Improved outcomes after anterior cruciate ligament reconstruction with quadrupled hamstring autografts and additional bone plug augmentation at five year follow-up

Nebelung, Sven; Deitmer, Gregor; Gebing, Rolf; Reichwein, Frank; Nebelung, W.

doi:10.1007/s00264-012-1542-5

Cited by 9 publications

(5 citation statements)

References 21 publications

(30 reference statements)

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“…Substantial interest has arisen in the ability of anterior cruciate ligament reconstruction (ACLR) to restore normal functional knee mechanics; as well, it is of interest whether residual abnormalities after surgery may contribute to the high rates of anterior knee pain 2,31 and early-onset osteoarthritis seen in ACLR knees. 32,37 While conventional anterior-posterior laxity tests often fail to detect significant differences in ACLR knees, 8,40 numerous studies have found evidence of abnormal tibiofemoral kinematics during whole body movement such as gait, 10,49 downhill running, 55 and quasi-static lunges. 57 In particular, a number of publications report a shift toward external tibial rotation and medial translation in ACLR knees compared with healthy knees.…”

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confidence: 99%

Effect of Loading on In Vivo Tibiofemoral and Patellofemoral Kinematics of Healthy and ACL-Reconstructed Knees

et al. 2017

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Background Although knees that have undergone anterior cruciate ligament reconstruction (ACLR) often exhibit normal laxity on clinical examination, abnormal kinematic patterns have been observed when the joint is dynamically loaded during whole body activity. This study investigated whether abnormal knee kinematics arise with loading under isolated dynamic movements. Hypothesis Tibiofemoral and patellofemoral kinematics of ACLR knees will be similar to those of the contralateral uninjured control knee during passive flexion-extension, with bilateral differences emerging when an inertial load is applied. Study Design Controlled laboratory study. Methods The bilateral knees of 18 subjects who had undergone unilateral ACLR within the past 4 years were imaged by use of magnetic resonance imaging (MRI). Their knees were cyclically (0.5 Hz) flexed passively. Subjects then actively flexed and extended their knees against an inertial load that induced stretch-shortening quadriceps contractions, as seen during the load acceptance phase of gait. A dynamic, volumetric, MRI sequence was used to track tibiofemoral and patellofemoral kinematics through 6 degrees of freedom. A repeated-measures analysis of variance was used to compare secondary tibiofemoral and patellofemoral kinematics between ACLR and healthy contralateral knees during the passive and active extension phases of the cyclic motion. Results Relative to the passive motion, inertial loading induced significant shifts in anterior and superior tibial translation, internal tibial rotation, and all patellofemoral degrees of freedom. As hypothesized, tibiofemoral and patellofemoral kinematics were bilaterally symmetric during the passive condition. However, inertial loading induced bilateral differences, with the ACLR knees exhibiting a significant shift toward external tibial rotation. A trend toward greater medial and anterior tibial translation was seen in the ACLR knees. Conclusion This study demonstrates that abnormal knee kinematic patterns in ACLR knees emerge during a simple, active knee flexion-extension task that can be performed in an MRI scanner. Clinical Relevance It is hypothesized that abnormal knee kinematics may alter cartilage loading patterns and thereby contribute to increased risk for osteoarthritis. Recent advances in quantitative MRI can be used to detect early cartilage degeneration in ACLR knees. This study demonstrates the feasibility of identifying abnormal ACLR kinematics by use of dynamic MRI, supporting the combined use of dynamic and quantitative MRI to investigate the proposed link between knee motion, cartilage contact, and early biomarkers of cartilage degeneration.

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confidence: 99%

Effect of Loading on In Vivo Tibiofemoral and Patellofemoral Kinematics of Healthy and ACL-Reconstructed Knees

et al. 2017

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“…The fact that femoral tunnel dilation was not significant could be explained because of their location in the correct position, both by the posterior quadrant of Harner 29 and the posterior position of Aglietti methods. 30 Dilation of the tunnels has not been associated with greater instability in less than 5-year follow-up studies, 24,27,31 with no significant differences in the Lachman test or arthrometer measurements, but we have no longterm follow-up studies. The results of this study suggest that 15% of patients with grade IV tibial tunnel widening were associated with good outcomes in KT-1000 measurements.…”

