Successful Arthroscopic Primary Repair of a Chronic Anterior Cruciate Ligament Tear 11 Years Following Injury.
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ABSTRACT:
SUBMITTER: van der List JP
PROVIDER: S-EPMC5264579 | biostudies-literature | 2017 Feb
REPOSITORIES: biostudies-literature
Publications
Successful Arthroscopic Primary Repair of a Chronic Anterior Cruciate Ligament Tear 11 Years Following Injury.
van der List Jelle P JP DiFelice Gregory S GS
HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20161118 1
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Project description:Although anterior cruciate ligament (ACL) reconstruction remains the gold standard for the treatment of ACL tears, repair is regaining popularity as a treatment option for proximal or distal ACL avulsions. Historically, ACL repairs had poor outcomes. To remedy this, techniques were developed using graft-based augmentation but never gained widespread popularity. Recently, there has been a renewed interest in primary ligament repairs, with newer techniques incorporating modern synthetic materials to augment the repair site. The term "internal bracing," or ligament repair with augmentation, has been used to describe the new philosophy for primary ligament repair and augmentation. We present our technique for arthroscopic primary ACL repair with augmentation for a proximal posterolateral bundle tear. The advantages of this technique include preservation of the intact fibers of the anteromedial bundle, intuitive suture augmentation with standard ACL tunnel placement techniques, and the ability to calibrate ligament tension.
| S-EPMC5982235 | biostudies-literature
Project description:BackgroundAnterior cruciate ligament (ACL) rupture is the most common ligament injury treated surgically by orthopaedic surgeons. The gold standard for the treatment of the majority of primary ACL tears is ACL reconstruction. However, novel methods of repair, such as bridge-enhanced ACL repair (BEAR), are currently being investigated as alternatives to reconstruction. To assess patients for midsubstance repair suitability, clarify the prognostic implications of injury location and damage, and evaluate the results of a repair technique, it is important to have a baseline classification system or grading scale that is reproducible across surgeons, particularly for multicenter collaboration. Currently, no such system or scale exists.PurposeTo develop an arthroscopic ACL tear classification system and to evaluate its interobserver reliability.Study designCohort study (diagnosis); Level of evidence, 3.MethodsEleven fellowship-trained orthopaedic surgeon investigators reviewed 75 video clips containing arthroscopic evaluation of a torn ACL and then completed the 6-question ACL Pathology Evaluation Form. Agreement statistics including exact agreement, Fleiss ?, Gwet agreement coefficient 1 (AC1), and Gwet AC2 were then calculated to assess interobserver reliability.ResultsIn aggregate, the multiple assessments of observer reproducibility revealed that surgeon participants in this study, when evaluating the same injury, agreed roughly 80% of the time on whether (1) at least 50% of the tibial footprint remained, (2) the remaining tibial stump was ?10 mm, and (3) the injury was therefore reparable using the BEAR procedure. Participants also agreed roughly 60% of the time on exactly how many suturable bundles were available. These characteristics are believed to be most important, among those studied, in determining whether a torn ACL is amenable to midsubstance repair.ConclusionThis study is the first of its kind to demonstrate the interobserver reliability of arthroscopic classification of ACL tears. We have demonstrated that this classification system, though not ideally reproducible, is reliable enough across surgeons at multiple institutions for use in multicenter studies.RegistrationNCT03776162 (ClinicalTrials.gov identifier).
| S-EPMC7720329 | biostudies-literature
Project description:Historically, poor results of open primary repair of anterior cruciate ligament (ACL) injuries have been reported. In hindsight, however, appropriate patient selection (i.e. proximal tears and good tissue quality) was not performed, because it has recently been recognized that good outcomes of primary ACL repair are possible when selectively performed in patients with proximal tears and good tissue quality. Moreover, with modern-day advances, arthroscopic primary repair can be an excellent treatment option for patients with proximal tears. Preserving the native ACL has several advantages, including maintaining native proprioceptive function and biology. The procedure is also minimally invasive and prevents the need for formal ACL reconstruction. Recently, it has been suggested that additional suture augmentation of the primary repair technique may be beneficial for protecting ligament healing during early range of motion. In this Technical Note, we present the surgical technique of arthroscopic primary repair with suture augmentation for patients with proximal ACL tears.
| S-EPMC5709701 | biostudies-literature
Project description:In a select group of patients with proximal anterior cruciate ligament (ACL) tears, primary repair can be a useful technique. Preservation of the native ACL may be advantageous for proprioceptive function and is thought to restore normal knee joint kinematics. The procedure is a less morbid and more conservative surgical approach to restore knee stability. Primary repair is preferably performed in the acute setting because of better healing capacity and tissue quality. We present the surgical technique of arthroscopic primary ACL repair with suture anchors in patients with proximal tears and excellent tissue quality.
| S-EPMC5124221 | biostudies-literature
Project description:Suture of the anterior cruciate ligament (ACL) has reemerged as a treatment option for proximal ACL tears. Preoperative imaging can provide insight into the feasibility of performing arthroscopic primary ACL repair, but the final decision is taken only after confirming with arthroscopy that the ACL remnant is reducible. We describe a test called the Figure-of-4 Cruciate Remnant Objective Assessment test that objectively interprets the reducibility of the ACL remnant for arthroscopic primary ACL repair.
