Adolescents show a lower healing rate of anterolateral ligament injury and a higher rotational laxity than adults after anterior cruciate ligament reconstruction

Lee, Dhong Won; Lee, Joon Kyu; Kwon, Sae Him; Moon, Sung Gyu; Cho, Seung Ik; Chung, Seung Hee; Kim, Jin Goo

doi:10.1016/j.knee.2021.03.020

Cited by 12 publications

(10 citation statements)

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“…The study indicates that, within the range of 0-140 °extension and flexion of the knee joint, it is an ideal isometric point near the "over-parietal position" behind the Blumensaat line, where the traditional single-bundle reconstruction of the femoral tunnel is located, while the anatomical double-bundle reconstruction of the femoral tunnel is located in the center of the attachment of the AMB and the posterior external bundle, respectively, and the anatomical single-bundle reconstruction of the femoral tunnel is located at the midpoint of the abovementioned two-center connection [23]. Biomechanical study found that the traditional single-bundle reconstruction can stabilize the flexion and extension of the knee joint but cannot well solve the stability of the rotation of the knee joint [23,24]. Through biomechanical and clinical studies, foreign scholars have indicated that anatomical double-beam reconstruction is significantly better than traditional single-beam reconstruction in controlling rotational stability [25].…”

Section: Discussionmentioning

confidence: 99%

Effect of Nursing in Operating Room Combined with Intraoperative Heat Preservation Intervention on Prevention of Incision Infection and Improvement of Hemodynamics in Patients with Anterior Cruciate Ligament Injury and Reconstruction under Knee Arthroscopy

Dai

2022

Computational and Mathematical Methods in Medicine

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Objective. To explore the effect of nursing in operating room combined with intraoperative heat preservation intervention on preventing incision infection and improving hemodynamics in patients with anterior cruciate ligament (ACL) injury and reconstruction under knee arthroscopy. Methods. About 200 patients with knee arthroscopic ACL reconstruction in our hospital from January 2019 to July 2021 were enrolled. The patients were randomly assigned into two groups: the control group and the study group. The former group received nursing care in the operating room operating room and the latter group received nursing care in operating room combined with intraoperative heat preservation intervention. Nursing satisfaction, incidence of incision infection, knee joint VAS score, knee joint range of motion, knee joint Lysholm score, and hemodynamic indexes were compared. Results. First of all, we compared the nursing satisfaction, the study group was very satisfied in 78 cases, satisfactory in 20 cases, and general in 2 cases, and the satisfaction rate was 100.00%, while in the control group, 445 cases were very satisfied, 20 cases were satisfied, 15 cases were general, and 8 cases were dissatisfied. The satisfaction rate was 82.00%. The nursing satisfaction of the study group was higher compared to the control group ( P < 0.05 ). Secondly, we compared the incidence of incision infection. The incidence of incision infection in the study group was lower compared to the control group ( P < 0.05 ). With regard to the knee joint VAS score, the knee joint VAS score of the study group was lower compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation ( P < 0.05 ). In terms of the range of motion of the knee joint, the range of motion of the knee joint in the study group was higher compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation ( P < 0.05 ). Regarding the knee joint Lysholm score, the knee joint Lysholm score of the study group was higher compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation ( P < 0.05 ). Finally, we compared the hemodynamic indexes. Before nursing, there exhibited no significant difference ( P > 0.05 ). During and after nursing, the indexes of HR and MAP in the study group fluctuated little ( P < 0.05 ). Conclusion. During the perioperative period of patients with ACL injury and reconstruction under knee arthroscopy, standardized and necessary operating room combined with intraoperative thermal insulation intervention measures should be given, attention should be paid to the management of operating room, and intraoperative thermal insulation intervention should be strengthened. It includes preoperative visit, psychological nursing of patients, strict application of antibiotics before operation, monitoring of air quality in operating room, disinfection and sterilization of surgical instruments, shortening operation time, maintaining body temperature during operation, and paying attention to hand hygiene of medical staff. It plays a supervisory role in promoting the attention of medical staff to the prevention of wound infection, which is beneficial to the healing of surgical wounds of patients. It plays a positive role in enhancing hemodynamic indexes. Comprehensive nursing intervention on the risk factors of each link can effectively prevent postoperative wound infection and strengthen the prognosis and quality of life of patients.

