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      Rotatory instability of the knee after ACL tear and reconstruction

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          Abstract

          Although ACL reconstructions provide satisfactory clinical results nowadays, regardless of the type of graft or the surgical technique used (out-in vs in-out or single- vs double-bundle), the residual rotatory instability which is often detected at clinical follow-ups is still a matter of concern among surgeons. In this paper we try to analyze all the aspects which might contribute to this phenomenon by summarizing the biomechanical functions of the two bundles of the ACL, and by evaluating all the other factors strictly related to the rotatory instability of a reconstructed knee, such as the anatomical positioning of the single- or double-bundle new ACL, or the importance of a valid lateral compartment (LCL, ALTFL). Clinical, biomechanical and cadaver studies are discussed in order to contribute to better understanding of the origin of post-operative residual rotatory instability.

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          Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction.

          Kyle Anderson, David Collon, Scott Tashman … (2004)
          The effectiveness of anterior cruciate ligament reconstruction for restoring normal knee kinematics is largely unknown, particularly during sports movements generating large, rapidly applied forces. Under dynamic in vivo loading, significant differences in 3-dimensional kinematics exist between anterior cruciate ligament-reconstructed knees and the contralateral, uninjured knees. Prospective, in vivo laboratory study. Kinematics of anterior cruciate ligament-reconstructed and contralateral (uninjured) knees were evaluated for 6 subjects during downhill running 4 to 12 months after anterior cruciate ligament reconstruction, using a 250 frame/s stereoradiographic system. Anatomical reference axes were determined from computed tomography scans. Kinematic differences between the uninjured and reconstructed limbs were evaluated with a repeated-measures analysis of variance. Anterior tibial translation was similar for the reconstructed and uninjured limbs. However, reconstructed knees were more externally rotated on average by 3.8 +/- 2.3 degrees across all subjects and time points (P =.0011). Reconstructed knees were also more adducted, by an average of 2.8 +/- 1.6 degrees (P =.0091). Although differences were small, they were consistent in all subjects. Anterior cruciate ligament reconstruction failed to restore normal rotational knee kinematics during dynamic loading. Although further study is required, these abnormal motions may contribute to long-term joint degeneration associated with anterior cruciate ligament injury/reconstruction.
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            Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts.

            L Pinczewski, Alison Waller, James Linklater … (2012)
            There is a lack of prospective studies comparing the long-term outcome of endoscopic anterior cruciate ligament (ACL) reconstruction with either a patellar tendon or hamstring tendon autograft. This prospective longitudinal study compared the results of isolated endoscopic ACL reconstruction utilizing a 4-strand hamstring tendon (HT) or patellar tendon (PT) autograft over a 15-year period with respect to reinjury, clinical outcomes, and the development of osteoarthritis. Cohort study; Level of evidence, 2. Ninety consecutive patients with isolated ACL rupture were reconstructed with a PT autograft, and 90 patients received an HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10, and 15 years. Assessment included the International Knee Documentation Committee (IKDC) knee ligament evaluation including radiographic evaluation, KT-1000 arthrometer testing, and Lysholm knee score. Patients who received the PT graft had significantly worse outcomes compared with those who received the HT graft at 15 years for the variables of radiologically detectable osteoarthritis (grade A: 46% in PT and 69% in HT; P = .04), motion loss (extension deficit <3°: 79% in PT and 94% in HT; P = .03), single-legged hop test (grade A: 65% in PT and 92% in HT; P = .001), participation in strenuous activity (very strenuous or strenuous: 62% of PT and 77% of HT; P = .04), and kneeling pain (moderate or greater pain: 42% of PT and 26% of HT; P = .04). There was no significant difference between the HT and PT groups in overall IKDC grade (grade A: 47% of PT and 57% of HT; P = .35). An ACL graft rupture occurred in 17% of the HT group and 8% of the PT group (P = .07). An ACL graft rupture was associated with nonideal tunnel position (odds ratio [OR], 5.0) and male sex (OR, 3.2). Contralateral ACL rupture occurred in significantly more PT patients (26%) than HT patients (12%) (P = .02) and was associated with age ≤18 years (OR, 4.1) and the PT graft (OR, 2.6). Anterior cruciate ligament reconstruction using ipsilateral autograft continues to show excellent results in terms of patient satisfaction, symptoms, function, activity level, and stability. The use of HT autograft does, however, show better outcomes than the PT autograft in all of these outcome measures. Additionally, at 15 years, the HT graft-reconstructed ACLs have shown a lower rate of radiological osteoarthritis.
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              Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study.

              Max Ekdahl, F Fu, Mario Ferretti … (2007)
              Anatomic tunnel placement is critical to the success of anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to determine qualitatively and quantitatively the osseous landmarks of femoral attachment of the ACL. The femoral attachment of the ACL was studied histologically in seven human fetuses, arthroscopically in 60 patients who underwent ACL surgery, and grossly in 16 cadaveric knees. Three-dimensional laser digitizer pictures of the cadaveric specimens were taken to quantify length, area, and angulations of the femoral attachment of the ACL. Two different osseous landmarks were detected. An osseous ridge that runs from proximal to distal ends was present in all the arthroscopic patients and cadaveric knees. It was named "lateral intercondylar ridge." Another osseous landmark between the femoral attachment of the anteromedial (AM) and posterolateral (PL) bundles running from anterior to posterior was observed in 6 out of 7 fetuses, 49 out of 60 arthroscopic patients, and 13 out of 16 cadaveric knees. It was named "lateral bifurcate ridge." A change of slope between the femoral attachment of the AM and PL bundles was observed in all specimens studied. The femoral attachment of the AM bundle formed an angle with the PL bundle of 27.6 degrees +/- 8.8 degrees and a radius of curvature of 25.7 +/- 12 mm. The area of the entire ACL footprint, AM, and PL bundle was 196.8 +/- 23.1 mm(2), 120 +/- 19 mm(2), and 76.8 +/- 15 mm(2), respectively. The ACL femoral attachment has a unique topography with a constant presence of the lateral intercondylar ridge and often an osseous ridge between AM and PL femoral attachment, the lateral bifurcate ridge. These findings may assist surgeons to perform ACL surgery in a more anatomic fashion.
              Article 0 comments Cited 71 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Andrea Ferretti: aferretti51@virgilio.it
                Antonio Vadalà: anto.vada@libero.it
                Journal
                Journal ID (nlm-ta): J Orthop Traumatol
                Journal ID (iso-abbrev): J Orthop Traumatol
                Title: Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology
                Publisher: Springer Milan (Milan )
                ISSN (Print): 1590-9921
                ISSN (Electronic): 1590-9999
                Publication date (Electronic): 6 August 2013
                Publication date PMC-release: 6 August 2013
                Publication date (Print): June 2014
                Volume: 15
                Issue: 2
                Pages: 75-79
                Affiliations
                Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant’andrea University Hospital, La Sapienza University, Via di Grottarossa, 1037, 00189 Rome, Italy
                Article
                Publisher ID: 254
                DOI: 10.1007/s10195-013-0254-y
                PMC ID: 4033809
                PubMed ID: 23917728
                SO-VID: 0ed06573-ae2c-4207-b332-9bf9482f596d
                Copyright © © The Author(s) 2013
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                Date received : 30 January 2013
                Date accepted : 9 July 2013
                Categories
                Subject: Review Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2014

                ScienceOpen disciplines: Orthopedics
                Keywords: acl reconstruction,single-bundle,double-bundle,navigator system,rotatory instability
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: acl reconstruction, single-bundle, double-bundle, navigator system, rotatory instability

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