| S-EPMC6624173 | biostudies-literature
Project description:Recently, there has been a resurgence of interest in ligament preservation of the anterior cruciate ligament (ACL) that has the advantage of preserving the native tissue and maintaining proprioceptive function. Studies reporting outcomes of remnant-preserving ACL surgery have shown encouraging results with a higher potential for early healing and better functional outcomes compared with remnant-resecting surgery. Over the past decade, several surgical techniques for remnant preservation of the ACL have been proposed. In this technical note, the technique of primary ACL repair with graft augmentation is described. The goal of this technique is to preserve and tension the native tissue, thereby restoring the anatomy as much as possible while avoiding cyclops lesions, whereas the additional graft provides strength to the repaired ligament.
| S-EPMC7093703 | biostudies-literature
Project description:Historically, poor results of open primary repair of anterior cruciate ligament (ACL) injuries have been reported. It has recently been recognized that favorable outcomes of primary ACL repair are possible when selectively performed in patients with proximal tears and good tissue quality. Moreover, with arthroscopic technological advances, primary repair can be a valuable treatment option for patients with proximal tears. Preserving the native ACL has several advantages, including maintenance of native proprioceptive function and biology. The procedure is also minimally invasive and reduces the inflammatory reaction often seen in ACL reconstruction. Recently, it has been suggested that additional suture augmentation of the primary repair technique may be beneficial for protecting ligament healing during early range of motion. In this Technical Note, we present the step-by-step surgical technique of arthroscopic primary repair using a femoral suspensory device with suture augmentation.
| S-EPMC6408695 | biostudies-literature
Project description:Anterior cruciate ligament (ACL) tears occur in isolation or in combination with other intra-articular injuries such as meniscus tears. The impact of injury pattern on the molecular biology of the injured ACL is unknown. Here, we tested the hypothesis that the biological response of the ACL to injury varies based on the presence or absence of concomitant meniscus tear. RNA-seq analysis was performed on 28 ACL tears remnants (12 isolated, 16 combined). 16,654 transcripts were differentially-expressed between isolated and combined injury groups at false-discovery-rate of 0.05. Due to the large number of differentially expressed transcripts, we undertook an Ensembl approach to discover features that acted as hub-genes that did not necessarily have large fold-changes or high statistical significance, but instead had high biological significance. Our data revealed a negatively-correlated turquoise-module containing 5960 transcripts (down-regulated in combined injury) and a positively-correlated blue-module containing 2260 transcripts (up-regulated in combined injury). TNS1, MEF2D, NOTCH3, SOGA1, and MLXIP were highly-connected hub-genes in the turquoise-module and SCN2A, CSMD3, LRC44, USH2A, and LRP1B were critical hub-genes in the blue-module. Transcripts in the turquoise-module were associated with biological-adhesion, actin-filament organization, cell-junction assembly, and cell-matrix adhesion. The blue-module transcripts were enriched for neuron-migration and exocytosis-regulation. These findings indicate a loss of healing and gain of neurogenic signaling in combined ACL and meniscus tears, suggesting they have diminished potential for repair. The biological response of the ACL to injury could have implications for the healing potential of the ligament and the long-term health of the knee.
2018-01-23 | GSE109419 | GEO
Project description:Purpose:To evaluate the outcomes of arthroscopic meniscal repair performed in combination with anterior cruciate ligament (ACL) repair. Methods:This study presents a case series of 34 patients who underwent repair of meniscal tears along with ACL reconstruction from 2014 to 2016. Cases of discoid meniscal lesions and combined or ligament injuries other than ACL injuries were excluded. Patients were followed up periodically, at 3, 6, 9, 12, and 24 months. Preoperative and postoperative functional evaluations were performed using visual analog scale, International Knee Documentation Committee, and Lysholm knee scores. Results:The mean age of the patients was 29.1 years (range, 17-44 years). The mean follow-up period was 18 ± 7.8 months (range, 6-24 months). Among the 34 individual knees, 1 patient (3%) underwent both medial and lateral meniscal repairs. Medial meniscal repair was performed in 20 knees (59%), whereas the lateral meniscus was repaired in 13 knees (38%). A longitudinal tear was the most common type of tear pattern, followed by radial (6 patients) and complex (3 patients) tear patterns. The radial and complex tears were treated with an additional partial meniscectomy. The mean International Knee Documentation Committee score was 38.46 preoperatively and improved to 80.30 at final postoperative follow-up (statistically significant difference, P < .01). The mean Lysholm score was 50.30 preoperatively and improved to 91.40 at final postoperative follow-up (statistically significant difference, P < .01). According to the Lysholm knee score, 31 patients (89%) had excellent or good results. The mean visual analog scale score decreased from 7.3 preoperatively to 2 postoperatively. The clinical success rate of the repairs was 89%. Of 35 repairs, 4 (11%) had retears. Conclusions:Arthroscopic meniscal repair along with ACL reconstruction provided predictable high rates of meniscal healing and yielded favorable functional and clinical results. Patient selection remains one of the most important prognostic factors. Level of Evidence:Level IV, therapeutic case series.
| S-EPMC7190550 | biostudies-literature
Project description:There has been a renewed interest in anterior cruciate ligament (ACL) repairs over the last decade with some early promising results in the right patient population. Additionally, the anterolateral ligament has been extensively studied and has recently been shown to have a protective effect on standard ACL reconstructions in a clinical trial. Given its protective effect on ACL reconstructions, we believe this phenomenon is also relevant to ACL repairs and can decrease rerupture rates. In this publication, we demonstrate a surgical technique for ACL repair using an internal brace combined with an anterolateral ligament reconstruction using a gracilis autograft.
| S-EPMC6408622 | biostudies-literature