How to Succeed in Arthroscopic Anterior Cruciate Ligament Primary Repair? Step-by-Step Technique

Olmos, Manuel Ignacio; Sonnery‐Cottet, Bertrand; Barth, Johannes

doi:10.1016/j.eats.2018.08.028

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…Descriptions of suture configurations in preparing the ACL remnant in repairs are varied in the literature. 11 , 25 Evidence to support one method over another remains anecdotal at this point. Comparison of the strength of locking sutures can be found in the flexor tendon literature, which has shown that the number of suture strands crossing the repair site is more important than the suture configuration itself.…”

Section: Discussionmentioning

confidence: 99%

Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study

Qin

Kahn

Amirouche

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose The purpose of our pilot study was to assess the effect of augmenting anterior cruciate ligament (ACL) repair with suture tape on biomechanical parameters including anterior tibial translation, gap formation, and load to failure. Methods Ten fresh-frozen nonpaired cadaveric knees were dissected, and baseline anterior-posterior stability of both ACL-intact and -deficient knees was obtained. The specimens were randomized to undergo ACL repair either with or without suture tape reinforcement, and anterior tibial translation, as well as gap formation, was measured after cyclic loading. Finally, all specimens were subjected to a single pullout force to determine maximum load to failure. We performed t test analysis to compare means between groups, and significance was defined as P < .05. Results On t test analysis, no statistically significant difference was found regarding anterior tibial translation between the ACL-intact group and either repair group or between the repair group without suture tape augmentation and the repair group with suture tape augmentation. No significant difference in gap formation was detected between the repair groups with and without suture tape augmentation at 100 cycles (1.25 mm vs 1.02 mm, P = .6), 250 cycles (2.87 mm vs 2.12 mm, P = .3), and 500 cycles (4.5 mm vs 4.55 mm, P = .5). The average load to failure of the repairs without suture tape augmentation was not significantly different from that of the repairs with suture tape augmentation (725.9 N vs 725.7 N, P = .99). Conclusions In this pilot study, we did not identify a difference between ACL repairs with and without suture tape augmentation regarding anterior tibial translation, gap formation, or maximum load to failure. Clinical Relevance Treatment of ACL tears with primary ACL repair is a highly debated topic, and studies such as this study to further our understanding of the biomechanical properties of augmented ACL repairs are important for surgeons when deciding the best treatments for their patients.

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Section: Discussionmentioning

confidence: 99%

Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study

Qin

Kahn

Amirouche

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…[5] Suture bridge technique has shown good results for fixation of ACL tibial avulsions. [6][7][8] Post-operative arthrofibrosis being most common complication encountered after suture bridge fixation. Delayed mobilization or mechanical impingement can lead to this complication.…”

Section: Discussionmentioning

confidence: 99%

Balanced, biologic, and cost-effective technique for anterior cruciate ligament tibial avulsion repair: A 15-step novel approach

Pandey¹

2021

JASSM

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Anterior cruciate ligament (ACL) is most common ligament injured in knee. Sometimes, these are tibial side avulsions, leading to anterior knee impingement and instability. Multiple arthroscopic techniques have been described ranging from screw, staple, and k-wire fixation. Recent past have shown emergence of various transosseous suture fixation techniques using button, disc, or bone bridge. Transosseous techniques described range from single, double, and four tunnel method using fiber wire in various configuration. Our technique highlights biologic, balanced, and knotless method of ACL tibial avulsion fixation using fiber tape and two tibial tunnels.

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“…2 FiberWire ® and TigerWire ® stitches (Arthrex) that were looped through the ligament using a lasso-loop knot-tying configuration (Fig. 1 a) [ 16 ]. The stitches were passed through the anteromedial and posterolateral bundle of the ACL.…”

Section: Methodsmentioning

confidence: 99%

“…Most articles recommend surgery within 4 weeks from injury; however, there is a wide variety of delay until treatment, including at least one case report of a patient treated 11 years after injury [ 14 ]. Since the renewal of interest in ACL primary repair has only been recent, there has been little investigation regarding MRI evaluation after ACL primary repair [ 7 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

The healing potential of an acutely repaired ACL: a sequential MRI study

Ferretti¹,

Monaco²,

Annibaldi³

et al. 2020

J Orthop Traumatol

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Background: Recently, there has been renewed interest in primary anterior cruciate ligament (ACL) repair. The aim of this study is to report early clinical and radiological results of a consecutive series of acute ACL tears treated with arthroscopic primary ACL repair within 14 days from injury. Patients and methods: A consecutive series of patients with acute ACL tears were prospectively included in the study. Based on MRI appearance, ACL tears were classified into five types, and tissue quality was graded as good, fair, and poor. Patients with type I, II, and III tears and at least 50% of ACL tibial remnant intact with good tissue quality were ultimately included. Clinical outcomes were measured using the Tegner Lysholm Knee Scoring Scale (TLKSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), subjective and objective International Knee Documentation Committee (IKDC) scores, and KT-1000. Patients were also followed up with MRI evaluations at 1, 3, and 6 months postoperatively. ACL appearance was graded based on morphology (normal or abnormal) and signal intensity (isointense, intermediate, and hyperintense). Results: The mean TLKSS was 98.1, the mean subjective IKDC was 97.6, and the mean KOOS was 98.2. The objective IKDC score was A in eight of ten patients and B in two patients. KT-1000 measurements showed a maximum manual side-to-side difference of less than 2 mm in eight of ten patients, whereas two patients showed a difference of 3 mm. The morphology of the repaired ACL was normal (grade 1) at 1 month follow-up in ten of ten cases, and this appearance persisted at 3 and 6 months postoperatively. The signal intensity at 1 month postoperatively was graded as isointense (grade 1) in four of ten patients, intermediate (grade 2) in five of ten patients, and hyperintense (grade 3) in one of ten patients. At both 3 and 6 months postoperatively, the signal intensity was graded as isointense (grade 1) in nine of ten patients and intermediate (grade 2) in one of ten patients. Conclusions: Arthroscopic primary ACL repair performed acutely in a carefully selected group of patients with proximal ACL tears and good tissue quality showed good early clinical and radiological results.

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How to Succeed in Arthroscopic Anterior Cruciate Ligament Primary Repair? Step-by-Step Technique

Cited by 8 publications

References 26 publications

Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study

Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study

Balanced, biologic, and cost-effective technique for anterior cruciate ligament tibial avulsion repair: A 15-step novel approach

The healing potential of an acutely repaired ACL: a sequential MRI study

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