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Section: Discussionmentioning

confidence: 99%

Effect of Nursing in Operating Room Combined with Intraoperative Heat Preservation Intervention on Prevention of Incision Infection and Improvement of Hemodynamics in Patients with Anterior Cruciate Ligament Injury and Reconstruction under Knee Arthroscopy

Dai

2022

Computational and Mathematical Methods in Medicine

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“…Radiographic measurement of the tibial slope, measured in relation to the anatomical axis [59], was performed by two knee sport fellows (PL and AD) and showed excellent inter‐observer reliability (intra class correlation) = 0.94 [95%CI: 0.92–0.95]. Antero‐posterior side‐to‐side laxity using the GNRB® device [40] (whose threshold was evaluated, respectively, at 3 and 1.5 mm for complete and partial ACL rupture [28, 29]) was performed preoperatively. Intra‐operative surgical data (duration of surgery, findings, other procedures, HT graft diameter) were collected.…”

Section: Methodsmentioning

confidence: 99%

“…Sonnery‐Cottet et al [50] demonstrated that combined HT + ALL reconstruction was associated with significantly lower rates of graft rupture and secondary meniscal tear [49, 50] in a high‐risk population when compared to HT and bone–patellar tendon–bone (B‐PT‐B) grafts. In addition, Lee et al [28] observed that adolescents with ACL rupture have greater rotational instability and a lower rate of healing of the ALL than adults.…”

Section: Introductionmentioning

confidence: 99%

Combined ACL and ALL reconstruction reduces the rate of reoperation for graft failure or secondary meniscal lesions in young athletes

Laboudie

Douiri

Bouguennec

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Graft failure and secondary meniscal tears are major concerns after anterior cruciate ligament (ACL) reconstruction in young athletes. The aim was to evaluate the link between ACL reconstruction with and without anterolateral ligament (ALL) reconstruction and outcomes in young patients participating in pivoting sports. Methods This was a retrospective study of data collected prospectively. Patients less than 20 years, involved in pivoting sports and undergoing primary ACL reconstruction with a quadruple hamstring tendon (4HT) graft or 4HT graft combined with anterolateral ligament reconstruction (4HT + ALL) were included. Survival analysis was performed to identify the prognostic indicators for reoperation due to graft failure or secondary meniscal lesions. Knee laxity was assessed and patient reported outcome measures (PROMs) were collected. Results A total of 203 patients (mean (± SD) age: 16.3 ± 2 years) with a mean follow-up of 4.8 ± 0.9 (range: 3.3-6.8) years were included. There were 101 4HT and 102 4HT + ALL grafts. Graft rupture rates were 11.9% for 4HT grafts and 5.8% for 4HT + ALL grafts (n.s.). There were 9.9% secondary meniscal procedures for 4HT grafts vs. 1.9% for 4HT + ALL grafts (p = 0.02). With reoperation for graft failure or secondary meniscal lesions at inal follow-up as the endpoint, survival was better in the 4HT + ALL group (91.4% vs. 77.8%, respectively; p = 0.03). Absence of ALL reconstruction (HR = 4.9 [95%CI: 1.4-17.9]; p = 0.01) and preoperative side-to-side laxity > 3 mm (HR = 3.1 [95%CI: 1.03-9.1]; p = 0.04) were independently associated with an increased rate of reoperations. Mean (± SD) side-to-side laxity was 1.3 ± 1.3 mm (range: − 2 to 5) for 4HT grafts vs. 0.9 ± 1.3 mm (range: − 6 to 4.8) for 4HT + ALL grafts (n.s.) 6 months post-surgery. The rate of return to the same sport at the same level was 42.2% for 4HT grafts vs. 52% for 4HT + ALL grafts (n.s.). There was no signiicant diference in subjective outcomes including PROMs between the two groups. Conclusion Combined ALL + ACL reconstruction reduced the rate of graft failure and secondary meniscal injury in young athletes when compared to ACL reconstruction alone. Subjective results were comparable, with a similar rate of complications. Combined reconstruction should be preferred in this young population. Level of evidence Level IV.

