Acute Proximal Anterior Cruciate Ligament Tears: Outcomes After Arthroscopic Suture Anchor Repair Versus Anatomic Single-Bundle Reconstruction

Achtnich, Andrea; Herbst, Elmar; Forkel, Philipp; Metzlaff, Sebastian; Sprenker, Frederike; Imhoff, Andreas B.; Petersen, Wolf

doi:10.1016/j.arthro.2016.04.031

Cited by 144 publications

(179 citation statements)

References 16 publications

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“…22,27 We believe that only assessing acute tears is appropriate, however, especially since preservation techniques are generally performed in the acute setting. 1,6 Finally, another selection bias cannot be excluded in this study. A relatively high number of patients had skiing injuries, which could have influenced the distribution of tear types.…”

Section: Discussionmentioning

confidence: 99%

“…If it was seen that the anteromedial and posterolateral bundles were torn at different levels, the tear locations of both separate bundles were noted. This classification was partially based on the tear locations as classified by Sherman et al, 30 and partially on a recently published ACL preservation treatment algorithm 36,37 in which type I tears were treated with arthroscopic primary repair, 1,7 type II tears with augmented repair, 16,21,36 type III and type IV tears with ACL reconstruction with remnant tensioning and preservation, respectively, 14,16 and type V tears with primary repair or a variety of fixation options for soft tissue avulsion or bony avulsion types, respectively. 19,31 …”

Section: Methodsmentioning

confidence: 99%

“…More recently, others have confirmed these findings. 1,32 Similarly, other surgeons have proposed preservation techniques for different tear types—techniques such as augmented repair, repair with biological scaffold, remnant tensioning, remnant preservation, and distal repair. 14,16,19,21,26 …”

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confidence: 99%

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The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging

List

Mintz

DiFelice

2017

Orthopaedic Journal of Sports Medicine

104

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Background:Over the past decade, there has been a resurgence of interest in anterior cruciate ligament (ACL) preservation. Proximal and distal avulsion tears have been treated with arthroscopic primary repair, while augmented repair, remnant tensioning, primary repair with biological scaffold, and remnant preservation have been proposed for different types of midsubstance tears. Currently, the incidence of these different tear types is unknown.Purpose:To propose a magnetic resonance imaging (MRI) classification system for different tear types based on clinical relevance and to assess the distribution of these different ACL tear types.Study Design:Case series; Level of evidence, 4.Methods:A retrospective search in an institutional radiographic database was performed for patients who underwent knee MRI at our institution between June 2014 and June 2016. Patients younger than 18 years and those with reports of chronic tears, partial tears, multiligamentous injuries, were excluded. Tear types were graded as proximal avulsion (distal remnant length >90% of total ligament length, type I), proximal (75%-90%, type II), midsubstance (25%-75%, type III), distal (10%-25%, type IV), and distal avulsion (<10%, type V). An orthopaedic surgeon, a radiologist, and a research fellow graded the tear type on 30 MRIs to determine reliability, and the research fellow graded all MRIs. Inter- and intraobserver reliability were measured using kappa statistics.Results:A total of 353 patients (57% male; mean age, 37.1 years; range, 18.1-81.2 years) were included. Interobserver reliability was 0.670 (95% confidence interval, 0.505-0.836), and intraobserver reliability ranged from 0.741 to 0.934. Incidence of type I tears was 16%, type II tears 27%, type III tears 52%, type IV tears 1%, and type V tears 3% (2.5% with bony avulsion). Type I tears were more common in patients older than 35 years compared with those younger than 35 years (23% vs 8%; P < .001).Conclusion:This classification system was reliable in assessing tear location in acute ACL injuries. Type I tears were seen in 16%, type II in 27%, and type III in 52% of patients in our cohort. These data suggest that there may be greater potential application for ACL preservation techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging

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Mintz

DiFelice

2017

Orthopaedic Journal of Sports Medicine

104

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“…In the study "Acute Proximal Anterior Cruciate Ligament Tears: Outcomes After Arthroscopic Suture Anchor Repair Versus Anatomic Single-Bundle Reconstruction," in this month's issue of Arthroscopy, the groups of Andreas Imhoff and Wolf Petersen have now compared the suture anchor repair of acute proximal ACL avulsion tears with single-bundle ACL reconstruction with the quadrupled semitendinosus tendon in a group of 40 patients. 12 At a mean follow-up of 28 months, the between-group differences were nonsignificant. Seventeen patients in the repair group had good and excellent outcomes compared with 20 patients in the ACL reconstruction group.…”

mentioning

confidence: 87%

Editorial Commentary: Renaissance of Primary Anterior Cruciate Ligament Repair: Is History Repeating Itself?

Hohmann¹

2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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In a comparative Level III study, Achtnich et al. compared suture anchor repair of acute proximal anterior cruciate ligament avulsion tears with single-bundle anterior cruciate ligament reconstruction with the quadrupled semitendinosus tendon. Short-term follow-up at a mean of 28 months showed that the between-group differences were not different. These results are encouraging but not different from other published series 25+ years ago. Only time will tell whether the long-term outcomes are identical and whether these techniques will also die a slow death. Hopefully history is not repeating itself.

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“…Not surprisingly, a recent case series of arthroscopically repaired proximal ACL tears has reported excellent results [5], and it seems that there is a recent resurgence of interest in primary ACL repair [1,4,31,34]. Several advantages of ACL preservation with primary repair exist, when compared to ACL reconstruction, including maintaining proprioceptive function [25,28] and the native ACL kinematics [27].…”

Section: Introductionmentioning

confidence: 99%

Successful Arthroscopic Primary Repair of a Chronic Anterior Cruciate Ligament Tear 11 Years Following Injury

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DiFelice

2016

HSS Jrnl

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Acute Proximal Anterior Cruciate Ligament Tears: Outcomes After Arthroscopic Suture Anchor Repair Versus Anatomic Single-Bundle Reconstruction

Cited by 144 publications

References 16 publications

The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging

The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging

Editorial Commentary: Renaissance of Primary Anterior Cruciate Ligament Repair: Is History Repeating Itself?

Successful Arthroscopic Primary Repair of a Chronic Anterior Cruciate Ligament Tear 11 Years Following Injury

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