 78/92 (85%, 95% CI 76–91%), with κ = 0.797 which corresponds to a level of agreement defined as “Strong”. Tendon sizes calculated on pre-operative MRI were evaluated both with intra-observer and inter-observer reliability demonstrating a statistically reproducible method. The predicted graft was then compared to the reported one with a statistically significant reliability found. Conclusion This study can help the surgeons to perform a fast pre-operative planning of an ACL reconstruction for graft selection. If the planned graft with ST and GT is smaller than 8 mm, the clinician can decide to switch to a different type of graft or plan a different graft preparing technique and, therefore, reduce the risk of post-operative ligament re-rupture. The method proposed is reliable and reproducible. The major strength of the planning technique proposed is that it relies on data that are already available for the clinician before surgery, without the need of further analysis. Level of evidence IV.

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“…In ACL reconstruction surgery, the importance of surgical planning is supported by the evidence that up to 8.2% of ACLR end in graft failure [7, 9, 11, 19, 22, 29, 34].…”

Section: Discussionmentioning

confidence: 99%

“…One of the risk factors for ACL re‐rupture is an insufficient graft diameter, leading to a weaker neo‐ligament. Different studies in literature have shown that an increased risk of re‐rupture is statistically related to an ACL reconstructed with a graft with a diameter of 7 mm or less [7, 15, 29, 32, 33].…”

Section: Introductionmentioning

confidence: 99%

A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction

Minoli,

Travi,

Monti

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…4,8 Large graft size was discovered to be an important factor in lowering ACL failure rates. 8 In addition, successful ACLR requires graft stability in the immediate postoperative period 9 and tendon-bone healing in the anatomic tunnel. 10,11 This is especially true for the tibial graft fixation, which has been considered the weakest link of the reconstruction 12 due to the lower density of the tibial bone and the parallel graft-fixation associated with the tunnel.…”

Section: Introductionmentioning

confidence: 99%

“…In athletes, ACL graft failure rate was reported in up to 34.2% 7 . There are a variety of risk factors for ACLR failure, in which the most associated with HT graft was the graft diameter 4,8 . Large graft size was discovered to be an important factor in lowering ACL failure rates 8 .…”

Section: Introductionmentioning

confidence: 99%

“…There are a variety of risk factors for ACLR failure, in which the most associated with HT graft was the graft diameter 4,8 . Large graft size was discovered to be an important factor in lowering ACL failure rates 8 . In addition, successful ACLR requires graft stability in the immediate postoperative period 9 and tendon‐bone healing in the anatomic tunnel 10,11 .…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of RigidFix Cross Pin Fixation in Femoral and Tibial Tunnel for Anterior Cruciate Ligament Reconstruction

Yuan,

Qi,

et al. 2023

Orthopaedic Surgery

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ObjectivesThere is no clear consensus so far on which fixation method is most favorable for the tibial tunnel in anterior cruciate ligament reconstruction (ACLR). The purpose of this paper is to investigate the outcome of RigidFix cross pins fixation in the tibial tunnel and to explore the advantages of RigidFix applied both in the femoral and tibial tunnel with hamstring tendon graft in anterior cruciate ligament reconstruction.MethodsThis retrospective study included 53 patients (male/female, 45/8) who underwent anterior cruciate ligament reconstruction using autologous hamstring tendons between January 2013 and December 2017 at our institute. The participants in group A (n = 36) received anterior cruciate ligament reconstruction with RigidFix cross pins fixation in both femoral and tibial tunnels, while those in group B (n = 17) with RigidFix cross pins fixation in the femoral tunnel and Interference screw fixation in the tibial tunnel. The visual analogue scale (VAS) score, International Knee Documentation Committee subjective knee form 2000 (IKDC2000) score, Lysholm knee scoring scale, Tegner activity score and the side‐to‐side difference were compared at 2 and 5 years postoperatively. The graft diameter, number of strands in graft and the average diameter of each strand were also compared between the two groups. The categorical parameters were analyzed by chi‐square test and the continuous variables conforming to a normal distribution were analyzed by Student's t‐test.ResultsAt 2 years postoperation, the VAS score (1.61 ± 0.55), side‐to‐side difference (1.50 ± 0.58) in group A were significantly lower than that in group B, and the IKDC2000 score (88.81 ± 3.88), Tegner activity score (6.14 ± 0.60) in group A were significantly higher than that in group B. At 5 years postoperation, the VAS score (1.64 ± 0.68), side‐to‐side difference (1.73 ± 0.63) in group A were significantly lower than that in group B, and the IKDC2000 score (89.09 ± 3.85), Tegner activity score (6.58 ± 0.94) in group A were slso significantly higher than that in group B. There was statistical difference in the change of the side‐to‐side difference between the two groups (group A vs. B, 0.22 ± 0.08 vs. 0.34 ± 0.11, p < 0.001). There were also statistical differences in the graft diameter (group A vs. B, 7.83 ± 0.74 vs. 7.41 ± 0.51, p = 0,038), number of strands in graft (5.67 ± 0.72 vs. 4.00 ± 0.00, p < 0.001) and the average diameter of each strand (1.41 ± 0.22 vs. 1.85 ± 0.13, p < 0.001) between the two groups.ConclusionRigidFix cross pins fixation in the tibial tunnel for anterior cruciate ligament reconstruction can achieve better 5‐year results when compared with the interference screw, and the hamstring tendon can be folded into a thicker graft when RigidFix cross pins were applied in both femoral and tibial tunnels.

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Editorial Commentary: What to Reinforce When You Have a Small Anterior Cruciate Ligament Graft? Focus on the Anterolateral Side!

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2023

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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A comparison of the outcomes of anterior curciate ligament reconstruction with large-size graft versus reconstruction with average-size graft combined with extraarticular tenodesis

Cited by 7 publications

References 36 publications

A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction

A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction

Outcomes of RigidFix Cross Pin Fixation in Femoral and Tibial Tunnel for Anterior Cruciate Ligament Reconstruction

Editorial Commentary: What to Reinforce When You Have a Small Anterior Cruciate Ligament Graft? Focus on the Anterolateral Side!

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