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“… 33 Many of the challenges faced in treating young athletes are nonmodifiable, as research has demonstrated that younger age, associated injury, and smaller graft size are independent risk factors for ACL graft failure. 3 , 15 , 18 , 19 , 31 , 33 Much of the research focus has been placed on determining the best graft choice for these patients. The most recent data from large American and Scandinavian registries consisting of thousands of patients have shown that, compared with bone-patellar tendon-bone graft (BTB), hamstring tendon grafts are more likely to require a revision surgery, with a relative risk ratio ranging from 1.4 to 2.3.…”

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confidence: 99%

Outcomes After Hamstring ACL Reconstruction With Suture Tape Reinforcement in Adolescent Athletes

Kitchen

Mitchell

Cognetti

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Previous studies have suggested that suture tape-reinforced anterior cruciate ligament (ACL) grafts may have higher ultimate failure loads without stress-shielding. In patients at high risk for graft failure, such as adolescents, the addition of suture tape could have beneficial outcomes. Hypothesis: Suture tape reinforcement (STR) of ACL grafts in adolescent patients would lead to fewer graft ruptures during early recovery, without hindering subjective outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed on adolescent patients with a minimum 2-year follow-up after hamstring tendon autograft ACL reconstruction; enrolled were patients from both before (n = 40) and after (n = 40) a shift in surgical technique that added STR. Both the no-STR and the STR cohorts were contacted yearly to obtain patient-reported outcome data for visual analog scale (VAS; range, 0-10) for pain score, Single Assessment Numeric Evaluation, Lysholm score, Tegner activity score, patient satisfaction score (range, 0-100), and return to previous level of sport (yes/no). The cohorts were then matched based on follow-up duration, excluding those with follow-up of <2 years and >3 years to maintain consistency in duration of follow-up. Graft failure was defined as either graft rupture or recurrent instability symptoms, and failures occurring from index procedure to the 3-year mark were recorded for calculations of failure rate. Results: There were no differences between cohorts in mean age [STR, 15.7 years (range, 9.5-18.7 years); no STR, 14.9 years (range, 9.3-18.8 years)], follow-up duration, laterality, or graft size. While not statistically significant, 2 (5%) patients in the STR cohort experienced graft rupture compared with 7 (17.5%) patients in the no-STR cohort. The Tegner score was significantly higher in the STR cohort ( P = .017); no between-group differences were seen on the other outcome scores. A subanalysis of the STR cohort comparing small-diameter grafts (<8 mm) with grafts ≥8 mm also demonstrated no difference in outcome measures, with 1 graft failure in each cohort. Conclusion: Study outcomes indicated that patients treated with ACL reconstruction and STR experienced a significant improvement in Tegner scores while at the same time maintaining the other subjective outcomes.

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Adolescents show a lower healing rate of anterolateral ligament injury and a higher rotational laxity than adults after anterior cruciate ligament reconstruction

Cited by 12 publications

References 63 publications

Effect of Nursing in Operating Room Combined with Intraoperative Heat Preservation Intervention on Prevention of Incision Infection and Improvement of Hemodynamics in Patients with Anterior Cruciate Ligament Injury and Reconstruction under Knee Arthroscopy

Effect of Nursing in Operating Room Combined with Intraoperative Heat Preservation Intervention on Prevention of Incision Infection and Improvement of Hemodynamics in Patients with Anterior Cruciate Ligament Injury and Reconstruction under Knee Arthroscopy

Combined ACL and ALL reconstruction reduces the rate of reoperation for graft failure or secondary meniscal lesions in young athletes

Outcomes After Hamstring ACL Reconstruction With Suture Tape Reinforcement in Adolescent Athletes

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