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      Characteristics of elongated and ruptured anterior cruciate ligament grafts: An analysis of 21 consecutive revision cases

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          Abstract

          Background/objective

          Anterior cruciate ligament (ACL) reconstructions often fail without graft rupture. The purpose of this study was to compare the characteristics of patients with elongated and ruptured bone-patellar tendon-bone (BTB) grafts that required revision surgery.

          Methods

          Twenty one patients who required revisions of a BTB-reconstructed ACL between 2010 and 2015 were enrolled in this study. All patients were evaluated for bone tunnel position using computed tomography. Tunnel angle was calculated with radiographs. Stability under anaesthesia, and meniscus and cartilage condition were evaluated during the revision surgery. Age at primary surgery, time between primary and revision surgery, activity level, original tunnel position of the graft, and meniscus and cartilage condition were compared between elongated and ruptured grafts.

          Results

          Age at primary surgery was not significantly different between the two groups ( p = 0.528). Time between primary and revision surgery as well as activity level were also not significantly different between the two groups ( p = 0.010 and p = 0.307, respectively). Femoral bone tunnel position was more proximal ( p = 0.003), and radiographic tunnel angle was not significantly different between the two groups ( p = 0.029). The rupture group was significantly more unstable on the pivot shift ( p < 0.003). Meniscus degeneration, meniscus tear, and cartilage damage were not significantly different between the two groups ( p = 0.030, p = 0.311, and p = 0.505, respectively).

          Conclusion

          The location of the original femoral tunnel was more proximal in patients with elongated grafts than in those with ruptured grafts. Different bone tunnel position from native ACL might lead to graft elongation.

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          Most cited references20

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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.
          Article 0 comments Cited 367 times – based on 0 reviews     Review now
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            Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 2002 Richard O'Connor Award paper.

            Haiyan Fu, Yukihisa Fukuda, Savio Woo … (2003)
            To study how well an anterior cruciate ligament (ACL) graft fixed at the 10 and 11 o'clock positions can restore knee function in response to both externally applied anterior tibial and combined rotatory loads by comparing the biomechanical results with each other and with the intact knee. Biomechanical experiment using human cadaveric specimens. Ten human cadaveric knees (age, 41+/-13 years) were reconstructed by placing a bone-patellar tendon-bone graft at the 10 and 11 o'clock positions, in a randomized order, and then tested using a robotic/universal force-moment sensor testing system. Two external loading conditions were applied: (1) 134 N anterior tibial load with the knee at full extension, 15 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion, and (2) a combined rotatory load of 10 N-m valgus and 5 N-m internal tibial torque with the knee at 15 degrees and 30 degrees of flexion. The resulting kinematics of the reconstructed knee and in situ forces in the ACL graft were determined for each femoral tunnel position. In response to a 134-N anterior tibial load, anterior tibial translation (ATT) for both femoral tunnel positions was not significantly different from the intact knee except at 90 degrees of knee flexion as well as at 60 degrees of knee flexion for the 10 o'clock position. There was no significant difference in the ATT between the 10 and 11 o'clock positions, except at 90 degrees of knee flexion. Under a combined rotatory load, however, the coupled ATT for the 11 o'clock position was approximately 130% of that for the intact knee at 15 degrees and 30 degrees of flexion. For the 10 o'clock position, the coupled ATT was not significantly different from the intact knee at 15 degrees of flexion and approximately 120% of that for the intact knee at 30 degrees of flexion. Coupled ATT for the 10 o'clock position was significantly smaller than for the 11 o'clock position at 15 degrees and 30 degrees of flexion. The in situ force in the ACL graft was also significantly higher for the 10 o'clock position than the 11 o'clock position at 30 degrees of flexion in response to the same loading condition (70 +/- 18 N v 60 +/- 15 N, respectively). The 10 o'clock position more effectively resists rotatory loads when compared with the 11 o'clock position as evidenced by smaller ATT and higher in situ force in the graft. Despite the fact that ACL grafts placed at the 10 or 11 o'clock positions are equally effective under an anterior tibial load, neither femoral tunnel position was able to fully restore knee stability to the level of the intact knee.
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              Patient-relevant outcomes fourteen years after meniscectomy: influence of type of meniscal tear and size of resection.

