Femoral tunnel position in chronic anterior cruciate ligament rupture reconstruction: randomized controlled trial comparing anatomic, biomechanical and clinical outcomes

Minguell, Joan; Núñez, Jorge H.; Reverte-Vinaixa, M M; Sallent, Andrea; Margarit, A. S.; Castellet, Enric

doi:10.1007/s00590-019-02455-x

Cited by 16 publications

(38 citation statements)

References 28 publications

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“…We retrieved 9 studies 9 – 12 , 16 , 18 , 20 , 22 , 26 in which ACL-reconstructed knees were analyzed for the range of tibial rotation. In 6 ACLR studies, 9 – 12 , 20 , 22 a CAS system was used during surgery to perform pre- and postoperative measurements. The other 3 studies 16 , 18 , 26 were classified as “other evaluation method” ( Tables 4 and 5 ).…”

Section: Resultsmentioning

confidence: 99%

“…In 6 studies, CAS software was used to measure range of tibial rotation before and after ACLR. 9 – 12 , 20 , 22 In all of these studies, a manual force was applied in order to rotate the tibia. Maximum internal and external rotations were applied to the foot of the anesthetized patient, and associated values of maximum internal and external rotation of the knee were recorded.…”

Section: Resultsmentioning

confidence: 99%

“…Minguell et al 22 performed the only study that randomized between an anteromedial portal technique (AMP) and a transtibial drilling technique (TT) to create the femoral tunnel. The AMP group showed a more anatomic positioning of the graft in both sagittal and coronal planes.…”

Section: Resultsmentioning

confidence: 99%

“…However, in terms of range of tibial rotation, no difference was observed. Both techniques reduced the amount of total tibial rotation by 19% 22 (Tables 1 and 2).…”

Section: Patients After Aclrmentioning

confidence: 98%

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Effect of ACL Reconstruction on Range of Tibial Rotation: A Systematic Review of Current Literature and a Recommendation for a Standard Measuring Protocol

Zee

Robben

Zuurmond

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Tibial rotation is an important topic in anterior cruciate ligament (ACL) surgery, and many efforts are being made to address rotational stability. The exact role of the ACL in controlling tibial rotation in clinical studies is unknown. Purpose: To quantify the effect of ACL reconstruction on the amount of tibial rotation based on the current available literature. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search of the PubMed and EMBASE databases was performed in August 2019. Two independent reviewers reviewed titles and abstracts as well as full-text articles. A total of 2383 studies were screened for eligibility. After screening of titles and abstracts, 178 articles remained for full-text assessment. Ultimately, 13 studies were included for analysis. A quality assessment was performed by means of the RoB 2.0 (revised tool for Risk of Bias in randomized trials) and the ROBINS-I (Risk Of Bias In Non-randomized Studies–of Interventions) tools. Results: According to the studies using computer-assisted surgery that were included in this review, ACL reconstruction resulted in an average reduction in tibial rotation of 17% to 32% compared with preoperatively; whether the range of tibial rotation returned to preinjury levels remained unclear. In the current literature, a gold standard for measuring tibial rotation is lacking. Major differences between the study protocols were found. Several techniques for measuring tibial rotation were used, each with its own limitations. Most studies lacked proper description of accompanying injuries. Conclusion: ACL reconstruction reduced the range of tibial rotation by 17% to 32%. Normal values for the range of tibial rotation in patients with ACL deficiency and those who undergo ACL reconstruction could not be provided based on the current available literature owing to a lack of uniform measuring techniques and protocols. Therefore, we advocate uniformity in measuring tibial rotation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…However, in terms of range of tibial rotation, no difference was observed. Both techniques reduced the amount of total tibial rotation by 19% 22 (Tables 1 and 2).…”

Section: Patients After Aclrmentioning

confidence: 98%

See 2 more Smart Citations

Effect of ACL Reconstruction on Range of Tibial Rotation: A Systematic Review of Current Literature and a Recommendation for a Standard Measuring Protocol

Zee

Robben

Zuurmond

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…It is difficult to locate the absolute isometric tunnel position in surgery because of individual differences including a lack of bony structure and surgical experience, therefore, surgeons prefer isometric reconstruction in ACLR [ 30 ]. However, the acceptable isometry of the graft remains controversial and clinical studies[ [31] , [32] , [33] ] have shown no advantage in certain tunnel positions with clinical outcomes or graft maturity. An animal model study may provide some evidence to support the advantages of near-isometric reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Establishment of near and non isometric anterior cruciate ligament reconstruction with artificial ligament in a rabbit model

