scholarly journals Arthroscopic ACL Reconstruction After Failed ACL Repair

2021 ◽  
Vol 10 (4) ◽  
pp. e1001-e1005
Author(s):  
Thomas Fradin ◽  
Ibrahim M. Haidar ◽  
Johnny Rayes ◽  
Cédric Ngbilo ◽  
Thais Dutra Vieira ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Acl Repair

scholarly journals Bridge-Enhanced ACL Repair: Two Year Results of the First In Human Study

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0019
Author(s):  
Martha M. Murray ◽  
Leslie Kalish ◽  
Braden C. Fleming ◽  
Brett Flutie ◽  
Laura Thurber ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Human Study ◽  
Hamstring Tendon ◽  
Suture Repair ◽  
Hamstring Autograft ◽  
Acl Repair ◽  
Time Points ◽  
Patient Reported ◽  
Kt 1000 ◽  
Objective Score

Objectives: The Bridge-Enhanced ACL Repair (BEAR) procedure is an alternate form of anterior cruciate ligament (ACL) surgery that involves suture repair of the ligament combined with a scaffold to bridge the gap between the torn ligament ends. In this paper, we report outcomes of this procedure and a non-randomized concurrent control group receiving ACL reconstruction with quadrupled hamstring tendon autograft. We hypothesized that patients treated with Bridge-Enhanced ACL Repair would have physical exam findings, patient reported outcomes and adverse events at one and two years that were similar to patients treated with ACL reconstruction. Methods: This was an observational cohort study. Twenty patients were enrolled. Ten patients received a Bridge-Enhanced ACL Repair (BEAR®) and 10 received a hamstring autograft ACL reconstruction. Outcomes were assessed at time points up to 2 years post-operatively, including the International Knee Documentation Committee (IKDC) Subjective Score, the IKDC Objective score, KT-1000 testing for AP laxity and functional testing. Results: There were no graft or repair failures in the first two years after surgery. The IKDC Subjective Scores in both groups improved significantly from baseline (p< 0.0001) but were similar in BEAR and ACL reconstruction groups at 12 and 24 months. An IKDC Objective score of A (normal) was found in 44% of the patients in the BEAR group and 29% of the patients in the ACL reconstruction group at two years; no patients in either group had a grade of C (abnormal) or D (severely abnormal). KT-1000 testing demonstrated a side to side difference that was similar in the two groups at 2 years (mean(±SD) 1.9(± 2.1) mm in the BEAR group, 3.1(± 2.7) mm in the ACLR group). Functional hop testing results were similar in the two groups at 1 and 2 years after surgery. Hamstring strength indices measured by dynamometer were significantly higher at all time points in the BEAR group than in the hamstring autograft group (mean percentages relative to contralateral side at two years, 98.6%(±10.5%) vs 56.3%(±19.0%), p=0.0001). Conclusion: In a small first-in-human study, Bridge-Enhanced ACL Repair produced similar outcomes to ACL reconstruction with autograft quadruple bundle hamstring tendon.

Return to Sports after Anterior Cruciate Ligament Injury: a Matched-Pair Analysis of Repair with Internal Brace and Reconstruction Using Hamstring or Quadriceps Tendons

2020 ◽  
Author(s):  
Reinhold Ortmaier ◽  
Christian Fink ◽  
Wolfgang Schobersberger ◽  
Harald Kindermann ◽  
Iris Leister ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Well Being ◽  
Matched Pair ◽  
Return To Sports ◽  
Acl Repair ◽  
Sports Activity ◽  
Matched Pair Analysis ◽  
Internal Brace

Abstract Purpose The purpose of this study was to evaluate sports activity before anterior cruciate ligament (ACL) injury and after surgical treatment of ACL rupture comparing ACL repair with an Internal Brace to ACL reconstruction using either a hamstring (HT) or quadriceps tendon (QT) autograft. Methods Between 12/2015 and 10/2016, we recruited 69 patients with a mean age of 33.4 years for a matched-pair analysis. Twenty-four patients who underwent Internal Brace reconstruction were matched according to age (± 5 years), gender, Tegner activity scale (± 1), BMI (± 1) and concomitant injuries with 25 patients who had undergone HT reconstruction and 20 patients who had undergone QT reconstruction. The minimum follow-up was 12 months. Results Overall, the return-to-sports rate was 91.3 %. There were no significant differences (p ≥ 0.05) in the number of sports disciplines and the time before return to sports within or among the groups. Overall and within the groups, the level of sports participation did not change significantly (p ≥ 0.05) postoperatively. The patients' sense of well-being was excellent after either ACL repair with an Internal Brace or ACL reconstruction with autologous HT or QT. Conclusion At short-term follow-up, ACL repair using an Internal Brace enables sports activity and provides a sense of well-being similar to that of classic ACL reconstruction using hamstring or quadriceps tendon autografts in a selected patient population. Level of Evidence: Level III Retrospective comparative study.

