Over-the-top ACL reconstruction yields comparable outcomes to traditional ACL reconstruction in primary and revision settings: a systematic review

Sarraj, Mohamed; de, Darren; Shanmugaraj, Ajaykumar; Musahl, Volker; Lesniak, Bryson P.

doi:10.1007/s00167-018-5084-2

Cited by 26 publications

(23 citation statements)

References 48 publications

(132 reference statements)

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“…Statistically significant improvement in KOOS scores comparing preoperative (average 66.1 ± 9.0) and postoperative (mean 89.5 ± 9.6) periods was found. These results are consistent with Kouloumentas et al [24] (95.3 ± 3.8) and in Sarraj et al [25] (89.5 ± 9.6) studies. A further subjective rating scale, Lysholm Knee Questionnaire, was also used.…”

Section: Discussionsupporting

confidence: 93%

“…All Inside G-ST BpTB obtained (61.5 ± 9.7 preoperatively and 92.4 ± 12.9 postoperatively) were similar to those reported in the literature by Volpi et al [26] (94.9 ± 5.1), Schurz et al [27] (mean 91.1) and Sarraj et al [25] (89.9 ± 5.7). The results we obtained reinforce the excellent outcomes shown in the literature and prove the effectiveness of this technique.…”

Section: Different Tegner Activity Scale Outcomes For Each Acl Reconssupporting

confidence: 88%

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All-inside technique in ACL reconstruction: mid-term clinical outcomes and comparison with AM technique (Hamstrings and BpTB grafts)

Pautasso

Capella

Barberis

et al. 2020

Eur J Orthop Surg Traumatol

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Purpose The aim of this study was to define the subjective and objective clinical results of all-inside surgical technique at a medium-term follow-up and to compare these results with those obtained from antero-medial (AM) ACL reconstruction technique using hamstrings (HS) or bone-patellar tendon-bone (BpTB) grafts to detect eventual superiority of one technique to another. Methods A retrospective analysis of routinely collected data was conducted. Inclusion criteria were ACL reconstruction through all-inside technique or AM technique with HS or BpTB performed between January 2015 and May 2018; age between 15 and 30 year old; minimum 24 months’ available follow-up. Exclusion criteria were contralateral ACL reconstruction; need for any other associated procedures during surgery. Clinical outcomes were assessed with KOOS, Lysholm, Tegner scores and KT-1000 device. Results According to the selection criteria, 157 patients were enrolled and divided subsequently into 3 groups: all-inside (51 patients), AM-HS (53 patients) and AM-BpTB (53 patients). A significant postoperative improvement of each score in all groups was detected. The mean KT-1000 was 3.1 ± 1.0 mm in all-inside group, while 3.3 ± 1.4 mm and 2.5 ± 0.4 mm in AM-HS and AM-BpTB groups, respectively. Comparing the results obtained, no statistically significant difference was found between the three techniques (p = 0.27). Statistically significant differences were highlighted in surgical duration: all-inside method was the longest (117′), followed by AM-BpTB surgery (101′) and AM-HS technique (87′). Conclusions The all-inside technique showed good postoperative results at medium-term follow-up. It could be a valuable solution for ACL reconstruction, especially in young patients due to its less invasiveness, despite surgical skills and time needed. Levels of evidence Level IV.

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Section: Discussionsupporting

confidence: 93%

Section: Different Tegner Activity Scale Outcomes For Each Acl Reconssupporting

confidence: 88%

All-inside technique in ACL reconstruction: mid-term clinical outcomes and comparison with AM technique (Hamstrings and BpTB grafts)

Pautasso

Capella

Barberis

et al. 2020

Eur J Orthop Surg Traumatol

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“…cycles in anteromedial portal femoral tunnel positioning technique is still unclear. Despite the fact that the transtibial technique has become less popular for ACL reconstruction, clinically important outcomes are actually comparable to literature figures for all the reported drilling techniques [30]. Furthermore, as the graft preparation board has been widely used nowadays, the comparison of the elongation and the clinical outcome between the static and the cyclic pretension might be also needed.…”

Section: Discussionmentioning

confidence: 68%

The effect of cyclic knee motion on the elongation of four-strand hamstring autograft in anterior cruciate ligament reconstruction: an in-situ pilot study

