Future trends in ACL rupture management

Gopinathan, Patinharayil

doi:10.1016/j.jor.2017.01.004

Journal of Orthopaedics

2017

DOI: 10.1016/j.jor.2017.01.004

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Future trends in ACL rupture management

Patinharayil Gopinathan

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Cited by 2 publications

(2 citation statements)

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confidence: 99%

“…23,24,30 However, studies increasingly demonstrate that nonoperative management may lead to poor outcomes such as chondral injuries, fractures, and persistent instability. 6,7,12,15,18,21,29,30 In young, active athletes with ACL injuries, early reconstruction may be indicated. Techniques include allepiphyseal (drill holes located in the tibial and femoral epiphyses), transphyseal (drill holes through the physes), or extraphyseal (graft passed without epiphyseal drill holes and avoidance of the physes) graft placement.…”

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Distance to the Neurovascular Bundle for Iliotibial Band Graft Passage During Anterior Cruciate Ligament Reconstruction: A Pediatric Cadaveric Study

Thomas

Ayala

Rohde

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The Micheli technique for anterior cruciate ligament (ACL) reconstruction (ACLR) has proven to be a reliable method with a minimal risk for growth disturbance among skeletally immature patients. Purposes: To evaluate the Micheli technique of iliotibial band (ITB) graft passage for ACLR using cadaveric knee models and to measure the distance between the surgical instrument tip and the neurovascular bundle in the posterior knee joint: specifically, the peroneal nerve, tibial nerve, and popliteal artery. Study Design: Descriptive laboratory study. Methods: Gross dissection was performed on 17 pediatric cadaveric knees (12 male and 5 female) aged between 4 and 12 years. To simulate ITB graft passage, we passed a curved-tip hemostat clamp through the posterior capsule, with the knee flexed from 90° to 100°. Next, clinical photographs were taken, and digital imaging software was used to measure the distance in centimeters from the clamp tip to each respective neurovascular structure. Results: The mean distances from the clamp tip to the tibial nerve, popliteal artery, and peroneal nerve were 0.875 cm (range, 0.468-1.737 cm), 0.968 cm (range, 0.312-1.819 cm), and 1.149 cm (range, 0.202-2.409 cm), respectively. Mean values were further calculated for age groups of ≤8, 9-10, and 11-12 years. The mean distance from the clamp tip to the peroneal nerve was 1.400 cm larger for 11- to 12-year-old specimens than for ≤8-year-old specimens (95% CI, 0.6-2.2 cm; P = .005). Conclusion: The neurovascular structures in the posterior knee were in close proximity to the path of graft passage, with distances <1 cm in many specimens in this study. When passing the graft through the knee for an over-the-top position, surgeons should consider these small distances between the path of graft passage and critical neurovascular structures. Clinical Relevance: As the incidence of ACL tears is continuously increasing within the pediatric population, there are a larger number of ACLR procedures being performed. Although neurovascular injuries during ACLR are rare, this study clarifies the close proximity of neurovascular structures during ITB graft passage using the Micheli technique of ACLR.

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confidence: 99%

mentioning

confidence: 99%

Distance to the Neurovascular Bundle for Iliotibial Band Graft Passage During Anterior Cruciate Ligament Reconstruction: A Pediatric Cadaveric Study

Thomas

Ayala

Rohde

et al. 2022

Orthopaedic Journal of Sports Medicine

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Effect of Quadriceps Tendon Autograft Preparation and Fixation on Graft Laxity During Suspensory Anterior Cruciate Ligament Reconstruction: A Biomechanical Analysis

Bedi,

Smith,

Mitchell

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Favorable collagen fibril density and thickness combined with advances in graft preparation and fixation have significantly increased interest in the quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction. While various suspensory techniques have been described, the biomechanical profile of these constructs is largely undefined. Purpose: To compare the biomechanics of suspensory techniques for soft tissue QT autograft fixation in an in vitro model of ACL reconstruction. Study Design: Controlled laboratory study. Methods: Full-thickness QT grafts were harvested using a 9-mm graft blade. Adjustable-loop devices (ALDs) were secured to the graft (n = 6 per group) with a combination implant containing the ALD and suture tape-reinforced whipstitching (tape-reinforced [TR] group), tethered superficially to the graft with a whipstitch (onlay [OL] group), luggage-tagged through and around the graft (luggage tag [LT] group), or staggered behind superficial suturing (staggered [SG] group). Grafts were tested on an electromechanical testing machine following a validated in vitro reconstruction model of intraoperative workflow and postoperative ACL kinematics, cyclic loading, and load to failure. Results: The TR group had significantly less postcyclic tension loss (mean, 24%) compared with the OL (56%; P = .002), LT (69%; P < .001), and SG (90%; P < .001) constructs. Cyclic elongation was below the 3.0-mm threshold defined as clinical failure for TR (1.6 mm), but not for OL (3.3 mm), LT (7.9 mm), and SG (11.3 mm). All constructs were within native ACL stiffness limits (220 ± 72 N/mm) without significant differences. Ultimate loads significantly exceeded a normal ACL loading limit of 454 N for TR (739 N; P = .023), OL (547 N; P = .020), and LT (769 N; P = .001), but not for SG (346 N; P = .236). Conclusion: The TR ALD construct demonstrated the most favorable time-zero biomechanical properties of modern soft tissue QT suspensory constructs, with 32% less tension loss and 52% less cyclic elongation versus the closest construct. Failure loading of all constructs was acceptable with respect to the native ACL except for the SG group, which had suboptimal ultimate load. Clinical Relevance: TR ALD implants may protect soft tissue QT autografts before graft-bone healing in ACL reconstruction by minimizing time-zero laxity and fixation failure.

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Future trends in ACL rupture management

Cited by 2 publications

References 21 publications

Distance to the Neurovascular Bundle for Iliotibial Band Graft Passage During Anterior Cruciate Ligament Reconstruction: A Pediatric Cadaveric Study

Distance to the Neurovascular Bundle for Iliotibial Band Graft Passage During Anterior Cruciate Ligament Reconstruction: A Pediatric Cadaveric Study

Effect of Quadriceps Tendon Autograft Preparation and Fixation on Graft Laxity During Suspensory Anterior Cruciate Ligament Reconstruction: A Biomechanical Analysis

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