Background: Rotational laxity control is one of the different options to improve functional results after anterior cruciate ligament reconstruction. Lateral extra-articular tenodesis has been proposed to reduce the rotational laxity, especially in challenging situations such as revision reconstruction after biological failure. We currently lack the practical clinical tools to objectively assess knee rotational laxities.
Hypothesis: Addition of a lateral tenodesis to anatomic single-bundle anterior cruciate ligament reconstruction with hamstring tendon graft could improve the knee laxity control, particularly the internal rotation, compared with a standard single-bundle anterior cruciate ligament reconstruction.
Study Design: Controlled laboratory study.
Methods: Twenty patients underwent navigated anatomic anteromedial bundle revision anterior cruciate ligament reconstruction with addition of percutaneous extra-articular tenodesis using the same hamstring tendon graft. The navigation was used to optimize femoral and tibial tunnel positions and to measure the knee kinematics in response to the anterior drawer test, Lachman test, maximum internal/external rotation test, and pivot-shift test. All patients underwent revision after failure without any technical error found or new trauma. Two sequential reconstruction protocols were used to assess the contribution of the extra-articular tenodesis and single anteromedial bundle anterior cruciate ligament reconstruction to restrain tibial translations and coupled axial rotation occurring with the manually performed clinical laxity tests. In group A, the intra-articular reconstruction was fixed first and then the lateral tenodesis was fixed, and in group B, the protocol was reversed. Measurements were performed before the reconstruction, after the first part was fixed, and after the second part was fixed in each protocol.
Results: At 90° of flexion, addition of lateral tenodesis had a significant effect on coupled internal rotation (P = .003). Addition of the intra-articular reconstruction to lateral tenodesis had a significant effect (P = .001) in reducing anterior tibial translation of the medial compartment, and the effect was also significant (P = .0001) in reduction of lateral compartment translation. For the rotational envelope, lateral tenodesis had a significant effect (P = .0001) in reducing maximum internal rotation at 90° of flexion.
Conclusion: Addition of an extra-articular procedure provided no significant improvement to anterior tibial translation and improved internal tibial rotation control only at 90° of flexion.
Background: Current trends in anterior cruciate ligament reconstruction (ACLR) have been toward anatomical reconstruction that restores the normal size and location of the anterior cruciate ligament insertions and its 2 bundles, the posterolateral (PL) and anteromedial (AM) bundles. This has resulted in a more individualized approach to ACLR. Several studies have shown that the size of the anterior cruciate ligament insertion sites is variable; however, these studies are limited by use of relatively small sample sizes and cadaveric specimens.
Purpose: This study was undertaken to evaluate the in vivo size variability of the anterior cruciate ligament insertion sites and its AM and PL bundles during arthroscopy in a large series of patients and to correlate these findings with individuals’ physical characteristics (height, weight, and body mass index).
Study Design: Cross-sectional study; Level of evidence, 3.
Methods: In 137 patients undergoing ACLR during the first 6 months after injury, the femoral and tibial anterior cruciate ligament insertion sites and the 2 bundles were identified, marked with electrocautery, and measured with an arthroscopic ruler. Additionally, physical characteristics of the patients, including self-reported height, weight, and body mass index, were recorded.
Results: The tibial anterior cruciate ligament insertion site had a mean length of 17.0 ± 2.0 mm. The tibial AM bundle length was 9.1 ± 1.2 mm and the width was 9.2 ± 1.1 mm. The tibial PL bundle insertion site length averaged 7.4± 1.0 mm and the width averaged 7.0 ± 1.0 mm. The femoral insertion sites had a mean length of 16.5 ± 2.0 mm. The length of the femoral AM bundle insertion site averaged 9.2 ± 1.2 mm and the width averaged 8.9 ± 0.9 mm. The femoral PL bundle insertion site length averaged 7.1 ± 1.1 mm and the width averaged 6.9 ± 1.0 mm. There were significant positive correlations between patient height and weight (P < .05) with femoral and tibial anterior cruciate ligament insertion site length, tibial PL bundle insertion site length, femoral AM bundle insertion site length, and tibial AM bundle and PL bundle insertion site areas. However, the coefficients of determination values were low (1.0% to 19.4%).
Conclusion: There is a large variation in size of the anterior cruciate ligament insertion sites and the AM and PL bundles. Additionally, there are significant but weak correlations between the size of the insertions and height, weight, and body mass index of the individual patient.
Background
The anterior cruciate ligament has been shown to have poor healing ability, and reconstruction is the standard treatment.
Hypothesis
Primary anterior cruciate ligament repair combined with bone marrow stimulation could restore stability and function in athletes with acute anterior cruciate ligament incomplete tears.
Study Design
Case series; Level of evidence, 4.
Methods
Among a group of 99 patients with clinically diagnosed anterior cruciate ligament acute lesions, 26 athletes with arthroscopically confirmed incomplete anterior cruciate ligament proximal tears were treated with primary repair combined with bone marrow stimulation of the anterior cruciate ligament femoral attachment site. Postoperatively, all patients underwent a specific rehabilitation program. All patients were prospectively evaluated; outcome measures were assessed using Marx, Noyes, Tegner, Single Assessment Numeric Evaluation, Lysholm, and International Knee Documentation Committee scores. Anterior tibial translation was measured using Rolimeter instrument under anesthesia and at final follow-up.
Results
All athletes were followed up for a mean 25.3 months (range, 17–38 months). Mean age was 26.6 years. Mean preinjury Tegner was 7.1 (SD, 1.1) and final Tegner 6.7 (SD, 1.4); mean preinjury Marx was 11.0 (SD, 3.4) and final Marx 9.6 (SD, 3.1); mean preinjury Noyes was 82.5 (SD, 5.8) and final Noyes 83.3 (SD, 7.2). These scores were not statistically different at P values of .020, .011, and .303, respectively. Final Single Assessment Numeric Evaluation rating was significantly lower than was preinjury Single Assessment Numeric Evaluation rating. This was mainly related to decreased self-confidence in high-risk sports and fear of new injury. Final Single Assessment Numeric Evaluation rating and Tegner scores were significantly higher than were their respective preoperative values. Mean Rolimeter side-to-side difference of anterior knee translation was significantly reduced from 3.5 mm (SD, 0.7) preoperatively to 1.3 mm (SD, 0.8) postoperatively.
Conclusion
In this athletic population, anterior cruciate ligament primary repair in acute incomplete lesion combined with bone marrow stimulation effectively restored knee stability and function.