Jin

Cai

Sheng

et al. 2021

Journal of Orthopaedic Translation

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Background Tunnel position deicide the isometry of graft attachment in synthetic anterior cruciate ligament (ACL) reconstruction. Near-isometric tunnel position may have advantage in graft integration and knee function in ACL reconstruction (ACLR) with polyethylene terephthalate (PET) ligament. Few studies focused on tunnel position isometry when conduct ACLR with an animal model. This study aimed to establish a preclinical rabbit model of near and non isometric ACLR with PET ligament and investigate the advantage of near-isometric ACLR compared to non-isometric ACLR. Methods Nine hind limbs of rabbit were used in tunnel position study. Two femoral(anatomic, nonanatomic) tunnels and three tibial(anterior, middle, posterior) tunnels were used to measure tunnel position isometry during knee full range of motion. The tunnel position combination with minimal isometry was considered as near-isometric tunnel position. Then, 48 rabbits divided into two groups were conducted near or non isometric ACLR with PET ligament with graft fixation angle of 30° and constant tension of 5N. PET ligament isometry, range of motion(ROM) restriction, knee laxity were recorded after operation and followed up with macroscopic observation, microcomputed tomography (micro-CT) analysis, histology assessment and biomechanical test at 4 and 8 weeks postoperatively. Results The tunnel combination with minimal isometry was femoral anatomic position and tibial posterior position(5.19 ± 1.78%) and considered as near-isometric tunnel position. ROM restriction were observed in non-isometric group (22.50 ± 14.14°) while none in near-isometric group. However, no ROM restriction observed at 8 weeks in both group. Knee laxity compared to contralateral knee were better in near-isometric group than non-isometric group (stable/slack/total 10/2/12 VS 3/9/12, p = 0.012) at 8 weeks postoperatively. Supeiror PET ligament integration were also observed in near-isometric group through macroscopic observation, micro-CT analysis, histology assessment at both 4 and 8 weeks. The failure load in the Near-Isometric group at 8 weeks were higher than timezero reconstruction with statistical difference (156.8N ± 25.98N vs.102.6 ± 22.96N, p = 0.02). Conclusion A rabbit model of ACLR based on tunnel position isometry was successfully established in this study. The near-isometric tunnel position in rabbit model was femoral anatomic position and tibial posterior position. A near-isometric ACLR with PET ligament did not cause ROM restriction and had a better graft integration and follow-up stability than non-isometric ACLR with ROM restriction. The Translational Potential of this Article The study demonstrate the establishmentof near-isometric tunnel position and non-isometric tunnel position with significant difference of ROM restriction and graft-bone integration. The described tunnel positions with differential isometry in a rabbi...

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Application of Nondegradable Synthetic Materials for Tendon and Ligament Injury

Feng

et al. 2023

Macromolecular Bioscience

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Tendon and ligament injuries, prevalent requiring surgical intervention, significantly impact joint stability and function. Owing to excellent mechanical properties and biochemical stability, Nondegradable synthetic materials, including polyethylene terephthalate (PET) and polytetrafluoroethylene (PTFE), have demonstrated significant potential in the treatment of tendon and ligament injuries. These above materials offer substantial mechanical support, joint mobility, and tissue healing promotion of the shoulder, knee, and ankle joint. This review conclude the latest development and application of nondegradable materials such as artificial patches and ligaments in tendon and ligament injuries including rotator cuff tears (RCTs), anterior cruciate ligament (ACL) injuries, and Achilles tendon ruptures.

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Femoral tunnel position in chronic anterior cruciate ligament rupture reconstruction: randomized controlled trial comparing anatomic, biomechanical and clinical outcomes

Cited by 16 publications

References 28 publications

Effect of ACL Reconstruction on Range of Tibial Rotation: A Systematic Review of Current Literature and a Recommendation for a Standard Measuring Protocol

Effect of ACL Reconstruction on Range of Tibial Rotation: A Systematic Review of Current Literature and a Recommendation for a Standard Measuring Protocol

Establishment of near and non isometric anterior cruciate ligament reconstruction with artificial ligament in a rabbit model

Application of Nondegradable Synthetic Materials for Tendon and Ligament Injury

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