scholarly journals ANATOMICAL DISSECTION AND CT IMAGING OF THE ANTERIOR CRUCIATE AND MEDIAL COLLATERAL LIGAMENT FOOTPRINT ANATOMY IN SKELETALLY IMMATURE CADAVER KNEES

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0014
Author(s):  
Kevin Shea ◽  
Peter C. Cannamela ◽  
Aleksei Dingel ◽  
Peter D. Fabricant ◽  
John D. Polousky ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Medial Collateral Ligament ◽  
Interquartile Range ◽  
Skeletally Immature ◽  
Collateral Ligament ◽  
Acl Repair ◽  
Median Distance ◽  
Text Figure ◽  
Anterior Cruciate ◽  
Femoral Physis

Background: Anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries in skeletally immature patients are increasingly recognized and surgically treated. However, the relationship between the footprint anatomy and the physes are not clearly defined. The purpose of this study was to identify the origin and insertion of the ACL and MCL, and define the footprint anatomy in relation to the physes in skeletally immature knees. Methods: Twenty-nine skeletally immature knees from 16 human cadaver specimens were dissected and divided into two groups: Group A (ages 2-5 years), and Group B (ages 7-11 years). Metallic markers were placed to mark the femoral and tibial attachments of the ACL and MCL. CT scans were obtained for each specimen used to measure the distance from the center of the ligament footprints to the respective distal femoral and proximal tibial physes. Results: Median distance from the ACL femoral epiphyseal origin to the distal femoral physis was 0.30 cm (interquartile range, 0.20 cm to 0.50 cm) and 0.70 cm (interquartile range, 0.45 cm to 0.90 cm) for Groups A and B, respectively. The median distance from the ACL epiphyseal tibial insertion to the proximal tibial physis for Groups A and B were 1.50 cm (interquartile range, 1.40 cm to 1.60 cm) and 1.80 cm (interquartile range, 1.60 cm to 1.85 cm), respectively. Median distance from the MCL femoral origin on the epiphysis to the distal femoral physis was 1.20 cm (interquartile range, 1.00 cm to 1.20 cm) and 0.85 cm (interquartile range, 0.63 cm to 1.00 cm) for Groups A and B, respectively. Median distance from the MCL insertion on the tibial metaphysis to the tibial physis was 3.05 cm (interquartile range, 2.63 cm to 3.30 cm) and 4.80 cm (interquartile range, 3.90 cm to 5.10 cm) for Groups A and B, respectively. Conclusion: Surgical reconstruction is a common treatment for ACL injury, and occasionally MCL reconstruction or repair is also required. Cadaveric dissection and CT scanning of exceptionally rare pediatric tissue clearly defines the location of the ACL and MCL with respect to the femoral and tibial physes, and may guide surgeons for physeal respecting procedures for both ACL reconstruction, and ACL repair procedures. Clinical Relevance: In addition to ACL reconstruction, recent basic science and clinical research suggest that ACL repair may be more commonly performed in the future. MCL repair and reconstruction is also occasionally required in skeletally immature patients. This information may be useful to help surgeons avoid or minimize physeal injury during ACL/MCL reconstructions and/or repair in skeletally immature patients. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]

scholarly journals Primary ACL Repair Revisited: Back to the Future?

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0044
Author(s):  
Bruce Reider
Keyword(s):  
Acl Reconstruction ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
The United States ◽  
Current Recommendation ◽  
Acl Repair ◽  
Early Results ◽  
Select Group ◽  
Anterior Cruciate

Primary repair of the Anterior Cruciate Ligament (ACL) had some popularity among a select group of surgeons in the mid 20th century. Techniques described by Ivar Palmer of Sweden were adopted in the United States by surgeons such as O’Donoghue, Marshall, and Feagin. However, promising early results were followed by disappointing failure rates at 5-year follow-up, and ACL reconstruction became the norm. Recently there has been a renewed interest in ACL repair. One use has been in conjunction with ACL reconstruction as remnant preservation. Isolated repair has been reported using a variety of techniques, including bridge-enhanced repair (BEAR) with a sheath, meticulous suturing with or without suture tape reinforcement, and repair to a dynamic intraligamentary stabilization (DIS) device. Early reports have been encouraging. However, in the case of the BEAR, the series is so far small and short-term; the two other techniques have more results reported but they include some studies with a concerning level of failure, especially in younger or more active patients. My current recommendation is to await more clinical documentation before adopting these technique in lieu of ACL reconstruction.

