A Technique for Anterior Cruciate Ligament Reconstruction in the Setting of Unicompartmental Knee Arthroplasty.
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SUBMITTER: Dees RL
PROVIDER: S-EPMC7823143 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionAnterior cruciate ligament (ACL) avulsion fracture after unicompartmental knee arthroplasty (UKA) has not been reported until recently. We describe a case of ACL avulsion fracture that developed after medial UKA.Case presentationA 57-year-old woman underwent UKA for right medial compartment osteoarthritis. She developed knee pain and swelling at 2 weeks after UKA, and radiographs showed an ACL avulsion fracture at 3 weeks after UKA. After conservative treatment failed, the fracture was fixed using screws. After 5 months from internal fixation, bone union was confirmed, and the screws were removed. At 16 months after removing screws, there was no further complication.DiscussionThe patient did not exhibit a fracture on the radiograph taken immediately after UKA. We carefully re-examined the radiographs and observed a 5-mm horizontal cement shadow on the lateral side of the tibial component. It is thought that excessive lateral resection of the proximal tibia during UKA may have resulted in a micro fracture and this outcome. In the present case, the posterior slope angle of the tibial component measured postoperatively was 11.5 degrees. The angle of more than 7 degrees along with excessive horizontal resection of the proximal tibia probably increased load on the ACL.ConclusionIf patients exhibit a horizontal cement shadow near the tibial component and a higher posterior slope angle of the tibial component on the radiograph after UKA, surgeons should be aware of possible ACL avulsion fracture and perform additional radiological examinations in patients with continuous knee pain and swelling.
| S-EPMC8099496 | biostudies-literature
Project description:Fixation of the graft during anterior cruciate ligament reconstruction surgery has been the subject of numerous technical innovations but still remains a challenge. This article describes a novel technique of graft fixation for hamstring tendon reconstruction: the Cage For One system (Sacimex, Aix-en-Provence, France). The technique uses only the semitendinosus tendon, which is looped to create a 4-strand graft. Leaving the gracilis tendon intact probably reduces the loss of knee flexion strength. The graft is indirectly anchored into both tunnels with polyetheretherketone cages by use of polyethylene terephthalate tape strips. Both cages and strips are magnetic resonance imaging compatible and do not create artifacts. The tunnels are drilled by an outside-in method with minimal incisions. This type of fixation creates a 360° bone contact at 1.5 cm in each tunnel and is compatible with double-bundle reconstruction. This easy-to-use novel technique of fixation for anterior cruciate ligament reconstruction produces a strong 4-strand graft while harvesting only the semitendinosus tendon and leaving the gracilis tendon intact to reduce flexion strength loss and preserve rotatory stability of the knee. It creates an immediate solid fixation that is independent of graft integration in the early postoperative period, allowing the patient to start immediate rehabilitation without the use of a brace.
| S-EPMC3678617 | biostudies-literature
Project description:Postoperative scarring is a known complication after arthroscopic anterior ligament reconstruction of the knee. The anterior interval of the knee has been previously identified as a common location for anterior scar formation. The anterior interval is defined as the space between the infrapatellar fat pad and the anterior border of the tibia. Patients with anterior interval scarring often present with lack of terminal knee extension, anterior knee pain, decreased patellar mobility, and quadriceps atrophy. The goal of this paper is to describe the technique for anterior interval release of the knee.
| S-EPMC6153305 | biostudies-literature
Project description:Hamstring autograft is one of the most used grafts for anterior cruciate ligament (ACL) reconstruction, although there are several graft preparation techniques. It is extremely difficult to mimic the biomechanical properties of the native ACL; thus, it is important to achieve a proper graft configuration, diameter, and length. To avoid reruptures, an optimal and reproducible hamstring autograft is desired. Hamstring autograft has been traditionally devalued when compared with other options such as bone-patellar tendon-bone autograft. The purpose of this Technical Note is to describe in detail a hamstring braid graft configuration that could potentially overcome the past disadvantages of ACL reconstruction.
| S-EPMC6823734 | biostudies-literature
Project description:The awareness of anterior cruciate ligament (ACL) injuries and their treatment is increasing among athletes and within the general population, so patients report early to orthopaedic surgeons. Because we encounter a thick ACL stump during arthroscopic ACL reconstruction, an attempt is made to preserve this stump. Remnant preservation-although promising in terms of graft healing because it enhances cell proliferation, revascularization, and regeneration of the proprioceptive organs in the reconstructed ACL-does not come without complications, such as cyclops lesions, impingement, and extension loss. These problems can be detrimental to an athlete's return to his or her preinjury level after ACL reconstruction. Therefore, we describe a technique in which the ACL is reconstructed using hamstring autograft and suture passes are made through the remnant with an antegrade suture-passing device. After anatomic tunnel drilling, the remnant is tensioned, along with the reconstructed ACL, at the femoral end without the use of an extra implant. Femoral-side fixation is achieved with an adjustable-loop button (Procinch; Stryker) and a bio-composite interference screw (Biosure Regenesorb; Smith & Nephew) on the tibial end. As the sutured remnant is tensioned and knots are made over the button, the remnant envelopes the graft in the orientation of the native ACL, which can be helpful for early and better ligamentization of the graft. The potential advantages of this technique are as follows: orientation of the remnant along the collagen of the ACL graft; no loose ACL stump in the notch, thus preventing cyclops lesions; retention of the proprioceptive organs in the ligament; and no extra implant.