Section: Discussionmentioning

confidence: 80%

“…While some authors detected widening in the first 3 or 4 months after surgery, 11 others defined it later: 10 to 12 months, 26 2 years, 9 or 5 years. 27 In contrast, others found no relationship between follow-up and tunnel dilation. 28 In our study, we observed a progression of the tibial tunnel dilation in the frontal plane in 43% of the patients between the mid-term and the final period, however 27% still dilating until final follow-up.…”

Section: Discussionmentioning

confidence: 97%

Relationship between Widening and Position of the Tunnels and Clinical Results of Anterior Cruciate Ligament Reconstruction to Knee Osteoarthritis: 30 Patients at a Minimum Follow-Up of 10 Years

Ayala-Mejías

Garcia-Gonzalez

Alcocer-Perez-España³

et al. 2016

J Knee Surg

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To evaluate the relationship between tunnel position and widening and long-term clinical results in anterior cruciate ligament (ACL) reconstruction, a retrospective cohort of 30 patients undergoing ACL reconstruction with double semitendinous plus double gracilis (SAC technique) with longer than 10-year follow-up was selected. CT scans in the first 3 months and at final follow-up was evaluated. Position, angle, and widening of tunnels including Nebelung criteria were recorded in all CT scans. Physical, KT-1000, and clinical evaluation were performed at final follow-up. Outcomes and knee arthritis severity were evaluated at final follow-up. Mean follow-up was 11.2 ± 1.2. At final follow-up, 85 and 57% of tibial and femoral tunnels, respectively, developed some degree of enlargement. Frontal tibial angle (mean) was 72°, sagittal tibial angle 63°, frontal femoral angle 47°, sagittal femoral angle 20°, and tunnels divergence angle 36°. Preoperatively, KT-1000 30L and Lachman test scores were 5.52 and 5.79 respectively. In the last follow-up, 30L and manual Lachman test scores were 0.97 and 1.13, respectively ( < 0.001). In IKDC scale, pivot shift and Jerk tests showed 83 and 84% grade A results, respectively ( < 0.0001). In Fairbank scale, 23% worsened one grade and 27% worsened more than one grade ( < 0.005). Tibial tunnels widened more than femoral tunnels and further dilatation was found between intermediate and final follow-up. Higher incidence of tibial tunnel widening was observed in patients with tunnel verticalization. Tibial tunnel dilation was associated with long-term degenerative changes but not with final knee instability.

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“…Despite variable techniques aiming to improve bone tunnel healing, bone morphogenetic protein (BMP) and calcium phosphate cement are still mainstays of treatment for optimization of the healing process in this purpose. Nebelung et al 66 evaluated midterm outcomes after transfemoral graft fixation using either a conventional or a modified technique and additional bone plug augmentation (BPA) of the femoral tunnel aperture after ACL reconstruction with a quadrupled hamstring autograft in 56 patients. Biomechanical pull-out testing showed that the ultimate failure load and stiffness of the reconstructed ACL in the experimental group were significantly higher than those in the control group at both 4 and 8 weeks (P < 0.05).…”

Section: Definitive Argument About Available Graft Choicesmentioning

confidence: 99%

Graft selection in ACL reconstructive surgery

Oryan

Moshiri

Meimandi-Parizi

2013

Current Orthopaedic Practice

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Anterior cruciate ligament (ACL) tear is a frequent orthopaedic injury. ACL reconstruction, both in humans and animals, is more developed than in past decades. Many experimental and clinical trial studies have been performed, using various grafts with several different techniques, aiming to improve ACL reconstruction. However, there is still a large gap between the present treatment modalities and the final outcome in patients who have had ACL reconstructive surgery. The autograft bonepatellar tendon-bone complex and hamstring tendon grafts are the gold standard graft types for ACL reconstruction. This review introduces graft options and discusses advantages, disadvantages, and outcomes. Bone tunnel healing, strategies to enhance the bone tunnel healing, and the future of ACL reconstruction also are briefly described.

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Improved outcomes after anterior cruciate ligament reconstruction with quadrupled hamstring autografts and additional bone plug augmentation at five year follow-up

Cited by 9 publications

References 21 publications

Effect of Loading on In Vivo Tibiofemoral and Patellofemoral Kinematics of Healthy and ACL-Reconstructed Knees

Effect of Loading on In Vivo Tibiofemoral and Patellofemoral Kinematics of Healthy and ACL-Reconstructed Knees

Relationship between Widening and Position of the Tunnels and Clinical Results of Anterior Cruciate Ligament Reconstruction to Knee Osteoarthritis: 30 Patients at a Minimum Follow-Up of 10 Years

Graft selection in ACL reconstructive surgery

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