The ACL Graft Has Different Cross-sectional Dimensions Compared With the Native ACL

Thein, Ran; Spitzer, Elad; Doyle, John B.; Khamaisy, Saker; Nawabi, Danyal H.; Chawla, Harshvardhan; Lipman, Joseph; Pearle, Andrew D.

doi:10.1177/0363546516645531

Cited by 23 publications

(30 citation statements)

References 28 publications

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“…Similar to previously reported clinical observations, 31 , 56 the reconstructed grafts in pigs had a substantially bigger cross-sectional area at the midsubstance of the ligament (mean, 147%) when compared with intact ACLs of the contralateral knee. Our regression analysis showed that the grafts with bigger deviations from the cross-sectional area of the native ACL resulted in greater cartilage damage across the tibiofemoral joint.…”

Section: Discussionsupporting

confidence: 87%

Structural and Anatomic Restoration of the Anterior Cruciate Ligament Is Associated With Less Cartilage Damage 1 Year After Surgery: Healing Ligament Properties Affect Cartilage Damage

Kiapour

Fleming

Murray

2017

Orthopaedic Journal of Sports Medicine

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Background:Abnormal joint motion has been linked to joint arthrosis after anterior cruciate ligament (ACL) reconstruction. However, the relationships between the graft properties (ie, structural and anatomic) and extent of posttraumatic osteoarthritis are not well defined.Hypotheses:(1) The structural (tensile) and anatomic (area and alignment) properties of the reconstructed graft or repaired ACL correlate with the total cartilage lesion area 1 year after ACL surgery, and (2) side-to-side differences in anterior-posterior (AP) knee laxity correlate with the total cartilage lesion area 1 year postoperatively.Study Design:Controlled laboratory study.Methods:Sixteen minipigs underwent unilateral ACL transection and were randomly treated with ACL reconstruction or bridge-enhanced ACL repair. The tensile properties, cross-sectional area, and multiplanar alignment of the healing ACL or graft, AP knee laxity, and cartilage lesion areas were assessed 1 year after surgery.Results:In the reconstructed group, the normalized graft yield and maximum failure loads, cross-sectional area, sagittal and coronal elevation angles, and side-to-side differences in AP knee laxity at 60° of flexion were associated with the total cartilage lesion area 1 year after surgery (R 2 > 0.5, P < .04). In the repaired group, normalized ACL yield load, linear stiffness, cross-sectional area, and the sagittal and coronal elevation angles were associated with the total cartilage lesion area (R 2 > 0.5, P < .05). Smaller cartilage lesion areas were observed in the surgically treated knees when the structural and anatomic properties of the ligament or graft and AP laxity values were closer to those of the contralateral ACL-intact knee. Reconstructed grafts had a significantly larger normalized cross-sectional area and sagittal elevation angle (more vertical) when compared with repaired ACLs (P < .02).Conclusion:The tensile properties, cross-sectional area, and multiplanar alignment of the healing ACLs or grafts and AP knee laxity in reconstructed knees were associated with the extent of tibiofemoral cartilage damage after ACL surgery.Clinical Relevance:These data highlight the need for novel ACL injury treatments that can restore the structural and anatomic properties of the torn ACL to those of the native ACL in an effort to minimize the risk of early-onset posttraumatic osteoarthritis.

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Section: Discussionsupporting

confidence: 87%

Structural and Anatomic Restoration of the Anterior Cruciate Ligament Is Associated With Less Cartilage Damage 1 Year After Surgery: Healing Ligament Properties Affect Cartilage Damage

Kiapour

Fleming

Murray

2017

Orthopaedic Journal of Sports Medicine

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“…In addition, the risk of graft impingement must be taken into consideration when selecting the ACL graft diameter. 28…”

Section: Discussionmentioning

confidence: 99%

Graft Diameter as a Predictor for Revision Anterior Cruciate Ligament Reconstruction and KOOS and EQ-5D Values: A Cohort Study From the Swedish National Knee Ligament Register Based on 2240 Patients

et al. 2017

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“…This has been suggested by other authors. Thein et al 34 evaluated the 3-dimensional shape and cross-sectional area of the native ACL versus the ACL graft and compared the impingement against the femoral notch and PCL, using the bilateral knee MRI of 27 patients with unilateral bone-patellar tendon-bone ACLR. They indicated that 19 operated knees (70%) showed contact or impingement between the ACL graft and the femoral notch as compared with zero knees with a native ACL.…”

Section: Discussionmentioning

confidence: 99%

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

et al. 2019

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Background: The combined influence of anatomic and operative factors affecting graft healing after anterior cruciate ligament (ACL) reconstruction within the femoral notch is not well understood. Purpose: To determine the influence of graft size and orientation in relation to femoral notch anatomy, with the signal/noise quotient (SNQ) of the graft used as a measure of graft healing after primary single-bundle ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: A total of 98 patients with a minimum 2-year follow-up after primary single-bundle ACL reconstruction with hamstring tendon autografts were included. Graft healing was evaluated at 1 year on magnetic resonance imaging (MRI) scan as the mean SNQ measured from 3 regions situated at sites at the proximal, middle, and distal graft. Patient characteristics, chondropenia severity score, tunnel sizes, tunnel locations, graft bending angle (GBA), graft sagittal angle, posterior tibial slope (PTS), graft length, graft volume, femoral notch volume, and graft-notch volume ratio (measured using postoperative 3-T high-resolution MRI) were evaluated to determine any association with 1-year graft healing. The correlation between 1-year graft healing and clinical outcome at minimum 2 years was also assessed. Results: There was no significant difference in mean SNQ between male and female patients ( P > .05). Univariate regression analysis showed that a low femoral tunnel ( P = .005), lateral tibial tunnel ( P = .009), large femoral tunnel ( P = .011), large tibial tunnel ( P < .001), steep lateral PTS ( P = .010), steep medial PTS ( P = .004), acute graft sagittal angle ( P < .001), acute GBA ( P < .001), large graft volume ( P = .003), and high graft-notch volume ratio ( P < .001) were all associated with higher graft SNQ values. A multivariate regression analysis showed 2 significant factors: a large graft-notch volume ratio ( P = .001) and an acute GBA ( P = .004). The 1-year SNQ had a weak correlation with 2-year Tegner Activity Scale score ( r = 0.227; P = .026) but no other clinical findings, such as International Knee Documentation Committee subjective and Lysholm scores and anterior tibial translation side-to-side difference. Conclusion: The 1-year SNQ value had a significant positive association with graft-notch volume ratio and GBA. Both graft size and graft orientation appeared to have a significant influence on graft healing as assessed on 1-year high-resolution MRI scan.

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The ACL Graft Has Different Cross-sectional Dimensions Compared With the Native ACL

Abstract: Native ACLs have a smaller cross-sectional area, are "flatter," and experience less incidence of impingement compared with anatomically placed BPTB ACL grafts.

Cited by 23 publications

References 28 publications

Structural and Anatomic Restoration of the Anterior Cruciate Ligament Is Associated With Less Cartilage Damage 1 Year After Surgery: Healing Ligament Properties Affect Cartilage Damage

Structural and Anatomic Restoration of the Anterior Cruciate Ligament Is Associated With Less Cartilage Damage 1 Year After Surgery: Healing Ligament Properties Affect Cartilage Damage

Graft Diameter as a Predictor for Revision Anterior Cruciate Ligament Reconstruction and KOOS and EQ-5D Values: A Cohort Study From the Swedish National Knee Ligament Register Based on 2240 Patients

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

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