              M Englund, M Englund, Wouter H. Roos … (2001)
              To study long-term patient-relevant outcomes after meniscectomy, a surgical procedure associated with a high risk of knee osteoarthritis (OA). Principal objectives were to compare traumatic with degenerative meniscal tear and partial with subtotal meniscectomy. We studied a well-defined cohort of 205 patients who had undergone isolated unilateral meniscectomy between 1983 and 1985. There was no previous knee surgery and all knees were stable. The type of meniscal tear and surgical resection was ascertained by review of medical records. Patients were followed up after 14 yr (range 12-15 yr) by self-administered questionnaires, one generic [Short Form 36 (SF-36)] and one disease-specific [Knee Injury and Osteoarthritis Outcome Score (KOOS)]. In a multivariate analysis, using the Sports and Recreation Function and knee-related Quality of Life subscales of the KOOS questionnaire as dependent variables, patients with a degenerative tear scored significantly worse than individuals with a traumatic tear (P < or = 0.001). When we analysed unmatched subgroups and age- and sex-matched patients with degenerative or traumatic lesions, the same result was found for the knee-specific outcome (P < or = 0.02) and SF-36 except for Social Functioning (P < or = 0.04). There was no difference in outcome for the total cohort according to the type of resection. However, subgroup analyses showed that patients who underwent subtotal meniscectomy for a degenerative tear scored significantly worse on the knee-specific outcome than individuals who had had a partial meniscectomy for the same type of tear (P < or = 0.02). The long-term outcome of meniscal injury and surgery appears to be determined largely by the type of meniscal tear. Furthermore, our findings support the use of minimal meniscal resection in the treatment of degenerative tears. We suggest that the disease processes associated with the development of OA of the joint cartilage may also be active in the meniscus, and that a tear in a meniscus with degenerative changes might be regarded as the first sign of OA of the joint.
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                Author and article information

                Contributors
                Kohei Iio
                Journal
                Journal ID (nlm-ta): Asia Pac J Sports Med Arthrosc Rehabil Technol
                Journal ID (iso-abbrev): Asia Pac J Sports Med Arthrosc Rehabil Technol
                Title: Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology
                Publisher: Asia-Pacific Knee, Arthroscopy and Sports Medicine Society
                ISSN (Electronic): 2214-6873
                Publication date PMC-release: 16 January 2017
                Publication date Collection: April 2017
                Publication date (Electronic): 16 January 2017
                Volume: 8
                Pages: 1-7
                Affiliations
                [a ]Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
                [b ]Department of Orthopaedic Surgery, National Hospital Hospital Organization Hirosaki National Hospital, Aomori, Japan
                [c ]Department of Rehabilitation, Hirosaki University Graduate School of Medicine, Aomori, Japan
                Author notes
                [∗ ]Corresponding author. Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan.Hirosaki University Graduate School of Medicine5 Zaifu-choHirosakiAomori036-8562Japan k_110@ 123456grace.ocn.ne.jp
                Article
                Publisher ID: S2214-6873(16)30294-1
                DOI: 10.1016/j.asmart.2016.12.001
                PMC ID: 5721916
                SO-VID: 813ba733-6f10-4350-84f8-0248ef6cf66c
                Copyright © Copyright © 2016, Asia Pacific Knee, Arthroscopy and Sports Medicine Society. Published by Elsevier (Singapore) Pte Ltd.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 16 August 2016
                Date revision received : 30 November 2016
                Date accepted : 1 December 2016
                Categories
                Subject: Original Article

                Keywords: failure pattern,graft elongation,revision anterior cruciate ligament,tunnel position
                Data availability:
                Keywords: failure pattern, graft elongation, revision anterior cruciate ligament, tunnel position

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