| S-EPMC7695627 | biostudies-literature
Project description:Severe metallosis following medial unicompartmental knee arthroplasty (UKA) is relatively rare. It is usually due to long-standing wear of the polyethylene component, resulting in frictional wear between the femoral and tibial metallic components. Biomechanical and cadaveric studies have shown the effects of anterior cruciate ligament (ACL) transection following medial UKA. We describe a case of a 58-year-old male who developed attritional rupture of the ACL 16 months following medial UKA leading on to early accelerated failure over the next 8 months. The patient underwent revision to total knee arthroplasty with good outcome. The clinical effect of spontaneous ACL transection on medial UKA causing abnormal posteromedial wear of polyethylene component and tibial tray, massive metallosis, and worsening of mechanical axis can be demonstrated in this case report.
| S-EPMC5859552 | biostudies-literature
Project description:During the past few decades, surgical techniques for anterior cruciate ligament (ACL) reconstruction have been developing significantly. To date, studies have shown that after ACL reconstruction, rotational stability has a greater impact on the patient's satisfaction, functional scores, and return to sports than translational stability. Although challenged by many authors in the literature, biomechanical studies on the anterolateral ligament (ALL) of the knee and clinical studies regarding ALL reconstruction have been revealing promising results. Thus, the potentially significant role of the ALL in biomechanical load sharing and improving rotational control of the knee has led to the development of various reconstruction techniques whose goal is to achieve simplicity and yield the best results possible. Guided by this idea, we have developed a modified ACL-ALL reconstruction surgical technique. In this article, our simple, bone-saving, anatomic technique to reconstruct both the ACL and ALL using hamstring tendon autograft is described.
| S-EPMC7917388 | biostudies-literature
Project description:Anterior cruciate ligament (ACL) injury results in altered knee joint mechanics which frequently continue even after ACL reconstruction. The persistence of altered mechanical loading of the knee is of concern due to its likely role in the development of post-traumatic osteoarthritis (OA). Joint contact forces are associated with post-traumatic OA development, but evaluation of factors influencing the magnitude of contact forces after ACL injury is needed to advance current strategies aimed at preventing post-traumatic OA. Therefore, the purpose of this study was to identify predictive factors of knee joint contact forces after ACL reconstruction. Thirty athletes completed standard gait analysis with surface electromyography 6 months after ACL reconstruction. An electromyographic-driven musculoskeletal model was used to estimate joint contact forces. External knee adduction moment was a significant predictor of medial compartment contact forces in both limbs, while vertical ground reaction force and co-contraction only contributed significantly in the uninvolved limb. The large influence of the knee adduction moment on joint contact forces provides mechanistic clues to understanding the mechanical pathway of post-traumatic OA after ACL injury. Statement of Clinical Significance: This study provides critical information in improving the understanding of mechanisms influencing the development of post-traumatic OA after ACL injury. Further work is needed to identify additional driving factors of joint loading in the ACL-injured limb and develop treatment strategies to avert the deleterious consequences of post-traumatic OA. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:651-656, 2017.
| S-EPMC6309880 | biostudies-literature
Project description:BackgroundWe aimed to evaluate clinical and radiological results after simultaneous open-wedge high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction in patients with ACL deficiency combined with medial uni-compartmental osteoarthritis (OA) and varus deformity.MethodsThis retrospective study was performed using data collected from 2005 to 2011 on a total of 24 patients who were diagnosed with ACL injury and medial unicompartmental OA with varus deformity, and who subsequently underwent simultaneous open-wedge HTO and arthroscopic ACL reconstruction. The mean follow-up duration was 5.2 years. For clinical outcomes, we evaluated Lysholm score, Tegner activity score, range of motion, Lachmann test, and pivot-shift test, and for radiological outcomes, we evaluated the degree of varus deformity, progression of medial OA, tibial posterior slope, anterior instability, and postoperative complication.ResultsThere were no limitations in range of motion found in any cases. Three patients showed progressive osteoarthritis on the medial compartment. The mechanical femorotibial angle was significantly corrected from varus 7.0 degrees to valgus 1.2 degrees, and the tibial posterior slope was not significantly changed. The Lysholm and Tegner activity scores were significantly improved after surgery (from 58 to 94 points on the Lysholm scale and from 4.0 to 5.3 points on the Tegner activity scale). Although the Lachman test and the pivot-shift test showed significant improvements after surgery, instability greater than Gr II was observed in three patients on the Lachman test and in four patients on the pivot-shift test. The side-to-side difference improved from 9.6 mm to 4.2 mm postoperatively as assessed using a Telos® arthrometer. There were no cases of nonunion or fixation loss.ConclusionsSimultaneous open-wedge HTO and ACL reconstruction in patients with ACL injury with medial compartmental OA showed satisfactory functional outcomes and postoperative activity level scores. However, some patients showed residual instability and progression of OA.
| S-EPMC6052617 | biostudies-literature
Project description:Concomitant injuries of the 4 groups of ligaments of the knee are a serious condition and challenge the orthopaedic surgeon when reconstruction of all ligaments is needed. Staged reconstruction can be chosen owing to the complexity of the combined procedures; however, simultaneous reconstruction is favored to facilitate recovery. We describe a simultaneous anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), posteromedial corner (PMC), and posterolateral corner (PLC) reconstruction technique, in which autografts are used and both cruciate ligaments are reconstructed in a single-bundle manner. We believe the introduction of this technique will familiarize surgeons with the principle of simultaneous 4-ligament reconstruction of the knee and the method of cruciate ligament balancing during bicruciate ligament reconstruction.
| S-EPMC8719229 | biostudies-literature