scholarly journals Repair vs. Reconstruction for Acute Isolated ACL Tears- 2-Year Results of a Prospective Randomized Study

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0032
Author(s):  
Johannes Glasbrenner ◽  
Clemens Kösters ◽  
Lena Spickermann ◽  
Christoph Kittl ◽  
Christoph Domnick ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Randomized Study ◽  
Functional Results ◽  
Lysholm Score ◽  
Activity Level ◽  
Acl Repair ◽  
Recurrent Instability ◽  
Primary Acl Reconstruction ◽  
Repair Group

Aims and Objectives: Recently, due to the development of new techniques, ACL repair has returned back into focus of experimental and clinical research. Newer studies highlight the fact that ACL repair can lead to satisfying functional results and healing rates. Aim of the present study was to compare the functional results after ACL repair in comparison to primary ACL reconstruction for acute isolated ACL tears. It was hypothesized, that functional results and knee joint stability after ACL repair are comparable to those after ACLR. Materials and Methods: A prospective randomized study (Level of evidence 1) including a total of 85 patients with acute ACL tears was performed. Patients were randomized to undergo either ACL repair or primary ACL reconstruction with a semitendinosus autograft. The preinjury activity level and function were recorded. Follow-up examinations were performed at six weeks, six, twelve and 24 months postoperatively. At each follow up, the Tegner activity scale, the International Knee Documentation Committee (IKDC) subjective score and the Lysholm score were acquired. Furthermore, anterior tibial translation (ATT) was evaluated by Rolimeter testing. The rate of recurrent instability and other complications were recorded. Results: 79 patients could be re-evaluated (follow-up rate 93%). No significant differences between ACL repair and ACLR were found for the Tegner, IKDC and Lysholm score at any time of the follow-up. ATT was increased in the ACL repair group (&#61508; ATT 1.9 vs. 0.9). This difference was statistically significant (p=0.0086). Seven patients (17%) of the ACL repair group presented with recurrent instability and underwent single-stage revision reconstruction with hamstring autografts. Another three patients showed increased laxity with insufficient healing after ACL repair but did not require revision. In the ACLR group, five patients (13%) sustained a re-tear after return to their previous activity level. However, in three cases, a two-staged revision was required. Recurrent instability was associated with young age and higher Tegner scores in both groups. Conclusion: Functional results after ACL repair for acute tears are comparable to those after ACLR. However, the rate of ACL insufficiency seems to be slightly increased after ACL repair. In the revision situation, single-stage revision was possible in all cases following primary repair, whereas after primary reconstruction, a two-staged revision had to be performed in three of five cases. The current study supports the use of ACL repair as an option to treat acute ACL tears.

0126 - DOES ACL REPAIR WITH DYNAMIC INTRALIGAMENTARY STABILIZATION SHOW SIMILAR OBJECTIVE SHORT-TERM OUTCOMES TO THE ACL RECONSTRUCTION?

The Knee ◽  
2017 ◽  
Vol 24 (6) ◽  
pp. IX ◽  
Author(s):  
A. Ateschrang ◽  
M.-D. Ahrend ◽  
S. Döbele ◽  
C. Ihle ◽  
U. Stöckle ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Short Term ◽  
Acl Repair ◽  
Dynamic Intraligamentary Stabilization

scholarly journals O’Donoghue Sports Injury Award: Bridge-Enhanced ACL Repair is Non-Inferior to Autograft ACL Reconstruction at 2-Years: Results of a Prospective Randomized Clinical Trial

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0035
Author(s):  
Braden Fleming ◽  
Gary Badger ◽  
Dennis Kramer ◽  
Lyle Micheli ◽  
Yi-Meng YenMD ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Suture Repair ◽  
Acl Repair ◽  
Acl Injuries ◽  
Patients Âgés ◽  
Patient Reported ◽  
Subjective Score ◽  
To Receive

