Revision Anterior Cruciate Surgery with Use of Bone-Patellar Tendon-Bone Autogenous Grafts

Noyes, Frank R.; Barber-Westin, Sue D.

doi:10.2106/00004623-200108000-00001

Cited by 236 publications

(195 citation statements)

References 37 publications

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“…However, if the patient had significant varus thrust gait or sustained medial knee pain, a high tibial osteotomy might be indicated. Nevertheless, such symptoms and function for high tibial osteotomy can be more frequent in patients undergoing revision ACL reconstruction [1,4,[14][15][16]. Therefore, our findings for more potential candidates in the revision ACL reconstruction group might not change even if we added patients' symptoms and function to the indications for high tibial osteotomy.…”

Section: Discussionmentioning

confidence: 77%

“…It is unclear why the revision ACL reconstruction group had more frequent varus malalignment than the primary ACL reconstruction group. The varus malalignment might be preexisting and a cause of failure in the reconstructed ACL [15,16], or this finding may be a consequence of failed ACL reconstruction owing to medial tibiofemoral joint space narrowing by progression of medial tibiofemoral OA. Its causal relationship would be important to determine for management of patients undergoing primary ACL reconstruction and revision ACL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction

Won

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Failed ACL reconstruction frequently is accompanied by irreparable medial meniscal tear and/or visible osteoarthritis (OA) in the medial tibiofemoral joint. Thus, assessment for the presence of varus malalignment is important in caring for patients in whom revision ACL reconstruction is considered. Questions/purposesWe determined whether patients undergoing revision ACL reconstruction (1) have more frequent varus malalignment coupled with more severe degrees of medial meniscal injury and/or medial tibiofemoral OA, and (2) would meet potential indications for high tibial osteotomy more frequently than patients undergoing primary ACL reconstruction. Methods We compared 58 patients undergoing revision ACL reconstruction and 116 patients undergoing primary ACL reconstruction. The mechanical tibiofemoral angle and the weight loading line (%) of the knee were measured. Additionally, radiographic degrees of OA in the tibiofemoral joints, and meniscal conditions were assessed. Then, proportions of potential candidates for high tibial osteotomy between the two groups were compared based on the following indications: (1) weight loading line less than 5%, (2) weight loading line less than 25% and medial tibiofemoral OA Kellgren-Lawrence Grade 3 or greater, or (3) weight loading line less than 25% and Kellgren-Lawrence Grade 2 medial tibiofemoral OA plus subtotal or total medial meniscectomy status. Results The revision ACL reconstruction group had more frequent varus malalignment in terms of proportion of knees with more varus mechanical tibiofemoral angle than varus 5°(19% versus 8%, p = 0.029) and knees with weight loading line less than 25% (22% versus 9%, p = 0.011). This group also had more frequent high-grade injury of the medial meniscus (34% versus 16%, p = 0.007) and tended to have more frequent higher-grade radiographic OA at the medial tibiofemoral joint (19% versus 9%, p = 0.076). The percentage of patients meeting potential indications for high tibial osteotomy was greater in this group (14% versus 2%, p = 0.003). Conclusions We found that many patients undergoing revision ACL surgery may be reasonable candidates for concurrent high tibial osteotomy to address concomitant alignment and OA issues in the medial compartment. However, whether that additional intervention is offset by added risk and morbidity should be the focus of a future study, as it cannot be answered by a study of this design.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction

Won

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Recognizing the difference between injuries involving the medial collateral ligament and the structures of the PMC has important clinical implications. Failure to recognize this difference has been implicated as a potential reason for failure of reconstructed cruciate ligaments in combined injuries [1][2][3]. This article provides information based on review of recent literature that describes the anatomy, biomechanical function, and current treatment principles regarding the PMC.…”

Section: Introductionmentioning

confidence: 99%

Surgical approach to the posteromedial corner: indications, technique, outcomes

Bauer

Stannard

2013

Curr Rev Musculoskelet Med

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Injuries to the medial side of the knee can occur in isolation or in conjunction with multiple other ligaments about the knee. In addition, medial knee injuries can involve isolated injury to the medial collateral ligament or include the posteromedial structures of the knee. Treatment strategies differ greatly depending on injury pattern. In order to select an appropriate treatment strategy, one must accurately diagnose the injury pattern based on clinical examination and the use of appropriate imaging studies. The fundamental basis for diagnosis of a medial sided knee injury stems from understanding the static and dynamic stabilizing structures that compose the medial side of the knee. It is our aim to define the anatomic roles of medial sided structures, their importance in protecting the biomechanical stability of the knee, as well as provide indications and our preferred procedures for surgical management of these complex injuries.

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“…6 Re-operations of the reconstructed ACL are frequently reported, however, because different operative techniques or rehabilitative programs to strengthen the joint can make the ligament unstable. [7][8][9] Extensive studies directed at enhancing the healing potential of the ACL by various growth factors have been conducted, and the more recent studies indicate that growth factors play important roles in stimulating fibroblast division that may influence ligament healing. [10][11][12][13] If native cytokines or growth factors were infused directly to the injured site, however, continuous treatment would be necessary due to their rapid local effects and their rapid elimination.…”

Section: Introductionmentioning

confidence: 99%

Proliferation of anterior cruciate ligament cells in vitro by photo‐immobilized epidermal growth factor

Woo

Kwon

Lee

et al. 2006

Journal Orthopaedic Research

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The purpose of this study was to explore the early treatment potential of anterior cruciate ligament (ACL) injuries using artificial juxtacrine stimulation by photo-immobilization of a growth factor. A photo-reactive epidermal growth factor complex (EGF-Az) was synthesized by conjugating EGF with N-(4-azidobenzoyloxy) succinimide followed by immobilization onto polystyrene culture plates using UV irradiation. ACL cells from human tissues (1 Â 10 5 cells, 100 ml/ well) were cultured as follows: control, no EGF; 50 ml native EGF; 50 ml EGF-Az immobilized; and 100 ml EGF-Az immobilized. The ACL cells were cultured long-term and evaluated for possible differences in their responses to EGF. An in vitro wound closure assay was developed to enable examination of cellular proliferation and migration. ACL cell proliferation was most evident in the photo-immobilized EGF culture group and was seen to increase in proportion to the amount of added EGF. In the in vitro wound closure assay, the lesioned area at 72 h after culture initiation was indistinguishable in the photo-immobilized cultures, but remained clearly visible in the controls. We conclude that photo-immobilized EGF induced rapid proliferation of ACL fibroblast cells by artificial juxtacrine stimulation and speculate that similar EGF immobilization onto bioabsorbable material (e.g., polyglycolic acid or polylactic acid) might contribute to a new therapy for the treatment of ACL injuries. ß

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Revision Anterior Cruciate Surgery with Use of Bone-Patellar Tendon-Bone Autogenous Grafts

Cited by 236 publications

References 37 publications

Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction

Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction

Surgical approach to the posteromedial corner: indications, technique, outcomes

Proliferation of anterior cruciate ligament cells in vitro by photo‐immobilized epidermal growth factor

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