Hamstrings substitution via anteromedial portal with optional anterolateral ligament reconstruction is the preferred surgical technique for anterior cruciate ligament reconstruction: a survey among ESSKA members

Vascellari, Alberto; Grassi, Alberto; Canata, Gian Luigi; Zaffagnini, Stefano; Gokeler, Alli; Jones, Henrique

doi:10.1007/s00167-020-06107-0

Cited by 7 publications

(8 citation statements)

References 34 publications

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“…The graft choice based on patient sex is in agreement with previous reports from national ACL registries and surgeon surveys [ 21 , 33 , 52 ], but the underlying reasons are still somewhat unclear. While female sex has been identified as a risk factor for primary ACL injury, there is conflicting evidence regarding the risk of graft rupture and revision rates between the sexes [ 3 , 5 , 25 , 43 , 45 ].…”

Section: Discussionsupporting

confidence: 80%

“…Previous registry-based studies confirm the use of HT as the most common autograft choice [ 25 , 32 , 33 ]. Additionally, studies investigating surgeon preference found a predilection for HT autografts in primary ACLR [ 14 , 52 ]. However, there is an emerging trend toward increased PT and QT graft utilization in Scandinavia [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is similar to previous estimates from the United States [ 26 ]. Primary ACL reconstruction (ACLR) is mostly performed with hamstring tendon (HT) or patellar tendon (PT) autografts [ 32 , 48 , 52 ], but the quadriceps tendon (QT) autograft has increased in popularity in recent years [ 41 , 48 ].…”

Section: Introductionmentioning

confidence: 99%

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Surgeon’s experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries

Rizvanovic

Waldén

Forssblad

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To investigate the influence of surgeon-related factors and clinic routines on autograft choice in primary anterior cruciate ligament reconstruction (ACLR). Methods Data from the Swedish National Knee Ligament Registry (SNKLR), 2008–2019, were used to study autograft choice (hamstring; HT, patellar; PT, or quadriceps tendon; QT) in primary ACLR. Patient/injury characteristics (sex, age at surgery, activity at time of injury and associated injuries) and surgeon-/clinic-related factors (operating volume, caseload and graft type use) were analyzed. Surgeon/clinic volume was divided into tertiles (low-, mid- and high-volume categories). Multivariable logistic regression was performed to assess variables influencing autograft choice in 2015–2019, presented as the odds ratio (OR) with a 95% confidence interval (CI). Results 39,964 primary ACLRs performed by 299 knee surgeons in 91 clinics were included. Most patients received HT (93.7%), followed by PT (4.2%) and QT (2.1%) grafts. Patients were mostly operated on by high-volume (> 28 ACLRs/year) surgeons (68.1%), surgeons with a caseload of ≥ 50 ACLRs (85.1%) and surgeons with the ability to use ≥ two autograft types (85.9%) (all p < 0.001). Most patients underwent ACLR at high-volume (> 55 ACLRs/year) clinics (72.2%) and at clinics capable of using ≥ two autograft types (93.1%) (both p < 0.001). Significantly increased odds of receiving PT/QT autografts were found for ACLR by surgeons with a caseload of ≥ 50 ACLRs (OR 1.41, 95% CI 1.11–1.79), but also for injury during handball (OR 1.31, 95% CI 1.02–1.67), various other pivoting sports (basketball, hockey, rugby and American football) (OR 1.59, 95% CI 1.24–2.03) and a concomitant medial collateral ligament (MCL) injury (OR 4.93, 95% CI 4.18–5.80). In contrast, female sex (OR 0.87, 95% CI 0.77–0.97), injury during floorball (OR 0.71, 95% CI 0.55–0.91) and ACLR by mid-volume relative to high-volume surgeons (OR 0.62, 95% CI 0.53–0.73) had significantly reduced odds of receiving PT/QT autografts. Conclusion An HT autograft was used in the vast majority of cases, but PT/QT autografts were used more frequently by experienced surgeons. Prior research has demonstrated significant differences in autograft characteristics. For this reason, patients might benefit if surgery is performed by more experienced surgeons. Level of evidence Level III.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Surgeon’s experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries

Rizvanovic

Waldén

Forssblad

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…As an anatomical femoral tunnel placement during anterior cruciate ligament (ACL) reconstruction was known to reproduce relatively normal knee kinematics and restore rotational laxity [3, 10, 22, 26, 31, 38, 42], the trend has shifted from using the transtibial technique to the transportal (anteromedial portal) or outside‐in reconstruction technique [18, 46, 48]. However, for anatomical ACL reconstruction, the concept of an isometry might still be a concern for most orthopedic surgeons.…”

Section: Introductionmentioning

confidence: 99%

Graft isometry during anatomical ACL reconstruction has little effect on surgical outcomes

