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      20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope

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          Abstract

          No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored.

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          Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

          Amelia J Wiggins, Ravi K Grandhi, Daniel Schneider … (2016)
          Injury to the ipsilateral graft used for reconstruction of the anterior cruciate ligament (ACL) or a new injury to the contralateral ACL are disastrous outcomes after successful ACL reconstruction (ACLR), rehabilitation, and return to activity. Studies reporting ACL reinjury rates in younger active populations are emerging in the literature, but these data have not yet been comprehensively synthesized.
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            Effects of increasing tibial slope on the biomechanics of the knee.

            J Giffin, Thore Zantop, T M Vogrin … (2004)
            To determine the effects of increasing anterior-posterior (A-P) tibial slope on knee kinematics and in situ forces in the cruciate ligaments. Ten cadaveric knees were studied using a robotic testing system using three loading conditions: (1) 200 N axial compression; (2) 134 N A-P tibial load; and (3) combined 200 N axial and 134 N A-P loads. Resulting knee kinematics were determined before and after a 5-mm anterior opening wedge osteotomy. Resulting in situ forces in each cruciate ligament were determined. Tibial slope was increased from 8.8 +/- 1.8 degrees to 13.2 +/- 2.1 degrees, causing an anterior shift in the resting position of the tibia relative to the femur up to 3.6 +/- 1.4 mm. Under axial compression, the osteotomy caused a significant anterior tibial translation up to 1.9 +/- 2.5 mm (90 degrees ). Under A-P and combined loads, no differences were detected in A-P translation or in situ forces in the cruciates (intact versus osteotomy). Results suggest that small increases in tibial slope do not affect A-P translations or in situ forces in the cruciate ligaments. However, increasing slope causes an anterior shift in tibial resting position that is accentuated under axial loads. This suggests that increasing tibial slope may be beneficial in reducing tibial sag in a PCL-deficient knee, whereas decreasing slope may be protective in an ACL-deficient knee.
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              Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery.

              Julian A Feller, Clare L. Ardern, Nicholas F Taylor … (2011)
              Most people have not returned to their preinjury level of sports participation at 12 months after anterior cruciate ligament (ACL) reconstruction surgery. Twelve months' follow-up may be too early to assess return-to-sport outcomes accurately. This study was undertaken to evaluate the medium-term return-to-sport outcomes after ACL reconstruction surgery. Case series; Level of evidence, 3. A self-report questionnaire was used to collect data at 2 to 7 years after ACL reconstruction surgery regarding preinjury sports participation, postoperative sports participation, and subjective knee function. The main inclusion criteria were participation in regular sports activity before injury and the attendance at routine surgical follow-up appointments. A total of 314 participants (mean age, 32.5 ± 10.2 years) were included at a mean 39.6 ± 13.8 months after ACL reconstruction surgery. At follow-up, 45% were playing sport at their preinjury level and 29% were playing competitive sport. Ninety-three percent of the study sample had attempted sport at some time after their ACL reconstruction surgery. Those who had not attempted their preinjury level of sport by 12 months after surgery were just as likely to have returned to preinjury level by 39 months after surgery as those who had played sport by 12 months (risk ratio, 1.1; 95% confidence interval, 0.76-1.6). Less than 50% of the study sample had returned to playing sport at their preinjury level or returned to participating in competitive sport when surveyed at 2 to 7 years after ACL reconstruction surgery. Return to the preinjury level of sport at 12 months after surgery was not predictive of participation at the preinjury level in the medium term, which suggests that people who return to sport within 12 months may not maintain their sports participation.
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                Author and article information

                Journal
                Title: The American Journal of Sports Medicine
                Abbreviated Title: Am J Sports Med
                Publisher: SAGE Publications
                ISSN (Print): 0363-5465
                ISSN (Electronic): 1552-3365
                Publication date Created: April 24 2017
                Publication date Created: March 2018
                Publication date (Electronic): December 15 2017
                Publication date (Print): March 2018
                Volume: 46
                Issue: 3
                Pages: 531-543
                Affiliations
                [1 ]North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia
                [2 ]Castlereagh Imaging, Sydney, Australia
                [3 ]University of Notre Dame, South Bend, Indiana, USA
                Article
                DOI: 10.1177/0363546517741497
                PubMed ID: 29244525
                SO-VID: 02f9675d-a970-457c-b5bf-7c85e9dd7edb
                Copyright © © 2018
                License:

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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