Jiang

Chen

et al. 2019

BMC Musculoskelet Disord

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Background Pretension of the viscoelastic graft by cyclic knee motion has been confirmed to decrease the graft creep and improve the outcome of anterior cruciate ligament (ACL) reconstruction. The purpose of the present study was to investigate the effect of cyclic knee motion on the elongation of the four-strand hamstring tendon autograft in situ and to explore the stable level cycle, in which the tendon length achieved a stable level. Methods The study was performed with 53 consecutive patients undergoing transtibial ACL reconstruction with four strand hamstring tendon from Aug 2013 to Apr 2015. 43 males and 10 females were included with mean age of 29 ± 10 years. The pretension of the tendons was operated by cyclical knee motion ranging from 0 to 110°after the femoral fixation with Endo-button. The tendon length after 10, 20, 30 and 40 cycles was measured respectively and compared by repeated measure ANOVA. Then multivariate logistic regression was used to investigate the effect of the patients’ parameters (age, gender, height, body weight, tendon length, etc.) on the elongation of the graft and the stable level cycle. Results The mean lengthening of the graft at 10, 20, 30 and 40 times was 3.0 ± 1.4 mm, 4.3 ± 1.5 mm, 4.8 ± 1.7 mm and 4.8 ± 1.8 mm respectively. No significant correlation was found between the elongation and the patients’ parameters. There was significant difference of the tendon length from 0 to 30 cycles (F = 264.8, df = 1.95, p <0.001). However, the tendon length achieved a stable level after 30 cycles and the median elongation from 30 cycles to 40 cycles was 0 (0–1) mm with no significant difference (F = 2.039, p = 0.159). The male and female tendon length achieved to a stable level at 20 cycles and 30 cycles respectively but with no significant difference ( p = 0.074). Conclusions The four-strand hamstring tendon was elongated after cyclic knee motion and the elongation achieved a stable level after 30 cycles for the transtibial technique. Both of the tendon elongation and the stable level cycle were not correlated with patients’ gender, age, preoperative duration, graft diameter and length.

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“…Total knee arthroplasty (TKA) and anterior cruciate ligament (ACL) reconstruction surgeries are two of the most performed orthopedic operations in the world [1][2][3][4]. TKA cases, revisions, and revisions per surgeon have all significantly increased in the last 10 years [2,5]; ACL reconstruction has similarly become more prevalent over the last 30 years, particularly in the pediatric population, corresponding with the United States' increase in youth sports injuries [1,3,6].…”

Section: Introductionmentioning

confidence: 99%

“…While both procedures are considered highly efficacious, with TKA having shown a 10- to 15-year implant survivorship rate of over 90% [ 2 ], and up to 92% of ACL reconstruction patients receiving “A” or “B” outcome scores in a 2018 systematic review by Sarraj et al [ 6 ], they are both operations consistently associated with moderate to severe postoperative pain [ 1 , 4 ]. Exposed by this are the sub-par anesthetic and analgesic perioperative pain management interventions used in the field of orthopedic surgery.…”

Section: Introductionmentioning

confidence: 99%

Reduction in opioid use with perioperative non-pharmacologic analgesia in total knee arthroplasty and ACL reconstruction: a systematic review

Juncker

Mirza

Gagnier

2021

SICOT-J

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Introduction: The world’s opioid epidemic has gotten increasingly severe over the last several decades and projects to continue worsening. Orthopedic surgery is the largest contributor to this epidemic, accounting for 8.8% of postoperative opioid dependence cases. Total knee arthroplasty (TKA) and anterior cruciate ligament (ACL) reconstruction are commonly performed orthopedic operations heavily reliant on opioids as the primary analgesic in the peri- and immediate postoperative period. These downfalls highlight the pressing need for an alternate, non-pharmacologic analgesic to reduce postoperative opioid use in orthopedic patients. The presented systematic review aimed to analyze and compare the most promising non-pharmacologic analgesic interventions in the available literature to guide future research in such a novel field. Methods: A systematic search of PubMed, MEDLINE, Embase, Cochrane, and Web of Science was performed for studies published before July 2020 based on the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, and the obtained manuscripts were evaluated for inclusion or exclusion against strict, pre-determined criteria. Risk-of-bias and GRADE (grades of recommendation, assessment, development, and evaluation) assessments were then performed on all included studies. Results: Six studies were deemed fit for inclusion, investigating three non-pharmacologic analgesics: percutaneous peripheral nerve stimulation, cryoneurolysis, and auricular acupressure. All three successfully reduced postoperative opioid use while simultaneously maintaining the safety and efficacy of the procedure. Discussion: The results indicate that all three presented non-pharmacologic analgesic interventions are viable and warrant future research. That said, because of its slight advantages in postoperative pain control and operational outcomes, cryoneurolysis seems to be the most promising. Further research and eventual clinical implementation of these analgesics is not only warranted but should be a priority because of their vast potential to reduce orthopedics surgeries’ contribution to the opioid epidemic.

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Over-the-top ACL reconstruction yields comparable outcomes to traditional ACL reconstruction in primary and revision settings: a systematic review

Abstract: IV.

Cited by 26 publications

References 48 publications

All-inside technique in ACL reconstruction: mid-term clinical outcomes and comparison with AM technique (Hamstrings and BpTB grafts)

All-inside technique in ACL reconstruction: mid-term clinical outcomes and comparison with AM technique (Hamstrings and BpTB grafts)

The effect of cyclic knee motion on the elongation of four-strand hamstring autograft in anterior cruciate ligament reconstruction: an in-situ pilot study

Reduction in opioid use with perioperative non-pharmacologic analgesia in total knee arthroplasty and ACL reconstruction: a systematic review

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