Moon

Choi

Yoo

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To investigate the surgical outcomes of anatomical anterior cruciate ligament (ACL) reconstruction according to the graft isometry measured during surgery. Methods Electrical medical records of patients who underwent an arthroscopic ACL reconstruction through the transportal technique using hamstring tendon autograft between 2012 and 2016 were retrospectively reviewed. The patients were classiied into two groups based on the graft length change throughout the knee range of motion measured just before graft ixation (Group 1, graft length change ≤ 2 mm; Group 2, graft length change > 2 mm). Comparative analyses, including a noninferiority trial, were performed regarding the clinical scores, knee laxity, and radiographic parameters between the groups. Results A total of 67 patients were included in the study. The total change in the length of ACL graft throughout the knee range of motion was 1.4 ± 0.4 mm in Group 1 (range, 0.2-2.0 mm), and 3.0 ± 0.7 mm in Group 2 (range, 2.2-5.0 mm). Group 1 showed a relatively high (proximal) femoral tunnel and shallow (anterior) tibial tunnel compared to Group 2 (P < 0.001 and P = 0.028, respectively), but there were no apparent diferences in the macroscopic view. There were no statistically signiicant diferences in the clinical outcomes between groups at 2 years after surgery, which satisied the non-inferiority criterion of Group 1 in terms of clinical scores and knee laxity compared to Group 2. Conclusion The surgical outcomes of anatomical ACL reconstruction in patients with non-isometric ACL graft were not inferior in terms of clinical scores and knee laxity, compared to those with nearly-isometric ACL graft. The graft tunnel placement in the isometric position during anatomical ACL reconstruction, which is technically challenging in the clinical setting, is not a crucial factor in terms of clinical outcomes. Level of evidence Level IV.

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“…Most surgeons perform either a hamstring tendon (HT) autograft in combination with ALLR (HT-ALL) or a BPTB graft combined with a modified Lemaire LET procedure (BPTB-Lemaire). 40 To our knowledge, there is no published study comparing the clinical results of these 2 techniques.…”

mentioning

confidence: 99%

Revision Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft Combined With Modified Lemaire Technique Versus Hamstring Graft Combined With Anterolateral Ligament Reconstruction: A Clinical Comparative Matched Study With a Mean Follow-up of 5 Years From The SANTI Study Group

Rayes

Ouanezar²,

Haidar

et al. 2021

Am J Sports Med

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Background: Additional lateral extra-articular tenodesis (LET) has recently been correlated with improved clinical outcomes and reduced failure rates in revision anterior cruciate ligament (ACL) reconstruction (ACLR). However, no data are available on clinical outcomes and reoperation after revision ACLR using different LET procedures. Purpose: To compare the clinical outcomes of ACL + anterolateral ligament (ALL) reconstruction using hamstring tendon graft (HT-ALL) and a bone–patellar tendon–bone (BPTB) graft + modified Lemaire tenodesis procedure (BPTB-Lemaire) in the setting of revision ACLR and to determine whether ALL reconstruction is associated with an increased rate of adverse outcomes when compared with a modified Lemaire tenodesis procedure. Study Design: Cohort study; Level of evidence, 3. Methods: Descriptive data and clinical outcomes were prospectively collected from patients who underwent revision ACLR with LET between 2009 and 2018 with a minimum follow-up of 2 years. Patients with an HT autograft combined with ALL reconstruction (HT-ALL group) were matched in a 1:1 propensity ratio to patients with a BPTB autograft combined with a modified Lemaire LET procedure (BPTB-Lemaire group). The evaluated parameters included complications and reoperations; knee laxity tests; return to sports; and various scores, including the Lysholm knee score, Tegner activity scale, Anterior Cruciate Ligament Return to Sport After Injury scale, Marx activity rating scale, International Knee Documentation Committee subjective knee evaluation form, and Knee injury and Osteoarthritis Outcome Score. Results: In total, 36 matched pairs were included in the analysis. The mean follow-up durations for the BPTB-Lemaire and HT-ALL groups were 56 ± 35 and 57 ± 23 months, respectively ( P = .91). No significant differences were found in graft rupture rate (HT-ALL, 0%; BPTB-Lemaire, 11.1%; P = .13) or reoperations (HT-ALL, 8.3%; BPTB-Lemaire, 22.2%; P = .23). No specific complications with regard to LET were noted in either group. Additionally, there were no significant differences in knee laxity parameters, return to sports, or clinical scores between the groups at the final follow-up, except for the Tegner activity scale score (HT-ALL, 6.4; BPTB-Lemaire, 7.3; P = .03). HT-ALL was associated with a shorter surgical time (41.4 vs 59.8 minutes; P < .0001). Conclusion: HT-ALL was at least equivalent, in terms of clinical outcomes, to the more commonly performed procedure, BPTB-Lemaire. Performing ALL reconstruction in the setting of revision ACLR is therefore safe and effective.

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Hamstrings substitution via anteromedial portal with optional anterolateral ligament reconstruction is the preferred surgical technique for anterior cruciate ligament reconstruction: a survey among ESSKA members

Abstract: Hamstrings substitution via anteromedial portal with optional anterolateral ligament reconstruction is the preferred surgical technique for anterior cruciate ligament reconstruction: a survey among ESSKA members.

Cited by 7 publications

References 34 publications

Surgeon’s experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries

Surgeon’s experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries

Graft isometry during anatomical ACL reconstruction has little effect on surgical outcomes

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