Clinical outcomes of contemporary lateral augmentation techniques in primary ACL reconstruction: a systematic review and meta-analysis

Beckers, L.; Vivacqua, Thiago; Firth, Andrew; Getgood, Alan

doi:10.1186/s40634-021-00368-5

Cited by 19 publications

(14 citation statements)

References 65 publications

(261 reference statements)

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“…21 The recording of additional surgical details such as graft diameter/size, ligament augmentation, lateral extra-articular tenodesis, or anterolateral ligament reconstruction may also be of value, given their recent association with outcomes. 1,10,15,16,24,26,42,52 Clinical examination and rehabilitation information such as preoperative knee laxity grade 25,43 could be obtained via third-party sources such as physical therapists or via natural language processing of patient chart notes. 49 Finally, the KOOS may not be the most appropriate patient-reported outcome tool for the patient population, and an alternative measurement of patient function, such as the baseline Marx activity level, could be considered for inclusion in registries moving forward.…”

Section: Discussionmentioning

confidence: 99%

Ceiling Effect of the Combined Norwegian and Danish Knee Ligament Registers Limits Anterior Cruciate Ligament Reconstruction Outcome Prediction

et al. 2023

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Background: Clinical tools based on machine learning analysis now exist for outcome prediction after primary anterior cruciate ligament reconstruction (ACLR). Relying partly on data volume, the general principle is that more data may lead to improved model accuracy. Purpose/Hypothesis: The purpose was to apply machine learning to a combined data set from the Norwegian and Danish knee ligament registers (NKLR and DKRR, respectively), with the aim of producing an algorithm that can predict revision surgery with improved accuracy relative to a previously published model developed using only the NKLR. The hypothesis was that the additional patient data would result in an algorithm that is more accurate. Study Design: Cohort study; Level of evidence, 3. Methods: Machine learning analysis was performed on combined data from the NKLR and DKRR. The primary outcome was the probability of revision ACLR within 1, 2, and 5 years. Data were split randomly into training sets (75%) and test sets (25%). There were 4 machine learning models examined: Cox lasso, random survival forest, gradient boosting, and super learner. Concordance and calibration were calculated for all 4 models. Results: The data set included 62,955 patients in which 5% underwent a revision surgical procedure with a mean follow-up of 7.6 ± 4.5 years. The 3 nonparametric models (random survival forest, gradient boosting, and super learner) performed best, demonstrating moderate concordance (0.67 [95% CI, 0.64-0.70]), and were well calibrated at 1 and 2 years. Model performance was similar to that of the previously published model (NKLR-only model: concordance, 0.67-0.69; well calibrated). Conclusion: Machine learning analysis of the combined NKLR and DKRR enabled prediction of the revision ACLR risk with moderate accuracy. However, the resulting algorithms were less user-friendly and did not demonstrate superior accuracy in comparison with the previously developed model based on patients from the NKLR alone, despite the analysis of nearly 63,000 patients. This ceiling effect suggests that simply adding more patients to current national knee ligament registers is unlikely to improve predictive capability and may prompt future changes to increase variable inclusion.

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Section: Discussionmentioning

confidence: 99%

Ceiling Effect of the Combined Norwegian and Danish Knee Ligament Registers Limits Anterior Cruciate Ligament Reconstruction Outcome Prediction

et al. 2023

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“…In a recent systematic review and metaanalysis, Beckers et al found a significant reduction in graft ruptures in patients treated with ACLR and lateral augmentation (3%) compared to isolated ACLR (12%) and rotational laxity significantly higher in isolated ACLR (14% vs. ACLR + LA (6%). 71 In another recent systematic review, Littlefield et al reported lower ACL graft failure rates for combined ACLR/ALLR (0.0% -15.7%) when compared to isolated ACLR patients (7.4% -21.7%), whereas Kunze et al reported a failure rate of 2.7%-11.1%, and significant improvement in the IKDC, Lysholm, and Tegner outcome scores postoperatively. 3,70 Recent systematic reviews showed that ACLR + ALLR improved patient-reported outcomes at short-term follow-up compared to those who underwent isolated ACLR.…”

Section: Outcomementioning

confidence: 98%

A Review of Current Concepts of the Anterolateral Complex of the Knee

et al. 2022

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The anterolateral complex (ALC) of the knee has gained increased interest over the last decades due to the high revision rates of anterior cruciate ligament reconstruction (ACLR). Furthermore, in patients with an ACL tear, the injury of at least one of the ALC’s anatomic structures has been shown to be significantly higher, thus affecting its secondary stabilizing role at the knee joint. As such, ACLR augmentation techniques, that embrace the ALC, have been proposed recently, and indications for these procedures are still evolving. This review aims to present and discuss the most current anatomical, biomechanical, and imaging data, current reconstruction techniques, and the clinical results of ALC reconstruction.

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“…Current literature suggests that combined ACLR with ALLR or LET can improve clinical outcomes and decrease the possibility of ACL graft failure compared to isolated ACLR[ 43 ]. Beckers et al [ 68 ] observed that both LET and ALLR during ACLR provided superior Lysholm Score and reduced ACL re-rupture rate. Na et al [ 69 ] in a systematic review found that ALLR or LET along with ACLR were related to superior subjective IKDC, Tegner and Lysholm scores than isolated ACLR.…”

Section: Clinical Evidencementioning

confidence: 99%

Graft choices for anterolateral ligament knee reconstruction surgery: Current concepts

Chalidis¹,

Pitsilos²,

Kitridis³

et al. 2022

WJCC

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The anterolateral ligament (ALL) is a primary structure of the anterolateral complex of the knee that contributes to internal rotational stability of the joint. Injury of the ALL is commonly associated with rupture of the anterior cruciate ligament. If left untreated, ALL lesions may lead to residual anterolateral rotational instability of the knee after anterior cruciate ligament reconstruction, which is a common cause of anterior cruciate ligament graft failure. The function of the ALL can be restored by lateral extraarticular tenodesis or anterolateral ligament reconstruction (ALLR). In the lateral extraarticular tenodesis procedure, a strip of the iliotibial band is placed in a non-anatomical position to restrain the internal rotation of the tibia, while in ALLR, a free graft is fixed at the insertion points of the native ALL. Gracilis and semitendinosus grafts have mainly been utilized for ALLR, but other autografts have also been suggested. Furthermore, allografts and synthetic grafts have been applied to minimize donor-site morbidity and maximize the size and strength of the graft. Nevertheless, there has been no strong evidence to fully support one method over another thus far. The present review presents a detailed description of the graft choices for ALLR and the current literature available in regard to the effectiveness and outcomes of published surgical techniques.

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Clinical outcomes of contemporary lateral augmentation techniques in primary ACL reconstruction: a systematic review and meta-analysis

Cited by 19 publications

References 65 publications

Ceiling Effect of the Combined Norwegian and Danish Knee Ligament Registers Limits Anterior Cruciate Ligament Reconstruction Outcome Prediction

Ceiling Effect of the Combined Norwegian and Danish Knee Ligament Registers Limits Anterior Cruciate Ligament Reconstruction Outcome Prediction

A Review of Current Concepts of the Anterolateral Complex of the Knee

Graft choices for anterolateral ligament knee reconstruction surgery: Current concepts

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