ACL reconstruction with physiological graft tension by intraoperative adjustment of the anteroposterior translation to the uninjured contralateral knee

Bastian, Johannes Dominik; Tomagra, Salvatore; Schuster, A. J.; Werlen, Stefan; Jakob, R. P.; Zumstein, Matthias A.

doi:10.1007/s00167-013-2465-4

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…The optimal graft tension for ATT intraoperatively is a matter of debate. Using the same device as that in the present study (Rolimeter), Bastian et al 3 reported that anteroposterior translation in the operated knee increased further from intraoperative measurements. Moreover, up to 30% of patients demonstrated a side-to-side difference of at least 3 mm at a median follow-up of 5.3 years, even if anteroposterior translation of the operated knee was equivalent to that of the contralateral uninjured knee measured intraoperatively.…”

Section: Discussionmentioning

confidence: 52%

Preoperative Knee Instability Affects Residual Instability as Evaluated by Quantitative Pivot-Shift Measurements During Double-Bundle ACL Reconstruction

Kawanishi

Nozaki

Kobayashi

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The pivot-shift test is an important indicator of functional outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR). Preoperative instability as indicated by the pivot-shift test is associated with residual instability after ACLR. Few studies have used quantitative means to evaluate the pivot shift after ACLR. Purpose: To investigate the relationship between preoperative and residual instability and to identify the risk factors for residual instability by using quantitative measurements of the pivot shift. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 91 patients undergoing primary double-bundle ACLR were retrospectively enrolled. Quantitative measurements of instability for ACL-deficient knees (ACLD) and uninjured contralateral knees (intact) preoperatively, as well as ACLR knees intraoperatively, were performed under general anesthesia using the pivot-shift test, with inertial sensors to measure acceleration and external rotational (ER) angular velocity. The ratios of intact to ACLD (ACLD/I) and intact to ACLR (ACLR/I) were measured. Patients who showed an ACLR/I of >1 were classified into the residual instability group, and those with an ACLR/I of ≤1 were classified into the noninstability group. Regarding demographic, surgical, and quantitative measurement factors, between-group comparisons and multivariate logistic regression were conducted for predictors of residual instability. Receiver operating characteristic curves were used to evaluate the correlations between ACLD/I and ACLR/I and the cutoff value of ACLD/I in predicting residual instability. Results: The predictive factors for intraoperative residual instability included female sex (odds ratio [OR], 0.3 [95% CI, 0.1-0.9]; P = .034) and ACLD/I for acceleration (OR, 1.6 [95% CI, 1.2-2.1]; P < .001), and ACLD/I for ER angular velocity (OR, 1.9 [95% CI, 1.2-3.1]; P = .013). Correlations between ACLD/I and ACLR/I were moderate with respect to both acceleration ( r = 0.435; P < .001) and ER angular velocity ( r = 0.533; P < .001). The cutoff points for ACLD/I were 4.9 for acceleration (sensitivity, 65.1%; specificity, 85.7%; area under the curve [AUC], 0.76) and 2.4 for ER angular velocity (sensitivity, 80.0%; specificity, 50.0%; AUC, 0.74). Conclusion: Greater preoperative instability was a risk factor for residual instability as measured intraoperatively by a quantitatively evaluation in the pivot shift during ACL reconstruction. Quantitative measurements of instability during the pivot shift mechanism under general anesthesia may enable surgeons to predict postoperative residual instability.

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Section: Discussionmentioning

confidence: 52%

Preoperative Knee Instability Affects Residual Instability as Evaluated by Quantitative Pivot-Shift Measurements During Double-Bundle ACL Reconstruction

Kawanishi

Nozaki

Kobayashi

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Patients with greater instability in the pivot-shift test have been reported to have higher risk for residual instability after ACL reconstruction at the time of surgery [ 13 ]. It has been proposed that intraoperative instability in the pivot-shift test after ACL reconstruction may worsen rather than improve during follow-up, because the anteroposterior translation has been reported to increased further [ 3 ]. Therefore, even a slight residual instability, detectable only by quantitative measurement, may be undesirable thus it is valuable that ALL reconstruction can improve this residual instability.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with criteria (2) and/or (3) were not included in this study. An arthroscopic procedure was performed through anteromedial, anterolateral, and medial accessory portals.…”