Objectives: Preclinical studies and an early clinical cohort study have suggested that for complete midsubstance ACL injuries, the technique of suture repair of the anterior cruciate ligament (ACL) augmented with a protein implant placed in the gap between the torn ends (bridge-enhanced ACL repair) may be a viable alternative to ACL reconstruction. We hypothesized that patients treated with bridge-enhanced ACL repair would have non-inferior patient reported outcomes and anteroposterior (AP) laxity, and superior hamstring strength at 2 years after surgery when compared with subjects who had ACL reconstruction with autograft. Study Design: Prospective Randomized Control Trial (NCT02664545). Methods: One hundred patients, ages 13 to 35, with complete mid-substance ACL injuries, were enrolled and underwent surgery within 45 days of injury. Sixty-five patients were randomized to receive a bridge-enhanced ACL repair (BEAR group) and 35 were randomized to receive autograft ACL reconstruction (ACLR group). Outcomes, including the International Knee Documentation Committee (IKDC) Subjective score, instrumented AP laxity and muscle strength were assessed at 2 years post-operatively. Both patients and assessors were blinded as to surgical assignment until after the 2-year assessment. Results: Ninety-six percent of the subjects returned for follow-up at 2 years. The median age of the subjects in both groups at enrollment was 17 years and the median pre-operative Marx score in both groups was 16 points. Non-inferiority criteria were met for both the IKDC subjective score and AP laxity. The BEAR group had significantly better recovery of hamstring strength than the ACLR group (p<0.001). The number of subjects who were reinjured and required a second ACL surgery was not statistically different between the two groups. Subjects who converted from BEAR to ACLR in the study period had outcomes at the 2-year point that were similar to those for subjects who had only a single ipsiateral ACL procedure (BEAR or ACLR). Conclusion: Bridge-enhanced ACL repair using a specific protein-based implant led to non-inferior outcomes to that of ACL reconstruction for patient reported and instrumented knee laxity measures at 2 years after surgery in a young and active cohort of patients with acute mid-substance ACL tears.

scholarly journals Bridge-Enhanced Anterior Cruciate Ligament Repair Leads to Greater Limb Asymmetry and Less Cartilage Damage Than Untreated ACL Transection or ACL Reconstruction in the Porcine Model

2021 ◽  
Vol 49 (3) ◽  
pp. 667-674
Author(s):  
Naga Padmini Karamchedu ◽  
Martha M. Murray ◽  
Jakob T. Sieker ◽  
Benedikt L. Proffen ◽  
Gabriela Portilla ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Surgical Treatment ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Maximum Force ◽  
Impulse Loading ◽  
Acl Repair ◽  
Anterior Cruciate ◽  
Acl Transection

Background: The extent of posttraumatic osteoarthritis (PTOA) in the porcine anterior cruciate ligament (ACL) transection model is dependent on the surgical treatment selected. In a previous study, animals treated with bridge-enhanced ACL repair using a tissue-engineered implant developed less PTOA than those treated with ACL reconstruction (ACLR). Alterations in gait, including asymmetric weightbearing and shorter stance times, have been noted in clinical studies of subjects with osteoarthritis. Hypothesis: Animals receiving a surgical treatment that results in less PTOA (ie, bridge-enhanced ACL repair) would exhibit fewer longitudinal postoperative gait asymmetries over a 1-year period when compared with treatments that result in greater PTOA (ie, ACLR and ACL transection). Study Design: Controlled laboratory study. Methods: Thirty-six Yucatan minipigs underwent ACL transection and were randomized to receive (1) no further treatment, (2) ACLR, or (3) bridge-enhanced ACL repair. Gait analyses were performed preoperatively, and at 4, 12, 26, and 52 weeks postoperatively. Macroscopic cartilage assessments were performed at 52 weeks. Results: Knees treated with bridge-enhanced ACL repair had less macroscopic damage in the medial tibial plateau than those treated with ACLR or ACL transection (adjusted P = .03 for both comparisons). The knees treated with bridge-enhanced ACL repair had greater asymmetry in hindlimb maximum force and impulse loading at 52 weeks than the knees treated with ACL transection (adjusted P < .05 for both comparisons). Although not significant, there was a trend that knees treated with bridge-enhanced ACL repair had greater asymmetry in hindlimb maximum force and impulse loading (adjusted P < .10 for both comparisons) compared with ACLR. Conclusion: Contrary to our hypothesis, the surgical treatment resulting in less macroscopic cartilage damage (ie, bridge-enhanced ACL repair) exhibited greater asymmetry in load-related gait parameters than the other surgical groups. This finding suggests that increased offloading of the surgical knee may be associated with a slower rate of PTOA development. Clinical Relevance: Less cartilage damage at 52 weeks was found in the surgical group that continued to protect the limb from full body weight during gait. This finding suggests that protection of the knee from maximum stresses may be important in minimizing the development of PTOA in the ACL-injured knee within 1 year.

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