Section: Surgical Techniquementioning

confidence: 99%

Anterolateral ligament reconstruction in addition to primary double-bundle anterior cruciate ligament reconstruction for grade 3 pivot shift improves residual knee instability during surgery

et al. 2021

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Purpose High-grade pivot shift in the anterior cruciate ligament (ACL) injured knee is a risk factor for postoperative residual pivot shift. Procedures in addition to ACL reconstruction such as anterolateral ligament (ALL) reconstruction have been performed for patients with a high-risk of residual pivot shift. The aim of this study was to investigate the effect of the addition of ALL reconstruction to primary double-bundle ACL reconstruction in patients with preoperative high-grade pivot shift to improve stability as evaluated by quantitative measurement. Methods Patients with ACL injuries who showed preoperative grade 3 subjective pivot shift and who underwent primary double-bundle ACL reconstruction combined with ALL reconstructions were retrospectively enrolled. Anterior tibial translation (ATT) in the Lachman test, and acceleration and external rotational angular velocity (ERAV) in the pivot shift were measured as quantitative values. Quantitative values before surgical intervention for ACL-injured knees (ACLD) and uninjured contralateral knees (intact), after temporary fixation of the isolated ACL grafts (ACLR), and subsequently after temporary fixation of both ACL and ALL grafts (ACLR + ALLR) were measured with the patient under general anaesthesia. Results In total, 18 patients were included. The ATT was lower in ACLR and ACLR + ALLR than in intact (P = .008 and .005), while there was no significant difference between ACLR and ACLR + ALLR (P > .05). The acceleration of ACLR + ALLR was lower than that for ACLR (P = .008), while there was no significant difference between intact and ACLR or ACLR + ALLR (P > .05). The ERAV of ACLR was higher than that of intact (P < .001), while that of ACLR + ALLR was lower than that of ACLR (P < 0.001), and there was no significant difference in ERAV between intact and ACLR + ALLR (P > 0.05). Conclusion According to quantitative assessment of the pivot shift, the addition of ALL reconstruction to primary double-bundle ACL reconstruction improved residual knee instability and restored knee stability during surgery. Combination of ALL reconstruction with primary double-bundle ACL reconstruction was effective for patients with ACL injuries exhibiting a preoperative grade 3 subjective pivot shift. Level of evidence IV

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“…45 On the other hand, the laxity-based tensioning protocol applies initial tension that is individualized for each patient by matching the laxity of the uninjured knee using an arthrometer. 5,14…”

mentioning

confidence: 99%

“…45 On the other hand, the laxitybased tensioning protocol applies initial tension that is individualized for each patient by matching the laxity of the uninjured knee using an arthrometer. 5,14 Several studies have compared the amount of initial tension of force-based protocols to determine the level that produces the best clinical outcomes. 23,40,50,54,56 However, the optimal amount of initial tension remains unclear, and there is variability in adopted tensioning protocols among surgeons.…”

mentioning

confidence: 99%

Factors Influencing the Initial Constraint Level of the Knee Joint and Its Effect on Clinical Outcomes After ACL Reconstruction With Hamstring Graft

Chung

Choi

Jung

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: A force-based tension protocol that uses a certain amount of tension at graft fixation could still give rise to variations in initial constraint levels of the knee joint in terms of side-to-side difference (SSD) in anterior translation. Purpose: To investigate the factors influencing the initial constraint level in anterior cruciate ligament (ACL)–reconstructed knees and compare outcomes according to the level of constraint in terms of anterior translation SSD. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 113 patients who underwent ipsilateral ACL reconstruction using an autologous hamstring graft and had minimum 2-year follow-up outcomes. All grafts were tensioned and fixed at 80 N using a tensioner at the time of graft fixation. The patients were classified into the following 2 groups according to the initial anterior translation SSD, measured using the KT-2000 arthrometer: a physiologic constraint group with restored anterior laxity ≤2 mm (group P; n = 66) and a high-constraint group with restored anterior laxity >2 mm (group H; n = 47). Clinical outcomes were compared between the groups, and preoperative and intraoperative variables were evaluated to identify factors affecting the initial constraint level. Results: Between group P and group H, generalized joint laxity ( P = .005), posterior tibial slope ( P = .022), and anterior translation measured in the contralateral knee ( P < .001) were found to differ significantly. Measured anterior translation in the contralateral knee was the only significant predictor of high initial graft tension ( P = .001). No significant differences were found between the groups regarding clinical outcomes and subsequent surgery. Conclusion: Greater anterior translation measured in the contralateral knee was an independent predictor of a more constrained knee after ACL reconstruction. The short-term clinical outcomes after ACL reconstruction were comparable, regardless of the initial constraint level in terms of anterior translation SSD.

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ACL reconstruction with physiological graft tension by intraoperative adjustment of the anteroposterior translation to the uninjured contralateral knee

Abstract: IV.

Cited by 8 publications

References 35 publications

Preoperative Knee Instability Affects Residual Instability as Evaluated by Quantitative Pivot-Shift Measurements During Double-Bundle ACL Reconstruction

Preoperative Knee Instability Affects Residual Instability as Evaluated by Quantitative Pivot-Shift Measurements During Double-Bundle ACL Reconstruction

Anterolateral ligament reconstruction in addition to primary double-bundle anterior cruciate ligament reconstruction for grade 3 pivot shift improves residual knee instability during surgery

Factors Influencing the Initial Constraint Level of the Knee Joint and Its Effect on Clinical Outcomes After ACL Reconstruction With Hamstring Graft

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